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- Kategorie: Fachliteratur
- Sprache: Englisch
A comprehensive guide to social sciences in person-centred healthcare practice
To deliver truly person-centred care, healthcare professionals must understand the complex social, psychological, and economic factors that influence health and wellbeing. Social Sciences for Healthcare Professionals bridges the gap between theory and practice, providing a thorough overview of essential social science concepts and their relevance in clinical settings. Covering a wide range of core topics, from understanding social determinants of health to promoting equitable care, Dr Chris Allen and his team provide readers with evidence-based insights to drive better outcomes for individuals and communities.
Social Sciences for Healthcare Professionals:
- Combines insights from disciplines including psychology, sociology, and economics for a multidisciplinary approach to healthcare
- Features practical case studies to illustrate theory and its application in diverse clinical settings
- Promotes critical thinking and reflective practices for improved healthcare delivery
- Includes activities and recommendations to support learning in both academic and professional contexts
- Emphasises the importance of evidence-based, socially sensitive healthcare
Written by experienced educators and experts in nursing education, Social Sciences for Healthcare Professionals is essential reading for pre-registration, undergraduate, and postgraduate healthcare students in nursing, midwifery, and allied health fields. It is designed to support both coursework and professional practice, aligning with degree programmes in healthcare and allied health sciences.
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Seitenzahl: 1217
Veröffentlichungsjahr: 2025
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Table of Contents
Cover
Table of Contents
Title Page
Copyright Page
List of Contributors
Preface
Acknowledgements
CHAPTER 1: An Introduction to Social Sciences for Healthcare Professionals
How to Use This Book
What Are the Social Sciences?
So Why the Social Sciences?
A Patient's Journey: The Social Sciences in Action
Completing Barry's Story
References
PART 1: Understanding Health, Healthcare Systems, and the Healthcare Workforce
CHAPTER 2: Social Theory, Social Research Methods and Health in the Context of Society and Care
Introduction
What Is a Theory?
Understanding Theories Through Levels of Abstraction
Grand Theories
Mid‐Range Theories
Programme Theories
How Grand, Mid‐Range and Programme Theories Work Together
Macro, Meso and Micro Levels
Macro Approaches: How Does Society Work?
Micro Approaches: How Does Society Work?
Social Research Methods
Positivism (Quantitative Methods)
Interpretivism (Qualitative Methods)
Conclusion
References
CHAPTER 3: What Is Health and Disease Why Do Definitions and Classifications of It Matter?
Introduction
What Is Health and Well‐Being?
Shifting Perspectives on Health
Health as a ‘Resource’
The Biopsychosocial Model
Salutogenesis and Positive Health
Disease Classifications
Medicalisation, Over Medicalisation and Overdiagnosis
Invisible Illness: Felt but Not Seen
Health, Disability and Personal Independence Payments
Conclusion
References
CHAPTER 4: The Social Science of Mental Health and Illness
Introduction
Stress, Vulnerability and Mental Health
Mental Health, Social Deviance and the Law
How Does Society Care for Those Who Are Mentally Unwell?
Early Psychology Within Modern Society and Cognitive Behavioural Therapy
Critical Views on Psychiatry and Mental Health Treatment
Modern (Integrated) Approaches in Current Health Contexts (4Ps Formulation)
Conclusion
References
CHAPTER 5: Understanding the Organisation of Health Systems and Health Economics
Introduction
What Is Health Economics?
How Are Decisions Made About Who Gets What?
What Is the Political Economy and How Does It Relate to Health?
What Is a ‘Health System’ and What Health Systems Are There?
Out‐of‐Pocket Healthcare Expenditure
How Do We Measure Success and Why Should We?
Conclusion
References
CHAPTER 6: The Global Healthcare Workforce and the Social Science of HealthCare Professions
Introduction
The Global Healthcare Workforce
Who Are Healthcare Professionals?
Sociological Explanations in the Study of Healthcare Professionals
Conclusion
References
PART 2: Meeting Population Health Needs and Health Inequalities
CHAPTER 7: Population Health Needs: Understanding the Care Transition
Introduction
A Changing Society, with Changing Health Needs
Not a Bath, but an Ocean
Conclusion
References
CHAPTER 8: Social Determinants of Health and Inequality
Introduction
What Determines Health?
Models of Health Determinants
Constitutional Factors – Modifiable or Unmodifiable?
