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This introduction to a special section brings together three papers first presented at a panel, 'Medical Professions in South Asia: Historical and Contemporary Analyses', at the 26th European Conference on South Asian Studies, held in Vienna, Austria and online, in July 2021. All three papers deal with aspects of the professionalisation of biomedical doctors in India since its independence in 1947. The authors bring together historical and sociological approaches to illuminate the growth of specialisms, patterns of practitioner–patient interactions and efforts to maintain occupational closure and maintain status in the face of growing challenges. The introduction concludes with a discussion of the relevance of these papers for the sociology of health and illness in India and beyond. [ABSTRACT FROM AUTHOR]

Health inequalities impact sex‐variant people in highly differentiated ways. This is evidenced in much academic and activist intersex research documenting the highly specific forms of inequalities arising from misrecognition, discrimination and human rights abuses inherent to pathologised accounts of non‐normative bodies. Important theoretical work further interrogates the implications of sex variant subjectivities, identities and bodies for static or binary notions of both sex and gender. In this paper, we aim to contribute further to this scholarship. We draw upon feminist materialist and Deleuzean‐informed understandings of materials or matter to rethink debates over sex‐variant subjectivities, identities and bodies in relation to inequalities in health. We argue 'the turn to matter' and associated new materialist theories draw attention to the complex, dynamic relational assemblages and entanglements mutually constituting the affective, embodied and socio‐material worlds of intersex people. Informed by these theories, we propose that inequalities can be more fully addressed through a new health equity research agenda that is co‐produced with sex‐variant people. This agenda will enable a fuller exploration of the unsettling but transformative capacities of intersex matters and meanings with the contextually specific understandings of equity in relation to health and health care. [ABSTRACT FROM AUTHOR]

Reducing health inequalities remains a challenge for policy makers across the world. Beginning from Lewin's famous dictum that "there is nothing as practical as a good theory", this paper begins from an appreciative discussion of 'fundamental cause theory', emphasizing the elegance of its theoretical encapsulation of the challenge, the relevance of its critical focus for action, and its potential to support the practical mobilisation of knowledge in generating change. Moreover, it is argued that recent developments in the theory, provide an opportunity for further theoretical development focused more clearly on the concept of power (Dickie et al. 2015). A critical focus on power as the essential element in maintaining, increasing or reducing social and economic inequalities – including health inequalities – can both enhance the coherence of the theory, and also enhance the capacity to challenge the roots of health inequalities at different levels and scales. This paper provides an initial contribution by proposing a framework to help to identify the most important sources, forms and positions of power, as well as the social spaces in which they operate. Subsequent work could usefully test, elaborate and adapt this framework, or indeed ultimately replace it with something better, to help focus actions to reduce inequalities. [ABSTRACT FROM AUTHOR]

In recent years, assistive technologies have gained acceptance as tools for supporting chronically ill patients in achieving improvements in physical activity. However, various healthcare and sociological studies show contradicting results regarding the physical and social impact of using such devices. This paper explores real‐time user appropriation of an assistive monitoring/tracking device, the pedometer, in a healthcare intervention, with a particular focus on the technology identities users attribute to the pedometer. The study site was a rehabilitation programme at a local Danish health centre supporting patients with chronic obstructive pulmonary disease. As part of this empirical study, six focus‐group interviews were conducted with patients before and after they used pedometers. The analysis of respondents' accounts shows that monitoring devices become part of users' complex socio‐technical ensembles in which the use of the device and its tracking of activity is constantly negotiated through experimentation with type and frequency of use; interpretation of knowledge and experience gained via the device; and negotiation of expectations, wellbeing, and the value of quantified knowledge for the management of chronic illness. On the basis of these findings the paper brings together and advances sociological scholarship on chronic illness, embodiment, the quantified self and technology adoption. [ABSTRACT FROM AUTHOR]

Given the considerable emphasis placed on informed choice, the management of health information has become an increasingly important part of living with chronic illness. This paper explores the intra‐familial dynamics of managing health information in the context of chronic illness. Drawing on 77 interviews with people affected by Multiple Sclerosis in the UK (patients, partners, family members and close friends), we show how families develop their own idiosyncratic information practices, including the careful, at times strategic, seeking, sharing and withholding of information. We describe how one individual, most commonly either the patient or their partner, often takes primary responsibility for managing growing quantities of health information. Doing this is a complex task, yet its dynamics within the family unit remain invisible and unacknowledged. In this paper we: (a) stress the importance of understanding information management in chronic illness as a collective process across all those affected, patients as well as carers; (b) conceptualise the process of managing health information in this context as 'health information work'; and (c) analyse it as part of the wider care practices families engage in and as a form of care in its own right. [ABSTRACT FROM AUTHOR]

The recent development of cancer precision medicine is associated with the emergence of 'molecular tumour boards' (MTBs). Attended by a heterogenous set of practitioners, MTBs link genomic platforms to clinical practices by establishing 'actionable' connections between drugs and molecular alterations. Their activities rely on a number of evidential resources – for example databases, clinical trial results, basic knowledge about mutations and pathways – that need to be associated with the clinical trajectory of individual patients. Experts from various domains are required to master and align diverse kinds of information. However, rather than examining MTBs as an institution interfacing different kinds of expertise embedded in individual experts, we argue that expertise is the emergent outcome of MTBs, which can be conceptualised as networks or 'agencements' of humans and devices. Based on the ethnographic analysis of the activities of four clinical trial MTBs (three in France and an international one) and of two French routine‐care MTBs, the paper analyses how MTBs produce therapeutic decisions, centring on the new kind of expertise they engender. The development and activities of MTBs signal a profound transformation of the evidentiary basis and processes upon which biomedical expertise and decision‐making in oncology are predicated and, in particular, the emergence of a clinic of variants. [ABSTRACT FROM AUTHOR]

