Medical Sociology
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INTRODUCTION
Medical sociology is a sub discipline of sociology that studies social causes and consequences of health and illness, (Cocker ham, 2004). Major areas of investigation include social aspects of health and illness, the social behaviour of health care workers and the people who utilize their services, the social functions of health organizations and institutions, the social patterns of health services, the relationship of health care delivery systems to other social systems, and the health policy. In other words, Medical sociology observes various elements of social structure within the areas of mental and physical health care, and the framework for the regulation of the health care system. It explains the rules of the social process guiding physician-patient relationships in the process of administering care.
What makes medical sociology important is the significant role social factors play in determining the health 0f individuals, groups and the larger society. Social conditions and situations not only cause illness, but they also help prevent it.
Medical sociologists have employment opportunities both within and outside academia. Medical sociologists work not only in university sociology departments, medical, nursing, and public health schools and various other health related professional schools, but also in research organizations and government agencies.
DEFINITION OF BASIC TERMINOLOGIES.
Health: It is a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity, (WHO). In other words, health can be defined as the state of optimum capacity for effective performance of value task.
Disease: A particular abnormal condition that negatively affects the structure or function of part or all of an organism. Diseases are often constructed as medical conditions that are associated with specific signs and symptoms.
Illness: A person’s experience of ill-health, sometimes when no disease can be found.
The difference between disease and illness is that disease is what affects the organ of the body and can be medically constructed whereas, illness is what man has.
Sickness: A state of being ill.
Patient: A person receiving treatment.
Hospital: A health care institution providing patient treatment with specialized medical and nursing and medical equipments.
Institution: An institution is an organized body form by human beings in order to achieve a common goal.
SOCIOLOGY AND HOW IT IS RELATED TO MEDICINE.
Sociology, the queen of all social sciences is the newest and the most exciting discipline in social sciences. It emerged from the turmoil of Western Europe particularly the French and industrial revolutions that pervaded Europe in 18th and 19th centuries. It founding fathers include August Comte, Emile Durkheim, Max Weber, Karl Marx and Herbert Spencer. These scholars were worried about the political and economic revolutions, social and gender inequalities as well as religious instability of their time and attempted to analyze the society by highlighting the various strategies that would be put in place to surmount disorder and restore social order. This provides impetus into the origin of society as an academic discipline.
By way of definition, sociology as an academic discipline focuses on social order and the analysis of social groups and the society in general. In simple terms, sociology is the science of the society. Sociologists in this context are interested in analyzing how human beings interact with one another (in health institutions) and the forces that determine social order. It is noteworthy that in their quest for understanding human behaviours sociologists employ scientific methodology.
Sociology is related to the field of medicine in the following undisputed facts:
- The incidence of illness to a larger extent is determined by social and cultural factors. As a result of this, knowledge of these factors in the etiology of illness cannot be under-stressed.
- Sociology equips us with the knowledge of understanding attitudes that may constrain or facilitate the treatment process.
- Sociology provides a careful study of all those who are relevant in providing support during treatment and post-treatment phases.
- It also helps us to understand and appreciate the various actors in the treatment setting such as pharmacists, laboratory technicians etc.
The study of these issues and many more definitely brings in to focus the relationship between sociology and medicine.
MEDICAL SOCIOLOGY: TOWARDS DEFINITION.
Medical sociology addresses a wide range of key issues and especially the interplay between social factors and health. It involves the application of sociological knowledge and concepts to social issues of health and illness. It considers the social and cultural factors on disease and illness processes as well as the organization and delivery of health care. According to Timuola (2014), medical sociology studies social behaviour and society by observing medical groups, organizations and other patterned network of interaction through which society achieves a healthy population.
APPROACHES TO MEDICAL SOCIOLOGY
Basically, there are two approaches to the study of medical sociology. Firstly, medicine is seen as a social institution which one should study and test sociological hypothesis. Secondly medicine is perceived as an applied enterprise seeking to minimize the suffering of humans and improve quality of life.
MAJOR CONCERN OF MEDICAL SOCIOLOGY.
Medical sociology is basically concerned with:
- Explaining how people respond to diseases with a view of defining it in a predictable way from the perspective of their culture and social class within a particular culture.
- Looking at how disease in a population is located among social groups.
- Describing how societies prescribe means of treating diseases.
- Investigating how social institutions give their support to the medical organizations in their bid to treat the sick.
MEDICAL CARE AND HEALTH CARE.
