Archives
Trust in the health system: An analysis and extension of the social theories of Giddens and Luhmann
Samantha Meyer
Department of Public Health, Flinders University, SA
Paul Ward
Department of Public Health, Flinders University, SA
John Coveney
Department of Public Health, Flinders University, SA
Wendy Rogers
Department of Public Health, Flinders University, SA
Abstract
Social theory provides a lens through which we can analyse the role of trust in health systems. However, the majority of theoretically informed trust literature addresses 'institutional' or 'interpersonal' trust individually, failing to investigate trust as determined by a 'web' of mutually interacting relationships between individuals and social systems. Current theoretical assumptions are also problematic as they fail to recognise the role that social factors (such as socio-economic status, class and age) play in an individual's willingness to trust.
Through the analysis and critique of existing social theories of trust, this paper demonstrates a need for further empirical research into the multidimensionality of trusting relationships, while suggesting new directions for research in public health.
Keywords
sociology, trust, social theory, health system, Giddens, Luhmann
Article Text
Sociology has been, and continues to be, fundamental for understanding the complex role of trust in the relationship between society and its health systems, as well as between patient, physician, health systems, and broader social systems (for example, economic, political, judicial). Through the study of social organisation, institutions, and the development of society, sociology offers a number of theoretical frameworks through which we can view trust in the health setting. Moreover, the application of social theory provides a useful lens through which the role of trust can be explored (Brown 2008). However, it has been argued that the subject of trust theory is 'disembodied', causing serious limitations to its scope and usefulness (Beasley & Bacchi 2007).
This paper specifically addresses the limitations of the trust theories of Anthony Giddens and Niklas Luhmann. Giddens addresses trusting relationships between the individual and the system, while Luhmann looks at the relationships and mutual interaction between social systems. While both offer compelling insight into the concept of trust, this paper challenges several of their theoretical assumptions, and offers suggestions for a reconstruction of their theories. These suggestions may assist with finding a more comprehensive way of empirically researching trust in healthcare.
References
Alexander J (1996) Critical reflections on reflexive modernization, Theory, Culture and Society 13: 133-138.
Andreassen HK, Trondsen MPE, Kummervold PE, Gammon D and Hjortdahl P (2006) Patients who use e-mediated communication with their doctor: New constructions of trust in the patient-doctor relationship, Qualitative Health Research 16: 238-248.
Armstrong D (1993) Public health spaces and the fabrication of identity, Sociology 27: 393-410.
Bauman Z (1987) Legislators and Interpreters: On Modernity, Postmodernity and Intellectuals, Cambridge University Press: Cambridge.
Beasley C and Bacchi C (2007) Envisaging a new politics for an ethical future, Feminist Theory 8: 279-299.
Beck U (1992) Risk Society: Towards a New Modernity, Sage Publications: London.
Beck U (2005) World Risk Society, Polity Press: Cambridge.
Beck U, Giddens A and Lash S (1994) Reflexive Modernization: Politics, Tradition and Aesthetics in the Modern Social Order, Blackwell Publishers: Oxford.
Birungi H (1998) Injections and self-help: Risk and trust in Ugandan health care, Social Science and Medicine 47: 1455-1462.
Bluhm LH (1987) Trust, terrorism, and technology, Journal of Business Ethics 6: 333-341.
Borch C (2005) Systemic power: Luhmann, Foucault, and analytics of power, Acta Sociologica 48: 155-166.
Bordum A (2004) Trust as a Critical Concept. Working Draft, Center of Market Economics Copenhagen Business School: Copenhagen.
Bordum A (2005) Trust and Leadership: On The Value Laden Concept of Trust. Working Draft, Center of Market Economic Copenhagen Business School: Copenhagen.
Bourdieu P (1984) Distinction: A Social Critique of the Judgement of Taste, Routledge: London.
Brownlie J and Howson A (2005) ‘Leaps of faith' and MMR: An empirical study of trust, Sociology 39: 221-239.
Carpiano RM (2006) Toward a neighborhood resource-based theory of social capital for health: Can Bourdieu and sociology help? Social Science and Medicine 62: 165-175.
Cooper G (2001) Conceptualising social life, in Gilbert N (ed) Researching Social Life, Sage: London, pp.2-13.
Crawford R (2004) Risk ritual and the management of control and anxiety in medical culture, Health: An Interdisciplinary Journal for the Social Study of Health, Illness and Medicine 8: 505-528.
Davies H (1999) Falling public trust in health services: Implications for accountability, The Milbank Quarterly 4: 193-194.
Elliot A (2002) Beck's sociology of risk: A critical assessment, Sociology 36: 293-315.
Fukuyama F (1995) Trust: The Social Virtues and the Creation of Prosperity, Free Press Paperback: New York.
Giddens A (1990) The Consequences of Modernity, Stanford University Press: Stanford.
Giddens A (1991) Modernity and Self-Identity: Self and Society in the Late Modern Age, Stanford University Press: Stanford.
Giddens A (1994) Risk, trust, reflexivity, in Beck U, Giddens A and Lash S (eds) Reflexive Modernization: Politics, Tradition, and Aesthetics is the Modern Social Order, Polity Press: Cambridge, pp.194-197.
Gifford S (2002) The meaning of lumps: A case study of the ambiguities or risk, in Nettleton S and Gustafsson U (eds) The Sociology of Health and Illness Reader, Polity: Cambridge, pp.211-222.
Gilson L (2003) Trust and the development of health care as a social institution, Social Science and Medicine 56: 1453-1468.
Gilson L (2005) Editorial: Building trust and value in health system in low-and middle-income countries, Social Science and Medicine 61: 1381-1384.
