Closing the health/wealth gap? An introduction to the sociology of health and illness

Aims

This course aims to: 

• promote an understanding of key terms and concepts used in medical sociology including health, illness, morbidity, mortality, social class and the health/wealth gap
   
• examine and interpret empirical evidence related to the extent and persistence of the health/wealth gap in the UK (e.g., differences in mortality rates and lifestyle factors by social class)
   
• evaluate explanations for the persistence of the health/wealth gap in the UK and public policy responses to them (e.g., the health policies of New Labour and the Coalition government)
   
• examine health inequalities experienced in the COVID-19 pandemic and critically reflect on the government’s response to the pandemic in the UK

Content

Medical sociology is concerned with the social dimensions of health, illness and longevity. Its three interrelated focuses are: 1) exploring the social definition and construction of health and illness (e.g., medical labels and the sick role); 2) measuring and explaining persistent health inequalities (e.g., the health/wealth gap); and 3) examining the effectiveness of public policy responses to health inequalities (e.g., healthcare provision). In this course, you will be introduced to these various aspects of medical sociology drawing on historic and contemporary research.

Topics covered will include an introduction to the key terms and concepts of medical sociology (e.g., a critical discussion of the World Health Organisation’s (1955) definition of health). Emphasis will be placed on understanding and analysing how health and illness are not simply biological states, but rather culturally defined through, for example, the doctor-patient relationship. Subsequently, you will explore the notion of the health/wealth gap i.e., empirical evidence of persistent inequalities in health and illness by social class in the UK.

Social scientists and medics have tried to explain these inequalities in a variety of ways including by reference to the unequal distribution of material resources and life chances; different lifestyles by socio-economic background; differential access to and use of healthcare; and the impact of modern working practices on health. You will explore official explanations for the health/wealth gap provided in, for example, The Marmot Review (2010). From an international perspective, you will also examine the findings of the WHO (Europe) report Closing the Health Inequalities Gap: An International Perspective (2005). A range of sociological concepts, theories and research which have tried to explain health inequalities will also be assessed. 

In addition, you will evaluate public policy responses to health inequalities including the introduction of the NHS (1948), the healthcare policies of New Labour (1997-2010) and the policies of the Coalition government (2010-2015). Health inequalities experienced in the COVID-19 pandemic will also be examined (including critical reflections on the government’s response to the pandemic). In summary, you will consider why one of the richest countries in the world, the UK, has failed to close the health/wealth gap.

Presentation of the course 

The course will be taught using highly interactive seminar-style sessions, which draw on your knowledge and experience to illustrate key ideas in relation to the sociological understanding of health and illness. PowerPoint presentations will be used to guide sessions. Class discussion and interaction will be encouraged. Individual and group learning activities will be used to promote engagement in the teaching sessions.

Course sessions

1. An introduction to the sociology of health, illness and longevity
   This session provides you with an introduction to the course. It will also define and explain key terms used in medical sociology including health, illness, morbidity, mortality and the health/wealth gap. You will also explore the World Health Organization (WHO, 1946) definition of health, consider the features of the bio-mechanical model of health, and examine the social constructivist approach to health and illness. 
    
2. Defining and measuring social class in the UK
   In this session, competing definitions and scales of social class are explored as a prelude to examining the relationship between health and measures of socio-economic inequality (Session 3). You will critically examine the Registrar-General’s (1913) occupational scale, the Goldthorpe (1987) scale and the ONS (2010) National Statistics Socio-economic Classification (NS-SEC). In addition, you will be introduced to key concepts in class analysis (identity, class culture, cultural capital etc.) and review the classical approaches of Marx and Weber to class. How can these concepts, measures and theories help explain persistent health inequalities?
    
3.  Inequalities in health: The extent of the health/wealth gap
   Having defined key terms and theories, Session 3 examines some of the historic and contemporary evidence related to the extent and persistence of the health/wealth gap over time in the UK. Specifically, a range of government reports into health inequalities, including the Black Report (1980), the Acheson Report (1998), the Health Committee Report (2009) and the Marmot Report (2010), will be examined. You will also explore the development of the NHS which had the intention of reducing health inequalities.
    
4. Explaining the persistence of the health/wealth gap 1: Official reports and models of the social determinants of health
   Why has the health/wealth gap persisted in the UK despite the expansion of healthcare services? In session 4, you will evaluate a range of concepts and models suggested in official reports into health which attempt to explain inequalities. How adequate are notions of natural and social selection, material deprivation and cultural deprivation as explanations of the health/wealth gap? Are models of the ‘social determinants of health’, as proposed by Acheson (1998), WHO (2010) and Selbie and Newton (2017) sufficient to explain health inequalities? Can they help us tackle persistent inequality? 
    
