perspectives on health 1: functionalism and marxism

s/l dr anthony pryce

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To consider the influence of three ‘traditional’ perspectives highlight tensions in the way we view social structures and health and illness.

To revisit the sick role defined by Talcott Parsons

To consider how Weber’s concept of bureaucracies remains important in the contemporary health service through the McDonaldization of society


Generally taken to mean the view that society’s structures and organisations operate towards an organic model of growth and development - all parts serving the greater needs of the whole.

In other words events explained in terms of the contribution they make to the continuity of a society.

The individual actor is socialised to fit society and its structures not vice versa


Concerned with conflict rather than stability

Economic system shapes societies therefore the class system (see previous lecture on inequalities) has produced two distinct classes, the bourgeoisie and the proletariat i.e. those who own the means of production and those that sell their labour

In relation to health...

NHS is a means that benefits the bourgeoisie by ensuring that the workers remain well enough to work

Workers may understand their inequality but believe the system is fair (false consciousness)

Some Marxists argue that the ‘free’ health service is a victory for the proletariat

Not one Marxism...

Some argue that social wage provides free state resources on top of payment to individual

However, critics such as Le Grand (1979) argues that in fact the middle classes have gained more from the health service than lower classes - inverse care law.

Contemporary health reforms are perpetuating these inequalities

Medicine as social control...

Althusser (1969) argues that there are institutions that control the population through ideological state apparatus such as education and religion and health e.g. controls of welfare and disability rights

If illness is caused by biological factors rather than social factors alone what is the best action?

Do you eradicate the causes of inequalities or focus on curative medicine?

Curative medicine can merely veil the causes of social illnesses

Navarro(1979) suggested that doctors (and nurses?) are agents of the State by promoting individualistic view of responsibility for illness - lifestyle focus. However, McKinley argues that doctors are themselves little more than workers in a vast industry concerned with the production of profit e.g. pharmaceutical R>


Lack of regulation

Irritation, frustration

Suicides after divorce or economic crisis


Excessive regulation

Energy & Passion

Suicides in "primitive" societies; military suicides


Excessive regulation

Acceptance & resignation

Suicides of slaves,

Problems :

Theory based on inconclusive/unreliable statistics

Moral and social status of suicide

Suicide needs to be intended

Functionalism is characterised by synergy, engine metaphors - each social role occupying that of a cog in the engine. Failure to fulfil the role is deviant. How does it deal with sickness and ill-health?

Parson’s (1951) Functionalist perspective - Illness as deviance

The sick role identifies two rights:

the exemption from normal social roles

from responsibility for their own state

and two obligations:

to want to get well speedily

to consult expert medical opinion

Doctors too are involved in this role and have obligations to:

Apply a high degree of skill and knowledge to illness

Act in the welfare of the patient not self-interest

Be ‘objective’ and emotionally detached and non-judgmental

Be guided by rules of practice and code of conduct

Weaknesses of the sick role

Does not address culture, gender, sexuality, race or class; chronic illness; mental illness nor the experience of women and childbearing

He is uncritical of inequalities in role of doctors as gatekeepers and agents of social control - to diagnose disease is to define its bearer as in need of ‘corrective treatment’ of body or mind

(Friedson 1970 cited by Scambler 1997)

functionalist explanations...	

Tend to support high prestige, status and salary of medical professions because of its efficiency and value to society.

However, McKeown 91976) demonstrated other factors that improved health in the social model

Illich (1976) suggested iatrogenic aspect of Western medical system

Patients/populations not always compliant

Max Weber (1864-1920)

Developed theories of how capitalist societies were becoming increasingly regulated and rationalised through bureacratisation. Each job becoming more and more defined and specialised - we have become cogs in the machinery of society. To some extent we do this because of what we seek to gain from selling our labour - holidays, clothes, aspirational material wealth We have become prisoners within the iron cage. We have the illusion of freedom whilst also being shackled to capital. This was demonstrated by the production line factories such as Ford cars.

Ritzer (1996) suggests this has lead to what he calls McDonaldisation of society


Characterises much of everyday experience and also forms of management including health:




employee controls


Functionalist perspectives assume that societies are like engines - each cog contributing to the working of the whole set of structures. However, many of these ideas depend on dominant stories being seen as true and useful. We shall later examine how these stories are being challenged in the potential meltdown of postmodernity

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