According to Fair (2011), health is multidimensional concept that regards the social, physical or mental wellbeing. Some of the sociological theories and perspectives on theories in health are Marxism, feminism, Weberianism, conflict theory, functionalism and social interactionism. Dominance is defined as the disposition of a person to show control in their dealings with other people (Willis, 1989). Medical dominance (power) is as a result of the clinical position doctors take in diagnosis and treatment. It is maintained through economic, political and clinical autonomy. Doctors perform their work without direction from other health professions-autonomy (independence) (Willis, 1989). This is exerted in four distinct approaches; subordination, limitation, exclusion, and incorporation over the other health providers like nurses, and allied health providers. These characteristics are a clear reflection of the Australian health care system. It is a truism that occupational hierarchy is a representation of the Australian health care system. Doctors in Australia enjoy the most prestige as defined Braithwaite et al. (2016).
This essay is going to explore these two deep rooted aspects of the health care systems (medical dominance and hierarchy) in the Australian context borrowing reference and concepts from various sociological theorists and showing how they impact myself as a health practitioner.
The outline of this essay is as follows; first it will be a discussion on sociology and the role of perspectives in health care. That will be followed by a discussion of the Australian Health Care System and the biomedical model. Social theories for hierarchy and dominance (power) in the Australian health care Contexts will be discussed.
Sociology is learning about groups of people and societies and their social interactions starting from the very small groups to a very broad and large groups (Norbert, 1980). What sociologists do is exploring all aspects and micro and macro levels of society. Sociology is an important factor in health in that it focuses on the occurrence of health conditions and how they can be treated in different societal and locational settings (Norbert, 1980). In the case of Ebola in West Africa Nations in 2014, for example, sociological perspectives and aspects can prove important in the best way to respond to the virus to prevent its spread to other regions. Countries like Australia and America who could have some of their citizens or medical providers in Liberia or DRC had fears on how to prevent importation of the virus, and at the same time identify and treat present or potential cases in the shortest time possible.
Sociology in health care is comprised of social epidemiology, mental health, disability, medicalization or disease (Pescosolido, Martin, McLeo & Rogers, 2010). Perception of health is an evolving aspect and that necessitates continuous control of new diseases as they develop. This is supported by the fact that society continues to evolve as a result of globalization and consequently disease spread also do evolve with it (Cockerham, 2015).
Some of the questions answered through sociology the definition of health from different people within the society, addiction to sex or gabbling, conditions previously regarded as diseases but currently taken for normal conditions or conditions now regarded as diseases and were previously identified as a symptom of laziness or character, and the reason for children vaccination among other questions ("Introduction to Health and Medicine · Sociology 2e", 2018).
This brings in the role of perspectives in the understanding of issues of this nature. Using the functionalist perspective, for example, which is macro-level analysis and takes concern on the bigger picture in order to concentrate more on the way societal aspects are integral to persistence in health and viability of the whole society ("Theoretical Perspectives in Sociology | Sociology: Understanding and Changing the Social World", 2018; Stolley, 2005). This perspective regards the contribution of the healthy population to influence a stable society like ensuring that the sick regain their health (like in the case of Ebola above).
The conflict perspective is too a macro-level analysis that aims at eliminating the social inequality between people within a health and a health care system (Andersen & Taylor, 2016). People from disadvantaged backgrounds are vulnerable to poor quality care whereas they are the most people who fall sick. Disparities in race, age, gender and tribe are among the factors that need to be considered (Livesey, 2014). Interactionist perspective is concerned about how people understand personal health and how the status of their health impacts the other people (Rubington, & Weinberg, 2015). A practical example is a person with Ebola virus and being secluded to avoid transmission while socializing with members of the society.