Contributing to critical digital health research and the sociology of health consumption, this study investigates the phenomenon of self‐tracking and interpretation of consumer data via wearable technology and mobile fitness software applications (apps). It critically analyses qualitative data collected from members of running communities in the UK who are heavy users of apps and wearables. The study seeks to understand the meaning and practise of long‐term use of apps and wearables targeted at consumers interested in tracking fitness, and the collection of personal health information over time. The paper offers an interpretative perspective on runners as performance‐seeking fitness consumers engaged in long‐term self‐management of health. These consumers are driven by a profound motivation to visualise and embody a long‐term state of fitness. Participants were also hyper‐aware of advertising and promotional methods used to engage consumers. The findings raise concerns about the validity of personal fitness data, and how its collection promises improved personal health while visually promoting sought‐after fit bodies. Further research is required to understand the transformative impact of fitness‐tracking and how individuals negotiate personal classifications of health. [ABSTRACT FROM AUTHOR]

Using data collected through semi‐structured interviews and focus group discussions with 37 adult men living in Brunei Darussalam, this paper explores how masculinities and expectations about male roles across the life course influence men's perceptions, of and attitudes towards health and health help‐seeking behaviour. Bruneian men gave accounts that consistently spoke of a series of masculine roles and associated attributes and behaviours, which mapped across the life course. Men described health and the steps that they had taken to protect their health in terms of responsibilities associated with being a breadwinner, provider of support for parents, role model and leader of the family. Whilst adherence to Bruneian norms about masculinity could obstruct men's engagement with health help‐seeking, we also found that men mobilised their understanding of Bruneian masculinity such that it provided culturally legitimate way of engaging in health help‐seeking. We conclude by considering implications for further development of conceptualisations of masculinities, particularly responding to the call to consider Connell's theory of 'hegemonic masculinity' in the context of the Global South. We also consider the implications of the findings of this research for policy and practice in provision of health promotion and services in Brunei. [ABSTRACT FROM AUTHOR]

This paper explores experiences of 16 people claiming to have recovered from Myalgic Encephalomyelitis ( ME) or Chronic Fatigue Syndrome ( CFS) using the concept of liminality. Liminality describes the status of those falling between socially recognised and medically sanctioned categories, and illuminates both the experience of illness and the process of recovery from ME/ CFS. The liminality experienced during illness was akin to that described by Turner with a degree of communitas among sufferers. As recovery progressed, participants stressed the percentage to which they had improved, and compared themselves with peers and themselves prior to the illness. Recovery did not mean transition into a post-liminal phase, but involved a new liminality, characterised by straddling boundaries between illness and wellness. Participants continued strategies such as rest, pacing and meditation. This second liminal state included difficulty in communicating the experience convincingly, and estrangement from the ME/ CFS community. Thus, recoverees moved from the liminality of illness to a second, and less legible state of sustained liminality in recovery, described as having one foot in the ill world, one foot in the well world. This suggests that more needs to be understood about the recovery experience to assist those making the transition toward wellness. [ABSTRACT FROM AUTHOR]

In an interview study of decision-making about statins, many participants said they took pills regularly, yet described themselves as 'not really pill-takers'. This paper explores this paradox and its implications. The practice of pill-taking itself can constitute a challenge to the presentation of moral adequacy, beyond the potential for rendering stigmatised illnesses visible. Meeting this challenge involves a complex process of calibrating often-conflicting moral imperatives: to be concerned, but not too concerned, over one's health; to be informed, but not over-informed; and deferential but not over-deferential to medical expertise. This calibration reflects a broader tension between rival tropes: embracing medical progress and resisting medicalisation. Participants who take statins present them as unquestionably necessary; 'needing' pills, as opposed to choosing to take them, serves as a defence against the devalued identity of being a pill-taker. However, needing to take statins offers an additional threat to identity, because taking statins is widely perceived to be an alternative strategy to 'choosing a healthy lifestyle'. This perception underpins a responsibilising health promotion discourse that shapes and complicates the work participants do to avoid presenting themselves as 'pill-takers'. The salience of this discourse should be acknowledged where discussions of medicalisation use statins as an example. [ABSTRACT FROM AUTHOR]

The paper describes and evaluates the theoretical underpinnings of the International Classification of Functioning, Disability and Health (ICF), and develops the proposition that its conceptual framework provides a coherent, if uneven, guide through the competing conceptions of disability. To date, however, there has been little evaluation of the theoretical efficacy of the ICF. In seeking to redress this, the paper develops the argument that the ICF fails to specify, in any detail, the content of some of its main claims about the nature of impairment and disability. This has the potential to limit its capacity to educate and influence users about the relational nature of disability. The paper develops the contention that three parts of the ICF require further conceptual clarification and development: (a) (re)defining the nature of impairment; (b) specifying the content of biopsychosocial theory; and (c) clarifying the meaning and implications of universalisation as a principle for guiding the development of disability policies. [ABSTRACT FROM AUTHOR]

This paper seeks to understand better the media practices of people who are directly affected by an illness or health problem. Internet sites that have been created by people with HIV/AIDS are examined as a strategy for self-representation. This analysis identifies four prominent 'organising themes' in Internet sites: autobiography; expertise; self promotion; and dissent. It is argued that there is a connection between media activism within the contemporary AIDS movement and Internet use among people with HIV/AIDS. This paper discusses the potential of the Internet, as a form of media activism, to raise the private troubles of people with health problems as public issues through a revitalisation of the public sphere in contemporary post-industrial societies. [ABSTRACT FROM AUTHOR]

