Social Construction of Health and Illness

Social construction of health and illness: definition

First, let us look at the definition of social constructionism.

So, how does this theory link to the social construction of health and illness?

Fig. 1 - The concept of social construction can be applied to our understanding of health and illness.

Medical sociologists seek to move away from the biomedical model of health and illness as they feel it is deterministic. It conceptualises health, illness, and disability as biological phenomena, and ignores socio-political contexts.

Medical sociologists use the social constructionist framework to interpret and understand the social, cultural, and political dimensions of health and illness. They focus on:

• Healthcare choices.

• The unequal social distribution of health opportunities.

• Inequalities in access to health care provisions.

• The nature and social distribution of illnesses.

• The role of the medical-industrial complex in the construction of health and illness. The medical-industrial complex is a network of corporations, enterprises, healthcare professionals, hospitals, and surgeries, that provides healthcare services and products for profit, control, and/or influence.

The role of technology on the social construction of health and illness

Ivan Illich (1926-2002) believed that the medical-industrial complex sponsored illness. It has made us dependent on medication and technologies. Pharmaceutical companies have developed expensive treatments to treat non-diseases; we can no longer cope with life's problems and non-problems. This is referred to as social iatrogenesis.

Let's look at therole of technology on the social construction of health and illness.

The social construction of the body

Sociologists use the term embodiment to emphasise that the body is both a psychical and social entity. The body is situated within many historical, political, social, cultural, and philosophical frameworks. Chrystal Jaye, a New Zealand-based academic, defines embodiment as being specifically concerned with the lived experience of one's own body.

These frameworks of the body lead to it being subjectively valued as healthy, unhealthy, beautiful, ugly, strong, weak, young, and old. As a result, there are ways in which we experience the world and ways in which we do not. People with 'healthy' bodies experience the world differently to those with 'unhealthy' bodies.

Society and culture impact the formation and construction of its members, and what types of bodies are considered ideal, normal, or healthy has varied over time and across cultures and societies.

In her research into Fijian cultures, Anne Becker (2004) found that larger bodies were more appreciated before the colonisation of the archipelago by the British, and later, the introduction of American television. Eating disorders common in the West also did not exist in Fiji. Television and western influences altered Fijian eating customs and perception of the body. In 'Television, Disordered Eating, and Young Women in Fiji', Becker (2004, p.540) explains this shift:

Illness narratives and the social construction of health

Health and disease may be measurable, but that does not mean you cannot argue that they are socially constructed. Illness narratives play a role in the social construction of health.

Disease is seen as an objective medical reality (some medical sociologists argue even that is a social construction) because viruses, fungi, germs, and hormonal imbalances can be identified and diagnosed. However, illness is subjective because it has more to do with how people experience symptoms of diseases and viruses.

How diseases and medical conditions are assessed and treated depends on historical, social-cultural, and political factors. Those factors shape our collective and individual understanding of health and illness.

Example of the social construction of health

A prominent example of the social construction of health is the Body Mass Index (BMI). According to the National Health Service (NHS), the BMI uses height and weight to determine whether someone is of a 'healthy' weight.

The BMI was created in the nineteenth century by Belgian mathematician Lambert Adolphe Jacques Quetelet. Quetelet developed a mathematical model using the law of probability to measure the ideal body weight, not individual health, and determine what he called l'homme moyen (the average man). He gathered European army data and concluded what a person's ideal weight should be proportional to their height.

Quetelet's research was conducted during the height of race science and empire, and his sample consisted of White European male soldiers. He did not account for human diversity or environment. The BMI is criticised because it is based mainly on White populations, and does not account for human diversity.

Example of the social construction of illness

Illnesses have a social and cultural dimension and sometimes metaphorical connotations, leading to stigmatisation and medicalisation. The metaphorical meaning of cancer as evil or repressive and obesity metaphors such as 'obesity is sinful' impact those with the conditions differently, as they do policy responses.

Fig. 2 - The social construction of illness is demonstrated through a careful analysis of illness experiences and medical knowledge.

Medicalisation is the process by which biological conditions, diversity, and moral, social and other nonmedical issues become defined and treated as medical problems. Let's look at the following examples of the social construction of illness.

The social construction of the illness experience

Using the example of HIV and AIDS, Conrad and Barker argue that people enact their illnesses and endow them with meaning. People's construction of their sense of self is based on how they interact with society and society.

The social construction of medical knowledge

Conrad and Barker use women's health to show how medical knowledge is socially constructed, and how it can both reflect and reproduce inequalities in gender, race, ethnicity, and class.

The social construction of disability

The UK Equality Act 2010 (GOV.UK, n.d.) defines disability (including physical impairments, chronic illnesses, mental illnesses, autoimmune diseases, learning, and development disabilities) as "a physical or mental impairment that has a 'substantial' and 'long-term' negative effect on your ability to do normal daily activities" ².

There is a moral element to disability, and perceptions of disability change over time.

Medical model of disability

The medical model defines disability as a long term/chronic illness or impairment, caused by biological abnormalities linked to inabilities in performing certain tasks.

Social model of disability

Michael Oliver (1945–2019) and other activists have argued that disability is not caused by impairments, but rather by how society is organised. Among other things, they argue:

• Society alienates disabled people and prioritises the economy over their lives.

• Society views disabled people as disposable because they cannot be fully integrated into the workforce.

• Certain disabilities such as attention deficit hyperactivity disorder (ADHD) have been created by society to alienate and pathologise normal responses to capitalist conditions.

Functionalist theorist Talcott Parsons (1902–1979) described disease and disability as deviant behaviours. He argued that when people are sick, they cannot be productive members of society and are pushed to assume the 'sick role', which gives them certain rights and responsibilities (e.g. being allowed time off work or school). In this view:

• Being chronically ill or disabled is disloyal to society and the family, as every member of society is obliged to perform their allocated roles.

• Recovery is a must and failure to fulfil role expectations can be interpreted as disloyalty, therefore risking social exclusion. Sickness is detrimental to the functioning of society. (Matthias Sick Varul, 2010).