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 eras
1. Immediate post WW2
2. The break with consensus
3. Retrenchment
4. 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 journals British journals

AJS/ASR/SF/SP SR/BJS/SOC
Concepts Concepts
(infant) mortality; (mental/ public/national/infant) health body/ies; trust; sociology/ical; discourse/s/ursive; modernity;
(care/status/behaviour); (labor force) participation; fertility, identity; governance; (social) movement; Weber; citizenship;
stress, (social) integration; religious (involvement) ethics; Giddens; feminist

Illness conditions Illness conditions

suicide; mental Sleep; disability/ables; death

Social divisions Social divisions

White/s; Black/s; birth; age; socioeconomic status; children; NO KEYWORDS
racial/race; sex [for gender]; African American; men;
 Journal of Health and Social Behavior and Sociology of Health and Illness:
Journal of Health and Social Behavior
Concepts: social psychology
(social / emotional) support; psychological; (perceived / racial)
discrimination; (differential) exposure (to vulnerability / to stress);
anger; roles; parental (separation / divorce / behavior)
Illness conditions
depression/ive; distress; mental; stress/ors
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
The medical profession
NO KEYWORDS
Sociology of Health and Illness
Concepts: social construction of self
accounts; body/ies; discourse/s; lay; everyday (life / experiences);
moral (responsibility); (social and / socio-) cultural (values); stories
Illness conditions
(chronic / mental) illness (experience / narratives); cancer
Social divisions
inequalities; (social / middle / working) class (differences /
inequalities)
The medical profession
medical (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 2000-2007
General sociology journals: all abstracts

1992-1999 2000-2007

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
AJS/ASR/SF/SP
Global/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

(white / blue) collar; families; metropolitan (area/s); lesbian;
earnings
SR/BJS/SOC
Privatisation; Weber; organisations/al; regimes; (social)
movements; crime; policing; ideological; discourse
adolescent/s; college (completion); (black) students; couples
SR/BJS/SOC
Body; identity/ies; Bourdieu’s; (social / cultural) capital; space;
global; experiences; cosmopolitan; complexity; caring; aesthetic

unemployed/ment; underclass poverty; migrants

 Changes over time: 1992-1999 compared with 2000-2007
Sociology of Health and Illness

1992-1999 2000-2007
SHI SHI

concepts concepts
behaviour; health; structural; wellbeing; transition; lived (experience)

social divisions social divisions

mortality differentials; differences; classes; spouses NONE

health care/knowledge health care/knowledge

team/work; complaints; preventive CAM; science; midwifery

health behaviour
health behaviour NONE
condom; safer (sex)
health conditions / treatments
health conditions / treatments Menopause; cancer; Viagra; sleep
pain; AIDS; accidents
Sociology / medical sociology in the USA and UK

USA UK

race class

social issues social theory

accept cultural critical of cultural

authority 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