Original Article

Sociological theory in medical sociology

in the early twenty-rst century
William C. Cockerham
Department of Sociology, College of Arts and Sciences, University of Alabama at
Birmingham, 460H Heritage Hall Building, Birmingham, AL 35294, USA.
E-mail: wcocker@uab.edu

Abstract This article examines current trends in theory in medical sociology and
nds that the use of theory is ourishing. The central thesis is that the eld has reached
a mature state and is in the early stage of a paradigm shift away from a past focus on
methodological individualism (in which the individual is the primary unit of analysis)
toward a growing utilization of theories with a structural orientation This outcome is
materially aided by research methods (for example, hierarchal linear modeling,
biomarkers) providing measures of structural effects on the health of the individual that
were often absent or underdeveloped in the past. Both quantitative and qualitative
methods can be utilized in such research and qualitative studies based on symbolic
interaction or social constructionism are not disqualied because of their methodologies
and focus. Structure needs to be accounted for in any social endeavor and contemporary
medical sociology appears to be doing precisely that as part of the next stage of its
evolution.
Social Theory & Health (2013) 11, 241255. doi:10.1057/sth.2013.12;
published online 26 June 2013
Keywords: medical sociology; contemporary sociological theory; Durkheim;
Marx; Weber; middle range theories

The purpose of this article is to examine trends in sociological theory in health

or medical sociology in the early twenty-rst century. The previous century
ended with new social, cultural, economic and political realities requiring
medical sociology to adjust and consider fresh theoretical orientations, as well
as adapt older ones to account for change (Cockerham and Scambler, 2010).
Medical sociology had acquired a reputation for being theoretically impoverished
in its early years that persisted for decades (Johnson, 1975; Scambler, 1987),
even after it was no longer true (Cockerham, 2000, 2013b; Cockerham and
Scambler, 2010; Scambler, 2012a). Considerable theoretical work had, in fact,
been taking place, much of it in sociology departments in major American
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universities, while medical sociology matured as a subdiscipline and became

more closely aligned with general sociology through their commonalities
especially theory and methods. Contemporary medical sociology came to have
a rich and abundant literature with its own theories specic to the subdiscipline,
some of which are based on perspectives shared with sociology at large and
others that are unique to its subject matter.
The result is that medical sociologists are making greater use of sociological
theory than ever before to amplify the explanatory power of their empirical
ndings. Forecasting this outcome, Turner (1992) earlier had suggested that
medical sociology may indeed prove to be the leading edge in some areas of the
development of contemporary theory. Evidence for this is found in the virtual
explosion of recent books on theory in medical sociology, marking the eld today
as a highly theoretically engaged sociological subdiscipline (McDonnell et al,
2009; De Maio, 2010; Scambler, 2012a; Collyer, 2012; Cockerham, 2013a, b).

The Current Paradigm Shift

The central thesis of this article is that the eld has reached a mature state and, in
the process, is in the early stage of a paradigm shift away from a past focus on
methodological individualism (in which the individual is the primary unit of
analysis) toward a growing utilization of theories with a structural orientation
(Cockerham, 2013b). Initially, in the 1960s, a period that Judt (2005, p. 398)
describes as the great age of theory, different social sciences (for example,
structural linguistics, cultural anthropology, history) emphasized structuralist
theories. Similarly, structural functionalism was the dominant theoretical
perspective in all of sociology, including medical sociology. This theoretical
dominance did not last long. Structural functionalism was severely criticized
for its advocacy of a static image of dominant social structures highly resistant
to change; moreover, its emphasis upon consensus, stability, order and balance
seemed to justify the maintenance of the status quo perpetuating existing social
inequalities and the power of already existing elite groups. Conict theorists
found structural functionalism additionally lacking because it did not adequately
consider conict as a catalyst for social change, especially rapid and revolutionary change. Symbolic interaction attacked structural functionalism for its
disregard of individual creativity and micro-level social processes.
Conict theory, in turn, was condemned by some because it also accorded the
individual little opportunity for creativity, was never fully developed and ignored
social order and stability, just as it had earlier attacked structural functionalisms
failure to account for conict and change (Ritzer, 2011). The result over time
was the ascendency of symbolic interaction that ourished during 19631970,
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with important contributions in medical sociology from Howard Becker,

