Health is not just biology

• The biomedical model treats health as the absence of disease, the body as a machine, and illness as an objective malfunction to be fixed by trained doctors, usually in hospital, with drugs or surgery. It is the model medicine itself works with.
• The social model treats health and illness as socially constructed: what counts as illness varies by time, place and culture. Homosexuality was once classified as a mental disorder; drapetomania, the alleged 'disease' of enslaved people who ran away, was invented to pathologise resistance. Illness, in short, is not simply given by nature — it is defined, and definitions carry power.
• Being ill is a social role, not just a bodily state. Parsons's famous concept of the sick role spells out the bargain. The sick person is granted two rights — exemption from normal role obligations, and freedom from blame for their condition — in return for two duties: they must want to get well, and must seek and cooperate with competent (medical) help. For Parsons the sick role is a functional mechanism: it controls the disruption illness causes and channels the sick person back to productive society, with the doctor as gatekeeper.
• Criticisms of the sick role: it fits acute, short-term illness far better than chronic conditions or disability, where there is no 'getting well'; it assumes people always consult a doctor; and it ignores the fact that blame is attached to some illnesses — a point about stigma.
• Becoming a patient. Zola showed that most symptoms never reach a doctor at all: the 'symptom iceberg' means the visible tip of consultation rests on a vast submerged mass of untreated illness, and the decision to consult depends on social 'triggers', not just severity.

The sick role

Who gets ill, and who dies early?

Your chances of good health are patterned by class, gender, ethnicity and region. The core of this topic is explaining that pattern.

• The Black Report (1980) set out four explanations of class inequalities in health, and they remain the framework AQA expects:
  1. Artefact — the inequality is an illusion produced by the way the statistics are constructed and classes measured.
  2. Social selection — causation runs backwards: ill health pushes people down the class structure, rather than low class causing ill health.
  3. Cultural or behavioural — the poor make worse choices (smoking, diet, exercise, alcohol). Critics call this victim-blaming: choices are made within constraints.
  4. Material or structural — poverty itself is the cause: cold, damp housing, hazardous work, poor diet because healthy food costs more, stress. The Black Report itself judged this the most important explanation.
• Marmot's Whitehall studies of civil servants found a social gradient in health running right through the ranks — it is not simply that the poorest are sick and everyone else is fine. Marmot links this to control over one's work and life. The Marmot Review (Fair Society, Healthy Lives, 2010) argued health inequality flows from inequality in the social determinants of health — the conditions in which people are born, grow, live, work and age.
• Gender. Women on average live longer but report more illness — the 'women get sick, men die' paradox. Explanations: men's greater exposure to hazardous work and risk-taking, and men's reluctance to consult a doctor; but also women's greater contact with medicine (through reproductive health) and the medicalisation of women's bodies.
• Ethnicity and region. Differences reflect class and material circumstances, migration histories, racism and discrimination within services, and cultural factors — and never map neatly onto one cause.

The Black Report

Unequal provision: the inverse care law

• Tudor Hart (1971) formulated the inverse care law: the availability of good medical care tends to vary inversely with the need of the population served. The areas with the greatest need — poorer, sicker communities — tend to get the least, and worst-resourced, provision. He argued this operates most strongly where care is exposed to market forces.
• Class. Middle-class patients are typically better able to navigate the system, articulate their needs and secure specialist referral — an application of cultural capital to medicine.
• Region. The 'postcode lottery' — differences between areas in waiting times, funding and what treatments are available.
• Ethnicity. Barriers include language, culturally inappropriate services, and discrimination; some services are underused because they are experienced as unwelcoming.
• Gender and age. Feminists argue medicine has treated women's bodies as objects of surveillance; older patients may face ageist assumptions about what is 'worth' treating.
• Marxist critics (Navarro) argue health services under capitalism serve capital: they patch workers up to keep them productive, and the profits of the pharmaceutical industry shape what gets researched and treated. Real health gains, on this view, require redistribution, not more hospitals.

Which explanation of health inequality?

Tap a claim, then tap the explanation it belongs to.

Mental illness: label, institution or disease?

• Szasz made the provocative case that mental illness is a myth — a label attached to behaviour society finds deviant, dressed up in medical language. Critics say this is going much too far and can leave suffering people untreated; but Szasz's core insight, that psychiatric diagnosis carries a moral judgement, has proved durable.
• Rosenhan (On Being Sane in Insane Places, 1973) sent healthy 'pseudopatients' to psychiatric hospitals, where they reported a single hallucinated word and then behaved entirely normally. They were nonetheless admitted, and once admitted, ordinary behaviour (such as taking notes) was interpreted as a symptom. Once the label was applied, everything the person did was read through it — a powerful demonstration of labelling and master status.
• Goffman (Asylums), from participant observation in a psychiatric hospital, described the total institution — a place where all of life is conducted in one setting under a single authority. New inmates undergo a mortification of the self: possessions, clothing and name are stripped away, and the institution rebuilds an 'inmate' identity. Much of what looks like the illness, Goffman argued, is actually the effect of institutionalisation.
• The social patterning of mental illness mirrors the physical: diagnosis rates vary by class, gender and ethnicity. Are those differences real, or artefacts of who does the diagnosing? Feminists point to the medicalisation of women's distress; critical race scholars point to the over-diagnosis of some conditions among Black men. Both raise the labelling question directly.

