Handbook of Social Studies in Health and Medicine


Edited by: Gary L. Albrecht, Ray Fitzpatrick & Susan C. Scrimshaw

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  • Chapters
  • Front Matter
  • Back Matter
  • Subject Index
  • Part One: Social and Cultural Frameworks of Analysis

    Part Two: The Experience of Health and Illness

    Part Three: Health-Care Systems and Practices

  • Introduction

    “The collection will offer a unique range of work, both in terms of topics and of theoretical perspectives, written by leading scholars from around the world. It will be an essential resource for teaching and research.”

    “I've wanted a handbook like this on my desk for a long time – one with broad coverage and extensive bibliographies. This is one of those books that you point to when a graduate student asks: ‘How do I get started in …?’ The coverage of the 33 chapters is really impressive: from an exposition on the use of ethnographic case studies to a discussion of the globalization of health care; from a discussion of how people experience illness to a discussion of how best to measure health status and quality of life variable” – H. Russell Bernard, University of Florida.

    The first international and interdisciplinary handbook about health and medicine is here!

    No Other Volume in the Marketplace Has the Range, Depth and Relevance of this Handbook. Three sections contain specially commissioned chapters designed to examine the vital conceptual, methodological, practice and policy issues. You'll receive not only a complete survey of social science, health and medicine in one volume, but also an authoritative guide to methodologies, key concepts, central theoretical traditions and an agenda for future research and practice. The Handbook offers researchers and scholars the best guide to what the leading figures in the field are thinking and doing. It also pinpoints the focal issues of research and debate in one volume. The Handbook answers the need, expressed by social scientists and medical practitioners, for an authoritative, inter-disciplinary study which demonstrates the contribution and promise of social science disciplines in the crucial and rapidly changing field of health and medicine.

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    International Editorial Advisory Board

    Nancy E. Adler, University of California, San Francisco

    David Armstrong, University of London

    H. Russell Bernard, University of Florida

    Michael Bury, University of London

    Kathy Charmaz, Sonoma State University

    Paul D. Cleary, Harvard Medical School

    Brian R. Flay, University of Illinois at Chicago

    H. K. Heggenhougen, Harvard Medical School

    David J. Hunter, Nuffield Institute for Health, University of Leeds

    Arthur Kleinman, Harvard Medical School

    Melvin Konner, Emory University

    Margaret Lock, McGill University

    Sally Macintyre, MRC Social and Public Health Sciences Unit, Glasgow

    David Mechanic, Rutgers University

    Robert A. Rubinstein, Syracuse University

    Ursula Sharma, University of Derby

    Johannes Siegrist, University of Dusseldorf

    Bryan S. Turner, University of Cambridge

    Evan Willis, La Trobe University


    To our mentors


    Lu Ann Aday is Professor of Behavioral Sciences and Management and Policy Sciences at The University of Texas School of Public Health. She received her B.S. degree (1968) in economics from Texas Tech University, and her M.S. (1970) and Ph.D. (1973) degrees in sociology from Purdue University. Dr Aday's principal research interests have focused on the conceptual, empirical, and policy dimensions of equity of access to care for vulnerable populations. She has conducted major national and community surveys and evaluations of national demonstrations and published extensively in this area. She is the author of twelve books, including, most recently, At Risk in America: The Health and Health Care Needs of Vulnerable Populations in the United States (1993); Designing and Conducting Health Surveys: A Comprehensive Guide (1st edn, 1989; 2nd edn, 1996); and Evaluating the Healthcare System: Effectiveness, Efficiency, and Equity (1st edn, 1993; 2nd edn, 1998).

    Gary L. Albrecht is Professor of Public Health and of Disability and Human Development at the University of Illinois at Chicago where he is Co-Principal Investigator of the Center for Emerging Disabilities and Principal Investigator of a National Institutes of Health-funded study of women with disabilities experiencing the menopausal transition. His current work focuses on the quality of life of persons with disabilities. He is past Chair of the Medical Sociology Section of the American Sociological Association and a member of the Strategic Planning Committee of the National Institute of Disability and Rehabilitation Research. He recently received the Award for the Promotion of Human Welfare and the Eliot Freidson Award for The Disability Business: Rehabilitation in America, a Switzer Distinguished Research Fellowship, the University of Illinois at Chicago Award for Excellence in Teaching, and was a Visiting Fellow at the University of Oxford and the Maison des Sciences de l'Homme, Paris.

    David Armstrong is Reader in Sociology as Applied to Medicine at the University of London. He is based in the Department of Primary Care in the medical school attached to Guy's and St. Thomas's Hospitals. He has had a longtime interest in the work of Michel Foucault and has written several papers and a monograph on changes in medicine over the last few decades using a Foucaultian perspective. He is also qualified in medicine and is a specialist in public health medicine in the British National Health Service. This has led to an interest in health service research and publications in the area of primary health care, the primary-secondary interface, and clinicians’ behavior.

    Mary Boulton is Professor of Sociology, Oxford Brookes University. Her main research interests are in lay understandings and experience of health and health care. She has worked predominantly in the areas of genetic screening, where her attention has focused on issues relating to cystic fibrosis carrier screening, and of HIV and AIDS, where she has conducted a number of studies on the experience of gay and bisexual men and families of children with HIV infection. She is editor of Challenge and Innovation: Methodological Advances in Social Research on HIV/AIDS (Taylor & Francis, 1994) as well as a number of papers on qualitative methods in health services research.

