Medical Socialogy Young Talent BSN 1st Professional

MEDICAL SOCIOLOGY
Te most comprehensive major academic textbook available on its topic, this classic
text presents the most important research studies in the feld. Te author integrates
engaging frst-person accounts from patients, physicians, and other health care
providers throughout the text. Since its inception, this book’s principal goal has been
to introduce students to the feld of medical sociology and serve as a reference for
faculty by presenting the most current ideas, issues, concepts, themes, theories, and
research fndings in the feld. Tis new edition is heavily revised with updated data
and important new additions.
New to this edition:
• A contemporary account of medical sociology’s subfelds (Chapter 1)

• New chapter on COVID-19 (Chapter 3)
• Update on the widening gap in life expectancy between the rich and the poor
(Chapter 4)
• New chapter on gender and health, including the convergence of life expectancy
between men and women and its reversal during the COVID-19 pandemic
(Chapter 5)
• Updated chapter on aging and expanded discussion of health and race (Chapter 6)
• New developments in doctor–patient interaction, including telemedicine
(Chapter 10)
• Te survival of the Afordable Care Act (Chapter 16)
William C. Cockerham is Distinguished Professor of Sociology and Chair Emeritus

at the University of Alabama at Birmingham and Research Scholar of Sociology at
the College of William & Mary in Williamsburg, Virginia, USA. He held secondary
appointments in medicine and public health at UAB and is recipient of several awards
for scholarly distinction. He is past President of the Research Committee on Health
Sociology of the International Sociological Association and formerly was on the editorial
boards of several journals, including the American Sociological Review and Society and
Mental Health. Currently, he is deputy editor of the Journal of Health and Social Behavior.
He has published numerous peer-reviewed papers and is author or editor of 20 books.
Recent books are the Wiley Blackwell Companion to Medical Sociology (Wiley Blackwell,
2021) and Social Causes of Health and Disease, 3rd ed. (Polity, 2021). His newest books
with Routledge are Sociological Teories of Health and Illness (2021), Sociology of Mental
Disorder, 11th ed. (2021), and Te COVID-19 Reader: What the Science Says About the
Social (2021).
15th Edition
Medical Sociology
William C. Cockerham
Fifeenth edition published 2022
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to infringe.
First edition published by Prentice Hall 1978

Fourteenth edition published by Routledge 2017
Library of Congress Cataloging-in-Publication Data

Names: Cockerham, William C., author.
Title: Medical sociology / William C. Cockerham.
Description: 15th Edition. | New York : Routledge, 2021. | Revised edition
of the author’s Medical sociology, 2017.
Identifers: LCCN 2021016714 | ISBN 9781032067957 (hardback) |
ISBN 9781032067933 (paperback) | ISBN 9781003203872 (ebook)
Subjects: LCSH: Social medicine.
Classifcation: LCC RA418 .C657 2021 | DDC 362.1—dc23
LC record available at https://lccn.loc.gov/2021016714
ISBN: 978-1-032-06795-7 (hbk)

ISBN: 978-1-032-06793-3 (pbk)
ISBN: 978-1-003-20387-2 (ebk)
DOI: 10.4324/9781003203872
Typeset in Minion
by Apex CoVantage, LLC
To Cynthia, and to Laura, Geoffrey, Sean, and Scott and their
spouses George, Erin, Lilia, and April, and their children Laurinda,
Haley, Mckenzie, Quinn, Anthony, Lia, Leo, Michael, and Max.
v
CONTENTS
PART I INTRODUCTION 1 Infuenza 42
SARS 42
1 Medical Sociology 3 MERS 44
The Social Determinants of Health 4 Ebola 45
The Development of Medical Zika 46

Sociology 5 Summary 48
Parsons 8 Critical Thinking Questions 49
Defning Health 13 Suggested Readings 49
Contrasting Ideas About Health and References 49
Social Behavior 13
Modern Medicine and the Regulation
3 COVID-19 53
of the Body 15
COVID-19: Origin, Transmission,
The Public’s Health 15
and Spread 54
The Germ Theory of Disease and the
Airborne Transmission and
Search for “Magic Bullets” 16
Asymptomatic Individuals 55
Return to the “Whole” Person 17
COVID-19’s Initial Impact on
The Reemergence of Infectious Society 55
Diseases 19
China 55
Summary 20
The Middle East and Europe 59
Critical Thinking Questions 20
India, Africa, and Latin America 63
Suggested Readings 20
The United States 66
References 21
Canada 71
COVID-19: Social Patterns 72
2 Social Epidemiology 23
Comorbid Conditions 72
Epidemiological Measures 24
Age 72
The Development of
Epidemiology 26 Race 73
Disease and Modernization 29 Gender 75
The Complexity of Modern Ills 30 Social Class 75
Heart Disease 31 Resolution 76
Obesity 33 Social Effects 77
Pandemics 36 Summary 78
HIV/AIDS 38 Critical Thinking Questions 78
vii
viii Contents
Suggested Readings 78 Social Trends in Aging and

Health 133
References 79
Life Course Theory 137
4 The Social Demography Race 140

of Health: Social Class 83 Race as a Social Construction 140
The Components of Social Class 85 Racism and Health 141
Social Class and Health Disparities 88 The Current Demographic
Equality of Care and the Social Transition 142
Gradient in Mortality: The British Black Americans 142
Experience 93
Hispanic Americans 149
Neighborhood Disadvantage 96
Native Americans 152
Socioeconomic Status as a
Fundamental Cause of Sickness and Asian Americans 153
Mortality 99 Race and Mental Health 153
Summary 101 Summary 156
Critical Thinking Questions 102 Critical Thinking Questions 156
Suggested Readings 102 Suggested Readings 157
References 102 References 157
5 The Social Demography

of Health: Gender 109 PART II HEALTH AND
Male–Female Life Expectancy 110 ILLNESS 165
Gender Differences in Morbidity 114
The Narrowing Gender Gap in 7 Social Stress and
Longevity 116 Health 167
Rural Residence 119 Cooley, Thomas, and Goffman:
Smoking 121 Symbolic Interaction 168
Gender and Mental Health 124 Durkheim: The Larger Society 171
Gender and LGBTQ Health 126 Stress and the Body 173
Summary 127 Physiological Responses to

Stress 174
Biomarkers 175
Social Factors and Stress 176
References 128
The Stress Process 176
Stress Adaptation 177
6 The Social Demography
of Health: Age and Race 132 Stress and the Social Group 178
Age 133 Social Capital 179

Contents ix
Stress and Socioeconomic The Physician–Patient Role

Status 181 Relationship 232
Life Changes 181 Criticisms of the Sick Role 234
Extreme Situations 181 Medicalization/Biomedicalization 235
Life Events 184 Summary 237
Gene–Environment Interaction 186 Critical Thinking Questions 238
Summary 187 Suggested Readings 239
Critical Thinking Questions 188 References 239
References 188
PART III PROVIDING HEALTH
8 Health Behavior and CARE 243
Lifestyles 193
Health Lifestyles: Background 195 10 Doctor–Patient
Interaction 245
Weber: Lifestyles 195
Models of Interaction 247
Bourdieu: Lifestyles 198
Misunderstandings in
A Theory of Health Lifestyles 199 Communication 250
Health Lifestyles: A Final Note on the Communication and Class
Infuence of Social Class 204 Background 250
Preventive Care 206 Male Physicians and Female
Summary 208 Patients 252
Critical Thinking Questions 209 Women Physicians 253
Suggested Readings 209 Cultural Differences in

