Image: Sick piggy bank, by Marco Verch

The government’s politics increasingly drive the detailed organisation and rapid privatisation of healthcare. Government austerity policies and mismanagement of healthcare during the COVID-19 pandemic have had a great impact on the nation’s health. There are less than half the number of NHS beds today than 30 years ago, and many staff are leaving. Many private contracts are being set up within the NHS.

Yet on these broad social matters, British sociologists of health and illness who might explain, make connections, and help the public to be far more generally informed are seldom heard in public discussions. Instead of involving university researchers, journalists mainly rely on three think tanks that are far from independent: the King’s Fund, Nuffield Trust and the Health Foundation. They are not “independent” and have deep roots in private healthcare. For example, the King’s Fund backed the drive to cut hospital beds. Critically informed organisations such as Keep Our NHS Public are seldom heard, while the Overton window (the range of government policy ideas that politicians and the public are willing to consider and accept) shifts inexorably rightwards. I will consider likely reasons for the relative public silence from critical sociology and possible ways forward.

Universities prefer researchers to apply to government departments and research councils for funds because they grant large overheads. Government agencies, therefore, influence social research questions and agendas. Although there are notable exceptions, there is less independent critical sociological research about the political economy of healthcare or the rapid privatisation of the NHS.

The favoured “gold-standard” health research method, randomised controlled trials, plays into the neoliberal agenda of individualism. This is because individuals can easily be randomised into different intervention groups so that reactions to their beliefs and behaviours may be measured. Macro political and economic influences on health are set aside when government policies and giant food and advertising corporations cannot be either randomised or subjected to researchers’ interventions. Qualitative research, usually in brief small-scale studies, also tends to exclude larger political and social contexts.

Some health sociologists write politically, for example, in the Cost of Living blog, personal blogs and excellent online resources, such as Discover Society. Yet how widely read are they, especially by the general public? Similarly, almost all academic papers describe or measure specific types of ill-health in impressive detail – like pieces of a jigsaw disconnected from the larger picture that would show more of their political contexts and meanings.  For example, interpretivists’ concern with personal experiences and realist evaluators’ attention to actual evidence both overlook the crucial third dimension in all social life: the mainly unseen real causal influences. Like the invisible COVID-19 virus, politicians’ and entrepreneurs’ unseen values, networks, personal interests and priorities work powerfully throughout society. They promote health and wealth in privileged areas and increase physical and mental illness in others.

The NHS is disintegrating into an under-funded public service mainly for the poor or those who need the costliest services, besides being a logo exploited by many private companies. Private services for anyone who can afford the fees or the insurance are growing fast. They rely on the NHS to train and supply their staff and rescue their failures – patients who need expensive help to recover from “mistakes” in the private sector. Recent newspaper reports indicate that the UK government has given the NHS database, by far the world’s largest, oldest, most valuable database, to Palantir, a private US tech company that will be paid to administer it. Oliver Eagleton and others contend that many politicians seem more interested in setting up lucrative, powerful contacts and future employment opportunities for themselves than in serving the public interest.

The rapid privatisation of the NHS, promoted by the main political parties, was ignored, for example, in all the abstracts in the programme for the 2023 medical sociology conference. I did not attend the conference. Maybe there were political economy debates, but if so, why not advertise them as major attractions? The abstracts indicate that the main UK annual medical sociology conference largely ignored these crises and concentrated on reports about specific healthcare conditions and clinical processes. That is like a conference which proceeds while the building around it is on fire. If sociologists who specialise in health and illness remain publicly silent on the politics of health, then which other informed experts can the British people, who fund our work, rely on to explain, analyse and speak critically with them and on their behalf? The BBC and almost all mass media are failing to do so.

There are pressures on sociologists to be neutral. Ever-increasing sub-specialism makes us wary of speaking outside our narrow areas of expertise.  Some interpretivists aim to report fairly and without evaluating or commenting on participants’ views, however harmful these may be.  Many researchers claim to present facts with value-free objectivity.

Yet health and illness research is value-laden, for example, in our hopes to increase knowledge and well-being and to reduce or prevent suffering, neglect and injustice. Researchers may try to ignore their own values, but they cannot avoid them. The COVID Inquiry shows how the science, politics and practical management of the pandemic all deeply overlap, despite the daily TV reports that tried to show them as separate. Within areas of clear inequality, such as in health standards and services nationally and internationally, neutrality is not possible. Silence about harm inevitably colludes with the powerful side, as happens now in Britain.

Could medical sociologists convene a small group to develop informed, agreed policies through setting up conferences, discussion groups and members’ surveys, commissioning research, and learning from related organisations and more publicly active ones? Further related problems and ways to address them, within research methods and at larger levels, are considered in my book Critical Realism for Health and Illness Research

Priscilla Alderson, Professor Emerita of Childhood Studies, Social Research Institute, University College London.

Image: The original photo and the license.