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The sociology of diagnosis has shown that diagnosis not only serves to label the underlying cause of disease but also to provide access to services and resources. Elaborating on this double‐affordance of diagnosis, this article examines how precision medicine reconfigures diagnosis as a label and as a process in regulatory and clinical settings. Reporting from an ethnographic case study of the introduction of immunotherapy for lung cancer, the paper unfolds the uncertainties involved in dissecting diagnosis into layers and examines the efforts and negotiations it takes to enable these layers to work both as clinical entities and regulative entities with the purpose of delineating access to treatment. I suggest that the work of subdividing diseases into molecularly defined categories for the purpose of delineating treatment‐eligible populations can be labelled 'diagnostic sub‐stratification' and argue that it is pertinent to understand the political capacity of this strategy. Diagnostic sub‐stratification involves a push of diagnosis from the clinic 'up' into the regulatory system and 'out' into the laboratories, obscuring who is accountable for the diagnostic categories employed to define patients' treatment access. [ABSTRACT FROM AUTHOR]

This article draws on 2 years' worth of ethnographic observation of team meetings to explore decision‐making in an NHS clinical genomics service. The focus of discussions was on ambiguous genomic results known as VUS or Variants of Uncertain Significance, which may be pathogenic but which also may turn out to be benign. In examining decision‐making around such results, we note how, in contrast to much policy and promotional material in this area, clinicians in these meetings (clinical geneticists and genetic counsellors) place great emphasis on parental phenotypes and whether the parents of a patient share the symptoms and signs of the suspected condition. This information is then combined with the result of genomic tests to decide whether the variant a patient has is responsible for their condition. This article explores the way in which clinicians attempt to flexibly enrol parents into genomic explanations through informal diagnosis of their possible phenotypes and the way in which actually meeting parents allows some clinicians to trump explanations based on documentary or photographic data. The paper sheds light on the way that earlier scholarly understandings of such decisions (around, say dysmorphology) remain relevant and explores claims that laboratory tests overrule clinical decision‐making. [ABSTRACT FROM AUTHOR]

This paper examines the citation counts of papers published in the first 25 years of the Sociology of Health and Illness. According to this measure only a small number of papers have made a major impact on the discipline of sociology of health and illness and an analysis of these select papers identifies some common themes. In particular, ‘successful’ papers have provided important theoretical constructs for the field while exploration of aspects of identity has been a recurrent focus. [ABSTRACT FROM AUTHOR]

This paper explores the potential of the perspective of epistemic injustice to reconcile medical sociology's attention to the micro level of experience and interpersonal exchange, and disability studies' focus on the macro level of oppressive structures. The first part of the paper provides an overview of the concept of epistemic injustice and its key instances—testimonial, hermeneutical, and contributory injustice. We also consider previous applications of the concept in the fields of health care and disability, and we contextualise our investigation by discussing key features of postsocialism from the perspective of epistemic injustice. In the second part, we explore specific epistemic injustices experienced by people who use disability support by drawing on interviews and focus groups conducted with parents of disabled children in present‐day Bulgaria. In our conclusion, we revisit our methodological and theoretical points about the potential of epistemic injustice to facilitate mutually beneficial exchanges between medical sociology and disability studies. [ABSTRACT FROM AUTHOR]

The article discusses information about the 27th Sociology of Health and Illness Monograph. Topics covered include the emergence of the construct of overdiagnosis, the impact of diagnostic, prognostic, and treatment uncertainty on the lay-professional interface, and organisational and health system level responses to uncertainty.

This paper draws attention to the health‐related work that disabled people do when engaging with rehabilitation services. Medical sociology has a rich history of looking at the 'illness work' that patients do, while disability studies scholars have explored the cultural value placed upon paid work and the effects on social status of being unable to work. Yet, a longstanding froideur between these two disciplines, which have fundamentally opposed ontologies of illness and disability, means that neither discipline has attended closely to the rehabilitation‐related work that disabled people do. The concept of 'adjusting' to illness highlights seemingly irreconcilable disciplinary differences. Yet this article argues that the notion of 'adjustment work' can elucidate the socio‐political character of the work disabled people do in their rehabilitation, which could create a more substantial and sustainable dialogue on this subject between disability studies and medical sociology. To make this case, we discuss interview data from the Rights‐based Rehabilitation project, which sought to explore disabled people's lived experiences of rehabilitation. [ABSTRACT FROM AUTHOR]

The shift towards recovery‐oriented mental health care has led to the extensive growth of peer support in contemporary service delivery. When enacting peer support, peer workers (PWs) use their lived experiences of mental illness to provide support to individuals experiencing mental health difficulties. While PWs are increasingly an integrated part of mental health services, the way in which peer support unfolds in everyday practices remains understudied. Drawing on ethnographic fieldwork from Danish mental health centres, this paper investigates how peer workers and users enact experiential knowledge and expertise to support one another. Theoretically, this paper draws on a micro‐sociological approach that comprehends expertise as an interactional accomplishment enacted within institutional arrangements. First, the analysis shows how PWs and users develop affective relations based on shared illness experiences that enable the enactment of expertise. Second, it demonstrates how PWs and users engage in these relations by exchanging sympathy and knowledge according to different situational demands. Third, it shows how experiences of relational limitations make service users contest the value of experiential knowledge and PWs' position as valid experts. Centrally, this paper contributes to a general discussion of expertise and the implications of bringing lived experiences into mental health services. [ABSTRACT FROM AUTHOR]

