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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. Employ a sociological perspective to increase understanding of - experience of health - social distribution of health disorders

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Sociology of Health in the UK

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  1. Sociology of Health in the UK Jonathan Gabe Royal Holloway, University of London (UK)

  2. 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

  3. 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

  4. 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)

  5. 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

  6. 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

  7. 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

  8. 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

  9. 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 • Immediate post WW2 • The break with consensus • Retrenchment • Consolidation

  10. 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

  11. 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

  12. 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.

  13. 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)

  14. 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

  15. 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

  16. 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)

  17. 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

  18. 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)

  19. 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)

  20. 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.

  21. Medical sociology abstracts in general sociology journals Britain and America compared 1992-2007 (Seale 2008)

  22. Journal of Health and Social Behavior and Sociology of Health and Illness:

  23. Changes over time: 1992-1999 compared with 2000-2007 General sociology journals: all abstracts

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

  25. 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

  26. How might Sociology of Health and Illness develop in the UK? • 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

  27. 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.

  28. 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)

  29. 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.

  30. 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

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