Lianne Appleing
Discuss the way in which explanations for disease are culturally defined. Assess the impact of key health care reforms in Britain during the second half of the 20th century.
There is no single agreed definition of “health”; it is a word that is essentially contested. The various definitions of “health” and “disease” are socially constructed and differ also from person to person within a society. As a result of the differing definitions, three main theories of health and illness have been constructed and studied. These are the Personalistic Theory, the Naturalistic Theory and the Biomedical Model. Treatment available to individuals in Britain today is based on the Biomedical Model and supplied by the National Health Trusts. The health care received by people in Britain to date is based on the socially constructed ideas of the government in power when the NHS was founded in 1948. The NHS has evolved with government changes, and many people now see the provision of health care as a form of social control.
The Personalistic Theory is similar to other theories of disease in that it is socially constructed. The followers of this theory believe that magic, religion or supernatural beings and occurrences have great influence over them throughout the course of their lives. This theory is what they have based their ideas of health and illness on. Illness is seen by followers of this theory to be a form of punishment as a result of wrongdoing, for example the person in question may not have lived their life as they were supposed to. Treatment of illnesses for people in a society where the Personalistic Theory is actively followed will usually be in the form of spiritual healers such as witch doctors, priests and shamans.
Eastern societies such as the Chinese and Indians believe strongly in the idea of equilibrium between the various elements of the body; one of the concepts involved in this Naturalistic Theory is “Yin and Yang”; “Yin” representing everything that is cold, damp and dark and “Yang” representing that which is warm and light. Followers of the Naturalistic Theory therefore believe that disease is a result of the two being thrown out of balance, and that once the equilibrium is regained, the health of the body will return to normal. Traditional remedies such as herbs are often used to achieve this balance.
The Biomedical Model is another theory of health and disease, created by Westernized societies such as Great Britain. Western societies generally believe that nearly all problems can be solved; this includes problems such as disease. The Biomedical Model takes the view that the body is nothing more than a machine and that when it goes wrong, i.e. during periods of disease and ill health, it can be fixed. This way of thinking is possible partly due to disease ceasing to be seen as spiritual and instead physical; it is also partly down to the introduction of professional bodies, which are used as a form of social control (i.e. hospitals). This theory has more recently been criticized, however, as the followers of the theory, particularly those deemed “medical professionals”, have seemed reluctant to accept that the lifestyle of an individual may also be responsible for disease and not simply a bacteria.
On 5th July 1948, the National Health Service (NHS) was founded. It originally consisted of fourteen regional hospital boards under the management of one central governing body; the Local Authorities were made responsible for community care. The NHS was established to provide the country with “a comprehensive health service designed to secure improvements in the physical and mental health of the people of England and Wales and the prevention, diagnosis and treatment of illness.” (Senior, ’98, p56). There were three main aims: to reduce inequality in the availability of healthcare, give General Practitioners independence and to provide one central service.
This new healthcare system experienced problems from the offset and many reforms have occurred since its beginnings. The originally high cost of providing the service was expected to
fall as the nation became healthier as a whole, however what had not been predicted was that the costs would increase steadily due to medical advancements in areas such as drug treatment and technology and increased public demand and expectation. The nation was also living longer due to the lower mortality rates.
1952 saw the introduction of small charges for prescriptions and basic dental work such as check ups and fillings as a result of these unforeseen rising costs. Money was taken from Income Tax rather than National Insurance to cope with the increasing need for finance for the NHS. Beds for tuberculosis were closed to release cash elsewhere, for example to finance the rising need for new medical advancements. Even though the NHS was beginning to be seen as cost inefficient, its introduction had, to an extent, produced the desired result of equality in the provision of healthcare.
The Conservative Party came to power in 1979. They viewed the NHS as an inefficient bureaucracy and believed that people were relying too heavily on welfare and not taking care of themselves. Reforms were introduced by the Government to increase cost efficiency, improve healthcare services and raise general standards of health. The NHS was split into several independent National Health Trusts and business-like managerial hierarchies were introduced.
Competition between ancillary services and also between the private and state healthcare providers was encouraged, in the hope that this would reduce costs also.
The Government reforms worked, in that more money was freed up to put back into patient care: a 1987 Government manifesto stated that: “The NHS could not function without ancillary services…. Savings are now approaching £100 million a year and they have gone directly and immediately into better patient care.” (www.conservative-party.net). However, due to the new, business-like structure of the NHS, a lot of money was also diverted to rising administrative costs. Inequality arose once again with the implementation of GP funding, as some patients obtained access to resources quicker than others.
Great Britain believes in the Biomedical Model theory of disease; this has resulted in the implementation of the NHS, a service primarily concerned with the treatment and cure of illness, as opposed to its prevention. NHS reforms have seen attempts to create and retain equality in the healthcare sectors and Government reforms have attempted to improve cost-efficiency and standards of healthcare. Despite these reforms, the target of equality in the provision of healthcare has not yet been met and although the population now has access to more advanced medical treatment, the continuous lack of funding continues to present problems.
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