sociological perspectives in health and social care essay

New Perspectives on Health and Social Care pp 1–17 Cite as

Introduction: Perspectives on Health and Social Care

• Jason Powell 4  
• First Online: 23 February 2023

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Part of the book series: International Perspectives on Social Policy, Administration, and Practice ((IPSPAP))

This chapter examines the way in which social theory can enrich our understanding of health and social care with specific reference to the range of perspectives which have emerged over the past several decades in particular. Indeed, the chapter is concerned with locating and scrutinising the accelerating theoretical developments in social health and social care and moves to reviewing their key concerns. The different social theories and philosophies which have materialised exemplify an interpretation of the consequences social policy has for vulnerable people. This opens up the pathway to understanding health and social care more creatively.

• Health and social care
• Social theories
• Perspectives
• Care relationships
• Biomedicine
• Life-course
• Postmodernism

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Powell, J. (2023). Introduction: Perspectives on Health and Social Care. In: New Perspectives on Health and Social Care. International Perspectives on Social Policy, Administration, and Practice. Springer, Cham. https://doi.org/10.1007/978-3-031-25432-1_1

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18.1 Understanding Health, Medicine, and Society

Learning objectives.

• Understand the basic views of the sociological approach to health and medicine.
• List the assumptions of the functionalist, conflict, and symbolic interactionist perspectives on health and medicine.

Health refers to the extent of a person’s physical, mental, and social well-being. This definition, taken from the World Health Organization’s treatment of health, emphasizes that health is a complex concept that involves not just the soundness of a person’s body but also the state of a person’s mind and the quality of the social environment in which she or he lives. The quality of the social environment in turn can affect a person’s physical and mental health, underscoring the importance of social factors for these twin aspects of our overall well-being.

Medicine is the social institution that seeks both to prevent, diagnose, and treat illness and to promote health as just defined. Dissatisfaction with the medical establishment has been growing. Part of this dissatisfaction stems from soaring health-care costs and what many perceive as insensitive stinginess by the health insurance industry, as the 2009 battle over health-care reform illustrated. Some of the dissatisfaction also reflects a growing view that the social and even spiritual realms of human existence play a key role in health and illness. This view has fueled renewed interest in alternative medicine. We return later to these many issues for the social institution of medicine.

The Sociological Approach to Health and Medicine

We usually think of health, illness, and medicine in individual terms. When a person becomes ill, we view the illness as a medical problem with biological causes, and a physician treats the individual accordingly. A sociological approach takes a different view. Unlike physicians, sociologists and other public health scholars do not try to understand why any one person becomes ill. Instead, they typically examine rates of illness to explain why people from certain social backgrounds are more likely than those from others to become sick. Here, as we will see, our social location in society—our social class, race and ethnicity, and gender—makes a critical difference.

A sociological approach emphasizes that our social class, race and ethnicity, and gender, among other aspects of our social backgrounds, influence our levels of health and illness.

U.S. Army Garrison Japan – Arnn students celebrate diversity; weeklong recognition – CC BY-NC-ND 2.0.

The fact that our social backgrounds affect our health may be difficult for many of us to accept. We all know someone, and often someone we love, who has died from a serious illness or currently suffers from one. There is always a “medical” cause of this person’s illness, and physicians do their best to try to cure it and prevent it from recurring. Sometimes they succeed; sometimes they fail. Whether someone suffers a serious illness is often simply a matter of bad luck or bad genes: we can do everything right and still become ill. In saying that our social backgrounds affect our health, sociologists do not deny any of these possibilities. They simply remind us that our social backgrounds also play an important role (Cockerham, 2009).

A sociological approach also emphasizes that a society’s culture shapes its understanding of health and illness and practice of medicine. In particular, culture shapes a society’s perceptions of what it means to be healthy or ill, the reasons to which it attributes illness, and the ways in which it tries to keep its members healthy and to cure those who are sick (Hahn & Inborn, 2009). Knowing about a society’s culture, then, helps us to understand how it perceives health and healing. By the same token, knowing about a society’s health and medicine helps us to understand important aspects of its culture.

An interesting example of culture in this regard is seen in Japan’s aversion to organ transplants, which are much less common in that nation than in other wealthy nations. Japanese families dislike disfiguring the bodies of the dead, even for autopsies, which are also much less common in Japan than other nations. This cultural view often prompts them to refuse permission for organ transplants when a family member dies, and it leads many Japanese to refuse to designate themselves as potential organ donors (Sehata & Kimura, 2009; Shinzo, 2004).

As culture changes over time, it is also true that perceptions of health and medicine may also change. Recall from Chapter 2 “Eye on Society: Doing Sociological Research” that physicians in top medical schools a century ago advised women not to go to college because the stress of higher education would disrupt their menstrual cycles (Ehrenreich & English, 2005). This nonsensical advice reflected the sexism of the times, and we no longer accept it now, but it also shows that what it means to be healthy or ill can change as a society’s culture changes.

A society’s culture matters in these various ways, but so does its social structure, in particular its level of economic development and extent of government involvement in health-care delivery. As we will see, poor societies have much worse health than richer societies. At the same time, richer societies have certain health risks and health problems, such as pollution and liver disease (brought on by high alcohol use), that poor societies avoid. The degree of government involvement in health-care delivery also matters: as we will also see, the United States lags behind many Western European nations in several health indicators, in part because the latter nations provide much more national health care than does the United States. Although illness is often a matter of bad luck or bad genes, the society we live in can nonetheless affect our chances of becoming and staying ill.

Sociological Perspectives on Health and Medicine

The major sociological perspectives on health and medicine all recognize these points but offer different ways of understanding health and medicine that fall into the functional, conflict, and symbolic interactionist approaches. Together they provide us with a more comprehensive understanding of health, medicine, and society than any one approach can do by itself (Cockerham, 2009). Table 18.1 “Theory Snapshot” summarizes what they say.

Table 18.1 Theory Snapshot

The Functionalist Approach

As conceived by Talcott Parsons (1951), the functionalist perspective on health and medicine emphasizes that good health and effective medical care are essential for a society’s ability to function. Ill health impairs our ability to perform our roles in society, and if too many people are unhealthy, society’s functioning and stability suffer. This was especially true for premature death, said Parsons, because it prevents individuals from fully carrying out all their social roles and thus represents a “poor return” to society for the various costs of pregnancy, birth, child care, and socialization of the individual who ends up dying early. Poor medical care is likewise dysfunctional for society, as people who are ill face greater difficulty in becoming healthy and people who are healthy are more likely to become ill.

For a person to be considered legitimately sick, said Parsons, several expectations must be met. He referred to these expectations as the sick role . First, sick people should not be perceived as having caused their own health problem. If we eat high-fat food, become obese, and have a heart attack, we evoke less sympathy than if we had practiced good nutrition and maintained a proper weight. If someone is driving drunk and smashes into a tree, there is much less sympathy than if the driver had been sober and skidded off the road in icy weather.

Second, sick people must want to get well. If they do not want to get well or, worse yet, are perceived as faking their illness or malingering after becoming healthier, they are no longer considered legitimately ill by the people who know them or, more generally, by society itself.

Third, sick people are expected to have their illness confirmed by a physician or other health-care professional and to follow the professional’s advice and instructions in order to become well. If a sick person fails to do so, she or he again loses the right to perform the sick role.

Talcott Parsons wrote that for a person to be perceived as legitimately ill, several expectations, called the sick role, must be met. These expectations include the perception that the person did not cause her or his own health problem.

Nathalie Babineau-Griffith – grand-maman’s blanket – CC BY-NC-ND 2.0.

If all of these expectations are met, said Parsons, sick people are treated as sick by their family, their friends, and other people they know, and they become exempt from their normal obligations to all these people. Sometimes they are even told to stay in bed when they want to remain active.

Physicians also have a role to perform, said Parsons. First and foremost, they have to diagnose the person’s illness, decide how to treat it, and help the person become well. To do so, they need the cooperation of the patient, who must answer the physician’s questions accurately and follow the physician’s instructions. Parsons thus viewed the physician-patient relationship as hierarchical: the physician gives the orders (or, more accurately, provides advice and instructions), and the patient follows them.

Parsons was certainly right in emphasizing the importance of individuals’ good health for society’s health, but his perspective has been criticized for several reasons. First, his idea of the sick role applies more to acute (short-term) illness than to chronic (long-term) illness. Although much of his discussion implies a person temporarily enters a sick role and leaves it soon after following adequate medical care, people with chronic illnesses can be locked into a sick role for a very long time or even permanently. Second, Parsons’s discussion ignores the fact, mentioned earlier, that our social location in society in the form of social class, race and ethnicity, and gender affects both the likelihood of becoming ill and the quality of medical care we receive. Third, Parsons wrote approvingly of the hierarchy implicit in the physician-patient relationship. Many experts say today that patients need to reduce this hierarchy by asking more questions of their physicians and by taking a more active role in maintaining their health. To the extent that physicians do not always provide the best medical care, the hierarchy that Parsons favored is at least partly to blame.

The Conflict Approach

The conflict approach emphasizes inequality in the quality of health and of health-care delivery (Conrad, 2009). As noted earlier, the quality of health and health care differ greatly around the world and within the United States. Society’s inequities along social class, race and ethnicity, and gender lines are reproduced in our health and health care. People from disadvantaged social backgrounds are more likely to become ill, and once they do become ill, inadequate health care makes it more difficult for them to become well. As we will see, the evidence of inequities in health and health care is vast and dramatic.

The conflict approach also critiques the degree to which physicians over the decades have tried to control the practice of medicine and to define various social problems as medical ones. Their motivation for doing so has been both good and bad. On the good side, they have believed that they are the most qualified professionals to diagnose problems and treat people who have these problems. On the negative side, they have also recognized that their financial status will improve if they succeed in characterizing social problems as medical problems and in monopolizing the treatment of these problems. Once these problems become “medicalized,” their possible social roots and thus potential solutions are neglected.

Several examples illustrate conflict theory’s criticism. Alternative medicine is becoming increasingly popular (see Chapter 18 “Health and Medicine” , Section 18.4 “Medicine and Health Care in the United States” ), but so has criticism of it by the medical establishment. Physicians may honestly feel that medical alternatives are inadequate, ineffective, or even dangerous, but they also recognize that the use of these alternatives is financially harmful to their own practices. Eating disorders also illustrate conflict theory’s criticism. Many of the women and girls who have eating disorders receive help from a physician, a psychiatrist, a psychologist, or another health-care professional. Although this care is often very helpful, the definition of eating disorders as a medical problem nonetheless provides a good source of income for the professionals who treat it and obscures its cultural roots in society’s standard of beauty for women (Whitehead & Kurz, 2008).

Obstetrical care provides another example. In most of human history, midwives or their equivalent were the people who helped pregnant women deliver their babies. In the 19th century, physicians claimed they were better trained than midwives and won legislation giving them authority to deliver babies. They may have honestly felt that midwives were inadequately trained, but they also fully recognized that obstetrical care would be quite lucrative (Ehrenreich & English, 2005). In a final example, many hyperactive children are now diagnosed with ADHD, or attention deficit/hyperactivity disorder. A generation or more ago, they would have been considered merely as overly active. After Ritalin, a drug that reduces hyperactivity, was developed, their behavior came to be considered a medical problem and the ADHD diagnosis was increasingly applied, and tens of thousands of children went to physicians’ offices and were given Ritalin or similar drugs. The definition of their behavior as a medical problem was very lucrative for physicians and for the company that developed Ritalin, and it also obscured the possible roots of their behavior in inadequate parenting, stultifying schools, or even gender socialization, as most hyperactive kids are boys (Conrad, 2008; Rao & Seaton, 2010).