Erving Goffman and Anselm Strauss. The rise of symbolic interaction in
sociology brought with it an increase in the inuence of agency and methodological individualism in sociological theory. By the 1980s, however, symbolic
interaction likewise entered a period of decline that extended to its use in medical
sociology. The theory showed signs of stagnation, was devalued by quantitative
sociologists for its dependence on subjective methodology and interpretation,
and was unable to explain relationships between institutions and societal-level
processes that affect each other, not just individuals, along with difculty in
satisfactorily linking small group processes to higher structural level social
phenomena.
This meant that at the beginning of the twenty-rst century, sociologys three
major theoretical perspectives structural functionalism, conict theory and
symbolic interaction that were still featured in most introductory textbooks
had all become what Ritzer and Yagatich (2012, p. 105) describe as zombie
theories or at least dying and transitioning into a zombie-like state. The theories,
Ritzer and Yagatich (2012, p. 105) observe, seem alive to many, especially supporters and textbook authors, but in fact, if they are not yet dead, there is only the
faintest of pulses reecting a bare minimum of life. Ritzer and Yagatich maintain
that having three major theoretical schools under which newer theories were
subsumed provided a tidy categorization system, even if the categories were
established over half a century ago and could no longer be justied. In their view,
theory is a liquid, not a solid, in line with Baumans (2000) notion of liquid
modernity, in which theories are not viewed as xed in time and space, but are
constantly owing and changing.
We see uidity and change in the fact that structural functionalism, once the
theory in sociology, has gone beyond a zombie state and is actually dead, as there
seems to be no structural functionalists today and virtually no signicant work in
this area. Ritzer and Yagatich say conict theory can also be considered a zombie
theory because it developed largely in opposition to structural functionalism
that has died and many of its sub-theories, such as economic determinism and
structural Marxism, have hit dead ends. In their view, just because theorists nd
conict in a society does not automatically mean they are conict theorists.
Moreover, the basic proposition of conict theory that inequality exists in all
societies that causes conict that leads to social change has not been widely
used in medical sociology. People can become sick and either recover, be
required to live with a chronic condition or die, and it may not have anything
to do with social conict.
Nevertheless, conict theory still has some support in medical sociology
(De Maio, 2010). It briey had new life with Wilkinsons (1996) income
inequality hypothesis that maintained once countries make a transition to high
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living standards and achieve a positive level of health, they can continue
to increase their wealth but not be any healthier if class differences do not
diminish. The greater the social inequality between rich and poor, the larger the
health disparities, even if the population is healthy overall. This thesis was
initially greeted with enthusiasm (De Maio, 2010). However, other studies failed
to replicate the ndings and the hypothesis has been rejected by study after study
for over a decade (Beckeld, 2004; Eberstadt and Satel, 2004; Link et al, 2013).
Eberstadt and Satel (2004, p. 36) refer to the income inequality hypothesis as
a doctrine in search of data rather than a scientically proven hypothesis.
Thus, the broader spectrum of conict theory is in decline, but there is important
work in the related areas of Marxist theory and political economy that allow it
to currently avoid the fate of structural functionalism.
As for symbolic interaction, Ritzer and Yagatich (2012) nd it on life support
and headed toward zombication. When symbolic interaction appeared to
reach its limits, some in the eld transferred its approach to other areas, such as
the study of embodiment, the experience of illness, adjustments to aging and
using the concept of negotiated order to study organizations (Charmaz and
Belgrave, 2013). Some symbolic interactionists embraced post-modern theory,
but that perspective, despite its early promise to explain social change, was
unable to account for the structure of post-modern society after its transition
from modernity, never gained a foothold in medical sociology and can be
considered a zombie theory as well (Cockerham, 2007). Symbolic interaction
theory, on the other hand, continues, as it also underlies many qualitative
methods and grounded theory, while inuencing a major branch of social
constructionism. Social constructionism takes the view that scientic knowledge about health and illness is produced by subjective, historically-determined
human interests and is subject to change and reinterpretation (Olafsdottir, 2013).
The more that social constructionism is inuenced by symbolic interaction,
the more agency oriented it is; the closer it is to its other branch, that based on
Foucault, the lesser the role for agency.
Given the beleaguered status of its three traditional categories of theoretical
work, it might be presumed that theory development in sociology is in trouble.
This is not true. The problem is with the outdated categories, not a lack of vibrant
theories or theorizing. Rather, what we are seeing in the rst decade of the
twenty-rst century is growth and change. Most signicantly, as noted, there is
a return to theories that focus on social structures that is an essential component
of what sociology is actually about. This is consistent with Durkheims ([1895]
1950, pp. 127128) original view that: Society is not a mere sum of individuals;
rather the system formed by their association represents a specic reality that has
its own characteristics. This reality is distinct not only from individuals, but also
from other realities, such as the biological and psychological.
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According to Durkheim ([1895] 1950), we need to look at the nature of society