This paper focuses on how adults with cystic fibrosis (CF) attending a specialist CF centre in the UK perceive their health. In common with many other genetic diseases, CF is traditionally conceptualised as a fatal childhood disease, yet the average survival age for those with CF has been steadily rising over the past half century. Thus it is now predicted that those born in 1990 will live on average for 40 years. To date, however, most sociological work has focused on children or adolescents affected by CF rather than on adults between the ages of 18 and 40, the focus of the study reported here. The paper shows that these adults' varying perceptions of health are related to the effects of CF, its treatment, and the context in which adults are placed. Four concepts of health are identified (health as 'normal', controllable, distressing and a release) along with certain styles, ways of coping and related strategies. Through these analytic distinctions the paper aims to make a contribution to the sociological understanding of lay concepts of health in adults with childhood or genetic disease. [ABSTRACT FROM AUTHOR]

This paper seeks to contribute to the limited body of work that has directly explored lay understandings of the causes of health inequalities. Using both quantitative and qualitative methodology, the views of people living in contrasting socio–economic neighbourhoods are compared. The findings support previous research in suggesting that lay theories about causality in relation to health inequalities, like lay concepts of health and illness in general, are multi–factorial. The findings, however, also illustrate how the ways in which questions about health and illness are asked shape people’s responses. In the survey reported on here people had no problem offering explanations for health inequalities and, in response to a question asking specifically about area differences in health experience, people living in disadvantaged areas ‘constructed’ explanations which included, but went beyond, individualistic factors to encompass structural explanations that gave prominence to aspects of ‘place’. In contrast, within thecontext of in–depth interviews, people living in disadvantaged areas were reluctant to accept the existence of health inequalities highlighting the moral dilemmas such questions pose for people living in poor material circumstances. While resisting the notion of health inequalities, however, in in–depth interviews the same people provided vivid accounts of the way in which inequalities in material circumstances have an adverse impact upon health. The paper highlights ways in which different methodologies provide different and not necessarily complementary understandings of lay perspectives on the causes of inequalities in health. [ABSTRACT FROM AUTHOR]

In this paper we use a social practice approach to explore men's experience of Football Fans in Training ( FFIT), a group-based weight management programme for men that harnesses men's symbolic attachment to professional football clubs to engage them in lifestyle change. FFIT is delivered by community coaches in clubs' stadia and is gender-sensitised in relation to context, content and style of delivery. Using a 'toolkit' of concepts from the work of Bourdieu, Goffman and Durkheim we analysed data from 13 focus group discussions with participants, and fieldwork notes from programme observations to investigate the appeal and success of FFIT, and how it worked to support change. Our analysis builds on our work on the importance of shared symbolic commitment to the football club and being with 'men like me' to understand how the interaction context facilitated 'effervescent' experiences. These experiences encouraged men to make changes to their diet and physical activity, talk about them, practice performing them and implement them in their lives. Thus a social practice approach illuminated the social processes through which lifestyle change was achieved, and we argue that it can deepen and enrich both intervention design and evaluation. [ABSTRACT FROM AUTHOR]

This paper is a direct response to Wilkinson's (1996) call for more research into housing insecurity and health. It explores the consequences of mortgage arrears for both the health of indebted home owners and their use of primary health care services. It is based on the results of a secondary analysis of the British Household Panel Survey. It demonstrates that the experience of mortgage indebtedness has an independent effect on the subjective well being of men and women, and that it increases the likelihood that men will visit their general practitioners. The paper draws upon the sociological notions of 'ontological security' and 'individualisation' to make sense of these empirical findings. It suggests that policies which have encouraged the growth of home ownership are premised on the idea of individual responsibility, a notion which underpins other spheres of contemporary welfare policies. Within this context, the consequences of mortgage indebtedness are likely to have profound psychosocial consequences for those who have direct experience of it. The spectre of mortgage debt may also contribute to the insecurity which has come to form a feature of our contemporary social and cultural life. [ABSTRACT FROM AUTHOR]

It is accepted that within Britain there are persistent and growing inequalities in mortality between groups of people as defined by their social class. This paper shows that similar persistent and growing inequalities prevail between groups of people defined by district of residence. Although there is some confusion between these two ways of grouping people -- there is a slight tendency for people of the same class to live in the same district. This paper reviews the geographical literature which may shed light on why inequalities in mortality are widening between districts in Britain. We present new data for a set of 293 unchanging districts by amalgamating published reports from the 1950s, 60s and 70s with individual post-coded mortality records from the 1980s and 90s, aggregated to the 293 districts using a Geographic Information System and Census data from 1971, 1981 and 1991 (including estimates of the residence of the 'missing million'). We find that a growing proportion of premature deaths in Britain can be attributed to some aspect of rising spatial inequalities. Changing geographical inequalities in health are not simply a passive reflection of social inequalities. To begin to investigate them, however, we first need to measure them properly. [ABSTRACT FROM AUTHOR]

This paper contributes to the development of theory and research on inequalities in health. Our central premise is that these are currently limited because they fail adequately to address the relationship between agency and structure, and that lay knowledge in the form of narrative has a significant contribution to make to this endeavour. The paper is divided into three sections. In the first section we briefly review the existing, largely quantitative research on inequalities in health. We then move on to consider some of the most significant critiques of this body of work highlighting three issues: the pursuit of overly simple unidimensional explanations within 'risk factor' epidemiology and the (probably inevitable) inability of this research tradition to encompass the full complexity of social processes; the failure to consider the social context of individual behaviour and, in particular, the possibility for, and determinants of, creative human agency; and, thirdly, the need for 'place' and 'time' (both historical and biographical) to be given greater theoretical prominence. In the final section of the paper the potential theoretical significance of 'place' and 'lay knowledge', and the relationship between these concepts, in inequalities research is explored. Here we suggest three developments as a necessary condition for a more adequate theoretical framework in this field. We consider first the need for the conceptualisation and measurement of 'place' within a historical context, as the location in which macro social structures impact on people's lives. Second, we argue for a re-conceptualisation of lay knowledge about everyday life in general and the nature and causes of health and illness in particular, as narratives which have embedded within them explanations for what people do and why -- and which, in turn, shape social action. Finally, we suggest that this narrative knowledge is also the medium through which people locate themselves with... [ABSTRACT FROM AUTHOR]