According to conflict theory, physicians have often sought to define various social problems as medical problems. An example is the development of the diagnosis of ADHD, or attention deficit/hyperactivity disorder.

birgerking – What I Really Do… ADD/ADHD – CC BY 2.0.

Critics of the conflict approach say that its assessment of health and medicine is overly harsh and its criticism of physicians’ motivation far too cynical. Scientific medicine has greatly improved the health of people in the industrial world; even in the poorer nations, moreover, health has improved from a century ago, however inadequate it remains today. Although physicians are certainly motivated, as many people are, by economic considerations, their efforts to extend their scope into previously nonmedical areas also stem from honest beliefs that people’s health and lives will improve if these efforts succeed. Certainly there is some truth in this criticism of the conflict approach, but the evidence of inequality in health and medicine and of the negative aspects of the medical establishment’s motivation for extending its reach remains compelling.

The Interactionist Approach

The interactionist approach emphasizes that health and illness are social constructions . This means that various physical and mental conditions have little or no objective reality but instead are considered healthy or ill conditions only if they are defined as such by a society and its members (Buckser, 2009; Lorber & Moore, 2002). The ADHD example just discussed also illustrates interactionist theory’s concerns, as a behavior that was not previously considered an illness came to be defined as one after the development of Ritalin. In another example, in the late 1800s opium use was quite common in the United States, as opium derivatives were included in all sorts of over-the-counter products. Opium use was considered neither a major health nor legal problem. That changed by the end of the century, as prejudice against Chinese Americans led to the banning of the opium dens (similar to today’s bars) they frequented, and calls for the banning of opium led to federal legislation early in the 20th century that banned most opium products except by prescription (Musto, 2002).

In a more current example, an attempt to redefine obesity is now under way in the United States. Obesity is a known health risk, but a “fat pride” movement composed mainly of heavy individuals is arguing that obesity’s health risks are exaggerated and calling attention to society’s discrimination against overweight people. Although such discrimination is certainly unfortunate, critics say the movement is going too far in trying to minimize obesity’s risks (Saulny, 2009).

The symbolic interactionist approach has also provided important studies of the interaction between patients and health-care professionals. Consciously or not, physicians “manage the situation” to display their authority and medical knowledge. Patients usually have to wait a long time for the physician to show up, and the physician is often in a white lab coat; the physician is also often addressed as “Doctor,” while patients are often called by their first name. Physicians typically use complex medical terms to describe a patient’s illness instead of the more simple terms used by laypeople and the patients themselves.

Management of the situation is perhaps especially important during a gynecological exam. When the physician is a man, this situation is fraught with potential embarrassment and uneasiness because a man is examining and touching a woman’s genital area. Under these circumstances, the physician must act in a purely professional manner. He must indicate no personal interest in the woman’s body and must instead treat the exam no differently from any other type of exam. To further “desex” the situation and reduce any potential uneasiness, a female nurse is often present during the exam (Cullum-Swan, 1992).

Critics fault the symbolic interactionist approach for implying that no illnesses have objective reality. Many serious health conditions do exist and put people at risk for their health regardless of what they or their society thinks. Critics also say the approach neglects the effects of social inequality for health and illness. Despite these possible faults, the symbolic interactionist approach reminds us that health and illness do have a subjective as well as an objective reality.

Key Takeaways

• A sociological understanding emphasizes the influence of people’s social backgrounds on the quality of their health and health care. A society’s culture and social structure also affect health and health care.
• The functionalist approach emphasizes that good health and effective health care are essential for a society’s ability to function. The conflict approach emphasizes inequality in the quality of health and in the quality of health care.
• The interactionist approach emphasizes that health and illness are social constructions; physical and mental conditions have little or no objective reality but instead are considered healthy or ill conditions only if they are defined as such by a society and its members.

For Your Review

• Which approach—functionalist, conflict, or symbolic interactionist—do you most favor regarding how you understand health and health care? Explain your answer.
• Think of the last time you visited a physician or another health-care professional. In what ways did this person come across as an authority figure possessing medical knowledge? In formulating your answer, think about the person’s clothing, body position and body language, and other aspects of nonverbal communication.

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Cockerham, W. C. (2009). Medical sociology (11th ed.). Upper Saddle River, NJ: Prentice Hall.

Conrad, P. (2008). The medicalization of society: On the transformation of human conditions into treatable disorders . Baltimore, MD: Johns Hopkins University Press.

Conrad, P. (Ed.). (2009). Sociology of health and illness: Critical perspectives (8th ed.). New York, NY: Worth.

Cullum-Swan, B. (1992). Behavior in public places: A frame analysis of gynecological exams . Paper presented at the American Sociological Association, Pittsburgh, PA.

Ehrenreich, B., & English, D. (2005). For her own good: Two centuries of the experts’ advice to women (2nd ed.). New York, NY: Anchor Books.

Hahn, R. A., & Inborn, M. (Eds.). (2009). Anthropology and public health: Bridging differences in culture and society (2nd ed.). New York, NY: Oxford University Press.

Lorber, J., & Moore, L. J. (2002). Gender and the social construction of illness (2nd ed.). Lanham, MD: Rowman & Littlefield.

Musto, D. F. (Ed.). (2002). Drugs in America: A documentary history . New York, NY: New York University Press.

Parsons, T. (1951). The social system . New York, NY: Free Press.

Rao, A., & Seaton, M. (2010). The way of boys: Promoting the social and emotional development of young boys . New York, NY: Harper Paperbacks.

Saulny, S. (2009, November 7). Heavier Americans push back on health debate. The New York Times , p. A23.

Sehata, G., & Kimura, T. (2009, February 28). A decade on, organ transplant law falls short. The Daily Yomiuri [Tokyo], p. 3.

Shinzo, K. (2004). Organ transplants and brain-dead donors: A Japanese doctor’s perspective. Mortality, 9 (1), 13–26.

Whitehead, K., & Kurz, T. (2008). Saints, sinners and standards of femininity: Discursive constructions of anorexia nervosa and obesity in women’s magazines. Journal of Gender Studies, 17 , 345–358.

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Sociology and Health

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3 Department of Sociology, Usmanu Danfodiyo University, Sokoto, Nigeria

Oliver Razum

4 AG3 Epidemiology & Intern Public Health, Faculty of Health Sciences, University of Bielefeld, Bielefeld, Germany

Many people (including students of sociology) often wonder about the relevance of social sciences (especially sociology) to health issues. In general, it is often a challenge to discuss the nexus between social science and health. Why medical sociology? What does sociology have to do with medicine or health? This chapter aims to answer these questions. It starts with the meaning of sociology and its links to health studies—a definition and brief history of medical sociology and topic description of the discipline. All health problems are conceived as social problems, which are the core focus of sociological studies. This chapter explains the characteristics of social problems with regard to health issues. Health problems are viewed as parts of social pathologies by advancing the sociological dimensions of health problems. The chapter then attempts to re-explain the topical description of medical sociology (first advanced by David Mechanic in 1968) and includes some current issues. The topical descriptions specifically include social aetiology of disease, cultural beliefs and social response to illness, sociology of medical care and hospitals, sociology of psychiatry, social transition and health care, traditional medicine (alternative medicine), sociology of bioethics, health policy and politics, social epidemiology, sociology of dying and death, and medical education.

Introduction

Many people (including students of sociology) often wonder about the relevance of sociology to health issues. In general, it is often a challenge to discuss the nexus between social science and health. Why medical sociology? What does sociology have to do with medicine or health? These are some of the pressing questions that require explanations. The fundamental problem starts with a lack of deeper knowledge of the meaning and focus of sociology. Therefore, it is necessary to proceed by defining sociology and briefly explaining some of its foundational focus. After this, its relevance to health will be explained.

Sociology has been variously defined since Auguste Comte coined the term in 1838. Simply, sociology is the study of human society and social problems. Sociology is the scientific study of social relations, institutions, and society (Smelser 1994 ) . In addition, sociology can be defined as the scientific study of the dynamics of society and their intricate connection to patterns of behaviour. It focuses on social structure and how the structures interact to modify human behaviour, actions, opportunities, and how the patterns of social existence engender social problems. Social institutions include kinship, economic, political, education, and religious institutions. The institutions are like pillars that hold up society because they are the constituent parts of the social system (society). These parts are interdependent and interrelated with specialised functions towards the survival of the society. This is why the human society is often referred to as a social system. Every institution fulfils some functional imperatives. The family institution supports the procreation and socialisation of new members of society while the economic institution deals with the production and exchange of goods. The economic institution employs people from the family institutions, and the family in turn needs the goods and services produced by the economic institution. The health institutions are organised to cater to the well-being and survival of human beings.

Generally, sociology employs scientific approach to study and develops generalisations about human patterns, groupings, and behaviour. In a more concise definition, the American Sociological Association (ASA) defined sociology “as the study of social life, social change, and the social causes and consequences of human behaviour”. Social life is the most central part of the focus of sociology; it implies the connection which an individual holds with others in the society. To sociologists, social life or interaction is the essence of human existence. The process of social interaction itself may put individuals at risk of some communicable disease such as tuberculosis (TB) , severe acute respiratory syndrome (SARS) , and measles. In terms of communicable diseases, mere contact with an infected person (in the process of social interaction) can normally put others at risk. The investigation of social “causes” and consequences is basic in sociological research. There is often a problem of biomedical reductionism , assuming “only the germ causes the disease” without an interrogation of the social conditions enabling vulnerability to diseases. For instance, commercial sex work puts an individual more at risk of human immunodeficiency virus (HIV) than many other occupation groups: that is a kind of occupational condition, which is a risk factor for HIV.

Health Problems as Social Problems

The historical focus of sociology is on social problems in human society. Social problems include health problems, crime , deviance, violence , poverty , inequality, population problems, delinquency, and institutional instability. Social forces such as modernisation and industrialisation marked the beginning of unprecedented social alteration, especially since the beginning of the eighteenth century. This social change led to a number of problems as a result of changes in the relations of production. The industrial revolution led to new forms of production systems, community relations, migration , urbanisation , and especially new forms of employer-employee relations. Industrialisation marked the overthrow of the family as an economic unit. This was a tremendous change in the social system with resultant consequences, hence emerging social problems such as unemployment, poverty, child labour , gender discrimination, crime, and health problems. This is not to argue that all these problems only emerged during the industrial revolution , but they rapidly multiplied during that period. Social problems are conceived as strains within the system, seen as the product of certain objective conditions within the society, which is inimical or detrimental to the realisation of some norms or values for members of the society (Lyman et al. 1973 , p. 474) . Any issue that threatens the well-being or survival of the society is regarded as a social problem. Weber ( 1995 , p. 9) defined social problems “as a social phenomenon that is damaging to the society or its members, is perceived as such, and is socially remediable.”

