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Sociology of Health in the UK. Jonathan Gabe Royal Holloway, University of London (UK). Two roles for sociology of health & illness. Employ a sociological perspective to increase understanding of - experience of health - social distribution of health disorders - PowerPoint PPT Presentation
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Sociology of Health in the UK
Jonathan Gabe
Royal Holloway, University of London (UK)
Two roles for sociology of health & illness
Employ a sociological perspective to increase understanding of
- experience of health - social distribution of health disorders - role of institutions that provide care/cure Use sociology of health & illness to
understand changes in society generally – e.g. consumption and consumerism
Sociology in medicine v sociology of medicine (1)
Sociology in medicine - somewhat accepting of medical categories - trying to satisfy objectives of health care
providers & policy makers - improving effectiveness of practitioners - e.g. evidence of social causes / consequences
of disease - similar to social medicine, health services
research
Sociology in medicine v sociology of medicine (2)
Sociology of medicine Adopts a more critical / analytical
approach Questions categories of biomedicine Questions the power of medicine Employs sociological theory Sometimes delivers critical political
messages (Straus 1957)
Three levels of analysis for IN / OF medicine (Turner 1995)
1. Individual – analyses of perceptions / experiences of health & illness
2. Social – social creation of illness (construction / causation)
3. Societal – health care systems national/global
Individual level
In medicine / health
Health behaviour Lay beliefs Lay referral Compliance Social support and stress / psycho-social perspectives Of Medicine / health
Social construction of disease categories / medical knowledge Narratives of self and identity Sociology of body
Social Level
In medicine/health
Social causes of disease Social epidemiology Evaluation of health care effectiveness Managerial effectiveness and efficiency Health promotion and education Health inequalities
Of medicine/health
Medical dominance / power / inter-professional rivalry Conflict perspective on lay-professional relationship Medicalisation Managerialism as an ideology or discourse
Societal level
In medicine / health
Improving the effectiveness and efficiency of policies and government initiatives Building social capital in the community
Of medicine / health
Relationship of capitalism / globalisation and health care systems Health social movements Social construction of the community via disciplinary surveillance / governmentality
Development of Sociology of Health in the UK
In part a history of 2 sociologies IN Medicine v OF medicine In part a history of the social/political climate in
which it is operating & history of sociology 4 eras1. Immediate post WW22. The break with consensus3. Retrenchment4. Consolidation
1. Immediate post Second World War
Post war re-construction 1945-60 Establishment of welfare state / NHS Sociologists interested in social class, poverty &
community life Social policy analysts – focusing on equitable
distribution & uptake of welfare Social theorists – dominated by Parson & Shils
from the US
Medical sociology post war
Embryonic Concerned with consolidating the health service
– how it operated, inhibitors to equal access Most problems defined by others
- public health interests and medically dominant funding agencies
Curiously incurious about assumptions behind health care
2. The break with consensus
1960s/1970s Time of student unrest, increasing economic & cultural
power of youth Sociology took a more critical turn – influenced by
French & German Marxists & micro sociology from USA Resurgence of feminism and growth of deviancy theory Some sociologists critical of shift to left, others positive –
new found energy/breaking relationship with establishment
Anti- authoritarianism meant policy related work out of favour.
UK Medical sociology in the 60s & 70s (1)
Developed rapidly, influenced by mainstream sociology
Sociology of medicine became popular Macro level critical of medical power –
medicine as oppressive agent of social control – masking professional power (Freidson 1970) or wider class interests (Navarro 1976)
UK Medical sociology in the 60s & 70s (2)
Micro level - interactionists (Bloor 1976) and feminists (Barrett & Roberts
1978) Also saw doctors as oppressive Focus on how strategies & routines in different settings - reinforced professional power and control - minimised opportunities for patient involvement Criticised by others as imperialist – exaggerating negative
aspects of medical practice – for own professional purposes (Strong 1979)
Policy issues ignored – helped by lack of public conflict over health care
3. Retrenchment in adversity
Late 70s - mid 90s cold political climate for sociology
Neo-conservative politics – support for sociology absent
Sociologists returned to classics in theory & method (the nature of capitalism, quantitative methods/secondary analysis
- qualitative v quantitative distinction now false
UK Medical Sociology – late 70s – mid 90s (1)
Mirrored developments in parent discipline Focused on how theory illuminates health,
disease & medicine – Scambler 1987 What theoretical paradigms used to explain
illness & relationship to general theory – Gerhardt 1989
Growing influence of Foucault – renewed debate about illness / its definitions (Armstrong 1983)
Secondary analysis of health care data from UK census (Arber & Gilbert 1989)
UK Medical Sociology – late 70s – mid 90s (2)
Medical sociology protected from cold political climate (unlike parent discipline) by social medicine
Positives – job opportunities Negatives – working `in’ medicine meant surrendering
selecting topics to research to doctors and civil servants e.g. HIV / AIDS
Few opportunities for rigorous, reflexive analysis of health policy even though now central in debates about
- future of welfare state - impact of consumerism - social consensus over NHS strained
4. Consolidation
Mid 1990s- milder political climate (under threat in 2010 with change of government?)
