The Sociology of Health, Healing, and Illness

Gregory L. Weiss

• Publisher: Routledge
• Year: 2017
• ISBN:
  9781317236429
• Edition: 9
• Topic: Scienze sociali
• Subtopic: Studi sullo sviluppo globale

With thorough coverage of inequality in health care access and practice, this leading textbook has been widely acclaimed by teachers as the most accessible of any available.

It introduces and integrates recent research in medical sociology and emphasizes the importance of race, class, gender throughout.

This new edition leads students through the complexities of the evolving Affordable Care Act. It significantly expands coverage of medical technology, end-of-life issues, and alternative and complementary health care—topics students typically debate in the classroom. Many new textboxes and enhancements in pedagogy grace this new edition, which is essential in the fast-changing area of health care.

New to this Edition

*More textboxes relating the social aspects of medicine to students' lives

*Expanded coverage leading students through the complex impacts of the ACA and health care reform

*Expanded coverage of medical technology, end-of-life issues, and alternative and complementary health care

*'Health and the Internet' sections updated and renovated toward student assignments

*New, end of chapter lists of terms

*Updated test bank

CHAPTER 1

A Brief Introduction to the Sociology of Health, Healing, and Illness

Learning Objectives

• Identify and explain the major historical factors that led to the development of medical sociology as a subfield of sociology.

• Identify and give specific examples of the four major categories of focus within medical sociology.

• Explain how the sociological perspective, sociological theory, and social research methods can be applied to the study of health, healing, and illness.

• Discuss the orientation of medical sociologists to their research in this early part of the twenty-first century.

Through much of the first half of the twentieth century, matters pertaining to health, healing, and illness were viewed as being primarily within the domain of physicians, other health care practitioners, and scholars in the chemical and biological sciences. Neither medicine nor sociology paid much attention to each other. This has changed dramatically in the ensuing years as the paths of sociology and medicine have increasingly converged. This chapter presents a brief introduction to the sociology of health, healing, and illness—a subfield of sociology commonly referred to as medical sociology.

DEFINITION OF MEDICAL SOCIOLOGY

Ruderman (1981:927) defines medical sociology as “the study of health care as it is institutionalized in a society, and of health, or illness, and its relationship to social factors.” The Committee on Certification in Medical Sociology (1986:1) of the American Sociological Association (ASA) provided the following elaboration:

Medical sociology is the subfield which applies the perspectives, conceptualizations, theories, and methodologies of sociology to phenomena having to do with human health and disease. As a specialization, medical sociology encompasses a body of knowledge which places health and disease in a social, cultural, and behavioral context. Included within its subject matter are descriptions and explanations or theories relating to the distribution of diseases among various population groups; the behaviors or actions taken by individuals to maintain, enhance, or restore health or cope with illness, disease, or disability; people’s attitudes and beliefs about health, disease, disability and medical care providers and organizations; medical occupations or professions and the organization, financing, and delivery of medical care services; medicine as a social institution and its relationship to other social institutions; cultural values and societal responses with respect to health, illness, and disability; and the role of social factors in the etiology of disease, especially functional and emotion-related.

Clearly, the focus of medical sociology is broader than just “medicine.” In fact, the title of this book was intentionally selected to connote that medical sociology includes a focus on health (in the positive sense of social, psychological, and emotional wellness), healing (the personal and institutional responses to perceived disease and illness), and illness (as an interference with health).

Sociologists study health, healing, and illness because they are a central part of the human experience, because they help us to understand how society works, and because they reflect patterns of social relationships. Sociologists emphasize that explanations for health and illness and for healing practices must go beyond biological and individualistic factors by examining the important influence of social context.

HISTORICAL DEVELOPMENT OF MEDICAL SOCIOLOGY

Setting the Foundation: The Importance of Social Factors on Health and Illness

It is difficult to identify any specific event as the “starting point” of the field of medical sociology. Certainly, some of the basic insights of the field were present among society’s earliest philosophers and physicians. Many physicians in ancient times (see Chapter 2) perceived an essential interrelationship among social and economic conditions, lifestyle, and health and illness. This understanding has been an integral part of medical thinking in some (though not all) civilizations since then. Often cited as a key historical figure who paved the way for medical sociology is Rudolf Virchow, the great mid-nineteenth-century physician (and the founder of modern pathology). Virchow identified social and economic conditions as being primary causes of an epidemic of typhus fever in 1847, and lobbied for improved living conditions for the poor as a primary preventive technique. Arguing against biomedical reductionism—attempting to reduce every disease and illness to a biological cause—Virchow contended that medicine is largely a social science that needs to consider the influence of social structure on the creation of both health and illness.

