This is the first in a series of posts which I have written alongside a module I will be teaching which is intended to help non-sociology students to gain an understanding of the sociology of health and illness. While these posts are primarily intended for that audience and are therefore intentionally introductory there might be something of interest to a more general audience. For that reason I have decided to put them on my blog in amongst more specific and specialist writings.
This first post deals with the fundamental issue of what sociology can offer to an understanding of health.
Perhaps the key challenge of teaching sociology of health and illness to non-sociologists is in establishing the pertinence of a sociological perspective to health. Health is generally considered (by the public and much of mainstream medicine and science) to be wholly or primarily a biomedical or at least individual issue. That is, the perspective which many people take is that ultimately the key determinants of health are situated within the biology or behaviour of the individual.
While of course many diseases have an entirely biological aetiology (or cause) many of the most significant health issues in contemporary societies are linked to what are often called “lifestyle factors”. Stress, obesity, Type 2 diabetes, (some) cancers and many others are all well-acknowledged to be to some extent caused by the type of life people live. The response that many people have to this is that the answer is simple: “those people need to change their behaviour”.
This quite simplistic position is questioned by sociologists who suggest the picture is a little more complex. In this post I will introduce two key sociological concepts which can offer something which those with a focus on biological or individual behaviours cannot. These important sociological concepts involve an understanding of social structures and experiences.
The first key lesson which can be taken from sociology is that:
“Men make their own history, but they do not make it just as they please; they do not make it under circumstances chosen by themselves. But under circumstances directly encountered, given and transmitted from the past”
This quotation from Karl Marx exemplifies the influence which social structures have on our individual lives. While it was not intended to refer specifically to health the influence which social structures have on our health behaviours, and subsequent health outcomes, is significant.
The first challenge for a student new to the sociology of health and illness is how to recognise a social structure and to understand how it impacts on our behaviour. There are two basic characteristics of a social structure which can help us to identify them. Social structures are:
- external to individuals
- exist independently of any particular individual but not of all people
Social structures are therefore social things (they have been “made up” by people) but are objective in the sense that they exist regardless of whether or not I as an individual am aware of their existence. An example is useful here:
- THE LAW –
- Laws are social (not natural) because they are made up by human beings
- They exist outside of individuals (it doesn’t matter whether I understand or believe in them they are still there)
- They constrain the behaviour of individuals (there are consequences to breaking them)
- They are dynamic (they change over time)
The law is something which has been created by human society and in some ways a product of our imaginations but exists objectively of any particular individual’s belief in it. Crucially, the law also constrains our behaviour in various ways. We do not have to follow the law but there are consequences if we do not. The law thus puts pressure on us to act in certain ways. Most of the time we cannot see this pressure but it affects our behaviour nevertheless.
In my next post I will explore in more detail how the social and political organisation of society influences the health outcomes which people experience.
The second key sociological insight which is vital to gain a better understanding of why people have particular health outcomes is that of experiences, identities and meanings. This branch of sociology seeks to understand the subjective ways in which people experience and understand the world. This requires interpretive understanding or trying to put yourself in someone else’s shoes. What is it like to have cancer or to be obese?
This is important because a health condition will always have an impact on how someone feels about themselves (or on how others feel about them) and therefore how they can manage it. For those conditions caused by lifestyle factors; it is necessary to understand the meanings associated with eating, smoking or exercise and how these relate to different identities (related to gender, class, nationality) in order to understand why some people engage in these activities differently to others.
To gain this kind of qualitative, interpretive understanding of a person’s situation sociologists try to get a sense of what it is like to be that person. To take an example a sociologist might try to understand what it is like to be a student by asking themselves:
- What characterises being a student?
- What clothes, music, behaviours?
- How have they experienced the social structures of the university?
- What is it like to study for exams or to live in halls?
- What does being a student mean to them?
- What is the role of a student? How do they think others see them?