It is important to note that just as crime is damaging to the society or individual, so is any health problem. Apart from this fact, a social problem can be identified through the following characteristics, which include:

• It is an objective condition. This implies that it can be empirically defined. A social problem exists as a condition that can be verified. Even when subjective interpretation may be required, a social problem is an evidence-based problem, not just mere perception of an individual but a general knowledge that is usually definite. This represents a utilitarian view, which holds that social problems are objective things, or what Durkheim regarded as social facts (Smelser 1996 ) . Smelser observed that the assertion is like the medical model which views social problems as a form of disease with an identifiable cause, definite symptoms, and calls for a cure.
• It has social aetiology or could be linked to it. This implies that a social problem emanates from the pattern of social interaction, organisation, association, or simply is engendered by social conditions. This point should be noted as a relevant perspective in explanation of human health/diseases and not an absolute explanation. For instance, Wellcome ( 2002 , p. 30), summarising Day Karen’s research report, observed that “… Falciparum parasite [malaria] we see today arose about 3200–7000 years ago—an era that coincides with the dawn of agriculture in Africa . This was a time of massive ecological change, when humans began to live in large communities and the rainforest was being cut down for slash-and-burn agriculture… there was also a major change in the mosquito vector at that time, when it began biting humans instead of animals… ” It is further observed that P. falciparum migrated with Africans to other parts of the world. This means that the process of migration aids the spread of malaria . This is why Smelser ( 1996 ) also observed that the increasing world traffic of people would internationalise many health problems. It is for this reason that HIV, first diagnosed in the United States in the early 1980s (Jackson 2002 ) , is now a global problem. Moreover, some diseases are rooted in genetics or heredity, thereby multiplying through marriage patterns or human relationships. Holtz et al. ( 2006 , p. 1665) observed that it is impossible to understand population health without considering the social origins of diseases—“the risk of exposure, host susceptibility, course of disease, and disease outcome; each is shaped by the social matrix… ” Social conditions are now invoked as fundamental causes of diseases in human society because such conditions affect exposure to diseases, as well as course and outcomes of diseases (see Chap. 10.1007/978-3-319-03986-2_4 for social determinants of health, Sect. 10.1007/978-3-319-03986-2_6#Sec5 for fundamental cause theory).
• It poses social damage. A social problem often incapacitates the individuals in a society. As poverty prevents individuals from satisfying basic needs, so, too, health problems prevent individuals from functioning effectively as members of society. A health problem may reduce the functionality of an individual within the social system . Invariably, a social problem is inconsistent with the normative value of the society. Society wants its members to be healthy, and the unattainability of this desire shows a discrepancy between social value and reality. Such a discrepancy represents a social problem.
• It affects the collectivity. A social problem is different from a personal problem in that the former affects a substantial number of people in the social system (see Harris 2013 ) . Health problems are ubiquitous like other problems such as crime and poverty. There may be a geographical variation in the magnitude or frequency, but most social problems are a pandemic. It is thus a problem when a significant number of people believe that a certain condition is, in fact, a problem (Kerbo and Coleman 2007 ) , and it constitute a problem to their social existence or wellbeing.
• It requires social action. Social problems require collective action. The solution to any social problem does not reside in just any individual; it requires the majority to act in order to ameliorate the problem. It may necessitate institutional or community approaches. Health problems also require collective action. This is why there has been a lot of implementation of research and policy engagement to improve the health of the people. This is also why health issues often appear in development agendas.

The aforementioned attributes qualify health problems as social problems. This is separate from the social dimensions of health problems, which will be examined later in this book. Health problems can also come with other dimensions apart from the aforementioned attributes. It may not only be socially damaging but also biologically damaging. Often, a health problem may move from being biological pathology to social pathology or vice versa. Whichever form it takes, it constitutes a pathology that must be remedied by the society. Sociology has been relevant ever since Comte conceived it as a science that would provide salvation from all the social problems confronting the world. Improved relevance of sociology in human society will alleviate human suffering and provide equitable well-being. Therefore, the application of sociological methods and perspective and attention to the social dimensions of disease should provide a vital step forward in disease control.

Apart from the fact that health problems constitute a major social problem, it is important to further stress the relevance of sociology to health. First, in this case, it is human health. It is about the people, community, and society. The health of the society cannot be grasped without understanding the intricacies of the community or society itself. George Simmel conceived of human society as an intricate web of multiple relations—of people in constant interaction with one another (Coser 2004 ) , of people who are bound with common fate, norms, values, socio-spatial conditions, exposures, and opportunities. It is about the health of people who build and share similar health institutions or who live, for instance, in an African rainforest where they are exposed to mosquito bites every day. It is also about the health of the community that has access or otherwise to simple preventive measures for malaria or diarrhoea. Health is about the society where there is self-accountability to take up smoking and bear the associated health risks. As mentioned earlier, any issue concerning the social collectivity is of enormous interest to sociology. Simply, health is one such issue of interest because it concerns the people and also affects the patterns of social interaction.

Apart from focusing on the people, health is intrinsic to human functioning or existence. It confers a form of capacity on the individual to perform social functions in human society. Human value or existence is enhanced by good health. Good health is instrumental to human survival and is required to strive for the basic necessities of life. As a contributing member of the social systems , one needs good health, and lack of this threatens the pattern of social interaction with other members in the social system. Health indicators have been used to assess the level of development in a society. It is also used as a measure of chance of survival in human societies. This is why health is a social value both at the individual and collective levels.

Medical Sociology Defined

Medical sociology is simply the application of sociological perspectives and methods in the study of health issues in human societies with a skewed focus on the sociocultural milieu that accounts for human health and illness. These perspectives include sociological theories and tools, which can be applied in the analysis of human health. In this case, the individual is examined as a member of the society, who partakes in the day-to-day functioning of the social system. The pre-comprehension is that humans exist within a socio-spatial milieu, which often affects their health. Such social conditions and the nature of human interaction are instrumental to the well-being of every individual in society. It is also assumed that the nature of social interaction and networking is a part of the determinants of human health. Sociologists are interested in issues regarding human health and employ systematic procedures to examine social phenomena. They have relied on quantitative and qualitative techniques to establish universal laws governing human societies. The essence of the methods is to look at the social links that can explain sociocultural linkages to health issues. In any case, medical sociology is the application of sociological theories, knowledge, and concepts to issues of health and illness (Hafferty and Castellani 2006 ) .

Medical sociology can also be defined as the scientific study of the social patterning of health. In this case, it is a study of how social factors (e.g., class, race, gender, religion , ethnicity, kinship network, marriage, educational status, age, place , and cultural practices) influence human health. The idea of social patterning indicates that these social factors could be the determinants of human health status (see Chap. 10.1007/978-3-319-03986-2_4). It is in this sense that some diseases may be referred to as diseases of poverty (e.g., malaria and TB) because they are much more prevalent in poor regions or among the poor. For example, a person residing in a slum is at a higher risk of being exposed to certain diseases which a person in affluent area may have lower risk of being exposed to. Medical sociology is distinct in its approach because it considers the “import that social and structural factors have on the disease and illness processes as well as on the organisation and delivery of health care” (Hafferty and Castellani 2006 , p. 334) . Hafferty and Castellani further observed that these factors also include culture (e.g., values, beliefs, normative expectations), organisational processes (e.g., hospital setting), politics (e.g., health care policy, health budget, political ideology), economic system (e.g., capitalism , the costs of health care), and microlevel processes such as socialisation and identity formation.

Apart from pure research, medical sociologists are also interested in implementation or applied research. This involves the implementation of interventions to improve the health of the population through community engagement and participation in policy formulation and implementation. As Kaminskas and Darulis ( 2007 ) noted, medical sociologists utilise applied sociological methods—such as needs assessment, social impact assessment, and case management options—in health care settings using evaluation research methods. This area of applied research has attracted a lot of grants and promoted collaboration with others in the medical field through a multidisciplinary approach to health management .

Cockerham ( 2001 ) further observed that medical sociology has actually established itself as a strong subfield of sociology and removed itself from being a subordinate of medicine. He provided four major reasons for the strong academic locus of the subfield. First, the extension of focus from acute to chronic diseases strengthens the relevance of sociology to medicine because of the key roles of social condition and social behaviour in the prevention, onset, and management of chronic disorders. Medical sociologists are more relevant in the analysis of social conditions of health than physicians. Second, medical sociology has focused extensively on issues relating to clinical medicine and health policy . Third, success over the years in medical sociological research has promoted the professional status of medical sociologists in the analysis of the social patterning of health. Fourth, medical sociologists have studied medical practice and policies—at times with a critical stance to expose some blind spots .

A Brief History of Medical Sociology

Medical sociology has become a substantive subfield of sociology . It can be argued that medical sociology began with the conception of sociology by August Comte ( 1896 ) through his concept of organismic analogy . This can be a deductive argument since Comte did not intend to establish medical sociology as a subfield and did not attach the importance of sociocultural issues in health. Comte, and later Herbert Spencer ( 1891 , 1896 ) , extensively compared human society to a biological being. Spencer observed that the universe consists of organic (living), inorganic (nonliving) and super-organic (society) entities. The idea of organismic analogy is that the human society has similar characteristics as that of the biological organism. The similarities include growth and development, differentiation of parts, specialisation of functions, interrelatedness, and interdependence of parts. The parts of the society include the social institutions, which work harmoniously for the survival of the society. The argument further relates that if one part is damaged, it will adversely affect other parts of the society. Health institution may be affected if the political institution is corrupt or not responsive to aspirations of the citizens. This is part of the reasons why strong political will is required in implementation of health programs.

The theory of Marx and Engels explains that economic infrastructure is the foundation on which other superstructures of the society rely. Inequalities in income translate to other forms of inequalities in human society, including health inequalities . This is why Marx’s proposition has been widely applied in all facets of life including health inequalities, accessibility to health care and allocation and distribution of health resources and infrastructures (see Sects. 10.1007/978-3-319-03986-2_6#Sec2 and 10.1007/978-3-319-03986-2_6#Sec3 for further elaboration). Another major landmark is the work of Emile Durkheim ( 1897/1951 ) on suicide . This is directly related to medical sociology since it is about the issue of death. Durkheimian perspective on suicide will be explained in detail later (see Sect. 10.1007/978-3-319-03986-2_5#Sec6 for further elaboration). The perspective examines the influence of social factors in self-termination of life. Durkheim identifies two major factors, which fluctuate to increase or decrease propensity to suicide. These factors are social regulation and integration. This has been a major sociological perspective in the analysis of suicide because it was a theory derived from empirical investigations. The works of Max Weber on bureaucratic rationality and social action have also been substantially applied in medical sociology to explain the organisation of health care institutions and why and how people care for others (see Sects. 10.1007/978-3-319-03986-2_7#Sec4 and 10.1007/978-3-319-03986-2_7#Sec9 for further elaboration) .

At the time these classical sociological scholars (August Comte, Emile Durkheim, Max Weber, and Karl Marx) were writing, they did not have medical sociology in mind; however, their works provided the landmark for the development of a subfield of sociology called medical sociology. The works created the foundation for the emergence of sociological perspectives and methods that can be applied in the study of social patterning of health.

In 1848 Rudolf Virchow (a German physician) laid the foundation of social medicine (Holtz et al. 2006 ) by advocating for the relevance and consideration of social factors in human health and disease. While this set a new agenda for medicine, it opened a wide passage for the social sciences involvement in the understanding of human health. The early 1900s marked the beginning in the study of sociological dimension of medicine, especially with the works of Charles McIntire (“The Importance of the Study of Medical Sociology,” published in 1894), along with other scholarly works of that period including the book by Elizabeth Blackwell ( 1902 ) and another by James P. Warbasse ( 1909 ), both on medical sociology (Bloom 2002 ; Hafferty and Castellani 2006 , p. 332) .