Habermas J (1989) The Theory of Communicative Action, volume 2: Lifeworld and system: A Critique Of Functionalist Reason, Beacon Press: Boston.
Hall MA, Dugan E, Zheung B and Mishra AK (2001) Trust in physicians and medical institutions: What IS IT, can it be measured, and does it matter? The Milbank Quarterly 79: 613-639.
Hardin R (2006) Trust, Polity Press: Cambridge.
Hibbert D, Bissell P and Ward PR (2002) Consumerism and professional work in the community pharmacy, Sociology of Health and Illness 24: 46-65.
Irwin A and Michael M (2003) Science, Social Theory and Public Knowledge, Open University Press: Maidenhead.
Kawachi I, Kennedy BP, Lochner K and Prothrow-Stith D (1997) Social capital, income inequality, and mortality, American Journal of Public Health 87: 1491-1498.
Khodyakov D (2007) Trust as a process: A three-dimensional approach, Sociology 4: 115-132.
Kim D, Subramanian SV and Kawachi I (2006) Bonding versus bridging social capital and their associations with self rated health: a multilevel analysis of 40 US communities, 60: 116-122.
Lewis DJ and Weigert A (1985) Trust as a Social Reality, Social Forces 63: 967-985.
Lochner KA, Kawachi I, Brennan RT and Buka SL (2003) Social capital and neighborhood mortality rates in Chicago, Social Science and Medicine 56: 1797-1805.
Luhmann N (1979) Trust and Power: Two Works by Niklas Luhmann, John Wiley & Sons: Brisbane.
Luhmann N (1988) Trust: Making and breaking cooperative relations, in Gambetta D (ed) Familiarity, Confidence, Trust: Problems and Alternatives, Basil Blackwell: New York, pp.94-107.
Luhmann N (1990) The paradox of system differentiation and the evolution of society, in Alexander J and Colomy P (ed) Differentiation Theory and Social Change, Columbia University Press: New York, pp.409-440.
Luhmann N (2005) Risk: A Sociological Theory, Transaction Publishers: New Brunswick, New Jersey.
Lupton D (1997) Consumerism, reflexivity and the medical encounter, Social Science and Medicine 45: 373-381.
Mechanic D and Meyer S (2000) Concepts of trust among patients with serious illness, Social Science and Medicine 51: 657-668.
Mollering G (2001) The nature of trust: From Georg Simmel to a theory of expectation, interpretation and suspension, Sociology 35: 403-420.
Pearson S, Crane S and Mont MC (2005) Persistent and dynamic trust: Analysis of trust properties and related impact of trusted platforms, in Hewlett-Packard Development Company, LP (ed) Trust Management, Springer Berlin: Bristol, pp.355-363.
Popay J, Bennett S, Thomas C, Williams G, Gatrell A and Bostock L (2003) Beyond ‘beer, fags, egg and chips'? Exploring lay understandings of social inequalities in health, Sociology of Health and Illness 25: 1-23.
Rhodes R and Strain JJ (2000) Trust and transforming medical institutions, Cambridge Quarterly of Healthcare Ethics 9: 205-217.
Russell S (2005) Treatment-seeking behaviour in urban Sri Lanka: Trusting the state, trusting private providers, Social Science and Medicine 61: 1396-1407.
Salvatore A and Sassatelli R (2004) Trust and food: A theoretical discussion, Consumer Trust in Food - A European Study of the Social and Institutional Conditions for the Production of Trust, University of Bologna: Bologna.
Scambler G and Britten N (2001) System, lifeworld and doctor-patient interaction: Issues of trust in a changing world, in Scambler G (ed) Habermas, Critical Theory and Health, Routledge: London, pp.45-67.
Schlesinger M, Quon N, Wynia M, Cummins D and Gray B (2005) Profit-Seeking, corporate control, and the trustworthiness of health care organizations: Assessments of health plan performance by their affiliated physicians, Health Services Research 40: 605-645.
Shapiro SP (1987) The social control of impersonal trust, The American Journal of Sociology 93: 623-658.
Subramanian SV, Lochner KA and Kawachi I (2003) Neighborhood differences in social capital: a compositional artifact or a contextual construct? Health and Place 9: 33-44.
Ward P (2006) Trust, reflexivity and dependence: A ‘social systems theory' analysis in/of medicine, European Journal of Social Quality 6: 143-158.
Ward P and Coates A (2006) ‘We shed tears, but there is no one there to wipe them up for us': narratives of (mis)trust in a materially deprived community, Health: An Interdisciplinary Journal for the Social Study of Health, Medicine and Illness 10: 283-301.
Welsh T and Pringle M (2001) Social capital. Trusts need to recreate trust, British Medical Journal 323: 177-178.
Williams G (2000) Knowledgeable narratives, Anthropology and Medicine 7: 135-140.
Williams G and Popay J (2001) Lay health knowledge and the concept of the lifeworld, in Scambler G (ed) Habermas, Critical Theory and Health, Routledge: London, pp.25-44.
Wynne B (1992) Misunderstood misunderstanding: Social identities and the public uptake of science, Public Understanding of Science 1: 281-304.
Wynne B (1996) May the sheep safely graze? A reflexive view of the expert-lay knowledge divide, in Lash S, Szerszynski B and Wynne B (eds) Risk, Environment and Modernity: Towards a New Ecology, Sage: London, pp.44-83.
Wynne B (2001) Expert discourses of risk and ethics on genetically manipulated organisms: The weaving of public alienation, Notizie di Politeia 17: 51-76.
eContent Home