Medical care has to do with essential provisions and services that are employed in the management and treatment of disease conditions and illness such as drugs, needles, syringes, reagents, hospitals, clinics, pharmacies, nurses, doctors etc. Health care on the other hand, encompasses all the essential requirements that are needed to keep people healthy. Health care needs include food security, proper hygiene, housing, sanitation, income, education and so on. In this way, medical care is basically curative while, health care is preventive.
THEORIES IN MEDICAL SOCIOLOGY
Theories in medical sociology generally may be divided into the following:
Structural functionalist theory: This theory may be compared with an analogy between a biological organism and the society. The perspective argues that sickness, health and health institutions can be analyzed with the framework of a dynamic social system. For instance, the illness of a particular member of the society may be traced to lack of family members to play their crucial role to keep the person healthy which may or may not be as a result of poverty. Whatever may be the cause of the illness, the sick member’s illness behavior has implication not only for himself but also for other members of the family, his peer group and the larger society.
The Marxist theory: This theory was pioneered with the works of Karl Marx who lived between 1818-1920. Marx saw the power relations and the divergent aspects of the social structure which can result to illness. He emphasized the role of power ideologies and economic system in health care. In this regard, proponents of this theory believe that power structure or ideology or economic system of any society cannot be divorced from the nature of its health care delivery.
Middle range theories: This paradigm is represented by the view of Geffman (1971) who believed that the social situations have greater implications for human behavior whether in health or sickness. For instance, fuel scarcity in a city at any given point in time may account for morbidity or sometimes mortality.
MODELS OF DISEASES.
According to WHO, health is a complete state of physical, social, mental wellbeing and not necessary the absence of disease or infirmity, (cited in Lewis 1953). Disease on the other hand has been defined as a form of deviation from normal functioning which has undesirable consequences because it produces personal discomfort or adversely affects the future health status of individuals, (Mechanic).
It is important to note that the concepts health, diseases and illness, generally speaking are amplified by the belief of a people, (Erinosho, 2015).
Basic models of disease include:
- Medical model: This model argues that disease is a function of biological discontinuity, and as such a discontinuity can be linked to the malnutrition of a part of the human organism. Disequilibrium in a human organism can occur if a part of the organism fails to perform its function effectively and efficiently.
- Psychological theory: This theory is about an appraisal of the contributions of psychiatrists and psychologists in the understanding of the etiology of mental disorder. Sigmund Freud (1914) was the psychoanalyst who propounded this theory to explain the role of psychology in the etiology of mental diseases by analyzing the unconscious drives in human beings.
- Culture–bond theory of diseases: This theory highlights the interplay between culture and diseases. This explains that disease conditions can be managed more effectively through an informed knowledge of the cultural context and the patient’s background. E.g. Obesity, sickle cell, hypertension, suicide etc.
Lambo (1955) of Nigeria and Yap (1951) of Hong Kong did a lot of works among their people on the cultural dimensions of health and ill-health. They submit that health and diseases are to a larger extent, determine by culture of a people. The evidence of disease is therefore usually attributed to witchcraft, sorcery and mystical forces.
- socio–environmental theory: The social factors such as income, education, occupation, and environmental cushions within which man lives and functions can to a larger extent, account for the etiology of health and disease. Behavioural patterns can also determine health and illness
THE CULTURAL CONCEPT OF DISEASE AND ILLNESS IN NIGERIA.
The cultural concept of disease and illness in Nigeria is dominant among Nigerians. This is anchored on three main factors. These include:
- Natural factors. This factor is akin with the medical model in the sense that many people accept the fact that germs and hereditary factors can cause disease and ill health. Disease and illness are attributed to things like insect bites, bad odor, and improper hygiene.
- Pre-natural factor: In Nigeria, disease and illness are also linked to witchcraft and sorcery. Witches are believed to have powers to inflict harm on any part of the body of their target. Sorcery is also reached out to their victims by making contact with their personal effects such as cloths, pictures, fingernails, hairs, shoes etc. in some instances; they produce poison which they use to cause bodily harm among perceived enemies.
- Mystical factors. The etiological factors revolve around mystical forces. Many Nigerians worship ancestors because of the belief that they can influence a lot in the life of the living. Aged parents are buried in the family homestead as it is believed that their spirits are invoked in times of personal family, community distress or difficulty and crises because of the wide belief that failure to honour ancestors could spell doom or dare consequences for the lineage and erring members.
THE SOCIAL AND ENVIRONMENTAL IMPLICATIONS OF ILL HEALTH.
