Health, Medicine and Society: Key Theories, Future Agendas

Citation

Bern, C. (2001), "Health, Medicine and Society: Key Theories, Future Agendas", Journal of Management in Medicine, Vol. 15 No. 1, pp. 95-97. https://doi.org/10.1108/jmm.2001.15.1.95.1

This is a stimulating and interesting book that is well worth reading. I suspect it will be of value both to the dedicated sociologist eager for an overview and for the general health professional keen to put the developments in health, medicine and society over the last decades into some theoretical perspective.

The aim of the book is to use contemporary sociological theories to give insight into the experience of illness and health care today. Following an introductory chapter by the editors, there are 17 single‐author chapters of 12‐15 pages (excluding references) grouped into themes that address the relationship of health with social structure, the body, risk and consumption and the emotions. Each chapter is coherent and readable and generally a good balance of the general and the specific, of theory and empirical observation. Each chapter is well referenced (sometimes running to over 100 references). The authors are almost all from the UK and mostly write from university departments of sociology.

It is a critical book, in the best sense of the word, providing an outsider’s view (the sociologist’s) on the language and practice of medical care. It draws on a variety of perspectives that include phenomenology, constructionism and postmodernism. It provides insights that will be relevant to all involved in health care. The editors also point out that health and illness have been a fertile field for generating sociological analyses that have then had significant influence in general sociology. The book shows that medical sociology remains a vigorous and relevant discipline, one that is able to engage in constructive and informative dialogue with institutions and practices whose ruling paradigms (such as cost‐efficiency and the application of scientific, objective numerical evidence) are contrary to its own. It draws attention to the validity and insight offered by qualitative health care research and the importance of stories, narrative, history and biography in understanding the nature and meaning of health and illness.

The first section of the book focuses on social structures and health with chapters on class, gender, race and age. There is a telling critique of the classification of class by occupation or material ownership as a risk factor for disease. The importance of social cohesion as reflected by income differentials and the place of job insecurity as risk factors for illness are described. Personal perceptions of health are explored through the work of Bourdieu. Observations are made on the different meanings of time – as calendar time, socio‐historic time (reflected through the experiences of cohorts of people of different age and generation each sharing a similar social and historical experience) and personal time (reflected in the individual patient’s story of his/her life and illness).

The second section of the book concerns body‐centred sociological discourse. How is the body experienced and interpreted socially and culturally? How does this relate to the personal experience and description of health and illness? How does this affect our perceptions of medical care? Chapters address the social construction of the body during childhood; the metaphor of immunity as discourse for healthy lifestyle; the iconic status of the gene as the key to control of the body and destiny; discourses on disability relating to normative function, political rights and spiritual meaning; and mortality.

Risk and consumption have probably become the defining paradigms of contemporary Western society. Their profound relevance to the practice and image of health are clearly and tellingly discussed in the third section of the book. Direct and real risk results from the environment, the vulnerability of major technologies to breakdown and from personal lifestyle. The sociologist is interested in the way these risks are narrated in the media, advertising, policy statements and personal life, and how these stories of risk help or hinder us in coping with life. One chapter takes up the representation, perception and experience of issues and risks related to food consumption and shows how food has become profoundly medicalised. Another shows how health care has itself become a commodity and also is used to create desire for other commodities. The section offers critical and revealing insights into the paradoxes present in societies which place consumption and individuality at the pinnacle of identity and experience yet which simultaneously, by necessity in a consumer economy, must encourage practices that are against health.

The final section considers the role of emotions in the sociology of health and helps define the paradox of health care that began its history as an act of compassion but which gains its modern ascendancy through the application of science and reason. Health is likewise a paradox, an emotional, subjective state of being (wholesomeness) but which has become defined in biologically reductionist terms. Emotions have been seen as rather “ethereal” in health care science and also in sociological analysis but the authors in this section provide much evidence and analysis to show that feelings have a validity in personal and social life. Feeling helps communication of self with one’s own experience and with others. Emotions can be communicatively rational. There are fine chapters that question the very foundations of reason, expose the technology of emotions as offered by the emotion industry and offer theories on emotions as the link that runs from the biological psycho‐neuro‐immunological adapatation to socio‐political praxis. The book ends with a chapter on the nature of care, caught as it is between two definitions, that focused on love and concern and that focused on a set of regulated practices.

I found the book enjoyable and a source of important observations. To me, it achieved its aim of presenting key theories coherently and laying out a future agenda of health sociology. I have one criticism however. Health sociologists need to act not only as outside observers on these agendas but also to engage from within. As observers both of health care and of society, a legitimate subject for study must be the nature and theory of a healthy society. What is healthy human behaviour? What is a healthy human society? How can health professionals engage constructively in achieving it? Health sociologists cannot evade this responsibility.