Summary of ‘The sociology of health and illness’ by Nettleton
Chapter 1
Health and illness receive considerable attention from the media: television, radio, newspapers,
magazines, and videos all devote space and time to health-related issues information and
knowledge about health and illness are recognized as no longer just the property of health ‘experts’;
everyone has at least some experience and knowledge
Sociology of health and illness: not confined to the narrow domain of the formal institutions of
medicine; it focuses on all those aspects of contemporary social life that affect well-being throughout
the life-course
Social processes impinge upon our health and well-being:
The social locations of our parents affect our life chances
Our birth may be mediated by technology and controlled by health professionals
The beliefs about health and illness held by our peers and by those with whom we live will
shape our own experiences and understandings
Our contact with health professionals is likely to become a routine fact of our lives
Our self-identity may be shaped by our experiences of illness and our interactions with
formal and informal institutions of health care
Our attitudes towards our bodies will be influenced by the discourses of health promotion
and consumer culture
Our experiences of death will be influenced by our sociocultural context
We may encounter new technologies of health care (for instance through our own illnesses
or through having children)
We may have to face the ethical and moral dilemmas central to the blurring of the beginning
and ending of life
We may work in organizations directly or indirectly associated with health work
We will all carry out some form of health work (may involve caring for elderly relatives,
children, partners, friends, and ourselves)
Biomedicine: dominant paradigm of Western medicine many of the central concerns of the
sociology of health and illness have emerged as reactions to, and critiques of, this paradigm
Biomedical model is based on 6 assumptions:
1. The mind and the body can be treated separately: medicine’s mind/body dualism
2. The body can be repaired like a machine medicine adopts a mechanical metaphor,
presuming that doctors can act like engineers to mend that which is dysfunctional
3. The merits of technological interventions are sometimes overplayed which results in
medicine adopting a technological imperative
4. Biomedicine is reductionist because explanations of disease focus on biological changes to
the relative neglect of social psychological and political factors
5. The reductionism is accentuated by the development of the germ theory of disease which
assumed that every disease is caused by a specific, identifiable agent, namely a disease entity
this is the doctrine of specific aetiology
6. The biomedical approach is universalized it was imposed throughout the world as the
legitimate way of approaching the treatment of disease, the management of illness and the
education of doctors the assumption that biomedicine is objective and universal was
bound up in the colonial projects whereby populations were exploited by clinical researchers
in the name of science
,Atkinson: the biomedical model is reductionist, seeking explanations of dysfunctions in invariant
biological structures and processes (at the expense of social, cultural, and biographical explanations)
this implies that diseases exist as distinct entities, that those entities are revealed through the
inspection of signs and symptoms, that the individual patient is a passive site of disease
manifestation, and that diseases are to be understood as categorical departures or deviations from
normality limitations: the body is isolated from the person, the social and material causes of
disease are neglected, and the subjective interpretations and meanings of health and illness are
deemed irrelevant
Western medicine is based on an objective science which in turn involves empirical observation and
induction medicine claims to offer the only valid approach to the understanding of disease and
illness medicine’s development is presumed to be one that has resulted in an increasingly accurate
knowledge of disease medicine claims to have eradicated certain diseases and eliminated
incorrect ideas and practices, and it holds the promise for further advancements for the control of
existing and new diseases Rhodes: the general course of the history of medicine is from massive
speculation gradually to more focused hypotheses, potentially testable by observation and
experiment there is also a move from supernatural to natural explanations of phenomena and it
all takes a very long time impeding its progress and having to be discarded as time passes, so that
novel ways of looking at events may emerge and be tested Whig history: sets out the
achievements of the past and details how they have contributed to present success in a linear and
progressive manner today these are not acceptable anymore
Challenges of biomedicine:
It has been argued that medicine’s efficacy has been overplayed McKeown: decline in
mortality that has occurred within Western societies has more to do with nutrition, hygiene,
and patterns of reproduction than it has to do with vaccinations, treatments, or other modes
of medical interventions pouring resources into medical technologies has resulted in
diminishing returns Illich: argued that biomedicine does more harm than good rather
than curing and healing, medicine contributes to illness through the iatrogenic effects of its
interventions:
- Pharmacological and surgical interventions and other treatments such as lobotomies and
electro convulsive therapy, which may seem barbaric to our eyes, were presented as
innovative and progressive during the 1950s
- Moncrieff: argues that when the drug imipramine was proposed as being effective in
depression, it was presented solely as acting in a disease specific way and it was soon
referred to as an antidepressant its widespread use was established before any
evidence was available to support this view (and jury is still out concerning the harms and
benefits of antidepressants) the forces that drove the widespread use of
antidepressant drugs included psychiatry’s ambition to be better integrated into
mainstream medicine, and be recognized as treating rather than just managing disease
this ambition, alongside the shift of psychiatric care from the asylum to the
community, helped to create a wider market for medications for mental health problems
- Antibiotic resistance: while antibiotics contributed to the control of infectious diseases
and made surgery safer, the overuse of antibiotics has led to an increase in antibiotic-
resistant organisms despite a growing consensus that there is an urgent need to
reduce use of antibiotics, their global human consumption increased
Evidence-based medicine: institutional and political response to these critiques there is
a move to evaluate all medical and health care interventions to ensure they are the most
effective in terms of treatment outcomes and value for money
People have become deskilled and are dependent on medical experts (Illich) self-care and
care of one’s own family and friends became regarded as inferior to that provided by trained
, health professionals there has been a popular reaction against this process, as people
increasingly try to take more control over their own health there has also been a political
reaction to this view, with policymakers and practitioners keen to acknowledge and capitalize