Starting out from the relationship between income equality and indicators of social cohesion and social trust, this paper explores the social processes which might account for the relationship between greater income equality and lower population mortality rates. We note that: homicide shows an even closer relationship to income inequality than does mortality from all other causes combined; there are several reports that homicide rates are particularly closely related to all cause mortality; and that there is a growing body of research on crime in relation to social disorganisation. We use US state level data to examine the relationships between various categories of income inequality, median state income, social trust and mortality. The data suggest that violent crime, but not property crime, is closely related to income inequality, social trust and mortality rates, excluding homicide. The second half of the paper is devoted to literature on the antecedents of violence. Feeling shamed, humiliated and disrespected seem to be central to the picture and are plausibly related to the way in which wider income differences are likely to mean more people are denied access to traditional sources of status and respect. We suggest that these aspects of low social status may be central to the psychosocial processes linking inequality, violence, social cohesion and mortality. [ABSTRACT FROM AUTHOR]

This paper argues that children, as an important social group, repay study in connection with the sociology of health and illness. The paper outlines the neglect of children within medical sociology and goes on to open up a discussion towards a sociology of child health. The paper makes three main points. First, consideration of the case of health and illness helps understanding of children's social positioning as a minority group. Secondly, children present a clear case for considering people as embodied health care actors. Thirdly, taking account of children in the sociology of health requires rethinking the division of labour and inter-generational relationships within it. [ABSTRACT FROM AUTHOR]

The paper investigates relationship between mortality and social class as measured by the Erikson-Goldthorpe schema, a validated measure of employment conditions, and compares this with differentials found using the Registrar General's social classes. Two cohorts of men aged 15/16-44 were drawn from the OPCS Longitudinal Study for 1971 and 1981. Mortality differences between social classes were estimated using deaths occurring between 1976 and 1980 in the first cohort and 1986 and 1989 in the second. The two classification were formally compared by means of the Relative Index of Dissimilarity and a likelihood-based statistic. Similar mortality differentials were found using both classifications in the two time periods. The Erikson-Goldthorpe schema showed a clear pattern of higher mortality in those groups without a career structure and with lower discretion over their work. The paper concludes that inequalities in health are seen when a validated social class schema based on employment conditions is used. The use of validated measures will make it possible for health differences to be more clearly interpreted in policy terms. [ABSTRACT FROM AUTHOR]

This paper argues that people's views of health and illness are best understood as accounts that they give to others. In that sense, such beliefs are neither the expression of fixed inner attitudes, nor evidence for shared social representations. Instead, we emphasise the importance of seeing health talk as both ideological and dilemmatic. The paper explores the way in which individuals who speak of health (or illness) in general must also give an account of their health in particular. Reviewing the distinction between 'private' and 'public' accounts, the article discusses the various rhetorical devices by which this is achieved. This shows how people's talk about health both defines their social fitness and exemplifies their claims to being ill or healthy. [ABSTRACT FROM AUTHOR]

This paper argues that analysis of the ethnic patterning of health has failed adequately to examine the social meaning of ethnicity, while too often becoming enmeshed in unhelpful dualities which counterpose material to cultural explanations, multiculturalism to anti-racism, and sociology to epidemiology. Against the background of anthropological, objectivist and postmodern theories in the broader sociology of 'race' and ethnicity, the paper develops a concept of ethnicity for the purposes of health research. This is used to evaluate biological, migration-based, material, cultural and racism-based explanations for the ethnic patterning of health. It is argued that these types of explanation are best understood within an interactive framework. The methodological implications of this for future research are discussed. [ABSTRACT FROM AUTHOR]

This paper derives its main hypothesis from results of the Health and Lifestyle Survey as reported in Blaxter's monograph Health and Lifestyles. In this book it is argued that in a favourable social environment a healthy lifestyle matters but in a unfavourable social environment a healthy lifestyle does not make much difference. This hypothesis is tested with data from health surveys from the Netherlands and Denmark. The Dutch data showed a highly significant relationship of unfavourable material and social circumstances with both poor health and an unhealthy lifestyle. In turn, an unhealthy lifestyle was also related to poor health. The Danish study showed similar, although generally weaker, associations. When the British findings would apply to Denmark and the Netherlands, we should find an interaction between material and social circumstances and health related behaviour in their association with health and illness. Neither the Dutch nor the Danish data showed an interaction of the type that the British study assumes. The paper concludes with a discussion of the reasons why the findings from the UK could not be replicated. [ABSTRACT FROM AUTHOR]

This paper draws together findings from studies of health and identity to develop a model of health identities, based upon Deleuze and Guattari's approach to understanding the relationship between self, body and society. The model is used to inform a methodology for the empirical study of identities in relation to health and the body. Using a sample interview transcript, the methodology of analysis is demonstrated. The application of the model and the methodology for studying health identities are discussed. [ABSTRACT FROM AUTHOR]

