Notes · SociologyUK · A-Levels

Health (optional topic)

This Paper 2 option treats health and illness as social as well as biological phenomena: it examines the social construction of health, illness, disability and the body, the unequal social distribution of health by class, gender, ethnicity and region, inequalities in provision, the power of the medical profession, and the social construction of mental illness. Throughout it applies the perspectives to show that who gets ill, who gets treated and what counts as illness are shaped by society.

5 sections~21 min reading time3 competenciesLevel Standard 2 · Advanced 3

T·0888 / 15

Exam profile

AO1 · Demonstrate knowledge and understanding of the models of health, health inequalities, provision, the professions and mental illnessAO2 · Apply this material to the Item and to specific inequalities and groupsAO3 · Analyse and evaluate competing explanations of health inequality and views of the medical profession, reaching a judgement

Operators:outline and explainapplying material from the Item, analyseevaluateassessdiscuss

basic level

AS-Level expects the social and biomedical models, the main health inequalities and the sick role.

higher level

The full A-Level requires sustained evaluation of competing explanations of health inequality and of the medical profession, reaching a judgement.

Depth

Text

Contents · 5 sections

Health (optional topic)

The social construction of health, illness and the body#

StandardAQA 7192/2 HealthDfE GCE Sociology subject content

Biomedical versus social model of health

Fig. 1The biomedical model locates illness in the individual body; the social model locates it in social conditions and definitions.

Sociologists argue that health and illness are not purely biological facts but are socially constructed - their definition, experience and meaning vary across societies, cultures and history. What counts as a healthy body, a symptom, an illness or a disability, and how these are understood and responded to, depends on cultural beliefs and social context as much as on physical states. This does not deny biological reality, but insists that the meanings we attach to bodily states, and the boundary between the normal and the pathological, are drawn by societies rather than given by nature - a claim illustrated by the way conditions once seen as normal become medicalised, and vice versa.

The contrast between the biomedical and social models of health organises the topic. The biomedical model, dominant in modern Western medicine, treats health as the absence of disease, locates illness in the individual body as a malfunction to be diagnosed and cured through medical intervention, and privileges the expertise of doctors. The social model argues that health and illness are shaped by social conditions - poverty, housing, work, diet, environment and inequality - and by social definitions, so that improving health requires social change, not only medical treatment. The social model draws attention to the wider determinants of health that the biomedical model neglects.

The sociology of the body extends the argument. Sociologists study how the body itself is socially shaped - through diet, exercise, medicine, cosmetic intervention and cultural ideals of beauty and normality - and how bodily norms are enforced. Foucault's analysis of the 'clinical gaze' and of surveillance shows how modern medicine came to observe, classify and discipline bodies, extending social control through the definition of the normal and the pathological. The related process of medicalisation - the extension of medical definition and authority over more and more areas of life, from birth and death to mood, behaviour and appearance - is a key theme, raising the question of whether medicine liberates or controls.

These ideas equip the rest of the topic by showing that health is a site of social definition and power, not just biology. If illness is partly socially constructed, then who is defined as ill, whose account of illness is believed, and what is done about it become sociological questions shaped by class, gender, ethnicity and professional power. Evaluating the social-construction thesis means granting the reality of biology while showing how thoroughly social meanings and conditions shape health - a balance that the strongest answers maintain, avoiding both a naive biological determinism and an implausible denial of physical illness.

Worked example

Applying social construction to medicalisation

Explain how medicalisation illustrates the social construction of illness.

Define medicalisation
Medicalisation is the extension of medical definition and authority over areas of life once seen as normal - birth, death, mood, behaviour, appearance.
Show the construction
As conditions become defined as medical problems, what counts as illness expands, showing the boundary of illness is drawn socially, not fixed by biology.
Add the power dimension
Foucault's clinical gaze shows medicine classifying and disciplining bodies, so medicalisation extends social control through definition.
Evaluate
Medicalisation can bring genuine help, but the trend shows the definition of illness is socially and professionally produced, not simply given.

Result: Medicalisation demonstrates the social construction of illness: as medicine defines more of life as pathological, the boundary of 'illness' is revealed to be drawn by society and professional power rather than fixed by biology.

