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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]

Modern health‐care systems have customarily approached hepatitis C in ways that resemble the public health approach to HIV/AIDS known as 'HIV exceptionalism'. HIV exceptionalism describes the unusual emphasis on privacy, confidentiality and consent in approaches to HIV and was partly developed to address HIV/AIDS‐related stigma. In the case of hepatitis C, exceptionalist approaches have included diagnosis and treatment by specialist physicians and other 'boutique' public health strategies. The recent availability of highly effective, direct‐acting antivirals alongside goals to eliminate hepatitis C have heralded dramatic changes to hepatitis C health care, including calls for its 'normalisation'. The corollary to exceptionalism, normalisation aims to bring hepatitis C into routine, mainstream health care. This article draws on interviews with stakeholders (n = 30) who work with hepatitis C‐affected communities in policy, community, legal and advocacy settings in Australia, alongside Fraser et al.'s (2017, International Journal of Drug Policy, 44, 192–201) theorisation of stigma, and Rosenbrock et al.'s (1999, The AIDS policy cycle in Western Europe: from exceptionalism to normalisation. WZB Discussion Paper, No. P 99‐202) critique of normalisation to consider the perceived effects of hepatitis C normalisation. Stakeholders described normalisation as a stigma‐reducing process. However, they also expressed concerns about the ongoing stigma and discrimination that is not ameliorated by normalisation. We suggest that in centring normalisation, changes in health care may exaggerate the power of technological solutions to transform the meanings of hepatitis C. [ABSTRACT FROM AUTHOR]

Until recently, the noncommunicable disease (NCD) category was composed of four chronic diseases (cancer, cardiovascular disease, diabetes and chronic respiratory disease) and four shared, 'modifiable' behavioural risk factors (smoking, diet, physical activity and alcohol). In late 2018, the NCD category was expanded to include mental health as an additional disease outcome and air pollution as an explicit environmental risk factor. The newly‐expanded NCD category connects behavioural and environmental readings of risk and shifts attention from individual acts of consumption to unequal and inescapable conditions of environmental exposure. It thus renders the increasing 'toxicity' of everyday life amid ubiquitous environmental contamination a new conceptual and empirical concern for NCD research. It also, as this paper explores, signals a new 'optics' of a much‐maligned disease category. This is particularly significant as chronic disease research has long been siloed between public and environmental health, with each discipline operationalising the notion of the 'environment' as a source of disease causation in contrasting ways. Given this, this paper is positioned as a significant contribution to both research on NCDs and environmental risk, bringing these interdisciplinary domains into a new critical conversation around the concept of toxicity. [ABSTRACT FROM AUTHOR]

Amidst public health campaigns urging people to sit less as well as being more physically active, this paper investigates how older adults make sense of their sedentary behaviour. Using an accounts framework focusing on how people rationalise their sitting practices, we analysed data from 44 qualitative interviews with older adults. All interviewees had received information about sedentary behaviour and health, visual feedback on their own objectively measured sitting over a week and guidance on sitting less. Participants used accounts to position sitting as a moral practice, distinguishing between 'good' (active/'busy') and 'bad' (passive/'not busy') sitting. This allowed them to align themselves with acceptable (worthwhile) forms of sitting and distance themselves from other people whose sitting they viewed as less worthwhile. However, some participants also described needing to sit more as they got older. The findings suggest that some public health messaging may lead to stigmatisation around sitting. Future sedentary behaviour guidelines and public health campaigns should consider more relatable guidelines that consider the lived realities of ageing, and the individual and social factors that shape them. They should advocate finding a balance between sitting and moving that is appropriate for each person. [ABSTRACT FROM AUTHOR]

Evidence is accumulating of the negative impact of the COVID‐19 pandemic and related public health measures on mental health. In this emergent field, there has been little research into the role of risk perception on depressive symptoms and the contribution of health‐care resources to model risk perception and mental health. The aim of this paper is to describe the relationship between individual‐level perception of risk and depression, controlling for a set of confounders and for country‐level heterogeneity. A cross‐sectional and observational online survey was conducted using a non‐probability snowball sampling technique. We use data on 11,340 respondents, living in six European countries (Italy, Sweden, United Kingdom, France, Poland, Czech Republic) who completed survey questionnaires during the first months of the pandemic. We used a fixed‐effect approach, which included individual and macro‐level variables. The findings suggest that a high proportion of people suffering from depression and heightened risk perception is positively associated with reporting depressive symptoms, even if this relationship varies significantly between countries. Moreover, the association is moderated by contextual factors including health‐care expenditure as a percentage of Gross Domestic Product, hospital beds for acute care, and number of medical specialists per head of population. Investment in health care offers a concrete means of protecting the mental health of a population living under pandemic restrictions. [ABSTRACT FROM AUTHOR]