Some sociologists helping to shape public culture & political agenda – Giddens
New interests in sociological theory - embodiment - emotions -biotechnologies & communication technologie - risk & trust - consumption, lifestyle & identity – cultural turn Call for a more publically engaged sociology (Burawoy 2005)
Consolidation in Medical Sociology
Medical sociology mirrored main stream developments & mirrored them E.g. Trust conditional in medicine and now needs to be earned – new
professionalism (Calnan & Rowe 2008). E.g. Cultural shaping of risk perception about hazards to health & its
management (Green 1997) E.g. Consumption and health promotion – how consumption of alcohol,
fitness & leisure services shape body image / sense of health (Bunton & Burrows 1995)
Call for a publically engaged medical sociology – providing a sociological perspective on health policy & organisation of health care
E.g. Evidence-based medicine as a social movement (ideology & strategy (Pope 2003)
E.g. sociologists mediating between lay participants and published evidence of health impact assessment of housing development in a former mining community (Elliott & Williams 2008)
Comparison between UK and US medical sociology
US medical sociology began earlier More influenced by psychiatry than social medicine - Mental health a dominant concern of Journal of
Health & Social Behaviour US more concerned with investigating social
problems & social divisions UK more focused on theoretical issues and micro
sociology – Sociology of Health & Illness (founded 1979) established to provide platform this approach.
Medical sociology abstracts in general sociology journals
Britain and America compared 1992-2007 (Seale 2008)
American journalsAJS/ASR/SF/SP
British journalsSR/BJS/SOC
Concepts(infant) mortality; (mental/ public/national/infant) health (care/status/behaviour); (labor force) participation; fertility, stress, (social) integration; religious (involvement)
Conceptsbody/ies; trust; sociology/ical; discourse/s/ursive; modernity; identity; governance; (social) movement; Weber; citizenship; ethics; Giddens; feminist
Illness conditionssuicide; mental
Illness conditionsSleep; disability/ables; death
Social divisionsWhite/s; Black/s; birth; age; socioeconomic status; children; racial/race; sex [for gender]; African American; men;
Social divisionsNO KEYWORDS
Journal of Health and Social Behavior and Sociology of Health and Illness:
Journal of Health and Social Behavior Sociology of Health and Illness
Concepts: social psychology(social / emotional) support; psychological; (perceived / racial) discrimination; (differential) exposure (to vulnerability / to stress); anger; roles; parental (separation / divorce / behavior)
Concepts: social construction of selfaccounts; body/ies; discourse/s; lay; everyday (life / experiences); moral (responsibility); (social and / socio-) cultural (values); stories
Illness conditionsdepression/ive; distress; mental; stress/ors
Illness conditions(chronic / mental) illness (experience / narratives); cancer
Social divisions(African / Mexican) American’s; marital (status) / married / marriage; adolescent/s; (socioeconomic / marital / health / social) status; (sociodemographic / socioeconomic) characteristics; adults; socioeconomic; White/s; age; racial; race; income; differences; job; African (American/s); Black
Social divisionsinequalities; (social / middle / working) class (differences / inequalities)
The medical professionNO KEYWORDS
The medical professionmedical (profession / practice / knowledge; work); (general / medical / clinical) practice; (general / medical) practitioners; doctors; nurses; (medical / professional) knowledge; medicalisation; GPs; managers; clinical; professional; medicine; biomedical; NHS
Changes over time: 1992-1999 compared with 2000-2007General sociology journals: all abstracts
AJS/ASR/SF/SP(family / social / opportunity / network) structure; unionization; (black / current) population (growth / size / density); cognitive (skill); (social) organization; (resource) mobilization; labelling; historical; theory; cohabitation; ethnic (groups / economy); self-esteem; economy; (collective) action; premarital (birth / childbearing); strategies
(white / blue) collar; families; metropolitan (area/s); lesbian; earnings
AJS/ASR/SF/SPGlobal/ization; transnational/ism; neighborhood/s; (perceived / racial) threat; peer; (social / friendship) network/s; migration/ants; civil (rights / society); civic (engagement / organization); (adolescent / mental) health; (civil / human) rights; (child / health) care; trajectories; international; (work) hours; (voluntary) associations; managerial; (religious) involvement; communities