itself, not individuals, in order to explain social life This does not mean that
people completely lack free will or are not responsible for their behavior, but that
we are drawn in social (collective) directions and the pressure of society to act in
specied ways can overcome individual inclinations (Durkheim, [1897] 1951;
Fournier, 2013). The structures that project societys inuence on daily life are
norms and patterned regularities in social interaction, systematic social relationships and forms of stratication, and levels of social and material resources.
According to Phelan and her colleagues (2004), Durkheim provided a bold model
for medical sociology to follow in his insistence that social forces outside of an
individuals direct control can affect peoples health and in some situations
curtail their lives.
The current expansion of what might be termed a neostructural focus in
theoretical work in medical sociology is inuenced by two factors. First is the
recognition that agency-oriented theories are unable to adequately account for
the effects of social structures on each other or on individuals. Explanations and
theories of social behavior neglecting these effects are incomplete as they omit an
important component of everyday life. As Emirbayer and Mische (1998, p. 1004)
point out in a statement that applies equally to both quantitative and qualitative
studies, there is no hypothetical moment in which agency actually gets free of
structure; it is not, in other words, some pure Kantian transcendental free will.
Social structures channel social behavior down particular pathways as opposed
to others that individuals could choose and such behaviors, when selected and
acted out, reect the structures (for example, social class, gender, race/ethnicity,
religion, kinship) from which they emanate (Bourdieu, 1984, 1990). Individuals
have choices, but in all circumstances those choices are structurally constrained
by (i) what is available to be chosen and (ii) the social rules or codes telling the
individual the rank order and appropriateness of choices (Bauman, 1999).
Second is the ready availability today of advanced statistical techniques
allowing researchers to determine the separate effects of successive or multiple
levels of social structures on the health of individuals. This includes not only
hierarchal level modeling and similar techniques, but also measures of biomarker data to uncover the effects of social structural variables on physiological
outcomes such as allostatic load, inammation or glucocorticoid secretion.
Hierarchical linear modeling simultaneously determines the relative effects of
different levels of structural variables on health outcomes by comparing changes
in the regression equations and assessing the amount of variation at each level
(Raudenbush and Bryk, 2002). Consequently, the strength of the interaction
between variables characteristic of individuals at Level 1, perhaps households at
Level 2, neighborhoods at Level 3, followed by sequentially higher levels in
a structural hierarchy can be determined.
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Biomarker studies measure physiological responses to social conditions (for

example, poverty, stress) external to the individual that are associated with
negative health outcomes, including mortality. This approach provides objective
measures of health risks obtained through clinical assessments (for example,
blood pressure, urine, blood tests for cholesterol and c-reactive protein, waist
hip ratios) of individuals independent of their self-reports and perhaps even
awareness. Seeman et al (2008), for example, used multivariate logistic regression to determine that low socioeconomic status (SES) is consistently and
negatively associated with cardiovascular, metabolic and inammatory risks, as
well as total biological risks. The biomarker approach helps us understand the
physiological paths that link SES and other structural variables to health
disparities.
Symbolic interactionists and other sociologists favoring social constructionism
might vehemently disagree with this thesis about a return to structural concerns.
Yet, as the author (Cockerham, 2005, p. 53) has stated elsewhere: Sociological
concepts reecting literally all theories of social life attest to the fact that
something (namely structure) exists beyond the individual to give rise to customary patterns of behavior. Structure is out there; the task at hand is to better
account for it, regardless of the theory, methodology or level (micromacro) of
analysis. With respect to qualitative research based on interviews, focus groups,
social histories or participant observation, researchers need to be attentive to
patterns of social interaction and the structural inuences beyond the individual
shaping those patterns that emerge in the analysis of their data. Searching for
structural bridges from the macro to the micro is required. This is seen in Lutfeys
and Freeses (2005) study of two clinics showing how SES and the organizational
structure of the clinics affected diabetes treatment and individual outcomes.
Meads (1934) concept of the generalized other is another vehicle for analyzing
structural inuences in symbolic interaction studies. Regardless of theoretical
preference, medical sociology today has the methodologies to more fully account
for structural effects on the health of the individual.

