payment page
Health and illness are universal human experiences, but how societies define, treat, and respond to medical conditions varies widely. The institution of medicine is responsible for defining and treating physical and mental illnesses among members of a society. The goal of a society’s medical establishment is to promote health, the total well-being of its people. The nature of both health and medicine in a given society are culturally determined.
Definitions of illness vary widely from society to society. Societies attach different values to conditions that people worldwide experience, and as such, they treat those conditions differently or not at all. In addition, societies have vastly differing views on the nature and origin of both physical and mental illness.
Healthcare Systems
Healthcare systems vary widely, reflecting different approaches to managing the health of a population. The different healthcare systems include public healthcare, private healthcare, socialized medicine, and universal healthcare.
Public Healthcare: Public healthcare refers to medical services provided by government-funded institutions. These services are typically financed through taxes and are either free or heavily subsidized for citizens. Public healthcare aims to ensure that all individuals, regardless of income, have access to basic medical services. Examples include the National Health Service (NHS) in the United Kingdom and Medicaid in the United States.
Private Healthcare: Private healthcare relies on privately funded institutions and services, often paid for by individuals or through private health insurance. While private healthcare systems can offer more immediate access and specialized services, they are often expensive and may be inaccessible to lower-income individuals. The United States, with its network of private hospitals and insurance companies, is an example of a system where private healthcare dominates.
Socialized Medicine: Socialized medicine refers to a system where the government owns and operates healthcare facilities and employs healthcare professionals. This system ensures that medical care is provided as a public service. Patients are typically responsible for little to no direct cost at the time of service. The Veterans Health Administration in the United States and Cuba’s national healthcare system are examples of socialized medicine.
Universal Healthcare: Universal healthcare is a system where all citizens have access to essential medical services, regardless of their ability to pay. Universal healthcare does not require the government to provide all services directly but ensures that no one is excluded from receiving necessary care. Systems like Canada’s single-payer healthcare system and Germany’s multi-payer model demonstrate how universal healthcare can be implemented through a mix of public and private providers.
The key difference between public and private healthcare is that public healthcare focuses on government-funded services, whereas private healthcare is market-driven and paid for by individuals or private insurance. The key difference between socialized medicine and universal healthcare is that socialized medicine involves direct government ownership and operation of healthcare facilities and employment of medical professionals, whereas universal healthcare ensures access to medical services for all citizens but can include a mix of public and private providers.
Medicalization and Demedicalization
As medical knowledge evolves, certain conditions that were once considered personal or social issues become classified as medical disorders. Medicalization refers to the process by which human conditions, behaviors, or issues that were previously considered non-medical are redefined and treated as medical conditions. This often involves identifying a condition, assigning it a medical label, and addressing it through medical interventions. For example, conditions like Attention Deficit Hyperactivity Disorder (ADHD) and obesity have become increasingly medicalized, leading to greater recognition, diagnoses, and treatments by healthcare professionals. Medicalization can provide individuals with access to care and resources but may also lead to the overuse of medical interventions or the pathologizing of normal behaviors.
On the other hand, demedicalization is the process by which certain conditions or behaviors are no longer viewed as requiring medical treatment and are redefined as non-medical. One notable example is homosexuality, which was historically classified as a mental disorder but was later recognized as a normal variation of human sexuality and removed from the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1973.
Physical Illness
The institution of medicine must not only define illness but also figure out how to cure it. The acceptance of a cure depends on how that society views the illness. In the West, illnesses are thought to originate primarily from physical sources, and doctors use biomedical or surgical cures to treat them. Other cultures consider illnesses punishment for certain deeds or curses that are put on individuals, so other methods of curing the condition, such as incantations or folk remedies, are more common.
Mental Illness
Just as physical illness is culturally shaped, mental illness is also subject to interpretation. The symptoms and origins of a mental illness can be as varied as those of a physical illness. In the West, hearing voices or hallucinating are generally viewed as symptoms of a mental illness, such as schizophrenia. In other societies, these symptoms might instead indicate a religious experience, and the afflicted individual may not be seen as mentally ill. Instead, he or she could be viewed as enlightened or special in a positive way.
Stigmatization
Not all illnesses are treated equally. The stigmatization of illness occurs when certain health conditions or diseases carry a negative social stigma, leading to discrimination, marginalization, or shame for those affected. This stigmatization often arises when an illness is misunderstood, perceived as self-inflicted, or associated with taboo behaviors. For instance, individuals with HIV/AIDS have historically faced significant stigma due to misconceptions about how the disease is transmitted and its association with marginalized groups. Mental health conditions, such as depression or anxiety, also continue to face stigma, discouraging many from seeking treatment.