Communication 255
References 209
Patient Compliance/Adherence 256
9 Illness Behavior and the The Future of Doctor–Patient

Relations 256
Sick Role 212
Doctor–Patient Relations and
Illness as Deviance 213
New Technology 258
Self-Care 217
Internet Medicine 259
Social Networks 218
Telemedicine 260
Sociodemographic Variables 221
Other Developments 261
Age and Gender 221
The New Genetics 262
Race 222
Privacy and Gene Ownership 263
Socioeconomic Status 225
Human Cloning 265
The Sick Role 229
x Contents
Summary 265 Summary 306

Critical Thinking Questions 266 Critical Thinking Questions 307
Suggested Readings 266 Suggested Readings 307
References 266 References 307
11 Physicians 270 13 Nurses, Physician

The Professionalization of the Assistants, Pharmacists,
Physician 271 and Midwives 310
The American Medical Nursing Past and Present 311
Association 273 The Early Development of Nursing as
The Control of Medical an Occupation 312
Education 276 Florence Nightingale 313
The Socialization of the Physician 278 Nursing Education 314
Osteopaths 284 Nursing Students 316
The Social Hierarchy of American Gender and “the Doctor–Nurse
Medicine 284 Game” 318
The Hospital 285 Nursing: Future Trends 321
The Clientele 285 Hospital Administration 321
The Inner Fraternity–Sorority 286 The Nurse Practitioner/Clinician 322
Summary 287 Physician Assistants 323
Critical Thinking Questions 288 Pharmacists 325
Suggested Readings 288 Midwives 327
References 288 Summary 328
12 The Physician in a Changing
Society 290
References 329
Social Control of Medical Practice 293
Countervailing Power 297
14 Complementary and
Government Regulation 298 Alternative Medicine
Managed Care 299 (CAM) 331
The Coming of the Corporation 300 Overview 332
The Changing Doctor–Patient Chiropractors 334
Relationship 303
Religion and Faith Healing 335
The Deprofessionalization of
Folk Healing 341
Physicians 304
Black Folk Healers 341
The Organization of Medical
Practice 306 Curanderismo Healing 344
Contents xi
The Road to Health Care Reform 379

Native American Healing: The Navajo
and the Cree 345 The Emergence of Managed
Care 382
Summary 347
State Efforts at Health Care
Reform 385
Enactment of the Affordable Care
References 348 Act 386
Legal Challenges to the Affordable
Care Act 389
PART IV HEALTH CARE DELIVERY Trump’s Health Care Reforms and the
SYSTEMS 351 Failed Repeal of the Affordable Care
Act 390
Biden and the Future of Health Care
15 Hospitals 353 Reform 392
The Development of the Hospital as a Equity in Health Services 392
Social Institution 354
Geographic Distribution of
Hospitals as Centers of Religious Services 393
Practice 354
Overview of Health Care Delivery 395
Hospitals as Poorhouses 355
Fee-for-Service Health Care 397
Hospitals as Deathhouses 357
Health Care: A Right or a
Hospitals as Centers of Medical Privilege? 399
Technology 358
Summary 402
Hospitals in the United States 358
Hospital Ownership 359
The Organization of the Non-proft
Community Hospital 361 References 403
The Hospital: Dual Authority 363

The Hospital Patient Role 368
17 Global Health Care 405
Socialized Medicine: Canada, Britain,
The Rising Cost of Hospitalization 370
and Sweden 410
Summary 373
Canada 411
Britain 413
Sweden 417
References 374
Decentralized National Health
Programs: Japan, Germany, and
16 Health Care Reform Mexico 419
and Health Policy in Japan 420
the United States 375 Germany 423
Rising Costs 377
Mexico 426
xii Contents
Socialist Medicine: Alterations in Critical Thinking Questions 439

Russia and China 428
Russia 429
References 440
China 433
Conclusion 438 Name Index 445
Subject Index 451
PART I
Introduction
1
CHAPTER 1
Medical Sociology
PHOTO 1.1 People lined up to receive COVID-19 vaccination at a county site. Medical
sociologists study the social causes and consequences of health, illness, and disease.
Source: © Alan Budman/Shutterstock.
DOI: 10.4324/9781003203872-2 3
4 PART I  Introduction
L E A R N ING O B JEC TIV ES

■ Be able to explain how social factors ■ Recognize why disease threats have
are determinants of health and disease. changed over time as society has
modernized.
■ Know why the development of medical
sociology was different from other
sociological specialties.
Te purpose of this book is to introduce readers to the feld of medical sociology. Rec-
ognition of the signifcance of the complex relationship between social factors and the
level of health characteristic of various groups and societies has led to the development
of medical sociology as a major substantive area within the general feld of sociology. As
an academic discipline, sociology is concerned with the social causes and consequences
of human behavior. Tus, it follows that medical sociology focuses on the social causes
and consequences of health, illness, and disease. Medical sociology brings sociological
perspectives, theories, and methods to the study of health-related situations. Areas of
investigation include the social causes of health and disease, health disparities, the
social behavior of health care personnel and their patients, the social functions of
health organizations and institutions, the social patterns of the utilization of health
services, social policies toward health, and similar topics. What makes medical sociol-
ogy important is the critical role social factors play in determining or infuencing health
outcomes.
The Social Determinants of Health

A signifcant development in the study of health and disease is the growing recognition
of the relevance of social determinants. Te term social determinants of health refers
to social practices and conditions (such as lifestyles, living and work situations), social
class position or socioeconomic status (income, education, and occupation), stressful
circumstances, poverty, and discrimination, along with economic (e.g., unemployment,
business recessions), political (e.g., policies, government benefts), and religious factors
that afect the health of individuals, groups, and communities, either positively or nega-
tively. Where a person is born and the social conditions they experience while growing
up determine their chances of a healthy and long life. To put it simply, the “social deter-
minants of health are nonmedical factors that can afect a person’s overall health and
health outcomes” (Daniel, Bornstein, and Kane 2018:677).
Social determinants not only foster illness and disability, but they also enhance pros-
pects for coping with or preventing disease and maintaining health. Once thought of as
secondary or distant infuences on health and disease, it now appears that social condi-
tions and behaviors are fundamental causes of health (Phelan and Link 2013, 2015).
Te social context of a person’s life determines the risk of exposure, the susceptibility
to a disease, and the course and outcome of the afiction—regardless of whether it is
CHAPTER 1  Medical Sociology 5
infectious, genetic, metabolic, malignant, degenerative (Holtz et al. 2006), or mental

(Cockerham 2021a). Tus it can be claimed that “society may indeed make you sick
or conversely promote your health” (Cockerham 2021b:1).
Social factors are also important in infuencing how societies organize their
resources to cope with health hazards and deliver health care to the population at large.
Individuals, groups, and societies typically respond to health problems in a manner
consistent with their culture, norms, and values. Social and political values infuence
the choices made, institutions formed, and funding levels provided for health. It is
no accident that the United States has its particular form of health care delivery and
other nations have their own approaches. Health is not simply a matter of biology but
involves a number of factors that are cultural, political, economic, and—especially—
social. It is the social aspects of health that are examined in this book.
The Development of Medical Sociology

