The Contribution of Sociology and the Understanding of Health, Research Paper Example
Introduction
Sociology deals not only with individuals but also with the society and the interaction of individuals in society. Sociology is the study of human beings as social beings and hence deals with human interactions, actions and social processes. Sociology also plays a crucial role in understanding social health. Society includes diseases as well as health and a study about society cannot avoid these factors as well. According to Cockerham (2007)
“It is cleat that most diseases have social connotations. That is, the social context can shape the risk of exposure, the susceptibility of the host, and the disease’s course and outcome – regardless of whether the disease is infectious, genetic, metabolic, malignant or degenerative”.
Public also realises the role played by social factors in society’s health. Health and medical practitioners during their initial training are supposed to study sociology. They are taught sociology as part of their curriculum in the form of academic literature along with sociological concepts. Research and policies about health are instigated by politicians of health department with the aid of recommendations that are sociologically informed and sociological investigative tools(Blaxter, Paterson & Bethel, 1982).
Sociology plays a crucial role in identifying factors leading to certain diseases and hence is considered to help largely to demystify the nature of illness and health. It is said that more importance is given to social factors that cause illness and disease and aids in the formation of a more discerning practitioner. Such a health practitioner will be able to act more focused and make decisions more competently. This is because sociology exposes ethical dilemmas and power factors in healthcare production (Clark et al., 1990).
Medical sociology has evolved as a branch of sociology playing significant role in health reforms. The branch elucidates the influence of professional, ideological and economic interests on organisation and provision of health care (Mechanic, 2006; Quadagno, 2005). Medical sociologists have conducted research on many micro processes characterising the functioning of health care system like access to health care and seeking of health care, behaviour of physician and patient, illness and health behaviour, healthcare institutions functioning etc. Research, teaching and writing of medical sociologists affects framing of issues and solutions by media, policy makers, opinion leaders etc. It is due to the effort of medical sociologists that policy makers began to consider health disparities, consumerism, broad determinants of health, patient behaviour and social networks influence on health(Cockerham, 2007).
Though it is considered that sociology is very crucial in demystifying health related issues, there are several criticisms against researches in this field. One of the main criticisms against sociologists is that they are diverted, disillusioned and disinterested. Disinterest of sociologists is eminent from loss evident in radical intellectualism and lack of activism in a genuine form emanating from this particular discipline (Furedi, 2004).
However sociology relates to individual behaviour and research about individual behaviour and its relation with social structure. It is the dynamic interaction between social structure and individual that changes and influences society as a whole. This notion has relevance to health promotion as this is also about bringing changes in organisational and individual structure. Thus role played by sociology to health of society gains crucial position in today’s environment. This paper tries to critically analyse the role played by sociology in health(Mechanic, 2006).
2. Concern of sociology
Sociology is interested in analysing structure of society and social process. Thus it is interested in analysing different groups constituting a society. This includes analysis of social race, class, age, gender etc. None of these categories are mutually exclusive and relationships between each of these categories are of interest to sociologists like relationship between effect of gender and age. Defining categories and groups are also of interest to sociologists(Füredi, 2004).
Thus it can be found that sociology is concerned about organisation of society and the process with which it is changing or is maintained. Sociological concepts of organisation, power and social process contribute to the concept of health promotion in a very useful manner. Sociological analysis can provide understanding and information that is capable of making more effective health promotion. Sociology can also analyse health promotion critically. Such practices can be called as application of sociology to health promotion(Farquhar, Sorkin & Summers, 2001).
2.1 Sociology of health
Sociology was initially used in the field of medicine as part of service to health and illness. Medical students were to be made aware of relationship between society and health care. It was the concern of clinicians that was of prime interest. For example sociology tried to explore the reasons behind illness experience and seeking of help; methods in which doctors ensure compliance to their patients; relationship between a doctor and a patient etc.(Bury, 2005).
