Mirage of Health in the Era of Biomedicalization: Evaluating Change in the Threshold of Illness, 1972–1996

Pooling National Health Interview Survey 1972–1996 data, this study examines whether the threshold of health is rising, such that individuals are more likely to report poor health based on weaker symptoms. The results suggest that those with some form of disability report poor health more often today than they did in the past. Yet the results also reveal a pattern more complex than a simple rising-threshold story. For one, the results suggest a non-linear trend: the conditional reporting of poor health grew steadily until 1983, as expected, but declined thereafter. The results also point to mechanisms not regularly considered in the current debate. Much of the increase, such as it is, has been due to trends in educational attainment, rather than changes in the organization or practice of medicine. Meanwhile, the post-1983 deceleration and reversal has been due, in large part, to population aging. Implications are discussed with respect to the centrality of education in shaping the meaning of and demand for health, as well as the double-edged nature of contemporary medicalization.