Total institutions

The medical and social models of disability

• The medical (individual) model locates disability in the impaired body: the disabled person is a problem to be cured, cared for or rehabilitated. Disability, on this view, is a personal tragedy.
• The social model reverses this. Oliver, Barnes and Shakespeare distinguish impairment (a bodily condition) from disability (the disadvantage imposed by a society organised around able bodies). A wheelchair user is not disabled by their legs but by the absence of a ramp. The politics follow directly: remove the barriers, not the person.
• Goffman's stigma applies with full force: disability can become a master status that overrides everything else about a person, so that the disabled person is constantly managing a 'spoiled identity'.
• Media representation matters here — Barnes catalogued recurring stereotypes (the pitiable victim, the sinister villain, the 'supercrip' who inspires) that shape how disabled people are seen and treated.
• Shakespeare, while a founder of the social model, has also criticised its strongest versions for denying that impairment itself can cause pain and limitation. A good answer holds both truths.

The social model of disability

Sociologist to concept

Match each sociologist to their key contribution to the sociology of health.

Who benefits from medicine?

• Functionalism. Parsons sees the medical profession as performing a vital function: doctors are altruistic, expert, affectively neutral and universalistic, and they police the sick role, keeping illness from disrupting society.
• Marxism. Navarro argues medicine serves capitalism: it maintains a healthy workforce, individualises problems that are really social (blaming the smoker rather than the tobacco firm or the stressful job), and generates enormous pharmaceutical profits.
• Weberian. The medical profession is best understood as an occupational monopoly — it has secured legal control over who may practise, thereby protecting its own market position, income and status. Doctors, on this view, are not merely servants of capital; they are a self-interested professional group.
• Feminism. Oakley traces the medicalisation of childbirth: what was once managed by women, at home, with midwives, became a hospital-based, male-doctor-controlled medical event, with women redefined as patients. Feminists extend this to menstruation, menopause and mental distress — normal female experience turned into pathology.
• Illich (Medical Nemesis) coined iatrogenesis — illness caused by medicine itself. Clinical iatrogenesis is direct harm (drug side-effects, hospital infection); social iatrogenesis is the medicalisation of ever more of life; cultural iatrogenesis is the loss of our own capacity to cope with pain, suffering and death. Medicine, Illich argues, has become a threat to health.
• Foucault. The clinical gaze constitutes the patient as an object of knowledge; medicine is a form of disciplinary power and surveillance over bodies and populations.

Iatrogenesis

Researching health — and judging the perspectives

• Official health statistics are large-scale, comparable and cheap, and reveal patterns positivists prize. But they only record illness that reaches a doctor — Zola's symptom iceberg means the true burden of ill health is much larger. They also use official categories, and diagnosis itself is a social act.
• Interpretivist research on illness narratives — how people make sense of, and live with, chronic illness — uses unstructured interviews for validity, at the cost of reliability and representativeness.
• Ethics loom large in health research: vulnerable participants, confidentiality of medical information, and the potential harm of raising distressing experiences. Rosenhan's study, so revealing, deceived staff and hospitals — a permanent illustration of the tension between validity and ethics.
• Judging the perspectives: functionalism illuminates why society needs a sick role but assumes a benign medical profession; Marxism exposes profit and class but is accused of economic determinism; feminism has transformed our understanding of medicalisation but risks treating women as one group; Foucault and Illich reveal medical power but can seem to underplay the enormous real gains in life expectancy that medicine and public health have delivered.

Exam craft: the strongest Health answers keep two questions in view at once — what causes the pattern of ill health? and who has the power to define illness? Structure, then meaning.

The symptom iceberg

The body, risk and how people explain their own health

• The body is social. Shilling argues the body in late modernity has become a project — something we work on, discipline and display through diet, exercise, tattoos and surgery. Health becomes a moral duty, and the fit body a badge of virtue.
• Risk. Beck's risk society thesis applies directly to health: the dangers that most worry us — pollutants, additives, radiation, new pathogens — are manufactured by our own technology, are hard to see, and cross borders. Governments respond with population-level surveillance and lifestyle campaigns, which Foucault would read as disciplinary power operating through 'healthism'.
• Lay beliefs. Sociologists such as Blaxter have shown that ordinary people hold complex, coherent ideas about what causes their own health and illness — luck, stress, heredity, the environment, their own conduct. These lay beliefs, not medical advice alone, shape whether people consult a doctor and whether they comply with treatment.
• Why this matters: health campaigns that assume ignorance ('educate them and they will change') routinely fail, because they mistake constrained circumstances for bad information. That is the sociological objection to the cultural/behavioural explanation restated at the level of policy.

Beck and health risk

The big ideas to know

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