Other than one of the primary needs of medicine at that time was the knowledge of factors leading to epidemic diseases, Data was collected about socio economic factors of people affected or not affected by epidemic diseases(Bury, 2005).
Thus it is very clearly proven that sociology is helpful in the field of medicine to improve health care provision to individual and in exploring factors leading to diseases. During early days sociology was used in medicine in such a way that interest of medicine was of prime importance as the agenda of sociology itself was set by medicinal interests. During 1950’s main exponent of medical sociology was Parsons (Clark et al., 1990).
2.2 Profession of medicine
Sociology entered medical field as a related interest in medical professions sociology. Primary concern of sociology in the field of medicine were related to medical profession like who are called as medical practitioners or how health is being maintained or illness dealt with by doctors. This approach of sociology to medicine made sociology of medicine rather than sociology being applied to medicine. But even then sociology during its earlier stages was confined to analysing of medical profession (Herzlich, 1973 as cited in Bury, 2005). It is seen that sociology started to contribute to medical practice and education and evolved as a critique to medical profession. Implications of such criticism made by sociology to medical profession were helpful in the deliver of health care.
2.3 Lay perspectives incorporation
Patients were not a subject of sociological study during earlier days. Sociologists did not enquire about patient’s expectation from doctor or how they decided to seek the aid of a doctor. It is clear that sociology can play crucial role in medical profession and it can provide insights at various levels. First role of lay beliefs will be considered.
It is found that non professional community like patients or general public will not be ready to accept medical model of factors leading to illness or diseases. According to a study conducted by Blaxter et al. (1982) on the behaviours and health attitudes of three generations it was found that health explanations were employed to factors causing diseases. This includes poverty, stress, infection, individual susceptibility, environment etc. Explanations given by Scottish women on whom study was conducted was influenced by their social contexts like poverty they are facing, their living conditions, role they perform as a daughter, mother, wife, grandmother etc, age, scientific medical explanations or their own interpretations of illness.
According to Blaxter et al. (1982) most important aspect was cause. All those people wanted to know the reason behind such a disease and why they are receiving a particular type of diagnosis. Several other authors also are of the same opinion that people always want to know reason behind a disease like why not and why me. Beliefs vary from person to person or from society to society and the same is with explanation. Not many are ready to accept a general explanation as to why a disease is affecting human beings. They always want to know why they are being affected by that disease. Though people are not ready to accept factors like hygiene, stress, drinking, smoking etc they are ready to accept factors like bad luck, family disposition of environmental influence. Pill and Scott (1982 as cited in Clark et al., 1990) was able to find increased degree of fatalism regarding aetiology of illness among les educated, working class mothers who were young.
According to Stacey (2004), “Ordinary people, in other words develop explanatory theories to account for their material, social and bodily circumstances, These they apply to themselves as individuals, but in developing them they draw all sorts of knowledge and wisdom, some of it derived from their own experiences, some of it handed in by word of mouth, other parts of it derived from highly trained practitioners. These explanations go beyond common sense in that explanations beyond the immediately obvious are included”.
It can be seen that these findings are having various implications on strategies of health promotion. For example for making initiatives of health promotion it is very important to understand the complexity of lay beliefs. This is because for benefits to reach correct target while making health care initiative, lay beliefs can help a lot. Lay behaviours and attitudes are to be considered and incorporated while forming strategies and programmes of health promotion. This will also help in development of more sophisticated approach to life style(Blaxter, Paterson & Bethel, 1982). This can further contribute to five principle areas of health promotion mentioned in Ottawa Charter, namely strengthening action of community, supportive environment creation, development of personal skills and health services reorientation. Lay beliefs can not exist in vacuum and medical diagnoses and theories are incorporated to explain ill health like viruses, germs etc. Doctors are also in need to apply lay beliefs while conducting diagnoses especially when they are dealing with general public. This is because doctors are also ordinary people in various aspects of life. As Stacey (2004) says
“As well as lay concepts being socially situated, so is professional practice socially contextualised such that it is itself influenced by lay models of conceptualisation”?
