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An Introduction to the
Sociology of
Health and Illness
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An Introduction to the
Sociology of
Health and Illness
Kevin White
SAGE Publications
London • Thousand Oaks • New Delhi
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© Kevin White 2002
First published 2002
Apart from any fair dealing for the purposes of research or private study, or criticism or review,
as permitted under the Copyright, Designs and Patents Act, 1988, this publication may be
reproduced, stored or transmitted in any form, or by any means, only with the prior
permission in writing of the publishers, or in the case of reprographic reproduction,
in accordance with the terms of licences issued by the Copyright Licensing Agency.
Inquiries concerning reproduction outside those terms should be sent to the publishers.
SAGE Publications Ltd
6 Bonhill Street
London EC2A4PU
SAGE Publications Inc.
2455 Teller Road
Thousand Oaks, California 91320
SAGE Publications India Pvt Ltd
32, M-Block Market
Greater Kailash - I
New Delhi 110 048
British Library Cataloguing in Publication data
ACatalogue record for this book is available from
the British Library
ISBN 0 7619 6399 5
ISBN 0 7619 6400 2 (pbk)
Library of Congress Control Number: 2001132943
Typeset by SIVAMath Setters, Chennai, India
Printed in Great Britain by The Cromwell Press Ltd, Trowbridge, Wiltshire
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Contents
Acknowledgements xi
1 Introduction 1
Sociology, Genetics, Social Mobility and Lifestyle 2
The Sociological Perspective 4
Postmodernity and Sociology 5
Sociological Approaches to Health and Illness 6
Political Economy and Marxist Approaches 7
Parsonian Sociology of Health 8
Foucault’s Sociology of Health 9
Feminist Approaches 9
Bringing the Approaches Together 10
Conclusion 12
Summary 13
Further Reading 13
2 The Social Construction of Medical Knowledge 14
Making Reality Problematic: The Problem of
the Medical Model of Disease 17
Medical Knowledge Mediates Social Relations 20
Masturbatory Insanity 20
Hysteria 20
The Technical Realm of Medical Practice 21
Medical Technology and Social Relations 22
The Sociology of Medical Knowledge 23
Fleck and Representations 24
Fleck’s Sociology of Medical Knowledge 25
Syphilis 25
Anatomical Drawings 26
Fleck, Foucault and Kuhn 27
Applying Fleck 28
Conclusion 30
Summary 31
Further Reading 31
3 The Development of the Sociology of Health 32
The Relationship Between Sociology and Medicine 32
Medical Bias in the Sociology of Health 34
Challenging Medicine 35
Social Aspects of Disease – The Critique of the Medical Model 36
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vi The Sociology of Health and Illness
Key Concepts in the Sociology of Health 39
The Concept of Medicalization 40
Disease: Nature or Society 41
Medicalization and Women 42
The Social Functions of Medical Knowledge and Practice 43
The Development of Medicalization 43
Case Study: Gambling 44
Case Study: Alcoholism 45
Developments in the Medical Profession 47
Characteristics of the Medicalization of Society 49
Case Study: Learning Disabilities, Dyslexia and the
Medicalization of the Classroom 50
Assessing Medicalization 50
Conclusion 51
Summary 52
Further Reading 52
4 Postmodernity, Epidemiology and Neo-Liberalism 53
Postmodernity 54
Liberalism and the Development of Neo-Liberalism
in Health Policy 57
The Nineteenth and Early Twentieth Centuries 57
The Dismantling of Welfare and the Resurgence
of Neo-Liberalism 58
Epidemiology: The Early Foundations 60
Limitations of the Risk Factor and Lifestyle Explanations 61
Developing a Sociological Model of Disease:
Disease Classified by Social Cause 62
Epidemiology and Statistics 64
Psycho-social Perspectives on Social Inequalities in Health 65
Stress 66
Social Support 68
The Social Drift Hypothesis 68
Talking About the Diseased Self 69
Community, Social Capital and Inequality 71
Social Capital 73
Social Capital or Income Inequality? 75
Conclusion 77
Summary 77
Further Reading 78
