Sociology Health
by
Sigrun Olafsdottir
  • LAST MODIFIED: 27 July 2011
  • DOI: 10.1093/obo/9780199756384-0024

Introduction

Medical sociology examines the interaction between society and health. It is a broad subfield that focuses on both macro- and micro-level components of health and illness. It generally focuses on both physical and mental health, although the sociology of mental health has emerged as a distinctive subfield (and is covered only minimally in this article). Medical sociology highlights how issues of health and illness are socially constructed, how social factors result in health disparities, how individuals and societies respond to illness, and how the professions and health care are organized within and across societies. Issues of health, illness, and healing reside at the intersection of multiple disciplines, including social epidemiology, public health, demography, sociology of knowledge, and science and technology studies. However, the distinctive contribution of medical sociology is its intense focus on a more theoretical understanding of health than more applied disciplines would offer, as well as an attempt to understand how the different actors and organizations work together to create the health realities of a specific context. Although all of the major social theorists (e.g., Marx, Weber, Durkheim) paid some attention to health-related issues, medical sociology developed later than many other sociological subdisciplines. Medical sociology has gone through three developmental areas. Early on, much research was classified as sociology in medicine, whereby the sociological perspective was used to solve practical problems within medicine. Later, sociologists used issues of health, illness, and healing as a window for understanding larger sociological processes, for example, the socialization of medical students or the impact of societal institutions on individual lives. Currently, some prefer the notion of sociology of health, illness, and healing, reflecting the realities that not all health-related issues take place within the medical realm. Another unique characteristic of the field is that it developed earlier in the United States as compared to Europe, where medical sociologists, until recently, were largely housed within medical schools. This can be explained partly by research funding for sociological research focusing on health, most notably from institutions associated with the National Institutes of Health, as well as the intense attention several key American sociologists have given health and illness, including Talcott Parsons, Erving Goffman, Howard Becker, and Eliot Freidson.

Textbooks

There are several textbooks and introductory readers available that focus on medical sociology. They can be distinguished into two categories. On the one hand, several books provide a general overview of medical sociology, highlighting the key areas that medical sociologists work on. On the other hand, several readers are available that focus on similar topics but present the information through original articles. The three overview books (Cockerham 2010, Weiss and Lonnquist 2009, Weitz 2009) are all widely used and frequently revised (e.g., Cockerham 2010 is the eleventh edition, Weiss and Lonnquist 2009 is the sixth edition, and Weitz 2009 is the fifth edition). Courses in medical sociology frequently attract students of multiple backgrounds who share an interest in health and health care. Cockerham 2010 provides a relatively uncritical approach to the study of health and illness, which often works well in courses where the majority of students are nonsociology majors. Weitz 2009 takes a more critical approach to the study of health and illness and explicitly challenges approaches that are too sympathetic to the medical approach to understanding health and illness. Cockerham and Glasser 2001 is a reader that can accompany a textbook, perhaps most directly Cockerham 2010, as the sections mirror the section organization of that text. Conrad 2008 also provides a selection of classical and contemporary readings from the field but from a more critical standpoint. Brown 2007 provides a selection of readings targeting key areas of medical sociology, illustrating how issues of health, illness, and healing must be understood in social context, and has a unique emphasis on social movements in health. Daniel 2009 addresses key controversies in the health care field by presenting opposing viewpoints on issues such as the role of pharmaceutical companies in high medication costs. This book can be a compliment to other readings and allows students to debate controversial issues in the field.

  • Brown, Phil. 2007. Perspectives in medical sociology. 4th ed. Long Grove, IL: Waveland.

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    A selection of theoretical and empirical articles in medical sociology with a focus on the social context of health and illness, the illness experienced both within and outside of encounters with the health care system, and the health care system.

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    • Cockerham, William C. 2010. Medical sociology. Upper Saddle River, NJ: Prentice Hall.

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      A comprehensive overview of medical sociology focusing on the impact of social factors on health, how individuals react to health and illness, the health professions, and social organization of health care.

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      • Cockerham, William C., and Michael Glasser. 2001. Readings in medical sociology. Upper Saddle River, NJ: Prentice Hall.

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        A reader companion to Cockerham’s 2010 textbook. The emphasis is on empirical work, both quantitative and qualitative, with few articles focusing on theoretical development. The reader can also be used on its own, especially as some of the articles may be too challenging for an introduction course.

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        • Conrad, Peter. 2008. The sociology of health and illness: Critical perspectives. 8th ed. New York: Worth.

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          A collection of articles that take a critical view against medicine and the social construction of illness in contemporary societies. The key areas covered are the social production of disease, the social organization of medicine, contemporary critical debates, and possible alternatives to the way we think about and organize health care currently.

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          • Daniel, Eileen. 2009. Taking sides: Clashing views in health and society. 9th ed. Boston: McGraw-Hill.

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            Presents eighteen key issues facing American medicine (e.g., should purchasing health insurance be mandatory?) and presents a set of articles that have opposing viewpoints. This book can be used effectively with other readings to help students engage in debates and critical thinking.

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            • Weiss, Gregory L., and Lynne E. Lonnquist. 2009. The sociology of health, healing, and illness. Upper Saddle River, NJ: Pearson Prentice Hall.

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              A comprehensive overview of medical sociology with a focus on what medical sociology is, the impact of social factors on health and illness, health and illness behavior, the health professions, and health systems.

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              • Weitz, Rose. 2009. The sociology of health, illness and health care: A critical approach. Boston: Wadsworth Cengage.

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                Provides a more critical approach to medical sociology in which recent research that questions various assumptions generally made by medical sociologists is questioned. The book is organized into four sections: social factors and illness; the meaning and experience of illness; health care systems, settings, and technologies; and health care providers and bioethics.

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                Handbooks

                Medical sociology has a long history of publishing handbooks. Each handbook contains between twenty-five and thirty-five chapters on diverse topics in medical sociology, including a focus on social factors and health outcomes, the social construction of health and illness, the health professions, and the delivery of health care. Bird, et al. 2010 has been published about once a decade since originally published in 1963 and is now in its sixth edition. The book consistently provides articles on key issues within medical sociology, such as the relationship between class and health, but each revision is updated to reflect new trends and research directions. For example, the most recent edition includes chapters on health social movements and the interplay between biology and society in creating health outcomes and understandings of health and illness. Cockerham 2001 and Cockerham 2009 provide a global perspective to understanding health and illness. Cockerham 2001 includes nine chapters focusing on substantive topics, but a large proportion of the book focuses on regional perspectives, including the Americas, Western Europe, Russia and Eastern Europe, Africa, the Middle East, and Asia and the Pacific Region. As there may not have been drastic changes in medical sociology of the health care environment of the countries covered in 2001, Cockerham 2009 focuses on substantive issues but from a global perspective. This is perhaps best reflected in the selection of scholars represented in the book; the largest proportion comes from the United States and the United Kingdom, but medical sociologists from Canada, Australia, Finland, Singapore, Germany, and the Netherlands are also featured. Pescosolido, et al. 2010 takes a different approach and emphasize what kind of questions medical sociologists should be asking and answering in the 21st century. This volume advances the understanding of medical sociology by identifying the most important contemporary challenges to the field and suggesting directions for future inquiry. The editors provide a blueprint for guiding research and teaching agendas for the first quarter of the 21st century.

                • Bird, Chloe E., Peter Conrad, Allen M. Fremont, and Stefan Timmermans, eds. 2010. Handbook of medical sociology. Nashville, TN: Vanderbilt Univ. Press.

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                  The sixth edition of the key handbook in the field of medical sociology. The book provides twenty-five chapters, some that update and reconfigure central topics in the field and others reflecting changes and new directions in the field. The book is divided into four sections: social contexts and health disparities; health trajectories and experiences; health care organization, delivery, and impact; and crosscutting issues.

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                  • Cockerham, William C., ed. 2001. The Blackwell companion to medical sociology. Oxford and Malden, MA: Blackwell.

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                    This book is one of the best resources for understanding the development of medical sociology in a wide array of countries as well as providing insights and details on health outcomes and health care delivery across the globe. The book has a small section on substantive issues and a large section devoted to regional perspectives.

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                    • Cockerham, William C., ed. 2009. The new Blackwell companion to medical sociology. Malden, MA: Wiley-Blackwell.

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                      This update to the Blackwell Companion to Medical Sociology provides a more global perspective on substantive issues in medical sociology than other handbooks, with more than half of the authors working in countries other than the United States. The book is divided into six sections: an overview of the field, health and social inequalities, health and social relationships, health and disease, health care delivery, and new developments.

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                      • Pescosolido, Bernice A., Jack K. Martin, Jane D. McLeod, and Anne Rogers, eds. 2010. Handbook of the sociology of health, illness, and healing: A blueprint for the 21st century. Handbooks of Sociology and Social Research. New York: Springer.

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                        This volume offers a systematic view of the critical questions that face our understanding of the role of social forces in health, illness, and healing. It also provides an overall theoretical framework and asks medical sociologists to consider the implications of taking on new directions and approaches.

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                        Data Sources

                        Multiple sources of data exist to study health outcomes, health behavior, opinions about health and health care, as well as country-level indicators for health. For studying individual-level health outcomes and health disparities, the Add Health website (see National Longitudinal Study of Adolescent Health), the National Health Interview Survey, and the National Longitudinal Studies provide detailed information for the United States. The General Social Survey provides over-time data allowing for exploration of changing in self-rated health from 1972 as well as an examination of trends in public opinion regarding issues related to health care. The GSS has also fielded several modules of special interest to medical sociologists. For comparative research on health and opinions about health-related topics, the International Social Survey Programme, the European Social Survey, and the World Values Survey provide data for various countries at different points in time. For an exploration of country-level indicators of health, the OECD Health Data 2010 and the World Health Organization provide various indicators for multiple countries.

                        Journals

                        Medical sociologists have a wide array of sociological and interdisciplinary journals available to them. In addition, general sociological journals (e.g., American Sociological Review (see Race), American Journal of Sociology (see The Life Course), Annual Review of Sociology (see Gender), Social Forces (see The Life Course), Sociological Forum) publish articles related to health and illness on regular basis. Two major sociological journals focus on health and illness: the Journal of Health and Social Behavior and Sociology of Health & Illness. Additionally, Social Science & Medicine is an important forum for medical sociologists. Medical sociologists also publish regularly in journals such as the American Journal of Public Health (see Social Causation of Illness), Health Affairs, The Milbank Quarterly (see Social Causation of Illness), Health Services Research (see Contextual Effects), and Health Expectations, as well as increasingly in medical journals.