    Sarah Cant is a Senior Lecturer in Sociology at Roehampton Institute, London. She has published extensively within medical sociology and has developed an interest in both private and alternative medicine. Her most recent books include Complementary and Alternative Medicines. Knowledge in Practice (Free Association Books, 1996), co-edited with Ursula Sharma, and A New Medical Pluralism? Alternative Medicine, Doctors, Patients and the State (UCL Press, 1999), co-authored with Ursula Sharma. Her current research interests cover social change, alternative medicine, and the sociology of the professions, and she is completing her Ph.D. on homeopathy and reflexive modernity.

    Ralph Catalano is Professor of Public Health at the University of California, Berkeley. He holds a Ph.D. in social science from the Maxwell School of Syracuse University. He has served as Associate Vice Chancellor at the Irvine Campus of the University of California, as well as Vice Mayor of the City of Irvine. He has also been Head of the Division of Health Policy and Management at the School of Public Health at Berkeley. In addition to his work on the spatial distribution of illness, he continues his research program into the health and behavioral effects of unemployment.

    Kathy Charmaz is Professor of Sociology and Faculty Writing Coordinator at Sonoma State University. Her books include two recent co-edited volumes, The Unknown Country: Death in Australia, Britain and the USA and Health, Illness, and Healing: Society, Social Context and Self in addition to The Social Reality of Death and Good Days, Bad Days: The Self in Chronic Illness and Time, which won awards from the Pacific Sociological Association and the Society for the Study of Symbolic Interaction. She is editor-elect of Symbolic Interaction and will serve as President of the Pacific Sociological Association for 1999–2000. Currently, Dr Charmaz is working on a study of the social psychology of suffering, explications of qualitative methods, and a handbook on writing for beleaguered social scientists.

    Donald A. Cibula, Ph.D., has served as the Director of Surveillance and Statistics for the Onondaga County Health Department since 1992. In this capacity, he has designed, conducted, and analyzed results of epidemiologic research projects, including infant mortality, hepatitis A, occupational exposure to PCBs, and fetal drug exposures. Dr Cibula has authored periodic reports to assess the local status of TB, HIV/AIDS, syphilis and gonorrhea, teenage pregnancy, maternal and child health, and many other topics. He has contributed to developing the computer hardware and software infrastructure that facilitates research and public health monitoring within the health department he serves.

    David Coburn is a sociologist and Professor in the Department of Public Health Sciences, University of Toronto. His research has mainly focused on the changing power structure in health care in Ontario. He has particularly analyzed ‘the rise and fall of medicine’ thesis, but he has also written on chiropractic, nursing, and naturopathy. His present interests lie in relating globalization and neoliberalism to changes in health care. Recent publications include editorship of the third edition oí Health and Canadian Society: Sociological Perspectives (University of Toronto Press, 1998) with Carl D'Arcy and George Torrance, a critique of ‘population health’ in Social Science and Medicine, and analysis of the ‘restratification of medicine’ thesis in Sociology of Health and Illness. With Ivy Bourgeault and Susan Rappolt he has written a series of papers on professional state relationships in Ontario, which will appear in the journal Health and Canadian Society.

    Angela Coulter is Director of Policy and Development at the King's Fund. A social scientist by training, she has a doctorate in health services research from the University of London. She is an Honorary Professor at the Royal Free and University College Schools of Medicine, a Visiting Fellow at Nuffield College, Oxford, and a Governor of Oxford Brookes University. Dr Coulter's research interests include user involvement in health care, primary care development, clinical effectiveness, women's health, public health, and evaluating health system reforms. She is editor oí Health Expectations, a new international journal of public participation in health care and health policy.

    Sarah Cunningham-Burley is Senior Lecturer in Medical Sociology, Department of Public Health Sciences, Medical School, University of Edinburgh. Her research interests span family and medical sociology, and she has conducted work on grandparenthood as well as the experience of health and illness at different stages of the lifecourse. Her research is informed by a commitment to understanding people's own interpretations of their experiences and of the factors which influence their lives. In recent years she has been investigating lay and professional views of the new genetics. She is especially concerned to develop sociological work in this crucial area and contribute to effective public debate of key issues. She has co-edited two volumes (with Neil McKeganey), Enter the Sociologist (Avebury, 1987) and Readings in Medical Sociology (Routledge, 1990), and has published widely in a range of journals.

    Carroll L. Estes is the Director of the Institute for Health & Aging and Professor of Sociology in the Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco. Dr. Estes (Ph.D., University of California, San Diego) conducts research on health and aging policy, long-term care, health and economic security of the aged, older women, fiscal crisis, and the impact of devolution on health and human services. She is the author of The Decision-Makers: The Power Structure of Dallas (SMU Press, 1963); The Aging Enterprise (Jossey Bass, 1979); co-author of Fiscal Austerity & Aging (Sage, 1983) with J. Swan; Political Economy, Health and Aging (Little Brown, 1984); The Long Term Care of the Elderly (Sage, 1984) with C. Harrington and R. Newcomer; The Long Term Care Crisis (Sage, 1993); co-editor of The Nation's Health (Jones & Bartlett, 1997) with P. Lee; Health Policy & Nursing (Jones & Bartlett, 1997) with C. Harrington; and Critical Gerontology (Baywood, 1998) with Meredith Minkler.

