Sociology of Health in the UK

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.

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