Individual Lifestyle Factors
Social and Community Networks
Living and Working Conditions
Social Position, Social Class and Social Status
Intersectionality
What Are Health Inequalities?
Explanations for Health Inequalities
How Are Health Inequalities Experienced?
Conclusion
References
CHAPTER 9: Stereotyping, Bias and Health‐Related Stigma
Introduction
Understanding Our Bias: Stereotyping and Unconscious Bias
Health‐Related Stigma
Addressing Stigma and Reducing Implicit Bias in Healthcare
Conclusion
References
CHAPTER 10: Meeting the Needs of Those Experiencing Social Exclusion and Significant Inequality
Introduction
What Is Social Exclusion and Marginalisation?
Inclusion Health
Forced Displacement, Migration and Health
Place‐Based Marginalisation, Nested Deprivation and Homelessness
Racial Inequalities in Cancer Care
Inclusive Healthcare Design and Research
Conclusion
References
CHAPTER 11: Disability, Society and Health
Introduction
Embodiment
What Is Disability?
Attitudes Towards Disability
How Is Disability Understood?
The Medical Model
The Social Model of Disability
Disability and Discrimination
Children and Young People with Disabilities
Learning Disability
Mental Distress
Conclusion
References
PART 3: Understanding Health Behaviors, Health Behavior Change, and Public Health
CHAPTER 12: Understanding Unhealthy Behaviour
Introduction
What Are Unhealthy Behaviours?
Why Do We Engage in Unhealthy Behaviour?
Structure and Agency
Social Structure
Personal and Individual Level Factors
Theoretical Models of Health Behaviour
Social Cognitive Theory
Conclusion
References
CHAPTER 13: Evidence‐Based Behaviour Change Approaches
Introduction
A Science of Behaviour Change
Healthcare Professionals Roles in Promoting Behaviour Change
Models and Theories of Behaviour Change
Transtheoretical/Stages of Change Model
Social Cognitive Theory
COM‐B and The Behaviour Change Wheel (BCW)
Behaviour Change Techniques
Behaviour Change Interventions
Motivational Interviewing
Making Every Contact Count (MECC) and Healthy Conversation Skills
Digital Behaviour Change Interventions
The Limits of Individual Approaches to Behaviour Change
Conclusion
References
CHAPTER 14: Public Health Interventions through the Lens of the Social Sciences
Introduction
Upstream Prevention
What Is Public Health?
What Is a Public Health Intervention?
The Political Philosophy, and (Bio)ethics of Public Health
Healthy Cities
Active Living
Diet
Smoking
Drinking
Nudging and Liberal Paternalism
A Whole Systems Approach to Public Health
Population and Planetary Health
Conclusion
References
PART 4: Social and Community Networks, Loneliness, and Social Prescribing
CHAPTER 15: Understanding Support Networks and Influence Across the Life Course
Introduction
The Life Course Perspective
Preconception and Maternity
The First 1,000 Days and Childhood
Adolescence and Emerging Adulthood
Working Age Adult Life
Retirement and Later Life
Conclusion
References
CHAPTER 16: Social Isolation and Loneliness in Contemporary Society
Introduction
Social Isolation and Loneliness
Who Is Affected, Where and Why?
How Is Loneliness Measured?
What Are the Health Impacts of Loneliness?
What Interventions Have Been Considered?
Conclusion
References
CHAPTER 17Social Prescribing and Health and Well‐Being
Introduction
Creative Health and Health Inequalities
What Is Social Prescribing?
Conclusion
References
PART 5: Leading Safe and Effective Care in Increasingly Changing Healthcare Systems
CHAPTER 18: Leading Safe and Effective Healthcare Teams: Leadership, Management and Complexity
Introduction
Complexity and Contemporary Healthcare
What Is Leadership and How Is It Different to Management?
What Makes a Leader?
Self‐Leadership and Emotional Intelligence
The Evolution of Leadership Theories and Approaches
Taking One Last SEIP
Conclusion
References
CHAPTER 19: Healthcare Teams, Team Effectiveness and Team Training
Introduction
What Is a Team, and Why Do We Work in Them?
Healthcare Teams
Team Effectiveness: Inputs, Processes, Outcomes
Team Inputs
Teamwork Processes
Understanding Team Performance (Outputs)
Teamwork Training and Teamwork Interventions
Teamwork and Innovation
Conclusion
References
CHAPTER 20: Digital and Technological Innovation in Complex Healthcare Systems
Introduction
The Social Sciences, Technology, Innovation and Digital Health
What Is a Health Technology?