The notion of digital health often remains an empty signifier, employed strategically for a vast array of demands to attract investments and legitimise reforms. Rather scarce are attempts to develop digital health towards an analytic notion that provides avenues for understanding the ongoing transformations in health care. This article develops a sociomaterial approach to understanding digital health, showing how digitalisation affords practices of health and medicine to cope with and utilise the combined and interrelated challenges of increases in quantification (data‐intensive medicine), varieties of connectivity (telemedicine), and unprecedented modes of instantaneous calculation (algorithmic medicine). This enables an engagement with questions about what forms of knowledge, relationships and control are produced through different manifestations of digital health. The paper then sets out, in detail, three innovative strategies that can guide explorations and negotiations into the type of care we want to achieve through digital transformation. These strategies embed Karen Barad's concept of agential cuts suggesting that responsible cuts towards the materialisation of digital health require participatory efforts that recognise the affordances and the generativity of technology developments. Through the sociomaterial approach presented in this article, we aim to lay the foundations to reorient and sensitise innovation and care processes in order to create new possibilities and value‐centric approaches for promoting health in digital societies as opposed to promoting digital health per se. [ABSTRACT FROM AUTHOR]

The lack of ethnic diversity in health research participation is a multi‐dimensional problem. Racism and intersectional disadvantage compel us to use racial and ethnic categories to explore health, but race theorists warn that these can be essentialising and pathologising. Yet, the alternative, the pursuit of colour‐blindness, can render the impact of race and ethnicity on health invisible. This paper describes the attempt to recruit an ethnically diverse sample to inform the development of an intervention for stroke patients. The study revealed deep uncertainties and tensions, which we use to re‐examine our own positionalities and perspectives. We focus on the experiences of researchers and participants to show how 'usual' research practices are unwittingly exclusionary and promote 'methodological whiteness' (The British Journal of Sociology, 2017, 68, S214). Calls for greater diversity in research are frequently made, yet health research remains tainted by the use of problematic epistemological starting points, rendering participation by minoritised people uneasy. Medical sociologists, especially those engaged in clinical trials, have a vital role to play in recalibrating health research to attend to ethnicity and race. This requires us to reflect on our practices, to recognise where we are complicit in replicating social inequalities and to actively engage with communities to produce more inclusive research. [ABSTRACT FROM AUTHOR]

This paper draws on the experience of two Romani and three non‐Romani scholars in knowledge production on the health and social inequalities experienced by European Roma populations. Together, we explore how we might better account for, and work against, the complex web of dynamic oppressions embedded within processes of academic knowledge production. Our aim is to encourage careful scrutiny through which sociologists of health and illness might better recognise our own complicity with oppression and identify concrete actions towards transforming our research practices. Drawing on a well‐known domains of racism typology (Annual Review of Public Health, 40, 2019, 105), we use examples from our own work to illustrate three interconnected domains of oppression in which we have found ourselves entangled (structural, cultural and interpersonal). A new conceptual framework is proposed as an aid to understanding the spectrum of different "types" of complicity (voluntary–involuntary, conscious–unconscious) that one might reproduce across all three domains. We conclude by exploring how sociologists of health and illness might promote a more actively anti‐racist research agenda, identifying and challenging subtle, hidden and embedded negative ideologies and practices as well as more obviously oppressive ones. We hope these reflections will help revitalise important conversations. [ABSTRACT FROM AUTHOR]

This article offers an overview of an Indigenous‐led participatory research project, The Future We Dream, co‐developed by rural land defenders in Central America and the Caribbean. To engage in recent dialectics concerning complicity and decolonising methodologies, we centre Indigenous Maya conceptions of health, wellbeing and what 'living well' means to community members. For context, The Future We Dream responds to the 2015 landmark ruling made by the Caribbean Court of Justice affirming the land rights of the Maya people of Southern Belize. Amidst tensions with the state that followed the ruling, an autonomous movement composed of grassroots organisers turned their attention towards imagining and constructing a self‐determined future. In turn, the communities initiated a research exercise inspired by desire‐based methodologies (Tuck, 2009) to articulate a collective vision of a healthful Maya future outside of colonial‐liberal worldviews, and notably, formulating Maya visions of healthful, sustainable worlds. In reporting on this one example of grassroots, anticolonial health research that departs from the hierarchal knowledge production practices of liberal academia, this paper details the collaborative process/project; the complexities/complicities of research involving Indigenous communities; and how Indigenous epistemologies are generative vis‐a‐vis unsettling conventional knowledge production practices in the contentious field of global health research. [ABSTRACT FROM AUTHOR]

The article provides insights on the urgent need for transformative responses in health and social care services due to challenges such as aging populations, chronic illnesses, infrastructure underinvestment, and workforce shortages. It presents papers that examine different aspects of these transformations, including the adoption of single-handed care.