Smoking in the home is, potentially, the next frontier in tobacco control in the developed world. As smoking regulations in public space are extended, attention is turning to private spaces and the contribution of parental, particularly maternal, smoking to children's health and socio-economic inequalities in family health. Yet relatively little is known about mothers’ smoking practices within the home and the social meanings of smoking that are constructed by these practices. In this paper we explore how mothers who smoke construct moralities of their smoking behaviour, particularly in relation to where and with whom they smoke. Drawing on in-depth Biographic Narrative Interpretative Method, in interviews with 12 smoking mothers, and their partners, we consider how these moral tales involve comparisons with other smokers and the importance of community endorsement of smoking practices, particularly around children. We also consider the role of children in the home and how children are actively involved in the regulation of smoking behaviours. Finally, we consider the implications of these moral tales for interventions around smoke-free homes. [ABSTRACT FROM AUTHOR]

This article addresses the complexity of children's risk landscapes through an ethnography of 10- to 12-year-old Danish children. The data revealed how children individually and collectively engaged with risk in their everyday activities. The children assessed risks in relation to their perceptions of their health as strength and control, negotiated the conditions of playing, and attuned their responses to situations of potential social and physical conflict. In the paper this risk engagement is illustrated in a variety of contexts: children's decisions to wear or not to wear a bicycle helmet; playing and games and routine pushing and shoving at school. In looking after themselves, children negotiate rules of participation and they safeguard personal and collective interests. Gender differences in these processes are addressed and discussed. The article argues that risk engagement is an important resource through which children also learn from their own mistakes. This is a necessary learning process when children engage with their personal health and safety. The article critically discusses different sociological frameworks and shows the significance of the study for the growing literature on understanding the meaning of risk in childhood. [ABSTRACT FROM AUTHOR]

The way mothers feed their babies is, internationally, the subject of research, health policy initiatives, and popular discussion, which commonly affirm the mantra ‘breast is best’. On one level, this mantra reflects scientific evidence about nutrition and maternal and infant health. From a socio-cultural perspective, the pro-breastfeeding message has, however, been considered an aspect of morality, which influences maternal identity in important ways. This article explores this idea. It does so primarily by reporting and discussing some findings from a study about British mothers’ experiences of using formula milk for infant feeding. The paper begins by contextualising this discussion by briefly outlining some aspects of the construction of infant feeding as a social problem in Britain, focusing in particular on the influence of ‘the new paradigm of health’. [ABSTRACT FROM AUTHOR]

This paper seeks to contribute to the recent debate within the field of inequalities in health that has focused on the relationship between income distribution and health. This has contested the extent to which the main effects of income on health are not directly related to material standards but operate through psychosocial mechanisms, linked to how people experience and perceive their relative position. However, whilst this has focused attention on the qualitative dimensions of income inequality as a potential determinant of health inequality, very little empirical work has directly examined lay perspectives. In this study I attempted to address this gap by exploring how two groups of working class men living in contrasting socio-economic areas understood and experienced differences in income and material circumstances and how these were perceived to impact on their health. This study shows that the anger and resentment felt by these men had their roots largely in the perceptions of others and the way others treated them, rather than in income differentials per se. There was little evidence of feelings of shame or inferiority. For men at the bottom of the social ladder, financial hardship was additionally perceived as having the greatest impact on their health and well-being. [ABSTRACT FROM AUTHOR]

This paper explores the online ‘pro-anorexia’ underground, a movement that supports those with anorexia and adopts an ‘anti-recovery’ perspective on the disease. While encouraging a ‘healthy’ diet to sustain an anorexic way-of-life, the movement also recommends the radical use of weight-loss pharmaceuticals to pursue and maintain low body weight, in contrast to their conventional use to treat obesity. Using ethnographic and interview data collected from participants in the ‘ Anagrrl’ website and online forum, we analyse the pro-anorexia (or ‘pro-ana’) movement in terms of its underlying ‘explanatory model’ of the disease, and contrast it with medical, psychosocial, sociocultural and feminist models that encourage a ‘normalisation’ of body shape and weight. We suggest that for participants in pro-ana, anorexia represents stability and control, and Anagrrl offers support and guidance for those who wish to remain in this ‘sanctuary’. We discuss the pro-anorexia movement's use of the internet to facilitate resistance to medical and social theories of disease, and its subversion of pharmaceutical technologies. [ABSTRACT FROM AUTHOR]

The internet is now a major source of health information for lay people. Within the medical, sociological and popular literatures there have been three main responses to this development. We classify these as ‘celebratory’, ‘concerned’ and ‘contingent’. This paper falls into the third category and, drawing on techniques of discourse analysis, examines people's accounts of their use of online health resources. It identifies six implicit rules – which we call ‘rhetorics of reliability’– that people readily draw upon when articulating why they trust some online sources and not others. In addition participants locate their accounts within broader discursive frameworks in order to present themselves as ‘sensible’ users. The article concludes by suggesting that there is an emerging concordance between the lay use of the internet for health and illness and dominant (generally) biomedical conceptions of what constitutes ‘good quality’ health information. [ABSTRACT FROM AUTHOR]

The healthcare professions have never been static in terms of their own disciplinary boundaries, nor in their role or status in society. Healthcare provision has been defined by changing societal expectations and beliefs, new ways of perceiving health and illness, the introduction of a range of technologies and, more recently, the formal recognition of particular groups through the introduction of education and regulation. It has also been shaped by both inter-professional and profession-state relationships forged over time. A number of factors have converged that place new pressures on workforce boundaries, including an unmet demand for some healthcare services; neo-liberal management philosophies and a greater emphasis on consumer preferences than professional-led services. To date, however, there has been little analysis of the evolution of the workforce as a whole. The discussion of workforce change that has taken place has largely been from the perspective of individual disciplines. Yet the dynamic boundaries of each discipline mean that there is an interrelationship between the components of the workforce that cannot be ignored. The purpose of this paper is to describe four directions in which the existing workforce can change: diversification; specialisation and vertical and horizontal substitution, and to discuss the implications of these changes for the workforce. [ABSTRACT FROM AUTHOR]