Te origin of medical sociology is in medicine, not sociology (Cockerham 2021c). Its
beginnings can be traced to the early infuence of three prominent German physicians:
Rudolf Virchow (1821–1902), Salomon Neumann (1819–1908), and Alfred Grotjahn
(1869–1931). All three linked medicine to the need for a socially oriented perspective
in health care. Virchow called attention to a close connection between health problems
and social conditions when investigating a typhus epidemic among a minority Polish
population in Upper Silesia in 1847. Noted for his discoveries in cellular pathology and
experimental physiology, Virchow went so far as to declare in 1848 that “medicine was
a social science” (Porter 1997:643). To improve health conditions over the long term,
Virchow maintained that were times when the physician’s responsibility was to serve
as an “attorney for the poor” (Porter 1997:415). Neumann took up the same theme
when he argued that medicine, at its core, was a social science afer observing a link
between poverty and poor health in Berlin in 1862 (Bloom 2002).
Grotjahn, on his part, studied sociology. He did so while a frst-year medical stu-
dent by taking a course at the University of Kiel with Ferdinand Tönnies (1855–1936),
author of the 1887 sociological classic, Gemeinschaf und Gesellschaf [Community and
Society]. Tönnies apparently was not an outstanding lecturer, so the two of them and
another student roamed the city together, discussing the sociological implications of
what they observed. Grotjahn later became one of the founders of the German Socio-
logical Association, published the book Social Pathology (1912), which linked specifc
diseases with various social conditions, and founded social hygiene as a branch of
medicine.
Tere were other developments in the United States. John Shaw Billings, organizer
of the National Library of Medicine and compiler of the Index Medicus, had written
about hygiene and sociology as early as 1879. Te term medical sociology frst appeared
in 1894, not in a sociology journal but a medical journal (the Bulletin of the American
Academy of Medicine) in an article on “Te Importance of the Study of Medical Sociol-
ogy.” It was written by the physician Charles McIntire, on the relevance of social factors
for health, and given as a keynote address at the American Academy of Medicine meet-
ing in 1893. McIntire was the frst to name this area of study “medical sociology.” Some
credit him as medical sociology’s founder. According to Norman Hawkins (1958:18),

the author of the frst textbook on medical sociology:
A careful and protracted search reveals no pronouncement on the subject prior

to McIntire, and it is very unlikely that the term could have occurred much
earlier. . . . In view of the social and medical climate then existing it is not surpris-
ing that McIntire’s paper should have been written, nor that it should have been
written by a physician.
Te American Academy of Medicine also published the Journal of Sociologic

Medicine from 1895 to 1918, which featured papers on medical education and vari-
ous health-related topics such as diet, sleep, cancer, and news about medical orga-
nizations and societies. Other early work by American physicians included Essays
in Medical Sociology, a Christian-oriented book on sexuality, sexually transmitted
diseases, and overpopulation written in 1902 by Elizabeth Blackwell. Tis was the
frst book to have medical sociology in its title. Blackwell was the frst woman to
graduate from an American medical school (Geneva Medical College in New York).
She was admitted as a practical joke by the all-male student body, who were allowed
to vote on accepting her as a medical student. She fnished at the top of her class
(Porter 1997). Ten there was James Warbasse, another medical doctor, who wrote
a book in 1909 called Medical Sociology: A Series of Observations upon the Sociology
of Health and the Relations of Medicine about physicians as a unique social class.
Warbasse organized a Section on Sociology for the American Public Health Associa-
tion in 1909 that lacked sociologists and was composed almost entirely of physicians
and social workers (Bloom 2002).
Where was sociology at this time? Obviously, its focus was elsewhere. Physicians
had taken the subject matter and applied it to their feld rather than the other way
around. Medical sociology had been both introduced and given a name in medicine.
Interest in the topic, however, fnally began to appear among sociologists in the early
twentieth century. Bernard Stern (1894–1956), a lecturer in sociology at Columbia
University who had attended medical school in his native Austria before dropping
out for health reasons, published Social Factors in Medical Progress in 1927. He used
William Ogburn’s (1922) theory of social change, which featured technological devel-
opment as the cause of change, to explain medicine’s history. Next came Lawrence
Henderson’s 1935 paper on the physician and patient as a social system, which sub-
sequently infuenced Talcott Parsons’s conceptualization of the sick role years later.
Henderson was a physician and biochemist at Harvard who became interested in
sociological theory and changed careers to teach in the new social relations (sociol-
ogy) department when it was formed in the early 1930s (Bloom 2002). Parsons was
one of his students.
Medical sociology did not begin in earnest until afer World War II, in the late
1940s, when signifcant amounts of federal funding for sociomedical research frst
became available. Under the auspices of the National Institute of Mental Health,
medical sociology’s initial alliance with medicine was in psychiatry. A basis for
cooperation between sociologists and psychiatrists existed because of earlier research

in Chicago in 1939 on urban mental health, conducted by Robert Faris (a sociolo-
gist) and H. Warren Dunham (a psychiatrist). A particularly signifcant cooperative
efort that followed was the publication in 1958 of Social Class and Mental Illness:
A Community Study by August Hollingshead (a sociologist) and Frederick Redlich
(a psychiatrist). Tis landmark research, conducted in New Haven, Connecticut,
produced substantial evidence that social factors could be correlated with diferent
types of mental disorders and the manner in which people received psychiatric care.
Persons in the most socially and economically disadvantaged segments of society
were found to have the highest rates of mental disorder in general and excessively
high rates of schizophrenia—the most disabling mental illness—in particular. Tis
study attracted international attention and is one of the most important pioneer-
ing studies on the relationship between mental disorder and social class. Te book
played a key role in the debate during the 1960s that led to the establishment of
community mental health centers in the United States.
Funding from federal and private organizations also helped stimulate cooperation
between sociologists and physicians in researching problems of physical health. In
1949, the Russell Sage Foundation funded a program to improve the utilization of
social science research in medical practice. One result of this efort was the publication
of Social Science in Medicine (Simmons and Wolf 1954). Other work sponsored by the
Russell Sage Foundation came later, including Edward Suchman’s book Sociology and
the Field of Public Health (1963). Tus, when large-scale funding frst became available,
the direction of work in medical sociology in the United States was toward applied or
practical problem-solving rather than the development of a theoretical basis for the
sociological study of health.
Tis situation had important consequences for the development of medical sociol-
ogy. Unlike law, religion, politics, economics, and other social institutions, medicine
was overlooked by sociology’s founders in the late nineteenth century because it did
not shape the structure and nature of society. Emile Durkheim, Karl Marx, Max Weber,
and other major classical social theorists, whose work helped to establish sociology as
an academic feld, did not show much interest in the social function of medicine or in
health and illness. Tis was the case even though Marx’s collaborator, Friedrich Engels
([1845] 1973), linked the poor health of the working class in England to capitalism in
a treatise published in 1845, and Durkheim (1951) analyzed European suicide rates
in 1897, which he blamed on a lack or loss of social solidarity. However, as noted by
Australian medical sociologist Fran Collyer (2012, 2015), the trio of Durkheim, Marx,
and Weber did not completely ignore the subject of health. Tey did, at times, refer to
health, disease, and physicians in their sociological writings. But there is no evidence
that the three leading classical theorists formulated theories of health and medicine,
recognized medical sociology as a potential feld of sociological inquiry, deliber-
ately promoted it, organized it, gave it a name, or were even aware of it (Cockerham
2021c:36–37).
Medical sociology did not emerge as an area of study in sociology until the
late 1940s and did not reach a signifcant level of development until the 1960s.
Te subdiscipline came of age in an intellectual climate far diferent from sociol-

