PREVENTION: HEALTH AND ILLNESS BEHAVIOUR

‘Illness behaviour’ is the term used to describe the way we respond to abnormal body signs and symptoms. Obviously this involves concepts such as how a particular person monitors his or her body and its functions, defines or interprets his or her symptoms, takes action and uses the health-care system.

‘Health behaviour’, in contrast, refers to patterns of response to health, when the person has no specific symptoms. This is an especially useful concept when thinking about prevention because a lot of prevention is done by an individual who is well at the time. Examples of such activities are regular medical and dental check-ups, screening and soon. A lot of research has been done on people’s views and beliefs in this area but the best is the Health Belief Model, which looks at the way an individual assesses the likelihood of a problem having serious consequences. It is really a sort of psychological cost-benefit analysis in which people do things according to how important they consider the consequences of not doing them. So it is that we weigh up the advantages and disadvantages of factors as different as wearing a seat-belt, exercise, nutrition, medical check-ups, clinical examinations, careful driving, sanitation and personal hygiene. According to the effect we perceive each factor as having on our lives (for good or bad) we make decisions about how to maintain our health.

Unfortunately, doctors and their patients tend to see health and illness rather differently Doctors are trained to identify illnesses and to treat them as individual entities, whereas their patients see health as a more global matter which governs their overall sense of well-being. Symptoms and other frank signs of illness are seen by patients in the context of how they interfere with the business of living. In other words, illness to most people has a lot to do with feelings.

Many studies show how people’s feelings influence their sense of physical well-being. People who complain of poor physical health are often depressed, feel neglected, have a low morale, feel alienated and are less satisfied with life than those not reporting poor physical health. Also, it is clear from many studies that psychological ill health and distress lead to a very much greater use of all kinds of health services. So psychological factors influence not only people’s views of their health but also how much they actually use health services.

The way we react to illness varies considerably with our personality type and from culture to culture. Some people are stoical in the face of illness, others matter-of-fact, and yet others hypochondriacal. Some people go straight to the doctor with the most minor of symptoms and others are reluctant to trouble him or her with even quite severe problems. The same person over quite a short time-span can react and behave in very different ways. Most studies of illness show that women go to doctors more readily and more frequently than do men. Just why this should be is not known. Perhaps there are real sex differences in many diseases (i.e. they are in fact more common in women); or women may have a lower threshold of tolerance to symptoms; they may be more likely to accept a symptom and seek help for it; they may be more interested in health; they may be more concerned that they keep well because of the considerable pressures on them to run and maintain family and home life; or they may be culturally conditioned to running (in a little-girl-like way) to an authority figure to sort out problems quickly. Whatever the reason-and it might be that none of these is correct-the difference is apparent very early. Studies have found that young “girls use child-driven school health-care systems more than do young boys. Wherever the truth lies, repeated research has shown that much of the disability associated with physical and mental illness is not the result of illness itself but rather the way the person responds to the condition and the way it is managed. For example, a lot of the aggressive behaviour previously seen with schizophrenia has been shown to be a result of the way that schizophrenics were dealt with by the authorities rather than as a part of the disease itself.

There are quite dramatic social and cultural differences in the way individuals and groups define illness and respond to it. Studies carried out in the US have shown that Jewish and Italian patients, for example, have been found to respond to pain in an emotional way-tending to make much of it-whilst the English and ‘Old Americans’ are more stoical and clear-headed about it. Irish patients more frequently deny pain. Whilst Jews and Italians appear to react similarly to pain, their underlying cultures are different. Italian patients seek relief from pain and seem satisfied when the pain is relieved, but Jewish patients seem to be more concerned about the significance of the pain for their future health. So pain relief may be what Italians need most but reassurance about the future may be what is most needed by Jews. Clearly this kind of information is essential if one is to plan any kind of preventive health programme.

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