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Medical Sociology

MEDICAL SOCIOLOGY

Some have argued that medical sociology should be thought of as a loosely connected network of disparate subgroups rather than as a single discipline. Many medical sociologists tend to argue against certain axioms in the biomedical model of health and illness. They reject the reductivist approach of biomedicine, which claims that health and disease are natural phenomena that exist in the individual body rather than in the interaction of the individual and the social world; they reject the doctrine of specific etiology, the vision that disease can be induced by introducing a single specific factor into a healthy animal; and they reject biomedicine's claim to scientific neutrality. Like sociology in general, subgroups within medical sociology vary according to dichotomies such as human agency versus social structure, conflict versus consensus, and idealism versus realism. Subgroups also vary according to subject matter, thus the sociology of medicine can be distinguished from the sociology of health and illness, the sociology of healers, and the sociology of the health care system. Medical sociologists also distinguish between the sociology of health, the study of health, illness, and health care to further sociological theory; and sociology in health, the use of sociological insights to complement biomedicine's objectives and priorities. There are four often interrelated areas of research in medical sociology: the social production of health and illness, the social construction of health and illness, postmodern perspectives on health and illness, and the study of the health care system and its constituent parts.

Research in the social production of health and illness tends to explore variations in biomedical indicators of health such as self-reported health status and morbidity or mortality statistics. Social epidemiology shows that the distribution of disease is related to the structure of social inequalities (i.e., to occupational class, socioeconomic status, gender, marital status, age, ethnicity, area of residence, housing, family structure, and employment status), although it does little to explain these microlevel relationships.

The political economy perspective incorporates a broader political and economic framework, arguing that relations of domination within patriarchal capitalism create conditions of deprivation within which some people must struggle to maintain health. It claims that there is a contradiction between the pursuit of health and the pursuit of profit. It notes the large differentials in health found among social classes, sometimes pointing to unhealthy work environments of the lower classes as an explanation, and also notes the strong relationship found among Western countries between aggregate health and degree of income inequality. This perspective has been criticized, however, for failing to recognize the substantial health gains that have accompanied capitalist development and for proposing a scenario with little opportunity for intervention or change.

Social relations (such as social support for individuals and social capital or social cohesion for communities) have been investigated as determinants of the health of individuals and communities. There is also strong empirical support for the importance of lifestyle practices and behaviors embedded in social environments and cultural contexts. On a global scale, some authors argue that capitalist imperialism influences the presence and distribution of illness in developing nations, through the transfer of modern medicine, industry, and technology from the West, which is motivated in part by profit-driven pharmaceutical companies, for example. Finally, some authors investigate the role of Western medicine in creating as well as preventing illness. They argue that improvements in health have come mainly from nonmedical factors, and that medicine reproduces the legitimacy of the dominant social order by serving as a means of social control.

Social construction research views illness behaviors and the experience of health and illness as social states. Interactionist theory argues that people bestow meaning on their interactions with othersthat selves are emergent and socially constructed. An early sociological contribution was the distinction between disease (an objective state), illness (the subjective experience of disorder), and sickness (the social state associated with being ill). Talcott Parsons's sick role, a social role with certain rights and obligations for those so labeled, shows the power of medicine to define illness and shows that illness is a form of social deviance. Subsequent work has introduced core sociological concepts such as deviance, labeling, career, medicalization, socialization, self, and identity to the field. Interactionist approaches have been criticized for neglecting the hard realities of power and politics and for their cognitivist bias, sharply separating the mind and body.

Postmodernist thought rejects binary oppositions, instead focusing on a shifting reality with multiple truths. Foucauldian social constructionism of claims that diseases are fabrications of powerful discourses wherein individuals explore the boundaries of their self-identity, engaging in the endless task of self-transformation. Others argue that the body is a liquid commodity, an object of circulating capital, in a new world of hyperreality filled with new forms of technology. The sociology of the body stresses the re-entrance of the physical body within sociological discourse, exploring how socially structured physiology affects social behavior and vice versa. These perspectives are criticized for their lack of an ethic, extreme relativism and abstraction, and lack of attention to the greater political context.

Some micro-level concerns when studying the health care system are entry into and experience with the health care system and patient-practitioner relationships, which have shifted focus from the provider's interest in compliance to a power-based perspective. Some argue that medicalization (providers defining needs) impinges on patient autonomy and acts as a form of social control directing deviance into controllable channels. Others explore the behaviors of providers, the management of uncertainty in practice, and implicit theories of professional knowledge. A prevailing theme at the meso-level, the interactional region between the face-to-face encounter and the wider social structure, is medical dominance, the power of medicine to define matters in its own interests, applied to the study of professions, occupations, hospitals, and medical schools, for example. Some have studied the adoption of a cloak of competence in the socialization of medical students. Community involvement in planning and decision makingthe democratization of medical carereceived attention in the late 1990s. Finally, some macro-level concerns are the role of multinational pharmaceutical companies in shaping the nature of health care and the reasons for and historical development of health insurance.

Gerry Veenstra

(see also: Cultural Norms; Social Networks and Social Support; Sociology in Public Health; Values in Health Education )

Bibliography

Annandale, E. (1998). The Sociology of Health and Medicine: A Critical Introduction. Malden, MA: Polity Press.

Evans, R. G.; Barer, M. L.; and Marmor, T. R., eds. (1994). Why Are Some People Healthy and Others Not? The Determinants of Health of Populations. New York: Aldine de Gruyter.

Freidson, E. (1970). Professional Dominance: The Social Structure of Medical Care. New York: Atherton Press. Illich, I. (1976). Limits to Medicine. Toronto: McClelland and Stewart.

Martin, E. (1987). The Woman in the Body. Boston: Beacon Press.

McKeown, T. (1976). The Role of Medicine: Dream, Mirage or Nemesis? London: Nutfield Provincial Hospitals Trust.

Parsons, T. (1951). The Social System. Glencoe, IL: Free Press.

Starr, P. (1982). The Social Transformation of American Medicine. New York: Basic Books.

Veenstra, G. (2000). "Social Capital, SES and Health: An Individual-level Analysis." Social Science and Medicine 50:619629.

Wilkinson, R. G. (1997). Unhealthy Societies: The Afflictions of Inequality. New York: Routledge.

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medical sociology

medical sociology See MEDICINE, SOCIOLOGY OF.

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