This practice is clearly illustrated by Helman (1978 as cited in Skelton and Croyle, 1991) in his paper “Feed a cold, starve a fever’ with regard to general practice in North London.
Lay beliefs further insist to acknowledge the general acceptance of socio economic factors by lay and professional people. Effect of social structure is recognised by ordinary people in defining their action. This helps us to understand the methods in which sociology analyses social stratification and how far it can contribute to health promotion.
Division of society into various forms will reflect values and social norms. Most common social divisions used in contemporary world are age, class, race, gender, wealth, ethnicity etc. These classifications itself can reflect the difference in relationship between various groups. Thus this categorisation also becomes relevant to health or illness experienced by society. Sociology of health has always focused on these factors and have always analysed the role played by socio economic factors over health of society(Armstrong, 1994).
According to Black Committee report (DHSS 1980 as cited in Smith et al., 1998) though there is a general improvement in the health of population over the last century there exist disparities between classes. Mortality was considered by this report as the health indicator and as social class indicator took the classification given by Registrar General of occupational classes, as both these can not be considered as perfect measures both of them worked well in predicting health levels. Thus continuing inequality of health was seen among classes in all cases including accidental death, infant mortality or death occurred due to chronic diseases. As this report is largely based on epidemiology Committee gave four explanations that are socially based and capable of explaining differences. Explanations are:
- Natural selection: preponderance of ill health that is prevailing among socially and economically backward class are explained by this. This suggests that people living with a tendency of ill health are not able to compete in occupational market favourably and are thus drifted down naturally into lower class.
- Artefact: according to this explanation results of the committee report are mere reflection of chosen statistical categories.
- Behavioural/Cultural: health inequalities are attributed by this model to differences of lifestyle among classes.
- Structuralist/ Materialist: correlation between health and social class is proposed as a consequence of unequal distribution of economic and social factors like wealth, unemployment, housing etc.
Committee itself was in favour of complex interaction between materialist and cultural explanations. As there were far reaching political implications to the findings of committee report was suppressed initially. It is acknowledged by Davey Smith et al. (1998) that even now these inequalities prevail in society. More complex indicators of social health and class used by Davey Smith et al. (1998) have upheld and accentuated the effect of class based measures even after ten years of initial findings.
Various studies other than these also have demonstrated that there exists a strong relation between health and illness to structural or material circumstances. These sociological studies based on field work shows that there exists strong relation between sociological aspects and health of society as a whole. Thus it is evident that the relationship is evident in daily life. Certain studies were also able to analyse the relation between life style, culture or health behaviour and socio economic circumstances (Blaxter et al., 1982).
2.3.3 Deprivation on the basis of social capital
According to Wilkinson (1996) it is from relative inequality that ill health derives and not from absolute inequality. This can explain widening health inequalities where over all standards of health and living remains increased. This finding is supported by the fact that rates of ill health are low among those societies which is having better level of wealth. Social capital is a debated concept and explained in various terms ranging from community development to individualised model. Building social capital was considered as an approach to better health of society was implemented during 1997. In order to reduce health related inequalities in society it is important that the approaches from government are more radical and integrated to health development.
It is very apparent that contributions of sociology have been able to highlight the key dilemma affecting health promotion. It is the tension that exists between concentrating on individual behavioural approach and facilitating of structural change that affects health promotion. It was the intervention of sociology that converted health education to health promotion and community medicine to public health. Though lifestyle approaches were not abandoned it was rather recognised that for increasing potential for health of communities or individuals both of them needed to be addressed together. Though both of them sound different theoretically they are practically inseparable. Even then it can be seen that lifestyle approach is still predominating. It is also seen that social capital notions have transmuted in a span of ten years and the persisting model of ‘stages of change’ in health promotion also plays a role in this (Bunton and McDonald, 2002).
