Title: Amzat, J. and Razum, O.Medical Sociology in Africa. Dordrecht: Springer. 2014. 299pp. £90 ISBN 10: 3319039857 (hbk)
Abstract: Medical sociology has been developing as a branch of sociology for more than a half century, covering questions relevant to the relations between health and society and often crossing discipline borders and attracting transdisciplinary expertise. Nevertheless, modern medical sociology is often marginalised as a result of the rise of bioethics and medical humanities. Medical sociology needs to rise to the forefront, especially work that combines local experience with a global outlook. The book under review consists of 12 chapters, combining fundamental theoretical discourse with issues and topics in modern and practical medical sociology. The first chapter, ‘Sociology and health’ offers a coherent and very useful introduction to the content of this book. As in in other disciplines, it is easier to understand modern medical sociology after a historical overview, enriched with basic sociological theses (for example, that social problems are objective conditions with a specific social aetiology: that they can cause social damage and affect groups and require social action). Recognising health problems as social problems in this sense is one of the most important tasks of medical sociology. The chapter also refers to various disciplines of sub-medical sociology (including the sociology of dying and death, the sociology of medical care and hospitals and the sociology of psychiatry), as well as to social epidemiology and alternative medicine. Chapter Two (‘Health, disease and illness as conceptual tools’), deals with the definitions listed, but also with their deeper meanings. This confronts the (bio)medical gaze of health with social science perspectives, followed by the introduction and explanation of the World Health Organisation model of health, as well as the increasingly important wellness and environmental models. Making a clear distinction between health, disease and illness (and sickness) is crucial for anyone involved in medical education, but what remains as a problem in many languages is the absence of suitable terms in translation. For example, the Croatian word bolest means disease, but it is also often translated as illness; when meaning social status, bolest is also used to mean sickness. However, the explanations offered in this chapter help make such distinctions clearer. After a chapter devoted to different concepts of health and disease (including the causes of disease, from natural and supranatural to mystical and genetical), Chapter Three makes a step towards a better understanding of behaviour related to the experience of health and disease. This deals with one of the major problems of medical sociology and the authors do not fail to offer a definition of health behaviour, tracking its origins to the work of Kasl and Cobb in 1966: ‘health behaviour refers to those activities undertaken by person believing himself [or herself] to be healthy, for the purpose of preventing disease or detecting it in as an asymptomatic stage’ (p. 39). Another part of this chapter explores risk behaviour (such as dietary and sexual behaviour, alcohol and drug use, sedentary lifestyles and smoking). Illness behaviour, a concept introduced by David Mechanic in the 1950s and developed over later decades, is the opposite of health behaviour and refers to the actions and responses to signs and symptoms of individuals after they have started to believe they are ill. The authors also elaborate on some of the factors affecting both health and illness behaviour (attributions or perceptions of disease depending on factors such as their socioeconomic status, gender, education, age, religion and spiritual worldview). Those factors are also relevant in exploring the social determinates of health, presented in Chapter Four. In a globalised world, the social factors of health are changing, but they still present the core of sociological research related to medicine, healthcare system and individual health. Social determinates of health vary from personal characteristics like gender, employment, ethnicity and race, to the systemic characteristics like the political situation, policies and cultural norms, but they always have an impact on social and health opportunities and inequalities. The authors mention several other social determinates of health – migration, urbanisation, globalisation and health policy, but do not offer deeper explanations for them. One such feature that could have been mentioned is poverty, bearing in mind the African context of the book. Of all these social determinants, poverty, in all six dimensions of availability, accessibility, affordability, adequacy, acceptability and ability, is critical for access to healthcare in Africa (pp. 77–8). In Chapter Five the authors describe the functionalist perspective on health. The early sociologists (Auguste Comte, Emile Durkheim, Herbert Spencer, Max Weber, Karl Marx, George Simmel) are introduced and a broad overview of Talcott Parsons's work is offered. The authors also examine Durkheim's suicidology and the meaning of social capital theory of health. The next three chapters discuss sociological perspectives and theories. Chapter Six analyses the relations between health and society from the perspectives of Marxist theory (political economy, emphasising the role of structral-economic factors in the generation of health and of especially health problems), feminism (Kate Millett, Simone de Beauvoir, Ann Oakley, Shulamith Firestone) and the fundamental cause theory. Ivan Illich's contribution is also recognised by the authors through his concept of iatrogenesis (p. 113). Chapters Seven and Eight deal with interpretive perspectives in medical sociology, system theories and the microsociological approach (which itself includes various theories from symbolic interactionism to social constructionism). The central notion in these theories is that so-called objective facts are not external to or coercive of human actions and behaviour so that the focus here is not on groups such as class or gender, but on individuals (p. 130). In this section the authors also address bureaucratic rationality and medical institutions, including the sociology of hospitals, thus involving Max Weber as a founder of the interpretive perspective. Part II of The Interpretive Perspectives in Medical Sociology (Chapter Eight) continues at a microsociological level, including contributions from the social construction of illness, the theory of the social stigma, Goffman's total institution, the chronic illness trajectory model, labelling theory and postmodernism. Modern medical sociology is closely related to the fields of bioethics and medical ethics. This issue is addressed in Chapter Nine, this time from the perspective of social science. The core topic of this chapter – medicalisation – is explained by the authors from various standpoints, including Friedson's concept of professional dominance, Foucault's concept of the clinical or medical gaze, Szasz' anti-psychiatry movement, Zola's work on social control and Illich's levels of medical intervention. Like geneticisation and medical enhancement, pharmaceuticalisation is explained as a special form of medicalisation. In explaining the client–physician model, the authors use several points of view: paternalistic, informative, interpretative and deliberative. Chapter Ten deals with the question of medical pluralism: traditional and modern health care, present also in African cultures with deeply rooted forms of traditional medicine (more than 100 African countries have some form of regulation of traditional medicine). After discussing the major features of traditional medicine (pp. 209–10), the authors offer a list of the categories of healers (especially useful to the increasing number of Western practitioners in African countries) and describe some of the shortcomings of the traditional medicine. This chapter also includes overviews of the current healthcare system in Africa, healthcare workers and political standpoints and finally, the challenges to the delivery of healthcare in Africa. Despite its importance, bioethics has not attracted much interest from social scientists in the previous few decades, with the exception of Raymond de Vries and Ivan Šegota. Amzat and Razum's Chapter 11 (‘Towards a Sociology of Bioethics’) therefore can be considered a really original and pioneering contribution. The aim of the chapter is not to provide a broader examination of bioethics as a discipline, but to ‘explore some of the critical areas of bioethics in order to provide (sociological) understanding of the core issues’ (p. 241), which is especially true of the application of sociological insights, perceptions and methods to the moral dimension of life and health sciences. The authors are to be praised for abandoning the general concept of bioethics as medical ethics and for entering the environmental discourse in a section on the history and notion of bioethics (including the work of V. R. Potter and F. Jahr from the 1920s). The crucial last chapter ‘A sociological study of health problems in Africa’ covers the main topic of the book. The authors have made a selection of a wide range of health problems in Africa (such as malaria, HIV, gender inequalities, polygyny, harmful cultural practices, stigma and religion beliefs) to discuss. There is special emphasis on the issues of maternal and child health, topics traditionaly used in sociology as a reflection of healthcare status. However, understanding healthcare problems in Africa is not a challenge only to medical sociology, but a duty of all those living in a globalised world: a duty the authors of this book and Springer have once again so successfully reminded us of.