Читать книгу The Social Causes of Health and Disease - William C. Cockerham - Страница 16

A number of factors, including the pervasiveness of the biomedical model in conceptualizing health problems, a research focus on health from the standpoint of the individual, and the former lack of appropriate statistical techniques, have all combined to relegate social structural factors to the background in the quest to discover the social connections to health. But this situation is changing in the direction of a more realistic approach in which the relevance of structure is not only being recognized but endowed with causal properties with regard to health and disease.

In fact, it can be argued that a major paradigm shift toward a neo-structural perspective is now appearing in twenty-first-century medical sociology. This is seen in the greater emphasis upon structure in both theory and research that is stimulated by the need to acquire a more comprehensive understanding of the social causes of health and illness in contemporary society. Considerable work in medical sociology is evidence of this paradigm shift (see for example, Cockerham 2013a, 2013b; Hargrove 2018; Karlsen and Nazroo 2002; Lippert 2016; Mollborn and Lawrence 2018; Simons et al. 2019; G. Williams 2003). As the old gives way to the new in medical sociology, the field is headed toward a fundamentally different orientation than the one prevailing in the late twentieth century, requiring new theoretical orientations and the adaption of older ones to account for change.

We now know that the biomedical model is limited in its application to problems in living and behavioral models emphasizing the individual’s failure to connect with structural effects on health. However, hierarchical linear modeling can be used to investigate multiple levels of social life simultaneously and so new ways of explaining the causal effects of structure on health are likely to be forthcoming. Society does act back on individuals and, in doing so, affects their health, diseases, and mortality. This outcome needs to be more fully explained by medical sociologists in their future work.

This does not mean that micro-level methods and theories like symbolic interaction are obsolete. Quite the contrary, qualitative research provides some of the most insightful data available on social relationships and situations. It puts a human face on what would otherwise be only a narrative of numbers. However, a neo-structuralist approach, in turn, allows medical sociologists to more accurately measure the effects of structure on individuals and assess structure’s causal qualities. The fact that structure may be able to overwhelm the influence of agency or individual-directed action in some social situations does not negate the need to account for micro-level phenomena. The ultimate goal of medical sociology, and, for that matter, all of sociology, is an accurate assessment of social life at all levels, which is only possible by accounting for the interplay of the individual and society in empirical settings. By incorporating methods which span levels of social reality, the new medical sociology should be able to take the field to an even higher level of development. The next chapter will examine the current state of sociological theory in relation to the social causation thesis and the remainder of this book will explore the coming neo-structural component of the field by further examining the causal qualities of structure in relation to health and disease.