ogy’s more traditional specialties, which had direct links to nineteenth- and early
twentieth-century social thought. As a result, it faced a set of circumstances in its
development diferent from that of other major sociological subdisciplines. It had
come into existence through the convergence of two branches of learning, medicine
and sociology, with very diferent orientations, histories, and goals, with medicine
having the dominant role in its origin.
What this meant for medical sociology in its early development was the pressure
to produce work that can be applied to medical practice and the formulation of health
policy. Tis pressure originated from government agencies and medical sources, which
either infuenced or controlled funding for sociomedical research but had little or no
interest in purely theoretical sociological work. Yet the tremendous growth of medical
sociology, in both the United States and Europe, would have been difcult without the
substantial fnancial support for applied studies provided by the respective govern-
ments. For example, in the United States, where medical sociology has developed most
extensively, the emergence of the feld was greatly stimulated by the expansion of the
National Institutes of Health in the late 1940s. Particularly signifcant, according to
Hollingshead (1973), who participated in some of the early research programs, was
the establishment of the National Institute of Mental Health, which was instrumental
in encouraging and funding joint social and medical projects.1
Parsons
A critical event occurred in 1951 that oriented American medical sociology toward
theory. Tis was the appearance of Talcott Parsons’s book Te Social System. Tis book,
written to explain a relatively complex structural-functionalist model of society, in
which social systems are linked to corresponding systems of personality and culture,
contained Parsons’s concept of the sick role. Unlike other major social theorists pre-
ceding him, Parsons (1902–1979) formulated an analysis of the function of medicine
in society. Parsons presented an ideal representation of how people in Western society
act when sick. Te merit of the concept is that it describes a patterned set of expecta-
tions defning the norms and values appropriate to being sick for both the sick person
and others who interact with that person. Parsons also pointed out that physicians are
invested by society with the function of social control, similar to the role provided by
priests and the police, to serve as a means to control deviance. In the case of the sick
role, illness is the deviance, and its undesirable nature reinforces the motivation to be
healthy.
In developing his concept of the sick role, Parsons linked his ideas to those of the
two most important classical theorists in sociology: Emile Durkheim (1858–1917) of
France and Max Weber (1864–1920) of Germany. Parsons was the frst to demonstrate
the controlling function of medicine in a large social system, and he did so in the con-
text of classical sociological theory. Having a theorist of Parsons’s stature rendering the
frst major theory in medical sociology called attention to the young subdiscipline—
especially among academic sociologists. Not only was Parsons’s concept of the sick
role “a penetrating and apt analysis of sickness from a distinctly sociological point of
PHOTO 1.2 Talcott Parsons.

Source: Granger.
view” (Freidson 1970:62), but also it was widely believed in the 1950s that Parsons
and his students were charting a future course for all of sociology through the insight
provided by his model of society.
However, this did not happen. Parsons’s model was severely criticized over the next
two decades, and his theoretical perspective is no longer popular. Nevertheless, he
provided a theoretical approach for medical sociology that brought the subdiscipline
the intellectual recognition it needed in its early development in the United States. Tis
is because the institutional support for sociology in America was in universities, where
the feld was established more frmly than elsewhere in the world. Without academic
legitimacy and the subsequent participation of established mainstream academic
sociologists in the 1960s, such as Robert Merton and Erving Gofman, who published
research in the feld, medical sociology would lack the early professional credentials
and stature it currently has in both academic and applied settings. Parsons’s views on
society may not be the optimal paradigm for explaining illness, but Parsons was the
leading fgure in the emergence of medical sociology as an academic feld, which ranks
as one of his most important contributions.
The Applied Versus the Theoretical

Te direction initially taken by medical sociology is summarized by Robert Straus
(1957). Straus suggested that medical sociology was divided into two separate but
closely interrelated subfelds: sociology in medicine and sociology of medicine.
Te sociologist in medicine is one who collaborates directly with physicians and
other health personnel in studying the social factors that are relevant to a particular
health problem. Te work of the sociologist in medicine is intended to be directly
applicable to patient care or to the solving of a public health problem. Some of the
tasks are to analyze the social etiology or causes of health disorders, the diferences
in social attitudes as they relate to health, and the way in which the incidence and
prevalence of a specifc health disorder is related to such social variables as age, gender,
socioeconomic status, racial/ethnic group identity, education, and occupation. Such
an analysis is then intended to be made available to health practitioners to assist them
in addressing health problems. Tus sociology in medicine can be characterized as
applied research and analysis primarily motivated by a medical problem, rather than a
sociological problem. Sociologists in medicine usually work in schools of medicine,
nursing, and public health, teaching hospitals, public health agencies, and other
health organizations. Tey may also work for a government agency, such as the U.S.
Department of Health and Human Services (HHS), the Centers for Disease Control
and Prevention (CDC), or the World Health Organization (WHO) in the capacity of
researchers, biostatisticians, health intervention planners, and administrators.
Te sociology of medicine has a diferent emphasis. It deals with such factors as the
organization, role relationships, norms, values, and beliefs about health as forms of
human social behavior. Te emphasis is on the social processes that occur in health-
related situations and how these contribute to our fund of knowledge on medical soci-
ology in particular and to our understanding of social life in general. Te sociology of
medicine shares the same goals as all other areas of sociology and may consequently
be characterized as research and analysis of the medical or health environment from a
sociological perspective. Most sociologists of medicine are employed as professors in
the sociology departments of universities and colleges.
However, problems were created by the division of work in medical sociology into
a sociology of medicine and a sociology in medicine. Medical sociologists who were
afliated with departments of sociology in universities were in a stronger position to

produce work that satisfed sociologists as good sociology. But sociologists in medical
institutions had the advantage of participation in medicine as well as research oppor-
tunities unavailable to those outside medical settings. Tension temporarily developed
between the two groups over whose work was more important. Tis situation resolved
itself as two major trends signifcantly reduced the diferences. First, regardless of
whether a medical sociologist works in a health care or academic setting, much of
the research in the feld deals with topics that have practical utility. Tis development
is largely because of the willingness of government agencies and private foundations
to only fund health-related research that can help solve problems or improve health
conditions. Moreover, many of the better studies, including those in medical settings
with a practical focus, use sociologically based theoretical models to illustrate the
utility of their fndings.
Second, a growing convergence between medical sociology and the general dis-
cipline of sociology took place. Medical sociology became too large and popular to
ignore. Tis situation is aided by the fact that all sociologists share the same training
and methodological strategies in their approach to research. Teoretical foundations
common throughout sociology are increasingly refected in medical sociological
work (Cockerham 2005, 2013a, 2013b, 2021b, 2021c; Cockerham and Scambler 2021;
Collyer 2012, 2015; De Maio 2010; Frohlich and Abel 2014; Scambler 2012, 2018;
Toits 2011), whereas many health issues investigated by medical sociologists call
for knowledge of social processes outside of the sociomedical realm. For example,
studies of health care reform may require consideration of the larger sociological
literature on social change, political power, class, and the welfare state, while research
on job-related stress requires familiarity with occupational structures. Tus much of
the future success of medical sociology is linked to its ability to utilize the fndings
and perspectives of the larger discipline in its work and to contribute, in turn, to
general sociology.
More than six decades have passed since Straus divided work in medical sociology
into two areas of interest. Since that time the feld has changed and expanded, thereby
requiring an update. According to Terrence Hill and his colleagues (2021), medical
sociology now consists of four major subfelds that illustrate its current orientation.
As shown in Figure 1.1, these subfelds are (1) social epidemiology and (2) the social
psychology of health and illness, which have been added to changed versions of (3) the
sociology of medicine and (4) sociology in medicine.
In the Hill et al. model, the subfeld of social epidemiology focuses on explaining
how health and disease are socially distributed and structured, along with determining
the social causes of health-related behaviors and outcomes. Te social psychology of
health and illness is concerned with the social psychological processes that explain or
modify health and health-related behaviors, such as stress. It also covers concepts of
self and identity resulting from illness and disability. Te sociology of medicine refers
back to Straus’s (1957) original two-subfeld model. It focuses on medicine and its
various activities as an object of study. Te sociology of medicine is characterized as
research and analysis of the medical or health environment from a sociological per-
spective. It is now primarily centered on issues linked with health care delivery and
MEDICAL
SOCIOLOGY
Social Social Psychology Sociology of Sociology in