Typical mistakes

Taking 'socially constructed' to mean illness is not real - the claim is about meaning and definition, not the denial of biology.
Confusing the biomedical and social models or presenting them as simply right or wrong rather than as complementary lenses.

Active revision

Outline and explain two ways in which health and illness can be seen as socially constructed. (10 marks)

Active recall

Recall the key points — then reveal.

Sources: GCE AS and A level subject content for sociology (Department for Education)

Health inequalities and their explanation#

AdvancedAQA 7192/2 HealthDfE GCE Sociology subject content

Four explanations of the class gradient in health

Fig. 2Four classic explanations of the class gradient in health - the material/structural explanation carries most weight.

One of the most robust findings in medical sociology is that health is unequally distributed across social groups: there is a persistent social-class gradient in health, illness and mortality, so that, on average, those in lower socio-economic positions experience worse health and shorter lives than those in higher positions. Similar patterned inequalities appear by gender, ethnicity and region. The task of the sociologist is to describe these inequalities accurately - as broad, well-established patterns rather than precise figures - and, above all, to explain them, and it is the competing explanations that generate the topic's evaluation.

Four classic explanations of the class gradient are conventionally distinguished. The artefact explanation suggests the gradient is partly an artefact of how class and health are measured; most sociologists regard it as a minor factor that cannot explain away a gradient this large and consistent. The social selection explanation reverses the causal arrow, arguing that ill health causes low class position (the sick drift downwards) rather than the other way round; again, this is judged a contributory but insufficient explanation. These two explanations are important to know but are generally regarded as unable to account for the bulk of the gradient.

The two explanations that carry most weight are the cultural/behavioural and the material/structural. The cultural or behavioural explanation attributes poorer health to the behaviour of lower socio-economic groups - higher rates of smoking, poorer diet, less exercise - and implies that health inequality follows lifestyle choices. Critics argue this risks blaming the victim and ignores why such behaviours cluster among the disadvantaged. The material or structural explanation, associated with the Black Report and later the Marmot reviews, attributes the gradient to the unequal distribution of material conditions - income, housing, working conditions, environment and the chronic stress of disadvantage - arguing that health follows the structure of inequality itself. Behaviour, on this view, is shaped by material circumstances, so the two explanations are linked.

Evaluating health inequality means weighing these explanations and relating them to the perspectives. Marxists and structural sociologists favour the material explanation, tying health inequality to capitalism and class; the material account has strong support because the gradient persists across the whole class range, not just among the very poorest, and because it tracks the distribution of resources so closely. The behavioural explanation captures real proximate causes but cannot explain why behaviours are socially patterned without reference to material conditions. The strongest answers integrate the explanations - material conditions shaping behaviour, both producing the gradient - and reach a judgement that favours structural over purely individual accounts, while noting gender, ethnic and regional inequalities as further dimensions requiring explanation.

Illustrative health gradient by social class

Fig. 3Typical illustrative pattern (not official statistics): health tends to worsen down the class hierarchy - the gradient explanations must account for.

Worked example

Model essay plan: explaining health inequality

Plan a 20-mark answer evaluating sociological explanations of class inequalities in health.

Set up the debate
Introduce the class gradient and the four explanations; signal that material/structural carries most weight. Hook to the Item.
Dispatch artefact and selection
Artefact (measurement) and social selection (ill health causing low class) are contributory but cannot explain a gradient this large and consistent.
Behavioural explanation
Smoking, diet and exercise differ by class and affect health - but this risks victim-blaming and cannot explain why behaviours cluster among the disadvantaged.
Material explanation
Income, housing, working conditions and chronic stress (Black Report, Marmot) shape health across the whole class range and shape behaviour too - the strongest account.
Judgement
Conclude that behaviour and materials are linked but material/structural conditions are the fundamental cause; add gender, ethnic and regional inequalities as further dimensions.

Result: A top-band plan evaluates all four explanations, shows behaviour to be materially shaped, and judges the material/structural account the most convincing because the gradient spans the whole class range - an evaluative, integrated conclusion.

