This article, “The sociology of health in the United States: recent theoretical contributions,” authored by William C. Cockerham, offers an insightful examination of recent theoretical trends within the sociology of health in the United States. The paper asserts that the field has evolved considerably from its early reputation as largely atheoretical, now showcasing a flourishing and theoretically engaged subdiscipline.
The central thesis of the paper is that the sociology of health has reached a mature state and is currently in the early stages of a significant paradigm shift. This shift represents a move away from a historical focus on methodological individualism, where the individual was considered the primary unit of analysis, toward an increasing utilization of theories with a structural or macro orientation. This structural focus signifies a return to explaining the effects of social structures on health and disease.
This analytical shift is materially aided by advancements in research methods. These modern techniques, such as hierarchical linear modeling (HLM) and the use of biomarkers, provide researchers with the capacity to measure the effects of structural variables on individual health, which was often difficult or underdeveloped in the past. HLM, for instance, can simultaneously determine the relative effects of different levels of structural variables on health outcomes, while biomarker studies offer objective measures of physiological responses to external social conditions like poverty or stress.
Cockerham identifies two primary factors influencing this expansion of a “neo-structural” focus in health sociology:
- The recognition that agency-oriented theories are insufficient to adequately account for the reciprocal effects of social structures on each other and on individuals. Social structures are presented as channeling behavior and reflecting the larger structures (e.g., social class, gender, race/ethnicity, religion, kinship) from which individual choices emanate, even though individuals have choices, they are structurally constrained.
- The ready availability of advanced statistical techniques, like HLM and biomarker data, which allow researchers to precisely determine the separate effects of multiple levels of social structures on individual health outcomes.
The article delves into five prominent recent theoretical contributions to the sociology of health that embody this neo-structural approach:
- Fundamental Cause: This theory posits that social conditions, particularly socioeconomic status (SES), are fundamental causes of disease because they influence multiple diseases through multiple pathways, are reproduced over time, and involve access to resources that can be used to avoid or minimize health risks.
- Medicalization: This concept describes the process by which nonmedical problems (e.g., deviant behavior, natural life events) are redefined as “medical,” bringing them under the jurisdiction of the medical profession. The “engines” of medicalization have shifted from solely the medical profession to include biotechnology, the pharmaceutical industry, consumerism, and genetics.
- Social Capital: Described as a characteristic of social structures, this involves networks of cooperative relationships among residents, characterized by trust, reciprocity, and mutual aid. Individuals embedded in such networks tend to have better health and longevity.
- Neighborhood Disadvantage: This emerging research area investigates unhealthy urban living conditions, focusing on neighborhood-specific variables such as the physical environment, availability of services, and social/cultural factors that impair health.
- Health Lifestyle Theory: Developed by William Cockerham, this theory defines health lifestyles as collective patterns of health-related behavior based on choices influenced by individuals’ “life chances” (structural constraints, especially class position). It integrates Max Weber’s concept of life chances and Pierre Bourdieu’s notion of the habitus, highlighting how social structures empower or constrain individual health choices.
The paper also notes the decline of traditional sociological theoretical perspectives such as structural-functionalism, conflict theory, and symbolic interaction, describing them as “zombie theories” due to their limited relevance or development in contemporary sociology. Instead, the prevailing trend in modern theorizing in health sociology is toward the utilization of “middle-range” theories that are specific to particular substantive areas and align with current methodological advancements.
Reference: Cockerham, W. C. (2014). The sociology of health in the United States: recent theoretical contributions. Ciência & Saúde Coletiva, 19(4), 1031–1039.