Epidemiology of Health and Illness Medicine Medicine
Focuses on the Focuses on social Focuses on issues Focuses on issues

social psychological linked with health within institutions of
distribution and processes, care delivery and medicine, including
social causes of especially those that health care medical treatment,
health-related mediate and experiences, health professions,
outcomes and moderate the social medical knowledge, and the marketing
behaviors. causes and social and health social of health care.
Emphasizes consequences of movements, Emphasizes applied
social structure health-related including social research questions.
and material outcomes and inequality, social
conditions. behaviors. institutions, and
Emphasizes culture health policy/law,
and meaning. often employing a
critical theoretical
perspective.
Emphasizes
institutions of
medicine.
FIGURE 1.1 The Major Subfelds of Medical Sociology
experiences, medicalization and medical knowledge, and health-related social prob-

lems, such as inequality, access to care, and health policy/law. Sociology in medicine
is retained as well as the subfeld of medical sociology that is primarily focused on
applied topics seen within medicine, including clinical care, doctor–patient interac-
tion and communication, relations between health professions, and the marketing of
health care.
At present, medical sociologists constitute the largest and one of the most active
groups of people doing sociological work. Medical sociologists constitute the third-
largest section of the American Sociological Association and the largest sections
of the British and German sociological associations. About one out of every ten
American sociologists is a medical sociologist. In Germany, the German Society for
Medical Sociology, an organization solely for persons working in the feld of medi-
cal sociology, has had more members than the German Sociological Association. In
Europe as a whole, medical sociologists provided the basis for the European Society
for Health and Medical Sociology, established in 1983. Earlier, in Asia, the Medi-
cal Sociology Section of the Sociological Association of Australia and New Zealand
had been founded in 1967, and the Japanese Society for Health and Medical Sociol-
ogy was established in 1974. More recently, the Canadian Society for the Sociology
of Health was formed in 2008. Additionally, the Research Committee on the Sociol-
ogy of Health (RC15) of the International Sociological Association, established in
1959, has members from all over the world.
Not only have the numbers of medical sociologists continually increased, but also
the scope of matters pertinent to medical sociology has broadened as issues of health,
illness, and medicine have become a medium through which general issues and con-
cerns about society have been expressed. One result is that numerous books and scien-
tifc journals dealing with medical sociology have been and continue to be published
in the United States, Britain, Australia, Scandinavia, and elsewhere, including Africa
(Amzat and Razum 2014), as the feld continues to evolve.
Defning Health
Tere is no single, all-purpose defnition of health that fts all circumstances, but there
are many concepts such as health being a state of normality, the absence of disease, or
the ability to function. Te WHO defnes health as a state of complete physical, mental,
and social well-being, and not merely the absence of disease or injury. Tis defnition
calls attention to the fact that being healthy involves much more than simply not being
ill or injured. Being healthy also means being physically ft, having good relationships
with friends and family, being able to function or do things, and having a sense of
well-being (Blaxter 2010).
What this means is that many people tend to view health as the capacity to carry out
their daily activities. Tat is, they consider health to be a state of functional ftness and
apply this defnition to their everyday lives. Good health is clearly a prerequisite for the
adequate functioning of any individual or society. If our health is sound, we can engage
in numerous types of activities. But if we are ill, distressed, or injured, we face the
curtailment of our usual round of daily life, and we may also become so preoccupied
with our state of health, control of pain, feelings of nausea, being handicapped, and so
forth, that other pursuits are of secondary importance or even meaningless. Terefore,
as microbiologist René Dubos (1981) and others (Blaxter 2010) once explained, health
can be defned as the ability to function. Tis does not mean that healthy people are free
from all health problems, but it means that they can function to the point that they
can do what they want to do. Ultimately, suggests Dubos, biological success in all of
its manifestations is a measure of ftness.
Contrasting Ideas About Health and

Social Behavior
Attempts to understand the relationship between social behavior and health have their
origin far back in history. Dubos suggested that primitive humans were similar to ani-
mals in that they, too, relied upon their instincts to stay healthy. Yet some recognized a
cause-and-efect relationship between doing certain things and alleviating symptoms
of a disease or improving the condition of a wound. Since there was so much that
early humans did not understand about the functioning of the body, magic became
an integral component of the beliefs about the causes and cures of health disorders.
In fact, an uncritical acceptance of magic and the supernatural pervaded practically
every aspect of primitive life. So it is not surprising that early humans thought that
illness was caused by evil spirits. Primitive medicines made from plants or animals
were invariably used in combination with some form of ritual to expel the harmful
spirit from a diseased body.
During the Neolithic period, 4,000 to 5,000 years ago, people living in what is today
the Eastern Mediterranean and North Africa are known to have even engaged in a
surgical procedure called trepanation or trephining, which involved boring a hole in
the skull to liberate the evil spirit supposedly contained in a person’s head. Te fnd-
ing by anthropologists of more than one hole in some skulls and the lack of signs of
osteomyelitis (erosion of bone tissue) suggests that the operation was not always fatal.
Some estimates indicate that the mortality rate from trepanation was low—an amazing
accomplishment considering the difculty of the procedure and the crude conditions
under which it must have been performed (Porter 1997).
One of the earliest attempts in the Western world to formulate principles of health
care, based upon rational thought and the rejection of supernatural phenomena, is
found in the work of the Greek physician Hippocrates. Little is known of Hippocrates,
who lived around 400 bc—not even whether he actually authored the collection of
books that bears his name. Nevertheless, the writings attributed to him have provided
a number of principles underlying modern medical practice. One of his most famous
contributions, the Hippocratic Oath, is the foundation of contemporary medical eth-
ics. Among other things, it requires a physician to swear that he or she will help the
sick, refrain from intentional wrongdoing or harm, and keep confdential all matters
pertaining to the doctor–patient relationship.
Hippocrates also argued that medical knowledge should be derived from an under-
standing of the natural sciences and the logic of cause-and-efect relationships. In
his classic treatise, On Airs, Waters, and Places, Hippocrates pointed out that human
well-being is infuenced by the totality of environmental factors: living habits or life-
style, climate, topography of the land, and the quality of air, water, and food. Concerns
about health in relation to lifestyles and the quality of air, water, and places are still
very much with us today. In their intellectual orientation toward disease, Hippocrates
and the ancient Greeks held views that were more in line with contemporary thinking
about health than was found later in the Middle Ages and the Renaissance. Much of the
medical knowledge of the ancient world was lost during the Dark Ages that descended
on Europe afer the fall of the Roman Empire. Te knowledge that survived in the
West was largely preserved by the Catholic Church. Te church took responsibility for
dealing with mental sufering and adverse social conditions such as poverty, whereas
physicians focused more or less exclusively on treating physical ailments. Te human
body was regarded as a machinelike entity that operated according to principles of
physics and chemistry. Te result was that both Western religion and medical science
sponsored the idea that the body was like a machine, disease was a malfunction of the
machine, and the doctor’s job was to repair the machine.
A few physicians, such as Paracelsus, a famous Swiss doctor who lived in the early
sixteenth century, did show interest in understanding more than the physical func-
tioning of the body. Paracelsus demonstrated that specifc diseases common among
miners were related to their work conditions. But Paracelsus was an exception, and
few systematic measures were employed to either research or cope with the efects
of adverse social situations on health until the late eighteenth and early nineteenth
centuries.
Modern Medicine and the Regulation of