Sociological analysis can play a role here by providing some intellectual credence. It is very evident from various facts that policies that are likely to imply widespread changes in economy, society and politics are resisted by social groups having least gain from that. For example, when a reform takes place on production of alcohol on behalf of its wide effects on health, breweries and government takes measures to change the type of beverages produced and advertising methods or level(Bunton & Macdonald, 2002). But there won’t be any initiative to constrain number of outlets for consumption or purchase or to increase taxation for beverages. Thus we can see that there are various underlying factors affecting policy decisions.
Policy varies according to nation, time etc and resistance and balance of power shifts in between parties who are interested and not those who are affected. Sociology studies help to reveal these factors and the same is done by this segment of study in health aspect as well. Local people find this shifting of power as either conflict or consensus; as between groups who are interested that are inherently unequal or equal(Blaxter, Paterson & Bethel, 1982).
2.3.4 Relation between health and gender
Several sociological studies have revealed the affect of gender and health. Inequalities in social life in almost all areas are related to gender. This is evident in wealth, education, family life, employment and even in linguistic matters (Brannen and Wilson, 1987). This is same for health as well. Health related gender difference is very evident in mortality and morbidity rates in UK. Men are seemed to have higher mortality rate while is found to be of higher morbidity rate. As stated by Armstrong (1994) that “women get ill but men die”. Sociology plays the role in revealing the reason behind this health aspect which is prevailing in society. It tries to analyse various social factors that is leading to such a situation. Is there any connection between social patterns of life with these differences in health aspects?
2.3.5 Sexuality and disability
Sociology contributing to health on the basis of social stratification needs to include sexuality and disability in its studies of society. This is because new health issues are evolving in today’s society and new sexuality factors like lesbian and gay concepts are also to be considered while studying about health of society. Effect of such factors is to be considered by sociologists in the wake of sexually explicit diseases like HIV/AIDS (Farquhar et al., 2001).
Disability is also considered as a category to be included in sociological enquiry and this has raised several debates on relation between disability and health especially in the matters of chronic illness. Till now specific health related campaigns are not being made targeting disabled people. But disability is used by health promoters to caution ignorant people to warn that they are also likely to be in such a state if warnings are ignored(Farquhar, Sorkin & Summers, 2001). For example disabilities are likely to occur from accidents that take place due to drunken drivers.
2.4 Sociology and health promotion
Sociology has made several contributions to health related matters and now what we need to analyse is the role played by sociology in health promotion. Is it possible to consider the role played by sociology in health promotion as good and beneficial? It is possible for sociology to reveal various norms and values that underpin promotion of health. It is also likely to ask about health promotion and its nature as a discourse(Armstrong, 1994).
Tuckett (2003) has addressed health education choices from the perspective of sociology. According to him there are three reasons behind health education.
- Health education can act as preventive medicine branch
- It can facilitate the use of resources of health care
- It can also provide general education regarding health
He says that it is due to these reasons that health education is involved in politics and ethics choices as well as in value judgement related questions. A question raised by value judgement is what is to be considered normal and what is considered as healthy.
One of the debates in this aspect is whether it is possible to have an effective health education by encouraging changes at individual level with out demanding political or social changes in wider. According to Tuckett (2003) it is more effective to have intervention of health education at social level than merely targeting individual behaviour and life style. This leads to the view that all health education can be called as political because any thing that do not demand for changes in status quo is to be considered as a political act. If this stand is accepted it is of no use in arguing against political role taken by health education.
Tuckett (2003) further states that health intervention must
“Consider and influence relevant social norms and values … and health norms and values do not exist independently of other norms and values in society”.
