Sociological Theories of Health and Illness

Functionalism is a theoretical approach that sees society as an interconnected system of institutions. These social institutions act as complex social forces that encourage stable, valued patterns of behavior in a society. Family, education, and religion are examples of social institutions. Medicine is also an important social institution. The institution of medicine includes organizations such as clinics and hospitals, as well as key figures such as doctors and nurses. It also includes health and illness within a society. Functionalists think of society as working like a body, with different social institutions each performing particular functions and working together. When one part of society does not work well, it can impact the whole of society. Consider the role of doctors and nurses in a society. If a society does not have enough doctors and nurses, or if these providers are not well trained, it has an impact on the larger society. Fewer people can receive necessary health care, which can then impact other parts of society such as the family and the economy. Parents who do not receive care are often too ill to care for children, or they may die, leaving society to care for their children. People who do not receive care cannot work, or may not work efficiently, meaning the economy is less productive. In these ways the institution of medicine is connected to and affects other parts of society.

A functionalist approach to analyzing health and illness considers how levels of health and illness impact overall social order. Illness, particularly widespread illness, is a threat to social order. It prevents people from working and fulfilling their social functions. Medicine is therefore essential to the smooth functioning of society. Particular norms and expectations govern how sick people are treated. A functionalist sociologist, Talcott Parsons (1902–79), coined the term sick role to describe the social role people play when they are ill, detailing the rights and responsibilities society gives to those who are sick. Parsons identified two rights of individuals in a sick role: they are excused from normal social duties, and they are not held responsible for their illness. He also identified two responsibilities: those who are sick are expected to try to get well, and they are expected to cooperate with doctors or other health care providers. The role of doctors and the health system is to diagnose illness, legitimizing an individual's sick role by confirming that the person is truly sick, and to provide treatment so people can return to their normal social roles. Those with chronic illnesses remain permanently in a sick role.

Conflict theory views society from the perspective of a competition for resources. Through this lens, sociologists see health care itself as a resource. There are only so many doctors, so many hospital beds, and so much medication. Conflict theorists ask how these things are distributed. The distribution of health care tends to follow the power differentials in a society. In the United States, people’s wealth or employability is directly related to their access to health care and the quality of the health care they receive. However, even wealth may not ensure quality care, if other forms of discrimination are at play. Studies have demonstrated that doctors tend to give black women less pain medication than white women, believing them to be exaggerating their pain levels. Obese patients often report having difficulty convincing doctors that they have real medical conditions that need treatment. Transgender people are often refused medical services outright. Conflict theorists examine these discrepancies to better understand how power affects health.

Symbolic interactionism emphasizes a subjective understanding of the individual and society. This approach seeks to analyze social phenomena and behavior by considering the ways that meaning is created through social interactions. Symbolic interactionists look at what health and illness mean in a society and how this meaning is constructed. Members of society collectively define certain conditions as health or illness. One example is obesity. The tool typically used to diagnose obesity, the body mass index (BMI) uses a person's ratio of weight to height to calculate body mass. The BMI is widely used to determine whether an individual has a healthy weight, is overweight, or is obese. However, it does not always accurately predict health outcomes, to the extent that it classifies most professional athletes as obese. A symbolic interactionist analysis would point to how this tool reflects normative body standards. It would also point out how the BMI is given more medical authority than other tools, such as measurement of body fat in relation to muscle mass or evidence-based models that can be used to predict specific health conditions such as hypertension. The body mass index may be considered a reflection of the social construction of health and illness. A social construct is an idea that has been created and accepted by a society. Symbolic interactionism considers how a society comes to understand particular conditions as representing health or illness.

A focus of symbolic interactionism is interactions between individuals. Health care providers and patients interact in particular ways. These interactions are governed by social norms and expectations. Symbolic interactionists look at the language, symbols, and settings of these interactions. They might analyze how the uniforms worn by doctors and nurses impact the social exchanges they have with patients or at the ways that a doctor's office is set up and how that can impact patients' feelings about and understandings of their experience there. Symbolic interactionism also considers how people cope with or make sense of being ill and how attitudes toward an illness or condition shape people's experience of illness. For example, a 1998 study looked at how people suffering from ulcerative colitis, a bowel disease, reacted to their illness. Because the patients associated bowel disease with embarrassment, dirtiness, and loss of control, they developed strategies that helped them present themselves as "normal" and healthy to others. Symbolic interactionists look at this kind of interaction of individuals with illness, as well as the ways that people incorporate social constructions of health or illness into their sense of self.