This paper takes a critical look at the role of chronobiology in society today, with particular reference to its entanglements with health and medicine and whether or not this amounts to the (bio)medicalisation of our bodily rhythms. What we have here, we show, is a complex unfolding storyline, within and beyond medicine. On the one hand, the promises and problems of these circadian, infradian and ultradian rhythms for our health and well‐being are now increasingly emphasised. On the other hand, a variety of new rhythmic interventions and forms of governance are now emerging within and beyond medicine, from chronotherapies and chronopharmacology to biocompatible school and work schedules, and from chronodiets to the optimisation of all we do according to our 'chronotypes'. Conceptualising these developments, we suggest challenges us to think within and beyond medicalisation to wider processes of biomedicalisation and the biopolitics of our body clocks: a vital new strand of chronopolitics today indeed which implicates us all in sickness and in health as the very embodiment of these rhythms of life itself. The paper concludes with a call for further research on these complex unfolding relations between chronobiology, health and society in these desynchronised times of ours. [ABSTRACT FROM AUTHOR]

This paper contributes to the debate on the patient–doctor relationship by focussing on a specific chronic disease: type 1 diabetes. This field is characterised by an increasing use of technology, specifically therapeutic devices and a significant requirement of patient self‐management. This paper presents the main findings of research conducted in Italy in 2018. It is argued that this relationship is more properly described as an interdependent figuration of actors characterised by a dynamic process of power balances, which recalls Elias' (What is sociology? Columbia University Press, 1978) figurational‐processual and relational sociology. In this theoretical context, patients may manage their (dis)satisfaction with their diabetologists by choosing different behaviours that stem from Hirschman's archetype (Exit, voice, and loyalty. Responses to decline firms, organizations, and states. Harvard University Press, 1970): voice, exit, loyalty and, we would add, resignation. These categories are fluid, and all of them can be experienced by patients over time, depending on the quality of the figurations built among these transactors. [ABSTRACT FROM AUTHOR]

Digital technologies are increasingly embedded in clinical encounters, reconfiguring the basis on which health care is delivered. Thereby, the delivery of care shifts from territorial locations in clinics and temporal modes of co‐presence towards digital platforms. Drawing on a sociotechnical evaluation of digitised patient follow‐up in HIV care, this paper argues that the forms of interactivity practised in platform encounters cannot be adequately understood through traditional interaction frameworks such as Erving Goffman's interaction order. To conceptualise the new informational space and temporal mode of 'response presence' within which platform encounters are conducted, the paper draws on theoretical advances made by Karin Knorr Cetina who further developed Goffman's interaction order to describe interactions augmented by 'scopic media'. A comprehensive framework is presented to elaborate the distinct qualities of interactions occurring in face‐to‐face, tele‐interaction and platform encounters and to analyse their affordances based on doctor and patient experiences. This framework is intended to stimulate further research on how new interactional forms between doctors and patients will reconfigure roles and responsibilities as well as wider structures of digital society. Furthermore, it can also support practical guidance of when and how different forms of clinical encounters may be integrated in care pathways. [ABSTRACT FROM AUTHOR]

This paper critically explores the research and development of 'digital phenotyping', which broadly refers to the idea that digital data can measure and predict people's mental health as well as their potential risk for mental ill health. Despite increasing research and efforts to digitally track and predict ill mental health, there has been little sociological and critical engagement with this field. This paper aims to fill this gap by introducing digital phenotyping to the social sciences. We explore the origins of digital phenotyping, the concept of the digital phenotype and its potential for benefit, linking these to broader developments within the field of 'mental health sensing'. We then critically discuss the technology, offering three critiques. First, that there may be assumptions of normality and bias present in the use of algorithms; second, we critique the idea that digital data can act as a proxy for social life; and third that the often biological language employed in this field risks reifying mental health problems. Our aim is not to discredit the scientific work in this area, but rather to call for scientists to remain reflexive in their work, and for more social science engagement in this area. [ABSTRACT FROM AUTHOR]

In this collection we revisit the enduring phenomenon of uncertainty in health care, and demonstrate how it still offers coherence and significance as an analytic concept. Through empirical studies of contemporary examples of health care related uncertainties and their management, our collection explores the different ways in which uncertainty may be articulated, enacted and experienced. The papers address a diverse range of healthcare contexts ‐ Alzheimer's disease, neonatal surgery, cardiovascular disease prevention, cancer, addiction (use of alcohol and other drugs during pregnancy), mental health/disorders and medical education – and many tackle issues of contemporary relevance, such as an ageing population, and novel medical interventions and their sequelae. These empirical papers are complemented by a further theoretical contribution, which considers the role of 'implicit normativity' in masking and containing potential ethical uncertainty. By mapping themes across the collection, in this introduction we present a number of core analytical strands: (1) conceptualising uncertainty; (2) intersections of uncertainty with aspects of care; (3) managing uncertainty; and (4) structural constraints, economic austerity and uncertainty work. We reflect on the methodological and theoretical stances used to think sociologically about uncertainty in health care, and the strengths, silences and gaps we observe in the collection. We conclude by considering the implications of the insights gained for 'synthesising certainty' in practice and for future research in this area. [ABSTRACT FROM AUTHOR]