In the 1950s, Talcott Parsons ( 1951 ) published a groundbreaking work with a section on the application of functionalism in medical sociology. He dedicated a substantial part of his work to the elaboration of the sick role , explaining the social trajectories of the sick within the social system and how the health institutions can support individuals to return to normal roles in the society (see Sect. 10.1007/978-3-319-03986-2_5#Sec4 for further elaboration). Parsons recognised the relevance of medicine for the society and drew attention to illness as a form of social deviance and the importance of sick role as a mechanism of social control (Freidson 1962 ; Stacey and Homans 1978 ). This is the first conscious application of sociological theory in the understanding of human illness. The sick role concept facilitated the expansion of other areas of research including the patient-physician relationship, illness behaviour, medicalisation of deviance, and medical professionalism (Hafferty and Castellani 2006 ) . The works of Freidson ( 1961a/1962 , 1961b ) and Mechanic ( 1966 , 1968 ) also promoted the relevance and understanding of medical sociology.

Conrad ( 2007 ) described Eliot Freidson’s works as revolutionary in medical sociology. Freidson (1961, 1970a , 1975 ) devoted his time to the study of professionalism and professionalisation in medicine which presents a comprehensive view of the social and professional dynamics of medicine with a particular reference to how disease and illness are constructed, power relations between the physician and patients, division of labour, ethical conducts, increasing commercialism, and bureaucratic control in medical practice. Freidson’s works were landmarks in the development of medical sociology. He practically demonstrated the relevance of sociology in medicine and health studies in general by situating his studies within applied domains .

During the same period, Glaser and Strauss ( 1965 , 1968 ) also examined the social process of death and dying, and Erving Goffman ( 1961 , 1963 ) released a masterpiece, Asylums , which introduced the concept of stigma and total institution (see Sects. 10.1007/978-3-319-03986-2_8#Sec6 and 10.1007/978-3-319-03986-2_8#Sec11 for further elaboration). The Asylums focused mainly on the study of mental health patients and health care institutions. It was a remarkable breakthrough in the application of medical sociology to the study of health care institutions. The work of Goffman has been one of the most successful sociological pieces in the management of patients and health care institutions. The concern of this subsection is to trace the development of medical sociology: Chapters 10.1007/978-3-319-03986-2_5, 10.1007/978-3-319-03986-2_6, 10.1007/978-3-319-03986-2_7, and 10.1007/978-3-319-03986-2_8 will expand some of the substantive theories of medical sociology.

The development of academic journals (e.g., Journal of Health and Social Behaviour ; Social Science and Medicine ; Sociology of Health and Illness in 1979) in the discipline, especially in the 1960s, also aided the development of the discipline (Hafferty and Castellani 2006 ) ; and now there are many other dedicated and related journals including Health and Place , Health Affairs , Women and Health , Reproductive Health Matters , Social Theory and Health , Medical Anthropology , The Lancet , Social History of Medicine , and many others .

Furthermore, not only do medical sociologists proclaim self-relevance to medicine but medical scientists have increasingly come to the realisation that a number of significant health care issues are outside the walls of the hospitals, pharmaceutical and medical laboratories. Clausen ( 1963 , p. 1) observed that it has become apparent that “the understanding of health and disease requires a holistic approach in which the social and cultural aspects of human behaviour are appropriately related to the biological nature of every human being and the physical environment in which he[/she] lives.” Clausen further observed that the emphasis upon the holistic approach to medical science and comprehensive health care has moved medicine to seek the services of social scientists, notably in connection with public health , preventive medicine, and psychiatry. In short, there is an unprecedented sociolisation of medicine, a term used by Barbour ( 2011 ) to describe how sociology has come to shape the profession of medicine, and to add to it, how sociology shapes the understanding of health and illness in the society.

From the 1960s onwards, there has been increasing popularisation of medical sociology with many departments of sociology now having specialisation in medical sociology as an option, especially for graduate programs. Cockerham has observed that medical sociology comprises one of the largest and most active sociological specialties in the developed world and the subdiscipline is expanding in Asia, Africa , Latin America, and other regions. Specifically, Africa has not been left out in this development as medical sociology is now recognised as a subfield of sociology. Medical sociology is growing in strength and importance in South Africa (Gilbert 2012 ) like in other African countries. There is a growing realisation that social issues are relevant and significant in explaining population health in Africa and elsewhere. The study of sexual behaviour and other social aspects of HIV/AIDS seemingly demonstrate the sociological milieu in the understanding of health. The first crops of medical sociologists in Africa were trained in western societies, specifically in the United Kingdom and United States . Now, the number of those trained in Africa is increasing, coupled with a demand for medical sociologists in health intervention in Africa.

Many medical sociologists from Africa now partner with their counterparts from other continents in addressing international health. Medical sociologists also collaborate with non-governmental organisations (NGOs) to address social determinants of health in communities. Likewise, there are many social science institutes in Africa (e.g., the Council for the Development of Social Science Research in Africa [CODESRIA]), which have incorporated health discourse as a priority. The introduction of the Health Institute by CODESRIA to train and offer small grants to young social scientists interested in health issues is part of this brilliant effort .

Topical Description of Medical Sociology

Many scholars have described medical sociology in various ways: sociology of health and illness or health sociology. “Medical sociology” is more encompassing to describe the broad aspect of sociology dealing with medicine and health in general. One particular description is that of Straus ( 1957 ) , who averred that medical sociology consists of sociology of medicine and sociology in medicine . Straus ( 1957 , p. 203) observed that “[s]tudies of the profession (of medicine) and those dealing with the organization of health resources are primarily in the sociology of medicine [while] teaching activities and research in which the sociologist is collaborating with the physician in studying a disease process or factors influencing the patient’s response to illness are primarily sociology in medicine.” Straus made the distinction as a result of activities and affiliations of 110 medical sociologists.

Straus ( 1999 , p. 109) further reiterated that sociology in medicine involves “activities that were associated with achieving the educational, research, or clinical goals of medicine. These were often collaborative with health professionals and occurred within health or medical institutions. They were carried out most frequently by sociologists who held appointments in health professional-schools, hospitals, or other health-care organisations.” On the other hand, sociology of medicine is close to what could be described as sociology of health and illness. It involves the study of social factors in disease aetiology, incidence, prevalence, distribution, social response to health and illness, therapeutic process, and community health needs .

Initially, Straus ( 1957 ) thought it was not feasible for a sociologist to engage in the sociology in and of medicine together; however, later he ( 1999 ) observed that because of crosscutting intellectual development, it is now feasible. Therefore, the distinction “of and in” is merely the distinction of activities, not that of persons involved. Medical sociology has now grown into a full subdiscipline of sociology with more diverged activities as a result of intellectual and research domains. It is now possible to present a topical description of medical sociology without a topical differentiation between that of sociology in or of medicine. Therefore, another major concern of students of sociology or professional is a clear topical description of medical sociology. It is imperative to explain the intellectual domain of medical sociology. The first major attempt at this was by David Mechanic ( 1968 ) , who highlighted a number of intellectual domains of medical sociology. Apart from the fact that there are still some new developments, a re-explanation of some of the domains in line with currents trends is necessary.

Social Aetiology of Disease

Medical sociology primarily focuses on the social causes of disease. Social causationism entails direct and indirect (social) exposure to diseases. While a medical doctor will simply note that a patient has HIV, a sociologist is more interested in the sexual network of the patient since HIV can be acquired through the process of sexual interaction with others in the society. This pattern of sexual relation is a social determinant. Another explanation is that the decision to engage in protective sex is entirely that of the parties involved. A medical sociologist is more interested in the “push” factors that expose individuals to any disease. Another example is the high prevalence of vesicovaginal fistula (VVF) in sub-Saharan Africa (SSA) . There are many social issues that expose women to the risk of VVF, which include age at marriage, access to maternal care, maternal education, and gender inequality , which prevent many women from obtaining permission for their partners to attend health facilities. Some of these issues are sociocultural issues, which need to be addressed in order to reduce the incidence of VVF in SSA.

The notion of social aetiology is embedded in risk factors, most of which occur at the individual or societal level (see Chap. 10.1007/978-3-319-03986-2_4 on social determinants of health) ; however, some risks have to do with the norms and values of the societies. For instance, a culture which promotes gender inequality or male hegemony puts women at a risk of gender violence including sexual abuse and female infanticide . The assertion that lifestyle and living conditions could expose individuals to diseases is not new and has been a major focal point in preventive medicine. Particularly in the developing world, vulnerability to disease often has less to do with germs than with the so-called social causes—factors such as income, education, gender, occupation , housing , and access to health services. Social deprivation is a key predictor of distribution of diseases and life expectancy . The social causes also include poor sanitation, nutritional deficiencies, poor infrastructures (e.g., water supply), lack of safety at work, overcrowded or poorly maintained housing , environmental pollution, stress, and lack of exercise due to a sedentary lifestyle. The social causes can also be explained in terms of the lack of education on preventive measures or appropriate health behaviour.

These social causes often found in the social condition of the individuals or societies constitute the primary crux of medical sociology. The relevance of medical sociology can be assessed based on the efforts in addressing these social causes.

Cultural Beliefs and Social Response to Illness

Cultural beliefs and responses have direct consequences for both preventive measures and cure-seeking behaviour. Illness perception is usually conceived in terms of local definition of the illness—its perceived cause(s), vulnerability, severity, and perceived modes of transmission. This illness perception or local understanding and cultural beliefs also constitute a part of the core focus of medical sociology. There is a cultural repertoire for recognising, diagnosing, or defining the illness condition (Alubo 2008 ; Erinosho 2006 ) . Illness is a deviation from societal norms and values, usually manifested through failure of an individual to perform his/her normal roles in the society. The course of illness is determined not merely by biomedical factors but also by the way the patients define and respond to the illness.

The response to illness often reflects a society’s medical beliefs about the causes of health problems, choices of treatment options, and other health-related concerns. Feyisetan et al. ( 1997 ) noted that certain disease-specific and non-disease-specific cultural beliefs may influence people’s health and health-seeking behaviour. This is why it is important to consider cultural beliefs and practices of the people when designing measures and programs aimed at improving their health (Comoro et al. 2003 ; Feyisetan and Adeokan 1992 ; Jegede 2002 ). It is further noted that the adoption of both preventive and curative methods may also depend on people’s conception of the causes of illness and on their level of conviction about the efficacy of the preventive and curative methods (Feyisetan et al. 1997 ) .

For instance, at the beginning of the HIV crisis in Africa , the problem was about people’s belief in the reality of the disease. For several years, the “HIV is real” campaign was widespread. The response then was very weak. In general, people who doubt the reality of a disease would not adopt any preventive measure. By the time the reality of AIDS (acquired immunodeficiency syndrome) was incontrovertible (at least to the general majority), the havoc had already been caused—HIV has eaten deep into all fabrics of the society and thousands of people are losing their lives daily. Additionally, there were a lot of causal misconceptions surrounding HIV/AIDS at the societal level, which also stymies adoption of both preventive and treatment options.

Sociology of Medical Care and Hospital

The concerns of this aspect are on the sociocultural aspects of medical care and hospital as a (social) institution. There are often options in medical care, especially traditional and modern approaches (Alubo 2008 ) . This interaction of plural systems of health care may be complementary, competitive, or even conflicting. Choice is usually modified by the cultural belief system in the community. Another main issue is the cost of seeking medical care in relation to affordability and quality of services from medical institutions. These are interwoven issues that have constituted focal points in medical care. Another significant issue is the gender context of medical care and hospital. Analysis of gender issues in terms of care providers and receivers is vital in medical care. At times, experts analyse the importance of cultural competence in health care delivery and desirability of gender concordance (patient-practitioner) in health care .

