1. Introduction to Medical Sociology
Dr Catherine Heffernan,
Consultant in Public Health ©

2. Outline of Talk General introduction to Sociology
Introduction to Medical Sociology
Medical Sociology & Public Health
Focus on medical sociology topics:
Illness behaviour & lay experiences
Health and social inequalities
Social construction of illness and medical knowledge
Social Capital

3. Thinking Sociologically!
Macro Level
Organisations, institutions, social structure, culture, social environment, access to services
Measured by quantitative methods, socio-historical research
Meso Level
Social Interactions, social capital, cultural capital
Measured by mathematical modelling, social network analysis, discriminant analysis
Micro Level
Individuals, social interactions
Measured by qualitative methods
Note: Medical Sociology does not equate qualitative research. Misconception!

4. Thinking Sociologically!
Making healthy choices:
If people know that they should be eating 5 a day yet don’t, what is stopping them?
If a woman knows she should breastfeed but doesn’t, what are the factors that are preventing her from breastfeeding?
If individuals know they should be using a condom to protect themselves against STIs but aren’t, what are the factors that are preventing them from exercising their knowledge?
Culture, social environment, social structure

5. Schools of Thought
There are a number of schools of thought within Sociology
Schools relevant to Medical Sociology
Functionalism (though now not popular)
Social Constructivism
Social Interactionalists (‘Chicago School)’
Risk Thesis

6. Medical Sociology
Medical sociology (sociology of health & illness) is concerned with all those aspects of contemporary social life which impinge upon well-being throughout the life-course.
Where you are born; access to services; beliefs about health and illness held by own peers; contact with health professionals; self-identity may be shaped by our experiences with illness and our interactions with health services; attitudes to our bodies shaped by the discourse of health promotion, consumer culture and media

7. Sociology of Medicine Theory orientated research
Examines medicine with sociological questions and uses sociological concepts
E.g. studies of institutions, health inequalities, professions

8. Sociology in Medicine Problem orientated research
Uses sociological perspectives and knowledge to investigate medically orientated questions
That is, solve medical problems and improve medical care
E.g. doctor/patient relationships, social epidemiology of disease, social factors affecting delivery of health services

9. Areas that Medical Sociology Examines
Study of the sick role and illness experience
Sociological epidemiology
Sociological study of healthcare services as organisations
Medicine as a profession
Social construction of illness and social knowledge

10. 1. Study of the Sick role and illness experience
Social role of the patient
Illness/patient careers
The ways that the above factors are shaped by doctor/patient interaction
Illness experience
Medical anthropological viewpoint
Sociological interpretation
Medical anthropologists study illness as part of a way to examine the values in a society or group in the face of uncontrollable events. Sociologists look at role expectations, norms, sanctions and the accommodations or lack thereof for the ill or disabled. For example, the women’s health movement criticizes medicine for devaluing women’s reports of their own health and their experiences of illness and medical treatment

11. 2. Sociological epidemiology
Looks at
social patterning of illness
how sociological factors (social class, gender, stress etc) feature in the development of disease & illness
Sociologists focus on the multiple ways in which social inequalities contribute to differences in health and how these relationships over time persist despite ever-changing mechanisms leading to poorer health amongst the disadvantaged
Differences between social and sociological epidemiology:
Social epidemiology focuses on disease distribution. Uses social concepts to help explain disease distributions. Little attention is paid to the theory behind it or relationships to other concepts. Sociologists are drive by theory.
Social epidemiology seeks to learn about the nature of human disease by studying social characteristics. Sociological epidemiology seeks to learn about the social characteristics of human population by studying the occurrence of disease.
Social epidemiology focuses on one disease in order to determine all the relevant causes of it. Sociological epidemiology uncovers all of the relevant disease consequences of a social condition.

12. 3. Study on healthcare services as organisations
Origins and development of NHS
Role and development of community care
Organizing and funding health care (e.g. types of health care systems, rationing etc)
Outcomes research
Methods include patient-centred surveys as tools to evaluate individual clinician and organisational practices

13. 4. Medicine as Profession
Definitions of professional work
Ways in which a profession obtains and maintains control of expertise
Studies power and authority physicians hold as a group, social and economic privileges associated with the status of medicine and the ways in which they protected these privileges

14. 5. Social Construction of Illness and social knowledge
Uses social constructionist perspectives
E.g. sociological history of diseases, medicalisation and social meaning of illness
Looks at how:
new illnesses are discovered and characterized
Attribution of new medical knowledge
How everyday life is intruded by medical concerns or is medicalised (e.g. diet, exercise, death)
Social meaning of illness -’What is normal depends on whom is being compared with whom’ (Lorber, 1997)

15. Medical Sociology & Public Health
Early development (1940s-60s)
Both closely linked, both were reformist, both employed survey methods and had complementary expertise
Separate development (1970s s)
Rise of new sociological theories and critiques of medicine and public health
Rise of qualitative methods in medical sociology
New Public Health (1990s onwards)
Increasing acceptance of ideas & methods other than epidemiology
Reformist - concerned with the social causes of disease and health of the poorest groups
Complementary expertise - PH brought their view of medicine with them; MS brought their theories and methods
New public health - emphasis on social environmental determinants of health and involvement of local communities in determining needs/priorities.

16. Critiques of Medicine Focus on public health overly individualistic
Harmful effects of medicine
Medicine is not as effective as claimed
Little recognition of patients’ perspectives and dominance of professional medical views of services/treatments
Over-emphasis on acute intervention (acute hospitals and high technology) and neglect of social causes of disease/social programme; public health considered to be overly individualistic (‘victim blaming’) in its approach to health behaviours (smoking, diet, low uptake of preventive services) and neglect of structural causes
Medicialisation thesis (Illich, 1976, Limits of Medicine)
Publication of McKeown (1976) Role of Medicine