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The sociology of health and illness in Australia: The 1980s and beyond
Evan Willis
School of Social Sciences, La Trobe University, VIC
Abstract
A decade ago, as part of the organisation for a conference on medical sociology in Australia sponsored by the International Sociological Association, I prepared a state-of-the-art paper on 'Research and teaching in the sociology of health and illness in Australia and New Zealand' (Willis 1982). A decade later, as part of this inaugural Annual Review, it is again appropriate to consider, albeit more briefly, the state of the art of sociological investigations in the field of health and illness.
In that paper, and defining sociological research very broadly and liberally, I identified a number of themes from the review of research in the area which had been undertaken up until that time. These included an eclecticism used in both theoretical and methodological approaches (reflective of the state of the discipline as a whole) and huge gaps in the literature reflective of the youthfulness of this area of study - those areas studied being the result of curiosity driven personal interests of the researchers involved. As well I noted a decline in the medicocentricity of the research undertaken with a growing independence and emancipation from the origins of the sub-discipline in medical education, taking its 'sense of problem' as well as many of its assumptions (in particular a commitment to philosophical positivism) from a medical world view. In spite of this, there was still considerable validity at the time in the charge levelled, in an editorial of a special issue of the Australia and New Zealand Journal of Sociology a couple of years previously (Ward 1979), of theoretical impoverishment in sociological terms and a failure to relate findings to the broader concerns of sociology, mainly because of the practical rather than sociological concerns which had traditionally informed such research.
To what extent do these observations hold a decade later? Firstly, indicative of the growing maturity of both social science analyses of health in general (as attested to by the variety of social science perspectives represented in this review) and of sociological approaches in particular, it is possible to be much more precise about what constitutes research in this sociological tradition. A decade previously I included 'works in which sociological theories or concepts are utilised' while admitting to a certain amount of (Willis 1982: 145). Then, research which was termed 'sociographic' was The blurring with traditional medical concerns such as social medicine, public health and social epidemiology which was apparent a decade ago, is less obvious today. While there is still properly a large amount of overlap, what is occurring at the boundaries distinctly recognised as multidisciplinary research than previously. Nowadays the use of some sociological concepts with which to analyse data, does not make a sociological analysis. Rather the analysis requires what might broadly be called the explicit use of the sociological imagination, including a sense of problem deriving in some at least loose way to the central theoretical and conceptual concerns of the discipline.
Still, the overall impression is of eclecticism in both theoretical and methodological The bulk of research probably continues to be curiosity driven, though there is growing amount which appears to be driven by the growing emphasis within tertiary educational institutions on competitive grant getting and a discernible willingness on the part of researchers in this, as indeed in other fields, to modify their research interests to suit the priorities of grant awarding agencies. Certainly, as evidence of the emancipation from the medical world view and its favoured methodologies, there has been a substantial growth in the use made of qualitative research methodologies, with sociological researchers even succeeding in winning grants from medically dominated funding bodies for whom qualitative research has until recently been considered something of an anathema.
On the theoretical front, the erstwhile Australian sociologist of health, Bryan Turner has contributed significantly with his textbook which amongst other things has shown he sociology of health and illness should be considered a mainstream part of the as a whole. In order to achieve this, he argues, it needs to draw more on the traditions of sociological theory. In particular he identifies the classic problematic relationship between culture and nature, as well as between the individual and society. He also so shows how recent theoretical developments in the discipline of sociology as a whole might be utilised in the health field. In the decade since my earlier review, social constructionism and the work of Michel Foucault has made a significant impact on this area as the long term significance of Foucault's work both to this field and to sociology in general is debated. Health is a major theme developed in his work and is used to illustrate his theories of the relationship between power and knowledge; his view of ill health, as a biological reality but as a social and cultural construction, is being actively debated; particularly as it is the conceptual approach most removed from the medical (and indeed the commonsense) world view.
A decade ago, I identified two strands of the sociology of health and illness; one within the education of health professionals and the other within sociology departments. In the intervening decade the two strands have grown closer together. The move of nurse education away from hospitals into tertiary institutions has stimulated the sociology of health and illness considerably at a number of levels. A growing workforce, a substantial market for textbooks and the beginnings of a literature on the sociology of nursing (for example Millen 1989) begin to fill the gap identified a decade ago. The Health section of the annual national conference of the Australian Sociological Association remains one of the largest and most lively, and sociologists continue to make their presence felt in the Public Health Association.
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