There is also a significant focus on the hospital as a social or total institution , a small society or a home of the vulnerable population. This aspect also attempts to explain the competing interests for managing the patients in the hospital environment, and consider how these interests or influences manifest, and are resolved in the delivery of care. The experiences of patients and quality of service delivery (especially patients’ satisfaction with care) are also part of the focus. This aspect also attempts to examine perceptions of and social relations within health care institutions—the patient-practitioner, practitioner-practitioner relationships, work-related difficulties and adjustments, and the role of health professionals in society.

Sociologists also tend to unravel the bureaucratic structures in medical care or hospitals and how such structures influence health care delivery systems. What is the impact of red tapism on service delivery? How do standardisation or organisation hierarchies pattern the service delivery system? How are the health professionals responding to the changing bureaucracy in the medical setting? How are or can health workers be motivated to achieve the goals of health organisation or policies? All of these questions constitute parts of the research focus of medical sociologists.

In addition, power relations within the hospital management are also part of sociological research. There are resultant power scuffles that often affect health care delivery systems. The constituent units in the hospital (medical doctors [including various specialists], pharmacists, nurses, administrative staff [e.g., accountants and personnel officers], laboratory professionals, and other cadre employees [down to the lowest cadre such as cleaners]) have sometimes been in conflict as a result of power relations in work contacts. Conflict often arises as a result of interrelated and interdependent tasks and, in some cases, unclear definition and demarcation of tasks, especially among related professionals (e.g., physicians and physiotherapists in the management of a fracture). These power relations have been a core part of medical sociological research.

Sociology of Psychiatry or Social Psychiatry

Psychiatry is a medical subdiscipline that works most closely with the social sciences , especially sociology. The thrust of social psychiatry is on the social and cultural context of mental health and illness. Social psychiatry is concerned with the cultural and social factors that engender, precipitate, intensify, or prolong maladaptive behaviour and complicate the management of mental disorders. It is also defined as a field of psychiatry based on the study of sociocultural and ecologic influences on the development and course/trajectory of mental diseases . Because of evidence-based social aspects of mental health, social psychiatry is perhaps the most visible aspect of mental health management. It also leads to the emergence of subprofessionals in psychiatry, known as social psychiatrists. Mental health has much to do with lifestyles and social conditions. In fact, most manifestations of mental disorders depict the contravention of normal standards of behaviour in the society. This implies that in most cases, a mental disorder is recognised through excessive abnormal behaviour within the social system . Hence, there was a shift in psychiatric ideology to the patient’s behaviour and social relationships (Pilgrim and Rogers 1994 ) .

Community psychiatry approach has been a major management approach in psychiatric treatment. This approach takes cognisant of the socio-spatial environment and the roles of significant others in the rehabilitation and re-integration of those with mental disorders. Positive support from such links will facilitate the rehabilitation and re-integration of the patients. Medical sociologists have been actively involved in the management of the patients and implementation of research necessary to improve patient management styles. There is also a growing body of research on the handling of patients in psychiatric hospitals, focusing on the use of physical and medical restraints and violence .

Social stigmatisation of the mentally ill is also part of the research focus in medical sociology (see Sect. 10.1007/978-3-319-03986-2_8#Sec5 on labelling and mental illness). Stigmatisation prevents proper re-integration of the patients and may lead to relapse of the mental health condition following a worsening social condition of the patients. This is why medical sociologists often prioritise how to reduce social stigmatisation among all categories of patients. Most importantly, the works of Erving Goffman ( 1961 , 1963 ) on total institution (see Sect. 10.1007/978-3-319-03986-2_8#Sec11) and stigma (see Sect. 10.1007/978-3-319-03986-2_8#Sec6 ) have been the major guiding theoretical underpinnings in social psychiatry and social reaction to illness/diseases. More often, community psychiatry depicts the de-institutionisation approach advocated by the Goffmanians in order to minimise alienating experiences and estrangement of the patients. The aforementioned issues constitute some of the areas of involvement of medical sociology in psychiatry.

Social Transition and Heath Care

There are dual aspects of social transition as it relates to health care—a change in both the society and health care itself. Change in the society might inform change in health care and there could also be meaningful development in health care as a result of improved technology. Medical sociologists are interested in both. They are riveted in social dynamics and responses of various facets of social organisation. Social change is constant; hence, human society is constantly undergoing numerous forms of social transition. The health care institutions have continuously been responding to changes in all sectors of the society. As a result of changes in the economic systems, for instance, some societies practise a capitalist health system , while others adopt a socialised health care system with embedded variations in how the systems are implemented. Medical sociologists are interested in how social transitions, whether political or economic, affect health care systems. They are interested in the course, causes, and consequences of such social transitions in the health care sector.

Apart from the institutional focus regarding social change, medical sociologists also study how such changes affect health and illness behaviour of the individuals. Both the individual and the institution often respond to change. In this regard, it is important to document what social change means for the health of the community. Social change may also affect vulnerability to different forms of diseases. Modern inventions create possibilities in health care systems and also raise copious sociocultural apprehensions. The advancement in information and communication technology makes telemedicine possible and improves diagnosis and treatment of patients. The Human Genome Project (HGP) continues to create more possibilities in health care systems. We are now living in a world with assisted reproductive technology , stem cell research , and nanotechnology. Many individuals now desire to enhance their bodies instead of treating disabilities. The possibility of transplantation leads to a proliferation of organ markets. These are some typical examples of issues generating new research directions in the sociological study of health and change.

Traditional Medicine/Complementary and Alternative Medicine

Ethno-medicine , or traditional medicine (TM) , has been one of the major focal points of sociological research (see Sect. 10.1007/978-3-319-03986-2_10#Sec2 for further elaboration) . The utilisation of TM in the prevention and treatment of diseases has been intensively researched by sociologists in an attempt to understand the sociocultural context associated with the continuous patronage of TM. What informs the choice of TM? How prevalent is the use of TM? Are patients getting results from TM? What is the cultural basis of the belief in TM? Are there diseases that are only amenable to TM? How does TM differ from the biomedical norm in the definition of disease, perception of symptoms, and treatment? How can TM be recognised and incorporated into the general health care system? How is TM itself organised as a health care alternative? What is the place of TM in health care policy? Is TM complementary or alternative to modern medicine? What are the limitations of TM in health care? These are some of the questions that sociologists want to answer.

In some countries, there is constant tension between traditional and modern medicine, especially as an alternative health care system. Unfortunately, most of the practices of TM are not amenable to science and are grossly less advanced than modern medicine. But the incessant reliance in some communities on TM informs its recognition as part of health care institutions. Such recognition is also necessary as most of such societies have limited access to modern health care . In addition, TM seems to be the closest health care system to underserved communities. More importantly, there is an argument that it conforms to the belief system of the community. It is because of these aforementioned reasons that sociologists are concerned about the developments in TM .

Sociology of Bioethics

There is now sociology’s engagement with bioethics, a field of growing interest that is defined by its concern with moral questions in biomedicine (De Vries 2003 ; Petersen 2011 ) , whether it is called sociology in bioethics or sociology of bioethics (see Chap. 10.1007/978-3-319-03986-2_11 for further elaboration) . The field of medical ethics or bioethics in general is multidisciplinary because the ethical dilemma in health care requires the inputs and understanding of various professionals. Some of these moral perplexities are part of societal concerns for equity, equality, and justice in health care. A majority of these issues are sociocultural issues and general ethical or moral standards of behaviour in the society. This is why sociological insights are necessary if the ethical conundrums presented by medicine are to be successfully resolved in practice. The most vital tool in medicine is the “human body.” The body is a place where medical practices and interventions are exercised. The human and his/her body have a significant place in sociological impetus. Sociologists collaborate in resolving moral challenges in health care practice and research. Humphreys ( 2008 , p. 51) observed that the sociological approach has brought out some interesting perspectives, especially unintended consequences of behaviours that bioethics (and research ethics) may not have anticipated.

While the field of sociology of biomedical ethics is still emerging, especially in SSA, a number of medical sociologists hold interest in it. In developed countries, there is a growing relevance of bioethicists in health care regulations and practices. Sociologists generally want to understand how ethical challenges can be resolved within the limits of societal conscience and how moral values and ethical behaviours are embodied and lived by social agents. How do ethical resolutions conform to the cultural milieu of the society? How are resolutions in the best interest of the individual? What are the future implications of ethical resolutions? How do medical practices incline with the norms and values of the society? How can we structure the development of new technology and its application within the moral values of the society? Sociologists have often challenged bioethics to look beyond principlism (Petersen 2011 ) . Humphreys ( 2008 ) noted that sociology of bioethics has concentrated on social processes within bioethical debate, on role relationships, and on the norms, values, and beliefs of those engaged in the bioethical endeavour. Invariably, sociology now has keen interest in the relevance of social processes in the understanding of moral uneasiness posed by some advancement in biomedical sciences such as biobanks, stem cell research , biotechnology, nanotechnologies, genetic testing , clinical trials , transplantation , and medical enhancement .

Heath Policy and Politics

One major factor that greatly influences the health of the society, beyond the handling of a stethoscope or syringe in the hospital, is health policy and politics . Health politics is about who gets what health resources, why and when. Such politics involves the creation of medical schools; construction of health facilities; recruitment and deployment of health personnel; determination of health workers’ benefits and their motivation, procurement, and provision of equipment; appointment of health care administrators; and initiation, formulation, and implementation of national, regional, or community health care policies. These issues are really crucial and are usually not under the control of the physicians, but rather the politicians or political leaders. This further signifies that a number of fundamental issues are beyond the confines of the hospital walls that must be properly considered in order to improve the health of the people.

Medical sociologists in particular are interested in the community or societal processes in the formulation of health policy . Most sociological questions include, among others: What are the social consequences of health care policy on the health of the community? Which policy is working, which is not, and why? How does health policy affect access to health care? What are the attitudes towards health policy? Who benefits from a particular policy and why? How can policies be modified to get better results? How are health facilities distributed and why? How adequate are health personnel and are they properly motivated to deliver national health policies? What is the influence of political will or political agenda on health care prioritisation? All of these questions are often treated using sociological perspectives and methods.

The intricacies involved in health care politics are often overwhelming and often require unparalleled attention if population health must be improved. In most SSA countries, there is paltry health political will, which accounts for poor health care facilities and, hence, high prevalence of health problems. There is often an insufficient budget and diminutive political will to implement the best practices, which explain the high rate of mortality from preventable diseases each year. The meagre foreign aid is mismanaged and good health policies often turn ineffective. There are critical issues for health policy and politics, which, if addressed, could improve population health in many countries. This is why medical sociologists consider health politics a part of the crux of the discipline .

Social Epidemiology

This is the study of the sociocultural factors in the distribution, incidence, and prevalence of health problems in human society. Jegede ( 1996 ) defined social epidemiology as the study of the disease process; its occurrence in population groups; those social and cultural factors that affect their incidence, prevalence, and distribution; and the host response in disease prevention and control in human population. Social epidemiology often focuses on what Krieger ( 1994 , 2001) described as the multifactorial aetiology or web of causation—an array of social determinants of health distribution, an interplay of host, agent, and environment. There are numerous interconnected risk factors in the social system , which exposes individuals to the agents of diseases. These multifactorial links constitute the focus of social epidemiologists. It is through the understanding of the multicausality of disease that the differential distribution of diseases can be explained. One fundamental principle in social epidemiology is that humans are embodied agents (both socially and biologically). The interplay of these embodiments plays significant roles in risk exposure and susceptibility. Social epidemiology is a marriage of sociological frameworks to epidemiological studies (Krieger 2001 ) , which represent a holistic approach.