The Turn of the Century: Development of Social Medicine

The last decades of the nineteenth century and the first decades of the twentieth century were a period of heightened awareness in both the United States and Europe of the need for social programs to respond to health crises. These were years of social upheaval caused in part by the effects of the Industrial Revolution and rapid urban growth (and, in the United States, a tremendous influx of largely poor and unskilled immigrants). In 1915, Alfred Grotjahn published a classic work, Soziale Pathologie, documenting the role of social factors in disease and illness and urging the development of a social science framework for working with communities and providers in reducing health problems. The term social medicine was coined to refer to efforts to improve public health.

However, an important crosscurrent was occurring simultaneously. The discovery of the germ theory of disease enabled physicians to more successfully treat the acute infectious diseases that plagued society. This reinforced a belief that medicine could rely solely on biological science. The discipline of sociology was still in its infancy and was not able to provide sufficient documentation of the need for a complementary focus on social conditions.

The Early to Mid-Twentieth Century: More Studies on Health and Medicine

Several important precursors to the development of medical sociology occurred in the first half of the twentieth century. Social surveys became an important research technique, and many focused on health and living conditions. Sociologists often worked with charity organizations and settlement houses, which also became subjects for study. By the 1930s and 1940s, many sociological studies of the medical field, including Talcott Parsons’ 1939 work on the medical professions, appeared. Political scientist Oliver Garceau (1941) contributed to the political sociology of medicine by analyzing the political life of the American Medical Association. George Rosen (1944) studied increasing specialization in medicine. Oswald Hall (1946) studied the informal organization of medical practice in an American city (Rosen, 1976).

The 1950s and 1960s: The Formal Subdiscipline Emerges

The emergence of medical sociology as a field of study occurred in the 1950s and 1960s. The most important developments then pertain to changes in health, healing, and illness, external recognition of the field, and its institutionalization within sociology.

Changes in Health, Healing, and Illness. Based on analysis by Rodney Coe (1970) and others, the development of medical sociology was facilitated by four changes that had occurred or were occurring in medicine in the 1950s and 1960s. These are as follows:

1. Changing patterns of morbidity and mortality. During this time, the primary causes of sickness and death shifted from acute infectious diseases (e.g., influenza and tuberculosis) to chronic, degenerative diseases (e.g., heart disease and cancer). Because the factors that lead to degenerative diseases are more obviously interwoven with social patterns and lifestyle, the necessity for sociological contributions became more apparent.

2. The impact of preventive medicine and public health. In the 1800s and early 1900s, the field of public health focused primarily on bacteriology (linking particular germs to diseases) and immunology (preventing disease occurrence). As the twentieth century progressed, however, it became apparent that protection of public health also required consideration of social factors such as poverty, malnutrition, and congested living areas—all of obvious interest to sociologists.

3. The impact of modern psychiatry. The development of the field of psychiatry led to increased interest in the psychophysiological basis for many diseases and illnesses, in the importance of effective interaction between patients and practitioners, and in the use of patients’ social environment as part of therapy.

4. The impact of administrative medicine. Throughout the twentieth century, the organizational complexity of the medical field—in the settings in which care is delivered, in the ownership of medical facilities, and in the bureaucracies that were created to regulate and finance medical care—expanded enormously. The abilities of sociologists to analyze organizations and structures, identify those who are harmed as well as those who gain by various arrangements, and examine the consequences of alternative techniques were increasingly useful skills in organizationally complex environments.

External Recognition and Legitimation. Two key events during the 1950s and 1960s contributed to the increased interest in and legitimation of medical sociology. First, medical schools began to hire sociologists for their faculties. Although medical sociology was not always well integrated into the curriculum, the move symbolized an increasing recognition of sociology’s potential contribution to understanding disease and illness. Second, government agencies and private foundations initiated significant financial funding for medical sociology. The National Institutes of Health and the National Institute of Mental Health sponsored sociological research in medicine and subsidized training programs for graduate students in sociology. (Both authors of this book received fellowships from the U.S. Public Health Service for their graduate education.) The Russell Sage Foundation provided significant funding of programs to increase the use of social science research within medicine.

Institutionalization of Medical Sociology. Finally, two additional events are especially noteworthy in the institutionalization of medical sociology. In 1959, medical sociology was accepted as a formal section of the ASA—an important step in bringing recognition to a field and enabling recruitment of new members. Second, in 1965, the ASA assumed control of an existing journal in medical sociology and renamed it the Journal of Health and Social Behavior. Now the official ASA journal for medical sociology, it is a key mechanism for medical sociologists to share their research findings.

Since then the field has flourished. The ASA section on medical sociology currently has approximately 1,000 members (there are about 13,000 ASA members), and is the third largest special interest section within the association. Medical sociologists publish in a wide variety of journals in sociology, public health, and medicine, and are increasingly employed in health planning, community health education, education of health professionals, government at all levels, and health care administration in addition to colleges and universities. See the “In the Field” box on Major Topics in Medical Sociology for one way of organizing...