Chapter 17. Health as subject matter in sociology of medicine
17.1. Health as scientific concept
Science and the centuries-old healing practice accumulated numerous, convincing, and indisputable data on the nature of human being, the essence of diseases, and the parameters of health. Moreover, they learned how to diagnosticate and treat the diseases, including those that had been recently considered as incurable. However, the conceptual problem of health and its conditionality is still urgent and actual. Specifically, the disputable questions are what the health is and which factors affect the healthy state of a human being. The unresolved character of these questions cannot but affect the lifestyle of modern people, family life, and the whole society.
The study of vital problems on the nature of health can be fruitful only due to the consorted efforts of professionals from various fields of knowledge presenting the natural and social sciences. A rather wide circle of philosophical and specific scientific disciplines examine and generalize the problems of health and disease.
Philosophers examine the phenomena of health and disease in order to clarify the boundaries of human freedom and the sphere of personal choice of a certain type of human existence. Here, the ‘health’ is viewed as a form of actualization of the bodily potencies that provides the maximum possibilities for self-actualization (self-realization) of human being. From philosophical viewpoint, the personal attitude to health is ‘inalienable responsibility for self-being’. The health was examined as the object of philosophical and sociological study in the works of I.I. Brekhman, (1982), V.P. Kaznacheev (1996), Yu.P. Lisitsyn and A.V. Sakhno (1998), L.G. Matros (1992), P.D. Tishchenko (1986), G.I. Tsaregorodtsev and S.Ya. Chilin (1992), and B.G. Yudin (2001).
Medical demography examines health with particular emphasis on the state, dynamics, and structure of population. This science had been formed as the interface between theoretical medicine, social hygiene, and demography. Some authors refer to the medical demography as ‘demography of health’ (Bednyi, 1984).
Sociology of medicine examines the state of public health and organization of medical aid in dependence on the socioeconomic factors. It considers medicine as a social institution and a subsystem of the overall social system widely employing the sociological aspects in such analysis. It is important that sociology of medicine focuses on regularities in the formation of the value system and attitudes towards health, disease, medical service, medicine, and the healthcare system in various strata of population.
The problem of adequate selection of the indices of health and the attitude to the health at the level of individuals, social groups, and the whole society was analyzed in the works of A.I. Antonov (1998), N.L. Rusinova and J. Brown (1997), A.E. Ivanova (1996), A.Ya. Ivanyushkin (1982), E.N. Kudryavtseva (1989), T.M. Maksimova (2002), I.B. Nazarova (1998), and N.M. Rimashevskaya (2003).
Various facets of social politics in the sphere of health and the healthcare system were studied in the works of I.A. Grigorjeva (1998), V.I. Kashin (2003), L.V. Konstantinova (2005), A.E. Chirikova and S. V. Shishlina (2004), V.N. Yarskaya (2003), and other researchers.
The study of health and its conditional factors is necessary in order to create the complex system to control the state of health via tuning the socioeconomic parameters of the lifestyle.
The concept of ‘health’ belongs to such definitions, whose content is persistently modified. This process is mostly determined by 1) the progress in science, which yields more and more clear and fine definitions of the norm; 2) the development of society, which changes the environmental medium of human life and enhances the standards of human health; and 3) cultural evolution, which affects the formation of novel value attitudes to the health. In addition, a certain difficulty in this problem results from the fact that there is no health conception of some ‘standard’ human being. Instead, there are numerous ‘healthy states’ of men and women, children and elderly persons with their intrinsic and different lifestyles and social functions. It is also to be remembered that the requirements to the adaptive and functional capacities greatly differ among the people living in various geographic and climatic areas. Finally, there are evidently various types of health such as the health inherited from the robust parents and the health gained by initially sickly child due to persistent realization of the norms and requirements of the healthy lifestyle.
The problem of definition of the ‘health’ concept is of key importance, because it shapes the further stages of its study including elaboration of the specific health indices and integrative health indicators, selection of the methods to assess health, examination of the health-affecting factors and their manifestations, etc.
The notion ‘health’ originates from the Anglo-Saxon word ‘whole’ (integrate and safe), which is virtually the semantic definition of this term. The attempts to advance the generalized definition of ‘health’ originate from the ancient times. Thus, Ionian Greek philosopher, mathematician, and physician Pythagoras of Samos considered that ‘health is harmony and balance, while disease means disturbance of this harmony. The moral health is drive for good.’ At present, the number of definitions of ‘health’ is more than three hundreds, and each of them reflects the individual preferences of the authors. In an attempt to rank them, one should isolate a group of definitions based on 1) functional and activity-related approach, and 2) the harmony principle in the consistent performance of all organismic systems at various levels of their interaction with environmental medium and adaptation of the whole organism to the external conditions.