The Current Legacy of the Classics

An initial step in assessing the direction of theory in contemporary medical
sociology is to return briey to the classic theorists who were instrumental in the
establishment of sociology as a discipline. The reason for this is that theory
development in sociology tends to be cumulative, with the classics providing
inuential building blocks for many current theories (Baert, 2007). Whereas
some classic theories are relics and do not apply to our time, others have
persisted as authoritative sources for modern theorizing in medical sociology.
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Interestingly, the classic theorists from the beginning of the discipline whose
work is most relevant to modern notions of structure have had the greatest
survivability, namely Emile Durkheim, Karl Marx and Max Weber.
Durkheim
Sociologys story as an academic eld, as is well-known, largely originates with
Durkheim. His only work having a possible direct link to medical sociology is his
study of suicide. Durkheim ([1897] 1951) applied basic sociological principles
(for example, norms, values, social solidarity) to the problem of suicide (a highly
individual and private act) in Western Europe in the late nineteenth century by
identifying certain social conditions external to the individual that stimulated the
taking of ones life. His focus was not on physical, but moral health (Lukes,
1973). A principal nding was that individual peculiarities did not explain the
social features of suicide nor did the physical environment; rather, there were
decisive social forces at play (Fournier, 2013).
While sociology has moved a considerable distance since Durkheims pioneering efforts, we see his inuence today in medical sociology in the rapidly growing number of studies of social capital and health. Social capital is generally
described in the research literature as a characteristic of social structures consisting of a network of cooperative relationships between residents of particular
neighborhoods and communities. Networks providing social capital are characterized by interpersonal trust, norms of reciprocity and mutual aid, and a
supportive social atmosphere within which people look out for one another
and interact positively with a sense of belonging. People embedded in such
supportive networks have been consistently found to have better health and
longevity than those who lack this resource (Song, 2013). In locales where there
are serious social problems (for example, crime, stress, slums) and breakdowns
in social networks, social capital is reduced or absent with the residents having
poor health and shorter life spans (Scambler, 2012b).
Turner (2003) and others (De Maio, 2010; McDonnell et al, 2009) nd that the
various theories of social capital, such as those by Putnam, Lin and Bourdieu,
are contemporary applications of Durkheims ([1897] 1951) theory of suicide in
which individuals are protected by their close integration into society. Turner
(2003) observed that Durkheim never used the term social capital, but maintains
that his concepts of social solidarity and social facts are still valid in illustrating
how social capital is protective of the health of the individual. Theories of social
capital are of interest to medical sociologists because they can be a social
mechanism linking inequality to health or, conversely, enhancing the health of
people in neighborhoods and communities with high levels of it. The message
of social capital research, however, is not to claim individual-level characteristics are unimportant or are superseded by such capital, but that structural
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variables like communities can have a causal impact on health. This outcome is
also seen in the relatively new area of emerging research in medical sociology on
neighborhood disadvantage that investigates unhealthy urban living conditions. This research focuses on variables specic to neighborhoods, not individuals, such as the physical environment (for example, quality of housing, water,
air), availability of services (for example, banks, police, re, sanitation, health
care), and social and cultural factors (for example, social networks, single-parent
families) that impair health through psychological distress or exposure to
unhealthy living situations (Pearlin et al, 2005).
Marx
As for Marx, he appears to be having something of a comeback in the early
twenty-rst century. Literally written off as a dead dog in sociology a few years
ago (Callinicos, 2007) and critiqued by this author (Cockerham, 2013b) for the
failure of MarxistLeninist doctrine to produce healthy societies in Europes
former communist states, recent work in the political economy of health nevertheless shows a Marxist revival. An attribute of Marxist theory for modern
neostructural research is Marxs ([1852] 1954, p. 10) oft-cited statement that:
Men make their own history, but they do not make it as they please, they do not
make it under circumstances chosen by themselves, but under circumstances
directly found, given, and transmitted from the past. Therefore, although
individuals have choices, their choices are constrained by existing social structures, especially the economic systems in which they work.
The political economy critique in medical sociology centers on examining
the inequalities in the health-care marketplace when such care is treated as
a commodity in capitalist medical systems to be sold to those who have the
means to pay for it and beyond the reach or with lessened availability on the part
of those who cannot. In this scenario, health care is a privilege, not a right.
Socioeconomic disadvantage in society at large is thus converted into health
disparity as reduced opportunities for quality health care combine with the
greater likelihood of having an unhealthy lifestyle and increased exposure to
adverse living conditions, disease and injury. It is also relevant to note that
health-care delivery systems themselves do not evolve randomly. They are
deliberate creations that reect the social and political philosophies of the
populations that construct them. These philosophies underlie the policies made,
institutions formed and levels of funding provided for health care.
The recent resurgence in Marxist political economy appears linked to the
global economic crisis of 2008. A review of the causes of that crisis shows an
ideology of wealth appropriation and prot-maximizing strategies on the part
of individuals and major nancial corporations, along with a disregard for risks
that led to the global sub-prime mortgage debacle. Some nancial institutions
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failed, massive government loans were required for others and there was
a sharp rise in unemployment, loss of investments, a weakened economy, a few
criminal indictments and the dispossession of assets, particularly homes, from
vulnerable people. The effects of that crisis and other economic problems
are still lingering, particularly in the euro-zone. Even though safety nets are
provided by the state in capitalist economies in the form of welfare benets,
such benets can be reduced or curtailed in a major scal crisis thereby
accelerating the vulnerability of the disadvantaged (Scambler, 2012b). Thus,
we see another situation in which health can be harmed from structural
conditions over which individuals have no control.
Weber
Webers contributions to contemporary medical sociology generally fall into
three areas: (i) SES, (ii) lifestyles and (iii) rationality and bureaucracy. These
concepts underlie many studies in medical sociology today on social class and
health, health lifestyles and hospitals. The concept of SES, consisting of measures
of income, education and occupational prestige, comes from Weber and is the
standard measure of class position in American sociology. His notion of formal
rationality and bureaucracy remains central to studies of hospitals and other
health care organizations, even though there is variance from usual bureaucratic
procedures in clinical care. The most recent inuence of his work in the early
twenty-rst century is found in research on health lifestyles. Weber ([1922]
1978) associated lifestyles not with individuals but with status groups, thereby
showing they are principally a collective social phenomenon. Moreover, lifestyles are based on what people consume rather than what they produce.
Therefore, for Weber, the difference between social classes did not lie in their
relationship to the means of production as advocated by Marx, but in their
relationship to the means of consumption. It is obvious to say that the afuent
consume considerably more and higher-quality resources than the poor, including resources that promote health and ward off illness (Phelan et al, 2004).
Weber maintained that lifestyles consist of two components: life chances
and life choices. A persons life chances are the probabilities they have in life to
nd satisfaction and are largely determined by their SES and other factors that
shape the choices people make in their lives, including their lifestyle. There is
a dialectical relationship between life choices and life chances, with life choices
representing agency and life chances a proxy for structure. While choices about
lifestyles are voluntary, life chances which primarily represent class position
either empower or constrain choices as choices and chances interact to determine outcomes. This concept joins with Bourdieus notion of the habitus as the
centerpiece of Cockerhams (2005, 2013a, b) health lifestyle theory. Cockerham
denes health lifestyles as collective patterns of health-related behavior based
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on choices from options available to people according to their life chances.