                        Classic Works

                        The work of the founders of sociology addressed issues of health and illness in often inexplicit yet important ways. The attention of current medical sociologists on how communities and neighborhoods affect health outcomes has a clear resonance with Durkheim’s 1951 work on social integration and suicide rates. Parsons’ 1991 seminal work on the sick role fully incorporated issues of health into mainstream sociological theory. The strength of medical sociology as a subdiscipline grew as prominent U.S. scholars focused on issues of health, illness, and healing. Early on, much attention was on the medical profession itself, illustrated in Becker, et al.’s 1977 focus on medical students and Freidson’s 1988 notion of professional dominance. The ongoing tradition of understanding health as a social construction also has a firm foundation in Conrad and Schneider 1992, Foucault 1973, and Zola 1972. Zola 1972 highlights the increased importance played on medicine in contemporary societies, arguing that it is becoming a major, if not the most important, agent of social control. Conrad and Schneider 1992 follow this notion, arguing that various deviations in social behavior and feeling are increasingly understood as a medical problem that can be solved with medical solutions. Foucault 1973 argues that medicine provided societies with a new way of looking at and understanding the human body. Finally, McKinlay 1996 contributes both to sociological theory and medical knowledge, establishing that the agreed-on notion that women were unlikely to develop heart disease before menopause was based on a social construction of illness rates.

                        • Becker, Howard S., Blanche Geer, Everett C. Hughes, and Anselm L. Strauss. 1977. Boys in white: Student culture in medical school. New Brunswick, NJ: Transaction.

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                          An ethnography of the socialization of medical students and how they transform from students into doctors. The study focuses on medical students at the University of Kansas and on how they try to anticipate what the professors want from them, the “latent culture” of medical school, how they assimilate with medical values over time, and how they negotiate a hospital or a clinic.

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                          • Conrad, Peter, and Joseph W. Schneider. 1992. Deviance and medicalization: From badness to sickness. Philadelphia: Temple Univ. Press.

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                            In this book, Conrad and Schneider illustrate the social construction of deviant behavior, arguing that such behavior has gone through historical stages from being defined as a sin, to a crime, to an illness. They support their claim with various in-depth illustrations, including mental illness, alcoholism, homosexuality, and criminal behavior.

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                            • Durkheim, Emile. 1951. Suicide. Edited by George Simpson. Translated by John A. Spaulding and George Simpson. New York: Free Press.

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                              Durkheim shows that suicide, often viewed as a private act, is deeply social. He shows that suicide rates across countries vary by social groups. He argues that the relationship between individuals and society shapes rates. He distinguishes between four different types of suicide: egoistic, altruistic, anomic, and fatalistic, each caused by either too much or too little social integration and/or regulation.

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                              • Foucault, Michael. 1973. Birth of the clinic: An archaeology of medical perception. Translated by A. M. Sheridan Smith. New York: Pantheon.

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                                Foucault traces the development of the medical profession and the clinic/hospital, showing how they became powerful in defining our understanding of health and illness. His key concept, the medical gaze, illustrates how medicine separated the patient’s body from who the patient is as a person, specifically how the body became the major object of medical interest.

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                                • Freidson, Eliot. 1988. Profession of medicine: A study of the sociology of applied knowledge. Chicago: Univ. of Chicago Press.

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                                  A classical text on the development of the medical profession. Freidson uses the medical profession as an example of what distinguishes a profession from an occupation. He further develops his concept of professional dominance by showing how the American medical profession was able to obtain exclusive authority over its domain. First published in 1970.

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                                  • McKinlay, John B. 1996. Some contributions from the social system to gender inequalities in health. Journal of Health and Social Behavior 37:1–26.

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                                    McKinlay shows how illness rates are socially constructed through an examination of gender differences in heart disease. He argues that epidemiological rates do not reflect the “real” distribution of illness in society but are impacted by the social system, particularly provider behavior. This has resulted in systematic misdiagnosis of women when they have heart disease.

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                                    • Parsons, Talcott. 1991. Social structure and dynamic process: The case of modern medical practice. In The social system. By Talcott Parsons, 428–479. Glencoe, IL: Free Press.

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                                      Relies on functionalist theory to explain what happens when people encounter illness and how they restore health. Develops one of the most widely known sociological concepts in medical sociology, the sick role—the rights and responsibilities of the patients—arguing that people are exempt from their normal roles, are not held responsible for their conditions, should seek technically competent help, and should cooperate with the physician. First published in 1951.

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                                      • Zola, Irving K. 1972. Medicine as an institution of social control. The Sociological Review 20.4: 487–504.

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                                        One of the first scholars to point out the dominant role of medicine in contemporary societies, arguing that it has become more powerful than traditional institutions, such as religion and law, as the appropriate agent of controlling behavior that is deemed problematic.

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                                        Measuring Health

                                        While studies on health differences across social and population groups can rely on objective indicators, such as life expectancies or rates of disease, it can be argued that such indicators are too crude to examine health status in countries that have undergone the epidemiological transition. Sociologists have paid attention to how to obtain reliable health data through survey and interview data and discussed how to best measure health in advanced industrialized nations. Self-rated health is frequently used, and Idler and Benyamini 1997 argues that this measure represents a valid and reliable indicator of health status. Iburg, et al. 2001 focus on group differences across self-rated health and physician assessment and find that the latter may be more sensitive toward capturing differences in health status. Other measures that have been proposed are functional limitations (Long and Pavalko 2004a, Long and Pavalko 2004b) and quality of life (Bowling 1995). Although researchers frequently rely on a single indicator (or a scale composed of multiple indicators) in their work, it is important to consider how different measures of health interrelate, as considered by Johnson and Wolinsky 1993. Finally, sociologists increasingly pay attention to differences in health status across nations, making issues of comparability essential. Murray, et al. 2002 focuses on the challenges associated with comparing health across populations with a particular focus on how we can measure whether the health of the population within a nation is improving over time as well as how to compare the health of different populations across contexts.

                                        • Bowling, Ann. 1995. What things are important in people’s lives? A survey of the public’s judgements to inform scales of health-related quality of life. Social Science & Medicine 41.10: 1447–1462.

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                                          This article presents findings from a nationally representative sample in Great Britain. The objective is to understand what matters to individuals in terms of their quality of life. Available online for purchase.

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                                          • Iburg, Kim M., Joshua A. Salomon, Ajay Tandon, and Christopher J. L. Murray. 2001. Cross-population comparability of self-reported and physician-assessed mobility levels: Evidence from the Third National Health and Nutrition Examination Survey. Geneva, Switzerland: World Health Organization.

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                                            Iburg and colleagues introduce a new technique to compare how gender, race, and income impact self-reported health versus health status obtained through physician assessment.

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                                            • Idler, Ellen I., and Yael Benyamini. 1997. Self-rated health and mortality: A review of twenty-seven community studies. Journal of Health and Social Behavior 38.1: 21–37.

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                                              In this article, Idler and Benyamini review twenty-seven studies using self-rated health as a measure of health status and find it to be an independent predictor of mortality. They conclude that self-rated health is a valid and reliable measure of health.

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                                              • Johnson, Robert J., and Fred D. Wolinsky. 1993. The structure of health status among older adults: Disease, disability, functional limitation, and perceived health. Journal of Health and Social Behavior 34.2: 105–121.

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                                                Johnson and Wolinsky focus on a more complex conceptualization of health and how different measures of health interrelate.

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                                                • Long, J. Scott, and Eliza K. Pavalko. 2004a. Comparing alternative measures of functional limitation. Medical Care 42.1: 19–27.

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                                                  Long and Pavalko compare more than one hundred scales measuring functional limitations in a sample of women ages thirty-seven to sixty-eight. The scales using all nine indicators of functional limitations perform the best. Available online for purchase or by subscription.

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                                                  • Long, J. Scott, and Eliza K. Pavalko. 2004b. The life course of activity limitations: Exploring indicators of functional limitations over time. Journal of Aging and Health 16.4: 490–516.

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                                                    In this article, Long and Pavalko compare scales of functional limitations across the life course and conclude that scales of functional limitations can be used effectively both for younger and older women. Available online for purchase or by subscription.

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                                                    • Murray, Christopher J. L., Joshua A. Salomon, Colin D. Mathers, and Alan D. Lopez, eds. 2002. Summary measures of population health: Concepts, ethics, measurement and applications. Geneva, Switzerland: World Health Organization.

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                                                      An edited volume focusing on the challenges associated with measuring population health.

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                                                      Social Construction of Illness

                                                      The social construction of illness is a key component of medical sociology. Researchers have illustrated the power of social construction in important ways, for example by showing the important role of culture in how individuals and societies respond to illness, as well as highlighting how our notions of what constitutes an illness is, at least in part, socially constructed. Culture plays a key role in our understanding of what an illness is as Angel and Thoits 1987 points out; Brown 1995 highlights the importance of how we name and frame conditions. Armstrong 2003 and Barker 2005 offer two accounts of how new categories of illnesses have emerged. The social construction perspective may be reflected most strongly in writings on medicalization, which has been a key concept in medicalization. Here, research has both focused on how and why specific conditions were medicalized (Conrad 1975) as well as a broader theorization of the causes and consequences of medicalization (Conrad 2007). While recent work has illustrated how various groups of people have become at risk for medicalization (Conrad 2007), it is clear that women have been more susceptible toward medicalization than men. As an example of this, Rothman 1989 shows how the process of becoming a mother has been medicalized. While earlier work focused on the medical profession as a driving force of medicalization, more recent insights have pointed out how patients actively fight for having certain problems viewed within a medical framework. Specifically, Brown 2007 highlights how individuals and groups have fought to have environmental health risks recognized. Finally, Conrad and Baker 2010 offer a summary of the sociological contributions regarding the social construction of illness and how it may be translated into policy.

                                                      • Angel, Ronald, and Peggy A. Thoits. 1987. The impact of culture on the cognitive structure of illness. Culture, Medicine, and Psychiatry 11.4: 465–494.

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                                                        Angel and Thoits suggest that the experiences of illness are bound by culture and that the understanding and interpretation of illness is constrained by cultural understandings. They show how culture impacts various aspects of health, such as symptom recognition, labeling, and help-seeking, that in turn have an impact on epidemiological estimates of illness prevalence across different ethnic groups. Available online for purchase or by subscription.

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                                                        • Armstrong, Elizabeth M. 2003. Conceiving risk, bearing responsibility: Fetal alcohol syndrome and the diagnosis of moral disorders. Baltimore, MD: Johns Hopkins Univ. Press.

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                                                          Armstrong looks at how fetal alcohol syndrome has been constructed as an illness in American society by tracing the evolution of medical knowledge about the effects of alcohol on fetal development from the 19th century to the present. She argues that issues of race, class, and gender have impacted the debates and that medical discourse leaves out broader social issues that may be responsible for the adverse outcomes.

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                                                          • Barker, Kristin Kay. 2005. The fibromyalgia story: Medical authority and women’s world of pain. Philadelphia: Temple Univ. Press.

