Negotiating Health and Social Stratification

What are the factors that influence the ways in which people understand and express their health/illness behavior? The anthropological record shows that expressions of the sick role are mediated by individual determinants, such as ethnicity, age, education, "racial" classification, class, gender, and occupation, and structural determinants such as health policy, economic policy, and national policy.

If health is a negotiated process by which a standard of values is defined as "health," then communication lies at the base of determining the health of individuals within a society. Because the definition of health is a collective determination, it must have room for debate and negotiation of the standard by which individuals are to be judged (Habermas, 1970, p. 372). In biomedicine, as in other healing cultures, it is often the case that a small, but powerful minority decides definitions of health and the standard for a "healthy" individual.

Kleinman's (1980) was the first model that acknowledged that definitions of health and disease are arbitrary, culturally conditioned, and vary across space and time. The model could thus be used for analysis of culture-bound syndromes (such as premenstrual syndrome) as well as biomedically defined diseases such as tuberculosis. The model did not distinguish between biomedically and non-biomedically constructed illness and imparted the same legitimacy to each. Secondly, the explanatory model took into account and legitimated both patient and practitioner (healer) roles and participation in the health process. By demonstrating that health and disease are negotiated by individuals in the context of cultural and social experience, the explanatory model also provided a theoretical foundation, establishing communication as the crux of the health care encounter. At its simplest, the health experience is the meeting of patient and healer; at its most complex, health care is where biomedicine meets the global marketplace. Each of these represents points of articulation and communication.

The sick role is a mode of communication and the first step in the healing process because it is the acknowledgment of illness or abnormality. In assuming the sick role, the individual communicates several important messages: the first is a wish to be absolved of regular duties; second, a desire to validate illness via a healer; and third, an acknowledgment that this is not a normal or usual state. The patient might visit the doctor, ensuring "formal medical validation, and the submission of the sick person to the ministrations of the physician" (Foster & Anderson, 1978, p. 146). The sick role may be undertaken for utilitarian purposes. Nervios, susto, and stress may be excuses individuals use to separate themselves from expected social roles. Sufferers from legitimate illness are often excused from daily duties, including housework, occupational responsibilities, and child care.

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