Introduction To The Sociology Of Health And Medicine

[Violette Ransone]

Medicalsociology is the sociological analysis of medical organizations and institutions; the production of knowledge and selection of methods, the actions and interactions of healthcare professionals, and the social or cultural (rather than clinical or bodily) effects of medical practice. The field commonly interacts with the sociology of knowledge, science and technology studies, and social epistemology. Medical sociologists are also interested in the qualitative experiences of patients, often working at the boundaries of public health, social work, demography and gerontology to explore phenomena at the intersection of the social and clinical sciences. Health disparities commonly relate to typical categories such as class and race. Objective sociological research findings quickly become a normative and political issue.

Prior to training and working in public health medicine, I spent 10 years doing research as a medical sociologist. Academic public health is multidisciplinary and medical sociology is a major strand. The thing that makes me chuckle is that when I was a bone fide sociologist working in a sociology department, the question we were asked a lot was "isn't sociology just common sense?" Then I enter public health waters and have public health registrars quaking at the sight of the jargon. Too many theories they say and who on earth is Foucault?

Sociology is not that difficult. It's not quite common sense but it doesn't mean hours of learning about the Formalism School. In fact, I believe it to be a core element of public health work. Sometimes people want to make the right choice about their health but can't. Sociology helps you understand what those micro (individual), meso (network/community) and macro (societal) barriers are.

Sociology is about viewing patterns in populations. It's a sibling of anthropology except that sociologies study their own societies. Many talk about the three levels of society - micro, meso and macro. Micro level is all about the individual. How they relate to others, socialise, what culture influences them, their social behaviours and how they make decisions. Meso is about social networks and relationships, about communities, cultures, ethnic groups and how well connected social groups are to power and influence. Macro involves the higher level, the institutions. This includes social class, politics, religion, education, social structure, organisations, industries and societal attitudes.

To think sociologically involves being objective and scientific. For example, I once taught Sociology of Religion. Sometimes, students would be defensive and say that they were scientists and couldn't accept irrational thoughts. Others burst into tears at the term secularisation of western societies. They were getting personal. I asked them to visualise themselves as an observer sent from Mars who was asked to report back on this situation called religion was organised and practice on the plant called Earth. Sounds a bit ridiculous but it worked.

If you want to approach a public health topic in a sociological manner, ask yourself why does a woman who wants to breastfeed doesn't? What cultural and societal influences are stopping her? A man wants to lose weight and despite having the knowledge he can't. Again what is it that is stopping him? Is it long working hours seated in front of a computer screen? A culture of having lunch at the desk or on the go? No workplace encouragement to exercise? Reliance on a car, long working days and habit of collapsing on the couch to watch sport in the evenings? No safe green spaces nearby? All of these questions are sociological questions.

Medical sociology (or sociology of health and illness) is the study of all those aspects of contemporary social life which impact upon health and well-being throughout the life course. If you work in public health, you should probably know a bit about the different social theories and the domains of medical sociology such as:

Back in the 1950s, the causes and nature of physical illness and health were seen to be shaped by biological processes and medical care. Nowadays, differences in health and illness are seen to be a function of biological, social, psychological and behavioural factors. It wasn't until 2000 that there was rediscovery of the effects of socio-economic and racial-ethnic disparities in health. Social class and race shape exposure and experiences which in turn produce psychosocial, environmental and biomedical risk factors. Improving socio-economic position of a broad range of socio-economic and racial-ethnic strata constitutes a major way for reducing exposure to and experience of risk factors for ill-health. This improves the health of these groups and the overall population.

Socio-economic position and race/ethnicity shape individuals' exposure to and experience of virtually all known psychosocial risk factors as well as environmental and biomedical risk factors. These risk factors are known to help explain size and persistence of social disparities in health. Social epidemiology has identified a broad range of psychosocial risk factors for health such as social relationships and support, acute or event based stress, chronic stress in work or life and psychological dispositions such as anger/hostility, lack of self-efficacy/control and negative feelings like pessimism or hopelessness.