What Is a Digital Health Technology?
Preparing Healthcare Professionals for the Digital Future
What Does Success Look Like? Needs Led and Responsible Innovation
Intended User and Stakeholder Engagement
Adoption: Moving Beyond Creation
Healthcare Systems Readiness for Innovations
Technologies, Inequality and Their Impact on Health
Conclusion
References
Index
End User License Agreement
List of Tables
Chapter 2
TABLE 2.1
Levels of theory.
TABLE 2.2
Summary of grand theories and their relevance to health.
Chapter 4
TABLE 4.1
The 4Ps model combined with the biopsychosocial model – the table
...
Chapter 9
TABLE 9.1
Stereotype content – the relevance of perceived warmth and compet
...
Chapter 11
TABLE 11.1
How our bodies and minds impact social life, and the life course
...
Chapter 14
TABLE 14.1 Nuffield Ladder of Interventions and example interventions for e...
Chapter 18
TABLE 18.1
Different types of power.
TABLE 18.2
Evolution of leadership theories.
Chapter 19
TABLE 19.1
Examples of inputs, processes and outputs relevant to health and
...
TABLE 19.2
Outputs that are often used to assess performance, specifically
...
List of Illustrations
Chapter 2
FIGURE 2.1 The relationships between concepts, empirical research, and theor...
FIGURE 2.2 The relationship and roles of ‘small’ or ‘programme theories’, ‘m...
Chapter 4
FIGURE 4.1 Cognitive behavioural therapy.
Chapter 5
FIGURE 5.1 Global distribution of out‐of‐pocket expenditure on health.
Chapter 6
FIGURE 6.1 Density of health workers per 10,000 population in 2020 by income...
FIGURE 6.2 Map of health workers (including medical doctors, dentists, nurse...
FIGURE 6.3 The influence of vertical and horizontal task substitution betwee...
Chapter 7
FIGURE 7.1 The global population pyramid.
FIGURE 7.2 Bathtub representing the ‘at risk’ population.
FIGURE 7.3 New cases filling the bathtub as ‘incidence’.
FIGURE 7.4 ‘Prevalence’ representing the total number of cases.
FIGURE 7.5 ‘Prevalence’, mortality and recovery.
Chapter 8
FIGURE 8.1 Dahlgren and Whitehead's model of health determinants.
FIGURE 8.2 Male life expectancy and disability‐free life expectancy at birth...
FIGURE 8.3 Female life expectancy and disability‐free life expectancy at bir...
FIGURE 8.4 Cascade of disease and health status in socio‐economically disadv...
Chapter 10
FIGURE 10.1 Inclusion health groups have higher mortality ratios than even t...
FIGURE 10.2 Crude prevalence of coronary heart health by lower layer super o...
Chapter 12
FIGURE 12.1 Causal loop diagram of causes of childhood obesity in the commun...
FIGURE 12.2 How class relations explain inequalities in health outcomes.
Chapter 13
FIGURE 13.1 The Transtheoretical/stages of change model.
FIGURE 13.2 Social cognitive theory.
FIGURE 13.3 The behaviour change wheel (BCW).
FIGURE 13.4 Communication styles.
Chapter 14
FIGURE 14.1 Levelling up health, using a whole systems approach.
FIGURE 14.2 The doughnut used to consider shortfalls in the social foundatio...
Chapter 18
FIGURE 18.1 Reason's Swiss Cheese Model.
FIGURE 18.2 The SEIPS 2.0 model.
FIGURE 18.3 Leadership high and low direction behaviours.
FIGURE 18.4 SEIPS 3.0 model: socio‐technical systems approach highlighting a...
Chapter 19
FIGURE 19.1 Law of
n
‐squared. As the number of team members increases, the n...
Chapter 20
FIGURE 20.1 Diffusion of innovation curve.
FIGURE 20.2 The NASSS framework – a useful framework for considering the var...
FIGURE 20.3 Adapted Dahlgren and Whitehead model, highlighting the relevance...