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                                                            In this book, Barker focuses on a heated debate surrounding the diagnosis of fibromyalgia syndrome (FMS). She argues that FMS represents a union between the practices of modern medicine and the complexity of women’s world of pain and shows how the diagnosis can give meaning to the experiences of women suffering from various symptoms related to pain.

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                                                            • Brown, Phil. 1995. Naming and framing: The social construction of diagnosis and illness. Journal of Health and Social Behavior 35:34–52.

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                                                              Brown provides an overview of how medical sociologists have contributed to our understanding of social construction and argues for the need of sociology of diagnosis. He offers a categorization for how conditions are labeled based on whether the condition is generally accepted and whether a biomedical definition is applied. Four categorizations emerge: routinely diagnosed; medicalized definitions; contested definitions; and potentially contested definitions.

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                                                              • Brown, Phil. 2007. Toxic exposures: Contested illnesses and the environmental health movement. New York: Columbia Univ. Press.

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                                                                In this book, Brown describes the struggles of scientists and individuals and families who have been affected by illness caused by chemical exposure to achieve public recognition of the impact of the environment on health. He provides three case studies—breast cancer, asthma, and Gulf War–related illness—and argues that a new environmental health movement has emerged from these efforts.

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                                                                • Conrad, Peter. 1975. The discovery of hyperkinesis: Notes on the medicalization of deviant behavior. Social Problems 23.1: 12–21.

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                                                                  In one of his first writings on medicalization, Conrad views how the label of hyperkinesis was assigned to children exposing deviant behavior and shows how the treatment for the condition was available twenty years prior to the medical label of hyperkinesis.

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                                                                  • Conrad, Peter. 2007. The medicalization of society: On the transformation of human conditions into treatable disorders. Baltimore: Johns Hopkins Univ. Press.

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                                                                    Conrad, the leading scholar on medicalization, provides an overview of the causes and consequences of medicalization and argues that medicalization can happen through four different mechanisms: extension (e.g., andropause, baldness, and erectile dysfunction); expansion (e.g., adult ADHD); enhancement (e.g., human growth hormone); and continuity (e.g., homosexuality).

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                                                                    • Conrad, Peter, and Kristin A. Baker. 2010. The social construction of illness: Key insights and policy implications. Journal of Health and Social Behavior 51.1(suppl.):S67–S79.

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                                                                      In an article published in a special issue focusing on the key findings from fifty years of medical sociology, Conrad and Barker discuss three major contributions that the social construction tradition has contributed to our understanding of illness: the cultural meaning of illness, the illness experience as socially constructed, and medical knowledge as socially constructed.

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                                                                      • Rothman, Barbara. 1989. Recreating motherhood: Ideology and technology in a patriarchal society. New York: Norton.

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                                                                        In this book, Rothman looks at the changing meaning of motherhood in American society with specific attention on how medicine and technology are changing the meaning and experience of having a baby.

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                                                                        Social Causation of Illness

                                                                        An understanding of health disparities requires an interdisciplinary approach. While the sociological perspective provides a theoretical foundation and empirical support for how and why social factors matter for health, it is important to understand the context within which health and illness are embedded and how the disease profile has changed over time. Social epidemiology sets the stage for this understanding by showing how health problems are embedded within specific historical times and contexts. Susser and Susser 1996a and Susser and Susser 1996b trace the development of epidemiology and relate the major tasks of epidemiologists in each era to the major health threat that advanced industrialized societies have faced. Related to this, researchers have also shown interest in how the disease profile changes as nations advance, often referred to as the epidemiological transition. This refers to a change from infectious diseases that potentially kill a large proportion of the population to a chronic illness that individuals may live with for an extended period of time (Omran 2005). Epidemiologists and sociologists have also debated the role of medical intervention in improving population health, and McKinlay and McKinlay 1977 argues that medical intervention played a minimum role in the decline in mortality for several diseases in the United States. Krieger 1994 criticizes the tendency of epidemiology to provide empirical evidence without relying extensively on theory, especially regarding the broader social context within which individual lives are embedded, and House 2002 and Schnittker and McLeod 2005 make similar arguments from a sociological perspective. Finally, Berkman 2009 and Ezzati, et al. 2008 are examples of recent articles focusing on unique and emerging patterns regarding the health of the U.S. population. Specifically, Berkman 2009 focuses on the relatively unfavorable health outcomes of Americans, whereas Ezzati, et al. 2008 illustrate a unique health trend currently observed—that current generations can for the first time in history expect to live shorter lives than past generations.

                                                                        • Berkman, Lisa F. 2009. Social epidemiology: Social determinants of health in the United States: Are we losing ground? Annual Review of Public Health 30:27–41.

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                                                                          Despite being the richest country in the world, the United States has among the worst aggregate health outcomes among advanced industrialized nations. Berkman uses life-course perspective and contextual-level influences to explain these unfavorable health outcomes and to examine what kind of interventions are needed to reduce health disparities. Available online for rent, for purchase, or by subscription.

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                                                                          • Ezzati, Majid, Ari B. Friedman, Sandeep C. Kulkarni, and Christopher J. L. Murray. 2008. The reversal of fortunes: Trends in county mortality and cross-county mortality disparities in the United States. PLoS Medicine 5.4: 557–568.

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                                                                            Ezzati and colleagues examine sex-specific life expectancies for U.S. counties between 1961 and 1999. Past decades have witnessed consistent improvements in aggregate health outcomes, but they show that life expectancies for women have declined in 180 counties, indicating the possibility that American children born today may have shorter life expectancies than their parents.

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                                                                            • House, James S. 2002. Understanding social factors and inequalities in health: 20th century progress and 21st century prospects. Journal of Health and Social Behavior 43.2: 125–142.

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                                                                              An overview article of the development of social epidemiology illustrating that we have moved from an understanding of illness as a strictly biological process toward recognition of the critical role that social factors play in creating illness.

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                                                                              • Krieger, Nancy. 1994. Epidemiology and the web of causation: Has anyone seen the spider? Social Science & Medicine 39.7: 887–903.

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                                                                                Krieger argues that the preoccupation that epidemiology has with the “web of causation” is problematic and that the health outcomes of individuals must be understood in a social context. Available online for purchase.

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                                                                                • McKinlay, John, and Sonja J. McKinlay. 1977. The questionable effect of medical measures on the decline of mortality in the United States in the twentieth century. The Milbank Memorial Fund Quarterly: Health and Society 55.3: 405–428.

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                                                                                  McKinlay and McKinlay address whether medical innovations improved population health and conclude that they have contributed little to the decline in mortality in the United States since 1900. They support their argument by looking at whether innovations for specific conditions (e.g., influenza, pneumonia) resulted in declining mortality.

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                                                                                  • Omran, Abdel R. 2005. The epidemiologic transition: A theory of the epidemiology of population change. The Milbank Quarterly 83:731–757.

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                                                                                    The notion of the epidemiological transition is well established, indicating that the disease profile changes as countries become more advanced. Omran tests propositions to build a theory of the epidemiology of population change focusing on how changes in the population structure relate to mortality patterns. Originally published in 1971.

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                                                                                    • Schnittker, Jason, and Jane D. McLeod. 2005. The social psychology of health disparities. Annual Review of Sociology 31:75–103.

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                                                                                      Schnittker and McLeod argue for the importance of incorporating insights from social psychology when attempting to understand health disparities. In particular, insights from the social structure and personality paradigm allow us to consider both individual factors and the social context in which individuals are embedded. Available online for purchase or by subscription.

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                                                                                      • Susser, Mervyn, and Ezra Susser. 1996a. Choosing a future for epidemiology: I. Eras and paradigms. American Journal of Public Health 86:668–673.

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                                                                                        Susser and Susser provide an overview of the development of epidemiology, arguing that it has gone through four eras since its infancy in the 17th century: the sanitary era, the infectious disease era, the chronic disease era, and the eco-epidemiology era.

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                                                                                        • Susser, Mervyn, and Ezra Susser. 1996b. Choosing a future for epidemiology: II. From black box to Chinese boxes and eco-epidemiology. American Journal of Public Health 86:674–677.

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                                                                                          Susser and Susser further develop and advocate for their concept of eco-epidemiology. They argue that the current health realities require an epidemiology that analyzes determinants and health outcomes at multiple levels and within and across contexts.

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                                                                                          Class

                                                                                          The relationship between social class and health is an enduring theme within medical sociology. Early on, policymakers in Great Britain believed that the relationship could be eliminated if access to health care was equally available to everyone, but the experience showed that class differences remained when individuals returned to the same dire social conditions. This led sociologists to think about the impact of relative poverty as compared to absolute poverty, as well as consider how a relative status may impact health. The famous Whitehall Studies in Great Britain concluded that all of us belong somewhere on a social ladder, and even standing slightly below someone else results in worse health outcomes (Marmot 2004; Marmot, et al. 1991). Williams 1990 points out the importance of considering individual characteristics as well as the broader social context within the framework of the social structure and personality perspective. The persistent relationship between class and health led Link and Phelan 1995 to theorize about social class as a fundamental cause of disease, arguing that those individuals with greater access to resources will always be able to transform those resources into better health, even as the disease profile and threats to health change. This perspective has been one of the most influential sociological perspectives to understand the relationship between class and health. A more recent article, Link, et al. 2010 reviews the theory and the empirical evidence that has tested it for the past fifteen years. As more sophisticated methods became available, researchers pointed out the importance of disaggregating measures for social class, most frequently relying on separate indicators for education, income, and occupation. This research showed that education was the single strongest predictor of good health, as illustrated by Mirowsky and Ross 2003. Schnittker 2004 considers this further by looking at whether the impact of education is different depending on where on the income gradient individuals fall. Research on social class and health has increasingly become cross-national, and Elo 2009 argues for the importance of taking a comparative perspective when looking at social class differences in health.

                                                                                          • Elo, Irma T. 2009. Social class differentials in health and mortality: Patterns and explanations in comparative perspective. Annual Review of Sociology 35:553–572.

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                                                                                            A review article of the relationship between socioeconomic status (SES) and health in developed nations. The article focuses on the patterns that help explain the association and suggests a life-course perspective and multilevel modeling as fruitful steps for future research. Available online for purchase or by subscription.

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                                                                                            • Link, Bruce G., and Jo C. Phelan. 1995. Social conditions as fundamental causes of disease. Journal of Health and Social Behavior 35:80–94.

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                                                                                              A key article in which Link and Phelan originally proposed the fundamental cause argument. They argue that the association between SES and health is so profound that it should be viewed as a fundamental cause of disease. This association will persist because those of higher SES are constantly able to take advantage of their position to enhance and protect their health.

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                                                                                              • Link, Bruce G., Jo C. Phelan, and Parisa Tehranifar. 2010. Social conditions as fundamental causes of health disparities: Theory, evidence, and policy implications. Journal of Health and Social Behavior 51(suppl.): S28–S40.