This paper draws on two reception studies. One focuses on an American medical drama which respondents perceived as entertainment but also as a reliable source of information from which they collected medical and social data by using emotional and ludic strategies. The second compares parallel illness narratives in a soap opera and a documentary. Soap operas were described by informants as good pedagogic tools because they attracted large audiences and promoted identification and repetition which enhance learning. On the other hand, they criticised the documentary for being incomplete and artificial. The conclusion argues that viewers are media-literate, astute and insightful. They produce sophisticated, subtle interpretations which cannot be predicted by content analyses of programmes alone. More reception research is therefore needed, particularly since television is increasingly omnipresent and provides a considerable portion of the public's medical knowledge. [ABSTRACT FROM AUTHOR]

Over the last two decades the repositioning of state-funded health systems and the increased use of private services have been the focus of extensive public debate. This paper explores the ways in which media coverage of healthcare reform is made sense of by lower socio-economic status (SES) audiences. We presented television documentaries to participants and analysed their accounts from focus group discussions following the viewing. We explore these discussions as shared social spaces within which participants work through the dilemmas posed by the reforms. In exploring reception as a storytelling process, we link audience and lay beliefs research and investigate how aspects of television coverage are appropriated by viewers to make sense of the causes and implications of healthcare reform. [ABSTRACT FROM AUTHOR]

Abstract This paper contributes to debate on social constructionism in the sociology of health and illness through a study of injury among ballet dancers. In this empirical study of classical ballet dancers, we outline a phenomenology of the injured and ageing body in terms of a critical commentary on constructionism. We explore dancers’ experiences of embodiment to illustrate our critique of recent interpretations of dance as a textual practice. Those forms of social constructionism that define the body as a text provide a forceful attack on discourses of authority and legitimation, but we argue that they are problematic as epistemologies and ontologies of embodiment. Through a phenomenological understanding of the experiences of embodiment, we observe how injury and ageing disrupt the practical accomplishments that underpin the ballet habitus and the dancer's identity. Although ballet injuries can terminate a dancing career, they are accepted as an inevitable part of the vocation of ballet. Our aim is to understand the interaction between injuries, dancers’ experiences of discomfort and the social support that emerges from the ballet dancers as a social group. We draw on the concepts of social solidarity and collective consciousness in Emile Durkheim to show that injury is mediated through the social bonding of dancers into a professional ballet company, where injury is accepted as a sign of vocational commitment, and suggest that this ‘collective effervescence’ gives a novel meaning to the idea of a corps de ballet. [ABSTRACT FROM AUTHOR]

The paper focuses on the redistribution of medical work within primary health care teams. It reports the results of the analysis of interviews with general practitioners, practice nurses and managers, undertaken as part of an ethnographic study of primary care organisation and practice during a period of rapid organisational change. By examining the ways in which the respondents account for how work is being redefined and redistributed, we explore how current government policy and professional discourses combine to reconfigure both the identities of those who work in primary care and the nature of patienthood. In particular, we show how general practitioners are being reconfigured as medical specialists or consultants in ways that seem to depart radically from earlier claims that general practice is a distinctive field of social or biographical medicine. Within this new discourse medical work is distributed between doctors, nurses and unqualified staff in ways which make explicit the reduction of general practice work to sets of biomedical problems or tasks. At the same time, the devolution of much general practice work to less qualified and cheaper personnel is justified by drawing on a discourse of person-centred medicine. [ABSTRACT FROM AUTHOR]

This paper describes how the categorisation of patients by staff in a French emergency department (ED) leads to the micro-rationing of care. Although ED staff are reluctant to acknowledge it, they refuse to treat many would-be patients at the reception stage, and advise them to go to other care settings (such as general practitioners’ premises or social dispensaries). The study analyses the judgmental categories staff use to decide patients’ eligibility for care, paying particular attention to their clinical, organisational, moral and social dimensions. Staff ration care at the point of service delivery but they soften the harshness of the rationing by making a positive discrimination in favour of those seen to be in real need. Data from observations and interviews are used to analyse the tensions between the different models of ‘local justice’ employed by doctors. [ABSTRACT FROM AUTHOR]

Social scientists of medicine have largely, although by no means exclusively, focused their research on illness and sickness thus obscuring social scientific investigations of positive health and wellbeing. Undoubtedly, important reasons exist for this but the relevance of studying `healthy' bodies requires emphasis and wider acknowledgement within the newer (embodied, non-dualistic) sociology of health and illness. This is necessary because the concrete corporeal manifestations of `health' in everyday life - components of and preconditions for embodied social practice - may, paradoxically, erode bodily capital while simultaneously contributing to it. Using qualitative data generated during an ethnography of bodybuilding subculture, this paper contributes to the sociology of `healthy' (transgressive) bodies. it describes the somatic representation of health and youth, the so-called erotics of the gym and the perceived benefits of anaerobic exercise for everyday pragmatic embodiment. Contra critical feminist studies, it furthers an appreciative understanding of `risky' bodywork in post- or late modernity and underscores the value of bringing healthy lived bodies into medical sociology. [ABSTRACT FROM AUTHOR]

This paper addresses the impact on midwifery of its recent integration into the provincial health care system in Ontario, Canada. Data are derived from participant-observation, primary and secondary source documents, and key informant interviews. Based on these data. I argue that midwifery has changed throughout the integration process but it has also successfully resisted change Specifically, the organisation of the midwifery community evolved from an amorphous social movement to a more bureaucratically organised professor The regulation of midwifery also shifted from direct-regulation by clients to professional self-regulation. The educational model of midwifery also changed from an eclectic apprentice-based approach to a more standardised baccalaureate degree programme. The midwifery model of practice, however, was sustained. Although these changes occurred at the hands of key members of the midwifery community, they were made in response to the structural context of the health care system into which they were attempting to become integrated. [ABSTRACT FROM AUTHOR]