Applying of this kind of sociological theories have led to severe criticisms on health education practices. For example Pearson’s (1986 as cited in Stacey, 2004) exposure of ideologies of racism forming the base of various campaigns of health education is directing ethnic minorities. She has adopted campaigns on rickets, surma, dietary education and antenatal care as case studies. She reveals that these campaigns are concentrating on lifestyle aspects and failed to acknowledge social factors that are likely to affect over all health and there by contribute to overall health outcome. For example, surma campaign concentrating on accumulation of lead in eye through cosmetics (surma) has very evidently ignored several other factors like accumulation of lead in blood stream through pipe water (lead mixes with water from the paint used in old pipes) in old housing where these groups are living. It has also very clearly ignored the effect of an environment which is traffic filled. People who were part of these campaigns resided in inner city where they were living in an environment which is heavily filled by traffic.
Similarly in order to avoid rickets white British population were encouraged to use food materials rich in Vitamin D and thus this disease was eradicated from this sect. But when a campaign was conducted in Asia against rickets more measures were suggested in lifestyle changes than in food consumption pattern. It was said that in order to avoid rickets people need to be exposed to sunlight more, eat more cornflakes and use margarine. Similar case can be found in Asian mother and baby campaign also. In this case it was said that booking of antenatal lately is the issue that lead to problem and not the method in which that service was delivered (Smith, Morris & Shaw, 1998).
Applying sociological methods in health do not lead us to a debate on individual v. Social structure. We reject the approach of victim blaming, which is revealed easily through a close examination of after effects of giving more importance to lifestyle factors on health education. But Pearson (1986 as cited in Stacey, 2004) helps us to understand the ideologies that are used for underpinning such strategies. According to her these policies are of no use and the methods of victim blaming and life style approach is wrong and ineffective respectively. Such policies are considered racist by Pearson (1986 as cited in Stacey, 2004) for they are based on a particular view which is already in existence like Asian, African etc. Such views constructs a large group like Africans as a homogenous group which is following a single culture embraced by all which is very wrong in every aspect. It is often construed that this group which is undifferentiated is prone to some disease and it is often construed further that disease occurs due to their ethnic origin which is highly varying.
Thus it is very evident that sociology needs to consider relevant culture and social norms while conducting research in matters related to health. This is because even a minor variation is likely to create great consequence on health of people. More over classifying large group of population in general can not be of help in health related matters.
2.6 Conclusions
Sociology is of help in health promotion projects in future considering the contributions made by it to health and illness earlier. This is possible by addressing social stratification aspects like age, class, race, gender, disability and sexuality. It is also necessary to address varying type of power relations among groups or by explicit exchange of concepts between expert and lay belief system. Campaigns and policies can be targeted more effectively by explicitly taking various factors for granted.
A critical analysis of role played by sociology in health related matters makes it clear that sociology has made great contributions to health sector. It is due to sociological interventions that major health reforms were possible in an effective and successful manner. More over sociology can not be avoided in health matters due to the interrelation of health and society. It is very important that medical practitioners understand the patients they are dealing with. This will make their job easy and people are also concerned about various factors while approaching doctor seeking help. But it is also found that the methods adopted by sociology in considering population of study is not always true or precisely correct. At times certain factors which are very relevant are avoided by sociologists while conducting a study. Campaign conducted in various countries for same reason varies greatly and most of such differences are due to gross negligence on the part of sociologists. Though sociologists can contribute greatly to medicine and illness their negligence is likely to create a negative impact rather than a positive benefit.
Social norms and values are of great importance in considering social factors affecting a group of individuals. No group of individuals will be relying on exactly same social norms or values and same is with genetical factors also. It is not advisable to consider Asians as a whole while considering ethnicity, race etc. This is because Asia is a large area and people of Asia varies very much their ethnicity of origin, norms, values, lifestyles, behaviours, social and cultural aspects, economic and educational aspects etc. It is very evident that racism plays a crucial role in sociological researches which is not acceptable or beneficial while research results are used for a field like medicine. Culture is yet another matter which is to be considered while studying about people for health related purpose. These critical issues are apparent in various other areas and need to be avoided for sociology to play an effective role in health and related researches.
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