6.3 Responsibility for health and illness
In Activity 6 you explored factors which influence people's experience of health and we noted that inequalities in health are clearly related to the conditions of people's lives, such as their housing, income and education. On the other hand, health education messages have tended to focus on behaviour – what we eat or drink or whether we exercise. To muddy the waters still further, research in genetics is telling us more and more that genes predispose us to certain conditions. How do people, whether in a personal or professional capacity, make sense of such a confusing picture, and where does responsibility lie?
Research into the meaning of illness has explored how people perceive the cause of illness and who or what is responsible and therefore to blame for that illness. In her article ‘Why do the victims blame themselves?’ Blaster (1993) reanalysed data from her previous research, the Health and Lifestyles survey of 9,000 people and in-depth, tape-recorded conversations with a group of Scottish women of about 50 years old (1990).
The survey data indicated that, when questions were asked about the cause of specific diseases, overwhelmingly people gave behavioural answers such as lack of exercise or poor eating habits. Behavioural explanations were given for illhealth in the abstract – ‘my life is unhealthy because I can’t control my weight,’ or ‘because I smoke’. Structural factors such as poverty, poor housing or the environment were infrequently mentioned in relation to the respondent's own illhealth or as a cause of specific diseases. They were, however, given more frequently as a cause of illhealth in society at large. Blaxter concludes that:
On the evidence of this one large-scale survey at least, the lessons of public policy and health education – ‘you are responsible for your health’ – have been accepted.
(Blaster, 1993, p. 126)
There is a striking echo here of an observation made 10 years before Blaxter's work by two social researchers reviewing studies on deprivation and welfare in Britain. These authors comment:
... although many of the poor recognise that they are relatively deprived, these feelings are ... largely sealed off from more general or abstract perceptions of society. Some of the poor have come to conclude that poverty does not exist. Many of those who recognise that it exists have come to conclude that it is individually caused, attributed to a mixture of ill luck, indolence, and mismanagement ... In this they share the perceptions of the better-off. Divided, they blame individual behaviour and motivation, and unwittingly lend support to the existing institutional order.
(Townsend and Yeo, 1979, p. 429)
Blaxter's analysis of the qualitative data in many ways confirms this but reveals a great deal of complexity in the way people explain illness. She calls these explanations ‘chains of cause’.
So far in this course we have explored health from many perspectives encompassing wellbeing and quality of life, as well as illness and disease. Although people see health as a multifaceted concept which is more than the absence of disease, the official health agenda has been dominated by an emphasis on eradicating disease and treating illness. In the final section we explore an attempt to refocus attention on a more positive way of viewing health.