Sociology, Health and the Fractured Society: A Critical Realist Account

217 Pages·2018·2.372 MB·English

by  Graham Scambler

Sociology, Health and the
Fractured Society
It is now accepted that many of the determinants of health and health
care are social. This volume offers a philosophical and theoretical frame
within which the nature and extent of this might be optimally examined.
The analysis is rooted in Roy Bhaskar’s basic and dialectical critical realism,
although it draws also on the critical theory of Jurgen Habermas. It p urports
to provide an ontologically and epistemologically grounded comparative so-
ciology of contemporary health and health care in the twenty-first century.
Carrying a fourfold agenda, the volume sets out a dialectical critical re-
alist frame for a sociology of health and health care; it clarifies sociology’s
potential and limitations; it suggests a research programme and a series of
questions for investigation; and it offers an argument for an action sociology
embedded in a dialectical theory of transformative action.
This volume will be of interest to students and scholars in the areas of
philosophy, sociology and critical realism, as well as those working in health
and social care.
Graham Scambler was Professor of Medical Sociology at UCL until his re-
tirement in 2013 and is currently Emeritus Professor of Sociology at UCL
and Visiting Professor of Sociology at Surrey University.
Routledge Studies in Critical Realism
For a full list of titles in this series, please visit www.routledge.com
Some other books in the series:
Critical Realism, Post-positivism and the Possibility of Knowledge
Ruth Groff
Emergentist Marxism
Dialectical Philosophy and Social Theory
Sean Creaven
Engendering the State
The International Diffusion of Women’s Human Rights
Lynn Savery
Explaining Global Poverty
A Critical Realist Approach
Branwen Gruffydd Jones
Ontology of Sex
Carrie Hull
Revitalizing Causality
Realism about Causality in Philosophy and Social Science
Edited by Ruth Groff
Interdisciplinarity and Wellbeing
A Critical Realist General Theory of Interdisciplinarity
Roy Bhaskar, Berth Danermark, and Leigh Price
Sociology, Health and the Fractured Society
A Critical Realist Account
Graham Scambler
Empiricism and The Metatheory of The Social Sciences
Roy Bhaskar
Sociology, Health and the
Fractured Society
A Critical Realist Account
Graham Scambler
First published 2018
by Routledge
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© 2018 Graham Scambler
The right of Graham Scambler to be identified as author of this
work has been asserted by him in accordance with sections 77 and
78 of the Copyright, Designs and Patents Act 1988.
All rights reserved. No part of this book may be reprinted or
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British Library Cataloguing-in-Publication Data
A catalogue record for this book is available from the British
Library
Library of Congress Cataloging-in-Publication Data
Names: Scambler, Graham, author.
Title: Sociology, health and the fractured society: a critical
realist account / Graham Scambler.
Description: Milton Park, Abingdon, Oxon; New York, NY:
Routledge, 2018. |
Series: Routledge studies in critical realism | Includes
bibliographical references and index.
Identifiers: LCCN 2017053108
Subjects: LCSH: Health—Social aspects. | Social medicine. |
Medicine—Philosophy.
Classification: LCC RA418 .S296 2018 | DDC 362.1—dc23
LC record available at https://lccn.loc.gov/2017053108
ISBN: 978-1-138-90982-3 (hbk)
ISBN: 978-1-315-69376-7 (ebk)
Typeset in Times New Roman
by codeMantra
Contents
Acknowledgements vii
Introduction 1
PaRT I 5
1 Health as a social lens 7
2 Perspectives in health sociology 26
PaRT II 57
3 Basic critical realism and health 59
4 Archer, reflexivity and middle-range theories 90
5 The sociological potential of dialectical critical realism 110
PaRT III 129
6 ‘Fractured society’: health and the mechanisms that
matter most 131
7 Transformative politics and change 153
8 A sociological Manifesto 171
References 189
Index 199

acknowledgements
Much is owed, as ever, to predecessors and consociates. This is a work of
‘meta-reflection’ indebted equally to social and critical theorists and to em-
pirical researchers.
More than this, I pay tribute to the late Roy Bhaskar’s pioneering and
creative philosophical underlabouring and to his generosity of spirit. Like
many, I miss conversing with him. He didn’t just talk philosophy and sociol-
ogy: whenever we met he asked after Annette and our four daughters. I still
owe much to the remarkable work of Jurgen Habermas, as will be apparent.
Finally, Margaret Archer too has been a source of inspiration as well as
always being a pleasure to meet and debate with. There are occasions in
which I question my ‘only child’ predilection for secreting myself away to
write alone! But then …
The book is dedicated to Annette Scambler, sociologist and feminist, who
puts up with a lot with remarkable forbearance.

Introduction
My orientation to the substantive domain of the sociology of health and
health care was initially and has remained philosophical and theoretical.
The present volume has provided an opportunity to pull together strands
in my thinking that straddle what are often even now seen and treated as
discrete discourses: philosophically grounded theory on the one hand, and
substantive research on the other. Doubtless I have fallen short of my aspi-
rations, but my overriding aim has been to put together a critical account of
sociology’s contribution to our understanding of health and health care in
modern societies like Britain. Why ‘critical’? It is an adjective that I deploy
quite readily having learned much from Jurgen Habermas’s late-Frankfurt
School critical theory and Roy Bhaskar’s critical realism. What my and their
usages have in common is a commitment not only to achieving understand-
ing, or even explaining, but to an ‘active’ publicly oriented sociology beyond
the artificial constraints of Hume’s ‘is-ought’ dichotomy.
Several of the chapters are given over to or incorporate explications of
dense philosophical and theoretical arguments developed by Habermas,
Bhaskar and others. I have considered myself bound, however, by a stric-
ture or two. The first and most important one for me is that my sociology
is geared to throwing such light on the interrelations between society and
health as allows people to see a short way ahead. To this end, my more
abstruse digressions are subordinated to the sociological project as I see
it. While I consider it important to represent others’ arguments faithfully,
my paramount concern is with sociology, health and health care. Getting a
credible grasp of how things are, why they are as they are and what might
be done to change them for the better trumps all else. This is most salient in
relation to Bhaskar’s dialectical critical realism (or DCR). A development
well beyond his basic critical realism (BCR), DCR is notoriously resistant
to exegesis. But this matters less to me here than DCR’s potential to deepen,
underpin and reinvigorate the sociological project. I do not hesitate to learn
lessons from Bhaskar’s BCR and DCR that might not have been intended;
that is, I am faithful to a point, but not above all else.
My second stricture is that I regard sociology both as irreducible ‘down-
wards’ towards psychology, biology and beyond, or ‘upwards’ towards