Theoretical approaches - Sociology of Health

Theoretical approaches:

The sociology of health and illness is informed by five theoretical traditions:

Functionalism is based on the following basic assumptions:

·                 It is an analogy between society and biological organism.

·                 It provides a ‘consensual’ representation of society based on agreement to sustain society as it is.

·                 It is an analogy between society and biological organism. It offers an explanation of human society as a collection of inter‐related substructures, the purpose of which is to sustain the overarching structure of society.

Parsonsian functionalism and ‘the sick role’

In relation to the study of health and illness the functionalist perspective is usefully illuminated by Talcott Parsons’ concept of the ‘sick role’. Here the concept is used to analyze sickness as a social role, not merely a biological entity and physical experience. For any society to function smoothly, ‘sickness’ needs to be managed in such a way that the majority of people maintain their normal social roles and obligations. This perspective is based on the assumption that if too many people were to describe themselves as sick and need of being excused from their normal range of social obligations, this would be dysfunctional in the sense of disruptive for society as a whole. Since being sick means choosing to withdraw from the normal patterns of social behavior, it amounts to a form of deviance, and hence the efficient functioning of the social system depends on the sick being managed and controlled. The role of medicine is to regulate and control those who have decided they are sick so that they can return to their normal tasks and responsibilities. In short, the sick role enquires a commitment on the part of those who feel unwell to return to normality as soon as possible. Four features define the sick role:

·              Sick people are legitimately exempted from normal social responsibilities associated with work and the family.

·              Sick people cannot make themselves better – they need professional help.

·              Sick people are obliged to want to get better – being sick is only tolerated if there is a desire to return to health.

·              Sick people are therefore expected to seek professional treatment.

Symbolic interactionism in contrast to functionalism is based on the following assumptions:

·                 It is based on the fundamental difference between the subject matter of sociology and that of natural sciences. While the study of the former deals with physical, inanimate objects, the subject matter of the latter consists of people whose actions are motivated by human consciousness.

·                 It explains social phenomena from the perspective of its participants.

·                 The meaning of human action must be interpreted by studying the meanings that people attach to their behavior.

·                 It is concerned with how people see and understand the social world.

·                 This approach is concerned less with the larger social system or structure than with interpreting human behavior.

The significance of this approach in relation to understanding health behavior is that: it is basically concerned with examining the interaction between the different role players in the health and illness drama. The focus is on how illness and the subjective experience of being sick are constructed through the doctor–patient exchange. The argument here is that illness is a social accomplishment among actors rather than just a matter of physiological malfunction.

Marxism provides a powerful insight into the structure of society is based on the following ideas:

·                 It is the economic structure of any society that determines the social relations contained within that structure.

·                 It is the distribution of the ownership of the means of production that gives rise to specific patterns of class relations, which crucially in all societies are characterized by inequalities of power.

·                 Society is divided between those who privately own the means of production (a minority) and those are dependent on selling their labor power to make a living (the majority).

·                 The relation between these two classes bourgeoisie and proletariat is unequal, exploitation and oppressive.

·                 Marxist theory is concerned with the way in which the dominant economic structure of society determines inequality and power, as well as shaping the relations upon which the major social institutions are built.

Marxist explanation relating to the cause of ill health and relationship between the state and medical profession is based on the insight of the relationship between health and illness and capitalist social organization. The main focus is on how the definition and treatment of health and illness are influenced by the nature of economic activity in a capitalist society. Medicine is a major social institution, and in capitalist societies, it is shaped by capitalist interests. Marxist accounts of capitalist medicine have been developed by a number of sociologists and health policy analysts, notably Navarro (1985). According to Navarro, there are four features that define medicine as capitalist, or as he puts it, that point to ‘the invasion of the house of medicine by capital’ (ibid., p. 31):

·              Medicine has changed from an individual craft or skill to ‘corporate medicine’.

·              Medicine has become increasingly specialized and hierarchical.