He suggests that four categories of (i) structural variables, especially (a) class
circumstances, but also (b) age, gender and race/ethnicity, (c) collectivities
(for example, religion, kinship) and (d) living conditions, provide the social
context for (ii) socialization and experience that inuence (iii) life choices
(agency). These structural variables also collectively constitute (iv) life chances
(structure). Choices and chances interact and commission the formation of
(v) dispositions to act (habitus), leading to (vi) practices (action), involving
(vii) alcohol use, smoking, diet and other health-related actions. Health practices constitute patterns of (viii) health lifestyles whose reenactment results in
their reproduction (or modication) through feedback to the habitus. Hence, we
see the ideas of a classical theorist (Weber) combining with a contemporary
theorist (Bourdieu) to provide the basis of a modern-day neostructuralist theory
of the health lifestyle phenomenon.

Current Developments
While classical theories still inuence some of the current work in medical
sociology, few contemporary theoretical schools of thought are linked to named
theorists in what seems to be a characteristic of modern theorizing. Prominent
exceptions include Foucault and Bourdieu. Otherwise, the clear trend is toward
the utilization of theories of the middle range that are specic to both particular
substantive areas of study in medical sociology and to this period of theoretical
development and its corresponding methodological advances. These theories
include medicalization, fundamental cause, life course, as well as health lifestyle
theory noted above, and others. As will be seen, each of these theoretical perspectives tends to take a neostructural approach.
Foucault
Foucaults work has inuenced a number of studies in medical sociology and
related areas, such as the sociology of the body, emotions, social constructionism
and feminist theories critiquing male patriarchy. A major focus was on power
relations. He provided social histories of clinics, prisons and sexuality that
depicted the manner in which knowledge produced expertise. This knowledge
was used by professions and institutions, including medicine and psychiatry,
along with religion and the state, as a means of social control and regulation.
Knowledge and power were described as being so closely connected that an
extension of one meant a simultaneous expansion of the other. He used the term
knowledge/power to express this unity. When it came to medical practice,
Foucault (1973) found two distinct trends in the history of medicine: what he
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called medicine of the species (the classication, diagnosis and treatment

