Elizabeth B. Pearce and Amy Huskey

“It is health that is real wealth and not pieces of gold and silver.”

— Mahatma Gandhi

Health is the “state of complete physical, mental and social well-being and not merely the absence of disease or infirmity,” as defined by the World Health Organization (WHO) (2005) in its Constitution. The organization goes on to state that families and communities are able to thrive when individuals are able to maintain health. Our employment, finances, mental and emotional functioning, and spiritual lives all interact with our overall health.

While the status of health is very real, it is also important to examine the aspects of health and illness that are socially constructed. As members of society, we share assumptions about reality that define both health and illness. Illness has a biological component, yet it also embodies an independent element that is experienced by the person and observed by those outside of the illness. Societies construct the idea of “health” differently from place to place, and over time. For example, many societies consider health and health care to be a human right that all human beings are entitled to, but this is not universally true (Figure 7.1). What is your viewpoint?

The social construction of the idea of family, as discussed in Chapter 1, plays a special role in the health of families in the United States. In all other industrialized countries, health care is considered a human right, and all individuals can access comparable care regardless of family status. But in the U.S., health care insurance is accessed through a variety of systems, all of which have age, income, employment status, and family relationships as criteria. How do definitions of “family” impact the access of any individual to health care?

Figure 7.1. Activists around the world continue to strive for universal access to health care.

Society informs the definitions for when an illness can be considered a disability, how eligibility for insurance and medical coverage are determined, what illnesses are perceived as legitimate, when the reality of an illness is questioned, and what illnesses are stigmatized (Griffiths & Keirns, 2015). These social constructs can, in themselves, contribute to differentiation in individual health as well as stereotypes, prejudice, and discrimination. Stigma, the social process whereby individuals that are taken to be different in some way are rejected by the greater society in which they live based on that difference, operates in the world of health, ability, and illness. Sociologist Erving Goffman said, “Stigma is a process by which the reaction of others spoils normal identity.” A disease or illness that is stigmatized is one in which there is some societal disapproval or questioning of the integrity of people who have the disease, which can also include medical professionals and the person with the disease stigmatizing themselves (Figure 7.2).

Figure 7. 2. Stigma – Social and self | Individuals and Society | MCAT | Khan Academy [YouTube Video]. The Khan Academy Medicine channel describes the interrelationship among stigma, self, and society in this 7-minute video.

There are many socially stigmatized diseases which can include mental disorders, HIV/AIDS and other sexually transmitted diseases, substance abuse disorders, skin conditions, and diseases that are less understood by the medical community, such as auto-immune disorders and chronic fatigue syndrome. Individuals may be less likely to seek treatment when experiencing symptoms of a stigmatized condition. In the United States, where health insurance creates another layer of bureaucracy, less understood illnesses and treatments may not be covered by some insurance.

Even if a person with a stigmatized disease accesses health care, they may have fewer social supports and greater chances of isolation and discrimination in the health care setting and beyond. Management of a disability because of the deterioration of health due to a stigmatized illness can prove to be a tremendous hardship (Sartorius, 2007). It is important to consider how marginalized groups experience health inequities, including those experienced due to the stigma and prejudices linked with the societal perception of specific illnesses.

One’s status in society, or structural power, can complicate the experience of social stigma related to medical conditions. For example, cisgender men hold more power in the United States than women or people outside the gender binary. What role does that play in the diagnosis of real health concerns and the social construction of those concerns?

We know that overwhelmingly men are the subjects of the majority of medical studies and research. That affects what is thought of as “typical” or “normal.” Women have more often been told that their symptoms are “all in your head” or related to “female troubles.” While this is less common than in the past, it likely continues to play a part in the misdiagnosis of serious illness in women and people with nonbinary gender identities. We also know that women experience diseases such as myalgic encephalomyelitis/chronic fatigue syndrome and fibromyalgia in much higher numbers than do men. The medical community describes these syndromes in overly broad terms that make diagnosis difficult. We must ask ourselves, how do these multiple complex factors serve to continue to reinforce the existing power dynamic in the United States? What systemic changes in healthcare would reduce this inequity?

In this chapter, we will examine the overall health of families in the United States, with attention to comparisons among families’ experiences with health, illness, injury, and diseases as well as comparisons with other countries. We will describe the daily life factors and resources that affect health, including the effects of stigma, prejudice and discrimination. We will look closely at how families access health care services, including the health care insurance system. We will discuss the question of health care as a human right.

Understanding intersectionality and stigma provides a way of analyzing how intersectionality can be illustrated through the lens of the social construction of illness. The LGBTQ+ community, for instance, already faces challenges in finding health care providers who are culturally competent and have adequate knowledge in LGBTQ+ health (U.S. Dept. of Health and Human Services, n.d.). If you couple this with the stigma related to a lung cancer diagnosis, then you are compounding the obstacles that stand in the way of receiving quality health care. One could also examine how socioeconomic status may further complicate this scenario by realizing that people living in poverty are more likely to have no health insurance, therefore restricting access even more (U.S. Census Bureau, 2019). Even geographical location, like living in a rural area, or in the Southern portion of the United States, will reduce accessibility to healthcare (Warshaw, 2017). Every time an individual is grouped into a marginalized group, including illness status, it intensifies the effects of discrimination and resulting health disparities.

7.2.3 References

World Health Organization. (2005, September 15). Constitution. Retrieved December 30, 2019, from https://www.who.int/about/who-we-are/constitution

OpenStax. (2015, April 24). Introduction to Sociology 2e. Retrieved March 8, 2020, from https://openstax.org/books/introduction-sociology-2e/pages/19-1-the-social-construction-of-health

Sartorius, N. (2007). Stigmatized illnesses and health care. Croatian Medical Journal, 48(3), 396–397.

American Cancer Society. (2020, January 8). Lung cancer statistics: How common is lung cancer. https://www.cancer.org/cancer/lung-cancer/about/key-statistics.htm

Kamath, S. D., Kircher, S. M., & Benson, A. B. (2019). Comparison of cancer burden and nonprofit organization funding reveals disparities in funding across cancer types. Journal of the National Comprehensive Cancer Network, 17(7), 849–854. https://doi.org/10.6004/jnccn.2018.7280

American Lung Association. (2014, April). Addressing the stigma of lung cancer. Retrieved March 8, 2020, from U.S. Dept. of Health and Human Services. (n.d.) https://www.lung.org/lung-health-diseases/lung-disease-lookup/lung-cancer/living-with-lung-cancer/how-to-talk-about-your-cancer/addressing-lung-cancer-stigma

Lesbian, gay, bisexual, and transgender health. Healthy People 2020. Retrieved March 8, 2020, from https://www.healthypeople.gov/2020/topics-objectives/topic/lesbian-gay-bisexual-and-transgender-health#31

U.S. Census Bureau. (2019, May 23). Who are the uninsured? Retrieved March 8, 2020, from https://www.census.gov/library/stories/2018/09/who-are-the-uninsured.html

Warshaw, R. (2017, October 31). Health Disparities Affect Millions in Rural U.S. Communities. Retrieved March 8, 2020, from https://www.aamc.org/news-insights/health-disparities-affect-millions-rural-us-communities