Despite the ubiquity of the body mass index (BMI) in discourse on health, there is ambiguity in its use as a biomarker of current abnormality versus future risk. This distinction is consequential for knowledge of the relationship between body size and health, as well as for individuals deemed to have abnormal and 'unhealthy' bodies. Consequently, the purposes of this review are threefold. The first is to differentiate this 'biomarker' perspective from extant critiques of BMI as a proxy for health behaviours or as the defining characteristic of obesity as a disease. The second is to highlight the shift towards treating BMI as a measure of attained unhealthiness, rather than a probabilistic indicator of risk. Finally, rather than call for the abolition of BMI, this paper argues that its continued use as 'just a number' is in keeping with the push for weight neutrality in research and practice. The review concludes by demonstrating how the riskiness and unhealthiness of body size is conflated in public health messaging on COVID‐19. BMI is a marker of risk, but its use as a surrogate for COVID‐19 severity equates body size with health, shaping beliefs about vulnerability and personal responsibility amid an ongoing pandemic. [ABSTRACT FROM AUTHOR]

The substantial literature in political economy and sociology has shown that the increasing importance of financial activities (financialisation) exhibits significant effects on many socioeconomic conditions. While these conditions are relevant to public health, the dominant focus of the literature has been centred on the impact of financial markets on health services and health‐care systems. This paper analyses how the financialisation of non‐financial corporations, real estate and pensions can worsen public health through the transformation of workplace and living conditions as well as financially dependent social groups' perception of health risk. Our analysis raises several questions which aim to provide the basis of a future research agenda on the effects of financialisation on public and global health. [ABSTRACT FROM AUTHOR]

Abstract: Research in the health sciences has been highly successful in revealing the aetiologies of many morbidities, particularly those involving the microbiology of communicable disease. This success has helped form a narrative to be found in numerous public health documents, about interventions to reduce the burden of non‐communicable diseases (e.g., obesity or alcohol related pathologies). These focus on tackling the purported pathogenic factors causing the diseases as a means of prevention. In this paper, we argue that this approach has been sub‐optimal. The mechanisms of aetiology and of prevention are sometimes significantly different and failure to make this distinction has hindered efforts at preventing non‐communicable diseases linked to diet, exercise and alcohol consumption. We propose a sociological approach as an alternative based on social practice theory. (A virtual abstract for this paper can be found at: https://www.youtube.com/channel/UC_979cmCmR9rLrKuD7z0ycA). [ABSTRACT FROM AUTHOR]

While social construction of illness research has examined the redefinition of medically defined illness as non‐illness by laypersons, nothing has considered this process alongside emerging infectious diseases (EIDs). Using Gidden's notion of modern risk society and distrust in expert authority, this paper examines how social media posts construct Zika virus as nonhazardous while displaying a distrust in research and prevention. Using qualitative content analysis, we examine 801 posts on the Centers for Disease Control and Prevention's (CDC) Facebook page to highlight the interplay between risk, the social construction of Zika and trust in experts. Three themes are discussed, including Zika: (i) as legitimate public health threat; (ii) as product of CDC corruption and (iii) used to question medical expertise. We find the latter two themes supportive of Gidden's focus on risk and distrust in expert authority and discuss the danger of constructing EIDs as products of corrupt expert authority on public health social media platforms. [ABSTRACT FROM AUTHOR]

This paper explores the tensions between UN calls for private sector engagement in the post-2015 landscape and public health opposition to those 'harm industries' that are 'corporate vectors of disease' for the mounting global non-communicable disease burden. The UN's support for public-private partnership has provided industries with 'vested interests' in the propagation of unhealthy behaviours with new opportunities for the strategic alignment of their corporate social responsibility ( CSR) endeavours with the post-2015 sustainable development agenda. This has galvanised public health advocates to place pressure on the World Health Organisation to formalise their ambiguous stance towards private sector involvement in public policy formation and the resultant 'conflicts of interest'. This paper critically examines the 'gathering storm' between this 'anti-corporate movement' and the alcohol industry in the increasingly politicised domain of CSR. Drawing on the example of SABMiller's Tavern Intervention Program, the paper argues that CSR represents a profound threat to the sanctity and moral authority of the public health worldview. Questions therefore need to be asked about whether the public health-led path of industry non-association will necessarily result in health improvements or just a further retrenchment of the ideological faultlines explored in the paper. [ABSTRACT FROM AUTHOR]

With the human papillomavirus (HPV) vaccine positioned as the "right tool" to protect girls' health and sexual health, public discourse positions parents as "responsible" if they vaccinate, "irresponsible" if they do not. The problem with this binary, however, is that it cannot account for the full spectrum of responsibilities and social norms that parents enact in vaccine decisions. In this paper, and in the context of low HPV vaccination rates, I confront this binary and encourage a fuller view of adolescent health and sexual health. Using data from qualitative semi‐structured interviews with 28 Canadian mothers tasked with consenting to the HPV vaccine, I examine the complexity of this responsibility. I find HPV vaccine‐consenting mothers have normative conceptualisations of responsibility aligned with dominant interpretations of public health. Rather than expressing irresponsibility, some non‐HPV vaccine‐consenting mothers articulated alternate responsibilities, aligned with broad efforts to manage their teens' sexual health and sexuality. They extend responsibility beyond cancer protection vis‐à‐vis vaccines to a general responsibility for daughters' sexual health and self‐esteem. In conclusion, I recommend the need for a broader public health approach to HPV, which includes, and goes beyond vaccination. Moreover, I suggest that some of these alternate responsibilities be viewed as complementary to vaccination. [ABSTRACT FROM AUTHOR]