the Body
Modern medicine traces its birth to Western Europe in the late eighteenth century. In
analyzing the history of French medicine at this time in his seminal book, Te Birth of
the Clinic (1973), social theorist Michel Foucault noted the emergence of two distinct
trends in medical practice—what he called “medicine of the species” and “medicine
of social spaces.” Medicine of the species pertained to the strong emphasis in Western
medicine upon classifying diseases, diagnosing and treating patients, and fnding
cures. Te human body became an object of study and observation in order that physi-
ological processes could be demystifed and brought under medical control. Physi-
cians perfected their so-called clinical gaze, allowing them to observe and perceive
bodily functions and dysfunctions within a standardized frame of reference. Clinics
were established to both treat patients and train doctors, with the clinic providing the
optimal setting for physicians to exercise authority and control over their patients
while practicing their craf.
Te medicine of social spaces was concerned not with curing diseases but with
preventing them. Prevention required greater government involvement in regulating
the conduct of daily life—especially public hygiene. Physicians served as advisers in
the enactment of laws and regulations specifying standards for food, water, and the
disposal of wastes. Te health of the human body thus became a subject of regulation
by medical doctors and civil authorities, as social norms for healthy behavior became
more widely established. In such a context, Foucault found that scientifc concepts
of disease had replaced notions that sickness had metaphysical (religious, magical,
superstitious) origins. Disease was no longer considered an entity outside of the exist-
ing boundaries of knowledge but an object to be studied, confronted scientifcally, and
controlled.
The Public’s Health

Awareness that disease could be caused by unhealthy social conditions and lifestyles
spread through common sense and practical experience. A most signifcant develop-
ment occurred when it was realized that uncontaminated food, water, and air, as well
as sanitary living conditions, could reduce the onset and spread of infectious diseases.
Prior to the advent of modern medicine, high mortality rates from infectious diseases
such as typhus, tuberculosis, scarlet fever, measles, and cholera were signifcantly
lowered in both Europe and North America through improved hygiene and sanita-
tion. Tus, the late eighteenth and early nineteenth centuries are conspicuous for the
systematic implementation of public health measures.
Noting the link between social conditions, lifestyles, and health, some nineteenth-
century European physicians argued that improvement was necessary in the living
situations of the poor. Tey advocated governmental recognition of the social as well
as medical nature of measures undertaken to promote health. Virchow, as noted earlier
in this chapter, had insisted that medicine was a social science. He argued not only that
the poor should have quality medical care but also that they should have free choice
of a physician. Improved medical care was to go hand in hand with changed social
conditions, leading to a better life. However, these proposals had little efect outside
Virchow’s small circle of colleagues. Virchow’s views were simply seen as too liberal
by many European rulers and politicians of the period, who feared that social reforms
would erode their authority and lead to revolution.
Nevertheless, the decline in deaths from infectious diseases in the second half of
the nineteenth century was mainly because of improvements in diet, housing, public
sanitation, and personal hygiene instead of medical innovations (Porter 1997, 2006).
Te decline in infant mortality was due more to improved nutrition for mothers and
better care and feeding for infants than to improved obstetric services. Deaths from
typhus also fell dramatically without a specifc medical cause as a result of upgraded
hygiene (Hempel 2020). A similar drop in mortality from typhoid and dysentery
occurred because of better-quality water and food safety.
The Germ Theory of Disease and the Search

for “Magic Bullets”
Most physicians in the 1800s were primarily interested in treating patients and
improving the state of medical technology. Tey were not necessarily concerned
with social reform. However, the medical doctors of the time had a history of only
mixed success in curing human ailments. But as British medical historian Roy Porter
(1997:428) reported, “the latter part of the nineteenth century brought one of medi-
cine’s true revolutions: bacteriology.” Louis Pasteur, Robert Koch, and others in bac-
teriological research decisively confrmed the germ theory of disease and uncovered
the cause of a host of diseases, including smallpox, typhoid, tetanus, and diphtheria,
along with the vaccines providing immunity. Alexander Fleming followed up these
advances in 1928 with the discovery of penicillin—the frst antibiotic. Drug produc-
tion became industrialized, which allowed mass production. Te tremendous progress
in the development of internal medicine, anesthesiology, pathology, immunology, and
surgical techniques convinced physicians to focus exclusively upon a clinical medicine
grounded in exact scientifc laboratory procedures. Tus, the practice of medicine in
the twentieth century rested solidly upon the premise that every disease had a specifc
pathogenic cause, the treatment of which could best be accomplished by removing or
controlling that cause within a biomedical framework.
Medicine’s thinking was dominated by the search for vaccines as “magic bullets”
that could be shot into the body to prevent, control, or kill all diseases, according
to the description provided by Dubos (1959). Because research in microbiology,

biochemistry, and related felds resulted in the discovery and production of a large
variety of drugs and drug-based techniques for successfully treating many diseases,
this approach became medicine’s primary method for dealing with the problems it was
called upon to treat.
Return to the “Whole” Person

By the late 1960s, polio and smallpox were largely eradicated, and infectious diseases
had been severely curtailed in most regions of the world. Tis situation produced a
major change in the pattern of diseases, with chronic illnesses—which by defnition
are long-term and incurable—replacing infectious diseases at that time as the major
threats to health. Sandra Hempel (2020:8) provides an account of a medical student
thinking about a career in infectious diseases who was warned by that person’s pro-
fessor that such diseases were largely overcome and there was nothing else lef to do.
Tis epidemiological transition occurred initially in industrialized nations and
then spread throughout the world. It was characterized by the emergence of chronic
diseases such as cancer, heart disease, and stroke as the leading causes of death. Heart
disease and cancer became more prevalent as people lived longer. Despite the vast
sums spent on cancer research, no magic bullet has yet been found to cure it, although
chemotherapy is sometimes successful in shrinking tumors. As for heart disease, Por-
ter (1997) noted the comments of a prominent British doctor who observed in 1892
that cardiac deaths were “relatively rare.” However, within a few decades, coronary
heart disease had become the leading cause of death in Western society with the aging
of the population. New diagnostic techniques, drugs, and surgical procedures were
developed, including heart transplants, bypass surgery, insertion of stents, and angio-
plasty. Also, as Porter (1997:585) states: “Public understanding of risk factors—smok-
ing, diet, obesity, lack of exercise—improved, and lifestyle shifs made a fundamental
contribution to solving the problem.” Between 1970 and 1990, heart disease mortality
in the United States decreased by 50 percent, and this trend continues into the twenty-
frst century. Life expectancy in many regions of the world has almost doubled since
the Spanish fu pandemic of 1918 (Johnson 2021).
Te transition to chronic diseases meant that physicians were increasingly called
upon to deal with the health problems of the “whole person,” which extend well
beyond singular causes of disease such as a germ or virus. Medical doctors are required
to treat health disorders more aptly described as “problems in living,” dysfunctions
that involve multiple factors of causation, not all of them biological in origin. Social
and psychological factors infuence not only whether or not a person becomes sick
but also the form, duration, and intensity of the symptoms. Consequently, modern
medicine is increasingly required to develop insights into the behaviors characteristic
of the people it treats.
Also, it is not uncommon for an individual sufering from a chronic disease to feel
perfectly normal, even when irreversible damage to organs and tissues is occurring.
Because of the irremediable damage done to the body by a chronic disease, patients
may be required to permanently change their style of living. Health practitioners
need to know how patients with chronic diseases can control their symptoms, adjust
to changes in their physical condition, and live their lives without stress. Tis is in
addition to all else that physicians need to know about the behavior and lifestyles of
individuals that infuence whether they are likely to develop chronic disorders in the
frst place.
According to Porter, it was not only radical thinkers who appealed for a new
“wholism” in medical practice; many of the most respected fgures in medicine were
insistent that treating the body as a mechanical model would not produce true health.
Porter (1997:634) described the situation as follows:
Diseases became conceptualized afer 1900 as a social no less than a biological