A healthcare system works towards promoting and restoring or maintaining health (WHO, 2009). Both formal and informal services are characteristics of healthcare systems. Health care systems are not systematic but are still operational. The present day health care systems like that one of Australia is a large economic sector. Australian Health Care System (AHCS) comprises of both the private and the public sectors. These two sectors are overseen by 3 ranks of the government; commonwealth, territorial and local providers. The system is comprised of private insurance. This system is influenced by a range of factors like social, technical, legal, constitutional, political and economic. The ideologies of equality and freedom in a big percentage fuel health care in Australia. Equality regards the collective duty for equal health outcomes without discrimination on disparities previously identified (Annandale, 1998; Duckett, & Willcox, 2015). The biomedical model is predominant from the 19ty Century and has all along been applied in the diagnoses of diseases. It has a curative focus (Mazzotta, 2016).This model comprises freedom from pain, defects or diseases to bring about health. The role of social factors or personal subjectivity are not considered in process of the biomedical model such as pathology, physiology and biochemistry. Under this model, only the biological factors are taken into considerations excluding the psychosomatic, ecological and social influences (Mythen, & Walklate, 2006).
Medical dominance is explained by social theorists. The concept depends on the interests of the medical profession that coincide with those of the dominating class (Willis 1989).There are two views of medical dominance can be explained from their distinguished understanding of autonomy and the extent to which the autonomy may apply in health care (Ovretveit, 1985). Autonomy in the medical fields is expressed not only in the clinical fields, but also in the political and economic domain (Willis 1989).
An example of medical dominance is the medicalization of childbirth (Naidoo & Wills, 2016). Doctors in Australia gain and maintain their dominance by use of political approaches. They have formed association and enticed the government to abolish the practicing of other health professions. This is clear in history when the Australian government only held the role of signing death certificates, holding appointments with the government, using medical titles and suing for non-payment only to the doctors (Furze, 2014; Oths & Hinojosa, 2004). The functionalist theorists maintain that the interaction between doctors and patients is a complex one and thus demands similar complex analyses of the passivity of the patient ("Social theory and the sociology of health and medicine", 2011).
According to Friedson (1988), the organization of healthcare depends on the relations between occupations in the division of labour in the health sector. Friedson explains that the medical profession is occupies a dominant position establishing a monopoly in that domain. The medical profession preserves legal and formal rules and regulations to dominate. He stated that medicine has the power to direct and evaluate the work of others without being and not in a subjective manner to the other professions. Friedson also advocated for the development of a well distinct kind of medical sociology that would apply structural points of view to medical institutions but still being afar from medicine’s assumptions and points of standpoints (Conrad, 2008).
The medical profession demonstrates dominance over the nursing profession in Australia. In the hierarchy of medicine. The medical field is explained to be subjected to professionalism with doctors standing at the peak of the hierarchy in medicine. This domination of doctors in Australia limits the nursing profession and the performance of nurses. Nurses’ roles in decision making and other aspects in their job are limited and there is no that wide context where nurses can portray in health care services. Medical dominance in Australia is therefore a boundary of clinical knowledge and proficiency of the professional doctors from nurses (Willis 1989). This is captured by the Profession of Medicine (1970) which clearly explained the boundaries of the medical sociology on the examination of the sociological perspectives on the practice and occupation of medicine (Freidson, 1988).
In Australia, dominance of the doctors over nurses and other health occupations result from the doctors’ professionalism. From it, doctors have a higher status and wealth as compared to nurses and allied health providers. The dominance has also restricted the opportunities affordable to other health workers. The medical field is thus more legitimized. The legitimacy of doctors as experts is via political and legal systems (Furze, 2014). In Australia, the stiff increase in the demand for health care and the lucrative market for pharmaceuticals cures assisted in bolstering the profession to its present dominant state. According to Michel Foucault, a theorist, medical dominance is a historical concept that transformed from how power is exercised and from it the professional form of medical status gained origin. In Australia therefore, when there is superiority in decision making, there is dominance as that overpowers the other health professions.
