Lay Concepts of Health - Essay Example

Lay Concepts of Health 2009 Lay Concepts of Health Exploration of lay beliefs about health and illness is one of the top concerns of modern medical sociologists. The core reason for such concern is the well-proven fact that health beliefs adopted by lay people strongly affect their health-related behaviour and thus have grave implications for effectiveness of health interventions and treatment (Gillick, 1985; Helman, 1991). The biomedical model also known as ‘allopathy’ is a relatively novel approach that has recently become the mainstream of western health care systems, including that of the UK. This model incorporates the main features of scientific and objective medicine treating professional medical knowledge as the only source of rational and genuinely scientific information. Consequently, lay concepts of health and illness are dismissed as ill-informed, unscientific and non-rational (Bury, 1997). In the ideal form of the biomedical model, “All authority over health matters was seen to reside in the doctors’ expertise and skill, especially as shown in diagnosis. This meant that the patient’s view of illness and alternative approaches to health were excluded from serious consideration” (Bury, 2005, p. 4). However, modern form of the medical model does consider multifactor or unknown aetiology of an illness though the focuses on discovering specific causes of illness still remains overwhelming (Bury, 2005). Concepts of health and illness adopted by lay people provide additional essential data to further development and improvement of the biomedical model (Lawton, 2003). Serious research in this field started with the publication of Claudine Herzlich in 1973 and continued with a series of publications that examined values, priorities, and worries inherent in the conceptions of health shared by lay people. Despite relatively weak methodological framework adopted by those early authors (research methodology was largely underdeveloped to explore lay health beliefs), several essential features of the lay perception of health and illness were identified. The findings discovered over the last three decades largely show high level of complexity associated with lay beliefs about health and illness and stress the need for health practitioners to improve the relationship between doctor and patient instead of neglecting the patient’s views as unknowledgeable (Bury, 2005). One of the most essential features of lay health beliefs revealed by Herzlich (1973) was the notion that origins of any illness or good health were very complex and multifaceted. Despite the fact that lay persons often take health for granted, it does not mean that they do not understand the complex relationship between illness and health. Particularly, Herzlich (1973) discovered that lay people linked illness and health to lifestyle: the participants shared the belief that stress, fatigue, and other adverse tensions associated with urban living could either exacerbate an illness caused by other factors or generate an illness on their own. Based on this finding Herzlich (1973) justified the lay concept of duality of health. According to that concept, health is an endogenous (within a person) thing maintaining of which requires constant struggle against a variety of exogenous (external) factors that cause illness. A series of subsequent studies further explored the links revealed by Herzlich (1973) across a range of ages, sexes, occupations, social classes, cultural backgrounds and other variables to discover the most essential features of lay beliefs about health and illness. Most of these studies exposed the variation between lay perception of health and illness and direct social and material conditions of participants. The origins of lay conceptions of health were also identified. These findings were brilliantly summarized by Stacey (1988) in the following statement: “Ordinary people develop explanatory theories to account for their material, social and bodily circumstances. These they apply to themselves as individuals, but in developing them they draw on all sorts of knowledge and wisdom, some of it derived from their own experience, some of it handed on by word of mouth, other parts of it derived from highly trained practitioners. Thus lay explanations go beyond common sense, in that explanations beyond the immediately obvious are included” (p. 142). Perception of health as functional capacity is also a common characteristic of lay health beliefs (Blaxter, 2004). Lay people treat ‘good health’ as the ability to normally fulfill the duties inherent in their social and/or economic roles. This means that health may be perceived as the absence of illness on the one hand and as the ability to successfully cope with one’s duties despite illness. Such concept of health is predominantly shared by representatives of the middle class and the elderly who, therefore, viewed health as a sort of reserve enabling them to cope with illnesses. By contrast, those people who have poor health are less likely to adopt the functional conception of health (Blaxter, 2004). The notion of so-called ‘candidacy’ is an important feature of lay health concept. This notion is used by lay persons to explain relative risk of illness and effectiveness of preventive behaviours. The onset of illness, its appearance, and circumstances surrounding it play the main role in construction of the ‘candidacy’ notion (Davison, Davey Smith, & Frankel, 1991). One of the most notable outcomes of the ongoing lay health concepts research is bringing about change in the traditional perception of patient as a mere recipient of information and health services within the biomedical model. This change was clearly reflected in the Public Health White Paper, Saving Lives: Our Healthier Nation (1999) published by the government. The document contains, inter alia, the following statement: “[In the past] people were treated as passive recipients of information and services, rather than active partners. This contributed to a widening of the health gap: we now know that the better off are more likely to act on health information to change behaviour…” (DoH, 1999, 3.2/4.10). The new guidelines called ‘The Expert Patients Initiative eventually published by the Department of Health in 2001 advocated the new doctor-patient relations on the basis of growing research data in the area of lay health beliefs and their effects of health care effectiveness. The document contains the formal recognition of the importance of lay persons’ beliefs about health and illness and their active role in health care. On the other hand, the ongoing dominance of the biomedical model in UK health care suggests that it has already affected and will continue to influence lay concepts of health observed in the country. Comprehensive medical information generated within this model is available nowadays from a variety of sources and can be disseminated very effectively using modern media such as television and internet. As a result, lay concepts of health in developed societies such as UK are largely shaped by the available information and it is almost impossible to identify lay concepts and beliefs about health and illness shaped by a non-medical set of determinants (Bury, 2005). Perhaps the best example of this tendency is collapse of the traditional religious concept of illness: it has almost disappeared from the public domain though some minor groups and communities practice this concept up to now. References Blaxter, M. (2004) Health. Oxford: Polity Press Bury, M. (1997) Health and Illness in a Changing Society. Routledge Bury, M. (2005) Health and Illness. Oxford: Polity Press Davison, C., Davey Smith, G. and Frankel, S. (1991). Lay epidemiology and the prevention paradox. So- ciology of Health and Illness 3(1), 1-19 Department of Health (DoH) (1999) HSC 1999/152: Saving Lives: Our healthier nation White paper and reducing health inequalities: a action report [retrieved November 29, 2009 from http://www.dh.gov.uk/en/PublicationsAndStatistics/LettersAndCirculars/HealthServiceCirculars/DH_4004289] Gillick, M. R. (1985) “Common-sense models of health and disease”. New England Journal of Medicine, Vol. 313: pp. 700–3 Helman, C. G. (1991) “Limits of biomedical explanation”. Lancet, Vol. 337: pp. 1080–1083 Herzlich, C. (1973). Health and Illness. A Social Psychological Study. Academic Press, London. (Originally published in 1968) Lawton, J. (2003) ‘Lay experiences of health and illness: past research and further agendas’, Sociology of Health & Illness, 25(3): pp. 23-40. Stacey, M. (1988) The Sociology of Health and Healing. London: Routledge. Read More