This paper uses social practice theory to study the interweaving of walking into everyday practices and considers how greater awareness of everyday walking can influence its position within the organisation and scheduling of everyday life. Walking is of policy interest because of its perceived benefits for health. This paper asserts that increased awareness of everyday walking allows users to become more active without having to reschedule existing activities. Using Schatzki's distinction between dispersed and integrative practices, it argues that increasing awareness of dispersed walking can enlist walking into the teleoaffective organisation of some social practices and prompt the performance of new 'health practices' within everyday domains of life such as shopping and employment. While this analysis offers useful insights for the design of behaviour change strategies, it also points to some unintended consequences of using digital feedback to increase walking awareness. In directing the gaze of participants at one particular element of their daily practices, the paper suggests, digital walking feedback provides a 'partial' view of practices: by highlighting the exercise value of walking at the expense of other values it can prompt feedback recipients to pass moral judgements on themselves based on this partial view. A Virtual Abstract of this paper can be found at: [ABSTRACT FROM AUTHOR]

The last decade has seen the development of an important literature on the contradictions between neoliberal norms of corporal citizenship and the forms of consumption that market-based food systems promote. This paper seeks to contribute to the literature by exploring the relationship between these contradictions and the increased prevalence of particular eating disorders (binge eating disorder ( BED) and bulimia nervosa). Within contemporary neoliberal food systems bingeing is increasingly normalised and consumption temporally disorganised. At the same time, neoliberal public health policy, and the wider 'health' entertainment media it legitimates, focuses on the promotion of 'correct' forms of consumer agency. Individuals who fail to manage consumption 'appropriately' are stigmatised. The growth of bulimia and BED can be related to the contradictory pressures that the food system and regime of corporal governance place on individuals. The paper also seeks to explore how the increased medicalisation and biomedicalisation of eating since the 1980s fits within a broader neoliberal governance strategy. By medicalising key social problems the neoliberal state depoliticises these issues. Medicalisation and biomedicalisation obscure the role of capitalism in generating these problems and encourage a focus on individual dysfunction. [ABSTRACT FROM AUTHOR]

As governments and healthcare systems grow increasingly concerned with the current obesity ‘epidemic’, sociological interest in the condition has also increased. Despite the emergence of work discussing obesity as a social phenomenon, the sociological dimensions of medical weight-loss treatments for obesity remain underexplored. This paper reports on a conversation analytic (CA) study and describes how moral issues surrounding weight and patienthood become visible when doctors and patients discuss obesity. Consultations in two UK National Health Service clinics were video-recorded and analysed to identify recurring patterns of interaction. This paper describes how patients answer opening questions: questions which begin the consultation, enabling patients to report their medical status. Analysis reveals that when producing their answers, patients typically imply either ‘success’ or ‘lack of success’ in their weight-loss progress. Whilst doing so, they construct their personal agency in different ways, crediting themselves for implied successes and resisting responsibility for lack of success. Through interaction the doctor and patient collaboratively construct obesity as a moral issue. The moral obligations invoked share similarities with certain perceived normative dynamics surrounding obesity and the responsibilities of patienthood. These findings have relevance to healthcare practice and add to sociological understanding of the modern obesity ‘crisis’. [ABSTRACT FROM AUTHOR]

The paper seeks to identify and explain shifts in dominance relationships between the medical profession and allied health professions in Germany, taking the occupational fields of nursing and psychotherapy as examples. It suggests an actor-based perspective which focuses on the strategic interplay between collective actors in the fields in question, namely professional associations and unions, state actors, sickness funds, universities, polytechnics and associations of work organisations. It considers the context of governance of the German health care system and an awareness of a changed demand. The thesis is that the interplay between the actors has led to a small reduction of medical dominance. It is examined whether changes in governance structures of the health care system have led to a more favourable context for shifts in the dominance relationships. Moreover, the possible effects of the recent re-organisation of health provision are considered. Based on an empirical investigation using the method of document analysis, the paper shows that there has been a small reduction of medical dominance which is essentially the outcome of the interrelated strategic actions of various collective actors in the fields. A public perception of a new kind of health care demand has facilitated this development. [ABSTRACT FROM AUTHOR]

In response to widely documented racial and ethnic disparities in health, clinicians and public health advocates have taken great strides to implement ‘culturally competent’ care. While laudable, this important policy and intellectual endeavour has suffered from a lack of conceptual clarity and rigour. This paper develops a more careful conceptual model for understanding the role of culture in the clinical encounter, paying particular attention to the relationship between culture, contexts and social structures. Linking Bourdieu's (1977 ) notion of ‘habitus’ and William Sewell's (1992 ) axioms of multiple and intersecting structures, we theorise patient culture in terms of ‘hybrid habitus’. This conceptualisation of patient culture highlights three analytical dimensions: the multiplicity of schemas and resources available to patients, their specific patterns of integration and application in specific contexts, and the constitutive role of clinical encounters. The paper concludes with a discussion of directions for future research as well as reforms of cultural competency training courses. [ABSTRACT FROM AUTHOR]

