Medicine, Health and Society: A Critical Sociology


Hannah Bradby

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    Many people have encouraged and provoked this book into existence. I would like to thank Gillian Bendelow, David Bradby, Gill Green, Gillian Hundt, Helen Roberts, Stuart Robertson and Jai Seaman.

    I am grateful to colleagues with whom I have developed ideas through joint writing, especially Helen Minnis, James Nazroo, Tarani Chandola and Waqar Ahmad.

    Serving time as a conference convenor and journal editor has informed my sense of what constitutes the sociology of health and illness, both as a group of people and as a critical practice. I acknowledge my debt to the British Sociological Association Medical Sociology Group and the editorial board of the journal Sociology of Health & Illness.

  • Glossary of Terms

    Actor network theory – an analysis of relationships that are simultaneously conceptual and material which originated with Science and Technology Studies. The theory insists on the performed and contingent nature of social relations and has engendered controversy over the agency of non-human actors within networks.

    Biomedicine – refers to scientifically informed medicine which employs chemistry, biology and physics to develop new diagnostic and therapeutic approaches to disease. Associated with a reductionist and individualizing approach that focuses on pathology and ignores the social context in which the ill person lives and thereby limits therapeutic possibilities.

    Capitalism – an economic system associated with industrialized society, whereby the means of production is in private ownership and operated as a profit-making concern by manipulating wages and commodity prices. Karl Marx's critique of capitalism and those who have built on his work, remain central to sociological analyses of modernity.

    Class system – a hierarchy of classes of the populace from the powerless and disenfranchised through to the powerful elite. A Marxist definition of class depends on a group's relationship to the means of production, whereas Weberian approaches emphasize differentials in status and prestige as well as wealth and income.

    Corporatization – public services, including healthcare, are taken over by commercial corporations and organized to maximize profit, rather than following professional or humanitarian values.

    Cultural capital – associated with Pierre Bourdieu's description of assets such as education and skills that are distinct from economic assets (wealth, income) and social assets deriving from networks of influence and support.

    Cyborg – a being with organic and artificial (electronic or mechanical) components used as a metaphor for the reconfiguration of gender and ethnicity in late modernity and associated with Donna Harraway's description of humanity's altered status in a technologically sophisticated society.

    Deprofessionalization – the loss of status and authority of professionals where a population's high levels of education and of access to information mean that knowledge is no longer restricted to a particular group, such as doctors.

    Determinism – generally a doctrine that attributes the cause of events, including human behaviour, to external causes, rather than individual will. Sociologically, its use implies a social feature that is taken to be an inevitable corollary of a biological trait or economic character such that, for instance, all women are assumed to be caring and all poor people to be uneducable.

    Disability – a physical, sensory, cognitive or developmental impairment that differentiates a person from the group norm and limits individual activities and/or social participation. Impairments do not necessarily amount to a disability since the latter is a social as well as an embodied process.

    Discourse – a set of communicative activities, whether written, spoken, broadcast or enacted, that address a particular topic such as ‘women's health problems’ or ‘migrants’.

    Embodied – to be a reflective, spiritual being whose body takes part in the social and psychological processes involved with living in society, including negotiating health and illness.

    Embodiment – the social and cultural processes by which we construct reality, which involve the interplay of both conceptual and bodily aspects.

    Empiricism – a theory of knowledge in which observations from the natural world, and especially those derived from experiments, are seen as necessarily more valid and reliable than any other.

    Enlightenment – a historical period where reason became valued as the main source of authority, over and above religion, custom or tradition. This rise of rationality and scientific reasoning paved the way for modernity and the industrial revolution.

    Equality – a state of parity between two groups or classes of people on a measurable variable or observable trait.

    Equity – parity between two groups or classes of people that reflects processes of fairness and social justice.

    Essentialism – a view that certain specific traits are always associated with a particular class of people, independent of context.

    Ethnicity – the characteristic commonality around which ethnic groups identify, usually composed of a common and specific culture often identified in terms of language, religion, marriage patterns and origins. Ethnicity is both a voluntaristic self-identification as well as a negotiation with what minority and majority groups permit.

    Ethnic group – a group of people who identify as sharing a common ancestry and culture, often including a religion, and who identify with a common future. Ethnic identification may depend on a common language (or idealized language) or an ideal or actual homeland, and may involve an idea of biological as well as social reproduction.

    Feminism – a practice and a theory that looks at how gendered inequality affects women's social and economic standing and seeks the means of promoting women's rights, opportunities and status. Liberal feminism seeks to promote women's participation in existing social and economic institutions whereas radical feminism seeks to reconfigure those institutions along feminist principles, variously defined.

    GDP (Gross Domestic Product) – a macroeconomic measure that is a summation of the value of one country's production of goods and services over a limited period and used as an indicator of standard of living.

    Gender – the social attribution of feminine and masculine qualities which may be justified by recourse to biological indicators of sex.

    Globalization – international economic trade has increased the volume and rate of flows of commodities, information, investment, ideas, people and pathogens between formerly distinct national settings. Effects of this flow include a greater international connectedness (at least for some classes), a homogenization of culture and language, and, more controversially, an increased demand for democracy, and increased militarization.

    Healthy migrant effect – a theory that only people with good health and vitality will volunteer for, and be able to withstand, the exigencies of migration; and therefore when they arrive in a new society, this section of the population should have better health on average than the local, non-migrant population.

    Iatrogenesis – damage as a direct result of medical intervention intended to be therapeutic and that may occur to individual bodies or to social groups.

    Identity – refers to a person's self-image in every-day language, whereas sociological usage implies the constraints that social attitudes and structures place on the identities an individual can claim. Identities around gender, sexuality, ethnicity, class and age are negotiated between the subjectivity of the individual and the range of what is bureaucratically and culturally permitted.

