BOOK REVIEW FOR NATIONAL MEDICAL JOURNAL OF INDIA

Amar Jesani, MBBS

310, Prabhu Darshan, 31 S. Sainik Nagar, Amboli,
Andheri West, Mumbai 400 058
Email: jesani@vsnl.com

THE BOOK

Anne-Marie Barry and Chris Yuill

“Understanding Health: A Sociological Introduction”
London, Thousand Oaks, New Delhi: SAGE Publications
2002, Pages: 152, Price: 16.99 pounds.
ISBN 0 7619 7306 0
ISBN 0 7619 7307 9 (pbk)

The medical education and health professions are perhaps some of the most neglected areas
of research and discussion in our country, barring the controversy related to the private
medical colleges, the exorbitant fees charged by them and the possibility of “lowering” the
“standard” of medical education. Even the latter issues are more a part of public debate, with
the lay media playing dominant role rather than the profession and its publications. One
would have to search hard, mostly in vain, to get a serious well-researched book on the
history of modern medical education – allopathic as well as non-allopathic – in India. In this
situation it is not surprising that the discussion on the content of what is taught in medical
colleges, particularly at the under-graduate level and how it is taught has remained within
narrow circles of the elite institutions, and not-enough has been documented and published
for the profession and society to understand and react on. In the mad rush for the linear
expansion of number of medical colleges, scanty attention is being paid to relevance of the
social content of the textbooks of medicine published from within the country.

One them, is the subject of preventive and social medicine, particularly the component of
social sciences and health. While some of the textbooks almost completely gloss over it, the
others provide a very disjointed and superfluous account. The changes brought about since
1980 by the introduction of the ROME with emphasis on field/practice based learning and
involvement of Primary Health Centres have remained grossly incomplete not only in terms
of its tardy implementation at the medical college level but also the incomplete and at times
biased integration of the sensitive findings from the field on inequities and discrimination
affecting medical practice and public health due to the gender, caste, class and religion based
differences in the society. It is in this context that this slim volume by two sociologists from
the UK comes a wave of fresh air, giving some idea to the social scientists involved in field
of health and to public health experts from India how various disciplines of the social
sciences need to be taught in our medical colleges.
The book is designed as an introductory volume in sociology of health (and thus, other social
sciences are touched upon but not elaborated) both for the students of health sciences and
social sciences. Printed in 23x18 cm broad good quality papers and elegant attractive cover,
there is side space left on each page for highlights and also for notes by students. In the
introduction the authors explain the organisation of the book, including the scope and
objectives of chapters; and more importantly, they meticulously follow the plan in each
chapter. Each chapter then opens with two boxes, one with a brief summary of the major
contents of the chapter and another in grey with key concepts explained in it. Besides, in the
side space, the highlights give definitions of terms or the gist of some of the important
arguments. The illustrations are all over the books, including case studies. They have been
designed to ensure that the reader is impacted with ideas and at the same time make the
reader to develop critical thinking. At the end of each chapter there is a summary, and
recommended reading. I was very impressed by the kind of reading recommended and for
each one, there is one sentence note by the authors in bold explaining what to expect in that
reading. For example, in the chapter on “Gender, ethnicity, ‘race’ and mental health” they
recommend G. Philo’s edited volume titled “Media and mental distress” (1996, London:
Orient Longman) with a note, “Very good and easy-to-read- exploration of media portrayals
of mental illness” but while recommending L. Prior’s “The social organisation of mental
illness” (1993, London: Sage) they warn readers that it is “A slightly more advanced text, but
highly useful”. Indeed, they also provide recommended reading available on the Internet.

My final commendation of the book is about its content, the language and the coverage.
Lucidly written using simple language to explain very complex sociological concepts, it is
well rooted in history while providing the latest developments in the field. It begins with an
explanation of what sociology is and how it is different from other sciences. The sociological
theories are not neglected either – beginning with functionalism, it covers theories such as
symbolic interactionism, Marxism, feminism and post-modernism; explained in a few
paragraphs and elaborated wherever required in subsequent chapters. Since the authors are
informed well in such theories, their treatment of the subject matter is full of human
sensitivity including the otherwise much ignored gender sensitivity. I was delighted to read
chapters 2 to 4, which look at not on health and illness in narrow sense, but examine medical
knowledge and medical practice by giving sociological understanding of the history,
development and practice of bio-medicine in the Western world and their critiques by the
feminist sociologists and the practitioners of what the authors term as alternative medicine. In
chapters 5 to 8, the book explores gender, ethnicity, ‘race’, class, capitalism and the body.
The neglected area of mental health is used to explore inequities in health, while the social
context in which health and diseases are understood linked up in explaining the health
seeking as well as delivery of health care. Another chapter explores how in practicing
medicine the status of body is taken-for-granted and hardly much attempt is made to
recognise that the body is a bearer of values and also a means of representing our identities;
and how the normative concepts of ‘good’ and ‘bad’ body underpin the scientific quest for
the perfection of body. In the similar line, in another chapter the book summarises the social
understanding of agism and how a set of negative attitudes about the aging process and older
people formed. Lastly, the final chapter explores context in which the health care takes place
or is delivered. Although many of the ideas of this chapter run throughout the book and in
this chapter both theories and practical aspects of the National Health Services in the UK are
examined, I came out with a feeling that this chapter could only be a prelude to some
extended treatment of the sociology of health services, not just the one organised under the
auspices of the government, but also in the non-government sector.

The review of this immensely readable book that should be available in all medical schools
and specialised public health institutions for reference and should be used by teachers to
teach sociology of health, would remain incomplete without making a point on its relevance
for sensitising the medical textbooks, teaching and health research in India. This is simply
because unless the medical and social sciences disciplines in India assimilate the large
amount of social research in health undertaken in last two decades by the academic as well as
the NGO researchers and activists across the country, they would be grossly insensitive and
indifferent; and at times consciously or unconsciously biased on the gender, class, caste and
communal inequities in the country. While this teaching and learning aid from Anne-Marie
Barry and Chris Yuill is not a last word on the subject, it provides enough material for
teachers and students in India to look at the health and diseases beyond the bio-medical
model.