Unit 11 Approaches to health - Essay - Distinction PDF

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Unit 11 - Approaches to health - Essay - Distinction Grade...

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Emma O’Casey 03/03/2021 Approaches to health

The purpose of this essay is to investigate sociological perspectives on health and ill health, as well as the models and definitions of health and wellness.

Health and ill health There are many definitions of health and ill health. To a greater or lesser extent, all are socially constructed – meaning that social issues influence new theories or alter old definitions. People esteem good health, and venerate long life, wanting to stay healthy throughout their lives. The World Health Organisation (1948) defines health as “a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity.” This represents the Holistic model of health which combines physiological, psychological and social factors. This definition was adapted by the Ottawa Charter (1986), which describes health as “a resource for everyday life, not the object of living”. Before discovering a small lump in her breast, the patient in the case study, Emma Jones, was nearly forty, with a baby and four other children. Emma would not be healthy according to the holistic model, either before or after discovering the lump. Though laudable, Smith. R (2008) criticizes the WHO/Ottawa view of health that it is unrealistic, and “leaves most of us unhealthy most of the time.” Merriam and Webster (n.d.) medical dictionary define ill health as “a condition of inferior health in which some disease or impairment of function is present but is usually not as serious in terms of curtailing activity as an illness” Emma had tried to be healthy; neither smoking nor drinking despite working in a pub. After her partner left her, Emma had not gone out much and became stressed and depressed. Her oldest children, 12 and 10, were in trouble with school and police, and the threat of social services intervention hung over her. The traditional medical definition of health – the absence of illness or disease – emphasises the role of clinical diagnosis and intervention. It is straightforward and, according to this, Emma would be considered healthy before she discovered the lump. This model is restrictive because Emma was in a downward spiral: struggling to make ends meet, with no support group, putting on weight fast, and with the possibility of care of her children being taken over by social services.

Models of health and ill health Models of health and ill health are constructed from sociological and psychological theories. These are then developed over time to adapt to the changing needs of people. They are designed to show a clear representation of hypothetical issues and how to deal with them. Across multidisciplinary healthcare settings, many professionals have combined a Biomedical approach with the Holistic approach to meet complex needs and requirements. Although this creates a united and systematic approach it may not always be compassionate and caring. Holistic The Holistic approach treats the person as a whole, and not just their illness. The person is considered to be healthy when all aspects of their life are in a state of well-being. Through the Holistic model, good health is maintained by sensible eating, exercise, fulfilment in life and work, successful relationships, low stress, and being at peace with oneself. Maslow proposed a hierarchy of human needs. Although it was criticised for being too simple, it is essential when judging mental health. Emma tried to be healthy; neither smoking nor drinking. Using the Holistic model, the root cause of a disease is much more likely to be addressed, as well as other linked factors. At the initial GP appointment, the GP would have inquired after Emma’s well-being. Consistent with the Holistic approach, the GP would have been aware Emma had gained weight, and would discuss this with her. At 38, a mother of four under-13s and a baby, with no partner or friends, it would be clear that at the very least Emma would benefit from additional support and explanations about procedures and diagnoses. When she was referred, the consultant surgeon would have explained at the first appointment why the lump was being removed. In particular, was the procedure mainly a precaution because of her family history? At the hospital, Emma doesn’t quite understand what is going on. She gets repeatedly lost. She is late, and has not read the pre-operative information. Before the surgery, a phone call to reassure her, and explain where she should go and what she should do would have been of benefit. Biomedical Traditionally considered the dominant, modern mode of healthcare delivery; good health and well-being are defined as being free from pain, defect or disease. It is infamous for using patient descriptors like “broken leg in room nine.” It is focussed around physical cycles and physiology, and the pathology of a condition. Every illness consists of one underlying cause, and once that cause is eliminated the patient will be healthy again. The Biomedical model emphasises possession of expert scientific knowledge and therefore places doctors in positions of power. However, this does not always address complex needs. For example; Emma, an anxious, depressed, single mother, being treated as: “small lump in

left breast.” This is a direct consequence of the Biomedical approach. There is no one to reassure Emma, provide support, or explain what is going to happen. According to the Biomedical model, removing the small breast lump will yield the result that Emma “will be healthy again.” However, Emma’s lump is not the root cause of her stress or depression. Growing evidence from Beneden Health (2014) and others shows this model is failing. “25 per cent of all patients in England have a long-term medical condition, accounting for 70 per cent of total NHS spend, 50 per cent of GP appointments and 64 per cent of hospital outpatient appointments.” The Biomedical model also fuels accelerating health spending. Glimpse the future in the insurance-based U.S. system, where health spending as a share of GDP has tripled in 45 years. Two thirds ($2.6 trillion) go on hospital costs, doctors’ bills, and prescription drugs. Probasco (2019) Concluding on Emma at hospital. All the medical team endeavour to accommodate Emma’s lack of preparation. However, moving Emma on the list may have adverse knock-on effects for other patients. Emma would benefit from support from staff and reassurance, as she made it clear she did not read the letter sent to her.