Sociology of Dying and Death

Medical sociologists are also interested in patterns of mortality in human society. The major focus is on the social factors responsible for differential mortality rates in different social groups and societies in general. Issues such as income, gender , race, education, marital status, and occupation are associated with death rates. Sociologists study the interplay of these factors with risk exposures. Life expectancy in various nations is also unconnected with social conditions. There is strong relevance of sociological frameworks in the analysis of death in human society.

Apart from this, death is also a biosocial issue. It is biological because of the failure of biological organ(s) in the body, which often signifies death. Certification of death is thus a biomedical necessity. Social death could, however, occur before (biological) death. The inability to be a functioning member of the society due to total social incapacitation, and signals the expectation of (biological) death. Apart from this, death itself is a form of social transition; a new form of being that creates a vacuum, which often signifies emptiness of social roles. This implies that death has significant social repercussions for the affected individuals and the society at large. Hence, society often prepares to cater for the social blankness created by death. Bryant ( 2002 ) observed that society shapes social structure to constrain and contain the disruptive effects of death.

Furthermore, one of the primary interests is on the causes of death in human society—especially those causes that have links with sociocultural issues. Such causes are usually studied sociologically and historically. This will expose the social patterns of death: which group dies more from what ailment and why. What are the sociological explanations of the exposure of the group to a particular ailment in the society? More so, sociologists are also interested in passage rite for the dead. Different societies respond and receive death in various ways. Other issues of interest include notions of good and bad death , death and social institution, social responses to death, political economy of death, death and religion , death after life, life after death, and increasing versus decreasing life expectancy across the globe.

Medical Education

The bedrock of sociology of medical education is the prioritisation of health and social origin of medical education, which has profound implications for knowledge orientation and dissemination, organisational arrangements, and access to such education . It focuses on current issues affecting medical students, the profession, faculty members, and the impact of medical education on the society at large. Light ( 1988 , p. 307) also observed that “the changing locus of medical education in the matrix of social, cultural, political, and organizational forces exhibited by the health care system calls for the attention of medical sociologists.” A number of research priorities in sociology of medical education include: how social changes affect delivery and content of medical education; access to medical education among various social groups; orientation of medical education; outcomes of medical education; and health policy and medical education. Mechanic ( 1990 ) averred that focus of this area also includes how to improve medical curricula, cultural competence in medical education, and ethical behaviour of medical professionals as well as the study of the pattern and context of professional socialisation .

Contributor Information

Jimoh Amzat, Email: ku.oc.oohay@aojtaerg .

Oliver Razum, Email: [email protected] .

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Theoretical Perspectives on Health

Learning objectives.

• Understand how the three different perspectives view health and illness.

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.

Functionalism

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.

Parsons argues that since the sick are unable to fulfill their normal societal roles, their sickness weakens the society. Therefore, it is sometimes necessary for various forms of social control to bring the behavior of a sick person back in line with normal expectations. In this model of health, doctors serve as gatekeepers, deciding who is healthy and who is sick—a relationship in which the doctor has all the power. But is it appropriate to allow doctors so much power over deciding who is sick? And what about people who are sick, but are unwilling to leave their positions for any number of reasons (personal/social obligations, financial need, or lack of insurance, for instance).

Conflict Perspective

Theorists using the conflict perspective suggest that issues with the healthcare system, as with most other social problems, are rooted in capitalist society. According to conflict theorists, capitalism and the pursuit of profit lead to the  commodification  of health: the changing of something not generally thought of as a commodity into something that can be bought and sold in a marketplace. In this view, people with money and power—the dominant group—are the ones who make decisions about how the healthcare system will be run. They therefore ensure that they will have healthcare coverage, while simultaneously ensuring that subordinate groups stay subordinate through lack of access. This creates significant healthcare—and health—disparities between the dominant and subordinate groups.

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.

While conflict theorists are accurate in pointing out certain inequalities in the healthcare system, they do not give enough credit to medical advances that would not have been made without an economic structure to support and reward researchers: a structure dependent on profitability. Additionally, in their criticism of the power differential between doctor and patient, they are perhaps dismissive of the hard-won medical expertise possessed by doctors and not patients, which renders a truly egalitarian relationship more elusive.

Symbolic Interactionism

According to theorists working in this perspective, health and illness are both socially constructed. As we discussed in the beginning of the chapter, interactionists focus on the specific meanings and causes people attribute to illness. The term  medicalization of deviance  refers to the process that changes “bad” behavior into “sick” behavior. A related process is  demedicalization , in which “sick” behavior is normalized again. Medicalization and demedicalization affect who responds to the patient, how people respond to the patient, and how people view the personal responsibility of the patient (Conrad and Schneider 1992).

An example of medicalization is illustrated by the history of how our society views alcohol and alcoholism. During the nineteenth century, people who drank too much were considered bad, lazy people. They were called drunks, and it was not uncommon for them to be arrested or run out of a town. Drunks were not treated in a sympathetic way because, at that time, it was thought that it was their own fault that they could not stop drinking. During the latter half of the twentieth century, however, people who drank too much were increasingly defined as alcoholics: people with a disease or a genetic predisposition to addiction who were not responsible for their drinking. With alcoholism defined as a disease and not a personal choice, alcoholics came to be viewed with more compassion and understanding. Thus, “badness” was transformed into “sickness.”

There are numerous examples of demedicalization in history as well. During the Civil War era, slaves who frequently ran away from their owners were diagnosed with a mental disorder called  drapetomania . This has since been reinterpreted as a completely appropriate response to being enslaved. A more recent example is homosexuality, which was labeled a mental disorder or a sexual orientation disturbance by the American Psychological Association until 1973.

While interactionism does acknowledge the subjective nature of diagnosis, it is important to remember who most benefits when a behavior becomes defined as illness. Pharmaceutical companies make billions treating illnesses such as fatigue, insomnia, and hyperactivity that may not actually be illnesses in need of treatment, but opportunities for companies to make more money.

Key Takeaways

• The functionalist approach emphasizes that good health and effective health care are essential for a society’s ability to function. The conflict approach emphasizes inequality in the quality of health and in the quality of health care.
• The interactionist approach emphasizes that health and illness are social constructions; physical and mental conditions have little or no objective reality but instead are considered healthy or ill conditions only if they are defined as such by a society and its members.

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Did you know that in some parts of the world, mental health issues are widely accepted as possessions by demons rather than medical conditions? Therefore, they have traditional preventive measures and treatment methods to tackle this issue. Local understandings of health require a close study of society and related factors.

• In this explanation, we will examine the sociology of health
• Next, we'll take a look at the role of sociology in public health, as well as the importance of sociology of health as a discipline
• After this, we will briefly explore some sociological perspectives in health and social care
• Then, we'll look at both the social construction and social distribution of health
• Finally, we'll take a brief look at the social distribution of mental health

Sociology of health definition

The sociology of health, also referred to as medical sociology, studies the relationship between human health issues, medical institutions and society, through the application of sociological theories and research methods. First, we need to know what health is and then the sociology of health.

Huber et al. (2011) quoted the World Health Organization (WHO) definition of health as;

Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.

What is the sociology of health?

According to Amzat and Razum (2014) ...

The sociology of health focuses on applying sociological perspectives and methods while studying the health issues of human societies. Its major focus is on the sociocultural perspective related to human health and illness.”

• The sociology of health is interested in social factors that affect human health, such as race, gender, sexuality, social class, and region. It also studies the structures and processes in healthcare and medical institutes and their impact on health issues and patterns.

The role of sociology in public health

Now, we understand there is a strong relationship between health and sociology. Societies have their cultural definitions of health and illnesses. In Public Health, sociology can help to understand the definitions, prevalence, causes, and associated perspectives of diseases and illnesses. Moreover, it also helps to understand the treatment-related issues in different societies. The concepts are further described in the social construction of health.

The i mportance of sociology of health

The sociology of health plays a vital role in analysing the social and cultural reasons for diseases and illnesses. It provides information starting from the issues' onset, preventative measures, and managements.

Physicians focus more on the medical perspectives rather than on the social conditions of the diseases. At the same time sociologists may find that those living in a certain region are more likely to catch certain diseases compared to those living outside that region. This finding is directly related to medical sociology as it concerns human health issues with the social factor of geographical location.

Continuing with the example, let us assume that sociologists have found the reason for the higher susceptibility to certain diseases for people living in that region: they do not have access to adequate healthcare for prevention and treatment. Sociologists will ask why this is the case. Is it because the local medical institutions do not have the resources to deal with certain diseases? Is it because the region, in general, has lower trust levels in healthcare for cultural or political reasons?

Holistic concept of health in sociology

The word holistic means wholeness, and holistic health means all perspectives included. To get a complete picture, not only the individuals but also the societal and cultural factors are essential. Svalastog et al. (2017) explained that health is a relative state that describes the physical, mental, social, and spiritual perspectives of health, further presenting the full potential of individuals in a social context.

Sociological perspectives in health and social care

Mooney, Knox, and Schacht (2007) explain the word perspective as "a way of looking at the world”. However, the theories in sociology give us different perspectives on understanding society. In sociology, three major theoretical perspectives exist, functionalist, symbolic interactionist, and conflict perspective. These sociological perspectives explain health and social care in specific ways;

Functionalist perspective of health

According to this perspective, society works as a human body, where every part plays its role in keeping its functions properly. Similarly, the effective management of health issues is essential for societies’ smooth functioning. For example, patients need treatment, and physicians need to provide this treatment.

Conflict perspective of health

Conflict theory states that two social classes exist where the lower class has less access to resources. They are more prone to illness and have less access to good quality health care. Equality should be ensured in society so that everyone gets good healthcare.

Symbolic interactionist perspective of health

This approach states that health-related issues and social care are socially constructed terms. For example, understanding schizophrenia differs in different societies, so their treatment methods are diverse and require social perspectives for their implementation.

What is the social construction of health?

The social construction of health is an important research topic in the sociology of health. It states that many aspects of health and illness are socially constructed. The topic was introduced by Conrad and Barker (2010) . It outlines three main subheadings under which diseases are stated to be socially constructed.

The cultural meaning of illness

Medical sociologists state that while diseases and disabilities exist biologically, some are considered worse than others because of the added 'layer' of socio-cultural stigmas or negative perceptions.

The stigmatisation of illness can prevent patients from receiving the best care. In some cases, it may prevent patients from seeking medical assistance at all. An example of a commonly stigmatised illness is AIDS.

Suspicion from medical professionals about the genuineness of the patient's disease can affect the patient's treatment.

The experience of illness

How individuals experience illness may be down to individual personalities and culture, to a large extent.

Some people may feel defined by a long-term illness. Culture can heavily influence the experience of patients' illnesses. For example, some cultures do not have names for certain illnesses as they simply did not exist. In Fijian cultures, larger bodies are culturally appreciated. Therefore, eating disorders did not 'exist' in Fiji prior to the colonial period.

The social construction of medical knowledge

Although diseases are not socially constructed, medical knowledge is. It is changing all the time and does not apply equally to everyone.

Beliefs about illness and pain tolerance can lead to inequalities in medical access and treatment.

For example, it was a common misconception among some medical professionals that Black people were biologically wired to feel less pain than white people. Such beliefs started in the nineteenth century but are still held by some medical professionals today.