Health inequalities between groups and areas are brought about by differences in the composition of the area or group populations and the nature of day-to-day lives within those groups or areas. Health inequalities are influenced by both social (i.e. position in society, such as employment status, gender, social group, social roles) and spatial (i.e. where they live, e.g. urban, rural, neighbourhoods, noise pollution etc ) contexts.

Social capital is a fashionable paradigm for the explanation of differences in health and illness between social groups. It emerged in the 1990s although Bryan Turner (2003) argues that the roots can be found in Emile Durkheim's work (see "Social Capital, Inequality and Health: the Durkheimian Revival" Social Theory and Health , 1:4-20). Social Capital is based on the notion that social networks matter - i.e. 'it's who you know not what you know'. The quantity and quality of a person's social relationships and social networks play an important part in the maintenance of their health and at the same time, provide resources for their recovery from illness. Often the terms 'social networks', 'social support', 'social ties' and 'social integration' are used interchangeably but they are different.

Social relationships and affiliation have powerful effects on physical and mental health. Bowlby's 'Attachment Theory' states that there is a universal human need to form close affectional bonds. These are created in childhood, although we continue to make them in adulthood - e.g. marriage. Such bonds to other people help you to venture forth and offers security.

This is largely done through social network analysis. Such analysis focuses on the characteristic patterns of ties between actors in a social system rather than on characteristics of the individual actors themselves and use these descriptions to study how these social structures constrain network members' behaviour.

This is loosely based on Bourdieu's theory of cultural reproduction. The term cultural capital refers to non-financial social assets that promote social mobility beyond economic means. Examples can include education, intellect, style of speech, dress, or physical appearance. Children from middle-class families are advantaged in gaining educational credentials due to their possession of cultural capital. Cultural capital is transmitted in the home and can have a significant effect on performance in school. In laypeople's terms, if you grow up in a household where parents are 'cultured' i.e. have an interest in learning, arts, literature etc., the children are more likely to do well at school. In relation to public health, children are more likely to be fitter and healthier if they come from a home with much cultural capital.

Each of the three major theoretical perspectives approaches the topics of health, illness, and medicine differently. You may prefer just one of the theories that follow, or you may find that combining theories and perspectives provides a fuller picture of how we experience health and wellness.

According to the functionalist perspective, health is vital to the stability of the society, and therefore sickness is a sanctioned form of deviance. Talcott Parsons (1951) was the first to discuss this in terms of the sick role: patterns of expectations that define appropriate behavior for the sick and for those who take care of them.

According to Parsons, the sick person has a specific role with both rights and responsibilities. To start with, she has not chosen to be sick and should not be treated as responsible for her condition. The sick person also has the right of being exempt from normal social roles; she is not required to fulfill the obligation of a well person and can avoid her normal responsibilities without censure. However, this exemption is temporary and relative to the severity of the illness. The exemption also requires legitimation by a physician; that is, a physician must certify that the illness is genuine.

The responsibility of the sick person is twofold: to try to get well and to seek technically competent help from a physician. If the sick person stays ill longer than is appropriate (malingers), she may be stigmatized.

Alongside the health disparities created by class inequalities, there are a number of health disparities created by racism, sexism, ageism, and heterosexism. When health is a commodity, the poor are more likely to experience illness caused by poor diet, to live and work in unhealthy environments, and are less likely to challenge the system. In the United States, a disproportionate number of racial minorities also have less economic power, so they bear a great deal of the burden of poor health. It is not only the poor who suffer from the conflict between dominant and subordinate groups. For many years now, homosexual couples have been denied spousal benefits, either in the form of health insurance or in terms of medical responsibility. Further adding to the issue, doctors hold a disproportionate amount of power in the doctor/patient relationship, which provides them with extensive social and economic benefits.

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