In this editorial introduction, we explore how digital health is being explored at the intersection of sociology of health and science and technology studies (STS). We suggest that socio‐material approaches and practice theories provide a shared space within which productive tensions between sociology of health and STS can continue. These tensions emerge around the long‐standing challenges of avoiding technological determinism while maintaining a clear focus on the materiality and agency of technologies and recognising enduring sets of relations that emerge in new digital health practices while avoiding social determinism. The papers in this Special Issue explore diverse fields of healthcare (e.g. reproductive health, primary care, diabetes management, mental health) within which heterogenous technologies (e.g. health apps, mobile platforms, smart textiles, time‐lapse imaging) are becoming increasingly embedded. By synthesising the main arguments and contributions in each paper, we elaborate on four key dimensions within which digital technologies create ambivalence and (re)configure health practices. First, promissory digital health highlights contradictory virtues within discourses that configure digital health. Second, (re)configuring knowledge outlines ambivalences of navigating new information environments and handling quantified data. Third, (re)configuring connectivity explores the relationships that evolve through digital networks. Fourth, (re)configuring control explores how new forms of power are inscribed and handled within algorithmic decision‐making in health. We argue that these dimensions offer fruitful perspectives along which digital health can be explored across a range of technologies and health practices. We conclude by highlighting applications, methods and dimensions of digital health that require further research. [ABSTRACT FROM AUTHOR]

The "problem" of public resistance to hospital closure is a recurring trope in health policy debates around the world. Recent papers have argued that when it comes to major change to hospitals, "the public" cannot be persuaded by clinical evidence, and that mechanisms of public involvement are ill‐equipped to reconcile opposition with management desire for radical change. This paper presents data from in‐depth qualitative case studies of three hospital change processes in Scotland's National Health Service, including interviews with 44 members of the public. Informed by sociological accounts of both hospitals and publics as heterogeneous, shifting entities, I explore how hospitals play meaningful roles within their communities. I identify community responses to change proposals which go beyond simple opposition, including evading, engaging with and acquiescing to changes. Explicating both hospitals and the publics they serve as complex social phenomena strengthens the case for policy and practice to prioritise dialogic processes of engagement. It also demonstrates the continuing value of careful, empirical research into public perspectives on contentious healthcare issues in the context of everyday life. [ABSTRACT FROM AUTHOR]

Over two decades, the checklist has risen to prominence in healthcare improvement. This paper contributes to the debate between its proponents and critics, making the case for an Science and Technology Studies‐informed understanding of the checklist that demonstrates the limitations of both the "checklist‐as‐panacea" and "checklist‐as‐socially‐determined" positions. Attending to the checklist as a socio‐material object endowed with affordances that call upon clinicians to act (Allen 2012, Hutchby 2001), the study revisits the efforts of a recent improvement initiative, the Enhanced Peri‐Operative Care for High‐risk patients trial. Rather than a singularised simple tool, this study discusses four different and relationally enacted logics of the checklist as a stop and check tool, a clinical prompt, an audit tool and a clinical record. Each logic is associated with specific temporality, beneficiaries, relationship with material forms, and interpellates (Law 2002) clinicians to initiate specific actions which can conflict. The paper seeks to make the case for intervention to improve such tools and consciously account for the consequences of their design and materiality and calls for supporting such settings and arrangements in which incoherences collected in tools can be locally negotiated. [ABSTRACT FROM AUTHOR]

The materialist thread within health sociology has observed a clear gradient linking inequalities in health with measures of social class and poverty. More recently, Bourdieu's approach to social class complemented the 'economic capital' of Marxist analysis with 'symbolic' capitals such as 'social' and 'cultural'. However, efforts to assess how symbolic capital interacts with health disparities reveal complex or contradictory effects. In this paper, we re‐materialise the study of health and social position via a new materialist focus on the interactions between humans and non‐human matter (NHM). We analyse empirical data to disclose the range of human/NHM interactions in daily life, and how these affect people's health status. These interactions establish physical, psychological and social opportunities and constraints on what human bodies can do, contributing to relative advantages and disadvantages. We argue for a revised materialist understanding of sociomaterial position as constituted by a 'thousand tiny dis/advantages', and suggest that health and wellbeing are inextricably linked to dis/advantage. [ABSTRACT FROM AUTHOR]