phenomenon, to be understood statistically, sociologically, and psychologically—
even politically. Medicine’s gaze had to incorporate wider questions of income,
lifestyle, diet, habit, employment, education and family structure—in short, the
entire psychosocial economy. Only thus could medicine meet the challenges of
mass society, supplanting laboratory medicine preoccupied with minute investi-
gation of lesions but indiferent as to how they got there.
At this time in history, it is clear that social behavior and social conditions play a
critically important role in causing disease or spreading it. Negative health lifestyles
involving poor diets, lack of exercise, smoking, alcohol and drug abuse, stress, and
exposure to infectious diseases like HIV/AIDS or COVID-19 can lead to sickness,
disability, and death. Positive health lifestyles—the reverse of the practices listed
above—help lessen the extent of health problems, better control these problems when
they appear, or allow the individual to avoid them until the onset of old age. However,
adverse social conditions, such as poverty, also promote health problems and reduce
life expectancy. Several studies report, for example, that the poor are more likely to
engage in practices that promote ill health and less likely to engage in practices that
forestall illness-inducing situations (Cockerham 2021b; Hummer and Hamilton 2019).
Te poor are exposed to more unhealthy situations in their daily lives and fnd
themselves in circumstances where there is less opportunity for quality health care.
Tey may confront more stress, have inadequate diets and housing, and live in
areas where industries pollute the environment with cancer-causing agents or other
chemicals causing skin and respiratory disorders. Tey may have greater exposure to
communicable diseases because of crowded living conditions, parasites, insects, and
vermin. To be poor by defnition means to have less of the good things in life. It also
means the possibility of having more of the bad things, and with respect to health
problems, this seems to be the case. Te poor have the highest rates of disease and dis-
ability, including heart disease, of any socioeconomic group (Atkinson 2015; Burdette
et al. 2017; Carpiano, Link, and Phelan 2008).
Te need to understand the impact of lifestyles and social conditions on health
has become increasingly important in preventing or coping with modern health dis-
orders. Tis situation has promoted a closer association between medicine and the
behavioral sciences of sociology, anthropology, and psychology. Medical sociologists
are increasingly familiar fgures not only in medical schools but also in schools of
nursing, dentistry, pharmacy, and public health, as well as in the wards and clinics of
teaching hospitals. Medical sociologists now routinely hold joint teaching and research
appointments between sociology departments and departments in various health-
related educational institutions or are employed full-time in those institutions. Tey
also work full-time in research organizations like the CDC and the WHO.
The Reemergence of Infectious Diseases

While chronic diseases were attracting the most attention, infectious diseases resur-
faced with a vengeance. A new challenge for medical sociology today is researching the
surprising reemergence of infectious diseases, especially COVID-19, as a major threat
to human health and the conduct of social life. Te term newly emerging or re-emerging
infectious disease is currently being used to refer to this phenomenon. In the late 1960s
there was a widespread belief that some infectious diseases were on the verge of extinc-
tion, and the remainder were controllable through immunization or treatment with
antibiotics. In 1967, the surgeon general of the United States had in fact declared that
infectious diseases were no longer a signifcant problem for Americans, saying that it
was “time to close the book on infectious disease as a major health threat” (Armelagos,
Brown, and Turner 2005:755). We now know this was wrong. Some pathogens have
shown a remarkable ability to resist antibiotics, certain disease-transmitting insects
have successfully resisted pesticides, and humans have created ecological disturbances
uncovering new diseases.
For example, some previously unknown and deadly viruses such as HIV, Lassa
fever, the Marburg virus, Ebola, and Zika have emerged from areas of tropical rain
forests or savanna penetrated by increasing numbers of human settlements. Viruses
like SARS and COVID-19 have found it easier to jump from wild animals to humans
(Cockerham and Cockerham 2021). A particular problem with newly emerging dis-
eases is that their appearance is unpredictable, their pathogenesis is initially unknown,
and they are ofen difcult to control in the early stages because of a lack of efective
vaccines and government unpreparedness. Other epidemics are the result of old dis-
eases resurfacing, such as cholera and polio. Even the bubonic plague of the Middle
Ages reappeared to cause a death in Mongolia in 2020.
Te potential for the spread of infectious diseases has been signifcantly enhanced
in today’s world by the globalization of trade and travel (Cockerham and Cockerham
2010, 2021; Oldstone 2010; Osterholm 2005). Air travel, in particular, makes it easy
for infected people or shipments of diseased animals to move from one continent to
another, spreading their virus as they go. A cough or a sneeze from an infected but
symptomless passenger could pass a respiratory infection to another passenger or
someone else that would not appear until days afer that person reaches his or her
destination. Since the 1980s, there has been a cavalcade of viruses emerging year afer
year, and at the end of 2019, the COVID-19 virus initiated a new age of pestilence and
reprioritized research in medical sociology. Te resurgence of infectious diseases fore-
casts a shif in the research perspective of medical sociologists from a relatively exclu-
sive concern with chronic illnesses to considerations of both chronic and infectious
diseases. Lifestyles and social behavior play an important role in the transmission of
infection, including sexual activities, drug use, travel, dietary habits, living situations,
and bioterrorism. Terefore the study of social factors relevant to the prevention and
spread of infectious diseases takes on increased importance for medical sociologists
in the twenty-frst century.
Summary
Troughout history, human beings have been interested in and deeply concerned with
the efects of the social environment on the health of individuals and the groups to
which they belong. Today, it is clear that social factors play a critically important role
in health, as the greatest threats to the health and well-being of individuals stem largely
from unhealthy lifestyles, high-risk behavior, disadvantaged living conditions, and
newly emerging diseases. Sociology’s interest in medicine as a unique system of human
social behavior, and medicine’s recognition that sociology can help health practitio-
ners to better understand their patients and provide improved forms of health care,
have begun to bring about a convergence of the mutual interests of the two disciplines.
More and more, medical sociologists are on the stafs of medical institutions and par-
ticipate in medical research projects. Medical sociology courses, concentrations, and
degrees are now more frequently ofered by universities and colleges. Te extensive
growth of sociological literature in academic medicine is further evidence of the rising
status of the medical sociologist. Although a considerable amount of work remains to
be done, the medical sociologist at this time is in the enviable position of participating
in and infuencing the development of an exciting, signifcant, and developing feld.
Tis book provides an overview of medical sociology and its major topics of interest.
Critical Thinking Questions