    Ray Fitzpatrick is Professor of Public Health and Primary Care, Institute of Health Sciences, University of Oxford, and Fellow and Dean, Nuffield College, Oxford. His research interests focus on measurement of outcomes of health care, such as health status, quality of life, and patient satisfaction, and their use in clinical trials and evaluative research. With Gary Albrecht he edited Quality of Life in Health Care (JAI Press, Greenwich, Connecticut, 1994). With Stan Newman, Tracy Revenson, Sue Skevington, and Gareth Williams he wrote Understanding Rheumatoid Arthritis (Routledge, London, 1995). He co-edited with Nick Black, John Brazier, and Barnaby Reeves Health Services Research Methods: A Guide to Best Practice (BMJ Books, London, 1998). He is currently editing with colleagues a Handbook of Methods of Health Technology Assessment to be published by Sage.

    Renée C. Fox, Ph.D. in sociology, Harvard University, 1954, is Professor Emérita at the University of Pennsylvania. She was a member of the Columbia University Bureau of Applied Social Research and a member of the faculty of Barnard College. At the University of Pennsylvania, she was Professor of Sociology with joint appointments in Psychiatry and Medicine and Nursing and held an interdisciplinary chair as the Annenberg Professor of Social Sciences. During the 1996–97 academic year, she was the George Eastman Visiting Professor at the University of Oxford.

    Her research on the sociology of medicine, medical education, and medical ethics has involved her in first-hand, participant observation studies in Continental Europe, Central Africa, the People's Republic of China, and the United States. She is the author of seven books and numerous articles. Her best known books are Experiment Perilous: Physicians and Patients Facing the Unknown; The Courage to Fail: A Social View of Organ Transplants and Dialysis; Spare Parts: Organ Replacement in American Society; and In the Belgian Chateau: The Spirit and Culture of a European Society in an Age of Change.

    Dr Fox is a member of the American Academy of Arts and Sciences and of the Institute of Medicine of the National Academy of Sciences, a Fellow of the American Association for the Advancement of Science, the holder of a Centennial Medal from the Graduate School of Arts and Sciences of Harvard University, and a recipient of the American Sociological Association's Leo G. Reeder Award for Distinguished Contributions to Medical Sociology. She holds six honorary degrees, and in 1995 she was named Chevalier of the Order of Leopold II by the Belgian government.

    Byron J. Good is Professor of Medical Anthropology, Department of Social Medicine, Harvard Medical School. Professor Good has written widely about social theory and medical anthropology (with a special interest in phenomenology and narrative studies), cultural issues relevant to psychopathology and mental health services, and the implications of new and emerging biotechnologies for medical practice. He is currently conducting research in central Java, Indonesia. Professor Good is author of Medicine, Rationality and Experience: An Anthropological Perspective (Cambridge University Press, 1994), and co-editor of several books, including Culture and Depression (University of California Press, 1985) and Pain as Human Experience (University of California Press, 1992). Together with Mary-Jo Good, he is editor of the international journal, Culture, Medicine and Psychiatry: A Journal of International and Cross-Cultural Research.

    Mary-Jo DelVecchio Good is Professor of Social Medicine at Harvard Medical School. Professor Good studies the culture and political economy of biomedicine in the United States and in international contexts. Her most recent work examines the worlds of research and clinical oncology and the influence of innovations in biotechnology on clinical narratives that physicians create with and for patients in cancer treatment. She is the author of American Medicine: The Quest for Competence (University of California Press, 1995, 1998); ‘Cultural Studies of Biomedicine’ in Social Science and Medicine, 1995; and ‘L'Abbracio Biotecnico: Un Invito al trattamento sperimentale’ in II sapere della quarigione (Laterza, 1996); and author and editor of Pain as Human Experience (University of California Press, 1992, 1994), with P. Brodwin, A. Kleinman, and B. Good. She is co-editor in chief, with Byron Good, of Culture, Medicine and Psychiatry: A Journal of International and Cross-Cultural Research. She and Byron have collaborated for nearly three decades in medical anthropology research, writing, and teaching. In addition to this chapter, their most recent article is “‘Fiction’ and ‘Historicity’ in Doctors’ Stories: Social and Narrative Dimensions of Learning Medicine” in Narrative and the Cultural Construction of Illness and Healing (University of California Press, 1999), and they have a new book in progress, The Biotechnical Embrace.

    Steve Harrison is Reader in Health Policy and Politics at the University of Leeds Nuffield Institute for Health, where he has taught and researched since 1978. His main research interests are in the macropolitics of health care, including government decisions about funding and organising services, and in its micropolitics, especially medical-managerial relationships, NHS-user group politics, and public consultation. In 1997–98 he was Hallsworth Research Fellow in the Department of Government at the University of Manchester, and is currently studying the politics of ‘evidence-based medicine.’ He is author or co-author often books and over 200 other publications.

    James S. House is Professor of Sociology and Director of the Survey Research Center in the Institute for Social Research at the University of Michigan, where he is also affiliated with the Department of Epidemiology and Institute of Gerontology. He received his Ph.D. in social psychology from the University of Michigan in 1972. His research has focused on the role of psychosocial factors in the etiology of health and illness, initially on occupational stress and health, later on social relationships, social support, and health, and currently on the nature and explanation of socioeconomic differences in health and the relation of age to health. He is an elected Fellow of the American Academy of Arts and Sciences and has been a Guggenheim Fellow and a member of the editorial boards of the Annual Review of Sociology, Journal of Health and Social Behavior, Social Psychology Quarterly, Work & Stress, and the Journal of Behavioral Medicine.