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                                                                                                An article in a special issue on key findings from fifty years of medical sociology in which Link, Phelan, and Tehranifar review the theory and the empirical evidence that have tested it, as well as discussing its limitations and policy implications.

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                                                                                                • Marmot, Michael. 2004. The status syndrome: How social standing affects our health and longevity. New York: Holt.

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                                                                                                  In this book, Marmot develops his key argument based on research showing the impact of relative standing on health. More specifically, an individual’s location on the social hierarchy has profound implications for his or her chances of getting ill and life expectancies.

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                                                                                                  • Marmot, Michael, S. Stansfeld, C. Patel, F. North, J. Head, I. White, et al. 1991. Health inequalities among British civil servants: The Whitehall II Study. The Lancet 337.8754: 1387–1393.

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                                                                                                    A follow-up to the important Whitehall studies in Great Britain that established the importance of the social hierarchy for health. This study was conducted twenty years later with a sample that included women and reaffirmed the importance of the social hierarchy. Available online for purchase.

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                                                                                                    • Mirowsky, John, and Catherine Ross. 2003. Education, social status, and health. New York: de Gruyter.

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                                                                                                      In this book, Mirowsky and Ross argue that education is the most important factor in explaining the relationship between SES and health, largely due to the skills and abilities that are obtained through higher education.

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                                                                                                      • Schnittker, Jason. 2004. Education and the changing shape of the income gradient in health. Journal of Health and Social Behavior 45.3: 286–305.

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                                                                                                        Schnittker focuses on how education impacts the well-known income gradient in health and argues that education represents an important mechanism to reduce health inequalities.

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                                                                                                        • Williams, David R. 1990. Socioeconomic differentials in health: A review and redirection. Social Psychology Quarterly 53.2: 81–99.

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                                                                                                          Williams uses the social structure and personality perspective to address the relationship between SES and health, arguing for an attention to how SES is linked to health directly and indirectly.

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                                                                                                          Race

                                                                                                          Much of the sociological debates on race and health centers on the social construction of race and what it is about racial differences that results in unequal health outcomes. Several articles are available that review the racial differences in health, including Angel and Angel 2006 and House and Williams 2000. One of the key insights of sociological research has shown the importance of the intersection of race and class in explaining unequal health outcomes, illustrating how the historical racial inequality in the United States has resulted in blacks being more likely to live in poverty, which in turn impacts health negatively (Hayward, et al. 2000). However, it has also been argued and showed that the story is about more than simply race and class, illustrating the profound impact racism has on health outcomes, as theorized by Hummer 1996 and Williams and Collins 1995. A review of 138 empirical studies supports that racism is related to health outcomes, although the relationship appears to be stronger with mental health as compared to physical health (Paradies 2006). Finally, Williams and Sternthal 2010 reviews the key sociological findings on the relationship between race and health in a special issue of fifty years of findings in medical sociology.

                                                                                                          • Angel, Jacqueline L., and Ronald J. Angel. 2006. Minority group status and healthful aging: Social structure still matters. American Journal of Public Health 96:1152–1159.

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                                                                                                            A review article on the relationship between minority status and health. The authors discuss the importance of how race is classified and the major explanations for racial disparities in health, and propose a future agenda for research on race and health.

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                                                                                                            • Hayward, Mark D., Eileen M. Crimmins, Toni P. Miles, and Yu Yang. 2000. The significance of socioeconomic status in explaining the racial gap in chronic health conditions. American Sociological Review 65.6: 910–930.

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                                                                                                              Hayward and colleagues show that African Americans have worse health outcomes regarding several chronic conditions and that the differences are largely explained by a lower socioeconomic position rather than health behavior.

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                                                                                                              • House, James S., and David R. Williams. 2000. Understanding and reducing socioeconomic and racial/ethnic disparities in health. In Promoting health: Intervention strategies from social and behavioral science. Edited by B. D. Smedley and S. L. Syme, 81–124. Washington, DC: National Academy Press.

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                                                                                                                House and Williams review findings on the relationships among SES, race, and health, illustrating both the role of SES in explaining racial differences in health and the independent effect of race (e.g., through racism and discrimination). They suggest potential strategies to reduce health disparities through interventions in medical care and health promotions among vulnerable groups.

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                                                                                                                • Hummer, Robert A. 1996. Black–white differences in health and mortality: A review and conceptual model. The Sociological Quarterly 37.1: 105–125.

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                                                                                                                  Hummer criticizes the traditional explanations of racial differences in health and proposes an alternative framework for understanding racial disparities highlighting the central role of racism. Available online by subscription.

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                                                                                                                  • Paradies, Yin. 2006. A systematic review of empirical research on self-reported racism and health. International Journal of Epidemiology 35.4: 888–901.

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                                                                                                                    Paradies reviews 138 studies that empirically test the relationship between self-assessed racism and various health outcomes.

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                                                                                                                    • Williams, David R., and Chiquita Collins. 1995. US socioeconomic and racial differences in health: Patterns and explanations. Annual Review of Sociology 21:349–386.

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                                                                                                                      A review article of the relationships among race, class, and health in the United States. The authors highlight the importance of SES for explaining racial differences in health but argue for the importance of looking at racism, acculturation, and power as important mechanisms for understanding racial disparities. Available online for purchase.

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                                                                                                                      • Williams, David R., and Michelle Sternthal. 2010. Understanding racial-ethnic disparities in health: Sociological contributions. Journal of Health and Social Behavior 51(suppl.): S15–S27.

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                                                                                                                        Williams and Sternthal provide an overview of the major contributions sociologists have made to our understanding of the relationship between race and health.

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                                                                                                                        Gender

                                                                                                                        The relationship between gender and health did not receive much sociological attention before the 1980s, when sociologists began to pay attention to the different health profiles by gender within and across societies. Nathanson 1984 reviews the well-established pattern that women live longer than men and argues that it is related to the roles men and women are assigned in society. Verbrugge 1989 introduces the gender paradox in health, showing the complex pattern of men’s and women’s health where women have more health problems throughout the life course, despite higher life expectancy. This paradox was explained by Ross and Bird 1994 as being related to sex stratification in the labor market and the home that disadvantaged women’s health, as well as lifestyle choices putting men’s health at risk. While much of the research on gender and health has focused on women’s health, Courtenay 2000 focuses on how the ways in which masculinity is constructed in the United States has harmful health consequences for men. While early studies on gender and health largely focused on gender differences as a result of social roles allocated to men and women, Krieger 2003 points out that some studies use gender and sex interchangeably and illustrates the importance of distinguishing between the two, as some gender differences in health are purely biological, some are exclusively social, and some are a combination of both. Providing a broader framework for how to think about gender and health, Annandale 2009 relates gender differences in health to broader societal changes, and Bird and Rieker 2008 advocate for the perspective of constrained choices, arguing that men and women make choices that impact their health but the choices that are available to them are shaped by gendered policies within and across nations. Finally, Read and Gorman 2010 provide a review article illustrating the sociological contributions to understanding gender and health since the emergence of the interest in the issue in the 1980s.

                                                                                                                        • Annandale, Ellen. 2009. Women’s health and social change. London: Routledge.

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                                                                                                                          Annandale explores the health of women in advanced, industrialized nations and how gender differences in health are impacted by larger societal changes.

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                                                                                                                          • Bird, Chloe E., and Patricia Perri Rieker. 2008. Gender and health: The effects of constrained choices and social policies. New York: Cambridge Univ. Press.

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                                                                                                                            Bird and Rieker provide a framework for understanding gender differences in health in a comparative perspective. They introduce the concept of constrained choices, arguing that men and women make health-related choices, yet these choices are constrained by the larger social policy landscape of each country.

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                                                                                                                            • Courtenay, Will H. 2000. Constructions of masculinity and their influence on men’s well-being: A theory of gender and health. Social Science & Medicine 50.10: 1385–1401.

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                                                                                                                              While much of the literature on gender and health focuses on the health disadvantages experienced by women, Courtenay argues that ideas of masculinity in the United States results in worse health practices among men as compared to women, which in turn contribute to their lower life expectancies and higher rates of severe illness. Available online for purchase.

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                                                                                                                              • Krieger, Nancy. 2003. Genders, sexes, and health: What are the connections—and why does it matter? International Journal of Epidemiology 32.4: 652–657.

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                                                                                                                                Krieger clarifies the importance of considering both sex as a biological construct and gender as a social construct when explaining gender differences in health. Through twelve case studies, she shows examples of when gender differences are exclusively biological, social, and a combination of both.

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                                                                                                                                • Nathanson, Constance A. 1984. Sex differences in mortality. Annual Review of Sociology 10:191–213.

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                                                                                                                                  In an early attempt to address gender differences in health, Nathanson reviews differences in mortality between men and women, arguing that gender roles play a part in creating gender differences in mortality. The article largely focuses on developed countries but also pays some attention to developing countries. Available online for purchase.

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                                                                                                                                  • Read, Jen’nan G., and Bridget K. Gorman. 2010. Gender and health inequality. Annual Review of Sociology 36:371–386.

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                                                                                                                                    A review article focusing on the sociological contributions to gender disparities in health since the emergence of the attention to gender disparities in the 1980s. The authors review publications on gender and health in five major sociological journals. Available online for purchase or by subscription.

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                                                                                                                                    • Ross, Catherine E., and Chloe E. Bird. 1994. Sex stratification and health lifestyle: Consequences for men’s and women’s perceived health. Journal of Health and Social Behavior 35.2: 161–178.

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                                                                                                                                      Ross and Bird explain the gender paradox in health by focusing on gender stratification and lifestyle differences. They conclude that men’s lifestyles put them at risk whereas women’s protect them but that women’s health suffers from stratification in the labor market and at home.

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                                                                                                                                      • Verbrugge, Lois M. 1989. The twain meet: Empirical explanations of sex differences in health and mortality. Journal of Health and Social Behavior 30.3: 282–304.

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                                                                                                                                        One of the early articles addressing the gender paradox of men’s shorter life expectancies and women’s higher rates of health problems throughout the life course.

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                                                                                                                                        Contextual Effects

                                                                                                                                        Building off the emphasis on broader social conditions impacting health, recent research has focused on contextual effects on health. This strand of research has begun theorizing about why context matters as well as utilizing the availability of more sophisticated statistical models to test the impact of contextual factors. Some of this research has focused on independent effect of the neighborhood in which individuals reside (Robert 1999, Ross and Mirowsky 2008), arguing and testing that not only do individual characteristics matter for health, but also the kind of neighborhood one resides in. The cross-national work focusing on context largely concentrates on how income inequality at the aggregate level impacts population health. In an important book, Wilkinson 1996 argues that the most equalitarian societies enjoy the best population health, largely due to social cohesion. Research in the United States has supported this, focusing on the relationship across American states (Kawachi and Kennedy 1999; Kawachi, et al. 1999). Despite this empirical support, Beckfield 2004 fails to support this relationship after testing it in a larger number of countries and using more appropriate methods. Moving away from the income inequality debate toward the impact of the welfare state, Olafsdottir 2007 compares two capitalist societies with fundamentally different social organizations of welfare and illustrates that while the impact of traditional stratification variables such as education and poverty are the same across the context, the welfare state may be more successful in intervening in the negative impact related to family stratification. Finally, Beckfield and Krieger 2009 reviews studies that have tested how politics affect health outcomes and argue that more theoretical and empirical work should focus on the ways in which the organization of political systems is related to health outcomes.