1. Medical sociology largely developed outside of mainstream sociology before becoming
fully integrated within the larger discipline. What factors changed its course?
2. Explain why medical sociologists are interested in studying newly emerging infectious
diseases. What is sociological about such diseases?
Suggested Readings
Cockerham, William C. (2021) Sociological theories of health and illness. New York: Routledge.
Provides an in-depth discussion of the development of medical sociology and its major theories.
Cockerham, William C. (ed.) (2021) Te Wiley Blackwell companion to medical sociology. Oxford,
UK: Wiley Blackwell.
Essays by leading medical sociologists reviewing the major topics in the feld.
Garcia-Alexander, Ginny, Hyeyoung Woo, and Matthew J. Carlson (2017) Social foundations of
behavior for the health sciences. Cham, Switzerland: Springer International.
A book on sociology for health professions students.
Hinote, Brian P. and Jason Adam Wasserman (2020) Social and behavioral science for health profes-
sionals, 2nd ed. Lanham, MD: Rowman & Littlefeld.
An interdisciplinary, in-depth account of the social and behavioral sciences for students in the
health professions.
Note
1. For historical discussions of the development of medical sociology, see Bloom (2002), Cockerham
(2013a, 2013b, 2021b, 2021c), Collyer (2012), Collyer and Scambler (2015), and Cockerham and
Scambler (2021).
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The Social Demography of Health

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Suggested Readings
Annandale, Ellen C. (2021) “Health status and gender,” pp. 237–257 in The Wiley Blackwell companion to medical
sociology, W. Cockerham (ed.). Oxford, UK: Wiley Blackwell. An updated discussion of gender differences in health from
an international perspective.
Austad, Steven N. and Kathleen E. Fischer (2016) “Sex differences in lifespan.” Cell Metabolism 23: 1022–1032. An
informative paper examining the male–female mortality paradox.
Ailshire, Jennifer A. and Sarah A. Burgard (2012) “Family relationships and troubled sleep among U.S. adults.” Journal of
Annandale, Ellen C. (2021) “Health status and gender.” Pp. 237–257 in The Wiley Blackwell companion to medical
Austad, Steven N. and Kathleen E. Fischer (2016) “Sex differences in lifespan.” Cell Metabolism 23: 1022–1032.
Avison, William R. and Jinette Comeau (2013) “The impact of mental illness on the family.” Pp. 543–562 in Handbook of
the sociology of mental health, 2nd ed., C. Aneshensel , J. Phelan , and A. Bierman (eds.). Dordrecht: Springer.
Behler, Rachel , Rachel Donnelly , and Debra Umberson . 2019. “Psychological distress transmission in same-sex and
different sex marriages.” Journal of Health and Social Behavior 60: 118–135.
Bianchi, Suzanne M. , Liana C. Sayer , Melissa A. Milkie , and John P. Robinson (2012) “Housework: Who did, does or
will do it, and how much does it matter?” Social Forces 91: 55–63.
Bierman, Alex (2012) “Functional limitations and psychological distress: Marital status as moderation.” Society and
Mental Health 2: 35–52.
Bird, Chole E. and Patricia P. Rieker (2008) Gender and health: The effects of constrained choices and social policies.
Cambridge, UK: Cambridge University Press.
Bostwick, Wendy R. , Carol J. Boyd , Tonda L. Hughes , and Brady West (2014) “Discrimination and mental health
among lesbian, gay, and bisexual adults in the United States.” American Journal of Orthopsychiatry 84: 35–45.
Brown, Robyn Lewis , and Gabriele Ciciurkaite (2017) “Understanding the connection between social support and mental
health.” Pp. 207–223 in A handbook for the study of mental health: Social contexts, theories, and systems, 3rd ed., T.
Scheid and E. Wright (eds.). Cambridge: Cambridge University Press.
Bunn, Christopher , Sally Wyke , Cindy M. Gray , Alice Maclean , and Kate Hunt (2016) “‘Coz football is what we all
have’: Masculinities, practice, performance and effervescence in a gender-sensitised weight-loss and healthy living
programme for men.” Sociology of Health & Illness 38: 812–838.
Caddick, Nick , Brett Smith , and Cassandra Phoenix (2015) “Male combat veterans’ narratives of PTSD, masculinity,
and health.” Sociology of Health & Illness 37: 87–111.
Case, Anne and Angus Deaton (2015) “Rising mortality in midlife among white non-Hispanic Americans in the 21st
century.” Proceedings of the National Academy of Science 112: 15078–15083.
Case, Anne and Angus Deaton (2017) “Mortality and morbidity in the 21st century.” Brookings Papers on Economic
Activity (Spring): 397–476.
Case, Anne and Angus Deaton (2020) Deaths of despair and the future of capitalism. Princeton, NJ: Princeton University
Press.
Cockerham, William C. (2014) “The emerging crisis of American female longevity.” Social Currents 1: 220–227.
Cockerham, William C. (2018) “Health lifestyles and the search for a gender-specific habitus.” Social Theory & Health 16:
142–155.
Collins, Gail (2009) When everything changed: The amazing journey of American women from 1960 to the present. New
York: Little, Brown.
Cosby, Arthur G. , M. Maya McDoom-Echebiri , Wesley James , Hasna Khandekar , Willie Brown , and Heather L.
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MEDICAL SOCIOLOGY

• A contemporary account of medical sociology’s subfelds (Chapter 1)

William C. Cockerham is Distinguished Professor of Sociology and Chair Emeritus

Routledge is an imprint of the Taylor & Francis Group, an informa business

© 2022 Taylor & Francis

All rights reserved. No part of this book may be reprinted or reproduced or

Trademark notice: Product or corporate names may be trademarks or registered

First edition published by Prentice Hall 1978

Library of Congress Cataloging-in-Publication Data

ISBN: 978-1-032-06795-7 (hbk)

1 Medical Sociology 3 MERS 44

The Social Determinants of Health 4 Ebola 45

The Development of Medical Zika 46

Disease and Modernization 29 Gender 75

The Complexity of Modern Ills 30 Social Class 75

Heart Disease 31 Resolution 76

Obesity 33 Social Effects 77

HIV/AIDS 38 Critical Thinking Questions 78

Suggested Readings 78 Social Trends in Aging and

4 The Social Demography Race 140

5 The Social Demography

Summary 127 Physiological Responses to

Age 133 Social Capital 179

Stress and Socioeconomic The Physician–Patient Role

Critical Thinking Questions 209 Women Physicians 253

Suggested Readings 209 Cultural Differences in

9 Illness Behavior and the The Future of Doctor–Patient

Summary 265 Summary 306

11 Physicians 270 13 Nurses, Physician

The Road to Health Care Reform 379

The Hospital: Dual Authority 363

Socialist Medicine: Alterations in Critical Thinking Questions 439

L E A R N ING O B JEC TIV ES

The Social Determinants of Health

infectious, genetic, metabolic, malignant, degenerative (Holtz et al. 2006), or mental

The Development of Medical Sociology

credit him as medical sociology’s founder. According to Norman Hawkins (1958:18),

A careful and protracted search reveals no pronouncement on the subject prior

Te American Academy of Medicine also published the Journal of Sociologic

cooperation between sociologists and psychiatrists existed because of earlier research

Te subdiscipline came of age in an intellectual climate far diferent from sociol-

PHOTO 1.2 Talcott Parsons.

The Applied Versus the Theoretical

afliated with departments of sociology in universities were in a stronger position to

Social Social Psychology Sociology of Sociology in

Focuses on the Focuses on social Focuses on issues Focuses on issues

FIGURE 1.1 The Major Subfelds of Medical Sociology

experiences, medicalization and medical knowledge, and health-related social prob-

Contrasting Ideas About Health and

Modern Medicine and the Regulation of

The Public’s Health

The Germ Theory of Disease and the Search

to the description provided by Dubos (1959). Because research in microbiology,

Return to the “Whole” Person

Diseases became conceptualized afer 1900 as a social no less than a biological

The Reemergence of Infectious Diseases

Critical Thinking Questions

The Social Demography of Health

The Social Demography of Health

The Social Demography of Health