Health, Illness, and Society An Introduction to Medical
Sociology, 2nd Edition
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BRIEF CONTENTS
CHAPTER 1 Sociology and the Study of Health and Illness 1
CHAPTER 2 A Social History of Health and Illness 16
CHAPTER 3 Health Behavior 37
CHAPTER 4 Illness Behavior and the Illness Experience 60
CHAPTER 5 Social Causes of Health and Health Problems 85
CHAPTER 6 Global Disparities in Health and Disease 112
CHAPTER 7 Medical School and the Training of Physicians 132
CHAPTER 8 Physicians and Their Interaction with Patients 153
CHAPTER 9 Other Health Care Providers: Conventional
and Alternative 174
CHAPTER 10 Hospitals and Other Health Care Settings 196
CHAPTER 11 Health and Health Care in the World’s Wealthy
Democracies 219
CHAPTER 12 The U.S. Health Care System 243
CHAPTER 13 Health Care Reform: Obamacare and Beyond 270
CHAPTER 14 The COVID-19 Pandemic 298
CONTENTS
Preface to the Updated Second Edition xi
Preface xii
Acknowledgments xv
About the Author xvi
1 SOCIOLOGY AND THE STUDY OF HEALTH AND ILLNESS 1
LEARNING QUESTIONS 1
SOCIOLOGY AND MEDICAL SOCIOLOGY 3
Sociology’s Major Themes 3
The Sociological Imagination 5
Sociology’s Theoretical Traditions 5
THE SCOPE OF MEDICAL SOCIOLOGY 6
The Influence of the Social Environment 6
The Practice of Health Care 8
The Social Construction of Illness 8
RESEARCH METHODS IN MEDICAL SOCIOLOGY 10
Surveys 10
Qualitative Research 11
Experiments 12
Criteria of Causality 12
CONCLUSION 14
Summary | Giving It Some Thought | Key Terms 14
2 A SOCIAL HISTORY OF HEALTH AND ILLNESS 16
LEARNING QUESTIONS 16
HEALTH AND ILLNESS IN THE PREINDUSTRIAL WORLD 18
The Ancient Civilizations 18
The Middle Ages 20
THE RISE OF SCIENTIFIC MEDICINE 21
The Renaissance 21
The Eighteenth Century 23
The Nineteenth Century 23
Ethical Issues in Scientific Medicine 25
Contents v
SOCIAL EPIDEMIOLOGY YESTERDAY AND TODAY 28
The Industrial Revolution 28
The Beginning of Epidemiology: John Snow and Cholera 29
The Epidemiological Transition 30
Public Health 32
A Word about Rates 33
CONCLUSION 35
Summary | Giving It Some Thought | Key Terms 35
3 HEALTH BEHAVIOR 37
LEARNING QUESTIONS 37
WHAT IS HEALTH BEHAVIOR? 38
UNDERSTANDING HEALTH BEHAVIOR 39
Macro Factors 40
Micro Factors 40
THE SOCIAL CONTEXT OF HEALTH BEHAVIOR: SOCIAL CLASS,
RACE AND ETHNICITY, AND GENDER 42
Social Class 42
Race and Ethnicity 45
Gender 46
Illustrating the Effects of Social Class, Race and Ethnicity, and Gender 47
THE SOCIAL CONTEXT OF HEALTH BEHAVIOR: OTHER FACTORS 54
Social Relationships 54
Neighborhood Living Conditions 55
Sexual Orientation and Gender Identity 56
Religious Involvement 56
Corporate Practices 57
Public Policy 57
CONCLUSION 58
Summary | Giving It Some Thought | Key Terms 58
4 ILLNESS BEHAVIOR AND THE ILLNESS EXPERIENCE 60
LEARNING QUESTIONS 60
UNDERSTANDING ILLNESS 61
Illness as a Social Construction 62
Medicalization 63
ILLNESS BEHAVIOR 67
Stages of the Illness Experience 68
Self-Care 68
vi Contents
Help-Seeking Behavior 69
The Social Context of Help-Seeking Behavior 71
THE EXPERIENCE OF ILLNESS 75
The Sick Role 76
Coping with Illness 79
A Representative Study of the Illness Experience: Women with STDs 82
CONCLUSION 83
Summary | Giving It Some Thought | Key Terms 83