Contested Illness
Some medical conditions remain controversial, with ongoing debates about their legitimacy, causes, and appropriate treatments. Contested illnesses refer to conditions that are not universally recognized as legitimate by medical professionals, society, or both. These illnesses often lack clear diagnostic criteria, definitive tests, or widely accepted treatments, making them the subject of debate and skepticism. Examples include chronic fatigue syndrome (CFS), fibromyalgia, and irritable bowel syndrome (IBS). For individuals with contested illnesses, the lack of medical validation can compound their suffering by leading to additional stigmatization, difficulties obtaining treatment, and challenges in attaining social or workplace accommodations.
The Sick Role
Illness is not just a biological condition but also a social role. Sociologist Talcott Parsons proposed the concept of the sick role to describe the social expectations and obligations associated with illness. According to Parsons, illness is not only a physical condition but also a social one that requires individuals to adopt a specific role within society. The sick role allows individuals to step away from their usual social responsibilities while they recover, but it also comes with certain expectations.
Key aspects of the sick role include:
Exemption from normal duties: Society temporarily relieves the sick individual from their regular responsibilities, such as work or school, acknowledging that they are unable to fulfill these obligations.
Expectation to seek help: The individual is expected to actively seek medical attention and cooperate with healthcare professionals to recover.
Obligation to recover: The sick person is not expected to remain in the sick role indefinitely. They are obligated to make efforts to get better and return to their normal responsibilities.
The concept of the sick role has been critiqued for its limitations:
- The sick role assumes that illness is temporary and that individuals will eventually recover. However, it does not account for people with chronic or incurable conditions, who may face ongoing challenges in balancing societal expectations and their health needs.
- Conditions such as mental health disorders or substance use disorders may not receive the same level of legitimation as physical illnesses, leaving individuals struggling to gain acceptance for their sick role.
- Not all societies define or respond to illness in the same way. For instance, some cultures may emphasize self-reliance over seeking medical validation.
Scientific Medicine
What Americans consider “medical treatment” is actually a fairly new approach to health care. Before the 19th century, any number of people might be called upon to treat a sick person: herbalists, druggists, midwives, and even barbers (in the Middle Ages, barbers became skilled at bloodletting). Today, most Americans seek medical treatment from trained, certified medical doctors who focus on treating their particular illnesses and symptoms. This modern, scientific medical practice has been remarkably effective at saving people’s lives. Women and children, in particular, have benefited, and rates of maternal death in childbirth and infant mortality have plummeted since the turn of the 20th century.
Still, the scientific approach has its drawbacks. Practitioners tend to focus on only one part of the patient at a time and don’t try to see the “big picture” of patient health or ask questions about the patient’s diet, exercise habits, or emotional well-being, all of which might influence treatment.
Holistic Medicine
Once scientific medicine became dominant in industrialized countries, practitioners of traditional forms of medicine, such as midwives, acupuncturists, and herbalists, were pushed to the fringe of the medical establishment, their work dismissed as quackery. But a growing body of evidence suggests that holistic medicine, a medical approach that involves learning about a patient’s physical environment and mental status, may be just as effective as scientific medicine for some illnesses. More and more medical doctors are opening themselves to the possibility of a balance between holistic and scientific medicine.
Social Epidemiology
Health is not just an individual matter. It is shaped by broader social forces. Social epidemiology is the study of how social factors influence the spread and causes of illness within a population. This field recognizes that health outcomes are not only shaped by biological and genetic factors but also by social structures, cultural norms, and economic conditions. Social epidemiologists look at patterns of illness, differences in health outcomes, and the ways in which societal factors contribute to these differences. Social factors like income, education, occupation, race, gender, and access to healthcare can significantly impact health outcomes. For instance, people living in poverty often face higher rates of chronic illness due to limited access to nutritious food, safe housing, and medical care.
Commodification of Medicine
As healthcare becomes increasingly profit-driven, concerns arise over the commodification of medicine. The commodification of medicine refers to the process by which healthcare services, treatments, and even the concept of health itself become products to be bought, sold, and marketed within a profit-driven system. This trend emphasizes the economic value of medicine over its social or ethical responsibilities, framing patients as consumers and health as a purchasable commodity.
One key aspect of commodification is the profit-oriented nature of pharmaceuticals and medical treatments. For example, lifesaving medications, such as insulin or cancer drugs, are often expensive making them inaccessible, especially in countries without universal healthcare. The focus on profitability can also lead pharmaceutical companies to prioritize the development of drugs for chronic or common conditions, which ensure long-term revenue, over treatments for rare less profitable diseases.
Critics argue that the commodification of medicine can worsen inequalities in access to care and shift the focus of healthcare systems away from patient welfare and public health priorities. Proponents, however, suggest that market competition can drive innovation and efficiency.