Forms of large‐scale change, such as the regiona l re‐distribution of clinical services, are an enduring reform orthodoxy in health systems of high‐income countries. The topic is of relevance and importance to medical sociology because of the way that large‐scale change significantly disrupts and transforms therapeutic landscapes, relationships and practices. In this paper we review the literature on large‐scale change. We find that the literature is dominated by competing forms of knowledge, such as health services research, and show how sociology can contribute new and critical perspectives and insights on what is for many people a troubling issue. [ABSTRACT FROM AUTHOR]

Accompanying the ageing of contemporary ageing societies is an increase in age associated morbidity, with dementia having an important impact. Mental frailty in later life is a source of fear for many and a major policy concern to all those concerned with health and welfare services. This introduction to the special issue on 'Ageing, dementia and the social mind' situates the selected papers within the context of debates about dementia and its social relations. In particular it draws attention to the importance of the social imaginary of the fourth age and what this means for the issue of personhood, care, social representations of dementia and its social contextualisation. The papers illuminating these themes draw on a variety of disciplines and approaches; from the social sciences to the humanities and from the theoretical to the empirical in order to help orientate future researchers to the complexities of dementia and the social and cultural matrix in which it exists. This paper provides an introduction to the potential for a more extended sociology of dementia; one which could combine the insights from medical sociology with the concerns of social gerontology. [ABSTRACT FROM AUTHOR]

Attending to the material discursive constructions of the patient body within cone beam computed tomography ( CBCT) imaging in radiotherapy treatments, in this paper I describe how bodies and machines co-create images. Using an analytical framework inspired by Science and Technology Studies and Feminist Technoscience, I describe the interplay between machines and bodies and the implications of materialities and agency. I argue that patients' bodies play a part in producing scans within acceptable limits of machines as set out through organisational arrangements. In doing so I argue that bodies are fabricated into the order of work prescribed and embedded within and around the CBCT system, becoming, not only the subject of resulting images, but part of that image. The scan is not therefore a representation of a passive subject (a body) but co-produced by the work of practitioners and patients who actively control (and contort) and discipline their body according to protocols and instructions and the CBCT system. In this way I suggest they are ' con-forming' the CBCT image. A Virtual Abstract of this paper can be found at: . [ABSTRACT FROM AUTHOR]

Medicalisation has been an important concept in sociological discussions of medicine since its adoption by medical sociologists in the early 1970s. Yet it has been criticised by some sociologists, in part because it seems too negative about medicine, and modified or replaced by others with concepts deemed more relevant like biomedicalisation and pharmaceuticalisation. My aim in this paper is to reassess the concept and consider whether it still has value in exploring significant aspects of the role of medicine in present-day society. I start with an archaeology of the concept's development and the different ways it has been used. This covers some familiar ground but is essential to the main task: examining criticisms of the concept and assessing its value. I conclude that the concept continues to have a crucial and productive place in sociological analyses of medicine and that the process of medicalisation is still a key feature of late-modern social life and culture. [ABSTRACT FROM AUTHOR]

Within western cultures, portrayals of dementia as 'a living death' are being challenged by people living with the diagnosis. Yet dementia remains one of the most feared conditions. The sociological lens of citizenship provides a conceptual framework for reviewing the role of society and culture in repositioning dementia away from deficit to a discourse of agency and interdependence. Awareness of cognitive change, and engaging with the diagnostic process, moves people into a transitional, or 'liminal' state of uncertainty. They are no longer able to return to their previous status, but may resist the unwanted status of 'person with dementia'. Drawing on qualitative studies on social participation by people with dementia, we suggest that whether people are able to move beyond the liminal phase depends on acceptance of the diagnosis, social capital, personal and cultural beliefs, the responses of others and comorbidities. Some people publicly embrace a new identity whereas others withdraw, or are withdrawn, from society to live in the shadow of the fourth age. We suggest narratives of deficit fail to reflect the agency people with dementia can enact to shape their social worlds in ways which enable them to establish post-liminal citizen roles. (A Virtual Abstract of this paper can be viewed at: ) [ABSTRACT FROM AUTHOR]

This paper argues for the importance of a broad sociological engagement with bioethics. It begins by considering why sociologists should be interested in bioethics and then goes on to explore the cognitive critique of bioethics developed by ethnographers. Some of these authors have also suggested that a more robust bioethics might emerge through the incorporation of the tools of ethnographic analysis. In this paper, it is argued that this is an important claim which needs to be analysed further and that Foucault's concept of discursive formations provides a useful framework for doing so. Once bioethics is redescribed as a discursive formation, the paper explores the challenges and obstacles that sociology and ethnography face in their attempt to open up a space for themselves in bioethics. The paper concludes by suggesting that sociologists and ethnographers need to reflect on the ways in which they might democratically secure legitimacy for their own claims in the field of social ethics. [ABSTRACT FROM AUTHOR]