5 SOCIAL CAUSES OF HEALTH AND HEALTH PROBLEMS 85
LEARNING QUESTIONS 85
SOCIAL CONDITIONS AS FUNDAMENTAL CAUSES OF DISEASE 86
SOCIAL CONDITIONS AS FUNDAMENTAL CAUSES OF HEALTH
INEQUALITIES 88
Social Class 89
Race and Ethnicity 92
Gender and Sex 97
Age 99
Sexual Orientation and Gender Identity 100
OTHER SOCIAL CAUSES OF HEALTH AND HEALTH PROBLEMS 101
Social Stress 101
Social Relationships and Social Support 103
Religion 106
Neighborhood Living Conditions 106
Environmental Pollution and Hazards 108
Unsafe Products and Workplaces 108
Interpersonal Violence and Handgun Violence 109
CONCLUSION 110
Summary | Giving It Some Thought | Key Terms 110
6 GLOBAL DISPARITIES IN HEALTH AND DISEASE 112
LEARNING QUESTIONS 112
UNDERSTANDING GLOBAL INEQUALITY 113
Categorizing Global Inequality 114
Measuring World Poverty 115
Explaining Global Inequality 116
DIMENSIONS OF GLOBAL HEALTH DISPARITIES 116
Malnutrition and Hunger 117
Children’s Health 118
Contents vii
Women’s Health 118
Environmental Pollution and Hazards 119
Substandard Health Care 122
HIV and AIDS 123
DOCUMENTING GLOBAL HEALTH DISPARITIES 124
Life Expectancy 125
HIV/AIDS 125
Tuberculosis 126
Child Mortality 126
Child Underweight 127
Maternal Mortality 128
Natural Disaster Deaths 128
Births Attended by Skilled Health Personnel 130
CONCLUSION 130
Summary | Giving It Some Thought | Key Terms 130
7 MEDICAL SCHOOL AND THE TRAINING OF PHYSICIANS 132
LEARNING QUESTIONS 132
DEVELOPMENT OF MEDICAL SCHOOLS AND MEDICAL
EDUCATION 133
Medical Education in Early America 134
Nineteenth-Century Developments 134
The Flexner Report 137
MEDICAL SCHOOLS TODAY 138
Sociodemographic Profile of U.S. Medical Students 139
A Brief Look at Medical School Faculty 143
THE LIVES AND EXPERIENCES OF MEDICAL STUDENTS 144
Stress, Fatigue, and Burnout 145
The Socialization of Medical Students 149
CONCLUSION 151
Summary | Giving It Some Thought | Key Terms 152
8 PHYSICIANS AND THEIR INTERACTION WITH PATIENTS 153
LEARNING QUESTIONS 153
THE PROFESSION OF MEDICINE 154
The Practice of Medicine in Early America 155
Impact of the American Medical Association 156
The Downside of Professionalization 157
Decline of the Medical Profession’s Dominance 159
Medical Malpractice 160
viii Contents
A PROFILE OF PHYSICIANS TODAY 162
Types of Physicians 163
The Physician Shortage 163
Women Physicians 165
PHYSICIAN-PATIENT INTERACTION 167
Models of Physician-Patient Interaction 167
Gender, Race and Ethnicity, and Physician-Patient Interaction 168
CONCLUSION 172
Summary | Giving It Some Thought | Key Terms 172
9 OTHER HEALTH CARE PROVIDERS: CONVENTIONAL AND
ALTERNATIVE 174
LEARNING QUESTIONS 174
MAINSTREAM HEALTH CARE 175
Nurses and Nursing 175
Other Mainstream Health Care Providers 184
COMPLEMENTARY AND ALTERNATIVE MEDICINE (CAM) 188
Prevalence of CAM 189
Sociodemographic Characteristics and CAM Use 190
Effectiveness of CAM 190
CONCLUSION 194
Summary | Giving It Some Thought | Key Terms 194
10 HOSPITALS AND OTHER HEALTH CARE SETTINGS 196
LEARNING QUESTIONS 196
HOSPITALS 197
A Brief History of Hospitals 197
Hospitals in the United States Today 202
Problems with U.S. Hospitals 205
OTHER HEALTH CARE SETTINGS 211
Ambulatory Care Facilities 211
Nursing Homes 213
Home Health Care and Hospice Care 215