Guide
Cover Page
Table of Contents
Title Page
Copyright Page
List of Contributors
Preface
Acknowledgements
Begin Reading
Index
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Social Sciences for Healthcare Professionals
Edited by
CHRIS ALLEN
University of Southampton, UK
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List of Contributors
Chris AllenSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
Louise BaxterFaculty of Arts and HumanitiesUniversity College LondonLondonUK
Lynn CalmanSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
Matt FlynnSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
Assaf GivatiDepartment of Population Health SciencesKing’s College LondonLondonUK
Erica GoddardSchool of Health, Wellbeing & Social CareThe Open UniversityMilton KeynesUK
Janine HallSchool of Health and Social WellbeingUniversity of the West of EnglandBristolUK
Simon HallSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
Gilly ManczSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
Cheryl MetcalfSchool of Healthcare Enterprise and InnovationUniversity of SouthamptonSouthamptonUK
Eloise MongerSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
Ellen Kitson‐ReynoldsSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
Robert SlinnDepartment of Social SciencesA maintained Secondary School and Sixth Form CollegeSouthamptonUK
Jasmine SnowdenSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
Neil SummersSchool of Health, Wellbeing & Social CareThe Open UniversityMilton KeynesUK
Lindsay WelchFaculty of Health and Social SciencesBournemouth UniversityBournemouthUK
Sam WoodnuttSchool of Health SciencesUniversity of SouthamptonSouthamptonUK
Preface
I completed my nursing training in 2010, before going on to work as a Staff Nurse at a local general hospital, specifically working in an acute care for older person’s medical ward. My training, which was clinically excellent, as with many other healthcare professional programmes at the time, largely followed the biomedical model. People were ‘well’ until they became ‘unwell’, at which point, it was the role of healthcare, and healthcare professionals specifically, to make them ‘well’. Health promotion and public health were already well established by this time. Aspects of these were taught, of course, but these were generally the side dish to biomedicine’s main course, and very much took a back seat to more reactionary care. The social sciences were visible, but barely, and rarely related back to the social context of health and healthcare, and how people found themselves in the position of needing healthcare in the first place.
As such, the healthcare professional role I was socialized into was largely directed by biomedicine. I was very familiar and comfortable with a range of acute care presentations and what was needed including a range of pharmacological interventions, alongside the fundamentals of care, that have rightfully become an essential feature of hospital and community healthcare: fluid balance, nutrition, skin integrity, etc. As Florence Nightingale famously emphasised, the importance of hospitals not harming the sick, has and will continue to remain at the core of what healthcare professionals do. However, healthcare has become significantly more complex since then. Florence Nightingale, alongside other key thinkers of her time, was able to identify the social causes of ill health. The recognition of relationships between poor living and working conditions are by no means new, but increasingly, the social context of care is necessitating new ways of thinking about health and how healthcare is delivered, and in my view, how healthcare professionals are trained and supported.
As a healthcare professional, I have been very fortunate to have been socialised into the social sciences over years of further study. First, in Gerontology, where I was first able to see and really grasp the importance of health across the life course and determining later‐life health and wellbeing. Then, later, through a PhD in Health Sciences, which had a specific focus on technology and social networks in the context of chronic condition management. Many of the theories and concepts I was able to engage with arose from the social sciences and have been incredibly powerful in shaping my thinking about health, and what is important in terms of supporting individuals and populations. Overtime, and through these academic and clinical experiences, I have seen that health is about more than being in a hospital stuck to an IV drip. Working in the community, including supporting those who were vulnerable, and who had significant multimorbidity, showed me firsthand how people’s social contexts shaped their health, making it more likely they would become unwell, but also then making it more challenging for them to engage with healthcare and manage their health conditions with the material and social resources they were able to access.
All these experiences have supported my social understanding of health and illness, and through this socialization, I have been able to see where my healthcare professional education (as clinically brilliant as it was at the time), was lacking. Important social science contributions such as how health and disease are understood, how physical and mental health is classified and how this relates to the care people are able to access, how healthcare systems are set up and who is advantaged and disadvantaged by their design, how health inequalities manifest and how they can be addressed, and the impact this has on people’s care. Other vital contributions have changed and continue to change how society responds to people and groups, such as the social model of disability, which has influenced how impairment and disability are seen in society, drawing attention to the unjust barriers people face to full social and economic participation, alongside inclusion health, which is directing focus towards those experiencing social exclusion and extremely poor health outcomes in our communities.
