Young people's attitudes toward medicines
01 August 2018
This is an edited version of a Monash University assignment for Anthropology of Health from 26 March 2017
Today, many non-prescription medicines are available and in full view at supermarkets. Hence, children and teenagers are readily exposed to this kind of open medication smorgasbord during a routine shopping experience. The impact such normalisation of medication has, and the claim that society as a whole is becoming increasingly ‘pharmaceuticalised’ (Abraham, 2010), has been studied in various forms. However, not many studies have looked at young people’s attitudes towards medicines (Thomas, 2016:157).
This paper represents a critical review of Felicity Thomas’ article “Young people’s use of medicines: Pharmaceuticalised governance and illness management within household and school settings”. With the aim of identifying ways of avoiding adverse health and environmental outcomes, the researcher sets out to understand how societal factors influence the behaviours and attitudes in young people towards illness management.
The article begins by giving an overview of what is known from previous studies, such as reports of “surprisingly high use of medication amongst young people to treat common ailments such as colds and low-level infections and to help ‘normalize’ or augment their bodies” (p151). Thomas draws on current research and literature to scaffold her argument that “policy makers would do well to consider how everyday settings such as homes and schools can be used as key intervention points to both address misuse [of medicines], and foster positive and sustainable medicine-related attitudes and behaviours” (p157).
In order to build on these previous findings, and to test her hypothesis that the frequent exposure many young people now have to a wide range of medicines affects the way in which attitudes become embedded, Thomas performs fieldwork at a secondary school in the South West of England.
Data-generating methodology involved a series of vignettes (fictional young people making decisions over medicine) was used to drive discussions within focus groups, consisting of fifty 11-12 year-old students (24 female, 26 male) and ten parents (9 female, 1 male). Additionally, individual interviews were conducted with forty-three (21 female, 22 male) students who had taken part in the focus groups. I believe this approach of presenting fictional scenarios, rather than openly discussing personal experiences, is an effective way to elicit discussion among young people, particularly adolescents.
Often, adolescents strongly believe that “no other person can have a clear understanding of how a young person feels” (Christie, 2005:303). Fictional scenarios therefore act like a buffer through which they can safely voice their personal opinion without making it implicitly about themselves. I claim it is important to treat young people with respect, be patient and essentially treat them as capable social actors – subjects rather than objects - by letting their interests feature fully in the interviews. Borrowing from Gabe et al. (2002:1622), “in these ways it is hoped to attenuate the interviewer’s authority as an adult.”
In an effort to discover an answer to her research question, I assert Thomas uses the sociological perspectives of ‘symbolic interactionist’ and ‘social constructionist’ – being both ‘interpretive approaches’ within sociology (Crinson, 2007). Rather than merely looking at ‘what’ the behaviours are - for instance increased medicine use and misuse of prescribed medicines – Thomas looks through an interpretive lens to establish ‘why’ these behaviours ensue. She looks at the relationship of two things: what it means to be healthy or ill for the individual and their social construction of reality, and the societal forces that shape those meanings.
So, what does the concept of health mean to young people in South West England? It means that taking medicine is a normal part of everyday life, going to school or work whilst being a little bit ill is normal and modelled by parents, and some health issues are socially acceptable whereas some are taboo. If you are ill, on the other hand, it means you are weak, different, at risk of being socially rejected or ostracised, and the continuity of your identity is interrupted.
The societal forces that shape those meanings include: socio-economic status (the study showing more open discussions about medicine occurring in lower socio-economic climates, p155); gendering of certain medicines and illnesses (for example sports injuries are seen as ‘cool’ for boys as it authenticates masculinity; girls hide menstruation pain medication due to risk of social rejection); presenteeism and pressures to perform; social stigma; socio-cultural concepts what it means to be a child (too much autonomy over medicine use is discouraged due the associated health risk); commoditisation and ease of medicine availability welcomed by busy working mothers; current biomedical paradigm shift to self-surveillance and ‘e-scaped medicine’ (Davis, 2017) resulting in self-medication; and intergenerational influences on medicine-related attitudes and practices (witnessing medicine use of parents and other adults embeds attitudes in children).
The way Thomas reached a deep understanding of the above issues is by performing ‘qualitative research’, within which the interview is a ‘meaning-making partnership’, a ‘knowledge-producing dialogue’ (Hesse-Biber & Leavy in Clair & Wasserman, 2007). Qualitative methods require interpretivist notions of reality (Clair & Wasserman, 2007), where reality is a human construction, thus, it can vary from culture to culture, or even person to person. “The sine qua non of interpretivism is a commitment to seeing the world from the point of view of the actor” (Clair & Wasserman, 2007).
Thomas’ data confirms findings from previous studies regarding young people’s attitudes towards medicines. However, I argue that there are aspects of this study that lack depth and diversity. Fieldwork was only performed in one school in one socio-economic area, with only fifty students. Out of ten parents only one parent was male, resulting in highly gendered data. Although the article shows the “complex interaction of both structural and agential factors in the governance of medication practices” (p157), I contend it would not be entirely convincing to policy makers seeking to address the challenge of medicine misuse.
Completing this review has enhanced my understanding of health sociology in a number of ways. The way individuals construct their concept of health is not one-dimensional. It is greatly influenced by the societal forces around them, which can change over time. What I found most illuminating in this article is the concept surrounding presenteeism - essentially meaning continuing work while sick. Whereas in the beginning I believed the commoditisation of medicines to be main contributor of increased medicine use, I have now come to an alternative understanding.
Even though medicines are normalised, I argue, it is not the medicines that children register at the supermarket. Although unsubstantiated by empirical evidence, my experience with my own children (9 year-old and 11 year-old) and after consulting other mothers, I argue that children know things like the toy aisle and the aisles containing sugar and artificial additives-loaded goods – whereas they are oblivious to where medicines are located. Perhaps it is a ‘viscous cycle’: starting with the consumption of these foods (and other foods containing inflammation-causing substances like gluten), may contribute to children (and adults) getting illnesses such as headaches, stomach upsets, lowered immunity and increased susceptibility to viruses, which is then passed onto fellow students and co-workers due to presenteeism, which in turn necessitates a higher intake of medicines.
In a US study, Schultz et al. (2009:374) identified presenteeism as a major problem due to its association with many health conditions. Although it is difficult to translate into definitive values, Schultz et al. (2009:368) estimate that, for example, the cost attributed to presenteeism is 19% for heart disease and 89% for migraine headaches. In a Swedish study (Aronsson, Gustafsson & Dallner, 2000), presenteeism was blamed for musculo-skeletal pain, fatigue and slight depression. The study also found that “people with children at home show higher presenteeism than those without children” (ibid:505) as well as evidence of “significant associations between mental exhaustion and susceptibility to the common cold” (ibid:509).
Seeing presenteeism represents a significant socio-economic problem, perhaps research into the reasons why young people get sick in the first place is needed in order to avoid adverse health outcomes, more so than why they take medicines.
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