rank seventeenth in life expectancy, and twenty-first in infant
mortality (United Nations, 2005).
In fact, when comparing wealthy countries, there is con-
siderable variation in the levels of health achieved. To look at
the amount of money spent on health care, one would think
the United States is the healthiest country in the industrialized
world. Today, U.S. health expenditures equal $6,102 per per-
son per year, while Japan spends just $2,249 (in U.S. dollars).
Australia spends $3,120. Yet life expectancy in Japan is the
highest in the ten most industrialized countries of the world,
and life expectancy in the United States is lowest of all these
countries. Australia, eighth in spending, enjoys the third high-
est life expectancy of the top ten countries. Canada spends
$3,165 per capita, yet the average Canadian’s life expectancy
is also more than two years longer than the average Ameri-
can’s. Moreover, on many measures of health care quality, the
United States ranks at the bottom when compared with other
developed countries, including Canada, Britain, and Australia
(Table 16.3).
Sickness and Stigma
Our experience of illness may be individual, but the way we
understand our illness and the way we act are deeply socially
patterned. In a still relevant formulation, sociologist Talcott
Parsons (1951) described what he called the sick roleto
describe not how we “get” sick, but how we learn to “be” sick.
The Sick Role.According to Parsons, the individual is not
responsible for being sick. Getting sick is not a moral failure; the origins of illness
are seen as coming from outside the individual’s control. As a result, the sick
individual is entitled to certain privileges, including a withdrawal from normal
responsibilities, and to expect others to exhibit compassion and sympathy, often in
the form of caretaking behaviors. However, such rights and privileges of the ill are
not indefinite; they are temporary. The sick person must actively make an effort to
get better, by seeing a doctor, taking medication, and doing whatever therapies a
medical expert prescribes (Parsons, 1951).
Other sociologists refined the idea of the sick role. Elliot Freidson specified three
different types of sick roles (Freidson, 1970):
■The most typical is the conditionalsick role. This concerns individuals who are
suffering from an illness from which they will recover. As long as the sick person
plays his or her part (tries to get better), then other aspects of the role (relief from
work or family obligations, expectation of compassion) will be forthcoming.
■Theunconditionally legitimatesick role concerns those people who have either
long-term or incurable illnesses, such as certain forms of cancer, and who are
unable to get better by their own behavior. They are therefore entitled to occupy
the sick role for as long as they are ill with no moral disapproval.
■Finally, there is the illegitimatesick role. This may concern those people who do
nothing to improve their situation or people who are believed to be ill because
of something they themselves did. Those who suffer from sexually transmitted
diseases (STDs) may be seen by some as bringing the disease on themselves and
therefore are not entitled to play the sick role. Initially, those suffering fromHEALTHY BODIES, SICK BODIES 537JGlobally, health varies with
wealth: the poorer the country,
the poorer its citizens’ health.
This girl in Mauritania holds a
bowl of water from the village
well, its only source of drink-
ing water. In the developing
world, the major cause of
death is infectious disease,
many of which are transmitted
by unclean water.