Sociology for Pharmacists

An Introduction

Kevin M. G. Taylor, Sarah Nettleton, Geoffrey Harding

• Publisher: Routledge
• Year: 2018
• eBook ISBN: 9781134478064
• Topic: Medicine
• Subtopic: Health Care Delivery

Sociology for Pharmacists: An Introduction is written specifically for professionals and students in pharmacy who are newcomers to the study of sociology. It introduces the key concepts of sociology and demonstrates their importance and application to pharmacy practice in the 21st century. It is unique in its role as the only text to introduce sociology specifically to pharmacists.

Rather than an exhaustive treatment, the book provides a concise introduction to major perspectives in sociology-drawing on research evidence pertaining to health, illness, and professional practice-which will inform and enhance pharmacy practice. It offers an overview of sociology for rather than sociology of pharmacy, and will both inform practitioners and stimulate informed research into the social aspects of pharmacy practice.

Key issues covered include:

Key sociological concepts and perspectives

Contemporary developments in pharmacy practice and pharmacy's professional status

A review of research into the way people react to illness and look after their health

How and why illness and disease are influenced by gender, ethnicity, and social class

Health education and pharmacists' role in promoting health and ensuring appropriate medicine usage

Social research methods

Pharmacists are frequently encouraged to broaden their day-to-day practice. This timely book does just that by encouraging pharmacists to become more involved with advising clients, managing medicines, and supporting the promotion of health. In addition to providing an overview of these topics, the book also reviews the relevant research, and directs readers to further information.

1 Sociology: An Introduction

WHAT IS SOCIOLOGY?
The sociological imagination
SOCIOLOGICAL PERSPECTIVES AND THEIR APPLICATION TO PHARMACY
Key theorists
Emile Durkheim (1858 – 1917)
Karl Marx (1818 – 83)
Max Weber (1864 – 1920)
Modernity – the ‘old world order ’
Post – modernity
Scientific knowledge, medicines use and the dilemmas of choice
Pharmacy in contemporary society
SUMMARY
FURTHER READING
REFERENCES

Initially, the idea that pharmacists might usefully study sociology may appear a little odd. After all, pharmacists are surely concerned with drugs use, an activity which requires a sound understanding of the disciplines of physiology, pharmacology, pharmaceutical chemistry and pharmaceutics. Prescriptions need to be carefully checked and the therapeutic and adverse effects of medicines thoroughly understood. But of course, pharmacy is also ‘people work’; drugs are dispensed to patients directly, or indirectly via informal carers, or other health professionals in the health care team. Furthermore, the general public seeks advice from pharmacists about medicines, treatments, alternative therapies and other aspects of their illness management and health maintenance. Pharmacists therefore need to be good communicators who are equipped with the appropriate skills for ensuring that they offer effective pharmaceutical care, and to this end there is now a range of texts available on communication and related skills for pharmacists. A sociological understanding of the issues of health, illness and health care can contribute to a deeper understanding of this people work. Sociologists have contributed to a better understanding of the actions and experiences of patients, the public, and health professionals who work within the health care system. This has resulted in a better appreciation of the nature of the relationships between health professionals and patients.

All of us have experience of health and illness. No doubt you will have been a patient, or you will have treated yourself when you felt ill, or you may have taken care of friends or relatives when they were unwell. This means that you will already have some knowledge and experience of the subject matter of this book. However, because the issues of health and illness are so familiar, it is difficult to distance ourselves from these and subject them to academic scrutiny. Indeed, a characteristic feature of sociology is that it often involves the systematic study of aspects of everyday life which are so familiar or routine that we do not give them a second thought. This means that it is all too easy to make assumptions about the way things are, and although they may appear to be ‘obvious’ they might in fact not be so. For instance, it is easy to assume that how we experience a disease and its symptoms are the consequence of biophysical changes in our bodies. However, social scientists have shown that the same physical symptoms can be interpreted in very different ways in different contexts, not only by patients but also by practitioners. For example, in Germany, low blood pressure is routinely treated by physicians as a disease, whereas in the UK this is not the case. Disease categories are not unambiguous descriptions of anatomical and physiological processes but are also imbued by the language, metaphors and values of a particular society (Sontag, 1978; Martin, 1994). They may also be contingent upon the nature of social and political relations in a given historical period. Consider hysteria for example, a disease classification that is now very rarely used by medical practitioners but which was common in the early part of the last century (Figlio, 1978). The diagnosis of disease is also affected by social factors. For example, a study undertaken in New Zealand found that out of 822 coronary bypass operations performed in 1983, only ten were carried out on the minority indigenous population – the Maori – even though the death rates from heart attack are significantly higher amongst that group (Pomare, 1998). This suggests that diagnostic procedures might not be purely objective but are in fact affected by social issues – the subject matter of sociology.