    Mary Ann Jezewski, Ph.D., R.N., is Associate Professor at the University at Buffalo, School of Nursing. With a master's degree in nursing and a Ph.D. in anthropology, Dr Jezewski has focused her research on culture brokering in health care and patient/provider interactions during end-of-life decision making. She has studied migrant farmworkers and the homeless as part of her research on culture brokering.

    Judith D. Kasper is Associate Professor in the Department of Health Policy and Management in the Johns Hopkins University School of Hygiene and Public Health. Her research and teaching interests include health policy in long-term care, expenditures and access to health care for vulnerable populations, and the development and application of data sources for health policy and health services research. She has extensive experience in the design, conduct, and analysis of population-based health surveys and has served on the National Committee on Vital and Health Statistics. She has published in numerous journals in the fields of health policy, health services research, and gerontology. Dr Kasper holds a Ph.D. in sociology from the University of Chicago.

    Carl Kendall is Professor of Medical Anthropology and International Health at the London School of Hygiene and Tropical Medicine. He holds joint appointments at the Johns Hopkins University School of Hygiene and Public Health and the Tulane University School of Public Health and Tropical Medicine. He was the founder and first Director of the International Center for Community-Based Disease Control at Johns Hopkins. Professor Kendall is the author of more than sixty books and articles in general anthropology and in the field of applied medical anthropology. Professor Kendall has worked in more than forty countries in the areas of child health, women's reproductive health, AIDS, and community-based vector-borne disease control. His primary focus in this research has been the design, implementation, and evaluation of community-based interventions, with an eye to understanding why interventions work or fail. His current research focuses on health-seeking behaviors and using ethnographic models to explore the health transition.

    Arthur Kleinman is the Maude and Lillian Presley Professor of Medical Anthropology in the Departments of Anthropology and Social Medicine at Harvard University. A psychiatrist and anthropologist, he has carried out intensive research on illness experience, other forms of suffering, and therapeutic practices in China, Taiwan, and North America since 1968.

    Sandra D. Lane is a medical anthropologist/epidemiologist with a background in clinical nursing. She is currently Project Director of Syracuse Healthy Start and a behavioral scientist with the Onondaga County Health Department in Syracuse, New York. Dr Lane's research background includes work on behavioral factors in trachoma infection, the differential mortality of females in Egypt, the political, economic, and health consequences of unsafe abortion in Egypt, evaluation methods for media-based health education messages, and evaluation of the public health costs and benefits of needle exchange in North America. She has served as an expert consultant to the United Nations Population Program on rapid methods in program evaluation and as a member of an advisory committee on operations research for tuberculosis for the World Health Organization.

    Steven Lewis received a B.A. and an M.A. in political science from the University of Saskatchewan (Canada). Since 1974 he has worked as a healthcare planner, researcher, program evaluator, and research administrator. He is currently Chief Executive Officer of the Health Services Utilization and Research Commission, Province of Saskatchewan, which includes responsibility for the province's extramural research granting programs. The Commission analyses the use of health services and develops recommendations to improve effectiveness and efficiency, and in general promotes evidence-based change. He is theme leader of HEALNet, a major national project linking research and evidence to decision making in health care, funded under the Networks of Centres of Excellence program. He has been a member of numerous provincial and national bodies, including the National Forum on Health chaired by Prime Minister Jean Chretien, the Advisory Committee on Health Services to the Federal/Provincial/Territorial Deputy Ministers of Health, the board of directors of the Canadian Nurses’ Association, the board of the Saskatchewan Health Information Network, and the Health Services Research review committee of the Medical Research Council of Canada.

    Donald W. Light does comparative research on health-care systems, markets, insurance, and the professions as a professor at the University of Medicine and Dentistry of New Jersey and at Rutgers University. In the past decade, he has been involved in the evolution of competitive health-care markets in both the United States and the United Kingdom, and he is editing a set of studies on how sociological and political forces interacted with policies advocating ‘managed competition’ in various countries. Professor Light majored in history at Stanford University before going on to do his graduate work at the University of Chicago and Brandéis University.

    Karen W. Linkins, Ph.D., is a Research Specialist and Project Director at the Institute for Health & Aging, University of California, San Francisco. Currently, Dr Linkins is the co-investigator of two studies: an investigation of the impact of welfare reform on community-based nonprofit organizations serving the elderly and persons with disabilities in the San Francisco Bay area; and an evaluation of the effectiveness of substance abuse and mental health services for the elderly in a managed care setting. In addition, she is conducting a United States provider and payer analysis for drug therapies targeting the severely and persistently mentally ill, as well as a retrospective review of pharmacy and clinical databases to assess treatment patterns and quality of life in patients with psychosis or schizophrenia. Dr Linkins has written widely on the political economy of the health and social service systems in the United States.

    Margaret Lock is Professor in the Department of Social Studies of Medicine and the Department of Anthropology at McGill University. She is the author of East Asian Medicine in Urban Japan: Varieties of Medical Experience (1980) and Encounters with Aging: Mythologies of Menopause in Japan and North America (1993), which won the J. I. Staley Prize, School of American Research, the Eileen Basker Memorial Prize, the Canada-Japan Book Award, the Berkeley Award, the Wellcome Medal of the Royal Anthropological Institute, and was a finalist for the Hiromi Arisawa Award. Both books were published by the University of California Press and have been translated into Japanese. Dr Lock has edited five other books and written over 100 scholarly articles. She was the recipient of a Canada Council Izaak Killam Fellowship for 1993–95, is a Fellow of the Royal Society of Canada, a member of the Canadian Institute of Advanced Research, Population Health Program, and was awarded the 1997 Prix Leon-Gerin by the government of Quebec. Dr Lock is currently a member of a strategic network grant team funded by the Social Sciences and Humanities Research Council of Canada and a member of the MELSI committee (Medical, Ethical, Legal and Social Issues) of the Canadian Human Genome Project (CGAT).

