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Book Review
An Introduction to the Sociology of Health and Illness
Kevin White
ISBN: 0-7619640-0-2 2002 196 pages Sage Publications, London
Alena Heitlinger
Department of Sociology, Trent University, Peterborough, Ontario, Canada
White's book is unlike other medical sociology textbooks on my office bookshelves. Most American and Canadian sociology of health and illness textbooks are empirically driven and, as such, oriented towards concrete epidemiological and health care issues. Although they claim to challenge key medical assumptions, the empiricist orientation and organization of these texts suggests that most of the authors take medical definitions of the specific social situation for granted. The typical textbook starts with a section on social production and distribution of health and illness, followed by a discussion of the variation in meanings and experiences of illness, especially chronic illness. The remainder typically covers health care systems, institutions, settings, technologies, and providers. White covers all of these issues but in a novel way: through the prism of sociological theory rather than through issues of relevance to epidemiologists and health care providers.
Opening the text and perusing its Table of Contents makes it clear right from the beginning that this book is rather different from most of the other textbooks in the field. The tone is set by the Introductory chapter, which lists as its sub-headings 'Sociology, Genetics, Social Mobility and Lifestyle', 'The Sociological Perspective', 'Postmodernity and Sociology', and five key 'Sociological Approaches to Health and Illness', namely 'Political Economy and Marxist Approaches', 'Parsonian Sociology of Health', 'Foucault's Sociology of Health', 'Feminist Approaches', and a synthesizing model entitled 'Bringing These Approaches Together'. While the titles of some of the subsequent chapters appear quite traditional and mainstream (eg, 'The Social Construction of Medical Knowledge', 'The Development of the Sociology of Health', 'Race, Ethnicity and Health'), other titles look rather unusual in an introductory textbook (eg, 'Postmodernity, Epidemiology and Neo-Liberalism', 'Parsons, American Sociology of Medicine and the Sick Role', 'Foucault and the Sociology of Health', and 'Health, Gender and Feminism'). More importantly, the content of all these chapters is driven by theory, which is then applied to various empirical issues, rather than the other way around.
Like most sociologists, White is concerned to present to students a sociological model of disease and, like most sociologists, he constructs this model in opposition to the dominant medical explanation of disease as an inherently individual occurrence. Since this is a theoretically driven text, the starting points of analysis in each chapter are various sociological perspectives and analytical concerns. For example, Chapter Two, 'The Social Construction of Medical Knowledge', introduces students to the 'social constructionism' of the classical sociology of knowledge developed by Durkheim, the sociological approaches of the Polish-born physician Ludwick Fleck (1896-1961), and to the sociology of knowledge paradigms of Michel Foucault and Thomas Kuhn. Chapter Three, 'The Development of the Sociology of Health', critically reviews the relationship between sociology and medicine from the 1950s onwards. It points out self-evident and hidden medical biases in much of contemporary sociology of health, introduces key concepts in the sociology of health (such as medicalization), outlines social aspects of disease, and identifies a shift in the scope of medical practice from the body to the social relations between bodies. The author notes a major paradox in this shift. Medicine increasingly focuses on our social relations and communities as opposed to simply our biological bodies, and sees these relations as problematic. While they are brought 'into the orbit of surveillance', medical discourse nonetheless 'ultimately suggests solutions that are biological' (p.49).
This line of argument about the limitations of individualist therapeutic approaches is also followed in subsequent chapters. Chapter Four on 'Postmodernity, Epidemiology and Neo-Liberalism' briefly reviews key characteristics of postmodernity and neo-liberalism, and then explores their implications for epidemiology and statistics, risk and life-style discourse, other psycho-social perspectives on health and illness, and the downgrading of structural sociological explanations. Systemic material approaches, addressing such things as diet, housing, and pollution, along with the Marxist analyses of the medical profession, are the subject of Chapter Five. Chapter Six provides an excellent summary and critique of Parsons' work on the sick role and on the medical profession, while Chapter Seven focuses on Foucault's sociology of health and its implications for our understanding of society. In a similar vein, Chapter Eight summarizes and critiques feminist and Foucauldian-feminist approaches to our understanding of the impact of gender on health. Chapter Nine, 'Race, Ethnicity and Health', is theoretically grounded in Weber's concept of status groups, and focuses on a case study of Australian Aborigines. Each chapter is introduced with a helpful box summarizing the main themes, theoretical positions and concepts, and empirical issues addressed. Additional boxes succinctly summarizing specific theoretical positions, concepts, social problems, or case studies of specific diseases, are scattered throughout each chapter. They provide interesting illustrative examples and, as such, should be very valuable to any reader encountering sociology of health and illness for the first time.
My only criticism of this otherwise excellent textbook is that the author's obvious sympathy with the materialist approach prevents him from seeing ways in which risk and lifestyle factors can be used as components of a genuine sociological explanation. White dismisses lifestyle explanations as 'the so-called risk factors of individual behaviour', or as clinical epidemiology that reflects 'the core assumptions of neo-liberalism'. He goes as far as claiming that there is 'now overwhelming evidence that 'risk factors' do not account for the patterning of disease' (p.61). Moreover, this line of argument is misleadingly applied to the explanation of declining life expectancy in postcommunist Russia. White is evidently unfamiliar with the work of William C Cockerham (1999) who convincingly demonstrates that the primary explanation for the adverse morbidity and mortality in contemporary East Central Europe is to be found in policy, societal stress, and health lifestyles, with lifestyles as the leading cause. Cockerham's insightful explanatory model integrates the work of Weber (on social action, life chances and status groups), Giddens (on modernity, and the relationship between agency and structure), and Bourdieu (on social worlds, mind-sets and modes of behaving). Like Cockerham, White would find Bourdieu's concept of 'habitus' sociologically very useful, since it could be applied to health lifestyles grounded in social conditions and general orientation towards life.
Most sociologists, postgraduate students, and above-average undergraduate students will find the book under review a delight to read. I am not sure, however, how well this book will be received by the average sociology student with little interest in, and appreciation of, theory. Undergraduate nursing students (who increasingly form an important segment of upper-year sociology of health and illness courses, and who are typically not required to take any courses in sociological theory) might also find the level of analysis in this text too difficult, not reflecting the main issues in which they are interested, and which they can easily comprehend. Nevertheless, this text is so well and lucidly written that it might achieve the 'near impossible'-spark an interest among these students not only in the sociology of health and illness, but in sociology in general.
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