Five of us studied sociology at university while the sixth only demurred because her early artistic talent shone brightly. We think and act as one across a range of social and political domains. Moreover we share the view that ‘doing sociology’ makes no sense unless this is oriented to, and produces outcomes for, those ‘publics’ that comprises our society. We have researched and/or written in ‘twos’ or ‘threes’ and have marched and protested as a family. Our views on apposite engagement are illustrated here in relation to health inequalities.
Health inequalities are discernible in all societies and in our neo-liberal present are increasing rather than decreasing. In a nutshell, being born into the ‘wrong’ segment of society – that is, into an impoverished or low-income family – mitigates against both longevity and prolonged good health. The mechanisms – biological, psychological, social – that combine to cause this patterning are clearly complex, dynamic and not readily accessible to disciplinary as opposed to genuinely interdisciplinary enquiry; but social mechanisms are a part of this explanatory process, and a part irreducible to other parts.
Given the indisputability of (1) the patterning of health inequalities in the UK and elsewhere, and (2) the causal salience of social mechanisms, we will skip on to what can/ought to be done. This will involve calling into question what Burawoy called ‘policy sociology’ and offering an alternative position, via his ‘professional’, ‘critical’ and ‘public’ sociologies, to what we will call ‘action’ sociology. Action sociology, we contend, represents an important and neglected fifth type of sociology. We have nothing against policy sociology except that it has proven largely ineffective. Sociologists have been among those who have striven mightily to influence policy regarding health inequalities, yet these inequalities have increased rather than decreased of late, most startlingly since the birth of financial capitalism in the early to mid-1970s. This failure itself warrants professional-cum-critical analysis. In the UK, notwithstanding a generation’s worth of evidence, we are seeing more ‘policy-based evidence’ than we are ‘evidence-based policy. We are of the view that Parliament, even should Labour be returned to office after a collapse of the ConDem coalition, would not act effectively to redistribute those asset flows most salient for health and longevity.
Since the ‘Arab spring’ resistance has been in the air. In common with most other western governments the ConDems have been enthusiastic about revolutions in foreign places while quickly condemning dissent at home. Meanwhile inequalities are underwritten and allowed to grow under the aegis of an ‘age of austerity’. The pulling in of belts, however, does not apply to the ‘banksters’ whose profligacy caused the crisis. The amount lost to the economy because of ‘benefit fraud’ (about which we hear a great deal) is dwarfed, by a factor of 70, by that lost through tax avoidance/evasion on the part of the wealthy. Worldwide in excess of £13 trillion is nestling in tax havens (more than the combined GDPs of the USA and Europe’s best, Germany).
This comprises a challenge for sociologists. Action sociology acknowledges that parliamentary democracy has formal merits but substantive failings. ‘Parliamentary democracy’, Ralph Miliband showed, cannot deliver social change that withdraws the privileges attendant on wealth and power in favour of the mass of low-income families. It does not presage regime change (to coin a phrase) but rather regime tweaking.
So what might action sociology deliver? It has a number of discernible properties:
- It is intrinsic to the sociological project: in any era sociologists will find themselves contesting ideologies (that is, erroneous worldviews or theories that sanction or provide cover for financial, business or political interests). Sociology’s very rationale is to oppose forces that suppress truths about the societies we inhabit: pace Habermas, it is necessarily oriented to justice and solidarity. It is active not passive: it lives or dies as a form of intervention against – Habermas again – ‘distorted communication’.
- It therefore contests the ‘taming’ of the discipline in the post-1970s neo-liberal era, including a shying away from contentious or ‘risky’ issues.
- Its focus is the study and theorizing of what Comte called society’s ‘statics’ and ‘dynamics’ in general, and of collective action to accomplish change in particular. This encompasses recruitment, context, and the dialectics of framing and implementing strategies.
- Its brief extends to forays into Giddens’ ‘utopian realism’, involving the mapping of alternative futures. This may well involve challenging or superceding the discourses or narratives for change on offer at any given time. An example of utopian realism would be a model for an NHS beyond the truly iniquitous Health and Social Care Act.
The Health and Social Care Act, designed to re-commodify health care in England, will accentuate health inequality. It is a paradigmatic example of policy-based evidence. The data do not speak loud enough for elite politicians, let alone their financial and business masters, to bend their ears in fear of a crisis of legitimation. So how to remove from the statute book an Act inimical to the wellbeing of most citizens?
An action sociology cannot shrug its shoulders. It has to dwell on and exploitation and oppression. It is the actions of the wealthy and powerful that condemn those in low-income households to suffer more than their share not only of long-term but of acute illness and to die prematurely, as the likes of Engels and Virschow who charged rulers with ‘murder’ recognized in the 19th century. And health inequalities afford but an illustration here: we could have pinpointed welfare as a whole, education, housing and so on with the self-same consequences. Action sociology offers resistance to ‘formal’ democracy in the name of ‘substantive’ democracy. It underwrites ‘effective’ as opposed to symbolic resistance.
It is appropriate to make a family reference to conclude. None of us has a strong record of action sociology/resistance, so there is no hubris; but we have come to see a need for a sociology that identifies and engages with the poor and powerless to confront class-based exploitation and state or command-based oppression. What is sociology for if it does not give voice to its publics? What action sociology explicitly requires is that sociology itself becomes a form of intervention.
About the authors: The corresponding author, Graham Scambler, is sociologist at UCL who has come slowly and late to the realization that it is not enough to give lectures and publish. None of the other Scamblers ever thought it was.