Typical mistakes

Presenting the behavioural explanation as a matter of free lifestyle choice, ignoring how material conditions shape behaviour (victim-blaming).
Describing the four explanations without evaluating their relative weight or reaching a judgement.

Active revision

Applying material from the Item and your knowledge, evaluate sociological explanations of social class inequalities in health. (20 marks)

Active recall

Recall the key points — then reveal.

Sources: AQA AS and A-level Sociology (7192) specification (AQA)

Inequalities in provision and the inverse care law#

StandardAQA 7192/2 HealthDfE GCE Sociology subject content

The inverse care law

Fig. 4Tudor Hart's inverse care law: the availability of good care tends to vary inversely with the need of the population served.

Alongside inequalities in health outcomes, sociologists study inequalities in the provision of, and access to, health care. Even in a system nominally free at the point of use, access and quality are unequally distributed by class, area, gender and ethnicity. Tudor Hart's 'inverse care law' captures the central paradox: the availability of good medical care tends to vary inversely with the need of the population served - those in greatest need, in the most deprived areas, often have the poorest access to services, while the healthier and better-off enjoy better provision. This runs directly counter to the principle of care according to need.

Several mechanisms produce unequal provision. The better-off may be more able to navigate the health system, articulate their needs, take time off work to attend, travel to services and secure referrals, so that even a universal system is used more effectively by those with more resources - a form of the middle-class advantage seen in education. Services themselves may be less well resourced in deprived areas, and geographical variation (the so-called 'postcode lottery') means that where a person lives affects what care they can obtain. Language, cultural barriers and discrimination can further disadvantage minority ethnic groups in accessing appropriate care.

The perspectives interpret unequal provision differently. Marxists see it as reflecting the priorities of a capitalist society in which health care, like other goods, follows the distribution of power and resources, and in which the state provides only enough to keep the workforce productive. Feminists examine how health services treat women, including the medicalisation of women's bodies and reproduction. Weberians and others focus on the professional and organisational processes through which access is rationed. Each perspective directs attention to different aspects of why care does not simply follow need.

Evaluating inequalities in provision means holding together the evidence of unequal access, the mechanisms that produce it, and the perspectives that explain it, while recognising the genuine achievements of universal systems in reducing inequality compared with wholly market-based provision. The inverse care law is a powerful organising idea, but the picture is complex: provision has expanded and some inequalities have narrowed even as others persist. A strong answer uses the inverse care law and the mechanisms of unequal access to argue that formal universalism does not guarantee substantive equality, connecting provision back to the wider structure of class and power the course documents, and reaching a judgement about how far care follows need.

Worked example

Analysing unequal access to care

Applying material from the Item, analyse two reasons why access to health care may be unequal.

Select reason one from the Item
Hook to a reference to deprived areas and develop the inverse care law: services are often least available where need is greatest (Tudor Hart).
Develop and link
Explain the mechanism (under-resourced services and geographical variation in deprived areas -> poorer access -> unmet need).
Select reason two from the Item
Hook to a reference to who uses services and develop the middle-class advantage: the better-off navigate the system more effectively, articulate needs and secure referrals.
Develop and link
Connect to the parallel with education and to the Marxist point that provision follows resources and power.

Result: A full-mark 10-marker develops exactly two reasons for unequal access - the inverse care law and the middle-class navigation advantage - each hooked to the Item with a clear mechanism, not a list.

Typical mistakes

Assuming a system free at the point of use guarantees equal access - the inverse care law shows otherwise.
Describing unequal provision without linking it to mechanisms or perspectives.

Active revision

Applying material from the Item, analyse two reasons why access to health care may be unequal. (10 marks)

Active recall

Recall the key points — then reveal.

Sources: GCE AS and A level subject content for sociology (Department for Education)

The medical profession and the sick role#

AdvancedAQA 7192/2 HealthDfE GCE Sociology subject content

Parsons: the sick role

Fig. 5Parsons's sick role grants rights and imposes obligations, with the doctor legitimating it - a mechanism of social control.

