PolyU-Hong Kong Community College


Lecture 4
AD Scheme in Health Studies
CCN2040 Sociology for Health Studies
L4 Culture and Health Beliefs

Health belief as social construction

Lay health beliefs

Development of biomedicine and medical model

Limits of medical model

Culture and illness: Contested illness and stigmatized illness

Cultural competence of healthcare professional

Health Belief Lay Beliefs of Health

The ability to fulfil social & work roles as
Health as functional main criterion of healthiness - never having
capacity (Blaxter:1982) a day’s illness' was found to be used as a
(positive) moral characteristic of
Health beliefs refer to the rules and meanings that individuals
different social groups use to order their lives and make This broad notion would also include
the notions of `health as the absence
sense of their experience of health and illness. of disease' (as not ill) as well as `health Conceiving health as coping or overcoming
despite disease'. 
 disease / misfortune. Related to this is the
idea of health as “reserve”
Health beliefs affect one’s health decision and Largely a working class conception,
but also held by the elderly,
behaviour. particularly those in poor health, were In a study of a working class community, it
is found that the way people thought about
less likely to define health in terms of
their health was a kind of “cheerful
illness. stoicism”, even when physically ill.

source: http://www.healthknowledge.org.uk/public-health-textbook/medical-sociology-policy-economics/4a-concepts-health-illness/section4
 Lay Beliefs of Health Lay Beliefs of Health
A positive approach to life, do not
Health as emotional well- `worry all the time'. Healthy behaviour as not
being Health as reflecting smoking, good diet, exercising,
lifestyle, including a and not drinking alcohol to excess.
(MacInnes & Milburn:1994)
moral dimension (MacInnes &
Illness as resulting from negative Milburn:1994)
Closely linked to health as attitudes - `moaners'.
energy / vitality (Blaxter:1990). Closely linked to health as `healthy' Moral evaluations of individuals,
d'Houtaud & Field (1986) saw behaviour, the `healthy life' (Blaxter:
1990).
role of `bad habits' in causative
this as essentially a middle explanations.
A holistic and multidimensional
class concept.
view of health and illness.

source: http://www.healthknowledge.org.uk/public-health-textbook/medical-sociology-policy-economics/4a-concepts-health-illness/section4
source: http://www.healthknowledge.org.uk/public-health-textbook/medical-sociology-policy-economics/4a-concepts-health-illness/section4

History of Illness in the West

Middle Ages:
Health beliefs are social constructions. It
Religious and secular healing coexisted.
keeps changing over time, place and
social location. Illness is caused by corruption of the air and the
corruption of morals. Ultimate cause: God’s will

Health practice: Direct contact with a saint’s relics,

pilgrimage, confession and prayer…
 Health beliefs in the The Rise of Biomedicine—

A “Rational Medicine” in Modern Society
Chinese Context The Enlightenment in the eighteenth century in Europe:

Secularisation of society: the increasing acceptance of non-religious explanations
Health=The balance between Yin and Yang; the circulation of of the world
Qi Qi is the flow of energy in the body. The flow of Qi
emphasis on reason rather than belief, superstition or even religious thought.
and liquids depends on the bodily condition and the external
environment. associated with rationality and the search for evidence

Illness= imbalances in a person’s life. Development of specific methods of investigation--scientific methods--in

relation to medicine
Health practice: Qi Gong, Tai Chi, Acupuncture, Cupping, Louis Pasteur (1822-96): Germ theory of disease
Herbal medicine…
Illness is caused by germs infecting organs of the human body
Illness is not isolated from the patients. It requires their Foundation of modern medicine
complete involvement in the treatment process.

Medical Model
A. Doctrine of specific etiology:
Health is seen as the absence of disease. All disease originate from specific and
knowable causes.
B. Mind/Body dualism:
Physical body, rather than the problems of “mind,” is the subject of medicine.
Foucault’s clinical gaze
C. “Body as machine” metaphor:
Mechanical view allows the physicians to repair any dysfunction of the body
D. Technological imperative:
Tend to overemphasize the curative aspect of medicine and underplay the benefit
from social and environmental factors.
E. Physical reductionism
Reduce all explanations to the physical workings of the body.
 Limits of Biomedicine Domains of Healthcare Systems
Specific aetiology: oversimplifies the causes of illness We exists in a society with multiple health belief systems
taken place in different domains of healthcare.
Mind/Body dualism and Machine metaphor:
objectification of patients
1. “Popular” health care: methods and practices of non-
ignore or downplay the social and psychological aspect of illness specialized members of any society (e.g. family)
Reductionism:
ignore the role played by social factors in affecting individual’s health. 2. “Folk” health care: non-professional non-bureaucratized
Tendency of “victim blaming” specialists within a culture. (e.g. herbalist)
individualization of health problems
3. “Professional” health care: biomedicine, and a few other
genetic fatalism and poor lifestyle choice
professionalized indigenous medical systems