Contrasting Sociological perspectives on health Functionalist Good health and medical care are essential for the smooth functioning of society. The health professional-patient relationship is hierarchical: Health Professional gives instructions, the patient must follow them. Under the functionalist perspective Emma has rights and obligations to fulfil the ‘sick role’. However, Emma lives a very busy lifestyle with no support from others and therefore cannot assume the ‘sick role’. Mitchell, (2013) Describes Talcott’s Rights and Obligations as: The person is not responsible for assuming the sick role. The sick person is exempted from carrying out some or all of normal social duties (e.g. work, family). The sick person must try and get well – the sick role is only a temporary phase. In order to get well, the sick person needs to seek and submit to appropriate medical care. Unfortunately, Emma failed at performing the latter obligation adequately (not reading instructions, not fasting, arriving late). In Emma’s case, she is reprimanded by each health professional in turn. Jane: “Why did you do that?” Senior Staff Nurse: “You will have to go to the end of the list.” The surgeon warns her that “operations are delayed for many reasons” and she must ‘do better’ next time.

Symbolic Interactionist This perspective focuses on illness as a social development instead of just a medical condition. It emphasises the use of language and how individuals create shared meanings through interaction. It’s also provided insights into the interaction between patients and healthcare professionals. Their reactions affect their relationships which in turn influence healthcare outcomes. Emma is alone, depressed and comfort eating, leading to weight gain, and this has affected her mental wellbeing. But the hospital staff take symbolic cues from Emma to reach the conclusion that she is ‘worried’. Emma changes the interaction, not behaving like a normal patient, and inadvertently breaking the rules. Nurse Jane becomes agitated, and the surgeon warns Emma that she must be “fully prepared” in future. Consciously or not, doctors ‘manage the situation’ to display their authority and medical knowledge. Patients are made to wait and addressed by first names. Healthcare professionals are called by titles and use complex medical terms to describe a patient’s illness. University of Minnesota (2016) Lay Perspective The Lay Health belief suggests that when a person suffers from an illness, they will seek advice from their friends and family before seeking medical advice. This creates a huge diversity among cultural and social groups. Blaxter (2012) stressed the importance of lay perspectives, because they offer simple explanations as to why health and illness can be experienced by different people in different ways. Each individual’s view of health is unique. For example, an older person with mobility issues will define it differently from a young sportswoman. In the case study, Emma has no friends or family nearby. However, Emma is aware from her family’s medical history that breast cancer runs in her family. This will cause additional stress as Emma has no support or anyone to reassure her that her lump may not be malignant. Emma may be more accustomed to internet culture, but she’s a single mother with five children, ‘making ends meet.’ This suggests Emma does not have the time to research her symptoms or even read the letter sent to her, which may have explained her condition in more detail. Perhaps a follow-up appointment after her biopsy, or phone call could have prevented this.

Factors that affect how people react to ill health One factor that truly influences wellbeing and sickness is age: maturing is out of a person’s control. Therefore, societal and cultural norms have brought forth a belief that growing old brings suffering and pain. Wellbeing is regularly depicted to decrease altogether with age, and primarily this is valid. Nevertheless, afflictions that are viewed as ‘part of getting old’ are

normally treatable. However, the same affliction may be dealt with very differently in younger individuals. Health is described in many different ways; a person’s experience of health and the NHS depends on their physical and mental state, situation in life, cultural background, etc. Therefore, two people affected with the same disease could react very differently. Emma has ‘obeyed’ national health guidelines not to smoke or consume alcohol, and may well think, “I should be healthy.” Health messages of former decades have had a greater impact on Emma’s behaviour than more recent concerns about growing obesity. Obesity is another risk factor which leads to further illness, for example, coronary illness and diabetes. Emma has no friends or family nearby to support her. She has a very busy lifestyle and juggles her everyday chores and appointments. Plus trying to look after her children alone has led to Emma being stressed, depressed and gaining weight. She now has the added stress of a possible illness that killed her grandmother. If Emma had the support of friends and family, she may have reacted differently to ill health.

Conclusion Health and wellbeing are perceived differently by individuals. What one person may call good health another may not. In society we have many different rules on health and ill health, and how we should or should not behave when we are ill. Unfortunately, this may affect the care you receive. Within the western world, the Biomedical approach is still prominent within healthcare services. This limits the quality-of-care people will receive because healthcare professionals may not be treating the root cause of an illness. For example, even when Emma has had her lump removed, she will still be depressed.

Recommendations In order for the Lay Perspective to be included, all NHS appointments and procedures should include a ‘Rate your NHS experience today’ card (zero to five stars).

References

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