CONCLUSION 217
Summary | Giving It Some Thought | Key Terms 217
11 HEALTH AND HEALTH CARE IN THE WORLD’S WEALTHY
DEMOCRACIES 219
LEARNING QUESTIONS 219
Contents ix
THE HEALTH CARE SYSTEMS OF WEALTHY DEMOCRACIES 220
Models of Health Care Systems 222
The Health Care Systems of Selected Nations 224
COMPARING THE WEALTHY DEMOCRACIES 232
Comparing Health in Wealthy Democracies 232
Comparing Health Care in Wealthy Democracies 236
Explaining the U.S. Health Disadvantage 238
CONCLUSION 241
Summary | Giving It Some Thought | Key Terms 241
12 THE U.S. HEALTH CARE SYSTEM 243
LEARNING QUESTIONS 243
THE U.S. HEALTH CARE “SYSTEM” 244
U.S. HEALTH CARE BY THE NUMBERS 245
The Cost of Health Care 245
Sources of Health Care Spending 245
Sponsors of Health Care Spending 247
Health Care Employment 248
Health Care Visits 249
Health Insurance 249
PROBLEMS IN U.S. HEALTH CARE DELIVERY 252
Fragmentation and Lack of Coordination 252
Health Insurance Coverage: Uninsurance and Underinsurance 254
Social Inequalities in Health Care Delivery 255
The High Cost of Health Care 261
Waste in Health Care Spending 266
CONCLUSION 268
Summary | Giving It Some Thought | Key Terms 268
13 HEALTH CARE REFORM: OBAMACARE AND BEYOND 270
LEARNING QUESTIONS 270
ORIGINS OF U.S. HEALTH INSURANCE 271
The Progressive Era 272
The Great Depression and the New Deal 273
The 1940s and 1950s 274
The 1960s: Medicare and Medicaid 275
The 1970s and 1980s 275
1990s–2008 276
x Contents
THE PATIENT PROTECTION AND AFFORDABLE
CARE ACT (OBAMACARE) 276
Major Health Benefit Provisions of Obamacare 277
The Individual Mandate 277
ACHIEVEMENTS AND LIMITATIONS OF OBAMACARE 280
Achievements of Obamacare 280
Limitations of Obamacare 286
Reforms within Obamacare 288
BEYOND OBAMACARE 289
Medicare for All 290
The Bismarck Model 293
A Nonprofit Insurance Alternative 294
A Final Word 294
POSTSCRIPT: A SOCIOLOGICAL PRESCRIPTION FOR
REDUCING THE U.S. HEALTH DISADVANTAGE 294
CONCLUSION 296
Summary | Giving It Some Thought | Key Terms 296
14 THE COVID-19 PANDEMIC 298
LEARNING QUESTIONS 298
SOCIOLOGY AND THE STUDY OF HEALTH AND ILLNESS 300
A SOCIAL HISTORY OF HEALTH AND ILLNESS 300
HEALTH BEHAVIOR 303
ILLNESS BEHAVIOR AND THE EXPERIENCES OF ILLNESS 306
SOCIAL CAUSES OF HEALTH AND HEALTH PROBLEMS 307
Race and Ethnicity 308
Social Class 309
Political Party Affiliation 309
Sexual Orientation and Gender Identity 310
GLOBAL DISPARITIES IN HEALTH AND DISEASE 310
PHYSICIANS AND OTHER HEALTH CARE PROVIDERS 311
HOSPITALS AND OTHER HEALTH CARE SETTINGS 312
HEALTH AND HEALTH CARE IN THE WORLD’S WEALTHY
DEMOCRACIES VERSUS THE UNITED STATES 313
CONCLUSION315
Summary | Giving It Some Thought | Key Terms 315
Glossary 317
References 324
Index 356
PREFACE TO THE UPDATED SECOND EDITION
Welcome to the updated second edition of Health, Illness, and Society! The original
second edition was published in January 2020, just a few weeks after the world first
heard of a novel coronavirus and two months before COVID-19 shut down normal life
in the United States and many other nations. At the time of this writing thirty months
later, the COVID-19 virus has infected more than 640 million people worldwide and
killed at least 6.5 million and perhaps as many as seventeen million.
