Social science & medicine. Part A, Medical sociology最新文献

The decision to consult a doctor for medical reasons may be assumed to be indicative of the perception of a health problem by the patient. A study was carried out to compare the scores of consulters and non-consulters of a general practice, on the Nottingham Health Profile, which is designed to be a standardized and simple measure of subjective health status in the physical, social and emotional domains. Data on physical activity, absence from work and overall self-rated health were also collected. Each section of the Profile showed significant differences in score between consulters and non-consulters. Significant associations were also found between scores on the Profile and both self-rated health and absence from work. The association between scores and amount of physical activity was less clear cut.

Females had a lower subjective health status than did males on all sections except those reflecting pain and physical mobility problems. The age-group 40–49 had a lower subjective health status than younger and older groups and for this age group males scored higher than females on sections representing emotional, social and sleep problems.

The study indicates that the Nottingham Health Profile is a valid and sensitive measure of subjective health, which may well be a better predictor of need for and utilization of health services than “hard” data such as mortality and morbidity statistics.

In interviews with a sample of laypersons about how they manage their health, we found that the way an individual feels is a prime criterion of health, illness, and recovery, as well as a feature of health interactions. In this paper, we describe the place of feeling in illness and its importance in the social organization of health care, both lay and professional. While other criteria of illness are certainly employed, the problems which the criterion of feeling poses for the social legitimation of illness permit us to begin to specify how these legitimation processes work. Based on interview data, we show that the use of feelings as a criterion generates the problem of proving that one is ill. The structure of knowledge on which physicians draw in their diagnoses is specifically suited to solving this problem of the patient. and thus provides one reason for the patient to consult or to avoid the doctor.

Examination is made of the multi disciplinary approach to cost control in health care, using examples from different countries. Recommendations are made for fresh comparative cost control experiments based on past experience in health services research.

Over the past two decades, with increasing evidence that medical science and technology alone has made little impact on dramatically improving the health of the majority of the world's population, interest and enthusiasm has focused on the idea that much greater gains might be made by involving the public in its own health care. Although advocates of this concept are increasingly winning converts, the umbrella of public participation hides many differences in approaches which are not often explicit. In order to begin to dissect this concept, it is suggested that four approaches to this topic might be made. These approaches are based on views about three issues: (1) the involvement of laymen in the highly specialized field of medicine, (2) the organization of this involvement, and (3) mobilization and motivation for public participation.

The four approaches are (1) the public health approach, which gives the reason for public participation as necessary to assist in the eradication, or at least control of communicable disease, (2) the health planning approach, which sees public involvement as a means to create additional health resources in a terms of manpower, money and materials and to gain public support for both better utilization and development of health services; (3) the community development approach, which argues public participation is necessary to correct the imbalance in health resources distribution and to have people, especially the poor and underprivileged, become active in decisions which affect their own daily lives; and (4) the self-care approach, which sees public involvement as the way in which people can meet their health needs because medical professionals are both unwilling and unable to meet them. These approaches reflect views about the role of the public in planning, managing and evaluating health activities. It is argued that different attitudes and expectations about public involvement must be carefully examined in both theoretical and practical terms in order to ensure a place for the layman in a field traditionally preserved for the medical professional.

The influence of psychosocial factors in the general aetiology of disease is examined with particular reference to the notions of vulnerability and susceptibility. Cultural definitions are considered as well as cultural variations in help-seeking behaviour. Analysis concludes by looking at eight patterns of help-seeking behaviour.

This paper deals with ‘medical social engineering’, which is now required to solve health problems in developing countries. The first section presents an historical background for social scientists participation in the health field and explores their involvement in classical public health approaches, such as direct interventions, epidemiology and ecology. In a second section, more recent types of participation, associated with the health political model, are discussed in reference to community medicine, ethnomedicine and clinics. The third section examines three promising recent developments in medical social science: health planning and evaluation, population studies and emergence of an indigenous social science. Finally, an interface is proposed between social and bio-medical sciences, and a reconceptualization of health and disease is explored which fills the gaps between these sciences.

Health resources are defined according to the inputs to the provision of health services. These may be human, material or financial. The distribution of health resources is then examined and then the role of politicians in their allocation. This role has to be related to the closely associated responsibilities of users and planners.