    Deborah Lupton is Associate Professor in Cultural Studies and Cultural Politics and Deputy Director of the Centre for Cultural Risk Research, School of Social Sciences and Liberal Studies, Charles Sturt University, Australia. Her current research interests are in the sociocultural aspects of medicine and public health, the body, food, HIV/AIDS, sexuality, the media and commodity culture, parenthood, the emotions and risk. She is author/coauthor of nine books on these topics, including Medicine as Culture: Illness, Disease and the Body in Western Societies (1994), The Imperative of Health: Public Health and the Regulated Body (1995), Food, the Body and the Self (1996) and The New Public Health: Health and Self in the Age of Risk (1996, with A. Petersen). Her latest book is The Emotional Self: A Sociocultural Exploration (1998).

    Ann McElroy is an Associate Professor of Anthropology and Director of the Program in Applied Medical Anthropology at the State University of New York (SUNY) at Buffalo. She received her Ph.D. in anthropology from the University of North Carolina at Chapel Hill in 1973. Dr McElroy has served on the Executive Boards of the Society for Medical Anthropology and the Society for Applied Anthropology, has been the book review editor for the Medical Anthropology Quarterly, and has chaired the Social Sciences Human Subjects Review Committee at SUNY Buffalo since 1995. Her research interests include medical ecology, maternal and child health, migrant farm worker health, disability studies, and the political ecology of the Arctic. She is coauthor with Patricia Townsend of Medical Anthropology in Ecological Perspective (3rd edn, 1996) and co-editor of Making our Research Useful (1989).

    Colleen A. McHorney, Ph.D., is an Associate Professor in the Departments of Medicine and Preventive Medicine at the University of Wisconsin-Madison Medical School. She is also Director of the Health Services Research & Development Program at the Wm. S. Middleton Memorial VA Hospital. She is deputy editor for Medical Care, the official journal of the Medical Care Section of the American Public Health Association. Prior to her relocation to Wisconsin, Dr McHorney was Scientist at The Health Institute, New England Medical Center, and on the faculty at the Harvard School of Public Health. Dr McHorney's research focuses on outcomes research and health status assessment, with particular emphasis on quality of life and quality of care assessment. As the Picker/Commonwealth Scholars Program Finalist, Dr McHorney examined attitudinal and methodological barriers to the use of health status measures in clinical practice.

    Michael Moran is Professor of Government at the University of Manchester, United Kingdom. A graduate of the Universities of Lancaster and of Essex, he has written widely on British politics and on comparative public policy. Among his publications are The Politics of the Financial Services Revolution (Macmillan, 1991) and States, Regulation and the Medical Profession (with Bruce Wood, OUP, 1993). He is presently completing a comparative study of health care policy, Governing the Health Care State, to be published in 1999 by Manchester University Press. Since 1993 he has been editor of Political Studies, the journal of the U.K. Political Studies Association.

    Suzanne E. Morrissey is a Ph.D. candidate in the Department of Anthropology at Syracuse University. She is an Assistant Professor of Epidemiology at the State University of New York Health Science Center. She is also a research anthropologist working for the Onondaga County Health Department in Syracuse, New York, on an infant mortality prevention project funded through the Health Resources and Services Administration. Her dissertation field research examines the interplay of poverty and urban living among WIC-eligible women at risk for poor birth outcomes. She has conducted research in the Republic of Ireland on maternal health and breastfeeding patterns.

    Lois LaCivita Nixon, Ph.D., M.P.H., is Professor of Ethics and Humanities in the College of Medicine and the College of Public Health at the University of South Florida. In addition to co-editing two books on health care and co-authoring one, Dr Nixon has published in The Journal of Clinical Ethics, Law, Medicine & Health Care, The Journal of Medical Humanities, Pharos, The Journal of Aging and Identity, and Academic Medicine. Her most recent articles are entitled ‘Pyramids and Rhomboids in the Rationalist World of Medicine’ and ‘Emerging Issues in International Health Systems Organization.’ Dr Nixon has graduate degrees from Rollins College (M.A.T.), Middlebury College (M.Litt.), and the University of South Florida (Ph.D., M.P.H.). For two years, she served as Chair of the Hillsborough County Hospital Authority and is currently a member of the Committee on Governance for the American Hospital Association and is active, as well, in the National Association of Public Hospitals. She is a former Peace Corps Volunteer (Togo), a three-time National Endowment for the Humanities Fellow, a Pew Trust Fellow, and a Fulbright Scholar in Jordan. Dr Nixon's areas of study include medical ethics and humanities, women's issues, and the impact of globalism on health care.

    Karen E. Peters, M.P.H., is a doctoral candidate in the Division of Health Policy and Administration at the University of Illinois at Chicago (UIC) School of Public Health. Her dissertation research focuses on home health care providers’ utilization of home care services and the outcomes of home care. She is currently Project Director of the Cooperative Actions for Health Program, Medicine and Public Health Initiative at the American Medical Association. Previously she served as project manager of two research efforts concerning health promotion interventions with diverse ethnic and racial older adult populations in Chicago at UIC's Prevention Research Center. Her main interest areas are health services research, program evaluation, ethnic aging studies, and organizational theory.