The aim of this paper is to present an interpretation of the accounts of depression provided by women from South Asian communities. The paper presents the findings from a qualitative study, conducted in the UK, which explored women from South Asian communities and their experiences of depression. It is argued here, through examples of women's accounts of their experiences, that depression is 'embodied', that is, grounded in the materiality of the body which is also immersed in subjective experiences and in the social context of women's lives.Qualitative data were collected from four focus groups and ten individual interviews with women. The analysis involved a discursive approach.Analysis revealed how women made strategic choices in how they presented their symptoms as legitimate and for gaining access to what they perceived to be appropriate healthcare. This is not to argue that this is a culturally specific phenomenon but one which is a feature of all healthcare negotiations. [ABSTRACT FROM AUTHOR]

Sociologists have researched the subject of illness behaviour for more than five decades. Recently the discussion has taken on new importance because of changes in the delivery of health care and the emergence of patients' rights and increased patient knowledge of medicine. Through a selective review of the literature on illness behaviour, the paper aims to show that singular and segmented approaches to illness behaviour have not clearly elucidated the complexity of the phenomenon. A more comprehensive and structured analysis of illness behaviour can be accomplished with mixed qualitative and hierarchical/structural quantitative techniques. Following a discussion of prior research in social psychology, demography, economics, social networks and geographic systems, this paper offers a template for future analysis of illness behaviour. [ABSTRACT FROM AUTHOR]

The concept of social structure is one of the main building blocks of the social sciences, but it lacks any precise technical definition within general sociological theory. This paper reviews the way in which the concept has been deployed within medical sociology, arguing that in recent times it has been used primarily as a frame for the sociological interpretation of health inequalities and their social determinants. It goes on to examine the contribution that medical sociologists have made to the debate over health inequalities, giving particular attention to contributions to Sociology of Health and Illness. These have often provided a focus for discussions outside or critical of the mainstream debates that have been driven primarily by epidemiologists. The paper reviews some of the main points of criticism of epidemiological approaches, focusing in particular on the methodological constraints that limit the capacity of epidemiologists to develop more theoretically satisfactory accounts of the inter–relationships of social structure, context and agency in their impact on health and well being. Some recent examples from the Journal of more theoretically innovative and analytically fine–grained approaches to understanding the impact of social structure on health are then explored. The paper concludes with an argument for a more historically–informed analysis of the relationships between social structure and health, using the knowledgeable narratives of people in places as a window onto those relationships. [ABSTRACT FROM AUTHOR]

Based on interviews with 37 women with HIV infection, this paper explores women’s perceptions of HIV/AIDS in relation to other traumatic life events. Employing a biographical disruption framework, this paper demonstrates how women reconstruct the meaning of HIV infection in light of other disruptive life situations. Findings indicate that despite initial disruption, in retrospect, many of the sample women did not consider HIV to be the most devastating event in their lives. Rather, violence, mother-child separation, and drug use were deemed more disruptive than HIV infection. Several factors, including race, drug use and abuse histories, social support and diagnosis, were central to women’s differential assessment of HIV in relation to other disruptive events. Results are discussed in terms of the practical and theoretical implications of the analysis. [ABSTRACT FROM AUTHOR]

Sociologists appear to have abandoned the study of serious mental illness. This paper argues that the work of the disability theorists provides new directions for an analysis of the plight of people suffering from serious mental illness. Disability theory, revolving around a 'social approach to disability', redirects analysis from the individual to processes of social oppression, discrimination and exclusion. The application of the ideas of disability theorists to the study of mental ill health will orient research and theoretical development towards an analysis of the complexity and multiplicity of the social restrictions faced by people diagnosed as 'mentally ill', and the social disadvantage and oppression they face. A number of vigorous debates within the disability theory literature are examined. One debate addresses the political and theoretical implications of identifying the differences that exist between people with disabilities. A second debate examines the relative importance of including an analysis of impairment in the social approach to disability. Finally, the paper discusses the critique of medical sociology, linking illness with disability, which is advanced by some disability theorists. This debate is particularly concerned with the linking of illness with disability and the ideological and conceptual disadvantages of a focus on illness. [ABSTRACT FROM AUTHOR]

The sociology of childbirth emerged in the 1970s largely as a result of influences from outside sociology. These included feminism, maternity care activism, the increasing medicalisation of childbirth, and evidence-based health care. This paper uses the author's own sociological 'career' to map a journey through four decades of childbirth research. It demonstrates the importance of social networks and interdisciplinary work, particularly across the medical-social science divide and including cross-cultural perspectives, argues that the study of reproduction has facilitated methodological development within the social sciences, and suggests that childbirth remains on the periphery of mainstream sociological concerns. [ABSTRACT FROM AUTHOR]

Some scholars contend that genetic medicine is transforming the experience of illness and the social category of the family - bringing future risks into the present, and potentially strengthening familial biological bonds in light of these shared genetic risks. However, research has shown that genetic information is interpreted and acted upon through a rich repertoire of adaptable social, cultural and familial factors which pre-exist and interact with biomedical knowledge. This paper reports research into families living with Neurofibromatosis Type 1 ( NF1), a highly uncertain condition the manifestation of which can vary considerably also within the same family and, for this reason, has been defined as a 'condition without parameters'. These characteristics make NF1 a particularly informative condition for the examination of family dynamics around genetic information. The study and the methodology are based on the exploration of family networks and allow us to investigate the interrelation of individual and familial constructions of the uncertainty of NF1. This also allows both theoretical and policy claims to be made about the danger of reductionist thinking about the transformative potential of genetic technologies. [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]

