Sociology and Health Care

275 Pages·2005·1.39 MB·English

by  Mike Sheaff

S Sociology &
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Sociology & Health Care o
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An Introduction for Nurses, Midwives and Allied Health Professionals
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• Are patients ‘customers’? What does this mean for the l
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patient–practitioner relationship? h
• What should the relationship be between expert knowledge and our C An Introduction for Nurses, Midwives and Allied Health Professionals
own experiences when dealing with health and illness? a
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• Do people who are better off get better access to health care? e
Debates about the future of health care bring questions about patient
choice, paternalism and inequalities to the fore. This book addresses some
of the sociological issues surrounding these questions including:
• The social distribution of knowledge
• The basis of professional power
• Sources of social inequalities in health
• The ability of health care services to address these issues
The book provides suggestions and examples of how sociological concepts
and insights can be used to help think about important contemporary
issues in health care. For that reason, it has a practical as well as academic
purpose, contributing to the improvement of the quality of interaction
between patients and practitioners. The core themes running throughout
the book are inequalities in health and the rise of chronic disease, with
particular attention being given to psycho-social models of illness which
locate individual experiences within wider social relationships.
Sociology and Health Care is key reading for student nurses and those on
allied health courses, and also appeals to a wide range of professionals
who are interested in current debates in health and social care.
Michael Sheaff is Head of the School of Social Policy and Sociology subject
groupatthe University of Plymouth.With teaching and research interests S
in the sociology of health, and work and organizations, he is also a Non- h
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Executive Director of a large Primary Care Trust and was formerly an
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elected member of a local authority. He is a member of the National
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Executive Council of the lecturers’ trade union, NATFHE. f
Cover Design by Grosvenor (Northampton) Ltd
Michael Sheaff
Sociology and Health Care

Sociology and Health
Care
AN INTRODUCTION FOR NURSES,
MIDWIVES AND ALLIED HEALTH
PROFESSIONALS
Michael Sheaff
Open University Press
OpenUniversity Press
McGraw-Hill Education
McGraw-Hill House
Shoppenhangers Road
Maidenhead
Berkshire
England
SL6 2QL
email: [email protected]
world wide web:www.openup.co.uk
and Two PennPlaza, New York,NY 10121-2289, USA
Firstpublished 2005
Copyright #Michael Sheaff 2005
Allrightsreserved.Exceptforthequotationofshortpassagesforthepurposesofcriticismand
review, nopartof thispublication maybereproduced, stored ina retrieval system,or
transmitted,inanyform,orbyanymeans,electronic,mechanical,photocopying,recordingor
otherwise, withoutthe priorpermission ofthe publisher ora licencefrom the Copyright
Licensing AgencyLimited. Detailsofsuch licences (forreprographic reproduction) maybe
obtainedfromtheCopyright LicensingAgencyLtdof90TottenhamCourtRoad,London,
W1T 4LP
Acatalogue record of thisbookis available from the BritishLibrary
ISBN-13 978 033521388 7(pb)978 033521389 4 (pb)
ISBN-10 0335 21388 X(pb) 0335 21389 8(hb)
Library ofCongress Cataloguing-in-Publicaton Data
CIP dataapplied for
Typeset byYHT Ltd,London
Printed in thUK byBelland BainLtd,Glasgow
For Fiona, Tristan and Daniel

Contents
Acknowledgements x
Preface xi
PART 1
Health care and the social distribution of knowledge 1
1 Health care and the ‘sociological imagination’ 3
What makes this book different? 4
Themes of the book 5
Theory and practice 6
The personal and the social 9
Facts and values 13
Understanding society 15
Structure of the book 20
2 Whose knowledge matters? 23
Patients, knowledge and choice 23
Being a customer 24
Knowledge, choice and the MMR vaccine 26
Experience and knowledge 29
Science, reason and the Enlightenment 30
Science, illness and patients 32
Max Weber and rationality 33
Rationality and choice 35
Science, experts and problems of trust 37
Commercial interests and medicine 40
3 Science, values, emotion and tradition 42
Values and utilitarian calculation 43
Health care and the role of emotions 50
viii CONTENTS
Health and the role of traditional beliefs 55
Defining ‘health problems’ 57
Illness and its social setting 60
Relationships between science, values, emotion and tradition 61
4 Diagnosis, meaning and experience 63
Diagnosis as a ‘personal trouble’ 64
Diagnosis as a ‘public issue’ 67
Illness and deviance: Talcott Parsons 70
Illness and stigma: Erving Goffman 74
Illness and ‘medicalization’: Irving Zola and Ivan Illich 78
From medicalization to commercialization? 83
Choice, power and knowledge 87
5 Patients, clients and professionals 90
The ‘sick role’ and the legacy of paternalism 90
Paediatric Cardiac Services Inquiry 95
Alder Hey Inquiry 96
Styles of decision making 98
The informed patient 98
The expert patient 102
Consumerism and the patient as ‘customer’ 104
PART 2
Health care and the social distribution of illness 111
6 Society, health and health care 113
A social history of infection 113
Clinical medicine in the late twentieth century 118
Social medicine and psychosocial medicine 119
Post-revolution health and health care in Cuba 121
Clinical consultations and social problems 123
Empowering or controlling the patient? 125
The social context of personal control 126
7 The social distribution of health 128
Health inequalities today 129
Do health inequalities matter? 129
Inequalities, risk and probability 131
Responding to health inequalities 134
The re-emergence of psychosocial explanations 135
Social relationships and work and control 137
Social class and health 138
Income, poverty and health 143
The concept of relative poverty 144
CONTENTS ix
The social distribution of health 146
Health and the role of lifestyle factors 147
Health: rights and responsibility 151
8 Society, relationships and health 153
Intimacy and confiding relationships 153
Social relationships and community 158
Wider, societal relationships 168
9 Work, control and health 175
Marx and the ‘work–life’ balance 175
Marx on working hours and health 177
Health and control in the workplace 179
Marx: work control and alienation 181
Taylorism and the ‘deskilling thesis’ 183
Health, work and unemployment 184
Health care hierarchies and control 187
Markets and networks 192
10 Inequality and access to health care 196
The inverse-care law 196
Are health services accessed equitably? 198
Inequalities in chronic illness 203
Inequality and seeking professional help 208
Ethnicity, health care and ‘institutional racism’ 210
Health care: making a difference 214
Conclusion: Choice, trust and responsibility 222
Contracts for health care? 223
Appendix: Marx, Weber and Durkheim 227
References 234
Index 246