people’s ability to care for themselves and for others
Biomedicine fails to locate the body within its socio-environmental context an alternative
to the biomedical model is the socio-environmental model of medicine focusing on the
biological changes within the body, biomedicine has underestimated the links between
people’s material circumstances and illness the privileging of the biological over the social
is evident in our contemporary preoccupation with genetic influences on health and illness
genetic explanations are popular and compelling Conrad: contemporary genetic
theories rest on the assumptions of the doctrine of specific causes, a focus on the internal
rather than the external environment, and the metaphor of the body as a machine there
are dangers inherent in presuming that the causes and treatment of disease reside within the
body of the individual patterns of mortality and morbidity or a person’s life chances are
related to social structures and vary according to gender, social class, race, and age; the
biomedical model fails to account for the social inequalities in health
Medicine treats patients as passive objects rather than whole persons lay people have
their own valid interpretations and accounts of their experiences of health and illness
Horton: for treatment and care to be effective, health practitioners need to be sensitive to
the perceptions, feelings, and concerns of their patients sociology of health and illness
argues that sociocultural factors influence people’s perceptions and experiences of health
and illness, which cannot be presumed to be simply reactions to physical bodily changes
The institution of medicine took control of childbirth out of the hands of women in the 19 th
century and managed to ensure, despite the lack of any sound evidence of benefit, that by
the 1970s virtually all babies were born in hospital what is fundamentally a women’s
experience was removed from the domestic domain to the public one of the hospital,
wherein a male-dominated branch of medicine (obstetrics) has control pregnancy and
childbirth also came to be treated as illnesses and were therefore subjected to technological
interventions the experience of having a baby was medicalized: a normal life event came
to be treated as a medical problem that required medical regulation and supervision
medical discourse has contributed to the construction of women’s bodies as fragile, passive
vessels that routinely require medical monitoring and interventions
Biomedicine assumes that through its scientific method, it identifies the truth about disease
sociologists suggest that disease and the body are socially constructed it is argued that
disease categories are not accurate descriptions of anatomical malfunctions, but are socially
created, so they are created as a result of reasonings that are socially imbued medical
belief systems are contingent upon the society which produces them there is also a
correspondence between modes of organization, technological forms, and medical
knowledge; it is evident that technology and practices co-construct knowledge of the body
this means that values may be transformed into apparent facts (for example ‘normal’ and
‘pathological’ bodies, ‘fit’ and ‘abject’ bodies) medicine also questions the basis of healing
that does not match its own paradigm, calling diverse and established forms of healing
‘unscientific’ (but another view suggests that alternative medicines are of equal validity and
that many people are successfully treated by alternative practitioners)
The claim that the boundaries of the medical profession are best viewed as the outcome of
sociopolitical struggles rather than being based on the demarcations of scientific knowledge
means that what counts as legitimate medical knowledge and practice is decided through
social processes rather than being shaped by natural objects of which the profession has an
accurate knowledge the division of labor between health professions is socially
negotiated and is mediated by gender, race, and class these sociopolitical processes,
mediated by social structures have permitted the continuation of professional medical
dominance this medical dominance has contributed to the perpetuation of capitalist,
, colonial, and patriarchal structures, and led to the dimming of healing activities which take
place beyond the boundaries of formal health care
The challenge to conventional biomedicine can be found in postcolonial studies of medicine
that examine the historical formation and perpetuation of scientific categories in the context
of colonial relations biomedical practices were, and still are, sustained and supported by
colonial relations, institutional structures, and violence biomedicine describes what
bodies are, what bodies are capable of, how bodies should be managed and treated if
biomedicine is assumed to be objective, neutral, and universal, then we can see that it is
politically potent but biomedicine attempts to upset categories and epistemologies,
decipher the social construction of knowledge, explore relations of power, and analyze
embodied social movements, and there is therefore much in common with postcolonial
approaches
The biomedical sciences and the social sciences were constructed in the global metropole (group of
rich capitalist countries of western Europe and north America) social movements and voices in the
global South are effectively challenging the epistemological, theoretical, and methodological
frameworks that form the core of mainstream sociology reworking orthodox sociological histories
of modernity and articulating epistemologies of the South encourages social scientists to critically
reflect on their key concepts, categories, and theories
Conceptual organizing principles that might help to provide a degree of coherence to sociology of
health and illness:
1. Turner suggests a levels-of-analysis approach that must involve the study of health and
illness in society at:
1. Individual level: examines perceptions of health and illness
2. Social level: examines the social creation of disease categories and health care
organizations
3. Societal level: examines health care systems within their political context
2. Clarke distinguishes between:
1. Positivists: whose aim is to discover causal laws
2. Activists: whose aim is to diagnose societies’ ills and propose solutions
3. Naturalists: whose aim is to interpret the meaning of situations
3. Gerhardt uses 4 theoretical paradigms:
1. Structural functionalism
2. Symbolic interactionism
3. Phenomenology
4. Conflict theory
Sociology in medicine: sociological research that serves the needs and interests of medicine
research agendas are professionally and institutionally determined, and sociologists work to provide
solutions to medically defined problems institutions that fund research predominantly take this
approach and so this skews the type of studies that are carried out they are keen to understand
the dynamics of the doctor-patient relationship, to improve patient compliance, to prevent patients
from presenting ‘trivial’ health matters, and to identify behavioral factors that may be modified to
prevent illness
Sociology of medicine: represents a more critical approach than sociology in medicine, wherein the
lay rather than the medical view of health and illness is privileged, the dominance of medicine is
recognized, the boundaries of the medical profession are questioned, the functioning of medical
organizations is scrutinized, and the wider sociopolitical determinants of health are studied