The division of labour in the health domain is a clear proof of medical dominance in nursing in Australia and other countries too (Willis 1989). The context within which labour is divided in Australia is within the capitalist structure (Andrews & Hale 2000). Willis maintains that the superiority of medicine is as a result of state patronage. The consequence of that is other domains becoming subjective to the medical profession.
In Australia, however, nursing profession aims at extending its image and role in the field of health service. Nurses oppose the medical dominance and have showed progress in the occupation of advanced roles in health service. Hegney is a theorist who deduces that the emergence of advance practice and roles of nurses is a threat to the dominance of the medical field (Paperdue, 2018).
Occupational hierarchy is a characteristic of the Australian health care system from the early days. Hierarchy is an encrusted social construction that conceptualises sovereign and subsidiary relationships transitively (Braithwaite et al., 2016). This hierarchy accounts for the prestige that doctors occupy and the material awards they accrue.
The concept of hierarchy is captured by the conflict approach theorists. As already noted earlier, medical dominance is closely related to the some social variables like gender. The health domain, even in Australia, has historically portrayed a gendered health occupation with majority of doctors being male and nurses being female. The conflict theory attaches itself to the quality of health and how it is delivered, Disparities in the social class race, gender, and ethnicity reflect so perfectly in the health care sectors (Andersen & Taylor, 2016). This approach contends the efforts of physicians to control how medicine is practiced and in the definition of various social challenges as medical ones. It is a truism for the theorists that a good diagnoses of problems and treatment is to be a duty of the most qualified doctor. However, the continued classification of social problems as medical problems and is monopolizing treatment and at the same time neglecting the potential social causes of the problems (Conrad & Leiter, 2003).
In the division of labour in care facilities, the nurse is submissive to the doctors. Some theorists reason that the superiority of medicine as a male dominated domain devalues nursing as a female career and hence “women’s work”. Despite the fact that many males have entered the nursing career since 1970’s, the very same nurses are at a better position of taking positions for advancement into specialised areas and nursing education. This therefore cannot eliminate the notion of nursing as feminine work (Willis, 1989).
The nursing career in Australia is yet to reach total professional status. This is so despite the progress made so far in the alteration of the career structures. Division of labour in healthcare is a process that is based on conflict. It is comprised of two features and one of it is its hierarchal nature and the other one is dominance by the medical profession. The division of labour is differentiated on 2 different but interrelated bases. One is occupational division of labour and the others sexual division. Both bases lead to a hierarchical structure that show a big gap in normal income (Willis, 1989).
Friedson view of hierarchy as organizational but subordination to senior officers is also based on the putatively superior knowledge of the professional expert. This argument by Friedson is more of dominance than hierarchy and according to Larkin hierarchy is not just a matter of health occupations but negotiated power (Willis, 1989). According to Hughes and Allen (2017), bureaucratic hierarchy or collegial relations are what shape the experience of team working and teamwork warrants that inform a solid aspect of labour division.
Feminist and Marxism theories are inclined towards the conflict theory in the understanding of inequality in health. The feminist theorists are against for a reduced patriarchal nature of the contemporary health domains (Henslin, Possamai, Possamai-Inesedy, Marjoribanks & Elder, 2014). They are for advocacy against women oppression. They extend their concern to the domination of medicine and the need for social control of the dominance in a move to protect the inferior position occupied by women providers and their high level of contact with the profession. Karl Marx did not look into the effects of the exploitative capitalist world on health but subsequent Marxists like Friedrich Engels explained the impact of the nature and experience of health and illness relating to the economic system (Henslin et al., 2014).
Andersen, M. L., & Taylor, H. F. (2012). Sociology: the essentials. Nelson Education.
Annandale, E. (1998). The Sociology of Health and Medicine: A Critical Introduction. Cambridge: Polity
Braithwaite, J., Clay-Williams, R., Vecellio, E., Marks, D., Hooper, T., & Westbrook, M. …Ludlow K. (2016). The basis of clinical tribalism, hierarchy and stereotyping: a laboratory-controlled teamwork experiment. BMJ Open, 6(7), e012467. doi: 10.1136/bmjopen-2016-012467
Cockerham, W. C. (2015). Medical sociology. Routledge.