5 Materialist Approaches to the Sociology of Health 79
What Causes Disease: The Materialist Explanation 80
Occupation 81
Diet 82
Housing 82
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Pollution 83
Case Study: Transformations in the Social
Structure of Eastern Europe 83
Class as Ocupational Position 84
Untangling Class and Socio-economic Status 86
Structural Position as Socio-economic Status 87
The Classical Marxist Approach 89
The Political and Economic Functions of Medicine 90
The Medical Profession in a Marxist Analysis 91
Modifications of Classical Marxism and
Changes in Capitalism 93
Changes in Class Theory and the Sociology of Health 94
Transformations of the Medical Profession:
The Australian Example 95
Technological Change 97
Commodification 98
Corporate Medicine 100
Conclusion 101
Summary 103
Further Reading 103
6 Parsons, American Sociology of Medicine
and the Sick Role 104
Parsons and the Professions 106
Diagnostic Variations 108
Prescribing Activities 108
Parsons: People Act Rather than Behave 109
The Sick Role 111
In Defence of the Sick Role 113
Sickness and American Values 114
Conclusion 115
Summary 116
Further Reading 116
7 Foucault and the Sociology of Medical Knowledge 117
Foucault: The Most General Picture 117
Foucault’s Sociology of Health 119
Disciplines of Knowledge, Disciplines of Power:
Power/Knowledge 120
Foucault's History of Medicine 121
The Body 122
Historical and Metaphorical Representations of the Body 123
Foucault's Body 125
The Anatomico-Metaphysical Register of the Body 126
Technico-Political Register of the Body 126
Conclusion 128
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viii The Sociology of Health and Illness
Summary 129
Further Reading 129
8 Health, Gender and Feminism 130
Why are There More Women Patients? 132
Medicalization 135
Are Women More Depressed than Men? 136
Different Forms of Feminism 137
Liberal Feminism 137
Radical Feminism 138
Marxist Feminism 139
Patriarchal Science and Medicine 140
Feminism and the Critique of Technology 141
Case Study: Foucault and Feminism and the Body 142
Bringing Out the Foucauldian-Feminist Position: Screening 144
Men, Gender and Health 147
Conclusion 150
Summary 151
Further Reading 151
9 Race, Ethnicity and Health 152
Race 153
Ethnicity 155
Aboriginality, ‘Race’ and Disease 156
Racist Bias in Drug Trials 158
Problems with the Appropriation of Ethnicity
in Medical Explanations 159
The Genetic Explanation 160
The Appeal of the Genetic Explanation 161
The Sociological Critique of Genetics 163
Conclusion 164
Summary 165
Further Reading 165
10 Conclusion 166
Bibliography 170
Index 191
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Boxes and Tables
Boxes
1.1 Aboriginality, lifestyle and genetics –
obscuring social processes 4
1.2 Modern society may have changed – but key
social structures persist 6
1.3 Sociology, science and medicine 11
2.1 The social constructionist theory of medical knowledge 16
2.2 Medical and dental knowledge as socially located 16
2.3 Diseases change independently of their biology –
the case of tuberculosis 18
2.4 Diseases produced in a social environment – RSI 19
2.5 Ludwik Fleck and the foundations of the sociology
of medical knowledge 23
2.6 Fleck’s concept of thought style 25
3.1 Structural-functionalism in sociology 33
3.2 Changing assessments of medicine – changing
explanations in sociology 36
3.3 Social factors shaping medical practice 37
3.4 The social production of cancer 38
3.5 Drapetomania 41
3.6 The process of medicalizing a social problem – gambling 45
4.1 Consequences of neo-liberalism on disease patterns 59
4.2 The World Health Organization and
the social basis of disease 59
4.3 Empirical lack of support for risk factor approaches 62
4.4 Asociological model of disease 63
4.5 Major findings from the social support literature 68
4.6 Functions of the illness narrative for the individual 70
5.1 Structural changes in employment conditions
as a determinant of the health of workers 80
5.2 Social change and increasing disease and death
in Eastern Europe 83
