Commentary on 'a Reflexive Account of Reusing Qualitative Data: Beyond Primary/secondary Dualism' (Libby Bishop)

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The causes of disease : Women talking

An analysis is presented of the concept of 'disease' and its causes, held by one group of middle-aged women brought up in poor social circumstances. The diseases which the women talked about, and their ideas of cause, are shown to be the products of a particular medical and social history. The categories of cause which were favoured were infection, heredity and family susceptibility and agents in the environment. The women preferred to reject natural degenerative processes or the idiopathic: inevitability and randomness were both found frightening. It is suggested that the women's models of disease processes (though often factually incorrect) were in principle no different to those of advanced medical science, and no less sophisticated. The most notable features of their talk, however, were the salience of knowing about cause, the strain towards rational explanation and the importance of linking together life events. It is suggested that these are common human traits, which have implications for the interaction between doctors and patients.

Whose fault is it? People's own conceptions of the reasons for health inequalities

How do people themselves think about inequalities in health? The topic has rarely been investigated, and oblique evidence has to be drawn from research on general lay ideas about health and the causes of illness. Data from a large British survey are combined with a review of the extensive body of, more usually, qualitative research on attitudes to health in Western industrialised societies. One tentative conclusion is that social inequality in health is not a topic which is very prominent in lay presentations, and paradoxically this is especially true among those who are most likely to be exposed to disadvantaging environments. Possible explanations are offered in terms of the effects of widespread "health promotion" activities, and the way in which lay theorising incorporates relationships between the group and the individual. The methods used in asking people to talk about health are also relevant: accounts of health and illness are accounts of social identity, and it is unreasonable to expect people to devalue that identity by labelling their own "inequality".inequalities lay attitudes

Health services as a defence against the consequences of poverty in industrialised societies

The purpose of this paper is to offer, as a basis for discussion, a review of the issues involved in a consideration of the role of helth services as a 'defence' against the consequences of poverty. First, some general questions are asked: It is true that industrialised nations have reached a stage of development where health care is irrelevant to health? Is the issue inequality in health, or more narrowly the particular problems of a minority, the 'poor'? Are the causes of disadvantage in health to be seen as behavioural or structural, and if health systems concern themselves with social-structural issues, is this medical imperialism or the proper exercise of responsibility? The role of health services is considered in relation to primary prevention, secondary prevention (or curative medicine) and tertiary prevention (or rehabilitative medicine). It is concluded that (though the impact of any form of universally-available health service must not be minimised) health systems in industrialised societies are not in general successful in mitigating or preventing the health problems of poverty. Some socio-medical policy programmes and some health-care delivery initiatives have, however, produced measurable effects. It is suggested that, while health systems can never wholly compensate for social inequalities in health, 'community' programmes may perhaps most effectively combine the structural and the individual approaches.