Download Sociology of Health in the UK

Sociology of Health in the UK
Jonathan Gabe
Royal Holloway, University of
London (UK)
Two roles for sociology of health
& illness
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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
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Sociology in medicine v sociology
of medicine (2)
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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
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In medicine / health
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Health behaviour
Lay beliefs
Lay referral
Compliance
Social support and stress / psycho-social perspectives
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Of Medicine / health
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Social construction of disease categories / medical knowledge
Narratives of self and identity
Sociology of body
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Social Level
In medicine/health
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Social causes of disease
Social epidemiology
Evaluation of health care effectiveness
Managerial effectiveness and efficiency
Health promotion and education
Health inequalities
Of medicine/health
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Medical dominance / power / inter-professional rivalry
Conflict perspective on lay-professional
relationship
Medicalisation
Managerialism as an ideology or discourse
Societal level
In medicine / health
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Improving the effectiveness and efficiency of
policies and government initiatives
Building social capital in the community
Of medicine / health
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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
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1.
2.
3.
4.
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
Immediate post WW2
The break with consensus
Retrenchment
Consolidation
1. Immediate post Second World
War
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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
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2. The break with consensus
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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)
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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)
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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
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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)
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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)
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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)
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Consolidation in Medical
Sociology
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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
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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
AJS/ASR/SF/SP
British journals
SR/BJS/SOC
Concepts
(infant) mortality; (mental/ public/national/infant) health
(care/status/behaviour); (labor force) participation; fertility,
stress, (social) integration; religious (involvement)
Concepts
body/ies; trust; sociology/ical; discourse/s/ursive; modernity;
identity; governance; (social) movement; Weber; citizenship;
ethics; Giddens; feminist
Illness conditions
suicide; mental
Illness conditions
Sleep; disability/ables; death
Social divisions
White/s; Black/s; birth; age; socioeconomic status; children;
racial/race; sex [for gender]; African American; men;
Social divisions
NO 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 self
accounts; body/ies; discourse/s; lay; everyday (life / experiences);
moral (responsibility); (social and / socio-) cultural (values); stories
Illness conditions
depression/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 divisions
inequalities; (social / middle / working) class (differences /
inequalities)
The medical profession
NO KEYWORDS
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); selfesteem; 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
adolescent/s; college (completion); (black) students; couples
SR/BJS/SOC
Privatisation; Weber; organisations/al; regimes; (social)
movements; crime; policing; ideological; discourse
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
behaviour; health; structural;
concepts
wellbeing; transition; lived (experience)
social divisions
mortality differentials; differences; classes; spouses
social divisions
NONE
health care/knowledge
team/work; complaints; preventive
health care/knowledge
CAM; science; midwifery
health behaviour
condom; safer (sex)
health conditions / treatments
pain; AIDS; accidents
health behaviour
NONE
health conditions / treatments
Menopause; cancer; Viagra; sleep
Sociology / medical sociology in the USA and UK
USA
UK
race
class
social issues
social theory
accept cultural
authority of medicine
critical of cultural
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:
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analysis of the role of the global pharmaceutical industry in influencing medical practice
and population health beliefs and behaviour.
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cross national comparative work on health care systems and policies.
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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)
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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)
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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