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PREVENTIVE MEDECINE: IMPLICATIONS OF PERSONAL LIFESTYLE FOR HEALTH

on April 23rd, 2009 by admin

Obviously there are many factors that influence what we believe about preventive health and our behaviour when we do decide to act. Many of these factors can be related to socioeconomic status. For example, studies have repeatedly found that people from the less advantaged sections of society receive less accurate health information and have more difficult access to health facilities, as well as being less inclined to take prevention seriously, defining illness differently, delaying longer in seeking health care and participating less in community health programmes. When they do approach the health-care system they are more likely to select sub-professionals, and once under the care of professionals are likely to be treated differently from middle and upper socioeconomic groups. This is partly to do with definitions of health and disease. If a condition is not seen as a disease in a particular sub-fraction of society then the individual in that sub-fraction will not react to it as a disease. If everyone you know has tooth decay or dentures you come to see these as normal, just as some people see back pain as normal-and do nothing about it.

Millions of people are simply not tuned in to thinking about health as something that is, to a significant extent, within the control of the individual. In a major study in Wales in 1982 the researchers did in-depth interviews with forty-one women to find out what their views were about the causation of diseases and who was ‘responsible’ for illness. When asked for the main reasons for illness the top five categories the women gave were all essentially outside their individual control and included environmental factors such as: the weather; heredity; individual susceptibility; germs, bugs and infections; and stress and worry. Most of the women were clearly thinking about short-term illness. (Indeed most People do think like this when asked to think about disease.) They put low down on the list causes such as diet, hygiene, and ‘way of life’. When questioned about individual behaviour they stressed the importance of being ‘run down’ and thus vulnerable to illness. Illness was something that attacked from outside, and people who ate well, exercised and didn’t abuse their bodies were in a much better position to ‘fight off germs effectively. For many, this was the extent of the link between their behaviour and resistance to illness.

Because it became evident that some of the women felt guilty for having allowed themselves to become ill the researchers looked at their willingness to accept blame for their illness. The researchers found that readiness to accept blame varied with the emphasis placed on the role of the individual behaviour in the theory of illness causation. The women fell into two main groups on the subject of blame. The first thought that one could be blamed if one didn’t go to the doctor or delayed too long, and the second group thought that blame was reasonable if one put oneself into dangerous or risky situations through carelessness, stupidity or lack of forethought.

Perhaps the most interesting finding of the study was on responsibility. A ‘responsible individual’ according to the Department of Health is one who ‘avails himself of the various preventive and screening measures offered by the health services; leads a healthy life and doesn’t bother his or her doctor unnecessarily with trivia’. The reader will have noticed that this definition is all from the service-provider’s point of view-the consumer’s point of view is almost totally ignored. So failure to act responsibly is the patient’s fault; is the result of his or her ignorance, personality shortcomings, or whatever. The authors of the study point out how strange it is that so great an emphasis is generally put on encouraging people to lead a healthier life when they by and large (according to this research) perceive germs and other outside factors to be the cause of their illness. Because germs can affect anyone and presumably are not malicious, such people argue, the sufferer is by definition blameless. Another researcher in this field claims that the amount of personal responsibility people feel for their illness has declined (certainly for colds and chills), and thinks illness has become more social.

An interesting finding from the original study was that even those women who said that they thought lifestyle was the main cause of illness stressed the germ theory of illness when talking to their children about disease. Very few made any link between behaviour and illness to their children and not one used the opportunity to discuss the implications for health of different lifestyles. In another study of students asked about ‘communicating their last illness to a five-year-old’ it was found that very few accepted moral responsibility for the illness-a situation that has changed dramatically over the years. An earlier study had found that ‘nearly every level from getting sick to recovery was a moral battle ground’.

One of the problems with the Department of Health’s definition of a responsible individual quoted above is that it assumes that everyone has the ability and the resources to make the changes necessary to ensure a healthier life. This simply is not so. One study of family life in an urban setting found that there was very little in the way of perceived flexibility associated with the events of the working day and that there were also very high levels of routine. The researcher found that for the average working-class inner London family routine was strict and choice-less. People in this study described about 70 per cent of their day (excluding sleep) as routine and over 90 per cent as characterized by the absence of any real choice.

The Welsh study detailed above proves what many of us with experience in health education had already realized from bitter experience- that a substantial sector of society is resistant to change partly because the people in it do not share the authorities’ view of personal responsibility for health. It is also clear that, attitudes apart, a certain sector of society lives in socio-economic circumstances that make the adoption of suggested healthier lifestyles impractical or irrelevant. Remember that in Ancient Greece, with all its lofty ideals of holistic health, only the most privileged section of society could afford to subscribe to them.

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