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Editorial
Jeanne Daly
Allan Kellehear
Professor of Palliative Care, School of Public Health, La Trobe University, VIC
Article Text
Welcome to the foundation issue of the Annual Review of Health Social Sciences. This journal was born from the recommendations of a workshop held at Ballarat in February, 1990. This workshop was sponsored by the Public Health Research and Development Committee (PHRDC) of the National Health and Medical Research Council (NHMRC). The Report of that workshop, called The Social Sciences and Health Research: The Report of a Workshop on the Contribution of the Social Sciences to Health Research, was published by the Public Health Association of Australia and is available from that body and from the Health Sociology Research Group at La Trobe University.
Apart from the PHRDC, the workshop was endorsed by the Australian Sociological Association, the Australian Society for Medical Anthropology and the Public Health Association. Thirty-nine participants came from all over Australia representing active social science researchers and users. The purpose of the workshop was to identify the rich variety of research, both empirical and theoretical, in the health social sciences and to identify ways in which the potential contribution of these disciplines to health research could be improved. The report of the workshop identified a number of initiatives for achieving a more sympathetic research environment for health social scientists. These included improving social science representation on funding bodies, revising the application forms to recognise social science as a distinct disciplinary category, ensuring the selection of appropriate reviewers for social science research proposals and establishing a career path for full-time research in the social sciences. Short term initiatives were to include setting up a register of social science researchers and publishing the Annual Review of research. These are long term aims which will require the concerted efforts of the whole social science research community. Setting up the Annual Review was seen as an important first step to bringing about this cooperative venture.
The Annual Review has two aims which follow on from the recommendations from the Workshop. Firstly, the health social scientists of Australia are concerned to show health workers in general, and funding bodies in particular, that the health social sciences are a range of disciplines with a diversity of research methods and theories which are sophisticated and rigorous, able to make important contributions to the wide range of problems encountered in health care and health research. Many medical researchers, and many funding bodies influenced by those medical researchers, are insufficiently aware of the nature of the social science contribution. In addition, when it comes to addressing the social context of health care, the behavioural sciences are too often inappropriately favoured because of their reliance on experimental and survey methods with a superficial resemblance to the physical and clinical sciences. Cultural, historical, qualitative and critical approaches are poorly understood. Increased understanding of our methods of research, and the problems which we are able to address with these methods, will be a necessary first step towards improving our health research profile.
Secondly, while we need better communication with the audiences for our research, we also need to communicate more with each other. Given the suspicion with which outsiders, and some insiders, view the different perspectives and methods used by social science researchers, we need to promote debate about the strengths, limitations and most appropriate role for each approach. This will provide an informed position from which we can sympathetically review research proposals from researchers with methods and theoretical positions different from our own. Given the geographic separation between various groups of researchers in Australia, we are not well informed of what research is being done and what new methodological developments are being implemented. Identifying who the researchers in a particular field are, will allow us to circulate research proposals, consult with other researchers in the field and improve the quality of both our research proposals and our research.
The appearance of the Annual Review in this context represents the first of an ongoing series of volumes dedicated to highlighting the professional profile of the health social sciences in Australia. It is meant to be a self indicator of our research directions in the health social sciences but also an annual professional statement for the use of those outside these disciplines. For funding bodies, the governments, health workers, consumers of health services and social sciences, the annual review will represent a clear and ongoing source of information about health social science research and expertise.
Apart from regular review articles, each issue of the Annual Review will also contain the Australasian Directory of Health Social Scientists. The directory, which appears at the back of this issue of the Annual Review, will contain the names, work locations and research expertise of active health social scientists in Australia and neighbouring regions such as New Zealand and the Pacific. The directory will have three functions. First, to provide a register for funding bodies to use when searching for referees to assess grant applications. Secondly, as a source of names to peer review articles for the Annual Review. Finally, as a register of active researchers in the health social sciences which other professionals, government and private bodies may use when seeking advice, consultancy or research input. The 1991 directory was assembled by distributing applications through the health social science networks of those who attended the Ballarat workshop. In this important respect, the current directory is only an early and very general guide to current workers in the health social sciences in Australia. In the next year or two, we hope that the directory will become more representative expanding into a valuable reference tool. To that end, we also publish with the directory a copy of the application for membership to the Directory. The Health Sociology Research Group was given the task of initiating the register and the journal for the first issues only but as their have been no enthusiastic takers for the second year, our proposal is that members of the Health Sociology Research Group continue to edit it for one year longer. All future enquiries, submissions and applications should be directed to us. In 1993 Stephanie Short has agreed to take on the editorship and enquiries for that year should be directed to:
The Editors
Annual Review of Health Social Sciences
Department of Sociology
University of Wollongong NSW 2500
The review articles in the current volume have been solicited and refereed by the Health Sociology Research Group. They are reviews of recent research in health education, health policy, health sociology and medical anthropology. For the initial volume; we thought it appropriate that the review papers attempt an overview of some of the major health social issues. The second issue in 1992 will focus on those health social sciences not covered issue such as health economics or the social history of health, but we are also calling for papers addressing substantive research concerns, whether theoretical (for example, social constructionism ethics) or empirical (for example, HIV/AIDS).
