Social Causes of Health and Disease ‐ by Cockerham, W.C

Cockerham, W.C. Social Causes of Health and Disease . Cambridge : Polity Press , 2007 £17.99 (pbk) viii+232 pp . ISBN 978-0-7456-3588-0 This book is an elegant and clear exposition of the thesis that some disease is caused directly by social factors. The argument is not that there is an epidemiological association, nor statistical correlation between patterns of illness and social factors, but rather that social factors in some circumstances are direct causal agents. There is a social aetiology of disease and medical sociology is the discipline to demonstrate this through sociological reasoning. Cockerham's thesis is advanced theoretically and empirically. The epidemiological and behavioural medicine approaches are taken to task for treating social factors as residual categories in their methodologically individualistic explanations. The effects of social factors are, according to Cockerham, direct and real. Diseases caused by smoking are taken as the quintessential cases, since the mechanisms of starting to smoke, continuing to smoke, and stopping smoking are grounded in social life. The social factors in turn impact directly on the experience of illness, on its social patterning as well as the aetiology. Although the social is difficult to link directly with the biomedical, Cockerham considers that there is overwhelming evidence to support the case. This evidence consists of data about health inequalities, social condition, and social behaviour, and is to be seen clearly in specific diseases like HIV/AIDS, diabetes, and heart disease and stroke linked to smoking. Having established this causal premise in the opening chapter, the book shifts several gears to review the history of medical sociology from Durkheim through Parsons, by way of interactionism, to explain why medical sociology has been slow to take up the question of the social causes of disease. It is salutary to be reminded that notwithstanding years of descriptions of health inequalities, libraries of material demonstrating problems of access to services, medical power and dominance, as well as critiques of health care systems, the question of the causal mechanisms of the social determinants of health remain under-researched in the literature. This review could be usefully used by newcomers to the discipline, as well as more seasoned practitioners who will find new insights into the history of medical sociology. Cockerham manages very expertly to produce a theoretical argument clearly and powerfully, which is richly informed by empirical data and evidence. What is very notable and highly commendable is that unlike many American scholars Cockerham takes very great care to use British data and evidence. He also demonstrates a very good knowledge and understanding of the work of many major British medical sociologists of the last several decades and their role and importance in the subject. The book is also strong on linking the specific arguments of medical sociology back to the mainstream theoretical concerns of sociology and particularly the theories of Durkheim and Weber, as well as the more recent writings of Bourdieu and Giddens and questions of habitus and agency and structure. Cockerham takes the interaction of the social structure and human agency very seriously. The central tenet in his argument is that social class is the paradigmatic social cause of disease. It qualifies as a fundamental cause because it influences multiple diseases, through multiple pathways of risk that are reproduced over time and involve access to resources that can be used to minimize or avert risk. The role of mediating variables like stress and social support are attended to in the argument. There is a very good discussion of the ways in which age, gender, race, ethnicity, neighbourhood and living conditions overlap and are part of the accumulated deficits and benefits in the causal pathway. However, in the end he argues that both American and British data demonstrate the fundamental cause is social class, overriding all other considerations. I thoroughly enjoyed this book. Cockerham demonstrates the power of sociological reasoning to explain the phenomenon of health and illness. The breadth of scholarship is impressive and the argument is convincing, at least in principle. One might take issue with the fact that he does not spell out precisely enough the concept of cause that he wished to advance. He never really comes clean on this, and uses the term cause in a number of different ways throughout the book. But perhaps this is where we are at the moment with the science. There clearly are social causes, but we don't quite know yet what the precise causal pathways are. The task set by Cockerham's thesis to the next generation of medical sociologists is to describe these in more precise detail than the current state of our knowledge allows. None of this will be music to the ears of many of those of a strong social constructionist persuasion, and the echoes of positivism in Cockerham's position will alarm others. Also, Cockerham's focus on the primacy of social class is an important challenge to researchers in the fields of gender and ethnicity and health and illness. However, in the final analysis, Cockerham has developed a sociological argument about the nature of health inequalities and the social determinants of health which should not be ignored

Argument (complex analysis · Disease · Pathology · Public health · Social determinants of health · Social epidemiology · Social medicine · Sociology · Epidemiology · Global Public Health Policies and Epidemiology · Health disparities and outcomes · Medicine · Obesity and Health Practices · Psychology · Social Psychology

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