    Kate E. Pickett is a doctoral student in the Division of Public Health Biology and Epidemiology, School of Public Health, University of California, Berkeley. She is conducting research on the effects of neighborhood social environments on risk of preterm birth. She holds masters’ degrees in nutritional science from Cornell University and in anthropology from Cambridge University.

    Thomas R. Prohaska is Professor and Chair of the Division of Community Health Sciences of the University of Illinois at Chicago School of Public Health. He is also Co-Director of the University of Illinois Center for Research on Health and Aging. He has recently co-edited a book, Public Health and Aging (with T. Hickey and M. Speers), which focuses on behavioral health issues in older populations. His research interests focus on gerontological public health including health behavior, illness behavior in older adults, and the psychosocial factors associated with self care in older populations. His current research activities involve the investigation of psychosocial issues associated with recruitment and retention of minority older adults in group exercise activities, doctor-patient interaction studies, and dissemination of community-based collaborative research and health promotion interventions among diverse older populations.

    Helena Ragoné received her Ph.D. in anthropology from Brown University. Surrogate Motherhood: Conception in the Heart (1994), her first book, was the first ethnographic study of surrogate motherhood. In it, Dr Ragoné documents the experiences of women who choose to become surrogate mothers as well as those of two previously inaccessible populations: commissioning couples and surrogate mother program staff. She has since co-edited three collections, Situated Lives: Gender and Culture in Everyday Life, Reproducing Reproduction: Kinship, Power, and Technological Innovation, and Ideologies and Technologies of Motherhood: Race, Class, Sexuality, and Nationalism. Dr Ragoné frequently delivers guest lectures throughout the United States and Europe and is currently completing Distant Kin: Gestational Surrogacy and Gamete Donation, an ethnography that will explore the meteoric rise in the rates of gestational surrogacy and ovum donation in the United States. She is also completing Riding Danger: Women in Horse Culture, an ethnography that highlights how and why women negotiate the risk of death and serious physical injury in the highly gendered sport of riding.

    Marc Renaud is currently President of the Social Sciences and Humanities Research Council of Canada, a position he has occupied since September 1997. He received a B.A. from College Saint-Viateur (Montreal, 1966), a B.Sc. (1968) and an M.A. (1970) in sociology from the Université de Montreal, and a Ph.D. in sociology from the University of Wisconsin (1976). Dr Renaud has been, since 1975, a Professor in the Department of Sociology at the Université de Montreal. From 1991 to 1997, he was President of the Conseil québécois de la recherche sociale. He has been Vice-President and Fellow of the Canadian Institute for Advanced Research since 1991, and was Director of the Groupe de recherche sur les aspects sociaux de la santé et de la prevention (GRASP) from 1984 to 1991. Dr Renaud was an active member of the National Forum on Health chaired by the Prime Minister. In 1992, he was elected to the Royal Society of Canada.

    Stephanie A. Robert is Assistant Professor of Social Work at the University of Wisconsin-Madison, where she is also affiliated with the Institute for Research on Poverty and the Institute on Aging. After receiving her joint Ph.D. in sociology and social work from the University of Michigan in 1996, Dr Robert spent two years as a Robert Wood Johnson Foundation Scholar in Health Policy Research at the University of California, Berkeley. Her primary research interest is in socioeconomic inequalities in health over the life course. She is also interested in community-based long-term care programs and policies for older adults. Her most recent research focuses on the impact of the socioeconomic characteristics of communities on the health, mortality, and well-being of community residents.

    Robert A. Rubinstein is Professor of Anthropology and of International Relations and Director of the Program on the Analysis and Resolution of Conflicts at Syracuse University. He received a Ph.D. in anthropology from the State University of New York at Binghamton (1977) and an M.S.P.H. from the School of Public Health, University of Illinois at Chicago (1983). He specializes in medical anthropology and conflict resolution. He has conducted research in Egypt, Belize, Yucatan, and the urban United States. His research focuses on community-based health interventions for preventing infectious disease, on cross-cultural negotiation, and on multilateral peacekeeping. He has published over fifty articles and is author or editor of five books, including Science as Cognitive Process: Towards an Empirical Philosophy of Science (University of Pennsylvania Press, 1984), Peace and War: Cross-Cultural Perspectives (Transaction, 1986), Fieldwork: The Correspondence of Robert Redfield and Sol Tax (Westview, 1991), and The Social Dynamics of Peace and Conflict: Culture in International Security (Kendall/Hunt, 1997).

    Marcel Saulnier is a Senior Policy Analyst in the Social Policy Division, Department of Finance, Government of Canada. Prior to this posting, Mr Saulnier worked for the secretariat of the Prime Minister's National Forum on Health, a federally appointed task force which delivered its final report in early 1997. Mr Saulnier's career in the federal public service also includes several years as policy analyst in the federal Department of Health, as well as various other positions in federal government departments, including the Privy Council Office, the Treasury Board Secretariat, and the Department of Western Economic Diversification.

    Susan C. Scrimshaw, Ph.D., Anthropology, Columbia University, 1974, is Dean, School of Public Health, and Professor of Community Health Sciences and Anthropology, University of Illinois at Chicago. Her research focuses on family planning and fertility decision making, improving pregnancy outcomes, child survival programs, violence prevention, and culturally appropriate delivery of health care. She has written extensively on quantitative and qualitative methodologies including the Rapid Anthropological Assessment Procedures (RAP) guidelines for nutrition and primary health.

