Social Stratification and Self-Management of Health

Data from the 1984 Illinois Comparative Health Survey are used to examine whether the poor have adopted a consumer orientation toward professional health services in view of the reduction of financial barriers and clear signs of increased physician utilization. It was found, however, that lower-status persons stand as more or less passive recipients of such services, with a significantly greater tendency to invest responsibility for their own physical health in the health-care delivery system itself. Yet there was a general lack of difference with respect to health lifestyles involving food habits, emphasis on appearance, sports and exercise, smoking, and alcohol use. A culture-of-medicine thesis was found to provide a stronger explanation of this situation than a culture-of-poverty perspective. Medicine and the mass media have promoted the practice of a healthy lifestyle, but have not encouraged consumerism in the physician-patient relationship. Consequently, it appears that where social institutions provide positive sanctions, self-management and consumerism seems to grow for the poor; but where negative sanctions exist, consumerism does not seem to flourish.