The United States was hardly immune from this virulent disease, as more than one
million Americans have died from it as of September 2022. The shutdown of American
society in March 2020 sent millions of children and college students home from school
and closed businesses everywhere. Many people were suddenly jobless, while others had to
juggle childcare and working from home. In these and numerous other ways, COVID-19
has taken a terrible toll not only on Americans’ lives but also on American society.
This book’s original second edition went to press before COVID-19 emerged and
thus did not even mention this new disease. As the pandemic proceeded, this lack of any
COVID-19 material became both ironic and glaring. To bring this important material to
students and instructors much sooner than a full-scale third edition would have taken,
my Rowman & Littlefield editor, Alyssa Palazzo, and I decided to publish this updated
second edition featuring a new concluding chapter about the COVID-19 pandemic.
NEW TO THE UPDATED SECOND EDITION
Chapter 14. The COVID-19 Pandemic. Illustrates the pandemic’s relevance to the
many topics and themes presented earlier in the book. After reading this chapter, stu-
dents will have a fuller understanding of how the pandemic is a social issue and not
just a medical issue. For example, the new chapter highlights several ways in which the
pandemic exhibits health and health behavior disparities resulting from social inequal-
ities, as fundamental cause theory would have predicted. To a large degree, the same
groups of people who were in poorer health pre-pandemic because of their social back-
grounds have also fared worse during the pandemic. In another instructive example,
the new chapter notes that the cumulative COVID-19 death rate in the United States
was 2.7 times higher than Canada’s rate as of September 2022 and that this disparity
partly reflects the deficiencies of the U.S. health system compared to Canada’s as dis-
cussed earlier in the book.
As I wrote the new chapter, I reflected somberly on how many American lives
would have been saved during the pandemic, and hospitalizations and other serious
health problems prevented, if the United States could somehow have been matching
the standards of health and health care of other wealthy democracies. This would
have meant taking the knowledge of medical sociology and public health to heart and
implementing the lessons this knowledge gives us. I thought, too, about the p andemic’s
impact on low- and middle-income nations, whose health and health care systems were
decidedly inferior long before the pandemic began and continue to be so nearly three
years later. But I was also glad for the opportunity to finally discuss the COVID-19
pandemic in this updated edition, because if our society neglects the social reasons for
the terrible toll the pandemic has taken, any future pandemics and other health crises
will harm many more people than otherwise.
PREFACE
Welcome to this introduction to medical sociology! Health problems have biological
causes, but medical sociologists emphasize that these problems also have social causes.
In particular, disease reflects the fault lines of our society. People of lower socio-
economic status tend to be sicker than wealthier people; African Americans, Native
Americans, and Latinos tend to be sicker than non-Latino whites; women tend to be
less healthy than men in several ways even though they outlive men; and LGBTQ peo-
ple tend to be less healthy than cisgender people.
The second edition of this text accordingly stresses the social causes of health and
disease and highlights issues of social class, race and ethnicity, and gender from cover
to cover. It also provides an overview of the exciting and important field of medical
sociology. This overview includes such topics as health behaviors and illness behaviors;
medicalization and the social construction of illness; medical school and the health
professions; health and disease in poor nations; the health care systems of the United
States and other democracies; and Obamacare and health care reform.
A wide range of readers should find this book of interest. Although the text
is intended primarily for undergraduates in sociology of health and illness/medical
sociology classes and public health classes, graduate students and instructors will
also find it a useful reference tool. Premedical students must now answer a series of
sociology and psychology questions on the medical school entrance exam, the Medical
College Admission Test (MCAT), and are advised to take sociology and psychology
classes to prepare for the exam. These students, too, will benefit from this book’s treat-
ment. So will practicing physicians, nurses, and other health care professionals, who
all encounter social aspects of health and disease virtually every day of their careers.
Even the general public might benefit from this book, since it discusses some of the
most important medical issues of the day and will help them understand why they as
individuals are relatively healthy or, instead, relatively unhealthy.