of disease) and medicine of social spaces (the prevention of disease). The
former dened the human body as an object of study subject to medical
intervention and control, whereas the latter made the publics health subject
to surveillance and regulation by medical and civil authorities. Surveillance
did not just include physical and mental health, but also sexuality as the state and
the church joined medicine in subjecting the most intimate bodily activities to
institutional jurisdiction, discourse and monitoring.
Foucault (Dumas and Turner, 2013) also introduced concepts of the clinical
gaze, disciplinary power, biopower, biopolitics and governmentality among
others that seem structurally heavy-handed and dark, because they were
repressive for the individual. He is not a structuralist, however, but a poststructuralist rejecting the existence of xed meanings, universal rules and the
eternal existence of traditional centers of authority in favor of a focus on
marginalized groups, social fragmentation and deconstruction. When it came to
power relations, Foucault insisted that power is not hierarchical (top-down) but
local (horizontal) in its scope, as it produces reality and is virtually everywhere.
Regardless of his inuence on many facets of contemporary theory, Foucault
has his critics. He does not recognize that power can have limits, nor explain
relations between macro-level power structures other than dwell on their mechanisms for reproduction; moreover, there is a disregard of agency (Giddens, 1987).
Giddens (1987, p. 98), for example, notes Foucaults histories seems to have no
active subjects at all and concludes: It is history with the agency removed.
Moreover, he goes on to say that the individuals who appear in Foucaults analyses
seem impotent to determine their own destinies. And in what may likely prove to be
fatal for Foucaults approach could reside in Judts (2005, pp. 400401) observation
that any theory dependent upon an arrangement of structures from which human
choice is eliminated is hobbled by its own assumptions.
Bourdieu
Bourdieus work is currently fashionable in medical sociology as it is increasingly
being applied to a number of studies and topics, ranging from injured ballerinas
to working-class diets. The most prominent of his concepts in play at present are
those of social capital, habitus and lifestyles. Bourdieu (1986) suggested three
fundamental types of capital economic, cultural and social and added a fourth
(symbolic) Social capital was viewed as a characteristic of social networks from
which people draw benets. Similar to Lin (2001), he sees such capital as a
resource (connections) that individuals can access instead of being a metaphor
for social cohesion and solidarity.
Bourdieu (1990) describes the habitus as a mental scheme or organized
framework of perceptions that predisposes the individual to follow a particular
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line of behavior as opposed to others that might be chosen. These perceptions are
developed, shaped and maintained in memory through socialization, experience
and the reality of the persons class circumstances. While the behavior selected
may be creative and even contrary to normative expectations, behavioral choices
are typically compatible with the dispositions and norms of a particular group,
class or the larger society; therefore, people tend to act in predictable and habitual
ways even though they have the capability to choose differently. Through selective
perception, the habitus adjusts aspirations and expectations to categories of the
probable that impose boundaries on the potential for action and its likely form.
Of all Bourdieus (1984) works, the one most relevant for medical sociologists
remains his book Distinction, in which he systematically accounts for the
patterns of cultural consumption and sees individual taste determined by
a class-based distance from necessity. He includes an analysis of food habits
and sports that describes how a class-oriented habitus shapes these particular
lifestyle practices. The merit of Bourdieus analysis for understanding the
relationship between class and health lifestyles lies in his depiction of the relative
durability of various forms of health-related behavior within particular social classes
and the relatively seamless fashion in which he links agency and structure
(Williams, 1995). The transcendence of the barriers between agency and structure
is what is likely to give Bourdieus work legs into the future. Although some might
view his work as overly deterministic, he nevertheless provides a framework for
medical sociologists to conceptualize health lifestyles and for sociologists generally
to address the agency-structure interface (Cockerham, 2005, 2013a, b).