Environmental factors play a crucial role in human development. Human exposure to hazardous agents in the air, water, soil, food and also to physical hazards in the environment are major contributors to illness, disability and death worldwide. More so, deterioration of environmental conditions impedes sustainable development. Poor environmental quality is estimated to be directly responsible for approximately 25% of overall preventable ill health in the world, especially among vulnerable population, WHO (2002).
Low income communities are the populations living with the worst built environmental conditions. Tradition holds that home is a heaven and where people are protected and nurtured. For the poor however, home is a health hazard when factors such as poverty, environmental contamination, and poor housing design combine to cause disease. For instance, lack or inadequate sidewalks and recreational centers may discourage physical activities and contribute to obesity or hypertension. While in those places where such amenities are present, the threat to crime keeps people in door. Dilapidated housing is also associated to asthma and mental stressors such as violence.
THE NEGATIVE, POSITIVE AND HOLISTIC CONCEPT OF HEALTH AND ILLNESS.
Health and illness can be defined as negative, positive and holistic. The negative concept of health is the view that being healthy is the absence of illness. For instance, not having any symptom of disease, pain or distress. People of this view believed that good health is normal and they take it for granted that they are well. They sometimes think they do not need any special action to keep them healthy and do not see themselves as ill when they are distressed or cold.
The positive concept of health is a belief that being healthy is a state achieved only by continuous effort. Thus being physically fit and meeting their health. For instance, through the choice of food, by taking exercise and other activities people believe will keep them well. Such people are likely to feel responsible for their own health. They take credit for the absence of disease and blame themselves if symptoms develop. According to this notion people who do not take action to maintain their own health by healthy eating cannot be healthy.
The holistic concept of health on its part is the belief that being healthy means without any physical disorder or disease and being emotionally comfortable. WHO defines health as the state of complete physical, mental, and social wellbeing and not merely the absence of disease or infirmity. This embraces all aspects of the individual psychologically, physically, spiritually, environmentally and socially, (Ewles and Simnett, 1992). For instance, a person who feels anxious or who has low self esteem would according to this concept not be well. According to this notion also, people are likely to know that they are ill when they experience any unpleasant feeling not just physical discomfort or pains but are likely to know any minor discomfort such as tiredness as one of the symptoms of illness.
HEALTH INSTITUTIONS, HEALTH WORKERS AND THE PROCESS OF SEEKING MEDICAL CARE.
DEFINITION OF HEALTH INSTITUTIONS
Health institutions can be defined as health care organizations. Health institutions can be classified into two. That is, the public and private. In Nigeria the two operate as parallel organizations, each having its own proprietors. The public oriented health institutions are organized under the auspices of federal and state ministries of health as well as local government authorities. On the other hand, the private health delivery sub-system in Nigeria consists of solo and partnership practitioners. Under this sub-system we also have health facilities built by philanthropic organizations, voluntary agencies etc.
DEVELOPMENT AND FUNCTIONS OF THE HOSPITAL.
The hospital developed in response to the needs, values, attitudes and aspirations of the societies they serve. Historically, hospitals have passed through four distinct phases or stages of development. Corker ham (1982) has highlighted these stages as:
- Centers of religious practice
- Poor house
- Death houses, and
- Centers of medical technology.
The genesis of the hospital as a health care organization is usually associated with the rise of Christianity. It was part of Christian theology that spiritual salvation could be obtained by providing care to the sick and needy. When religious institutions were relieved of their control of hospital in Europe, the hospitals were left loose under many separate administrations. This led to gross abuse, lowering of standard and misappropriation of funds. The poor became major victims.
After the renaissance and the reformations, there was still much to be desired in public hospitals with respect to their potentials to provide welfare services for the poor. Towards the 14th century however in Europe, physicians started to associate themselves with hospitals as they now saw themselves as major stakeholders in the administration of health care services. Even up to the 18th century, hospitals were regarded as death houses because typically, hospitals were dirty, poorly ventilated and congested.
Hospitals as centers for medical technology became a new phenomenon since the end of the 19th century. This new image of hospitals has been attributed to the improvement in the quality of medical care.
One major factor in this change was the fact that medicine had become a science in terms of employing scientific method for the acquisition of accurate knowledge. Also, the discovery and use of antiseptic measures in the hospitals to curtail infection has been a good development. There has also been a significant development in the qualities of hospitals personnel in modern times, not only in Euro-American societies, but also in many developing economies of the world like Nigeria.
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