Finally, healthcare professionals are taking on an increased role in health behavior change, and social science has contributed very significantly to our understanding of people’s health behaviors and how they can be best supported to make positive changes. Health behavior in particular provides an important example of why this book has included the main social sciences, as opposed to simply focusing on one discipline. Because health behavior is determined by so many things, it can only really be understood through engagement with work across the social sciences, such as that offered by Psychology, Sociology and Economics. Only by understanding these, can we make sense of people’s behaviors and how they can be best supported to change them. The many and varied contributions across the social sciences are hugely important in informing how support is provided to people wanting to make a change, and healthcare professionals need to be able to engage with this work, in order to support people’s behavior change using evidence‐based approaches.
However, many important contributions from the social sciences are published in their own disciplinary specific journals and are often written using a language and vocabulary that can make it difficult for those outside of that specific discipline to interpret and subsequently engage with important core concepts and in turn, use these to support and underpin their practice. Busy healthcare professionals at the front end of care are unlikely to hunt out papers published in social science specific journals, no matter how relevant these papers might be to their care. This is where my motivations for this writing this book emerged, to offer healthcare professionals a broader and wider understanding of health and its many and varied influences. The issues most healthcare systems around the world currently face cannot be solved with one discipline working in isolation, and instead, it is vital that healthcare professionals are able to access some of the most important contributions of the social sciences in one place, and in a format that allows these sometimes quite abstract concepts, to be translated into everyday clinical practice, where they can be used to improve care, reduce inequalities and improve the health of individuals and populations.
Acknowledgements
First, I would like to thank all of those who have dedicated their time, effort, energy and expertise to contributing to this book. Your many and varied contributions have helped shape this book and particularly its clinical relevance. I would also like to thank all those healthcare professionals I have had the privilege of teaching the Social Sciences to over many years. Your contributions to lectures, feedback on content, lively debate and discussion have helped shape this book more than you would believe, ensuring its current and fits the needs of healthcare students. You continue to teach me everyday, and for that I am grateful.
Thanks also to my employer and brilliant colleagues, many of whom have supported this book, either directly or indirectly through our many and varied debates over the years. Preparation of this book was supported by the University of Southampton Faculty of Medicine/Faculty of Environmental and Life Sciences Writing Retreat (July 2025). Special thanks for making this time available. There are a few colleagues who have been particularly influential in shaping my interest in the Social Sciences and who deserve special recognition. Professor Athina Vlachantoni, you provided me with the foundations and showed me the importance of the life course in shaping later‐life health. Thanks to my brilliant PhD supervisors: Professor Anne Rogers, Professor Anne Kennedy and Dr Ivaylo Vassilev. Our many supervisions have continued to shape my thinking. You have all taught me that health is about more than simply making people better when they fall ill, alongside the importance of people’s social support and community networks to maintaining health and wellbeing. Professor Anne Kennedy, I miss you, and your loss is still felt. Your legacy continues in your significant contributions to health and wellbeing that you have made, including in the social sciences.
Wiley, as a publisher, you have been incredibly supportive of this project from its inception. As a first‐time book editor finding my feet in the world of book publishing, you took a chance on me; you have been incredibly patient, supportive and motivating (often at just the right time). You have supported my personal development and, through that, the development of this book. Special thanks to Tom Marriott, who took this project on, and to Bhavya Boopathi and Christabel Daniel Raj for your unwavering support throughout the editing process, for being approachable, responsive and supportive.
Thank you to my mum, for proofreading and providing valuable feedback on the chapters. Finally, the biggest thanks goes to my wonderful family. Taking on a project this size, with two young girls under six, has been a significant undertaking (more than I had appreciated when I enthusiastically took this project on two years ago). Thank you to my amazing wife, Helen, who has been supportive of the many weekends and late evenings worked to bring this project to its conclusion. I could not have done this without you taking on a disproportionate share of child‐rearing. I owe you a huge debt of gratitude. Florence and Niamh, I am so proud of you and the girls you are becoming.
CHAPTER 1An Introduction to Social Sciences for Healthcare Professionals
Chris Allen
School of Health Sciences, University of Southampton, Southampton, UK
How to Use This Book
This book provides an overview across its 20 chapters of the aspects of the social sciences most relevant to informing your practice as healthcare professionals now, and in the future. As a summary of some of the social sciences’ largest bodies of work to date, crossing disciplines as diverse as Sociology, Psychology and Economics, this book provides readers with an overview of these disciplines work that has the most relevance to healthcare professionals in an accessible and easy to digest format. It is worth emphasising that all of these are large disciplines (and their sub‐disciplines) and comfortably fill entire textbooks. As such, this book’s chapters are intended as an introduction to some of the social sciences' most important contributions to health and healthcare. You can read this book's chapters in any order you like or you can start from chapter 2. A few of the chapters are particularly interrelated and we have highlighted these, both in this introduction and within the chapters themselves. In most of the chapters, we have provided opportunities to ‘stop and think’, and there are a number of case studies within this book that are intended to help you reflect on your own learning and relate the discussion and contents to your own practice and observations.