Public health researchers have used a number of concepts derived from the work of Durkheim, such as anomie and social capital. One concept that has not been deployed in public health discourses is that of the cult of humanity-Durkheim's religion in a society organised around organic solidarity. This paper discusses Durkheim's views on religion and science, and the cult of humanity. The cult of humanity is characterised as having humanity at the centre of worship and combining elements of religion and science. Medicine and complementary therapies are identified as possible candidates to fulfil the role of the cult of humanity, but the institution of public health seems to be a particularly apt candidate. The paper concludes by discussing the way in which this analysis provides insight into the dual advocacy and academic functions of public health, the tension between individual choice and constraint and the buffering role of public health in relation to other social institutions. [ABSTRACT FROM AUTHOR]

This paper addresses how London gay men use the internet to meet sexual partners, or for e-dating. Based on qualitative interviews conducted face-to-face or via the internet, this research develops an account of how information technologies mediate the negotiation of identity and risk in connection with sexual practice. E-dating itself is a bricolage, or heterogeneous DIY practice of internet-based-communication (IBC). A central aspect of IBC is 'filtering' in and out prospective e-dates based on the images and texts used to depict sexual identities. Interpretations and depictions of personal HIV risk management approaches in IBC are framed by the meanings of different identities, such as the stigma associated with being HIV positive. This paper argues for a sexualities perspective in a theory of network society. Further, HIV prevention in e-dating can potentially be addressed by considering the interplay of the HIV prevention imperatives associated with different HIV serostatus identities. There is a case for encouraging more explicit IBC about risk in e-dating and incorporating the expertise of e-daters in prevention activity. There is also a need to rethink traditional conceptions of risk management in HIV prevention to make space for the risk management bricolage of network society. [ABSTRACT FROM AUTHOR]

Maps are increasingly understood as socio-cultural and political constructs, rather than mirrors of nature. Drawing on the insights of cultural cartographers, this paper presents a critical analysis of a specific instance of map-making in health policy, namely the growing use of care pathways in care planning and service delivery. Widely regarded to date as devices for ensuring quality of care, equity of treatment, optimal resource allocation and a rational division of labour between healthcare professionals, they have been seen as helpful--and technically neutral--tools for routing patients through the system. By contrast, we argue that the metaphors are misleading: lived experience and its objectification in pathway maps continually re-create one another, as we explore the slippage between map, map-making and mapping. This paper is based on interviews and observations with a variety of healthcare workers in three areas of south eastern England. We trace the development of a series of pathways-in-process, and show how they configure the patient, highlighting some aspects of their experiences, whilst silencing others. We also analyse the role of pathways in the carving up and surveillance of space round the emergence of the 'hybrid professional', particularly new practitioners such as GP specialists, specialist nurses, extended scope therapists and others. In considering the wider implications of care pathways as part of the contemporary discourse on policy, the paper critiques the rationalist, and sometimes evangelical assumptions underpinning their current popularity. In particular, we suggest that a critical and processual understanding of pathways might contribute to a more informed appreciation of their potential (and their limitations) as mechanisms for healthcare policy implementation. [ABSTRACT FROM AUTHOR]

This paper draws on qualitative case-study research to discuss the impact of managerialism on the work organisation of public sector health professionals in Australia. The case studies included 71 semi-structured interviews with a broad range of public sector health professionals (predominantly nursing and allied health professionals, with some doctors and managers). The data are used to examine the implications of managerialism for the organisation of professional (public) bureaucracies. The findings show that while health professionals were able to exert their agency to influence managerial processes, the incorporation of managerial strategies into professional practice placed constraints upon professional autonomy. The impact of managerialism on professional bureaucracies is examined using the neo-Weberian framework of hyper-rationality, an ideal type derived from a combination of four forms of rationality identified in Weber's work: practical, formal, substantive and theoretical rationality. Applied to the social organisation of health-care work, this paper critically examines the utility of the hyper-rationality ideal type, noting its limitations and the insights it provides in conceptualising the impact of managerialism on professional (public) bureaucracies. [ABSTRACT FROM AUTHOR]

Abstract For almost two decades prior to the election of the New Labour government in 1997, inequalities in health were largely absent from the political debate in Britain. New Labour sought to bring inequalities, and the role of poverty as a ‘root cause’ of ill-health, back on to the public agenda. This paper analyses four key documents (Green and White Papers) laying out their proposals for public health. We explore the shifting emphasis on health inequalities between the four official documents, and between the documents and their associated press release. The paper also analyses how this translated into media coverage. It identifies common themes across the press coverage – such as criticisms about lack of targets – but also shows how coverage varied (e.g. between UK ‘national’ and ‘Scottish’ press). Finally, the study highlights the crucial issue of political context and news timing, illustrating how the English White Paper was overshadowed by other health stories which formed the basis for attacks on the Labour government in general and the Health Minister in particular. [ABSTRACT FROM AUTHOR]

