Book Reviews
Understanding health: A sociological discussion
Anne-Marie Barry and Chris Yuill
ISBN: 0-7619730-7-9 2002 152 pages London: Sage
Kevin White
Senior Lecturer, Department of Sociology,
Australian National University, Canberra
This is an extremely easy to read textbook which will have a lot of appeal at O Levels and first/second year undergraduate market, especially in the UK, where all its empirical data is drawn from. Its nine chapters develop a social constructionist perspective; pursue the medical nemesis thesis; and outline: the social control functions of medicine, especially in relation to the new public health; the rise of alternative medicine; gender and ethnic biases in medical practices, especially in relation to mental health; the impact of class on the production and distribution of sickness and disease; the sociology of the body; the rise of the ageing population; and the institutional contexts of health care delivery.
As a teaching book it has been extremely well laid out. There are introductory boxes, key concepts, summary tables and annotated recommended readings in each chapter. The chapters are well structured, interspersed with dialogue boxes of questions. The margins are wide and incorporate arrow boxes back and forth through the book to take the student back to key concepts or forward to further examples. Good use is made of dot points and inserts which keeps the text flowing easily.
Theoretically the book provides smooth access to major conceptual schools without muddying the waters. So Marxism and feminism are presented as distinct perspectives, notwithstanding Marxist-feminist work in the sociology of health; and there is no mention of Foucauldian-feminism which, given the attention to surveillance medicine, would have worked in well. The general social constructionist position is advanced through an outline of verstehen sociology and the argument that 'facts' don't speak for themselves. It's good and it works but it leaves out much of the sociology of knowledge argument that underpins the sub-discipline. Further because of the reasonably short bibliography students aren't alerted to wider debates and literatures. For example the disputes between Weberian stratificationists and Marxists over class are not signalled. (In fact 'strata' gets used as a synonym for class, while life chances-an explicitly Weberian concept-is used as a synonym for the experience of alienation).
This signals a good deal about the vitality of the subdiscipline indicating that it has got to a stage where the workings don't have to be constantly shown at each stage of the argument. Presenting medical knowledge and practices as social processes may be finally moving into the popular consciousness.
A bit more negatively, this approach doesn't expose students to the rich intellectual debates that have driven health sociology as it integrated the sociology of knowledge, the philosophy of science and the historical sociology of medicine. Furthermore the flavor of the political commitment that drove Raymond Illsey in his critique of the National Health Service in the UK, Vicente Navarro's scathing analysis of capitalist medicine in the USA, Thomas McKeown's demolition of the claim by medicine to have improved health, or Eliot Freidson's attack on the claims of professional medicine to be scientific are missing.
Occasionally the book gives a sense of being oddly dated. Rosenhan's study 'On Being Sane in Insane Places', published in 1973, Ivan Illich's Limits to medicine (1976), and Ann Oakley's books Woman confined (1980) and The Captured womb (1984) stand out. At the same time other classics, such as Eliot Freidson on the professions are not mentioned at all, while other major theorists (for example Talcott Parsons) are discussed through secondary sources (in this case via Bryan Turner).
Overall the authors are to be commended on a very clear text, easily communicating the insights of a wide range of theoretical perspectives, and marshalling clear empirical evidence for the arguments of the sociology of health. The editors at Sage are to be commended for a great layout and a text which is very easy on the reader.
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