sociology of health and medicine
sociology of health and medicinethe application of sociological approaches to the understanding of the experience, distribution and treatment of illness. This sub-area of the discipline has been a major growth area in terms of research and teaching, and in terms of membership it probably represents the largest section of both the British and American national sociological associations. The reasons for this expansion are perhaps twofold. The first has been the relatively greater access of workers in this area to research funds: both governments and medical sources have been anxious to promote research which could improve health policy and patient care. Secondly, it has become manifest that the profile of morbidity and mortality in the industrialized world is now dominated by so-called ‘lifestyle diseases’ (such as stroke, cancer and heart disease). As the name implies, the management of these problems often involves an adjustment to ways of living rather than subjection to a regime of drug therapy. Medicine has no ‘magic bullets’ to ‘take out’ these diseases (as antibiotics could with many infectious diseases), or immunization programmes to give prophylactic protection. Moreover, lifestyle diseases show a clear social class gradient, generally becoming less frequent as class position improves. There is also, then, a socially structured pattern of’opportunity’ for healthy living. Sociology has an obvious input to make in providing a fuller understanding of these ‘chances for life’.
The expansion of health and medicine as an area of sociological concern can be dated from the seminal contribution made by PARSONS’analysis of the SICK ROLE. Parsons’ interest, in fact, was part of a much larger theoretical project (1951) on the development of a complex functional model of society but his contribution served to establish the area of medicine as an institution whose sociological study could enhance the theoretical development of the discipline itself. Herein lies a long-established (if, in the end, overdrawn) distinction between two sociologies of medicine: one a sociology in medicine, whose research agenda is set by governments, policy makers and clinicians, the other, a sociology of medicine, whose questions are determined much more by sociologists and for sociology.
Parsons’ concept of the sick role was subjected to criticism and amendment (see, e.g., Morgan et al., 1985, for a recent overview of the major contributions here). Other topics of particular importance in the early expansion of the discipline were: medical education and socialization (MERTON et al.; 1957, BECKER et al., 1961); the social organization of death (Glasser and Strauss, 1965,1968); mental illness (GOFFMAN, 1961a; Scheff, 1966); and the analysis of medicine as a profession (Freidson, 1970a, 1970b). FUNCTIONALISM and SYMBOLIC INTERACTIONISM were the major theoretical traditions which informed much of this early work.
As the sociology of health and medicine has grown both in terms of maturity and in the number and theoretical predilections of its practitioners, research has been extended into still further areas. There can now be hardly any substantive area in the field in which work still remains to be initiated. Among the topics which have been, and continue to be, of interest to contemporary researchers are: the relationship between medicine and capitalism; medicine as an instrument of social control (medicine and patriarchy and the medicalization of life have been two prominent themes here); gender and health, with particular reference to the role of women as paid and unpaid health workers; eating disorders (see ANOREXIA NERVOSA); inequalities in health and health provision, including those of race and gender as well as class; the social construction of medical knowledge; doctor-patient communication and interaction; patterns of help-seeking and compliance among patients; the holistic health movement and complementary therapies (see ALTERNATIVE MEDICINE); and, most recently, the study of sexual behaviour, with special reference to sexually transmitted diseases and AIDS.