Abstract In this paper we describe and analyse results from an empirical study designed to provide insight into factors facilitating and/or inhibiting the emergence of the much-heralded ‘informed patient’ and its sociological equivalent, the ‘reflexive patient’ or ‘reflexive consumer’. In particular, we seek to examine the relationship between information and empowerment in a healthcare context and assess the significance of the Internet in mediating this relationship. The paper draws on data from interviews with 32 mid-life women concerned to know about HRT for the relief of menopausal symptoms. Having analysed these women's ‘information practices’, we conclude that constraints on the emergence of the informed patient identity exist within both patient and practitioner communities and within the space occupied by both in the medical encounter. In particular, in this paper we identify a tension caused by the emphasis on ‘information for choice’ in the informed patient discourse which itself obscures the potential conflict between lay and expert/medical knowledges in the clinical encounter. [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]

There is currently considerable renewed interest in narrative analysis in the humanities, social sciences and medicine, illness narratives, particularly those of patients or lay people, are a particular focus in health related settings. This paper discusses the background to this interest, especially its roots in critiques of medical dominance and distinctions between disease and illness, drawn by sociologists and anthropologists in the 1970s. The current emphasis on patient or personal narratives can also be seen to stem from changes in morbidity patterns, the expansion of information about disease and illness, and in public debates about the effectiveness of medicine. The paper then goes on to outline a framework for analysing illness narratives. This involves exploring three types of narrative form: `contingent narratives' which address beliefs about the origins of disease, the proximate causes of an illness episode, and the immediate effects of illness on everyday life; `moral narratives' that provide accounts of (and help to constitute) changes between the person, the illness and social identity, and which help to (re) establish the moral status of the individual or help maintain social distance; and `core narratives' that reveal connections between the lay person's experiences and deeper cultural levels of meaning attached to suffering and illness. Here, distinctions are drawn between such sub forms as heroic, tragic, ironic and comic, and regressive/progressive narratives. Finally, the paper discusses some of the methodological issues raised by narrative analysis. Given the complex character of illness narratives, their social and psychological functions, together with the motivational issues to which they relate, it is suggested that they constitute a major challenge for sociological analysis. From this viewpoint current claims about narrative analysis in medicine need to be treated with caution. [ABSTRACT FROM AUTHOR]

This paper analyses a prenatal genetic screening programme for three gene defects, conducted at maternity care centres in Eastern Finland in 1995 and 1996. What is special in this case is that the screening ended sooner than was planned. This paper investigates how the genetic screening programme was launched, the problems it encountered and the circumstances of its closure. The present analysis focuses on the co-existence of, and tensions between, the two major objectives of the project: preventing disability and increasing mothers' choices. The tensions between these two objectives were highlighted at maternity care centres. The public health nurses working at these centres were confused about whether or not they should offer autonomous consumer choice or guidance to mothers to behave in responsible and health-conscious ways. The nurses' confusion was intensified because the goal of prevention was identified with financial savings for the municipality, which the nurses thought was an inappropriate reason for abortions. [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]

First-person accounts of life-threatening or terminal illness appear frequently in the academic literature and in the media. This paper takes up the question of how these accounts might provide, for their authors, a sense of coherence and freedom, and for their readers a grasp of suffering and its potential. By focusing upon the 'horrors' integral to such accounts, the argument is made that such horrors are basic to the sufferer's symbolisation of an illness-world. This world, rather like the adventure, is torn from life, grounded in the sensuous fragments through which its elusory powers are expressed. Seen as the problematisation of life as a work of freedom, the illness account can then be analysed as an aesthetic project. The paper discusses this proposal, distinguishing between aesthetics and aestheticisation as social phenomena. It uses this distinction to make a critical observation upon attempts to understand suffering in the modern world in terms of power or of myth. [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]

Health promotion specialists and health promotion services within the health service have been neglected by policy makers and medical sociologists. This is perhaps surprising, given the high profile of health promotion on the health policy agenda. This paper presents the findings of an exploratory sociological study into the nature and function of health promotion services within the 'reformed' British National Health Service. The analysis draws on qualitative interviews with health promotion specialists, directors of public health and other health workers whose work involves the promotion of health. The paper argues that health promotion services do not fit easily into the purchaser provider divide and that they have experienced considerable organisational change and uncertainty. Four factors have further compounded this lack of fit: a lack of consensus as to what health promotion specialists work should be about; a lack of any secure knowledge base; prevailing images of health promotion and of health promotion specialists; and feelings of vulnerability about the future of health promotion. Furthermore, health promotion specialists are finding it difficult to shed their principles and values and take on the dominant enterprise culture which is characteristic of the new public management. The paper concludes by suggesting three further reasons why health promotion specialists have been marginalised: their insecure occupational status which in turn is linked to a lack of jurisdiction associated with the content of their work; the contradictions which are inherent in the knowledge base of health promotion, and the increasing application of 'modernist' evaluative frameworks, derived from economics, to health promotion interventions. [ABSTRACT FROM AUTHOR]