                                                                                                                                        • Beckfield, Jason. 2004. Does income inequality harm health? New cross-national evidence. Journal of Health and Social Behavior 45.3: 231–248.

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                                                                                                                                          Compared to previous research, Beckfield uses more comprehensive data and more appropriate methods to evaluate the long-standing claim that income inequality at the aggregate level harms population health. His analysis fails to support this relationship.

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                                                                                                                                          • Beckfield, Jason, and Nancy Krieger. 2009. Epi + demos + cracy: Linking political systems and priorities to the magnitude of health inequities—Evidence, gaps, and a research agenda. Epidemiological Reviews 31.1: 152–177.

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                                                                                                                                            The authors review forty-five studies that have tested how politics may affect health outcomes and disparities. A large proportion of the studies focus on the global North and center around four political factors, including the transition to a capitalist economy and welfare-state organization.

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                                                                                                                                            • Kawachi, Ichiro, and Bruce P. Kennedy. 1999. Income inequality and health: Pathways and mechanisms. Health Services Research 34.1: 215–227.

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                                                                                                                                              Kawachi and Kennedy argue that individual health is affected not only by the person’s own income but by the income distribution in society. They identify several potential mechanisms, including more investment in health and education in more equal societies as well as higher levels of social cohesion.

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                                                                                                                                              • Kawachi, Ichiro, Bruce P. Kennedy, and Roberta Glass. 1999. Social capital and self-rated health: A contextual analysis. American Journal of Public Health 89:1187–1193.

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                                                                                                                                                Earlier research had established a relationship between income inequality at the aggregate level and population health and identified social capital as an important mechanism. In this article, Kawachi and colleagues look at whether social capital impacts individual-level health in thirty-nine states and find that living in areas with low social capital is harmful for health.

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                                                                                                                                                • Olafsdottir, Sigrun. 2007. Fundamental causes of health disparities: Stratification, the welfare state, and health in the United States and Iceland. Journal of Health and Social Behavior 48.3: 239–253.

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                                                                                                                                                  The fundamental causes argument proposes that health inequalities are an inevitable part of capitalist societies, yet not all capitalist societies are the same. Olafsdottir uses a welfare-state framework to compare the impact of stratification variables on self-assessed health in the United States and Iceland. The findings both support and counter the fundamental cause argument.

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                                                                                                                                                  • Robert, Stephanie A. 1999. Socioeconomic position and health: The independent contribution of community socioeconomic context. Annual Review of Sociology 25:489–516.

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                                                                                                                                                    Robert evaluates whether the socioeconomic context of a community has an independent effect on health outcomes in addition to individual characteristics. She discusses the pathways that should link community characteristics to individual health and reviews the empirical evidence that test the relationship. Available online for purchase.

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                                                                                                                                                    • Ross, Catherine, and John Mirowsky. 2008. Neighborhood socioeconomic status and health: Context or composition? City and Community 7.2: 163–179.

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                                                                                                                                                      Ross and Mirowsky conceptualize measurement for SES at the micro- and macro-level and evaluate whether neighborhood characteristics impact physical impairment independently from individual-level characteristics. While individual-level characteristics have a stronger impact, they conclude that 40 percent of the association between neighborhood SES is contextual and 60 percent compositional. Available online by subscription.

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                                                                                                                                                      • Wilkinson, Richard G. 1996. Unhealthy societies: The afflictions of inequality. New York: Routledge.

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                                                                                                                                                        In this book, Wilkinson argues that it is not the richest societies that experience the best health, but the most equal societies. Largely relying on binary relationships in advanced, industrialized nations, he shows that countries with higher levels of income inequality have worse aggregate health outcomes. He suggests that social cohesion is a major mechanism that can explain this relationship.

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                                                                                                                                                        The Life Course

                                                                                                                                                        Health is affected not only by individual characteristics and broader social conditions but also by the things that have happened to us in the past. The life-course perspective takes a look at the health trajectories of individuals, considering how prior health status impacts future health outcomes and allowing researchers to begin to answer questions about health selection versus social causation. Sociologists working in this tradition focus on how key experiences throughout people’s lives have implications for health. Early on, the attention was on the impact of traumatic experiences, for example having experienced combat during World War II (Elder, et al. 1997). More recently, researchers have focused on the more frequent yet profound experiences of adults, especially within the family and the labor force. Williams and Umberson 2004 focuses on the impact of marriage on health, and Umberson, et al. 2010 looks at the impact of parenthood. Within the labor market, Pavalko and Smith 1999 shows how being in the labor force impacts the health of women, and Pavalko, et al. 2003 pays attention to perceived discrimination and its impact on health. The life-course perspective further allows sociologists to consider individual lives in historical context, and the individual trajectories have been studied in the context of cumulative advantages and disadvantages. This is, for example, illustrated by Ross and Wu 1996, who showed that educational attainment continues to impact health throughout the life course. Finally, Halfon and Hochstein 2002 provide a framework for how to study life course in social science research.

                                                                                                                                                        • Elder, Glen, Michael J. Shanahan, and Elizabeth C. Clipp. 1997. Linking combat and physical health: The legacy of World War II in men’s lives. American Journal of Psychiatry 154:330–336.

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                                                                                                                                                          A study of veterans serving in World War II showing that those who engaged in combat experienced worse physical health than those who did not.

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                                                                                                                                                          • Halfon, Neal, and Miles Hochstein. 2002. Life course health development: An integrated framework for developing health, policy, and research. The Milbank Quarterly 80.3: 433–479.

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                                                                                                                                                            In this article, Halfon and Hochstein describe the life course health development framework that focuses on health trajectories of individuals.

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                                                                                                                                                            • Moen, Phyllis, Donna Dempster-McClain, and Robin M. Williams Jr. 1992. Successful aging: A life-course perspective on women’s multiple roles and health. American Journal of Sociology 97.6: 1612–1638.

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                                                                                                                                                              Moen and colleagues use panel data over a thirty-year period to evaluate whether holding multiple roles at the earlier time had a positive impact on future health. Available online for purchase.

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                                                                                                                                                              • Pavalko, Eliza K., Krysia N. Mossakowsky, and Vanessa Hamilton. 2003. Does perceived discrimination affect health? Longitudinal relationships between work discrimination and women’s physical and emotional health. Journal of Health and Social Behavior 43:18–33.

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                                                                                                                                                                A longitudinal analysis that shows that discrimination has an impact on the subsequent health of women.

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                                                                                                                                                                • Pavalko, Eliza K., and Brad Smith. 1999. The rhythm of work: Health effects of women’s work dynamics. Social Forces 77.3: 1141–1162.

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                                                                                                                                                                  In this article, Pavalko and Smith focus on the health effects of work, specifically whether working has positive health benefits or whether those in worse health are selected out of the labor force.

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                                                                                                                                                                  • Ross, Catherine E., and Chia-Ling Wu. 1996. Education, age, and the cumulative advantage in health. Journal of Health and Social Behavior 37.1: 104–120.

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                                                                                                                                                                    In this article, Ross and Wu test whether the health gap between those with higher levels of education and lower levels of education increases with age, suggesting the cumulative advantages of educational attainment.

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                                                                                                                                                                    • Umberson, Debra, Tetyana Pudrovska, and Corrine Reczek. 2010. Parenthood, childlessness, and well-being: A life course perspective. Journal of Marriage and the Family 72.3: 612–629.

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                                                                                                                                                                      In this article, Umberson and colleagues review recent research using the life-course perspective to evaluate the impact of parenthood on well-being.

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                                                                                                                                                                      • Williams, Kristi, and Debra Umberson. 2004. Marital status, marital transitions, and health: A gendered life course perspective. Journal of Health and Social Behavior 45.1: 81–98.

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                                                                                                                                                                        Williams and Umberson test the impact of marriage on the self-assessed health of men and women.

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                                                                                                                                                                        Health and Illness Behavior

                                                                                                                                                                        Medical sociologists have long been interested in responses to illness and increasingly to what individuals do to maintain health and well-being. Kasl and Cobb 1966 defines health, illness, and sick-role behavior, illustrating what kind of actions individuals engage in. Several models have been developed to explain illness behavior, and the main approaches are reviewed in McKinlay 1972. The two most influential sociological models to explain illness behavior are the social-behavioral model (Andersen 1995) and the network-episode model (Pescosolido 1986, Pescosolido 1992). The social-behavioral model has gone through several revisions, most recently presented in Andersen 1995, and while taking multiple factors into account, the model highlights factors that enable or hinder individuals to seek help. Pescosolido (Pescosolido 1986, Pescosolido 1992) argues that traditional models of help-seeking do not take into account the dynamic nature of help-seeking, especially as individuals encounter more complex chronic and mental illness. The key insight of the model is the importance of social networks, arguing for the importance of understanding both the content and structure of the networks. Focusing on health lifestyles, Cockerham 2005 develops a model drawing on the work of Weber and Bourdieu to explain why some individuals are more likely to engage in health behavior focusing on the relationship between structure and agency. Although much of the original work on help-seeking behavior was criticized for being too embedded within the functionalist tradition, Waitzkin 1971 points out situations in which taking on the sick role can be functional rather than dysfunctional. Finally, Lutfey and Freese 2005 illustrates the importance of socioeconomic status for understanding help-seeking and adherence to treatment.

                                                                                                                                                                        • Andersen, Ronald M. 1995. Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior 36:1–10.

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                                                                                                                                                                          Andersen originally proposed the social-behavioral model to explain utilization of services in the 1960s. In this article, he illustrates how the model has developed as it has taken into account new insights and criticism.

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                                                                                                                                                                          • Cockerham, William C. 2005. Health lifestyle theory and the convergence of agency and structure. Journal of Health and Social Behavior 46:51–67.

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                                                                                                                                                                            Cockerham draws on the theories of Weber and Bourdieu to develop a theory of health and lifestyle that focuses on the interplay of structure and agency in determining the kind of lifestyles individuals are likely to adopt.

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                                                                                                                                                                            • Kasl, Stanislav, and Sidney Cobb. 1966. Health behavior, illness behavior and sick role behavior. Archives of Environmental Health 12:246–266, 531–541.

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                                                                                                                                                                              Kasl and Cobb provide definitions of health, illness, and sick role behavior to distinguish between the behavior individuals engage in to maintain or enhance health, to respond to illness, and as they take on the sick role.