Conrad, P. (2008). The medicalization of society: On the transformation of human conditions into treatable disorders. JHU Press.
Conrad, P., & Leiter, V. (2003). Health and health care as social problems. Lanham: Rowman & Littlefield.
Elias, Norbert. 1978. What Is Sociology? New York: Columbia University Press.
Fair, S. (2011). Wellness and physical therapy. Sudbury, Mass.: Jones and Bartlett.
Freidson, E. (1988). Profession of medicine: A study of the sociology of applied knowledge. University of Chicago Press.
Furze, B. (2014). Sociology in Today's World - with Student Resource Access 12 Months. Melbourne: Cengage Learning Australia.
Henslin, J., Possamai, A., Possamai-Inesedy, A., Marjoribanks, T., & Elder, C. (2014). Sociology Down to Earth Approach VS (2nd ed.). Sydney: Pearson Education Australia.
Hughes, D., & Allen, D. (2017). Nursing and the division of labour in healthcare; Sociology and Nursing Practice. Basingstoke: Macmillan International Higher Education,.
Introduction to Health and Medicine · Sociology 2e. (2018). Retrieved 28th Sep. 2018 from https://philschatz.com/sociology-book/contents/m52876.html
Livesey, C. (2014). Cambridge International AS and A level Sociology Coursebook. Cambridge University Press.
Mazzotta, C. (2016). Biomedical approaches to care and their influence on point of care nurses: a scoping review. Journal Of Nursing Education And Practice, 6(8). doi: 10.5430/jnep.v6n8p93
Naidoo, J., & Wills, J. (2016). Foundations for Health Promotion-E-Book. Elsevier Health Sciences.
Oths, K. S., & Hinojosa, S. Z. (Eds.). (2004). Healing by hand: manual medicine and bonesetting in global perspective. Rowman Altamira.
Ovretveit, J. (1985). Medical dominance and the development of professional autonomy in physiotherapy. Sociology Of Health And Illness, 7(1), 76-93. doi: 10.1111/1467-9566.ep10831370
Paperdue. (2018). Sociology -- Medical Dominance On The Profession Term Paper. Retrieved 28th Sep. 2018 from https://www.paperdue.com/essay/sociology-medical-dominance-on-the-profession-154483
Pescosolido, B. A., Martin, J. K., McLeod, J. D., & Rogers, A. (Eds.). (2010). Handbook of the sociology of health, illness, and healing: a blueprint for the 21st century. Springer Science & Business Media.
Rubington, E., & Weinberg, M. (2015). Deviance: The interactionist perspective. Routledge.
Social theory and the sociology of health and medicine. (2011). Retrieved 28th Sep. 2018 from https://uk.sagepub.com/sites/default/files/upm-binaries/46238_Bradby.pdf
Stolley, K. (2005). The basics of sociology (p. 30). Westport, Conn.: Greenwood Press.
Theoretical Perspectives in Sociology | Sociology: Understanding and Changing the Social World. (2018). Retrieved 28th Sep. 2018 from https://open.lib.umn.edu/sociology/chapter/1-3-theoretical-perspectives-in-sociology/
What Is Sociology? · Sociology 2e. (2018). Retrieved 28th Sep. 2018 from https://philschatz.com/sociology-book/contents/m52764.html
WHO. (2009). WHO Guidelines on Hand Hygiene in Health Care: First Global Patient Safety Challenge Clean Care Is Safer Care; Definitions of health-care settings and other related terms. Retrieved 28th Sep. 2018 from https://www.ncbi.nlm.nih.gov/books/NBK144006/
Willis, E. (1989). Medical Dominance Revised. Allen & Unwin,