This paper describes the first stage of a prospective study created to evaluate a public health problem - hepatitis B virus (HBV) infection - and to design a strategy of prevention suitable for the target population, Ethiopian Jews in Israel. In the first stage of the study serological tests were conducted on 165 Ethiopian Jews, all of whom were residing in one location. This stage was designed to estimate the prevalence of HBV infection and to identify the high risk groups. The paper explores the response of Ethiopian Jews to the procedures which the research involved as well as to the researchers. It thus presents a methodological case history, demonstrating the way in which the perceptions of the subjects can affect the outcome of a research programme. It also makes evident the advantages of adding qualitative data to an epidemiological study, if these responses are to be understood. The response of the target population was connected with the position of these newcomers in the new land. It was also influenced by perceptions of blood and blood drawing, which had been changing since their arrival in Israel. The relationships of Ethiopian Jews with the religious establishment in Israel were found to be linked to perceptions of blood and blood drawing. [ABSTRACT FROM AUTHOR]

This paper considers the topic of women's smoking in pregnancy within the general context of the current health promotion concern about smoking as a public health issue. Drawing on data from an ongoing research project which is investigating the interrelationships between 'risk', social support and reproductive health, the paper argues that smoking in pregnancy constitutes an area of women's behaviour which is linked in systematic ways with aspects of their material and social position. Consequently, conventional individualist models of smoking behaviour both fail to explain why pregnant women smoke and are unable adequately to account for the health consequences of this behaviour. The reason for singling out smoking in this analysis inheres not in any detrimental health effect directly attributable to it, but rather to the way in which pregnancy smoking has been socially constructed as a reprehensible feature of women's life-styles. [ABSTRACT FROM AUTHOR]

This paper offers an interpretation of contemporary developments in Britain's National Health Service which suggests that a major transformation is under way, the contours of which, while visible, are not yet fully appreciated or understood. The analysis is in sharp contrast with that recently proposed by Klein and deliberate comparisons are drawn. The paper is in three main sections. The first briefly summarises Klein's position. The second takes issue with certain of his views, notably those on structural change, but also to some extent those on the relevance of the private sector. Welfare pluralism is posited as the most plausible future for health care and as a phenomenon as yet not well understood in Britain's health care sector. [ABSTRACT FROM AUTHOR]

This paper suggests that conflict is an inescapable feature of National Health Service organisational life, and that it is legitimate area of study. It describes a number of powerful coalitions whose interactions can produce conflict as they attempt to influence the distribution of scarce resources. In particular, it focusses on the beliefs and power of a 'practitioner interests' coalition and an 'administrative ethic' coalition. To survive in this world of coalitions, NHS general managers need to assert their own positions. Are they to be agents of the existing coalitions or can they construct their own and achieve its dominance? The paper concludes by discussing how a distinctive general management coalition might emerge. [ABSTRACT FROM AUTHOR]

This paper explores nurses' experiences as members of primary care organisations set up to develop and commission health services for local communities. Nurses, alongside GPs and other health professionals, were given a place on the governing bodies (boards) of Local Health Groups - a move widely welcomed by the nursing profession as long overdue recognition of the important contribution nurses and nursing could bring to the policy arena. Nurse board members faced a number of challenges in their attempts to contribute to and influence local health policy. This ethnographic study (which involved non-participant observation of 33 board meetings and interviews with 29 board members including nurses) suggests that medical authority and control, and hierarchical power relations between doctors and nurses on the board, were seen by nurses as significant obstacles to their participation in this new policy arena. In response to their perceived lack of power and subordinate status, nurses employed a number of strategies to negotiate their participation as board members - these included 'getting it right', 'achieving the right balance', 'self-presentation' and 'unassertiveness'. These strategies reflected and reproduced gendered identities and relations of power and raise important questions regarding the influence of nurses and nursing within policy making. [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]

The renewed interest in ‘public sociology’ has sparked debate and discussion about forms of sociological work and their relationship to the State and civil society. Medical sociologists are accustomed to engaging with a range of publics and audiences inside and outside universities and are in a position to make an informed contribution to this debate. This paper describes how some of the debates about sociological work are played out through a ‘health impact assessment’ of a proposed housing renewal in a former coal mining community. We explore the dynamics of the health impact assessment process and relate it to wider debates, current in the social sciences, on the ‘new knowledge spaces’ within which contentious public issues are now being discussed, and the nature of different forms of expertise. The role of the ‘public sociologist’ in mediating the relationships between the accounts and interpretations of lay participants and the published ‘evidence’ is described as a process of mutual learning between publics, professionals and social scientists. It is argued that the continued existence and development of any meaningful ‘professional sociology’ requires an openness to a ‘public sociology’ which recognises and responds to new spaces of knowledge production. [ABSTRACT FROM AUTHOR]

Public involvement in healthcare is a prominent policy in countries across the economically developed world. A growing body of academic literature has focused on public participation, often presenting dichotomies between good and bad practice: between initiatives that offer empowerment and those constrained by consumerism, or between those which rely for recruitment on self-selecting members of the public, and those including a more broad-based, statistically representative group. In this paper I discuss the apparent tensions between differing rationales for participation, relating recent discussions about the nature of representation in public involvement to parallel writings about the contribution of laypeople's expertise and experience. In the academic literature, there is, I suggest, a thin line between democratic justifications for involvement, suggesting a representative role for involved publics, and technocratic ideas about the potential ‘expert’ contributions of particular subgroups of the public. Analysing recent policy documents on participation in healthcare in England, I seek moreover to show how contemporary policy transcends both categories, demanding complex roles of involved publics which invoke various qualities seen as important in governing the interface between state and society. I relate this to social-theoretical perspectives on the relationship between governmental authority and citizens in late-modern society. [ABSTRACT FROM AUTHOR]