Parsons offered the classic functionalist analysis of illness as a social role. Because illness prevents people performing their normal social roles, it is potentially disruptive to society, so illness is socially regulated through the 'sick role'. The sick person is granted two rights - exemption from normal responsibilities and freedom from blame for their condition - but must accept two obligations: to want to get well (not to enjoy or exploit the sick role) and to seek and cooperate with competent medical help. The doctor acts as gatekeeper, legitimating the sick role and returning the person to their social functions. For Parsons, this is a mechanism of social control that manages the disruption illness would otherwise cause.

The sick role has been much criticised. It fits acute, curable illness better than chronic conditions or disability, where recovery is not the goal; it assumes a passive, compliant patient and an unproblematic, benevolent doctor, ignoring conflict, negotiation and the patient's own knowledge; and interactionists show that whether someone adopts the sick role, and whether it is granted, is negotiated and shaped by class, gender and ethnicity rather than automatic. Despite these criticisms, the concept remains valuable for showing that illness is a social role subject to social control, not merely a biological state.

The medical profession itself is analysed through competing perspectives. Functionalist 'trait' approaches see the professions as benevolent, expert bodies whose autonomy and self-regulation serve society by guaranteeing competent, ethical care. Weberian approaches, by contrast, analyse professionalisation as 'social closure' - the profession securing its market position, status and rewards by controlling entry, excluding competitors and monopolising a body of knowledge - so that professional power serves the profession's interests as well as the public's. Marxists go further, seeing medicine as serving capitalism by defining health in individual, biomedical terms that ignore the social causes of illness and by keeping the workforce productive.

Foucault's analysis reframes professional power as a form of surveillance and discipline: the medical profession exercises power through the clinical gaze, classifying, monitoring and normalising bodies, so that its authority is a modality of social control rather than simply neutral expertise. Evaluating the medical profession means weighing the genuine benefits of medical expertise and self-regulation against the Weberian evidence of self-interested closure, the Marxist critique of medicine's ideological function, and the Foucauldian account of medical power - and reaching a judgement about whether the profession primarily serves patients, itself, capitalism, or the disciplining of bodies. The sick role and the analysis of professional power together show health care to be a domain of power and control, not just healing.

Worked example

Model essay plan: whose interests does the profession serve?

Plan a 20-mark answer evaluating the view that the medical profession serves society as a whole.

Set up the debate
The functionalist trait view says the profession serves society; Weberians, Marxists and Foucault disagree. Signal a judgement. Hook to the Item.
The trait case
Professions are expert, self-regulating and ethical, guaranteeing competent care - their autonomy serves the public interest.
The Weberian critique
Professionalisation is social closure: controlling entry and knowledge secures the profession's status, income and monopoly - serving itself as well as the public.
Marxist and Foucauldian critiques
Marxism: medicine's individual, biomedical focus serves capitalism by ignoring social causes and keeping workers productive. Foucault: professional power disciplines bodies through the clinical gaze.
Judgement
Conclude that the profession delivers real benefits but also serves its own interests and functions as social control, so the claim that it serves society alone is one-sided.

Result: A top-band plan credits medical expertise, then uses Weberian closure, Marxist and Foucauldian critiques to show the profession also serves itself, capitalism and social control - judging the 'serves society as a whole' claim incomplete.

Typical mistakes

Presenting the sick role as a straightforward description rather than a functionalist model open to interactionist and other critique.
Treating the medical profession as simply benevolent (trait view) without the Weberian, Marxist and Foucauldian critiques of professional power.

Active revision

Applying material from the Item and your knowledge, evaluate the view that the medical profession serves the interests of society as a whole. (20 marks)

Active recall

Recall the key points — then reveal.

Sources: AQA AS and A-level Sociology (7192) specification (AQA)

The social construction of mental illness#

AdvancedAQA 7192/2 HealthDfE GCE Sociology subject content

The social construction of mental illness

Fig. 6Labelling theory traces how social norms and professional power turn rule-breaking into a diagnosis, a master status and a career.