·              Medicine now has an extensive wage‐labor force (including employees in the pharmaceutical industry and related industrial sectors).

·              Medical practitioners have become proletarianised, that is, their professional status has gradually been undermined as a result of administrative and managerial staff taking over responsibility for health care provision.

These four processes mean that medicine has become a market commodity, to be bought and sold like any other product. Furthermore, it has become increasingly profitable for two dominant capitalist interests: the finance sector, through private insurance provision; and the corporate sector, through the sale of drugs, medical instruments and so on. The power to direct and exploit the medical system has been seized by large corporations that enjoy monopolistic control over related market sectors. This process is characteristic of (late) capitalism as a whole: ‘Monopoly capital invades, directs and dominates either directly (via the private sector) or indirectly (via the state) all areas of economic and social life’ (ibid., p. 243). The last point illustrates Marxists’ claim that just because medicine is organized as a national system of health care (as in the UK), this does not mean it is free of capitalist influence. Rather, it is part of the medical– industrial–state complex, involving close relations between large firms and state agencies. The state buys drugs and other equipment from large firms, subsidies their research through university laboratories and maintains a large hospital infrastructure that requires their goods.

Marxists also claim that health problems are closely tied to unhealthy and stressful work environments. Rather than seeing health problems as the result of individual frailty or weakness, they should be seen in terms of the unequal social structure and Navarro in his analysis suggests the alliance of interest between the ruling classes and the medical profession; each, for different reasons, derives power from the continuation of these conditions of inequality. For the ruling classes, health inequalities are an indication of the difference in life chances that exist between themselves and working classes in particular. The provision of health care through a system such as the National Health Service is largely about maintaining a reasonable level of health among the working classes, sufficient to ensure that people are able to work and be returned to work following illness. Therefore, the alliance between the ruling classes and the medical profession serves the interest of both by maintaining the professional dominance of the later and by sustaining a reasonably healthy working population for the former.

Feminism – Marxist theory has been criticized in particular for its almost exclusive emphasis on theeconomic determinants of social relationships and for the resulting primacy of social class in any analysis of inequality. Feminist theory from 1960s onwards sought to challenge the invisibility of gender in sociological theory. It is based on the following basic assumptions

·                 Social structure is fundamentally based on inequalities between women and men.

·                 It endorses the social equality of the sexes and opposes patriarchy and sexism.

·                 It seeks to eliminate violence against women and to give women control over their reproduction.

·                 There are three variants of feminist thinking:

Liberal feminism seeks equal opportunity for both in the existing society

Socialist feminism advocates abolishing private property as the means to social equality

Radical feminism seeks to create a gender‐free society.

Feminist theory thus makes a substantial contribution to the understanding of health and illness. It provides an analysis of gender relations on the basis of the way in which female inequality has been structured and maintained in society. It explores the gendered nature of the definition of illness and treatment of patients. Its main concern is the way in which medical treatment involves male control over women’s bodies and identities. Such as Oakley (1984) have argued that the women’s life have been subject to far better control and regulation by the medical profession than have men’s. Particular example can be seen in relation to pregnancy and childbirth.

Postmodernism - Postmodernism is the final theoretical approach to the understanding ofhealth and illness. It refers to the present historical period characterized by the globalization of the economy and culture. It shows a fragmentation of individual identity such that old certainties of class, national and gender identity. This theory is otherwise known as Foucauldianism for major contribution of Michel Foucault where he concentrates on the dominant medical discourse, which has constructed definitions of normality (health) and deviance (sickness). This discourse provides subjects in modern

societies with the vocabulary through which their medical needs and remedies are defined. The source and beneficiary of this discourse is the medical profession. Foucauldian theorists also argue that medical discourse plays an important role in the management of individual bodies (what Foucault called ‘anatomopolitics’) and bodies en masse (bio‐politics), Medicine is not just about medicine as it is conventionally understood, but also about wider structures of power and control.