    Dr Scrimshaw is a member of the Institute of Medicine, a Fellow of the American Association for the Advancement of Science, a Fellow of the American Anthropological Association, and an appointed member of the Chicago Board of Health. Awards for her work include the 1985 Margaret Mead Award. Most recently, her appointments include the Centers for Disease Control and Prevention Task Force on Community Preventive Services, the Institute of Medicine's Committees on Cancer Research Among Minorities and the Medically Underserved, the National Institutes of Health Priority Setting Process, and President-Elect of the Association of Schools of Public Health.

    Don Seeman is Lecturer in the Department of Sociology and Anthropology at The Hebrew University of Jerusalem. As an anthropologist, he has carried out research on the social context of infectious disease among migrants and on the relationship between illness experience, religion, and national identity in Israel.

    Ursula Sharma trained in both sociology and social anthropology at the University of London. Recently, she has specialized in medical anthropology and has published extensively on complementary and alternative medicine. She is the author of Complementary Medicine Today: Practitioners and Patients (Routledge, 1995), and with Sarah Cant has co-authored A New Medical Pluralism? Alternative Medicine, Doctors, Patients and the State (UCL Press, 1999). She is Research Professor of Comparative Sociology at the University of Derby, United Kingdom.

    Johannes Siegrist studied sociology, philosophy, and history and received his Ph.D. from the University of Freiburg, Germany, in 1969. From 1973 to 1992, Dr Siegrist was Professor of Medical Sociology at the University of Marburg. Since 1992, he has served as Professor of Medical Sociology and Director of the Postgraduate Training Program on Public Health in the Medical School at the University of Dusseldorf, Germany. Dr Siegrist is responsible for major scientific work in the social epidemiology of cardiovascular disease (psychosocial work environment) and in health-care evaluation research, and he is the author of some 200 original papers and several books, including a standard textbook on medical sociology. He has held Visiting Professorships at Johns Hopkins University, Baltimore, USA, and the Institute of Advanced Studies, Vienna, Austria. His honors include the Hans Roemer Award (German College of Psychosomatic Medicine), the Belle van Zuylen Chair, University of Utrecht, The Netherlands, and Honorary Membership, European Society of Health and Medical Sociology.

    Robert T. Trotter, II, is Regent's Professor of Anthropology at Northern Arizona University. He has conducted research on cross-cultural health care and educational issues in the United States, Mexico, and Puerto Rico, as well as World Health Organization multinational studies of substance abuse, and with the International Classification of Impairments, Handicaps and Disabilities (ICIDH). His research interests include HIV risk prevention research, cross-cultural alcohol and drug studies, and traditional medicine. He has a long-term interest in ethnographic research methods and the use of computers to assist ethnographic research. He is also active in both graduate and postgraduate training in ethical practices for ethnographic research.

    Bryan S. Turner is Professor of Sociology at the University of Cambridge. He has held professorial chairs in Australia, Britain, and The Netherlands, and was an Alexander von Humboldt Professorial Fellow at Bielefeld University, Germany (1986–87). He was the Morris Ginsberg Fellow at the London School of Economics in 1981. He is founding co-editor of the journal Body & Society and founding editor of Citizenship Studies. His current research interests include (1) voluntary associations and the privatization of the welfare state, (2) intimacy in old age, and (3) the lifestyle of postwar generations. He has published extensively in medical sociology, the sociology of religion, and political sociology. His recent publications include: The Blackwell Companion to Social Theory (1996) and The Body & Society (1996, 2nd edn). He is the series editor of Politics & Culture (Sage).

    Lois M. Verbrugge, Ph.D., M.P.H., is Distinguished Senior Research Scientist, Institute of Gerontology, at the University of Michigan. A social demographer, Dr Verbrugge centers her current research on disability in mid-and late life. She is engaged in research projects on (1) the efficacy of personal and equipment assistance in relieving disability, using data from the National Health Interview Survey Disability Supplement, (2) multiplicities of disability in adults (patterns of ADL/IADL disabilities, duration, and severity) using the same data set, and (3) how músculo skeletal function (strength, endurance, range of motion) affects physical and social functioning, using primary data collected on persons ages 60 +. Her research career has covered the topics of osteoarthritis and its disabling impacts, gender differences in health and mortality, health trends and future health prospects for American adults, multiple roles and physical health of women and men, and health diary methodology.

    Dr Verbrugge has had several prominent awards: (1) a Research Career Development Award from the National Institute on Child Health and Human Development to work on sex differentials in health and mortality; (2) a Special Emphasis Research Career Award from the National Institute on Aging to secure biomedical training in the rheumatic diseases and develop collaborative research with rheumatology colleagues; and (3) the Distinguished Contribution to Women's Health Award from the American Psychological Association. In 1992, she was awarded the Distinguished Research Scientist title by the University of Michigan in recognition of her research achievements.

    Jan S. Warren is currently a doctoral student in public health and gerontology at the University of Illinois at Chicago School of Public Health. She received an M.B.A from Lehigh University in 1983 and a B.A. in economics from Moravian College in 1981. Ms Warren works at the Center for Research on Health and Aging and is currently the Project Manager on an Edward R. Roybal Center grant to study the effects of exercise on older adults with multiple chronic illnesses. Her research background envelopes the life span including: cardiovascular risk assessment in school-aged children, school-based health interventions for adolescents, health issues of older women, and needs assessments of older adults living in low-income, federally subsidized housing.