WHAT IS SOCIOLOGY?

Sociology is an academic discipline which makes use of a wide range of research methods to study society and social behaviour or social actions. Pharmacists, as a result of their school education and subsequent exposure to the pharmaceutical sciences as undergraduates tend to define themselves primarily as scientists. Science and ‘scientific method’ are part of their identity. On being introduced to sociology, students often approach it with preconceived ideas of it being ‘soft’, ‘vague’, ‘undisciplined’ and at times pretentious, peddling ideas that are little more than common sense. However, this presumption disregards the fact that sociology is a coherent discipline with a long tradition of applying a scientific perspective to social behaviour. Sociology is a science, generating and testing hypotheses, rigorously applying robust methods of empirical investigation to generate data whose analysis and interpretation leads to the formulation of theories. Sociology has amassed a body of knowledge from a variety of sources, employing a range of methodologies which may at first sight appear strange to pharmacists. These include social surveys, observations, analysis of language, and interviews (see Chapter 9). This knowledge has to be sufficiently robust to withstand exhaustive and widespread peer criticism, taking into account conflicting interpretations.

Throughout this book we will refer to a range of key sociological concepts which are outlined in Box 1.1. For clarity, these concepts have been reduced to their simplest terms, though we have sought to retain their essence and indicate in the text how they are likely to be important for the practice of pharmacy.

Social action is complex and we should not expect to unravel the complexity of the social world, and our behaviour within it, by simply applying ‘common-sense’ understandings. Bauman (1997) argues that sociology differs from common sense in the following respects:

1. Responsible speech. Sociological propositions are not founded on beliefs, but on corroborative evidence.
2. Size of the field. We understand common sense only from our individual perspective, i.e. it is partial knowledge. Sociology pursues a wider perspective – recognising the link between individual accounts and social processes of which individuals may be unaware.
3. Making sense. From a common-sense perspective, accounts of our actions are attributed back to someone – our actions are the intention of an individual. Sociologically, our actions are understood to be the result of our interdependency with our fellow members in society.
4. Make the familiar strange. Common sense is self-affirming: ‘things are as they are’, and ‘people are as they are’. Sociology scrutinises the familiar in order to understand how common sense is as it is.

Agency:	Undetermined voluntary action by individuals
Norm:	Shared and expected social behaviour
Social role:	Expected actions associated with particular social positions
Social structure:	Recurring patterns of interrelationship between individuals or groups
Socialisation:	Acquiring and internalising the norms and values of a particular group
Society:	Configuration of cohesive social relationships within a particular group
Sociology:	Observation and analysis of societies

Box 1.1 Glossary of basic sociological concepts

The sociological imagination

In order to understand the processes that guarantee our ability to live cohesively together as members of a society, it is insufficient to take an individualistic point of view. That is, it is not sufficient to understand or explain people’s actions solely through the behaviour of the individual or individuals concerned. Rather, it is necessary to take a wider social perspective and to understand the social forces that impinge, influence, or interact with the individual. These social forces are usually beyond the control of the individual. In many ways this forms the essence of sociological inquiry, which involves asking the question: what is the relationship between individual behaviour (or ‘social action’) and the social context (or ‘social structure’)? To develop an appreciation of the interaction of the individual in society is to come close to what the sociologist, C.W. Mills (1959) calls the ‘sociological imagination’; that is, ‘the urge to know the social and historical meaning of the individual in society’.

