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Book Review
Sociology of Health, Illness, and Health Care: A Critical Approach (3rd Edn)
Rose Weitz
ISBN: 0-5346193-8-x 2004 HB 475 pages Wadsworth, Belmont CA
Karen Willis
School of Sociology and Social Work, University of Tasmania, Launceston, TAS
As a lecturer in the sociology of health and illness, primarily teaching first year nursing students, I am always interested to read about the approaches one may take to this area. Perennial challenges include the integration of theoretical knowledge into the subject content (how much theory do nursing students need?) and making this knowledge relevant to the lives and aspirations of first year students.
Rose Weitz provides an accessible and interesting introduction to sociology of health and illness. She smoothly integrates key theoretical concepts into discussion that I found engaging and informative. By locating her work clearly within one theoretical approach, she does not overwhelm potential readers with the need to understand a multitude of theories in order to adopt a critical approach to the world around them. I think this is as much as is possible in a first semester, first year subject for nursing students.
Dividing the book into four parts, Weitz takes the reader through an explication of the ways that social factors, meanings, the health care system, and health providers all impact on the way that illness care is structured in American society. Each chapter commences with a vignette which acts as a 'hook' into the remainder of the chapter. She provides interesting case studies throughout the chapter that problematise the chapter content, directs students to internet sources for further information and provides a list of tutorial questions and internet exercises at the conclusion of each chapter.
Part One considers social factors and illness, and introduces students to the ways in which social factors affect the distribution of illness: including information on US patterns, as well as patterns in developing nations. In both cases she provides epidemiological information, but then considers social health issues: for example, drug and alcohol use; the impact of the lack of funding for abortion; and the role of overseas aid, infant formula manufacturers, and environmental degradation in developing nations. Weitz clearly locates inequalities in health within power differences in her exploration of age, sex, social class, race and ethnicity.
In Part Two Weitz explores the meaning and experience of illness: commencing with how these meanings are constructed (including issues of medicalisation and demedicalisation, social control and the sick role) and how they change over time. She then uses these ideas to explore chronic illness, disability and mental illness. The chapter on chronic illness and disability has a good section on understanding disability, on stigma, and a brief discussion of the sociology of the body. Mental illness is examined in detail. First, Weitz discusses the intersection between various social factors and mental illness. She then explores the differences between medical and sociological approaches to defining mental illness. An historical overview of treatment is provided. Finally, Weitz considers the experience of mental illness.
Part Three focuses on health care systems and settings. After a detailed description of the US health system, she undertakes some interesting comparative descriptions of health care in other countries, and concludes with a good description of health care settings. These settings range from hospitals, to nursing homes, group homes, hospices and care in the home/family setting.
Weitz points to the need for a variety of health care settings, all of which have a role given the current trends in illness patterns, in particular, settings that accommodate chronic illness needs.
The final section of the book gives examples of health care providers, orthodox and alternative, and concludes with a discussion of bioethics. Weitz examines the medial profession, briefly considers other mainstream health care providers (nurses, midwives, pharmacists and osteopaths), and alternative health providers (lay midwives, curanderos, Christian Science practitioners). While interesting, this discussion needed a clearer articulation with concepts such as legitimation to move from description to analysis. Weitz then undertakes a useful examination of bioethics, arguing successfully that bioethics is indeed the concern of a sociological understanding of health and illness because it concerns power differences between social groups. She provides a history of the rise of bioethics, before briefly considering issues such as reproductive technology, the ethics of enhancing human traits and issues raised by contemporary debates around cloning.
Unfortunately this book is written for an American audience, and could not be used as the key text in the Australian context. However, Weitz's integrated use of case studies and theory in providing a critical perspective on current health issues is well worth considering from a teaching perspective. This is particularly evident in Parts one and two. Part three was largely descriptive; and Part four, while well constructed, needed more depth in considering alternative/complementary health care providers from a health systems approach. Many of the sources used are quite dated. Furthermore the focus of this book is definitely restricted to the notion of illness: whereas much Australian health sociology explores the ways in which both health and illness are constructed. All these weaknesses limit the book's usefulness to Australian students.
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