Despite the intense level of attention directed towards obesity, there has been limited success in addressing the rising rates of this public health phenomenon. This paper argues that current approaches to obesity fail to consider concepts of embodiment, and in particular, that gendered and class-based experiences of embodiment are ignored in health promotion practices and policies. Drawing on Bourdieu's concept of habitus, this ethnographic study sought to locate obesity within the biographies and everyday experiences of two groups of women from differing socio-economic settings. Rather than identify with the clinical category of obesity, these women constructed identities that were refracted through a gendered and classed habitus, and in particular, through their role as mothers. Food provision and practices were central to constructs of mothering, and these relational identities were at odds with the promotion of individual behavioural changes. Moreover, these women's daily lives were shaped by different class-based aspects of habitus, such as employment. In demonstrating the ways in which obesity is enmeshed in participants’ taken-for-granted, everyday practices, we problematise the universality of health-promotion messages and highlight the integral role that the critical theory of habitus has in understanding the embodiment of obesity. [ABSTRACT FROM AUTHOR]

This paper examines the pivotal role of social stratification in Russia's health crisis. The primary level causal factor is increased mortality from heart disease and alcohol-related poisonings and accidents. In order to understand the origin of the primary causes, it is necessary to look further for secondary level factors. Whereas policy and stress are important, the leading secondary determinant is negative health lifestyles. The question then arises: What is the source of this lifestyle? This question necessitates a search for tertiary level causes and the absence of a strong middle class in Russia is identified. In Western society, the middle class, especially the upper middle class, is the social carrier of positive health lifestyles across class boundaries. The Russian middle class has not initiated positive health lifestyles countering the predominately negative health lifestyle practices because a middle class similar to that in the West does not exist. Russia needs a civil society in which a similarly stable and empowered middle class can promote positive health lifestyles within its own stratum and elsewhere in the class structure; until this happens, the health situation in that country may not stabilise for the better. [ABSTRACT FROM AUTHOR]

After a history of neglect, bioethicists have recently turned their attention to the topic of infectious disease. In this paper we link bioethicists’ earlier neglect of infectious disease to their under-appreciation of the extent to which the problem of infectious disease is related to social factors and thus to questions of justice. We argue that a social causation of illness model – well-known to sociologists of medicine, but incompletely understood by bioethicists – will improve future bioethical analysis of issues related to infectious disease. By emphasising the relationships between social and economic structures of inequality and health, the social causation model provides a richer approach to ethical issues associated with infectious disease than the more commonly used biomedical model. [ABSTRACT FROM AUTHOR]

This paper draws on research exploring lay men's and community health professionals’ attitudes towards ‘masculinity’ and ‘preventative health care’ conducted in the northwest of England. It is specifically concerned with the findings from the men's narratives that relate to male embodiment and the relevance of this to health and wellbeing. Whilst there is a burgeoning interest in the ‘sociology of the body’ it is only relatively recently that debates about embodiment have been supported by empirical research. Empirical work on male embodiment remains minimal and even less work has been done in considering the links between masculinity, embodiment and health. A series of focus groups and interviews were conducted with men that captured narratives about the lived (male) body in everyday life and its relation to health. These data allowed for greater insight into Watson's (2000 ) previous empirical work on the ‘male body schema’. Current findings presented here suggest that male bodies need to be considered as both material and representational, and that these two modes are not distinct but continually interact, with each other and with men's conceptualisations of health, to influence health practices and wider social interactions that impact on health and wellbeing. [ABSTRACT FROM AUTHOR]

Freedom from sexual coercion is frequently cited as essential for good sexual health. Sexual experiences cannot usually be observed directly, and interpretation of interview data is therefore crucial in our understanding of sexual behaviour. This paper explores the ways in which narratives can be used to understand sexual experiences, using coercion as a specific example. The narratives examined are from interviews with young people in low-income areas of Mexico City. This study demonstrates that sexual coercion is impossible to define objectively. In addition, the concept of coercion is focused too much on women, excluding men's negative sexual experiences, and can include events that the 'victims' do not see as coercive. Coercion is a highly subjective and fluid concept, limiting its value as a defining element of sexual health. An alternative way of conceptualising coercive experiences is suggested. [ABSTRACT FROM AUTHOR]

This paper considers how middle-level managers in British Health Authorities and hospital Trusts orient to media reportage in the process of negotiating and monitoring contracts for clinical services. Although they sometimes produce media representations aimed at influencing the general public, local policy actors on both sides of the purchaser/provider split also use media messages as part of their negotiations with each other. We examine how they seek to manage negative publicity, and what happens when one side threatens to 'go public'. Managers must strike a balance between negotiating advantage and maintaining organisational relationships. Thus the powerful, but potentially double-edged, weapon of public disclosure was usually broached in indirect terms, and approached with some ambivalence. In rare cases, parties resorted to hostile press releases as relationships deteriorated. Arguably, these interactions reflect more general tensions that arise when managerial discourses, emphasising concepts such as adversarial contracting, markets and competition, are imported into professional organisations with a public service mission. [ABSTRACT FROM AUTHOR]