An essential tool of the sociological imagination is the ability to distinguish between what Mills terms ‘personal troubles of the milieu’ and ‘the public issues of social structure’. The complex relationship between individual social action and structured collective social action lies at the heart of the theoretical foundations of sociology and distinguishes it from the allied disciplines of social psychology and economics. We can consider society on two levels – the individual level (agency) and the collective level (structure). The sociologist aims to understand the interaction between these two. Let us take an example from Mills (1959):

‘Consider marriage. Inside a marriage a man and a woman may experience personal troubles, but when the divorce rate during the first four years of marriage is 250 out of every 1,000 attempts, this is an indication of a structural issue having to do with the institution of marriage and family, and other institutions that bear upon them.’

Another example of an individual trouble that became a public issue is the controversy concerning the mumps, measles and rubella (MMR) vaccination in recent years. When a small group of individuals have personal worries over the triple vaccine, perhaps based on their beliefs about the potential harmful effects of vaccination per se, they may simply refuse it for their children. However, when a movement develops that questions the vaccine’s safety, what once was a personal trouble becomes a public issue that impacts on public health and the public’s relationship with health practitioners, medical ‘experts’ and the State.

How people act, think and behave is a result of the way in which they have been ‘brought up’. In sociological terms, the relationship between our behaviour as both individuals and as members of society is termed ‘agency/structure’. That is to say, the way we, as individuals, act is shaped by our social environment. In this sense we can never be free of the influences exerted on us by the social order to which we belong. Social rules and social norms have become internalised; that is, they become internal to the individual and are thus self-imposed rather than being subject to the control of others. Norms refer to actions that are expected or considered ‘normal’ in any given society.

We can see then, that individuals and the relationships between individuals are influenced by structural, i.e. broader social, economic and political circumstances. Sociology is not just about the collection of facts and information but is concerned primarily with understanding and interpretation. It can be confusing and daunting for those who are not used to this way of learning and thinking. What the sociologist studies is often familiar, i.e. it concerns our everyday activities. ‘The sociologist does not look at a phenomenon that no one else is aware of, but he or she looks at the phenomenon in a different way’ (Berger, 1966).

SOCIOLOGICAL PERSPECTIVES AND THEIR APPLICATION TO PHARMACY

The boundaries of the discipline of sociology are difficult to define. This is in part because of the diverse and diffuse nature of its subject matter (namely people and society), but also because within the discipline of sociology there are many different approaches or perspectives – indeed there are many different types of sociology. While all the perspectives seek to understand how social structures interact with individual behaviours, they vary in terms of their level of analysis. Some are orientated towards micro-level issues, such as the actions and beliefs of individuals, while others illuminate macro-level issues that pertain to the way in which the ‘structures’ of society are organised. These would focus on questions such as: How are education or health care systems structured? How do economic systems work? What are the main social divisions within our society? Turner (1995) has usefully summarised three levels of analysis (individual, social and societal), and he illustrates the topics which might usefully be studied at these levels (see Table 1.1).

Working at the first level, sociologists examine people’s accounts of their experiences of illness and how they maintain their health. The aim here is to illuminate aspects of everyday life from the perspective of the individual. Sociological perspectives orientated towards the individual level of analysis are the ‘interpretive perspectives’ so called because they ‘interpret’ how people make sense of, and give meaning to, their lives or actions. Within interpretive approaches, attention is focused on how people interact at a face-to-face level; how they see their lives, make sense of their social circumstances and/or their physical symptoms. The key idea here is ‘meaning’, which refers to the way people make sense of what is happening to them. Sociologists therefore talk to and observe people to try and find out how they define their circumstances. To get an insight into how p...

Table of contents

• COVER PAGE
• TITLE PAGE
• COPYRIGHT PAGE
• PREFACE
• ACKNOWLEDGEMENTS
• WHY A SOCIOLOGY FOR PHARMACY?
• 1. SOCIOLOGY: AN INTRODUCTION
• 2. CONTEMPORARY PRACTICE OF PHARMACY
• 3. HEALTH AND ILLNESS: UNDERSTANDING THE PUBLIC’S PERSPECTIVE
• 4. SEEKING HELP AND CONSULTING HEALTH PROFESSIONALS
• 5. SOCIAL FACTORS AND HEALTH
• 6. SOCIAL INEQUALITIES AND HEALTH
• 7. THE OCCUPATIONAL STATUS OF PHARMACY
• 8. MAINTAINING AND PROMOTING HEALTH
• 9. SOCIAL RESEARCH METHODS