Cockerham, W. C. (2021) Social Causes of Health and Disease (3rd Ed). Cambridge, Polity Press.
It’s never a bad idea to return to a disciplinary handbook that offers up the fundamentals of a subject. Regarding this blog, that core discipline is medical sociology, also known as the sociology of health and illness. The sociological exploration (the cause of the cause) of ill-health focuses on the social causes, experiences and consequences of ill health. It offers ways of understanding health in relation to domestic relationships, economics, cultural norms, professional status, public health and societal prejudices, rather than assuming illness aetiologies are entirely devoid of social practices and free from context. As a relatively latecomer to this discipline, I readily accepted an opportunity to read the above book for Cost of Living and review its content.
In the third edition of the Social Causes of Health and Disease, William Cockerham repeats his argument of the first two editions that social factors play a significant part in the experience and cause of ill-health. That his book has been released for a third time is testament to its continued relevance to students of health, communication, sociology, public health and intersections thereof. It also speaks to the somewhat static impasse of the perennial ‘debate’ in various health-related studies as to the causes of illness. As in the original edition of 2007, Cockerham contributes to sociological arguments that structural stressors, such as poverty, unhealthy lifestyles and poor living and working conditions can result in poor health and poor health outcomes. He argues that many of these stressors are out of the control of the individual and result from inequalities in society. His work illustrates the limitations of the biomedical model, the challenge of which is a central tradition of medical sociology, and he provides a strong theoretical foundation from which to provide non-expert readers (such as myself) with an adequate background to understand the ideas he propounds in the following chapters.
Though the third edition, released this year, is extensively revised and updated from the original edition (2007) and the subsequent second edition in 2013, Cockerham’s arguments remain consistent. Over the three editions, he has updated the empirical material on which he draws to make his arguments, rather than alter his core message. This most recent edition sees him engaging with gender, implications of the life-course for human behaviour, the health impacts of social capital, class, neighbourhood deprivation and of course, the emergence of COVID-19, though with the latter, only in the addition of extra introductory material. Below, I focus on chapters 4, 7 and 8 as chapters I found particularly interesting.
It is to the author’s credit that he tackles social class as a determinant for ill-health, if only because class has historically been contentious to define. However, for the purpose of chapter 4, it is defined exclusively by socioeconomic status which avoids debate over what class might mean in cultural terms and enables the author to use large quantitative datasets that more nuanced definitions would inhibit. A strength of the chapter, which to some extent acknowledges the weakness in this definition, is to explicitly identify the benefit of taking an intersectional approach to understanding inequalities, as well as exploring inequalities across the life course. For example, Cockerham explains how for most elderly people ‘food habits and other healthy lifestyles have been “locked-in” along class lines over the life course’ (p.91). These notions of intersectionality and life course repeat throughout the subsequent chapters, in a sophisticated web of information that elevates the standard of this publication in comparison to other more disjointed handbooks.
Cockerham’s engagement with some topics highlight his efforts to address what can be considered contemporary political/activist zeitgeists in the UK and US. Gendered health inequalities, which are discussed in chapter 7, have been subject to increasing public attention through the publishing of non-academic literature including Invisible Women by Caroline Criado-Perez and Unwell Women by Elinor Cleghorn, and women’s health needs are more notable in political discussion, particularly relating to menopause and period poverty. Cockerham omits discussions of health inequalities in relation to transgender people, perhaps in an effort to avoid what have been described as ‘toxic’ disagreements between some transactivists and some women’s organisations – a context where representatives from two disadvantaged groups in healthcare struggle to find shared meaning in language. Though potentially remiss in exploring these issues in relation to intersectionality, this is drawn on in the following chapter.
Chapter 8 sees attention turn to Race and Ethnicity, which has found recent traction for discussion and change in response to the extraordinary global activism of Black Lives Matter inclusive of health inequalities experienced by black people, the felling of statues that glorify the horrors of slavery and recognition of the unspeakable violence experienced by black women in the name of medical advancement. As can be expected from a chapter in a handbook, this chapter does not use emotive language, nor does it invoke its readers to anger or represent a call to arms that this blog and other informal outlets have the ability to do. Cockerham presents deeply depressing statistics about life expectancy by race in the US somewhat dispassionately. Instead of offering opinion, he outlines the work of contemporary authors, and poses difficult questions ‘…is racism a fundamental cause [of health inequalities] in its own right or because racial patterns in health and mortality are largely determined by socioeconomic status (SES)?’ (p.177). For a reader who often reads impassioned, subjective journal articles, I had to remind myself that this is a handbook, which has a specific educational aspiration to provide a disciplinary overview, and not someone making intellectual sport out of the lived experiences of others which it sometimes felt like.
Earlier this year Judy Green asked ‘What are (sociology) books for?’ She answered, using three FSHI book prize-nominated books to illustrate, that books have the ability to cross disciplinary boundaries and allow ideas to circulate. She argues that they help Sociology leave the seminar room and be talked about. Conversely, with The Social Causes of Health and Disease, I almost suggest the opposite – let this book provide you with theoretical foundations, statistics and examples you need, perhaps through classroom discussion, and then apply this learning to activism. This is a brilliant book to provide the foundations to students and scholars who are keen to learn about inequalities and the impacts on health and illness, clinicians who know that something is unfair in healthcare but can’t put their finger on it or even those that want to have statistics and theories ready for a Christmas dinner debate with a relative.
Where this handbook is dispassionate and conservative in offering opinions or emotion, you have the freedom to be fervent in your beliefs. You can use the information available across the 10 chapters to focus your energies on one specific issue, to challenge local and domestic inequalities you identify and/or experience or to shape an essay or assignment for your studies. The Social Causes of Health and Disease might not change your life, but it provides an excellent and comprehensive beginner’s guide to how inequalities change the lives of others. Do with that information what you will.