What Exactly is Health

Anthropologists generally see "health" as a broad construct, consisting of physical, psychological, and social well-being, including role functionality. Such a definition works much better cross-culturally than one that links health only to "disease," which, technically, means simply a biomedically measurable lesion or anatomical or physiological irregularity. Disease is something that is either cured, or not. But disease itself does not spur people to seek medical treatment; illness does. "Illness" is the culturally structured, personal experience of being unwell and it entails the experience of suffering. The main goal of most people seeking medical treatment is to have their suffering removed. Illness thus underwrites the entire medical enterprise (Hahn, 1984, p. 17; also see Mechanic, 1962).

"Illness" can refer to a variety of conditions cross-culturally. In some cultures, it is limited to somatic experiences; in others it includes mental dysfunction; in others it includes suffering due to misfortune, too. That is, some medical systems deal with human struggles related to love, work, finances, etc. Social, somatic, emotional, and cognitive troubles often are not separated at all but quite intertwined and even fused together.

This underscores a major criticism of the disease-illness dichotomy: that it recapitulates the mind-body dichotomy that biomedicine has been criticized for trafficking in. "Disease," as the dichotomy defines it, is anchored in the body; conversely, "illness" may be seen as anchored in the mind. Disease is thus attributed a real, concrete, scientific factuality or objectivity that illness, as a subjective category, may be denied (Hahn, 1984).

A second criticism of the dichotomy hinges on the fact that both disease and illness are located in the individual or experienced at an individual level. The term "illness" does refer to an individual's social relations, but generally it does so only insofar as these were the cause of the illness (e.g., when an offended party places a hex) or as the illness leaves the individual unable to fulfill social or role obligations. However, some scholars would link suffering more palpably to the social order by examining how macro-social forces, processes, and events (such as capitalist trade arrangements) can culminate in public health problems (such as HIV/AIDS, tuberculosis, alcoholism, pesticide-induced anomalous pregnancy outcomes) and poorly functioning health systems (see Baer, Singer, & Johnson, 1986; Waitzkin, 2000).

Taking their cue from this movement, most social-cultural anthropologists have heeded the call to link individual illness experience with social context, at least minimally. Further, while it is the case that illness may be defined in opposition to disease, at least in more recent anthropological work (especially that which considers the concepts of embodiment or lived experience), this has generally not been the case; illness is conceived as affecting the whole person, body included. The disease-illness distinction therefore retains contemporary currency, although the term "sickness" may be used when the distinction is not important (e.g., Young, 1982) or when larger social processes are being highlighted (e.g., Frankenberg & Leeson, 1976).

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