Changing patterns of concern in medicine and health care have interacted with philosophic trends in social sciences and politics to create demands for new directions in the measurement of health. Traditional indicators such as morbidity and mortality are seen to require supplementation by more subjective assessments of need. The addition of subjective data, collected in a standardized way could enable those concerned to delineate more closely the needs and problems of the community.

The practical development of a subjective health indicator is described. The ultimate objective is to produce an instrument which can be used as a population survey tool, where the information obtained could add a new dimension to traditional indices of health. Studies carried out over the past four years have led to the construction of an indicator in the form of a profile which has been shown to provide valid measures of perceived health status and to be acceptable to respondents.

https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1467-9566.1980.tb00213.x

The development of a subjective health indicator

This study looks at the impact of a corrections environment upon prisoners through a process of monitoring inmate attendance at sick call clinic. Contrasting cell block designs and characteristics are compared on the basis of significant differential demands for health care services emanating from specific areas. Known psychological and physiological responses to situations perceived to be threatening provide the theory that health behavior may be used as one indirect measure of environmentally induced stress. Findings suggest there are architectural design features of the prison environment that provide basis of perceived threats to inmate safety and survival. Loss of privacy on several dimensions appears to be a critical environmental characteristic. Research has established that abnormally high utilization of health care services occurs in total institutions. This raises several questions. Do people who find themselves in total institutions have characteristics which are predominantly unique to their population but at variance from the general population? If so, would such variation influence the differences in utilization of health care? Are there common characteristics of total institution environments that would cause the high rates of health care utilization? Studies of Navy ship crews by Doll et al., 1969 [1] ; Gunderson et al., 1970 [2] ; and a prison study by Andrew Twaddle, 1976 [3], revealed health care utilization patterns which were similar to each other. Here two different total institutions with different subject profiles produced similar patterns. This suggests the possibility that characteristics of total institutions are causal rather than characteristics of the subjects.

A Prison Environment's Effect on Health Care Service Demands

Patients, Physicians, and Illness

The family as a basic unit in health and medical care: A social-behavioral overview

Although Western medicine has often been characterized, and criticized, as dualistic and reductionistic, contemporary biomedical physicians are largely unconcerned with the metaphysical “world-knot” of the mind-body problem. Science seems to be slowly untangling this knot, offering a multitude of empirical correspondances between physiology and behaviour that constrain philosophical speculation. Modern biology explains mindful action as an emergent property of the hierarchical organization of the nervous system. A more sophisticated version of this materialism recognizes that mind and consciousness are not simply functions of the isolated nervous system but can be better understood as emergent properties of social systems, that is, of interactions between many individual organisms (Bateson 1979; Harre 1984). However, biology leaves unexplored an aspect of the mind-body problem that is essentially ethical. This residual mind-body problem occurs because mind and body symbolize contrasting poles in human experience: the voluntary or intentional and the involuntary or accidental. It is because the contrast between willful action and impersonal accident is central to both the private sense of self and the public concept of the person that mind-body dualism persists in Western thinking about morally significant events like sickness and disability.

Mind and Body as Metaphors: Hidden Values in Biomedicine

Case interviews are used to explore variations in illness behavior and Parsons' sick role formulation. A decision-making model, focusing on the influence of status and role definers (significant others), produced findings relative to the nature of being "well", assignment of a "sick status", and illness behavior. While Parsons' formulation describes modal categories when each component is taken alone, his total configuration describes only a minority of responses. Seven sick role configurations are identified. In addition to interpersonal influence, the nature of "well roles" and the nature and severity of the illness are important variables for the study of illness behavior.

Health decisions and sick role variations: an exploration.

Utilization of medical services by a captive population: an analysis of sick call in a state prison.

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Health decisions and sick role variations: an exploration.

Utilization of medical services by a captive population: an analysis of sick call in a state prison.