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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]

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]

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 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]

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]

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]

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]

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]

Discussion of the persistence of social class inequalities in health has led to greater interest being paid to differences between the classes in lay health beliefs. Recent work on lay health beliefs, however, has mainly viewed social class as a proxy for wider aspects of lifestyle and paid less attention to its occupational component. Part of this can be explained by its predominant focus on the health beliefs of women. This paper remedies this imbalance by focusing on male Glaswegians' perceptions of the health effects of their occupations. It shows that not only were respondents very aware of the influence their jobs had on their health but that they also took action to redress the balance, either by compensating for such effects or controlling their work environment to minimise their influence. Respondents' degree of commitment to their work also had a direct bearing on their coping styles. Although traditional occupational class measures were found to obscure much of how occupation influences health, unskilled and semi-skilled workers did suffer the greatest limitations in coping with the health effects of work. [ABSTRACT FROM AUTHOR]

In the routine compilation of statistics on the relation between occupation and ill-health it is usually possible to demonstrate links to certain physically demanding occupations. However, studies of the causal links between work and iii-health present problems. Besides the difficulties that often occur in collecting information on present and previous occupations, exposure periods, latency, duration, etc, the analysis and interpretations themselves are complicated. The aim of this paper is to study the interviewees' own views on whether or not any ill-health they may suffer could be caused by any particular job they may hold or have held in the past. Does one get the same picture of the relationship between occupation and ill-health as when routinely compiling statistics? The study population comprised 12,664 men and 12,942 women between 25 and 75 years of age. For all respondents, detailed occupational histories were recorded The results indicated that health problems are more common among persons who have or have had physically demanding work. On the other hand, in certain heavy jobs with high numbers of persons reporting long-term illnesses it is rare for individuals to blame their health problems on working conditions. Conversely, other occupations have relatively low numbers of persons with long-term illnesses, yet high proportions of these attribute their health problems to their work. [ABSTRACT FROM AUTHOR]

This paper looks at the issue of private health care from the perspective of black (Afro-Caribbean) women in Britain. The research on which it is based (Thorogood 1988) indicates that these women have a particular relationship to health care, one aspect of which is their use of private consultations with General Practitioners. This is, I suggest, a consequence of their historical and contemporary experiences. [ABSTRACT FROM AUTHOR]