Julie Croston on Oct 26, 2012
There is a minority but growing movement of doctors, nurses, physicians assistants, and patients who have taken an unpopular stand for “just right” health care. In the U.S. one can track rising inequality in health care with the rise in “avoidable care” (e.g., proceduries and surgeries pushed onto patients because of a medical culture that de-emphasizes doctor-patient relationships, emphasizes knee-jerk, high tech testing, and the profit that accrues to some of the players). You might be interested in lownfoundation.org to plumb this further.
How it may or may not apply to U.K. Healthcare I’d be interested to know.
Apparently there is a similar set of voices emerging in France.
Ingrid on Nov 8, 2012
Out of curiosity does anyone know if any sociologists were involved in the “reading the riots” project? I think I checked a while ago and couldn’t find any!
Anne Brunton on Jun 16, 2015
Ingrid – Tim Newburn was a sociologist by trade.
benny goodman on Oct 16, 2014
During the 1980’s I studied Sociology, Politics and Economics at an ‘unfashionable’ Poly – now Plymouth University. This was before the “Russell group” came into being. However, this introduction gave me a huge personal boost both for personal development and career opportunities. Incidentally, I was amused by the ‘post crash economics’ action at Manchester, not because they do not have a point but because at the Poly we were introduced to political economy and challenged neo classical orthodoxy way before the crash.
Anyway, following graduation i found myself ‘training’ to be a registered general nurse, plunging into clinical practice at the deep end but always with the sociological lifeline which attempted to make sense of it all. I am now a lecturer, teaching nursing students about the social context of health care, using sociological concepts. I also have a climate change/sustainability strand to my work. This interdisciplinarity really helps in understanding and challenging students assumptions about health. The political economy of health, health inequalities and the social determinants of health (SDoH) are core to my academic life.
Julie’s comment above asks how inequality in health is being addressed here in the UK. In the context of action sociology, i think we have not got beyond tentative understanding of the subject in nursing. Action on inequalities is not on most nurses agenda. There are good reasons one of which is that our curriculae are burdened with an over instrumentalised/vocational orientation leaving most nurses upon registration ill equipped to understand, argue or act on the issues. Despite the Nursing and Midwifery ‘Standards for Education’ outlining the need to address, for example, the SDoH, the need to produce clinically competent nurses swamps this agenda at undergraduate level. This will be exacerbated by the fact that the social sciences are not the academic background for most new lecturers in nursing whose degrees hardly touch upon this body of knowledge. I was lucky, i read sociology first before nursing and entered at at time when sociology and psychology were actively taught, and many nurse teachers had first degrees in social science. This no longer happens across the board in Nursing faculties.
This leaves the post graduate opportunties which are woefully lacking in this regard.
What I take from this ‘action sociology’ is its drive, its reasoning, and like C Wright Mills the role of the liberal educator: “It is the political task of the social scientist — as of any liberal educator — continually to translate personal troubles into public issues, and public issues into the terms of their human meaning for a variety of individuals. It is his task to display in his work — and, as an educator, in his life as well — this kind of sociological imagination. And it is his purpose to cultivate such habits of mind among the men and women who are publicly exposed to him. To secure these ends is to secure reason and individuality, and to make these the predominant values of a democratic society” (1959 p187).
I am now challenged by ‘action sociology’ as I have always been by C Wright Mills. Lisa McKenzies story is also very moving: http://tinyurl.com/oevl7cd
Graham Scambler on Oct 16, 2014
I welcome these comments, which are interesting and informative. I take Benny’s point that a call to commit above and beyond trying to get by in today’s NHS is a tough one. I liked the last paragraph proclaiming the role of education underpinned by C.W.Mills’ sociological imagination. But I think we need to think further about an action sociology that extends to overtly political activities like civil disobedience. How else, for example, is our current governing oligarchy to be called to democratic account and stopped from seeing though its plan to destroy the NHS by handing it over to for-profit companies? This, it seems to me, necessarily means working in alliances with a plethora of other activist groupings to hasten a crisis of legitimation. Its Gramsci again, as so often: combatting the pessimism of our sociological intellects with the optimism of the wills of citizenship! Spread the word! Graham.
Kate Sherry on Nov 19, 2014
As both a current public health PhD student and an occupational therapist and health activist in South Africa, I am delighted to see the link being made by more people between academia and action. For health-care workers this seems to be a fairly natural two-way flow, but not always! For myself, I’ve found it essential to find a way to continue in clinical/community work while also researching, writing, joining academic debate, teaching (occasionally), and playing an active role in advocacy and policy. Each feeds into the other, and I see the danger of losing touch with the practice that informs everything else.
As a health-care worker, I feel enormously blessed to have practical skills with which to take action (although I have had to develop many along the way that they never taught me at university!). I see a challenge for activists whose primary skill area is academia – how do you work out the practical actions that allow you to respond to what sociology allows you to see? Positioning, opportunities, skills – not always easy to access and often an education in themselves.
Would love to hear how you have addressed this challenge!
Benny goodman on Oct 19, 2015
I take your point, Graham and hence have moved further towards (derivative I know) an ‘action nursing’. I can hear voices shouting ‘but, nurses already act everyday!’ That is why I’m developing a notion of action nursing that goes beyond it being a ‘practice based discipline’, a phrase beloved of nursing scholars but refers to nurses’ practice not praxis.