Chronic obstructive pulmonary disease ( COPD) is a progressive illness that changes the lives of patients and their spouses dramatically. The aim of this paper is to show how spouses of COPD patients integrate their tasks as informal carers with their role as spouses and the tensions and challenges involved in this. The study draws on qualitative interviews with spouses of COPD patients, recruited from the patient pool of ambulatory pulmonary services of two hospitals in Oslo, Norway. The spouses described their great efforts to re-establish normality and continuity in their everyday lives. Accomplishing this was a delicate process because they faced several dilemmas in this work. They balanced the need to sustain the independence and integrity of both parties against the need to ensure safety and deal with the progression of the illness. We propose 'biographical we' as a concept that can highlight the great effort spouses put into establishing a sense of continuity in their lives. In times when healthcare policy involves mobilising informal caregiving resources, an awareness of the complexity of caregiving relationships is crucial when developing appropriate support for informal carers. [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]

While sociologists earlier this century often used insights derived from psychoanalytic theory in their writings, contemporary sociology has largely tended to ignore this body of work. This is as true of medical sociologists as it is of others, despite the fact that the 'founding father' of medical sociology, Talcott Parsons, used psychoanalytic perspectives extensively in his theorising on the social aspects of medicine and health. In this paper I make a case for a return to a medical sociology that incorporates understandings of subjectivity derived from psychoanalytic writings, with particular reference to the medical encounter and the illness experience. The paper begins with an overview of psychoanalytic sociology. I go on to review the major insights Parsons developed in his writings and the work of other writers who have more recently used psychoanalytic theory productively in theorising the sociocultural dimensions of medicine and health care. The paper concludes with some thoughts about future directions for taking up the psychoanalytic perspective in the sociology of health and illness. [ABSTRACT FROM AUTHOR]

In the article the authors comment on the views of sociologists Rona Campbell and Sam Porter, on a paper on feminist theory and the sociology of human reproduction written by them. The authors clarify that while feminists and midwives may hold ideas in common, feminist and midwifery practice are diverse and contested fields and there is no intrinsic affinity between the two. In their earlier paper they argued that feminism is not disinterested in its response to midwifery. It is further argued that differences which have become increasingly vociferous within feminism have tended to be neglected within the sociology of health and illness, and proposed that post-structuralist approaches might provide a fruitful, although certainly not unproblematic, counterpoint to a range of modernist feminist perspectives as they relate to gender and reproduction. In response to Campbell and Porter's criticism for ignoring recent midwifery and social science research on midwifery practice, it is clarified that the authors never intended to question midwifery's credentials in working with childbearing women.

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]

Abortion represents a particularly interesting subject for a social movements analysis of healthcare issues because of the involvement of both feminist pro-choice activists and a segment of the medical profession. Although both groups have long shared the same general goal of legal abortion, the alliance has over time been an uneasy one, and in many ways a contradictory one. This paper traces points of convergence as well as points of contention between the two groups, specifically: highlighting the tensions between the feminist view of abortion as a women-centred service, with a limited,‘technical’ role for the physicians, and the abortion-providing physicians’ logic of further medicalization/professional upgrading of abortion services as a response to the longstanding marginality and stigmatisation of abortion providers. Only by noting the evolving relationships between these two crucial sets of actors can one fully understand the contemporary abortion rights movement. We conclude by speculating about similar patterns in medical/lay relationships in other health social movements where‘dissident doctors’ and lay activists are similarly seeking recognition for medical services that are controversial. [ABSTRACT FROM AUTHOR]

This paper explores routine resource allocation processes in health and social care. While there has been a small body of work which has drawn on Lipsky's (1980) insights into street level bureaucracy, few have taken seriously the opportunity offered by ethnography to explore in detail the work of front-line staff as a way of observing policy processes in action. Utilising ethnographic data from research into the continuing care of adults who had suffered a first acute stroke, we analyse how staff accommodated patient need and consider the implications that this had for the quality, equality and equity of service provision. [ABSTRACT FROM AUTHOR]

This paper examines medical intake screening through the process of making appointments with medical specialists. By employing a multi-method, qualitative approach, it shows how decisions to schedule doctors' appointments are based on medical knowledge about physicians' specialties and specific organisational practices. It draws on insights from first-contact interactions between clients and institutional gatekeepers to enrich our understanding of intake screening. In relation to gatekeeping, rationing commonly gets framed as restrictive screening practices, with a preference for denying or limiting access to treatment. Restrictive screening practices are typically organised to elicit a narrow range of information ('facts') relevant to specific eligibility criteria; whereas inclusive intake screening tends to involve less scripted, more complex and open-ended interactional exchanges between workers and clients, wherein workers help clients frame their claims in ways that will increase their chances of getting accepted. Front-office workers hold a preference for inclusive intake screening, a preference that is undergirded by the referral-driven nature of this stage of patient processing, and by a work environment that favours inclusive screening. This finding builds on the literature within medical sociology, but also extends our understanding of frontline decision-making and the distribution of resources within a variety of people-processing institutions. [ABSTRACT FROM AUTHOR]