All these parties will benefit from this new text’s pedagogical aids. These include:
(1) Learning Questions that begin each chapter; (2) a Health and Illness in the News
story that also begins every chapter; (3) a Summary that ends each chapter; (4) a Giv-
ing It Some Thought section at the end of each chapter that spells out a hypothetical
situation involving an issue from that chapter; and (5) a list of Key Terms that also
ends each chapter.
NEW TO THE SECOND EDITION
The second edition reflects a thorough revision, with updated data throughout, dis-
cussion of recent real-life developments and events concerning health and health care,
dozens of new references, and new Health and Illness in the News stories that begin
each chapter. Changes to specific chapters follow:
Chapter 1. Sociology and the Study of Health and Illness. New Health and Illness in
the News story
Preface xiii
Chapter 2. A Social History of Health and Illness. New Health and Illness in the
News story; new example of pharmaceutical company marketing an unsafe drug;
new discussion of research linking pharmaceutical payments to opioid prescrib-
ing; new discussion of the 2019 measles outbreak
Chapter 3. Health Behavior. New Health and Illness in the News story; updated data
on sociodemographic predictors of risky health behaviors
Chapter 4. Illness Behavior and the Illness Experience. New Health and Illness in the
News story; new discussion of the medicalization of prediabetes
Chapter 5. Social Causes of Health and Health Problems. New Health and Illness in
the News story; new discussion of recent research on marriage and health; new
discussion of food deserts
Chapter 6. Global Disparities in Health and Disease. New Health and Illness in the
News story; updated international data on income and poverty; updated interna-
tional data on disease and other health problems
Chapter 7. Medical School and the Training of Physicians. New Health and Illness
in the News story; updated data on medical students, on medical faculty, on sexual
harassment in medical school, and on medical school debt
Chapter 8. Physicians and Their Interaction with Patients. New Health and Illness
in the News story; updated physician profile data; new discussion of failure to use
professional titles when women physicians are introduced
Chapter 9. Other Health Care Providers: Conventional and Alternative. New Health
and Illness in the News story; updated nursing profile data; updated data on other
health care providers; new material on dieticians and nutritionists; updated data
on use of complementary and alternative medicine
Chapter 10. Hospitals and Other Health Care Settings. New Health and Illness in
the News story; updated hospital data; new discussion of rural Oklahoma hospital
facing closure
Chapter 11. Health and Health Care in the World’s Wealthy Democracies. New
Health and Illness in the News story; updated international health and health care
data; expanded discussion of Canadian waiting times for nonurgent care; new
discussion of health and health care rankings of U.S. women compared to peer
nations
Chapter 12. The U.S. Health Care System. New Health and Illness in the News story;
updated data on all aspects of the U.S. health care system discussed in the chapter,
including health insurance status; new discussion of price increases in the brain
tumor drug lomustine; new discussion of surprise medical billing; updated survey
data on the burdens to Americans of health care costs; new discussion of high
deductibles
Chapter 13. Health Care Reform: Obamacare and Beyond. New Health and Illness
in the News story; updated data on uninsurance and uninsurance trends; new
discussion of efforts of Trump administration to weaken Obamacare; completely
revised and updated discussion of the achievements and limitations of Obamacare,
including new material on Medicaid expansion under Obamacare; new discussion
of the Bismarck model as an alternative for the United States
xiv Preface
Instructor and Student Resources
Instructor’s Manual and Test Bank. For each chapter in Health, Illness, and Society,
the instructor’s manual provides student learning objectives, key terms with defini-
tions, discussion questions, and web resources. The test bank includes multiple choice,
true/false, and short answer questions. The Instructor’s Manual and Test Bank is
available to adopters for download on the text’s catalog page at https://rowman.com/
ISBN/9781538129920.
Presentation Slides. The presentation slides provide the tables and figures from
the text. The slides are available to adopters for download on the text’s catalog page at
https://rowman.com/ISBN/9781538129920.
Companion Website. Accompanying the text is an open-access Companion
Website designed to reinforce key topics and help students to master key vocabu-
lary and concepts through flashcards and self-graded quizzes. Students can access
the Companion Website from their computers or mobile devices at https://textbooks
.rowman.com/barkan2.