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                                                                                                                                                                              • Lutfey, Karen, and Jeremy Freese. 2005. Toward some fundamentals of fundamental causality: socioeconomic status and health in the routine clinic visit for diabetes. American Journal of Sociology 110.5: 1326–1372.

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                                                                                                                                                                                An ethnographic study of two diabetes clinics evaluating the role of SES regarding help-seeking and adhering to treatment. Comparing lower income and higher income groups that both have health care, the authors show how the lower income group is always disadvantaged when it comes to treatment. Available online for purchase.

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                                                                                                                                                                                • McKinlay, John. 1972. Some approaches and problems in the study of the use of services—An overview. Journal of Health and Social Behavior 13.2: 115–151.

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                                                                                                                                                                                  McKinlay provides a systematic review of utilization research in the United States and Europe from the 1950s to the 1970s.

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                                                                                                                                                                                  • Pescosolido, Bernice A. 1986. Migration, medical care preferences and the lay referral system: A network theory of role assimilation. American Sociological Review 51.4: 523–540.

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                                                                                                                                                                                    Pescosolido proposes that role assimilation occurs through the interplay of networks and context, where networks provide the mechanism through which contextual information travels. She uses data on medical care preferences of migrants in Taiwan to test the theory.

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                                                                                                                                                                                    • Pescosolido, Bernice A. 1992. Beyond rational choice: The social dynamics of how people seek help. American Journal of Sociology 97.4: 1096–1138.

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                                                                                                                                                                                      Pescosolido argues that decisions about medical care are made within social networks in consultations with others and do not represent a rational choice made in isolation from others, as often assumed in the rational choice literature on how people make decisions. Available online for purchase.

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                                                                                                                                                                                      • Waitzkin, Howard. 1971. Latent functions of the sick role in various institutional settings. Social Science & Medicine 5.1: 45–75.

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                                                                                                                                                                                        Although taking on the sick role is generally viewed as dysfunctional, Waitzkin shows that the sick role can contribute to social stability in selected institutional settings, including the family, the armed forces, and the mental hospital.

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                                                                                                                                                                                        Experiences of Illness

                                                                                                                                                                                        A more recent development in medical sociology is a focus on the illness experience. Kleinman 1988 provides the concept of the illness narrative, arguing for the importance of understanding illness from the viewpoint of the person who is suffering from it. Early work on the illness experience include Bury’s 1991 review article on how we have and should study the experience of chronic illness and Charmaz’s 1991 important study of the experiences of those with chronic illness. Research has approached the illness experience from various standpoints, including looking at those at risk for genetic disease (Boutté 1990), describing one’s own experience (Rier 2000), focusing on those with contested illness (Nettelton, et al. 2004), and discussing what it means to be labeled a survivor of cancer (Kaiser 2008). Although most research on the experiences of illness uses the narrative, frequently obtained through qualitative interviews, Bell 2002 utilizes photography to illustrate the illness experience from a time of diagnosis to the time of death of one person.

                                                                                                                                                                                        • Bell, Susan E. 2002. Photo images: Jo Spence’s narratives of living with illness. Health 6.1: 5–30.

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                                                                                                                                                                                          Bell extends the more common textual analysis of the illness experience to examine three photographs of illness taken by British feminist Jo Spence from the time of her breast cancer diagnosis in 1982 to the time of her death in 1992.

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                                                                                                                                                                                          • Boutté, Marie I. 1990. Waiting for the family legacy: The experience of being at risk for Machado-Joseph disease. Social Science & Medicine 30.8: 839–847.

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                                                                                                                                                                                            Current realities reflect a world in which individuals may know that they are at a genetic risk of developing specific diseases. Boutté uses data from individuals at risk for Machado-Joseph disease and looks at the variations in responses among individuals knowing that they are at risk. Available online for purchase.

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                                                                                                                                                                                            • Bury, Mike. 1991. The sociology of chronic illness: A review of research and prospects. Sociology of Health and Illness 13:461–468.

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                                                                                                                                                                                              A review article on how individuals cope with chronic illness. Bury criticizes the traditional focus on identifying the problems individuals and families face, and argues that we should compliment that understanding with a focus on how people tackle the challenges they face.

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                                                                                                                                                                                              • Charmaz, Kathy. 1991. Good days, bad days: The self in chronic illness and time. New Brunswick, NJ: Rutgers Univ. Press.

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                                                                                                                                                                                                Charmaz conducted interviews with ninety individuals experiencing chronic illness and twenty caregivers or providers to understand how individuals cope with chronic illness. Using a social constructivist framework, she looks at the meaning individuals experiencing chronic illness give to their experiences.

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                                                                                                                                                                                                • Kaiser, Karen. 2008. The meaning of the survivor identity for women with breast cancer. Social Science & Medicine 67.1: 79–87.

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                                                                                                                                                                                                  While American culture has generally created a positive image of the cancer survivor, Kaiser explores how this cultural image translates into the lived experience of women who have experienced breast cancer. Available online for purchase.

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                                                                                                                                                                                                  • Kleinman, Arthur. 1988. The illness narratives: Suffering, healing, and the human condition. New York: Basic Books.

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                                                                                                                                                                                                    Psychiatrist and medical anthropologist Kleinman highlights the importance of the illness narrative, focusing on patients’ own stories of their illness and dealing with chronic conditions.

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                                                                                                                                                                                                    • Nettelton, Sarah, Lisa O’Malley, Ian Watt, and Philip Duffey. 2004. Enigmatic illness: Narratives of patients who live with medically unexplained symptoms. Social Theory & Health 2.1: 47–66.

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                                                                                                                                                                                                      Nettelton and colleagues focus on the illness experience of individuals who feel sick yet have not been able to receive a diagnosis of a recognizable disease. They document their struggles both in terms of assigning meaning to their experience as well as locating appropriate sources of help. Available online by subscription.

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                                                                                                                                                                                                      • Rier, David A. 2000. The missing voice of the critically ill: A medical sociologist’s first-person account. Sociology of Health & Illness 22.1: 68–93.

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                                                                                                                                                                                                        Rier is a critical medical sociologist who did not consider Parsons’ concept of the sick role to be particularly useful in the current health context. However, when he encounters acute, life-threatening illness, he takes on the sick role as described by Parsons and documents his experiences in this article.

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                                                                                                                                                                                                        Doctor–Patient Interaction

                                                                                                                                                                                                        Doctor–patient interaction represents an area that has a long-standing interest among medical sociologists. As early as the 1950s, Szasz and Hollender 1956 developed three models of doctor–patient interaction, arguing that the type of interaction likely to take place depends on the severity of the situation and the type of illness encountered. While the medical encounter has often been viewed in paternalistic terms where the doctor gives an order and the patient complies, Hayes-Bautista 1976 points out that patients actively negotiate and modify the treatment they receive from doctors and that those belonging to the upper classes are more likely to do so. Another early insight came from Zola 1966 showing that not all patients behave the same, even when diagnosed with identical conditions, and the way in which they represent symptoms is related to ethnic background. Lutfey 2005 illustrates the multiple roles medical doctors have to take on to convince patients to undergo treatment, and Waitzkin 1991 points to the importance of not reducing the encounter to what is biologically wrong but to consider the patient within a social context. Illustrating the complexity of the doctor–patient relationship in acute situations, Weitz 1999 shows how doctors interacted with the family of a fatally injured family member and were not particularly willing to share information. The traditional doctor–patient relationship has changed for a wide array of reasons, including technology, and Barker 2008 focuses on how electronic support groups may contradict the information patients get from doctors and impact what kind of treatment they seek. Finally, Boyer and Lutfey 2010 reviews the key sociological findings on the doctor–patient relationships that the past fifty years of medical sociology has revealed.

                                                                                                                                                                                                        • Barker, Kristin. 2008. Electronic support groups, patient-consumers, and medicalization: The case of contested illness. Journal of Health and Social Behavior 49.1: 20–36.

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                                                                                                                                                                                                          An analysis of all postings to an Internet support web page for those believing they suffer from fibromyalgia over a one-year period. This article represents a study of how changing technology and lay knowledge has implications for the traditional doctor–patient relationship.

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                                                                                                                                                                                                          • Boyer, Carol A., and Karen E. Lutfey. 2010. Examining critical health policy issues within and beyond the clinical encounter: Patient–provider relationships and help-seeking behaviors. Journal of Health and Social Behavior 51(suppl.): S80–S93.

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                                                                                                                                                                                                            Boyer and Lutfey review six key findings on the relationship between doctors and patients for the past fifty years, including how patients have become more active in their interactions with doctors.

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                                                                                                                                                                                                            • Hayes-Bautista, David. 1976. Modifying the treatment: Patients compliance, patient control, and medical care. Social Science & Medicine 10.5: 233–238.

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                                                                                                                                                                                                              Rather than viewing patients as inactive followers of medical suggestions, Hayes-Bautista shows how patients actively modify treatment, either by trying to convince the physician that the current treatment is not working or by making changes to the treatment on their own.

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                                                                                                                                                                                                              • Lutfey, Karen. 2005. On practices of “good doctoring”: Reconsidering the relationship between provider roles and patients adherence. Sociology of Health & Illness 27.4: 421–447.

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                                                                                                                                                                                                                Lutfey conducted a year-long ethnography in two diabetes clinics and illustrates how doctors have to take on multiple roles to convince patients to adhere to treatment. The roles include the educator, the cheerleader, and the salesperson, among others.

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                                                                                                                                                                                                                • Szasz, Thomas, and Marc Hollender. 1956. A contribution to the philosophy of medicine: The basic models of the doctor–patient relationship. Archives of Internal Medicine 97.5: 585–592.

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                                                                                                                                                                                                                  Szasz and Hollender introduce three basic models of doctor–patient interaction: the activity-passivity model, the guidance-cooperation model, and the mutual participation model. The first applies to situations in which the patient is completely helpless, the second is most likely to apply to acute illness, and the third approach applies to chronic illness.

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                                                                                                                                                                                                                  • Waitzkin, Howard. 1991. The politics of the medical encounter: How patients and doctors deal with social problems. New Haven, CT: Yale Univ. Press.

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                                                                                                                                                                                                                    In this book, Waitzkin argues for a doctor–patient relationship that focuses on social change, as doctors’ tendencies to focus on the physical aspect of patients’ complaints often ignore the real problem that is caused by social circumstances.

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                                                                                                                                                                                                                    • Weitz, Rose. 1999. Watching Brian die: The rhetoric and reality of informed consent. Health 3.2: 209–227.

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                                                                                                                                                                                                                      Weitz is a medical sociologist who lost her brother-in-law in an accident. She observes the interaction between the emergency room doctors and family members and focuses on how the doctors withheld information from the family and how the sharing of information was shaped by factors related to both medical practice and social location.