5. Explaining the persistence of the health/wealth gap 2: Sociological concepts, theories and research
   This session assesses sociological concepts, research and theories which have been developed to account for the health/wealth gap. You will examine: the work of Parsons (1951, 1975) on the sick role; radical and Marxist accounts of health inequalities; feminist accounts of health inequalities; and new directions in medical sociology (Abel and Frohlich, 2012). How have such approached been criticised? What value, if any, do these explanations have for shaping health policy? 
    
6. Erving Goffman and social constructivism: The ‘self’, stigma and mental illness
   This session introduces you to constructivist and interactionist approaches to health and illness e.g., how doctor-patient relationships differ by social class and how power is central in the diagnosis and treatment of illness. It takes a detailed look at the research of Erving Goffman in The Presentation of Self in Everyday Life (1959), Asylums: Essays on the Social Situation of Mental Patients and Other Inmates (1962) and Stigma: Notes on the Management of Spoiled Identity (1963). It concludes with a critical evaluation of Goffman’s approach to mental health.
    
7. Closing the gap? Public policy responses to health inequalities
   Session 7 commences by briefly defining social policy and health policy (WHO 2019). It seeks to link the plurality of causes of health inequality to strategies and policies to reduce the health/wealth gap. The session will provide a review of the social and health policies of New Labour (1997-2010) and the Coalition government (2010-2015) and reflect on the effectiveness of these policies in reducing health inequality. What lessons can be learnt? 
    
8. Health inequalities and the COVID-19 pandemic
   The COVID-19 pandemic has laid bare health inequalities between different groups (e.g., age, gender, ethnic and socio-economic groups). Session 8 explores evidence related to inequalities in the experience of COVID-19, drawing on official statistics, by gender, occupation and ethnicity. It critically examines the model of the social determinants of health proposed by Independent SAGE (2020) to account for inequalities in the pandemic. Similarly, it explores the successes and failures of the government’s response to the COVID-19 pandemic.
    
9. Levelling up, the cost-of-living crisis and health inequalities
   What is the current Conservative government’s levelling up policy? This session takes a fresh look at the definition, elements and implementation of the government’s levelling up initiatives. It draws on the White Paper Levelling Up the United Kingdom (2022) to examine how the government proposes to achieve its health target i.e., the gap in Healthy Life Expectancy (HLE) between areas where it is highest and lowest will have narrowed by 2030, and by 2035 HLE will have increased by 5 years. Are the strategies proposed to achieve this target (improved public health, supporting people to change their food and diet, and tackling diagnostic backlogs) sufficient? Or, as Marmot (2022) has proposed, is the levelling up agenda a missed opportunity for improving public health given the cost-of-living crisis?
    
10. Closing the health/wealth gap? Summary, discussion and evaluation
    Session 10 will summarise the various strands of the course. It will allow you to consider the potential merits and limitations of research for fostering both better understandings of health inequalities and for devising effective healthcare strategies to reduce inequality. The session will also provide guidance on the essay questions detailed below.   

Learning outcomes

You are expected to gain from this series of classroom sessions a greater understanding of the subject and of the core issues and arguments central to the course. 

The learning outcomes for this course are:

• to define and explain a range of concepts linked to the study of health and illness
   
• to critically assess a range of explanations for the persistence of the health/wealth gap 
  in the UK
   
• to critically evaluate a range of public policy responses which have sought to reduce the health/wealth gap in the UK over time
   
• to identify and explain health inequalities experienced in the COVID-19 pandemic and critically evaluate the UK government’s response to the pandemic drawing on appropriate evidence 

Required reading

Marmot, M, et al, Fair Society, Healthy Lives, The Marmot Review (2010) Online: https://www.instituteofhealthequity.org/resources-reports/fair-society-healthy-lives-the-marmot-review/fair-society-healthy-lives-full-report-pdf.pdf

Nettleton, S, The Sociology of Health & Illness (Cambridge: Polity Press 2013, 3rd edition )
ISBN 9780745646015

Typical week: Monday to Friday 

Courses run from Monday to Friday. For each week of study, you select a morning (Am) course and an afternoon (Pm) course. The maximum class size is 25 students.   

Courses are complemented by a series of daily plenary lectures, exploring new ideas in a wide range of disciplines. To add to your learning experience, we are also planning additional evening talks and events. 

Evaluation and Academic Credit  

If you are seeking to enhance your own study experience, or earn academic credit from your Cambridge Summer Programme studies at your home institution, you can submit written work for assessment for one or more of your courses.  

Essay questions are set and assessed against the University of Cambridge standard by your Course Director, a list of essay questions can be found in the Course Materials. Essays are submitted two weeks after the end of each course, so those studying for multiple weeks need to plan their time accordingly. There is an evaluation fee of £75 per essay. 

For more information about writing essays see Evaluation and Academic Credit. 

Certificate of attendance 

A certificate of attendance will be sent to you electronically after the programme.