This paper sheds light on the debate about whether class inequalities have given way to new divisions by employment status, by comparing changes in health inequalities among British and Finnish men and women between 1986 and 1994. Britain experienced high unemployment in the early 1990s. We examine how these contrasting labour market situations have influenced changes in health inequalities by employment status narrowed among men, whereas in Britain they widened or remained stable, with a less strong pattern of change for women. We found similar or slightly larger health inequalities by class among all adults than among the currently employed, with larger class inequalities in health among the employed labour force because of the greater chance of a 'healthy worker effect'. [ABSTRACT FROM AUTHOR]

Working from a Foucauldian perspective, this paper examines the discourse of informal care and addresses three questions. When was it first possible to speak of 'the informal carer'? What are the characteristics of the discourse of informal care? And, what are the conditions of the possibility of the informal carer's recognition? Following an analysis of the appearance and conceptualisation of the informal carer in policy and related discourse since the 1970s, the visibility of this figure is situated in the context of the historical transformation of the medical gaze. It is argued that two broad axes of the gaze's ongoing transformation--its devolution to 'relays' and its extension to the whole population and the 'whole person'--underpinned the shift in emphasis from care in the community to care by the community in the 1970s, and the associated development of the discourse of informal care. [ABSTRACT FROM AUTHOR]

This paper examines the structure of popular conceptions of the new genetics, and assesses why genetics has been so readily accepted in medicine and in the public discourse. Adapting Rene Dubos' classic analysis, Mirage of Health, we examine the new genetics by comparing it to Dubos' analysis of the structure and limits of germ theory. Germ theory focuses on the internal rather than the external environment, emphasises a doctrine of specific aetiology, and adopts the metaphor of the body as a machine. The germ theory model narrowed our vision about disease aetiology, proved misleading in some cases, yet remained the basis for clinical medical models of disease. In recent years, genetics has moved to the cutting edge of medical research and thinking about disease and behaviour. The structure of popular conceptions of the new genetics shows remarkable parallels with germ theory. This has eased the acceptance of genetics but simultaneously raises questions about these genetic explanations. An appearance and allure of specificity privileges genetic explanations in the public discourse; on examination, this specificity may prove to be a mirage. [ABSTRACT FROM AUTHOR]

On the basis of a qualitative study of health in small enterprises, this paper attempts to theorise the social production of illness and injury in the workplace. Particular features of working life in small workplaces, especially their personalised social relations and low polarisation of employer-employee interests, shape workers' perceptions of the employment relationship and of health in relation to work. Strained authority relations at work can form a key social context in which health and injury are constructed. In situations of conflictful supervisory relations, bodily experiences can become 'problematised'. Meanings attributed to health conditions and the quality of the employment relationship are transformed and merged, prompting a questioning of the legitimacy of power asymmetries in the workplace and recognition of the conflicting interests of labour and capital. Bodily experiences and ill-health offer possibilities for resistance and become mediators of broader social tensions. Unheeded illness claims deepen feelings of distrust and blame, further causing labour relations to deteriorate, and re-producing the social conditions for illness. [ABSTRACT FROM AUTHOR]

Most work on ethnic inequalities in health in the UK has focused on genetic and cultural difference, ignoring issues relating to class disadvantage. However, more recent work, and that conducted in the US, suggests that material disadvantage might be crucial. Nevertheless, the wider sociological literature illustrates that ethnicity and 'race' cannot simply be reduced to class. This paper uses data from the Fourth National Survey of Ethnic Minorities to examine three alternative approaches to ethnic inequalities in health. Epidemiological approaches are driven by empirical findings and make little explicit acknowledgement of theoretical understandings of ethnicity, but they carry the assumption that ethnicity provides a natural and fixed division between population groups. Consequently, explanations for differences tend to be reduced to ahistoric and de-contextualised genetic and cultural factors. Structural approaches generally focus on material explanations for inequalities, but there are important methodological difficulties in assessing these. We also need to consider other elements of the structural disadvantage faced by ethnic minority groups, such as their experiences of racism or concentration in particular geographical locations. Approaches that focus on ethnic identity emphasise the importance of group affiliation and culture, while acknowledging the contingent and contextual nature of ethnicity. However, despite the promise carried by identity based approaches, there has been little empirical work undertaken. These varying approaches illustrate how important ethnic inequalities in health might be to a wider understanding of mechanisms producing inequalities in health. However, a concern with mechanisms in health inequalities research can lead to a focus on technical interventions along causal pathways, with the roots of health inequalities, wider social inequalities, being ignored. [ABSTRACT FROM AUTHOR]

South Asians have a high risk of heart disease in Britain and Italians low, and ere are corresponding differences in total energy and total fat intake. The present paper explores how far obligatory patterns of food intake exist in either group and are reflected in conventions of hospitality. Both groups are from peasant-based economies, where, despite the common pattern of low fat intake, food occupies a high proportion of family income, and is correspondingly important as a part of gift exchange in marriage, and as a bearer of collective meanings. Open-ended questions on meals suitable for family hospitality were asked of South Asian women (63 born abroad, 56 in Britain), and Italian women (39 abroad, 51 in Britain) together with 50 women from the general population, all aged 20-40 and resident in the West of Scotland urban area. The traditional family meal of the Glasgow general population corresponds to the cooked dinner described in South Wales, and suggests a pan- British cultural symbol. However traditional family hospitality meals play a more important part in the life of migrant South Asians and Italians than they do in the majority culture, and British-born South Asians maintain this pattern more than British-born Italians. This pattern of hospitality, in an economy where energy-dense foods are readily available, may result in high energy intake and increased coronary risk. However realisation of these implications, and increased weight consciousness, can lead to restoration of the traditional cardioprotective diet. [ABSTRACT FROM AUTHOR]