    Impairment – a loss or absence of a bodily structure or function or psychological ability that would normally be expected to be present. The result of this loss or absence may be disabling. An impairment does not necessarily amount to a disability since the latter is a social as well as an embodied process.

    Individualism – an ideology that values the individual as sovereign and emphasizes individual choice as the key locus for social action, thereby individualizing social problems and denying the possibility of collectivism and solidarity.

    Inequality – an observed or measurable difference that exists between two groups or classes of people.

    Inequity – a difference between two groups or classes of people that is unfair and unjust.

    Informatization – the process whereby information technology and health informatics has infused service provision to the extent that these activities have been reconfigured to consist in the flow and exchange of digitized information.

    Interactionism – a view of the self as a reflexive social product arising from interactions with, and responses from, others, largely mediated through language.

    Marketization – formerly publically funded services are deregulated and replaced with commercial structures in pursuit of profit, as a means of reducing statutory costs and responsibilities.

    Marxian – refers to a rather looser connection to Marxist models and is often used in contrast to Weberian (see below).

    Marxist – the scholarship of Karl Marx himself, describing the class structure of capitalist society and the possibilities for revolutionary change to abolish class divisions, was developed by others during his own lifetime and over the subsequent 130 years. The term Marxist tends to indicate a view of society as structured in socio-economic terms with a commitment to the possibility of progressive change towards socialism.

    Materialism – an analysis that places the material necessities of food, shelter and clothing, and the human activity around economic production to fulfil these needs, at the centre of the system of social relations. A materialist approach to health inequalities focuses on levels of income, standards of housing, schools, libraries and access to benefits before less tangible status-related aspects of social life, including relative poverty.

    Medical dominance – the authority and autonomy of medicine, including its regulation of other occupations involved in healthcare provision, that together confer a status that extends beyond the institution of medicine.

    Medicalization – a process whereby conditions formerly seen as non-medical (i.e. having social, economic or chance causes) come to be defined and treated as medical problems.

    Modernity – a historical period that follows the enlightenment and accompanies industrialization and the process of rationalization and secularization, whereby the certainties of religion and custom are lost, to be replaced by ideology that tends to be oriented to the future rather than the past. Post-modernity or high modernity follow modernity and imply a rise of uncertainty and an assertion that any truth serves a vested interest. The idea of multiple or alternative modernities sidesteps the ethnocentricity of the global North as offering the only model for socio-economic development.

    Morbidity rate – a measurement of the occurrence of symptoms or disease in a population over a fixed period of time.

    Mortality rate – a measurement of the occurrence of death in a population, usually expressed as a standardized mortality rate or SMR that sums the number of deaths per 1,000 population, standardized for age.

    Naturalist essentialism – the view that certain specific traits are always associated with a particular class of people, independent of context, and that also depends on an idea of naturally occurring characteristics with a timeless, universal, unalterable quality.

    Phenomenology – the experiential construction of meaning through the routine negotiation and resistance that constitutes interaction and speech.

    Positivism – a belief that only knowledge affirmed through scientific methods is credible and authentic.

    Poverty – in the absolute sense, poverty implies a lack of basic human needs such as food, shelter, education and clothing. In a stratified society, the people with fewest resources live in relative poverty, even if their basic needs are met.

    Power – the capacity to effect one's will which may be individually or collectively organized and exercised, and derives from economic, political and social resources and influence.

    Proletarianization – a proposed effect of capitalist expansion whereby all workers, regardless of their professional status, are eventually stripped of their autonomy and lose control over their conditions of work to become proletarian.

    Racism – prejudiced beliefs, attitudes and behaviour about people who are differentiated from oneself in essentialist ethnic or cultural terms.

    Reductionism – a means of understanding a complex system, such as a human body or a society, by reducing it to smaller constituent parts and ignoring interactions between the constituent parts.

    Reflexivity – a means of gaining some perspective on our and others' subjectivity by considering values and beliefs alongside our assessments and analysis in an effort to offer a full account from a particular point of view without claiming neutral or superior status for that knowledge.

    Sexuality – sexual desires and practices are understood to be socially constructed, in terms of their relationship with gender, age, queerness or straightness. Medicine has played an important role in determining deviant sexuality and its governance.

    Social capital – associated with Pierre Bourdieu's description of the assets deriving from networks of influence and support and distinct from cultural capital (education and skills) and economic assets (wealth, income).

    Social cohesion – the extent to which a social group is mutually and reciprocally supportive in their economic, political and social relationships.

    Social constructionism – normalized knowledge or practice can be understood as a result of the particular power relations pertaining in that historical and social context such that there is no ‘neutral knowledge’ since every representation of the way the world works serves some party's interests.

    Social stratification – the hierarchy of classes, defined by social and economic indicators, that runs from the lower class that is least privileged and least powerful to the upper class or elite that enjoys most privilege and exercises most power.

    Sociodicy – the existential meaning and ethical implications of human affliction and suffering as part of social life.

    Socio-economic class – a description of the systematic hierarchy of strata in society that uses both social and economic indicators of status.

    Structural functionalism – a theory that society operates as a stable and cohesive system due to norms, customs, traditions and institutions playing their constituent parts.

    Subjectivity – in opposition to objectivity, subjectivity refers to people's way of thinking and being that includes beliefs and values as well as the effects of social and demographic characteristics. An assessment of another group or person inevitably includes the effects of our own beliefs and values.

    Theodicy – the existential meaning and ethical implications of human affliction and suffering in religious thought and particularly the question of how human suffering affects our view of God.

    Weberian – relating to Max Weber's theories and, in particular, the way that his work on social status modified Marxist theories which emphasize economic social structures.

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