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                                                                                                                                                                                                                      • Zola, Irving K. 1966. Culture and symptoms—An analysis of patients’ presenting complaints. American Sociological Review 31.5: 615–630.

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                                                                                                                                                                                                                        Zola shows how patients from two different ethnic groups, Italian and Irish, present and respond to their symptoms differently, even when diagnosed with the same illness. This study illustrates the importance of culture in understanding doctor–patient encounters.

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                                                                                                                                                                                                                        Learning to Heal

                                                                                                                                                                                                                        Sociologists interested in socialization often relied on the training of medical doctors to understand how individuals became socialized into a profession, and the 1950s through the 1970s produced multiple influential studies on medical student socialization. Since then, less research has been done on medical training, which is somewhat problematic given the changes that have taken place. Among the first studies were Becker and Geer 1958 and Fox 1957. Bosk 1979 focused on surgeons in training, including what kinds of mistakes were tolerated and what kinds were not. Reflecting that medical training is unique compared to training of many other professionals, both in terms of the stakes involved and the fact that medical students have to deal with death and dying, Hafferty 1991 looks at how medical students are exposed to death during their first few months of training. In addition to considering medical students, sociologists have addressed the socialization of nursing (Davis 1975, Psathas 1968).

                                                                                                                                                                                                                        • Becker, Howard S., and Blance Geer. 1958. The fate of idealism in medical school. American Sociological Review 23.1: 50–56.

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                                                                                                                                                                                                                          Findings from a classical study of a participant observation of medical students showing that while medical students develop more cynical feelings during their medical training, they do not lose the idealism associated with the practice of medicine. The article focuses on the freshman year and the later years of medical school.

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                                                                                                                                                                                                                          • Bosk, Charles. 1979. Forgive and remember: Managing medical failure. Chicago: Univ. of Chicago Press.

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                                                                                                                                                                                                                            Bosk was a participant observer for eighteen months at a surgical training program focusing on how surgeons receive training within the American context and the relationships between surgeons in training and their mentors. He focuses on issues of social control and how medical failures are managed.

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                                                                                                                                                                                                                            • Davis, F. 1975. Professional socialization as subjective experience: The process of doctrinal conversion among student nurses. In A sociology of medical practice. Edited by Caroline Cox and Adrianne Mead, 116–131. London: Collier-Macmillan.

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                                                                                                                                                                                                                              Davis conducts a study of nursing students and identifies six stages of socialization they go through, starting with their original ideas about what it means to be a nurse as they enter nursing school to the formation of a stable, professional identity as they graduate.

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                                                                                                                                                                                                                              • Fox, Renee. 1957. Training for uncertainty. In The student-physician: Introduction studies in the sociology of medical education. Edited by Robert King Merton, George G. Reader, and Patricia L. Kendall, 207–241. Cambridge, MA: Harvard Univ. Press.

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                                                                                                                                                                                                                                A classical study on medical school socialization. Fox conducted participant observation for five years and reports on how medical students train for the uncertainty associated with medical practice. She identifies three types of uncertainty: not being able to master the available knowledge, the limits of medical knowledge, and not being able to distinguish between the two.

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                                                                                                                                                                                                                                • Hafferty, Frederic W. 1991. Into the valley: Death and the socialization of medical students. New Haven, CT: Yale Univ. Press.

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                                                                                                                                                                                                                                  In this book, Hafferty examines students’ encounters with death in the first few months of medical school, with a major focus on what some have identified as a central rite of passage into medicine when they are expected to dissect a human cadaver.

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                                                                                                                                                                                                                                  • Psathas, George. 1968. The fate of idealism in nursing school. Journal of Health and Social Behavior 9.1: 52–64.

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                                                                                                                                                                                                                                    A study of nurse socialization focusing on nurses’ idealism that becomes more realistic as they become more experienced in the nursing role.

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                                                                                                                                                                                                                                    The Medical Profession

                                                                                                                                                                                                                                    The medical profession has long been of interest to sociologists, and much of the attention has been given to the rise and fall of the American medical profession. As illustrated by Brown 1979 and Starr 1982, the American medical profession was able to obtain much greater power over its jurisdiction than the medical profession in any other country, and the profession strategically worked toward obtaining exclusive rights over issues of health, illness, and healing. An important part of obtaining that power was the alignment of the ideas of the medical profession with ideas of wealthier Americans, and Pescosolido and Martin 2004 shows how the cultural authority was first granted to the medical profession through middle-class social networks and then was translated into a broader cultural authority in American society. While sociological writings in the 1960s and 1970s used terms such as “professional dominance” and “the golden era of doctoring,” sociologists in the 1980s focused on the declining power of the American medical profession (Ritzer and Walczak 1988), partly illustrated by the declining trust the American public showed in the medical profession. Taking on the debate of declining trust, Pescosolido, et al. 2000 demonstrates that while the medical profession may have lost some trust, American society still has a relatively high level of trust in the profession, and people continue to trust their individual doctors. Reflecting the changing landscape the American medical profession operates within, Light 1995 uses the concept of countervailing powers to indicate that the medical profession does not hold the greatest power in the health field anymore but rather negotiates issues of health, illness, and healing with other stakeholders. To further illustrate the changes within the health care field, McKinlay and Marceau 2008 argues that the primary care doctor may disappear from American society within the next twenty-five years. Hafferty and McKinlay 1993 provides an international perspective on the American medical profession, providing case studies of medical professions in fourteen countries.

                                                                                                                                                                                                                                    • Brown, E. Richard. 1979. Rockefeller medicine men: Medicine and capitalism in America. Berkeley: Univ. of California Press.

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                                                                                                                                                                                                                                      In this book, Brown focuses on how American medicine came to be organized in the way it is, with a focus on how corporations were actively involved in the rise of scientific medicine, including medical education, which created a strong bond between capitalists and medical doctors in the United States.

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                                                                                                                                                                                                                                      • Hafferty, Frederic W., and John B. McKinlay, eds. 1993. The changing medical profession: An international perspective. New York: Oxford Univ. Press.

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                                                                                                                                                                                                                                        The American medical profession was able to obtain more power over its jurisdiction than the medical profession in any other country. In this edited volume, Hafferty and McKinlay offer a comparative look at the medical profession, with twenty-one prominent medical sociologists writing chapters and case studies of fourteen countries.

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                                                                                                                                                                                                                                        • Light, Donald W. 1995. Countervailing powers: A framework for professions in transition. In Health professions and the state in Europe. Edited by Terry Johnson, Gerald Larkin, and Mike Saks, 25–41. New York: Routledge.

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                                                                                                                                                                                                                                          Light introduced the concept of countervailing powers to describe the changing landscape of the power structure of American medicine, arguing that the medical profession has gone from having nearly exclusive power in the medical domain to sharing it with multiple other stakeholders, including the state and insurance companies.

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                                                                                                                                                                                                                                          • McKinlay, John, and Lisa Marceau. 2008. When there is no doctor: Reasons for the disappearance of primary care physicians in the US during the early 21st century. Social Science & Medicine 67.10: 1481–1491.

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                                                                                                                                                                                                                                            McKinlay and Marceau argue that the primary care doctor will be rare in the United States in twenty-five years—even nonexistent—and list seven reasons for why this will be the case. The same issue contains an article by Timmermans arguing the opposite view (pp. 1492–1496). Available online for purchase.

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                                                                                                                                                                                                                                            • Pescosolido, Bernice A., and Jack K. Martin. 2004. Cultural authority and the sovereignty of American medicine: The role of networks, class and community. The Journal of Health Politics, Policy, and Law 29.4–5: 735–756.

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                                                                                                                                                                                                                                              An article in a special Issue on Starr’s important work on the rise of the American medical profession. Pescosolido and Martin argue that the scientific approach to medicine was first embraced by individuals in specific social positions (e.g. philanthropy, academia) and then spread to the general public, granting the medical profession cultural authority over issues of health, illness, and healing. Available online by subscription.

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                                                                                                                                                                                                                                              • Pescosolido, Bernice A., Steven A. Tuch, and Jack K. Martin. 2001. The profession of medicine and the public: Examining Americans’ changing confidence in physicians from the beginning of the “health care crisis” to the era of health care reform. Journal of Health and Social Behavior 42.2: 1–16.

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                                                                                                                                                                                                                                                In this article, the authors compare public attitudes toward the medical profession using GSS data from 1976 and 1998 and conclude that while the medical profession may have lost some trust, it still maintained relatively high levels of public trust.

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                                                                                                                                                                                                                                                • Ritzer, George, and David Walczak. 1988. Rationalization and the deprofessionalization of physicians. Social Forces 67.1: 1–22.

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                                                                                                                                                                                                                                                  Consistent with sociological writings on the medical profession in the 1980s, Ritzer and Walczak apply a Weberian framework to understand the position of American medical doctors, arguing that their work is increasingly controlled by external forces, resulting in some degree of deprofessionalization of physicians.

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                                                                                                                                                                                                                                                  • Starr, Paul. 1982. The social transformation of American medicine. New York: Basic Books.

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                                                                                                                                                                                                                                                    A key book on the rise of the medical profession showing how the American medical profession became trusted as the legitimate source of help when individuals encountered illness.

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                                                                                                                                                                                                                                                    Social Organization of Health Care

                                                                                                                                                                                                                                                    Work on the social organization of health care has looked at the United States both as a unique case given its lack of universal health care and in a comparative framework illustrating different forms of social organization across countries. Quadagno 2006 provides one of the most important accounts of why the United States lacks universal health care, demonstrating the complex configuration of stakeholders that determines whether a health reform is successful. Mechanic 2004 focuses on managed care and shows how its opponents were successful in turning the American public against the plan, and Mechanic 2006 gives his opinion (based on years of researching the health care field) on why health reform is not working in America. Waitzkin 2000 provides an even more critical account of the faults of capitalist health care systems that ignore the real social causes of illness. On the comparative side, Mechanic and Rochefort 1996 provides a review piece on how health care systems are converging yet maintaining their uniqueness due to history and culture. Lee 1982 suggests that health care systems should be studied using the concepts of structural superiority and functional strength, which encompass the extent to which a medical profession has official legitimacy within a society and the capabilities of treating those who are ill. Ruggie 1996 applies a welfare-state framework to understand health care reform in the United States, Canada, and Britain. Finally, rather than focusing on the systems themselves, Kikuzawa, et al. 2008 evaluates public attitudes toward government responsibility in twenty-one countries.

                                                                                                                                                                                                                                                    • Lee, Rance P. L. 1982. Comparative studies of health care systems. Social Science & Medicine 16.6: 629–642.

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                                                                                                                                                                                                                                                      In this article, Lee provides a comparative analysis of health care systems in three Chinese societies. He introduces the concepts of functional strength and structural superiority as the way to study relationships between different medical traditions within a country. Available online for purchase.