What Are the Social Sciences?
Sociology and Medical Sociology
Sociology is a scientific discipline that is concerned with the study of human societies, the institutions that as a society we build and the social relationships and processes that emerge from these (Giddens and Sutton, 2017, Scambler, 2018). A particular focus of sociology is understanding the unequal distribution of status, power and resources within a society that sees some having significant advantages and some having significant disadvantages, as well as the various social processes that influence and lead to such differences occurring (Giddens and Sutton, 2017).
Much of this applies to health too, and medical sociology (sometimes referred to as the sociology of health and illness) is simply the sociological study of health and illness (Allan, 2016, Barry and Yuill, 2022, Scambler, 2018). How health is constructed and seen in a society, as well as the health inequalities that exist between different individuals and groups, and the sometimes significant differences that exist relating to access to safe and effective healthcare (Scambler, 2018, Barry and Yuill, 2022). Medical sociology has also had a long interest in the healthcare professions, including the relative differences in terms of power and status afforded to different professional groups (Crinson, 2018), as well as how healthcare systems are seen and understood within a broader social system (Mays, 2018). Sociologies contributions to all of this, and more are considered throughout this book.
Psychology and Health Psychology
Psychology, and in particular its sub‐discipline Health Psychology, is another scientific discipline. As a broad discipline, it is generally most concerned with our minds, our thoughts, our behaviours, as well as how we make decisions (Gross, 2015, Marks et al., 2020, Ogden, 2023). Essentially, how we think, and how we behave (Gross, 2015, Marks et al., 2020, Ogden, 2023). This relates to and influences our health in several ways, many of which are explored throughout this book. For example, how we think can influence our behaviours and our behaviours can be influenced by those we are in contact with (Marks et al., 2020, Ogden, 2023).
This can affect the health‐enhancing or health‐harming behaviours we follow (such as drinking too much and smoking), and how we think about these behaviours, including whether we have the belief or motivation to change them (Marks et al., 2020, Michie et al., 2011, Michie et al., 2024, Ogden, 2023). It can also influence how we feel about our social relationships and the social contact that we have (Cacioppo and Cacioppo, 2018). From a health systems and organisational perspective, it can also shape how well we work with, or indeed how well we are able to lead others (Northouse, 2022, Salas et al., 2018a, Salas et al., 2018b), both of which are increasingly recognised as being important to healthcare delivery. Psychology’s contributions to all of this, and more are considered throughout this book.
Economics and Health Economics
Economics is the study of human behaviour, especially relating to the production, distribution and consumption of scarce resources – notably goods and services (Sloman et al., 2022). Health economics is also concerned with these, but in the context of health and healthcare provision for individuals and populations (Glied and Smith, 2011, Wiseman, 2011). Generally, we want people to consume healthcare when they need it, but as healthcare is generally seen as being finite (i.e. there are only so many hospital beds, healthcare professionals, drugs, etc. to go around), we do not want people to overconsume it when it is not needed (Glied and Smith, 2011, Koohi Rostamkalaee et al., 2022). With scarce goods, economic decision‐making can be hugely important in determining what is and what is not funded, and economists are often concerned with how to maximise utility, by considering the tangible health benefits that arise through the consumption of healthcare, often when several alternative options exist (Feng et al., 2020, Glied and Smith, 2011, Rand and Kesselheim, 2021, Wiseman, 2011). The positive impacts of health consumption can of course relate to health outcomes, but can also relate to wider impacts on society, such as increased labour market productivity and reduced time off work, and these outcomes can have a reciprocal impact on health, as wider determinants (Dahlgren and Whitehead, 2021). Of course, all this consumption can impact on our planet, its resources and its ability to sustain life in a fair, just and equitable way (Raworth, 2017, Raworth, 2018).