Until the 1980s it was a common belief that babies did not feel pain, and that any responses to stimuli were simply reflexes. Due to this, babies were not given pain relief during surgery. Brain scan studies have shown that this is a myth. However, many babies still undergo painful procedures today.

In the nineteenth century, it was believed that if pregnant women danced or drove vehicles it would harm the unborn child.

The above examples show how medical knowledge can be socially constructed and affect particular groups of people in society. We will be learning more about the social construction of medical knowledge in the topic of health.

The social distribution of health

Below we will outline key points about the social distribution of health in the UK by the following factors: social class, gender, and ethnicity. These factors are called social determinants of health , as they are nonmedical in nature.

Sociologists have various explanations about why factors such as where you live, your socioeconomic background, gender, and religion affect your likelihood of getting ill.

Social distribution of health by social class

According to the data:

Working-class babies and children have higher infant mortality rates than the national average in the UK.

Working-class people are more likely to suffer from heart disease, strokes, and cancer.

Working-class people are more likely to die before retirement age than the national average in the UK.

Social class inequalities exist at every age for all major diseases in the UK.

The 'Inequalities in Health Working Group Report' (1980) , known as the Black Report , found that the poorer a person is, the less likely they are to be healthy. The Inverse Care Law, named as such in the Report, states that those with the most need for healthcare get the least, and those with the least need get the most.

The Marmot Review (2008) found that there is a gradient in health, namely that health improves as social status improves.

Sociologists have cultural and structural explanations for why differences in social class lead to health inequalities.

Cultural explanations suggest that working-class people make different health choices due to different values. For example, working-class people are less likely to take advantage of public health opportunities such as vaccinations and health screenings. In addition, working-class people generally make 'riskier' lifestyle choices such as having poor diets, smoking, and less exercise. The cultural deprivation theory is also an example of a cultural explanation for the differences between working and middle-class people.

Structural explanations include reasons such as the cost of healthy diets and gym memberships, the inability of working-class people to access private healthcare, and the quality of housing in poorer areas, which may be damper than more expensive homes. Such explanations claim that society is structured in a way that disadvantages the working class, and therefore they cannot take the same measures to stay healthy as middle-class people.

Social distribution of health by gender

On average, women have a greater life expectancy than men in the UK by four years.

Men and boys have a greater likelihood of dying from accidents, injuries and suicide, as well as from major diseases such as cancer and cardiovascular diseases.

Women are at greater risk of sickness throughout their lives and seek medical attention more than men.

Women are more prone to mental health difficulties (such as depression and anxiety) and spend more of their lives with a disability.

There are several social explanations for the difference in health between men and women. One of them is employment . Men are more likely to take risky jobs leading to a higher likelihood of accidents or injuries due to machinery, hazards and toxic chemicals, for example.

Men are more likely to generally participate in risky activities , such as driving under the influence of alcohol or drugs, and extreme sports activities such as racing.

Men are more likely to smoke , leading to long-term and serious health conditions. However, more women have started to smoke in recent years. Women are less likely to drink alcohol and are less likely to drink over the recommended alcohol intake.

Social distribution of health by ethnicity

Those of South Asian origin have higher rates of heart disease and stroke.

Those of African-Caribbean origin have higher rates of stroke, HIV/AIDS and schizophrenia.

Those of African origin have higher rates of sickle-cell anaemia.

Generally, non-white people have higher mortality rates for diabetes-related conditions.

Cultural factors can explain why some of these differences exist, for example, differences in diets, or attitudes towards the medical profession and medicine. Sociologists have also found that social class is a significant intersection with ethnicity, as the social distribution of health by ethnicity is not the same across different social classes.

Mental health

Galderisi (2015) gave the WHO definition of mental health as;

Mental health is “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and can make a contribution to his or her community

How is mental health distributed by social class, gender, and ethnicity?

Different social groups have different experiences with mental health in the UK.

Social class

Working-class people are more likely to be diagnosed with mental illness than their middle-class counterparts.

Structural explanations suggest that unemployment, poverty, stress, frustration, and poorer physical health may make it more likely for working-class people to suffer from mental illnesses.

Women are more likely than men to be diagnosed with depression, anxiety, or stress. They are also more likely to be put on drug treatments to treat mental illness.

Feminists claim that women have higher stress levels due to burdens of employment, housework, and childcare, which increases the likelihood of mental illnesses. Some also claim that the same illness is treated differently by doctors depending on the gender of the patient.

However, women are more likely to seek medical help.

Those of African-Caribbean origin are more likely to be sectioned (involuntary hospitalisation under the Mental Health Act) and more likely to suffer from schizophrenia. However, they are less likely to suffer from more common mental health issues than other ethnic minority groups.

Some sociologists suggest there are cultural explanations, such as medical staff being less likely to understand the language and culture of Black patients.

Other sociologists claim there are structural explanations. F or example, ethnic minorities are more likely to live in poorer conditions. This can increase stress, and the likelihood of mental illness.

Health - Key takeaways

• The sociology of health, also referred to as medical sociology, studies the relationship between human health issues, medical institutions, and society, through the application of sociological theories and research methods.
• The social construction of health is an important research topic in the sociology of health. It states that many aspects of health and illness are socially constructed. The three subheadings in this topic include the cultural meaning of illness, the experience of illness as a social construct, and the social construction of medical knowledge.
• Social distributions of health look at how it differs by social class, gender, and ethnicity.
• Mental health is different according to social class, gender, and ethnicity.
• Huber, M., Knottnerus, J. A., Green, L., Van Der Horst, H., Jadad, A. R., Kromhout, D., ... & Smid, H. (2011). How should we define health?. Bmj, 343. https://doi.org/10.1136/bmj.d4163
• Amzat, J., Razum, O. (2014). Sociology and Health. In: Medical Sociology in Africa. Springer, Cham. https://doi.org/10.1007/978-3-319-03986-2_1
• Mooney, L., Knox, D., & Schacht, C. (2007). Understanding Social Problems. 5th edition. https://laulima.hawaii.edu/access/content/user/kfrench/sociology/The%20Three%20Main%20Sociological%20Perspectives.pdf#:~:text=From%20Mooney%2C%20Knox%2C%20and%20Schacht%2C%202007.%20Understanding%20Social,simply%20a%20way%20of%20looking%20at%20the%20world.
• Galderisi, S., Heinz, A., Kastrup, M., Beezhold, J., & Sartorius, N. (2015). Toward a new definition of mental health. World psychiatry, 14(2), 231. https://doi.org/10.1002/wps.20231

Frequently Asked Questions about Health

--> what is meant by health in sociology.

Health is the condition of being sound in body, mind, or spirit.

--> What is the role of sociology in health?

The role of sociology in health is to study the relationship between human health issues, medical institutions, and society, through the application of sociological theories and research methods.

--> What is ill health in sociology?

Ill health or illness is an unhealthy condition of the body or mind.

--> What is the sociological model of health?

The sociological model of health states that social factors, such as culture, society, economy, and environment, influence health and well-being.

--> Why is sociology important in health and social care?

There is a strong relationship between health and sociology. Societies have cultural definitions of health and illnesses, and sociology can help understand these definitions, prevalence, causes, and associated perspectives of diseases and illnesses. Moreover, it also  helps to understand the treatment-related issues in different societies.

Test your knowledge with multiple choice flashcards

The sociology of health studies the relationship between which of the following?A: Medical institutionsB: Medical staffC: Human health issuesD: SocietyE: Models of health and illness

The article looks at the social distribution of health across which three social groups?

An explanation for health inequalities between social classes suggests that, amongst other factors, working-class people cannot afford healthy food, gym memberships, and private healthcare. Is this an example of a cultural or structural explanation?

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What is the definition of 'sociology of health'?

“The sociology of health focuses on applying sociological perspectives and methods while studying the health issues of human societies. Its major focus is on the sociocultural perspective related to human health and illness.”

What is the WHO definition of mental health?

Mental health is “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community

What is the sociology of health also referred to as?

Medical sociology.

The sociology of health studies the relationship between which of the following?

A: Medical institutions

B: Medical staff

C: Human health issues

E: Models of health and illness

According to medical sociologists, which social factors affect human health?

Social factors that affect human health include race, gender, sexuality, social class, and region.

Name the three major sociological perspectives 

In sociology, three major theoretical perspectives exist, functionalist, symbolic interactionist, and conflict perspective

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19.2: Sociological Perspectives on Health and Illness

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Sociological Perspective For Health And Social Care Sociology Essay

Published Date: 23 Mar 2015

Disclaimer: This essay has been written and submitted by students and is not an example of our work. Please click this link to view samples of our professional work witten by our professional essay writers . Any opinions, findings, conclusions or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of EssayCompany.

Introduction

Health and social care practitioners should study sociology to gain a better understanding of the relationships between humans and the ways in which organisations affect individuals. This essay will examine the sociological perspectives that may be used by health and social care practitioners to understand the wide range of topics within health and social care. Initially, the history of sociology will be discussed, along with the main perspectives that constitute sociology. The connections between sociology and health and social care will be outlined so that the reader will understand why this is an important topic. Following this, a discussion of the Medical Model will be presented, and the topic of health inequalities will be introduced. The political agenda of health and social care is then mentioned.

As sociology is the study of human behavioural interactions, there is a great deal of connection between this social science and topics within the health and social care field. How society and social forces affect the health of individuals is a pertinent topic for study for those students who wish to pursue a career in health and social care.

Sociological Perspectives and the History of Sociology

Sociology is a social science that has arisen from theoretical perspectives in philosophy and political theory. It is scientific in that it uses data that has been gathered from studies of human interactions to provide evidence for theories in relation to those interactions. As a discipline, sociology has developed differently within different cultures; for example, German sociology diverged dramatically from the rest of the world during the Nazi era (Maus, 1962). In essence, sociology is the study of how society is organised and how individuals function within society. Sociology is therefore the study of humans behaving in groups. It shares some similarities with psychology which is the study of individual human behaviour, and each of the social science disciplines can feed into the evidence base for the others. Sociology students want to understand the structure and dynamics of society and connections between human behaviours. Forms of social structure including groups, organisations and communities are examined, as well as the interactions within and between these social structures, and how they affect individuals’ attitudes and behaviour.

There are a number of perspectives within sociology, the principal perspectives being Functionalism, Marxism, Feminism, Interactionism, the New Right, Postmodernism and Collectivism. Some of these perspectives may combine such as Marxist Feminism (Whelehan, 1995) or Feminist Postmodernism (Nicholson, 2013). There is no single overarching perspective when it comes to sociological theory. Sociologists ask many questions about the world, and social theory provides answers; however, these answers often only work for a particular time, place, and circumstance, and may contradict each other (Ritzer, 1994). The sociology student must therefore be tolerant of ambiguity and understand that there is often not one single answer to these issues. Some aspects of social theory can be transferred between cultures and over generations, but others may become obsolete if they are unable to be flexible to change.

Functionalism

This perspective is an early version of sociology, looking at the social structure as a whole and how it functions. Functionalism linked sociology with biology (Giddens, 1987) in an attempt to make what had been philosophical theory more scientific. Therefore, as with biological organisms comprising of cells and systems, in functionalism the society is built on individuals and organisations, families and communities. Inequalities in society are seen as helpful to the society as they maintain the system and ensure the smooth running of societies.