The first article in this Review is written by Derek Colquhoun and reviews the discipline of education. He attempts to characterise the dominant research concerns of health and laments certain omissions. In this respect he is highly critical of the main directions in contemporary health education. The review does not comment on individual projects but rather attempts to typify the emergent issues in the area. Colquhoun argues that 'Healthism' is the over-riding concern of health education and promotion. A new version of victim blaming, 'healthism' represents the short hand way of referring to research which concentrates on lifestyle and individual behaviours. This is an unquestioning, decontextualising style of research work which ignores the influence of broader cultural systems such as the political and economic agendas in schools, governments and work places. Colquhoun argues for a new 'critical' health education which interrogates and makes connections between individual behaviours and lifestyles and the organisation of environments responsible for them.
Heather Gardner reviews health policy research and observes that most policy research has not emerged from politics departments, but rather departments of economics, sociology, public health or medical faculties. The major research directions have been in areas of health care finance, program evaluation, health education and occupational health and safety. There has been little research in health policy per se although of course, most social science research has policy implications. Gardner argues that much health research has a medical, clinical and/or behavioural focus and this has contributed substantially to a paucity of social policy work. The 'Health for All' report and recent criticism from health social sciences and consumer groups may begin to change all this.
Evan Willis reviews the sociology of health and illness by picking up from a similar review which he wrote for Community Health Studies in 1982. Health Sociology still reflects - eclectic methodology; is now as much driven by funding as by curiosity; but still reflects some sharing and overlap with allied research areas such as social medicine, public health and epidemiology. However, there has been change and this change foreshadows further important developments with implications for health sociology in the 1990s. Health sociology is becoming more concerned with developments in social theory; is developing a stronger interest in qualitative methodology; is becoming increasingly driven by funding in its research directions. Among major topic areas to feel these influences are social aspects of AIDS, gerontology, gender issues and policy and technology research.
Lenore Manderson examines the major projects undertaken by the medical anthropology network. Applied research is very much at the forefront of what is happening in the field of medical anthropology. Public health has been the focus of major attention by medical anthropology but, as Manderson is quick to point out, this has been analysis of as well as in public health. Medical anthropology has been busy in areas of nursing, occupational health and safety, immigrant health, aboriginal health, mental health, gender issues and communicable diseases. For medical anthropology, as for many other health social sciences, there is exciting evidence of inter-disciplinary work and sharing or marrying of theoretical approaches and methods from other disciplines.
The current volume of the Annual Review closes with the most recent-to-hand Directory of Health Social Scientists. It is, as mentioned earlier, a very preliminary list and any omissions are unintended and, hopefully, merely temporary. It is our intention that the Directory and its minder, the Annual Review, should represent an historic advance for Australian Health Social Sciences. These disciplines now have enough researchers across Australia for us to be regarded as a significant resource for health research.
Traditionally health social scientists in Australia have not enjoyed a high profile. The tendency of biomedical, clinical and behavioural sciences to ignore the social sciences has meant that the social and cultural context of health care has been ignored; yet the reason why many current health care initiatives fail is because they are aimed at the individual and ignore the fact that people live in a social context which exerts an important influence on individual action. While acknowledging that the study of the social context of health is difficult and may even be seen as methodologically messy by biomedical standards, the problem is too important to ignore.
It is immediately evident from the applications for the Register that, in recent years, have been important gains in the funding of health social science research. Funding like the PHRDC and the Health Services Research and Development Grants Advisory Committee (RADGAC) and even some of the more medically oriented committees of the NHMRC have funded projects which would not have been considered in previous years: these include projects using qualitative methods or action research, projects from a feminist perspective. It does, however, remain true that very little historical or theoretical is funded. Perhaps this reflects a lack of applications of this kind but it is also the case that social scientists believe that funding bodies will not consider applications which come from what Neville Hicks, in the Workshop proceedings called 'the critical end of the spectrum of social science methods'. As a result the bulk of this research is done for PhD theses or in small scale personal initiatives. Partly because social scientists in Australia are seldom able gain access to clinical settings, there is little research into the clinical processes of medical care.
A further important constraint on social science research using qualitative methods or an historical focus is that the task of collecting and interpreting the data goes on simultaneously and it is therefore very difficult to delegate any substantial part of the research process to a team of lowly research assistants. Since many social science researchers are full-time academics, this places a considerable limit on their productive capacity. Given these problems, the contribution of health social science in Australia is surprisingly large and varied, as the contributions in this volume demonstrate.
Local developments in social science health research such as the Directory and the Annual Review reflect international changes in the organisation of health research. It should have the result of improving access to local social science expertise for those within and outside the health social sciences. The appearance of this first issue of the Annual Review is testimony to our disciplines, the co-operative nature of our presence in the field of health research, and our continuing commitment to broader, more relevant, more critical social research into health.
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