The paper has three main aims. First, to trace – through the pages of Sociology of Health and Illness – the changing ways in which lay understandings of health and illness have been represented during the 1979–2002 period. Second, to say something about the limits of lay knowledge (and particularly lay expertise) in matters of health and medicine. Third, to call for a re–assessment of what lay people can offer to a democratised and customer–sensitive system of health care and to attempt to draw a boundary around the domain of expertise. In following through on those aims, the author calls upon data derived from three current projects. These latter concern the diagnosis of Alzheimer’s disease in people with Down’s syndrome; the development of an outcome measure for people who have suffered a traumatic brain injury; and a study of why older people might reject annual influenza vaccinations. [ABSTRACT FROM AUTHOR]

The multifactorial model of disease causation constitutes the dominant conceptual framework underwriting the epidemiology of chronic illness. Under this rubric, factors correlated with disease are analysed at the individual level; accordingly, race, social class and gender are routinely conceptualised and incorporated into epidemiological research as individualised measures of racial category, socioeconomic status and sex. This paper employs three concepts from the field of technoscience studies to elucidate how epidemiological constructions about bodily ‘differences’ are infused with authority and legitimacy. The multifactorial model and accompanying representations of race, class and gender can be usefully conceptualised as a black box (Latour 1987, Latour and Woolgar 1986), in which individualised inputs to epidemiological studies are routinised while the interior workings of the black box - how exactly ‘differences’ come to affect health - are taken for granted. Second, processes of triangulation (Star 1985, 1986) are evident, as results from multiple lines of research on an array of different diseases are used to enhance the stability of the multifactorial model and associated constructions of ’difference’. A final illuminating technoscience concept is that of the boundary object (Star and Griesemer 1989), whose dual properties of conceptual flexibility and integrity help in understanding the proliferation and institutionalisation of epidemiological methods of studying race, class and sex/gender in chronic disease. [ABSTRACT FROM AUTHOR]

In response to the burgeoning interest in ethnic health issues and related published research, a number of recent contributors have attempted to clarify or systematise the usage of overarching terminology like 'ethnicity', 'race', 'culture', and 'racism', including the development of guidelines. However, the operational problems of how to collect ethnicity data in studies of the sociology of health and illness have not been satisfactorily addressed. This paper explores conceptual issues, notably, the meanings of ethnic identity and ethnic origin/ancestry; methodological approaches, including which dimensions to collect, multidimensional versus global measures, and exclusive groups versus optional ethnicity; and also practical issues such as method of assignment. The approach calls for a stronger development of the theoretical understandings of ethnicity and work on how best ethnicity should be conceptualised and measured in the different approaches to explaining ethnic inequalities in health. [ABSTRACT FROM AUTHOR]

Which patients should be treated, and who should be treated first? in this paper, the attitudes of health professionals towards setting priorities are examined through an analysis of interview and questionnaire data answered by senior physicians and senior nurses in Norwegian hospitals. The data indicate that patients' needs remain the most important motive behind such decisions, especially among the eldest respondents. Expected medical effects of the intervention are also important, but not the ratio of effects to costs. Some, especially the youngest respondents, say that they give priority to patients' on sick leave. Differences between age groups may be a sign of a changing normative orientation. The two professions usually agree, except that nurses are more concerned about financial aspects than physicians are. Differences between departments and hospitals suggest that their normative orientation is influenced by the clinical problems with which they are dealing. [ABSTRACT FROM AUTHOR]

This paper examines the impact of recent changes in work organisation in the NHS, drawing on research undertaken in two English hospital wards. Nurses' and health care assistants' responses to the introduction of a new skill mix are explored through qualitative interview data. The nurses' perceptions are explored in relation to theories of occupational closure. These suggest that claims to distinct knowledge and ownership of the process of care may be undermined by the reproduction of hierarchical models of work organisation. The data suggest that the nurses' ambivalence, recognised by managers, seems to limit their effectiveness in resisting fordist practices of routinisation and deskilling. It also impacts upon health care assistants, who seem to be excluded from nursing's occupational project and whose contribution to care may, as a consequence, be devalued. [ABSTRACT FROM AUTHOR]

Contemporary systems of welfare are increasingly underpinned by the assumption that families should care for their dependent adult relatives. Yet, the burgeoning empirical literature in this area has given little attention to the ways in which family caregivers fit into the service system. Drawing on interactionist theories of the division of labour, this paper employs ethnographic data, taken from a recent study, to explore the ways in which formal and informal carers negotiate 'care' on an adult medical ward. It is argued that established family carers (referred to as expert carers) constitute a special case in understanding the negotiation of care in the hospital context because of the challenge they pose to fundamental features of the social organisation of the work: nurses' control over caring processes, their claim to expertise and their license to define standards of care. [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]