Karl Marx wrote about the inequalities in society, the class struggle between the Bourgeoisie (minority elite) and Proletariat (majority underclass). Marx was concerned mainly with capitalism, the workforce and the alienation of the worker from the product, but the Marxist theories can be extended to healthcare, for instance, in that many healthcare systems in the capitalist world are based around financial ability. Even in the UK where we have the National Health Service (NHS), it could be argued that we have a two-tier healthcare system in that if a person can afford to, they will access private medicine. Marx was concerned with capitalism and how price competition was fierce at the time he was developing his theory, which drove down the wages of the labourer (Ritzer, 1994). This became irrelevant in later years as the capitalist system changed and competition was focused on marketing campaigns rather than price; however, the issue has become pertinent again in recent years as low wages are now an issue again, and have been linked to poverty measures including poor health and poor education.

Feminism has been conceptualised as a series of waves, in that different generations of feminists have protested the inequalities in society between men and women (Whelehan, 1995). The feminist perspective on sociology is that society is ruled by men to the detriment of women, that society should be more equal (and modern feminists include intersectionalities in their arguments regarding equality, in that racism, ageism and prejudice against different sexualities and abilities are also relevant topics to discuss), and that women’s lives have been ignored by historians and sociologists in the past but could provide valuable insight. Politically, feminism has had a huge impact, and in terms of health and social care, there are a great many ways in which taking a feminist perspective will aid in understanding societal forces. For example, in looking at the role of the carer, which has traditionally been seen as a woman’s role, are female carers actually more prevalent than male or is it possible that male carers are ignored because they are not recognised for their caring role (and may not recognise themselves as such)? Is the role of the carer belittled by society due to being deemed a female role, or is it mainly a female role because of its low status? These are the sorts of questions that the feminist sociological perspective would ask in the health and social care setting.

Interactionism

Interactionism analyses the behaviours and actions of individuals in a small social group. Thoughts and actions may develop based on types of interactions between individuals. This perspective believes that labelling is used by those in authority to stereotype individuals. In a health and social care context, there could be an analysis of the relationships between health professionals and patients. It is often portrayed as being too focused on ‘micro’ sociology and unable to conceptualise ‘macro’ phenomena such as social structure, patterns of inequality and power (Dennis & Martin, 2005). However, Dennis and Martin argue that there has been a continued interest in authors such as Foucault and Weber that have contributed to a renewal of interests in these themes, such as the social processes through which power is enacted and institutionalized. This is especially relevant to power relationships in health and social care settings, for example with regard to institutional abuse.

The New Right is a political theory that arose in the 1980s and 90s and influenced social and economic policies. It is expressed in individualism and in opposition to the welfare state. A driving force behind the theory of the New Right is that the welfare state has created a dependence culture in that individuals no longer feel responsible for their own health and welfare. The political viewpoint is a contrast to Marxism and is an advocate of capitalism or the free market, with a trust that market forces will prevail to the good of all. A critique of this stance is that market forces have been in force for centuries and it was the inequality that these created, with only those rich enough to afford health care and a good diet able to live a long life, that has required intervention by the state.

Post-modernism

Modernism is presented as an era of study based on science, whereas post-modernism as the name suggests is presented as beyond this narrow view. Post-modernism argues that the range of sociological perspectives such as Functionalism and Marxism can be superseded due to the changes in society, as people make their own lifestyle choices and forge their own identities. For example, that class identity is no longer relevant but that other factors are an influence on lives such as gender, age and ethnicity. This perspective sees the media as an influence in society as it presents an image of how people should behave. Post-modernism may have arisen due to a fractionalisation of society, globalisation and an amalgamation of cultures which has exposed parts of each culture as being manufactured social constructs (Owens, 1985). It may be argued that we are not living in a post-modern society as there remain cultural clashes and inequalities persist. In addition, critics have argued that post-modernism does not take into account the role of individuals or the relationships between social institutions.

Collectivism

This perspective is based on the political belief of the collective society, with collective goals being more important than individual goals and society having a greater value than individual needs; therefore, each individual has a responsibility to other individuals. This is the basis of the welfare state where individuals pay into a communal pot and the money is then given to those who need it, the pot being National Insurance and extended to income tax. Those in need may include children, older people, people with disabilities and those with mental health needs. The initial collectivism of the NHS when it was originally set up after the Beveridge Report may have worked in the ‘golden age’ of the health service (O’Hara, 2013), but sits uncomfortably with the more recent consumerism and individualism that has come to characterise the health and social care services since the 1980s.

The Sociological Imagination

Mills (1959) developed the concept of the sociological imagination to describe how individuals shape society. Each person has a biography, or their individual history, which sits within the history of society. Individuals are influenced by and have an impact on their culture and the wider society. Individuals should be seen within the context of society, according to Mills, so that failure or success of the family or the individual cannot be understood in the abstract. A change to the social system will mean that individuals’ lives also change, such as a war creating orphans and poverty, the economic situation affecting unemployment. “Neither the life of an individual nor the history of a society can be understood without understanding both” (Mills, 1959, p.3). There is, therefore, an interaction between the culture to which individuals belong and the personal lives of each one in that culture.

A feminist take on Mills’ argument is the phrase ‘the personal is political’, in that it is impossible to talk about aspects of a person which may be considered personal such as lifestyle choices (e.g. nutrition, exercise, promiscuity, substance use) or health decisions (e.g. abortion, mastectomy), without seeing them within the context of the political and cultural backdrop (Nicholson, 2013). Mills has highlighted the disconnection between biography and history, and the implications are that the person is blamed for their failings rather than these being the result of their background or a lack of choice. Mills’ sociological imagination challenges the claim that problems are based in personal failings and reminds us that for many people, the problems are due to societal inequalities and pressures (Guearrero, 2005).

The Medical Model

For an understanding of the health of individuals and how to care for them, one of the most important sociological perspectives is a critique of the medical model and its alternatives. The medical model is the Western scientific approach to medicine, of looking at a disease or condition on its own without reference to other aspects of the individual who is experiencing the problem (Borrell-Carrió, Suchman & Epstein, 2004). The medical model focuses on the structure and function of the body, an approach to health which may be seen as functionalist and is the basis of policies and practice of the NHS.

The focus with this model will be the abnormalities of individuals’ bodies, biological factors which explain illness and physical examinations, observations and tests conducted by trained health professionals, with treatments being medications and technological interventions. The health care environments that are seen as appropriate places to undergo treatments may be clinical, de-personalised and quite frightening to individuals who are not familiar with this type of environment, which may impede their recovery. The model sees illness as temporary and reversible, with the intervention of medical expertise being able to provide a cure. Within the medical model, health is seen as the absence of disease, which is a functionalist perspective. The World Health Organisation (WHO) has defined positive health as a state of complete physical, mental, social, spiritual health and wellbeing, rather than merely the absence of disease.

The reliance on prescription medication has led to an attitude within the medical profession and society as a whole that every problem has a solution and that there is a single medical intervention that will treat them and resolve their issues. This attitude may prevent the individual from putting the effort into changing their lifestyle, or the professional from advising this. Although in many cases medication is appropriate, there are problems that have arisen from the reliance on medication, such as the over-prescription of antibiotics, which may be due to GPs overestimating symptoms as well as responding to patient expectations (Akkerman, Kuyvenhoven, van der Wouden & Verheij, 2005). Issues that may be considered as social in origin, such as alcoholism and some mental health problems, have been medicalised, which has been criticised as narrow-minded and dangerous (Read, 2004). Social problems could be addressed by social means rather than medicating or imposing restrictive treatment. Even conditions that are natural and normal such as pregnancy and childbirth have been pathologised within the medical model (Van Teijlingen, 2005).

It is by focussing on the biological, and by ignoring the individual as a whole, that perpetuates disease and fails patients and service users. Understanding the connections between an individual’s life history and their current health is an important part of diagnosing and treating the person. Information about the person’s culture, spiritual beliefs, financial status and physical habits may have an impact on their health and would be important information to take into account when giving health advice, but focussing purely on the biological status of the person means that this non-biological information might be missed.

An alternative to the medical model is the bio-psycho-social model of health (Borrell-Carrió, Suchman & Epstein, 2004). This model is an approach to health and illness that takes into account the environmental and social factors that may influence the health and well being of the individual including housing, diet and nutrition, economic and financial matters and other environmental factors such as pollution, overcrowding, heavy urbanisation or, in contrast, the lack of infrastructure in rural areas. There are many aspects of an individual’s environment and life that will affect their health and wellbeing. There are preventable deaths in modern Western society that are linked to personal choices and behavioural factors such as tobacco, alcohol and other substance use, diet and exercise, whereas in the developing world the unavailability of clean water is a significant factor in high childhood mortality rates.

The critique of the medical model, by taking into account political social aspects of the individual’s environment, can be seen as a Marxist critique as it refers to health inequalities due to class (i.e. wealth status) and as a consequence of capitalism. Sociologists may argue that the medical profession is powered by the educated upper class elite system, and that they are invested in keeping lower classes in the workforce and maintaining the status quo with the class system. The holistic or bio-psycho-social model of illness contrasts with the authoritarian model of approaching illnesses as sets of biological systems alone. An example of seeing the whole individual would be if a person was suffering from malnutrition and the doctor simply prescribed medication for this without looking at the person’s financial or psychological state. This would be a barrier to their recovery if the reason for their malnutrition was that they could not afford food or were restricting their intake by choice.

Health Inequalities and Disability

It has been known for some time that there are inequalities in health; for example, life expectancy in certain geographical areas is much lower than in others (Mackenbach, Karanikolos & McKee, 2013). Poverty is a big factor in health outcomes, as it is correlated with a number of other issues including poor housing, nutrition and education, limited access to health care, fitness and advice. From a Marxist point of view, poor health is caused directly by capitalism, as with a different societal structure there would be no poverty.

The medical model has treated disability as problematic on an individual level, with a focus on how people with disabilities can fit into society, with authorities deciding where disabled people should live, work and attend school (Dare & O’Donovan, 2002). This is a negative focus because although it can help with treatments and surgery, it encourages dependence and reduces autonomy. The social model of disability shows how people with disabilities are not a problem to be resolved, but that society is disabling due to barriers that are put in place to exclude those individuals with disabilities from fully participating. It has arisen in part due to disability rights activism. In the social model, everyone should be free to access facilities and exercise their rights, so that buildings are altered to be accessible and public documents available in a variety of formats, with changes to the workplace including physical changes and challenges to discrimination and inappropriate language use (Dare & O’Donovan, 2002).

Sociologists are interested in the way that societal attitudes have changed over the last decades towards people with disabilities. Some individuals may not have received adequate health care in the past as they were considered to be too disabled and not worth saving. For example, people with Down Syndrome had a life expectancy of 12 years in the 1940s in comparison to 60 years in present day developed countries (Bittles, Bower, Hussain & Glasson, 2006). This is an emotive topic and is a demonstration that inequalities in health exist and are not simply related to financial capabilities.

For those students who wish to pursue a career in social care, the models of disability are an important sociological topic. Although they may not be as obvious as the case of Down Syndrome described above, there remain subtle judgements and prejudices among society, if not the medical profession itself, regarding who deserves health care. Health and social care can be seen in a political context, and the ways in which health topics are represented in the media and by politicians can be viewed from a sociological perspective. The current debate surrounding the Liverpool Care Pathway, for example, is presented by the media as cruel and a way of quickly eliminating those patients who cannot afford private palliative care.

This essay has discussed a number of topics within the field of health and social care, where sociological perspectives are relevant. The main perspectives that constitute sociology have been presented, with the Medical Model and how this impacts on the treatment of patients. Health and social care can be seen as a political topic, and is regularly discussed in the media. The study of sociological perspectives and how these relate to health and social care may be able to help create a more egalitarian, healthy society.

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