adolescent/s; college (completion); (black) students; couples
SR/BJS/SOCPrivatisation; Weber; organisations/al; regimes; (social) movements; crime; policing; ideological; discourse
unemployed/ment; underclass
SR/BJS/SOCBody; identity/ies; Bourdieu’s; (social / cultural) capital; space; global; experiences; cosmopolitan; complexity; caring; aesthetic
poverty; migrants
1992-1999 2000-2007
SHI
conceptsbehaviour; health; structural;
social divisionsmortality differentials; differences; classes; spouses
health care/knowledgeteam/work; complaints; preventive
health behaviourcondom; safer (sex)
health conditions / treatmentspain; AIDS; accidents
SHI
conceptswellbeing; transition; lived (experience)
social divisionsNONE
health care/knowledgeCAM; science; midwifery
health behaviourNONE
health conditions / treatmentsMenopause; cancer; Viagra; sleep
Changes over time: 1992-1999 compared with 2000-2007Sociology of Health and Illness
1992-1999 2000-2007
Sociology / medical sociology in the USA and UK
USA UK
race class
social issues social theory
accept cultural critical of culturalauthority of medicine authority of medicine
epistemological conservatism social constructionism
quantitative methods qualitative methods / argumentation
mental conditions chronic illness
change over time little change over time
How might Sociology of Health and Illness develop in the UK?
(a) Use concepts from general sociology more:
In particular, globalisation, internationalism in health care, social systems-level analysis.
For example:
• analysis of the role of the global pharmaceutical industry in influencing medical practice and population health beliefs and behaviour.
• cross national comparative work on health care systems and policies.
• Internationalise medical sociology by studying medicine as an institution globally, not just in richer countries.
• Migration and health
How might Sociology of Health and Illness develop in the UK?
(b) Make use of the concept of social capital
either of the conflictual Bourdieusian type (ie: as a marker of class distinction, together with cultural capital)or the social consensus-style Putnam variety (ie: its role in community-building -neighbourhoods, social networks, civic engagement; voluntary association)
(c) Relate to social issues more directly / address a wider range of social divisions. For example, race, migration, human rights.
(d) Use more quantitative methods (?)
(e) Create a more ‘public’ sociology of health and illness.
Public sociology is an approach … which seeks to transcend the academy and engage wider audiences. [It is] a style of sociology, a way of writing and a form of intellectual engagement.
Michel Burawoy has contrasted it with professional sociology, a form of academic sociology that is concerned primarily with addressing other professional sociologists.
(Wikipedia 4th July 2007)
References (1)
Arber, S. and Gilbert, N (1989) Men: the forgotten carers, Sociology 23, 111-18. Armstrong, D. (1983) Political Anatomy of the Body, Cambridge University Press,
Cambridge. Barrett, M. and Roberts, H. (1978) Doctors and their patients. In Smart C. and Smart
B. (eds) Women Sexuality and Social Control. Routledge, London. Bloor. M. (1976) Professional autonomy and client exclusion. In Wadsworth, M. &
Robinson, D. (eds) Studies in Everyday Medical Life. Martin Robinson, London. Bunton, R. & Burrows, R. (1995) Consumption and health in the `epidemic clinic of
late modern medicine. In Bunton R et al. (eds) The Sociology of Health Promotion. Routledge, London.
Burawoy, M. (2005) For sociology. American Sociological Review 70, 4-28. Calnan, M. and Rowe, R. (2008) Trust Matters in Health Care, Open University
Press, Buckingham. Freidson, E (1970) The Profession of Medicine, Dodd Mead, New York.
References (2)
Elliott, E. and Williams, G. (2008) Developing public sociology through health impact
assessment. Sociology of Health & Illness 30, 1101-16. Gerhardt, U. (189) Ideas about Illness, Macmillan, Basingstoke. Navarro, V. (1976) Medicine under Capitalism, Prodist, New York. Green, J. (1997) Risk and Misfortune. A Social Construction of Accidents. UCL Press,
London. Pope, C. (2003) Resisting evidence: the study of evidence-based medicine as a
contemporary social movement.Health 7, 267-82. Scambler, G. (1987) Sociological Theory and Medical Sociology. Tavistock, London. Seale, C. (2008) Mapping the field of medical sociology. Sociology of Health & Illness
30, 677-95. Straus, R (1957) Nature and status of medical sociology. American Sociological Review
22, 200-4. Strong, P. (1979) Sociological imperialism and the profession of medicine. Social
Science & Medicine 13A, 613-19. Turner, B. (1995) Medical Power and Social Knowledge. Sage, London