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                                                                                                                                                                                                                                                      • Kikuzawa, Saeko, Sigrun Olafsdottir, and Bernice A. Pescosolido. 2008. Similar pressures, different contexts: Public attitudes toward government intervention for health care in 21 nations. Journal of Health and Social Behavior 69:385–399.

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                                                                                                                                                                                                                                                        An empirical tests of what impacts public attitudes toward government responsibility in health care and spending for health care in 21 nations, evaluating both how individual characteristics impact public attitudes as well as how these attitudes may be embedded in larger national context.

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                                                                                                                                                                                                                                                        • Mechanic, David. 2004. The rise and fall of managed care. Journal of Health and Social Behavior 45(suppl.): 76–86.

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                                                                                                                                                                                                                                                          One of the United States’ most prominent medical sociologists analyzes the backlash against managed care in this article, arguing that opponents of managed care were able to successfully convince the public that this was a bad system, despite empirical evidence showing otherwise.

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                                                                                                                                                                                                                                                          • Mechanic, David. 2006. The truth about health care: Why reform is not working in America. New Brunswick, NJ: Rutgers Univ. Press.

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                                                                                                                                                                                                                                                            In a more opinionated book than is often seen in academia, Mechanic discusses the main problems with the U.S. health care system, arguing that interests of those gaining economically from the system override the interests of those using the system.

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                                                                                                                                                                                                                                                            • Mechanic, David, and David A. Rochefort. 1996. Comparative medical systems. Annual Review of Sociology 22:239–270.

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                                                                                                                                                                                                                                                              A review article where Mechanic and Rochefort argue that health care systems around the world are converging due to similar pressures. However, despite these similar pressures, health care systems continue to be unique, as the responses are embedded within cultural and political traditions. Available online for purchase.

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                                                                                                                                                                                                                                                              • Quadagno, Jill. 2006. One nation, uninsured: Why the U.S. has no national health insurance. New York: Oxford Univ. Press.

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                                                                                                                                                                                                                                                                Quadagno uses comparative-historical analysis to argue that the success of health care reform in the United States depends on how the interests of multiple stakeholders in the country align and that the power of the stakeholders opposing universal health care have consistently been greater than the power of the stakeholders trying to implement such a system.

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                                                                                                                                                                                                                                                                • Ruggie, Mary. 1996. Realignments in the welfare state: Health policy in the United States, Britain, and Canada. New York: Columbia Univ. Press.

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                                                                                                                                                                                                                                                                  Ruggie focuses on health policy in Canada, Britain, and the United States and argues that while the three countries have different approaches in terms of providing health care, they have attempted similar strategies and share many of the same underlying principles and norms for how to provide health care.

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                                                                                                                                                                                                                                                                  • Waitzkin, Howard. 2000. The second sickness: Contradictions of capitalist health care. Lanham, MD: Rowman & Littlefield.

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                                                                                                                                                                                                                                                                    As a critical medical sociologist, Waitzkin uses a Marxist approach to understand the health care system, arguing that medicine is too narrowly focused on the physical aspect of illness, ignoring the larger social contribution that makes individuals sick.

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                                                                                                                                                                                                                                                                    Medical Ethics

                                                                                                                                                                                                                                                                    Sociologists have made important contributions to the study of ethical issues within the medical field. Most of these are ethnographical studies in various settings in which ethical dilemmas are likely to arise, such as in the neonatal intensive care unit (Anspach 1993), genetic counseling (Bosk 1992), and the intensive care unit (Zussman 1992). The studies have also focused more generally on how decisions are made (Chambliss 1996, Childress 1982) and on how various professions other than medical doctors became involved in the decision making (Rothman 1991).

                                                                                                                                                                                                                                                                    • Anspach, Renée R. 1993. Deciding who lives: Fateful choices in the intensive-care nursery. Berkeley: Univ. of California Press.

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                                                                                                                                                                                                                                                                      In this book, Anspach presents her findings from a sixteen-month ethnography in a neonatal intensive care unit. She observes how the parents, doctors, nurses, and bioethicists discuss and decide on treatment of children who are born prematurely.

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                                                                                                                                                                                                                                                                      • Bosk, Charles L. 1992. All God’s mistakes: Genetic counseling in a pediatric hospital. Chicago: Univ. of Chicago Press.

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                                                                                                                                                                                                                                                                        Using a field study in an elite medical center, Bosk presents multiple cases on how genetic counselors interact with families who are at risk for genetic diseases and parents who receive a diagnosis of disease before the child is born. This book illustrates the new ethical dilemmas associated with more advanced technology.

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                                                                                                                                                                                                                                                                        • Chambliss, Daniel F. 1996. Beyond caring: Hospitals, nurses, and the social organization of ethics. Chicago: Univ. of Chicago Press.

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                                                                                                                                                                                                                                                                          Chambliss conducted field research for more than ten years to observe how moral decisions are made within hospitals with a focus on the decisions made by nurses and how these decisions are impacted by larger organizational structures and occupational struggles.

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                                                                                                                                                                                                                                                                          • Childress, James Franklin. 1982. Who should decide? Paternalism in health care. New York: Oxford Univ. Press.

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                                                                                                                                                                                                                                                                            In this book, Childress addresses the increased demand of full disclosure in medicine and how there may be patients that would prefer reassurance from medical doctors. The book focuses on the ethical dilemmas faced by doctors in terms of what to tell patients about their medical condition.

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                                                                                                                                                                                                                                                                            • Rothman, David J. 1991. Strangers at the bedside: A history of how law and bioethics transformed medical decision making. New York: Basic Books.

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                                                                                                                                                                                                                                                                              A study of how medical decisions are made in the current health care landscape. Rothman focuses on how decisions once made exclusively by individual doctors are now potentially influenced by multiple actors who may never have met the patient, including lawyers and judges.

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                                                                                                                                                                                                                                                                              • Zussman, Robert. 1992. Intensive care: Medical ethics and the medical profession. Chicago: Univ. of Chicago Press.

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                                                                                                                                                                                                                                                                                Zussman presents case studies of how ethical decisions are made within the intensive care unit and how definitions of what is right and wrong are impacted by the actors involved.

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                                                                                                                                                                                                                                                                                Contemporary Controversies and New Directions

                                                                                                                                                                                                                                                                                Medical sociology represents one of the largest subfields of American sociology and continues to expand as health care realities change and expand. Some of the latest directions and recent work represent new ways to look at the social construction of illness, an integration of sociological perspectives with other disciplines or across sociological subfields, an increased attention to theorizing about cross-national differences in health outcomes with particular attention to how larger societal institutions contribute to health, and the expanding role of complementary and alternative medicine within advanced industrialized nations. Almeling 2007 combines economic and medical sociology to show how the value of bodily goods is socially constructed based on the gender of the donor. Epstein 2007 provides an important book on the politics of inclusion in medical research, how that has changed over time, and with what implications, while Timmermans 2006 looks at the role of medical examiners in constructing causes of deaths. Beckfield and Olafsdottir 2010 combine political and medical sociology, arguing for the importance of understanding how politics impact health outcomes across nations. Pescosolido, et al. 2008 provide an important empirical test of biological and sociological explanations for alcoholism. Perhaps most importantly they are able to demonstrate that while some may be more biologically vulnerable to alcoholism than others, the likelihood of developing alcoholism is embedded within social circumstances. Finally, while earlier medical sociologists would have predicted the end of alternative medicine as societies advance and medical knowledge becomes more sophisticated, current realities do not reflect this pattern, and we have witnessed the reemergence of complementary and alternative medicine, which individuals use instead and perhaps more commonly in combination with Western medicine (Freidin and Timmermans 2008; Kelner, et al. 2000).

                                                                                                                                                                                                                                                                                • Almeling, Rene. 2007. Selling genes, selling gender: Egg agencies, sperm banks, and the medical market in genetic material. American Sociological Review 72.3: 319–340.

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                                                                                                                                                                                                                                                                                  Almeling shows how the donation of eggs and sperm are constructed differently within the medical marketplace and how the men and women who are donating their bodily goods are treated differently in a manner consistent with how the two genders are viewed in society.

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                                                                                                                                                                                                                                                                                  • Beckfield, Jason, and Sigrun Olafsdottir. 2010. Empowering health: A comparative political sociology of health disparities. Perspectives on Europe 39.2: 9–12.

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                                                                                                                                                                                                                                                                                    In this article, Beckfield and Olafsdottir argue for the importance of integrating political and medical sociology to understand how larger societal processes impact health outcomes and present cross-national variation in the relationship between stratification and health.

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                                                                                                                                                                                                                                                                                    • Epstein, Steven. 2007. Inclusion: The politics of difference in medical research. Chicago: Univ. of Chicago Press.

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                                                                                                                                                                                                                                                                                      In this book, Epstein focuses on inclusion in medical research, specifically from research mostly including white males to an emphasis on inclusion of women and racial/ethnic minorities. He points out that these changes largely ignore the complex social identities and inequalities that are involved and may divert our attention away from how health disparities are a result of social inequalities.

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                                                                                                                                                                                                                                                                                      • Freidin, Betina, and Stefan Timmermans. 2008. Complementary and alternative medicine for children’s asthma: Satisfaction, care provider responsiveness, and networks of care. Qualitative Health Research 18.1: 43–55.

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                                                                                                                                                                                                                                                                                        In this article, Freidin and Timmermans present findings from qualitative interviews with fifty mothers, focusing on why some rely exclusively on biomedical treatment whereas others seek alternative options.

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                                                                                                                                                                                                                                                                                        • Kelner, Merrijoy, Beverly Sheila Wellman, Bernice A. Pescosolido, and Mike Saks, eds. 2000. Complementary medicine and alternative medicine: Challenge and change. Amsterdam: Harwood.

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                                                                                                                                                                                                                                                                                          An edited volume on complementary and alternative medicine (CAM). The book focuses on the rise of CAM in American society, the use and availability of such treatment, research on CAM, and the role that CAM will play in the future.

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                                                                                                                                                                                                                                                                                          • Pescosolido, Bernice A., Brea L. Perry, J. Scott Long, Jack K. Martin, John I. Nurnberger, and Victor Hesselbrock. 2008. Under the influence of genetics: How transdisciplinarity leads us to rethink social pathways to illness. American Journal of Sociology 114:S171–S201.

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                                                                                                                                                                                                                                                                                            The authors use alcoholism to evaluate the role of biology and society in individual likelihood of developing alcoholism and find evidence for their playing a role as well as the interaction between biological vulnerability and social circumstances. Available online for purchase.

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                                                                                                                                                                                                                                                                                            • Timmermans, Stefan. 2006. Postmortem: How medical examiners explain suspicious deaths. Univ. of Chicago Press: Chicago.

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                                                                                                                                                                                                                                                                                              In an ethnography extending over several years, Timmermans looks at the world of the medical examiner and explores how they were able to obtain cultural authority over decisions about the causes of death as well as the potential consequences of these decisions.

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