    Deena White is Associate Professor of Sociology at the Université de Montreal, specializing in social policy, and Director of the Interdisciplinary Ph.D. in Applied Social Science. She is also a senior researcher at the Social Aspects of Health and Prevention Research Center. There, she leads an applied research team that, in partnership with regional health and social service boards, investigates questions of macro- and microregulation in the health domain, with study topics ranging from policy and planning to doctor-patient relations. Her work over the past ten years has addressed the dynamics of health and welfare reform, with a particular focus on state-civil society relations in the areas of occupational health, mental health, and social assistance. Dr White has published extensively in recent years on community involvement in the area of mental health, at the levels of intervention, planning, and policy development. She is currently examining the phenomenon of inter-sectoral cooperation in this field.

    Linda M. Whiteford, Ph.D., M.P.H., a medical anthropologist, is Professor and Chair of the Department of Anthropology at the University of South Florida in Tampa, Florida. The focus of her research is infectious disease and international health, and much of her writing has focused on comparative health systems, particularly in the Caribbean and Latin America. Her publications related to comparative health systems are: ‘Children's Health as Accumulated Capital: Structural Adjustment in the Dominican Republic and Cuba’ in Small Wars: The Cultural Politics of Childhood; ‘Sembrando El Futuro: Globalization and the Commodification of Health’ in Crossing Currents: Latin America in Transition; ‘Caribbean Colonial History and Its Contemporary Consequences: The Case of the Dominican Republic’ in the Journal of Social Science and Medicine, 1992; and ‘International Policies and Child Health’ in the Journal of Social Science and Medicine, 1993. In addition to her work on comparative health systems, Dr Whiteford has also published on infectious and vector-borne diseases, such as cholera and dengue fever, and child-maternal health.

    Evan Willis is Associate Professor of Sociology in the School of Sociology, Politics and Anthropology at La Trobe University in Melbourne, Australia. His research interests in the field of health sociology include technology assessment, demarcation disputes between health professions, occupational health and safety, and the social implications of the ‘new’ genetics. He has lived and worked in New Zealand and Canada in addition to Australia.

    Sharla K. Willis is a doctoral candidate at the University of Illinois at Chicago School of Public Health in the Division of Community Health Sciences. Her past research has included qualitative studies with Latino-and African-American populations looking at issues related to pregnancy and prenatal care. She is currently finishing her dissertation research on the impact maternal experience with a jaundiced infant has on breastfeeding. She holds an M.P.H in international population and family health and an M.A. in Latin-American studies from the University of California, Los Angeles.

    Emily C. Zielinski Gutiérrez, M.P.H, is pursuing a doctorate in public health (DrPH) at the Tulane University School of Public Health and Tropical Medicine in the Department of International Health and Development. Her dissertation study is an evaluation of methods, outcomes, and sustainability of integrated, community-based dengue prevention in Guatemala. Ms Zielinski Gutiérrez has worked in the evaluation of HIV educational material, production of an HIV prevention print media series, and with young adult reproductive health programs in Latin America. She has also worked in HIV education and hospice care on the Texas-Mexico border and maintains a strong interest in border health issues.


    The germination of the ideas for this handbook took place in lively discussions with colleagues and Sage Publishers in England, Germany, France, Switzerland, and the United States over a period of years. Chris Rojek and Stephen Barr provided the opportunity and encouragement to produce an international, multidisciplinary handbook reflective of the intellectual work being done in the social studies of health and medicine. We thank the reviewers from different countries who read and commented on the original book prospectus for their thoughtful ideas, suggestions, and constructive criticism. Listening to their comments broadened our horizons and made us appreciate the diverse viewpoints in the field across disciplines, countries, and intellectual traditions.

    A sabbatical visit by Gary Albrecht to Nuffield College, the University of Oxford, and Centre de Recherche Medicine Maladie et Science Sociales (CERMES), Paris, provided the time and environment to conceive the project, discuss it with colleagues, and test ideas. David Cox and Anthony Atkinson were gracious hosts at Nuffield College, and the Fellows provided the intellectual stimulation that helped the book evolve. Claudine Herzlich, Isabelle Baszanger, Martine Bungener, Renée Waissman, Robert Castel, Serge Moscovici, Henri-Jacques Stiker, Jean-Francois Ravaud, Hans-Georg Brose, Harrison White, Aaron Cicourel, Jean-Luc Lory, and colleagues at the Maison des Sciences de l'Homme, Paris, engaged in lively discussions about social science and health which clarified the issues and content of the book. The administration and staff of the School of Public Health at the University of Illinois at Chicago were efficiently helpful in managing the production of the book. Special thanks go to our editorial assistant, Pamela Ippoliti, whose management skills, attention to detail, and cheerful reminders of deadlines made the idea of the book become a reality. Sharla K. Willis set up the original files, and Isabel Martinez helped to keep the project moving forward. Sandra Burkes provided secretarial and data processing assistance to help launch the project. Maggi Lunde handled many telephone calls, e-mail traffic, and express mail packages in an expeditious fashion which facilitated work on the book around the world. We also thank our technical editor, Phyllis Crittenden, who reviewed all chapter manuscripts for form and technical consistency.

    The International Editorial Advisory Board members gave freely of their time to review the book outline, raise questions, suggest authors, and review manuscripts. Their collective wisdom and insights improved the conception of the book and individual chapters. In addition, many other colleagues graciously contributed their thoughts and reviewed individual manuscripts for the book.

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