Male infertility has been under-researched, and in part this seems due to a strong reticence by men to talk to researchers about infertility. Rather than suggest possible features of male infertility that might lead to this reticence, this paper explores how researchers have themselves accounted for the high nonresponse rates. The analysis details the way in which social scientific reasoning about non-response incorporates both existing knowledge about infertility and everyday reasoning about health and illness. It is suggested that this process is a variant of a pervasive form of commonsense reasoning - the documentary method of interpretation. The interesting upshot of applying this method to non-response, is that an absence of information is 'condemned to be meaningful'. [ABSTRACT FROM AUTHOR]

In Australia and other western countries, research on the relationship between dietary intake and coronary heart disease has attracted wide news media coverage. One of the most recent issues to receive media attention is the role of cholesterol control in reducing the risk of coronary heart disease. News reports on cholesterol and diet have vacillated confusingly from supporting health promotional orthodoxy in warning individuals to monitor carefully their intake of certain substances such as fats, salt and cholesterol, to questioning the validity of such dietary control. This paper presents the findings of a study investigating media coverage of and the responses of members of the lay public to recent diet and cholesterol control controversies. Analysis found that while the participants commonly articulated concern about their diet, they also expressed a high degree of cynicism both in the news media's coverage and health promotional advice on diet and cholesterol control. Respondents drew upon discourses relating to the pleasurable nature of indulging oneself in eating, but also expressed moralistic discourses concerning the need to 'work' at being healthy, thus juggling the dialectic of health as control and health as release. The adage that 'everything in moderation' was the way to live one's life, regardless of official advice concerning dietary regulation, was commonly expressed as a strategy of coping with the confusions around diet. [ABSTRACT FROM AUTHOR]

This paper explores the relationship between unpaid domestic labour and health. Although the 'informal care' literature touches on the connection between aspects of domestic labour and health, sociologists have not engaged in a systematic analysis of the nature of this relationship. In the following discussion I examine i) the reasons why this relationship has been obscured, ii) possible ways forward in theorising the link and, iii) the under-recognised historical contribution made by domestic labourers to the improvement in the health status of the population in industrial Britain. In relation to the latter I critically examine the widely accepted 'McKeown thesis' (McKeown 1979) which postulates that falling mortality rates in late 19th and early 20th century Britain can be explained not by medical intervention but by rising standards of living and improved nutrition. I argue that in the McKeown thesis, and in the work of those like David Blanc (1987) who have examined it, the explanation for falling mortality rates is incomplete because it has not accounted for a then developing and expanding area of social activity, namely, domestic labour. [ABSTRACT FROM AUTHOR]

Theories of' pain have traditionally been dominated by biomedicine and concentrate upon its neurophysiological aspects, both in diagnosis and treatment. Hence, scientific medicine reduces the experience of pain to an elaborate broadcasting system of signals, rather than seeing it as moulded and shaped both by the individual and their particular socio-cultural context. Although pain lies at the intersection between biology and culture, making it an obvious topic for sociological investigation, scant attention has been paid to understanding beliefs about pain within the study of health and illness. A major impediment to a more adequate conceptualisation of pain is due to the manner in which it has been `medicalised', resulting in the inevitable Cartesian split between body and mind. Consequently, the dominant conceptualisation of pain has focused upon sensatwn, with the subsequent inference that it is able to be rationally and objectively measured. Yet as well as being a medical `problem', pain is an everyday experience. Moreover, sociological and phenomenological approaches to pain would add to, and enhance, existing bodies of knowledge and help to reclaim pain from the dominant scientific paradigm. In this paper, it is argued, firstly, that the elevation of sensation over emotion within medico-psychological approaches to pain, can be shown to be limiting and reductionist. Secondly, we attempt to show how insights from the newly-emerging sociological arenas of emotions and embodiment provide a framework which is able to both transcend the divide between mind and body and to develop a phenomeriological approach to pain. Finally, in order to bring the meaning of pain into fuller focus, we draw attention to the importance of studying theodices and narratives, as well as the cultural shaping and patterning of beliefs and responses to pain. [ABSTRACT FROM AUTHOR]

Over the years there has been increasing support from a number of different sources for General Practitioners and their primary health care teams to have greater involvement in prevention. However, while attention has been paid to what leading figures and official bodies such as the Royal College of General Practitioners say there has been less emphasis upon what the rank-and-file of GPs themselves think and feel about prevention. Hence, this paper reports on the results of a small-scale exploratory study of 40 GPs' perceptions of coronary heart disease (CHD) prevention. In particular it addresses three main issues: first, the value which GPs place upon prevention and their concepts of prevention; second, the extent to which they view prevention as problematic and the reasons given; finally, in the light of these issues, the manner in which they attempt to resolve these dilemmas. Whilst GPs appeared to positively endorse the principle of prevention, they nonetheless tended to view it as problematic and had limited personal involvement. In this respect five key themes emerged in GPs' accounts: i) that health promotion and prevention was tedious, dull and boring; ii) the constraints of rime and the manner in which it detracted from curative medicine; iii) the uncertainties of risk factor identification and interventions; iv) ambivalence towards the effectiveness of behavioural change and the problem of patient motivation, and finally; v) a concern that it represented a moral intrusion and inflated patients anxiety levels unnecessarily. Beyond the voicing of these concerns, the main way in which GPs attempted to resolve these dilemmas was by delegating much of this work to a new and relatively low-status member of the primary health care team: the practice nurse. [ABSTRACT FROM AUTHOR]