Social and psychological problems of surveys on health and illness

Survey methods offer the possibility of obtaining extensive health information on populations, including the identification of people's health status and the nature of their illnesses. The inadequacy of respondent reports concerning ill health conditions, as a substi- tute for medical diagnoses, has been amply demonstrated. Research has identified many factors that contribute to biased or inadequate reporting. The central problem, however, is a con- ceptual one. Data collection techniques must fit the nature of the problem. Many health relevant questions pertain to the psychosocial experience of health and illness; survey methods are often appropriate for such questions. WITH the popularity of health surveys, and their promise to provide health professionals with information on the health status of populations, a series of questions have been raised concerning the usefulness of such data (l-4). This paper will examine the objectives of sample surveys related to health, the difficulties encountered, remedies proposed to deal with shortcomings, and the central conceptual problem of our approach to health and illness. Survey methods appear to offer a relatively cheap, quick way to obtain large amounts of health-relevant information from any specifiable population. Historically, there appear to be several types of objectives that form the basis for a health survey: 1. Foremost perhaps is the need for basic information on the extent and nature of health problems in a population-we know that many problems are never treated by a physician, that much treatment initiated in response to symptoms is not followed through, and that most medical records are of little value in estimating illness in a group. The rationale behind the National Health Survey referred to the "need for general purpose health information for assessment of national health problems" (5). 2. The administration of health services seems to require knowledge of the people for whom services are to be provided-where are they, what are they like, what they need (6). With the recent emphasis on planning services and on rational decision making in allocating resources, information concerning health needs is in great demand. While health workers may think they know their communities, the fact is they don't. 3. Better understanding of factors related to health problems requires systematic collec- tion of information. There is no question that social and psychological factors are related to the occurrence and progress of diseases, for example, VD or coronary heart disease. Social research in general and survey research in particular seems necessary to identify conditions that contribute to illness and accidents (7). 4. Finally, we want to know what actions people take in response to health problems. Most behavior relative to illness is voluntary or, at least, socially determined. There are both very imperfect records of recommended health behaviors and astonishingly little information on the popular health culture that determines self-medication and lay referral (8). Survey research then has been regarded as an appropriate tool to deal with these kinds