Middle-Range Theories
Currently, there are several middle-range theories active in medical sociology.
Perhaps the most popular at this time are fundamental cause, medicalization and
life course. Fundamental cause theory is playing a leading role in the United
States in promoting a structural orientation toward health and mortality. This is
seen in Link and Phelans (1995, Phelan et al, 2004; Phelan and Link, 2013)
assertion that social conditions are fundamental causes of disease. In order for a
social variable to qualify as a fundamental cause, Link and Phelan (1995, p. 87)
hypothesize that it must (i) inuence multiple diseases, (ii) affect these diseases
through multiple pathways of risk, (iii) be reproduced over time and (iv) involve
access to resources that can be used to avoid risks or minimize the consequences
of disease if it occurs. They dene social conditions as factors that involve
a persons relationships with other people.
When fundamental cause theory is reduced to its most basic proposition, it is
the idea that resources consisting of money, knowledge, power, prestige and
social connections are vital to maintaining a health advantage (Phelan and Link,
2013). Conversely, an absence or shortage of these resources causes poor health
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outcomes and earlier deaths. People with resources have less risk of exposure
to preventable diseases in the rst place and are better able to achieve positive
outcomes when they occur by employing their resources. Persons with lower
income, education and social status lacking such resources not only have greater
exposure to risk and more likelihood of the risk being realized, but also a
diminished capacity for preventing negative consequences.
Medicalization theory, in turn, is largely based on the work of Conrad (2007,
2013) and its use has become widespread in North America and Europe.
Medicalization means to make medical, which in the case of medical sociology
refers to the process by which non-medical problems (deviant behavior, natural
life events, problems in living and health enhancements) become redened to
varying degrees as medical, with the medical profession taking jurisdiction over
their management. Conrad observes that the engines (the social forces) underlying medicalization have shifted from the medical profession to the pervasive inuence of biotechnology, the pharmaceutical industry, consumerism and
genetics, as well as physicians.
Life course theory is not associated with one particular theorist, but the body
of work advances the proposition that people go through a sequence of age-based
stages and social roles within particular social structures over the course of their
lives (Mortimer and Shanahan, 2003). In medical sociology, this perspective
suggests that socioeconomic disadvantages originating in childhood accumulate
over the life course to especially disadvantage health in old age. Not discussed
here because of space limitations, but nevertheless part of medical sociologys
arsenal of middle-range theories are those of intersectionality, cumulative inequality/
cumulative disadvantage, role strain, the stress process, labeling, trust, conservation of resources, social disorganization, critical realism, actor-network and a
host of others adding to the theoretical richness of the eld.

Conclusion
The use of theory is ourishing in medical sociology and this is particularly
apparent in theories bringing structure back into prominence in explaining the
social determinants of health and disease (Cockerham, 2013b). This development, as noted, is materially aided by research methods providing measures of
structural effects that were often absent or underdeveloped in the past. These
measures are both quantitative and qualitative; therefore, qualitative studies
based on symbolic interaction or social constructionism are not disqualied
because of their methodologies and focus. Structure needs to be accounted for in
any social endeavor and contemporary medical sociology appears to be doing
precisely that as part of the next stage of its development.
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Cockerham

About the Author

William C. Cockerham is Distinguished Professor of Sociology and Chair at
the University of Alabama at Birmingham. His most recent books include
Medical Sociology on the Move: New Directions in Theory (Springer, 2013),
Social Causes of Health and Disease, 2nd ed. (Polity, 2013) and Sociology of
Mental Disorder, 9th ed. (Pearson Prentice-Hall, in press). He is also senior
editor of the forthcoming Wiley-Blackwell Encyclopedia of Health, Illness,
Behavior, and Society (Wiley-Blackwell, in press).

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