Mental illness is a particularly clear case for the social-construction argument, because its definition depends heavily on social norms about acceptable thought and behaviour. Sociologists examine how the boundary between mental health and mental illness is drawn, who has the power to draw it, and how the definition varies across cultures and history. The distribution of diagnosed mental illness by class, gender and ethnicity - patterned rather than random - itself suggests that social factors shape both the causes of distress and the process of diagnosis, making mental illness a social as well as a medical phenomenon.

Labelling and interactionist approaches are central. Scheff argued that much mental illness can be understood as a societal reaction to 'residual rule-breaking' - behaviour that breaks unwritten social norms - and that being labelled mentally ill can launch a career in the sick role, with the label becoming a master status that shapes how the person is seen and treated, and how they come to see themselves. Goffman's study of the 'total institution' of the asylum showed how such institutions can strip inmates of their former identity and produce institutionalised behaviour, illustrating how the response to mental illness can shape the condition it claims merely to treat.

The anti-psychiatry tradition pushed the argument furthest. Szasz provocatively described mental illness as, in many cases, a 'myth' - not a disease of the body but a label attached to problems of living and to deviations from social norms, used to control and exclude. Whether or not one accepts so strong a claim, it dramatises the sociological point that psychiatric categories are historically variable and socially produced, and that psychiatry exercises social power in defining and managing deviance. Foucault's history of madness similarly traces how societies have defined and confined the 'mad', showing the definition of insanity to be bound up with power.

Evaluation must balance the social-construction insight against the reality of severe mental distress. Critics of the strongest labelling and anti-psychiatry positions argue that they risk denying the genuine suffering of serious mental illness and the value of treatment, and that some conditions have substantial biological components. Yet the sociological contribution remains powerful: the definition, distribution and treatment of mental illness are unmistakably shaped by social norms, professional power and inequality, so that mental illness cannot be understood in purely biomedical terms. A strong answer holds these together - taking distress seriously while showing how thoroughly the social shapes what counts as mental illness, who is labelled, and how they are treated - and reaches a judgement about the balance of the social and the biological.

Worked example

Evaluating the social construction of mental illness

Assess the view that mental illness is best understood as socially constructed.

State the construction case
Labelling (Scheff), the total institution (Goffman) and anti-psychiatry (Szasz, Foucault) show mental illness defined by social norms and professional power, with patterned diagnosis by class, gender and ethnicity.
Develop the argument
The boundary of mental illness varies across cultures and history, and a diagnosis can become a master status that shapes identity and treatment - evidence of construction.
Apply the critique
But the strongest 'myth' view risks denying real suffering and the value of treatment, and some conditions have biological components.
Judgement
Conclude that mental illness is not purely constructed nor purely biological: distress is real, but its definition, distribution and treatment are profoundly shaped by the social - so the construction thesis is largely, but not wholly, persuasive.

Result: Mental distress is real, but the social-construction thesis is largely persuasive because the definition, patterned distribution and treatment of mental illness are shaped by social norms and professional power - a balanced judgement, not the strong 'myth' claim.

Typical mistakes

Taking the strong 'myth of mental illness' view uncritically, denying genuine suffering.
Ignoring the patterned distribution of diagnosis by class, gender and ethnicity that signals social influence.

Active revision

Applying material from the Item and your knowledge, evaluate the view that mental illness is socially constructed. (20 marks)

Active recall

Recall the key points — then reveal.

Sources: GCE AS and A level subject content for sociology (Department for Education)

References & sources

Sources

Department for Education

GCE AS and A level subject content for sociology

AQA

AQA AS and A-level Sociology (7192) specification

Health (optional topic)

5 sections~21 min reading time3 competenciesLevel Standard 2 · Advanced 3

Health (optional topic)

Key points

Applying social construction to medicalisation

Key points

Model essay plan: explaining health inequality

Key points

Analysing unequal access to care

Key points

Model essay plan: whose interests does the profession serve?

Key points

Evaluating the social construction of mental illness

Sources

Health (optional topic)

Key points

Applying social construction to medicalisation

Key points

Model essay plan: explaining health inequality

Key points

Analysing unequal access to care

Key points

Model essay plan: whose interests does the profession serve?

Key points

Evaluating the social construction of mental illness

Sources