In this article, I describe the socio-technical organisation of surgical rehabilitation. After having gone through surgical intervention, patients are implicated within various types of medical work aimed at adjusting their bodies to post-operative social and material environments. My argument is that the process of re-establishment of a 'self' is mediated through a re-disposition of agency in the socio-technical ensemble upon which the patient depends immediately after surgery.Drawing on one year of ethnographic fieldwork in a neurosurgical clinic, and theoretical resources from science and technology studies, this paper is an attempt to describe how, within surgical post-operative practices, the relational dynamics of social and material components endorsed within those practices may re-institute patients' sense of themselves, and re-organise their relationship with the world and other people. In surgery, the outcome of this dynamic process is the reorganisation of forms of agency for the patient. I will refer to this reorganisation as 'detachment'. It is my contention that this research may contribute to the literature on the experience of chronic illness by specifying the socio-technical conditions for the local achievement of self and agency. [ABSTRACT FROM AUTHOR]

The article critiqued the paper "Expansion and Uncertainty: Cystic Fibrosis, Classification and Genetics," by Adam Hedgecoe, published in 2003. Hedgecoe explores the expansion of the cystic fibrosis continuum drawing on a previous study on the relationship between cystic fibrosis (CF) and a form of male infertility called Congenital Bilateral Absence of the Vas Deferens. The bulk of his analysis is based upon a review of two articles concerning CF and an outline of several discursive strategies that make a link between CF and male infertility. He supplements this with discussion of other more recent articles on the classification of CF. The argument is that the establishment of the CF clinical continuum involved dynamic processes of expansion and contraction and significant levels of interpretative flexibility.

Over the course of the 20th century, the menopause came to be viewed amongst the medical profession as a hormone deficiency state. This formulation of the menopause as a physiological and biochemical change, whilst in some ways appropriate, understates the importance of the social context in which the menopause is experienced. Drawing on women’s accounts of the menopause, as described in the comments section of a longitudinal national survey, this paper describes the experience of the menopause transition as a status passage (Glaser and Strauss 1971), where women move through a series of five stages: (1) expectation of symptoms; (2) experience of symptoms and loss of control; (3) confirmation of the menopause; (4) regaining control and (5) freedom from menstruation. The social changes experienced by women during this time are then considered as parallel status passages, often competing for attention with the menopause transition. These free comments made by women emphasise the importance of changing social relationships with partners, children and parents, and changes at work. We show that, whilst women conceive the menopause to be a medical event, they themselves place importance on the social context in which the menopause is experienced. We argue therefore that the predominantly lay term, the ‘change of life’, is appropriate to capture the multiplicity of biological and social changes that occur during midlife, of which menopause is only one part. [ABSTRACT FROM AUTHOR]

This paper examines lay accounts of illness and health gathered - by means of eight focus groups - from people living in two Cantonese-speaking communities in England. The authors concentrate on the manner in which Cantonese speakers recruit and mobilise various agents - such as traditional Chinese medicine (TCM), spirits, demons, food and the weather - to describe and explain aspects of their bodily and mental wellbeing. As well as providing information on what Cantonese speakers say about such matters, the data are also used to indicate how a concentration on 'accounts', rather than on 'beliefs', enables sociology to side-step a concern with the subjective and psychological and to focus, instead, on what is publicly available and verifiable. [ABSTRACT FROM AUTHOR]

Taking as its point of departure the contested nature of the body, in mainstream theory and the sociology of health and illness alike, this paper seeks, albeit tentatively, to chart a critical realist alternative to these debates using the controversial terrain of chronic illness and disability as a case study. A critical realist approach, it is suggested, enables us to: (i) bring the biological body, impaired or otherwise, 'back in'; (ii) relate the individual to society in a challenging, non-conflationary or non 'unidirectional' way; and (iii) rethink questions of identity, difference and the ethics of care through a commitment to real bodies and real selves, real lives and real worlds. Within all this, it is argued, modern medicine does indeed, contra disability theory and postmodern calls for the pursuit of so-called 'arche-health', have a continuing role to play in the mitigation of human pain and suffering, including the realities of chronic disabling illness conditions and the associated 'greying' of Western populations. [ABSTRACT FROM AUTHOR]

Using the implementation of the Griffiths Report as an example, this paper examines the way in which sociologists and others have examined the process of managing change within the NHS. Several studies of Griffiths have documented a number of unintended consequences of its implementation but it is argued that none of these have adequately theorised these unintended outcomes of the policy implementation process. It is suggested that the process-sociological approach of Norbert Elias, and in particular his game models, enable us better to understand the complex interweaving of planned and unplanned processes which is involved in all processes of managed change. [ABSTRACT FROM AUTHOR]