The Textbook of Health and Social Care

Darren Edwards, Stephanie Best, Darren Edwards, Stephanie Best

• Publisher: SAGE Publications Ltd
• Year: 2020
• ISBN:
  9781529717372
• Edition: 1
• Topic: Medicine
• Subtopic: Medical Theory, Practice & Reference

A comprehensive textbook designed to get you through the entirety of your Health and Social Care BSc degree. Covering all the important topics and pressing issues relevant to Health and Social Care today.

The book is split intothree parts, starting withthe essential areas and core knowledge you will need as you start your degree, these include the sociology and psychology of illness, academic skills, key legal and ethical issues, reflective practice, and the research process. Before moving onto health and social care in practice, highlighting topics such as health promotion, safeguarding children and their rights, and working with people experiencing mental health disorders. The final part coverssome of the challenges faced in present day health and social care, looking at social justice issues, legal and ethical considerations, leadership, and health inequalities.

All content is supported by practical and reflective features to helpyouthroughout your degree, these include: Interactive activities, real life case studies and examples related to chapter content, links and suggestions for further reading, and answers to key activities and case studies exercises.

The perfect companion text for a Health and Social Care degree, or any other course related to the health and social care services.

Part 1 Underpinning Knowledge

Chapter 1 Sociology of Health and Illness

Ashley Frawley

Overview

This chapter introduces the sociology of health and illness, first by considering the meaning of the ‘sociological imagination’ and associated importance of the concept of context to understanding human social life. It then discusses three contexts of health: socio-economic, institutional/professional and cultural. Within these contexts a number of key issues in the sociology of health and illness are considered: the social determinants of health, health inequalities, challenges to medical authority, social construction and health panics, medicalisation and growing cultural preoccupations with health risks.

Learning Outcomes

By the end of this chapter you will be able to:

• Define the ‘sociological imagination’ and its relationship to the concept of context
• Discuss the relationship between socio-economic context and health inequalities
• Critically examine different explanations of health inequalities
• Discuss several developments argued to indicate the decline of medical authority
• Explain and apply theories of social construction and medicalisation to think critically about health risks and panics

Introduction

Health and illness may seem solely individual matters. However, sociologists draw attention to social patterns in health and illness, seeking to situate our experiences and beliefs within broader social, historical and cultural contexts. This chapter introduces key concepts from the sociology of health and illness, beginning with an exploration of the ‘sociological imagination’ and importance of ‘context’ to understanding human social life. First, we examine socio-economic contexts of health in relation to social determinants and health inequalities. The context of health care professions is then considered with attention to changing professional relationships as well as challenges to medical authority. Introducing social constructionism, the cultural context of health is explored with reference to medicalisation, moral panics and risk.

The Sociological Imagination

A wide-ranging discipline, sociological studies span examinations of everyday social interactions through to global social processes (Giddens and Sutton, 2017). American sociologist C. Wright Mills famously described the ideal mindset of the social scientist as the ‘sociological imagination’ or the ability to grasp ‘history and biography and the relations between the two’ (Mills, 2000, p. 6). This outlook connects personal troubles to public issues, seeing individual problems as intimately tied to broader social structures like institutions, social divisions (e.g. class), and the economic system as a whole. Sociology is thus about delineating the social forces that affect ordinary lives (Dunn, 2018, p. 38).

For the sociological imagination, context is key to understanding human social life. Among animals, human beings are relatively unique in being born with comparatively little instinct. What it means to be human is fundamentally different depending on how our societies are organised at particular places and times. Even the most intimate aspects of personal experience like fear, hatred, love and rage can only be fully understood within the ‘social context in which they are experienced and expressed’ (Mills, 2000, pp. 161–162). Thus, the sociological imagination is above all an injunction to appreciate the deeply contextual nature of human experience.

But what is context? Erving Goffman described context as a ‘frame’ surrounding social phenomena that allows something to be understood (Goodwin and Duranti, 1992, p. 4). Context may be the immediate facts necessary to understand ‘what is going on’, for instance a doctor–patient consultation versus a conversation between two strangers on the street. Another level may be institutional context, such as the organisation of the National Health Service (NHS) or a private health care system. Intelligibility may also depend on cultural context. Culture refers to prevailing norms and values, where norms are expected and accepted ways of behaving and values more abstract beliefs about what is worthwhile. As Giddens et al. (2017, p. 3) summarise:

Sociology teaches us that what we regard as natural, inevitable, good, or true may not be such and that the ‘givens’ of our life—including things we assume to be genetic or biological—are strongly influenced by historical, cultural, social, and even technological forces. Understanding the subtle yet complex and profound ways in which our individual lives reflect the contexts of our social experience is central to the sociological outlook.

In other words, thinking like a sociologist involves critically examining taken for granted assumptions about the world, adopting a range of historical, structural and cross-cultural approaches to do so.

The Socio-economic Context of Health

One of medical sociology’s key contributions is the situation of health outcomes within a broader socio-economic context. This perspective, known as the social determinants of health, draws attention to the ‘conditions in which people are born, grow, live, work and age’ which are ‘shaped by the distribution of money, power and resources at global, national and local levels’ (WHO, 2019). These might include (but are not limited to):

• Education
• Housing
• Employment status
• Income
• Social class
• Gender
• Ethnicity

Inequalities in these areas can lead to health inequalities, or disparities in health between advantaged and disadvantaged groups.

Growing attention to social determinants of health and health inequalities arose from criticisms of health policy dating at least to the 1970s. Critics argued that too much research and expenditure had focused on individuals and illnesses and not enough on the broader social context producing ill-health, nor the factors involved in keeping people well. For instance, McKeown (1976a, 1976b) studied centuries of mortality records in England and Wales, arguing socio-economic improvements and public health measures had done more to improve population health than technological advancement. Thus, critics argued greater attention be paid to social policy and the effects of social factors like poverty rather than treatment of disease solely within health care settings.

Since the 1970s, systematic research and review have tended to reproduce the finding that while the overall health of people living in developed countries has improved, there remain strong and...