Explanatory Models Contested Illness

When Lay EM is in conflict with Doctor’s EM……
Explanatory model (EM): a way of looking at the process
by which illness is patterned, interpreted and treated. Contested illness: a category of disorders where sufferers claim
to have a specific disease that many physicians do not recognise
Lay EMs: idiosyncratic and changeable, influenced by or acknowledge as distinctly medical.
personality and cultural factors
Sufferers lack the cultural legitimation of symptoms and
Doctor’s EMs: single causal trains of scientific logic suffering, and are burdened by the cultural meaning of a
medically invisible condition in an era of high-tech
Consultations with a doctor are actually negotiations biomedicine.
between lay EMs and medical EMs. Example: Premenstrual syndrome, Chronic fatigue syndrome
 Stigmatized Illness Case 1: Depression
When Lay EM may resist the Doctor’s definition of illness…… A Chinese patient attend a medical clinic with tiredness,
dizziness, general weakness, pains in the upper back, heaviness
Stigmatized illness: a category of disorders that negative in feet, weight loss, insomnia for 6 months.
metaphorical meanings are attributed to them.
Patient’s description: Wind, not enough blood
Stigmatized illness is a social construction. There is nothing
inherent about a condition that makes it stigmatizing. It is the Denied feeling depressed and the diagnosis of disease
social response to the condition and some of its (depression)
manifestations, or the type of sufferers, that make a condition
stigmatized. Agree to enter psychiatric clinic only for medication

e.g. HIV/AIDS, obesity, cancer, leprosy Continual to use Chinese medicine and seek lay advices

Case 2: Angina
A university professor with chest pain was diagnosed in a cardiology
clinic as having angina based on coronary artery disease, but refused
The patient believe his sickness as physical disorder, to accept the diagnosis.
labeling it in Chinese medical term.
Lay EM: The belief that development of angina signals the end of an
In Chinese culture, mental illness is highly stigmatized. active lifestyle and the onset of invalidism.

Patient is trying to prove that cardiologist make a mistake in

Somatization: The unpleasant emotional states or the diagnosis.
experience of various social stresses is expressed in the
form of physical symptoms. After eliciting the patients’ model and informing the cardiologists
about the fears of the angina label, both were able to frankly discuss
the problem and patient comes to accept the disease.
 Culture and Illness
Disease is not simply a biological entity. Illness has its cultural
Medical model is medico-centric, cultural-specific and value laden.
meanings (e.g. stigmatized illness) Physicians tend to treat patient’s belief as simply “incorrect”.
Cultural factors determine which symptoms or signs are The systematic inattention to illness entity is in part responsible for
perceived as abnormal. patient noncompliance, patient and family dissatisfaction with
professional health care.
Process of “becoming ill” involves both patient’s experiences of
physical and emotional changes, and the confirmation of these To improve the relationship between patient and health professionals,
changes by others. health professionals should improve their cultural competence.

They shape the emotional and physical changes into a pattern Cultural competence: The sensitivity of health professionals to the
cultural beliefs, practices, expectations and backgrounds of their
recognizable by sufferer and others. This pattern of symptoms
patients and their communities.
form the “illness entity.”

Understanding Patients’ EM Round-up

1. What do you think has caused your problem? Meanings of health is diverse, depends on sociocultural
2. Why do you think it started when it did? circumstances and one’s history of illness.
3. What do you think your sickness does to you?
4. How severe is your sickness? Will it have a short or long course? Medical model is a dominant type of health belief in the
5. What kind of treatment do you think you should receive? West that sees health as the absence of disease.
6. What are the most important results you hope to receive from your
treatment? Limit of medical model: focus too much on disease,
7. What are the chief problems your sickness caused for you? physical reductionism, ignores patients’ perspective...
8. What do you fear most about your sickness?
Improving cultural sensitivity is important for medical
professionals to enable an effective healing.
Kleinman, A., Eisenberg, L. & Good, B. (2006) ‘Culture, illness, and care: clinical lessons
from anthropologic and cross-cultural research’, in Focus, 4(1): 147