As with psychology, economics is often also concerned with how people make decisions (especially decisions around consumption), particularly within behavioural economics (Glied and Smith, 2011, Sloman et al., 2022, Thaler and Sunstein, 2009). For example, much attention is often paid to how changing the price of products based on their harmful or helpful impacts on health may change patterns of consumption (known as elasticity), such as increasing the price of alcohol to deter consumption, or subsidising gym memberships to encourage uptake (Clements et al., 2022, Glied and Smith, 2011, Sloman et al., 2022). Economics’ contributions to all of this, and more are considered throughout this book.
So Why the Social Sciences?
Even outside of healthcare, your everyday experiences, and the experiences of those that you meet, are influenced by social, anthropological, psychological, economic and political influences. This book will introduce you to many of these and provide you with the underpinning social science knowledge to be able to make socially sensitive decisions in the care that you give, whatever healthcare role you do. As a healthcare professional, much of the care that you deliver will be shaped by these, and often in unexpected ways. Essentially, in your role as a healthcare professional, you must work within a set of complex and interconnected social conditions and structures that shape and influence how care is set up, organised and delivered.
So why is this all relevant to you, as a healthcare professional, or aspirant healthcare professional? Don’t you just want to make people better? Isn't this largely a matter of biology and medicine? The short answer – no. This book provides a longer answer and will hopefully show that sickness and health are cultural and social experiences that are influenced by many complex and interrelated social processes. The delivery of healthcare is essentially a social activity that is determined by many of these processes across societies many layers.
A Patient's Journey: The Social Sciences in Action
Source: Maskot/Adobe Stock Photos.
Barry is 58 and works in an office as a supervisor. He has recently divorced and lives on his own in a dank flat in the middle of town. Since his divorce six months ago, he has largely neglected himself and mostly just works. He has occasional contact with his sister, who is supportive, but apart from that he only really speaks to people at work (mostly his direct reports and his manager), as well as the local shopkeeper. It is a Friday, and Barry heads off to work, as he does every Friday.
Barry catches the 8:21 bus, which normally gets him to his office in about 20 minutes. Swiping his season ticket, he stands near the front of the bus next to another office worker who he occasionally speaks to; transactional, nothing too much. A ‘hi’ there, a nod here. Suddenly Barry begins to feel very funny and collapses into the aisle. A helpful bystander alerts the driver, the bus stops and Barry is tended too by bystanders. Someone calls an ambulance, and paramedics arrive at the scene and believe Barry to have had a stroke. They let the local Emergency Department know that they will be bringing Barry to hospital, under a blue light, and that they should expect to receive Barry in around 10 minutes. During the transit, the paramedics monitor his vital signs, pulse, blood pressure, levels of consciousness, etc. His levels of consciousness are poor, and he is slurring his speech, and tending to lean to one side. On arrival at the hospital, the paramedics transfer Barry's care to the Emergency Department team, who run through their various protocols and processes, and get him an urgent CT brain scan to determine if he has had a stroke, and what type of stroke he has had. This is an important information as it determines how Barry should be treated. Following this, Barry is diagnosed with an ischemic cerebrovascular accident (CVA), caused by a blockage to oxygenated blood flow to his brain. The decision is made to administer a drug delivered into his veins in the hope it will break down any clot that has caused a blockage, restoring blood oxygen flow to the affected areas of his brain. The treatment is partially successful, and in the weeks that follow, with the support of nurses, doctors, physiotherapists and occupational therapists, amongst others within the multi‐disciplinary teams across the hospital, and with input from various community healthcare teams, Barry is ready to be discharged home to his flat. Whilst Barry is well enough to go home, the stroke has resulted in some damage to his brain, which has resulted in Barry having some physical, cognitive and sensory impairments that he will likely have to live with for the rest of his life. Three months later, Barry returns to work on a ‘phased return’.
This is Barry's story. A story that many of you will be very familiar with.
So where are the social sciences and why are they relevant here? After all, wasn't Barry's recovery mostly through medicine? Wasn't it mostly healthcare professionals that put him back on his feet, got him home and back to work? All of these played a vital role, clearly, but this book will show you that Barry's story is actually incomplete; as too is the story of the healthcare professionals, healthcare system and wider society that provided his care. The social sciences can help us fill in the gaps in Barry's story, helping us understand, prevent and support Barry and his health, so that as a society, and in particular as healthcare professionals we are better placed to provide equitable care for all, and may even be able to prevent people like Barry collapsing on the bus in the first place. In the next section, we will step you through the book and how it will help you complete Barry's story.
Completing Barry's Story
Part 1: Understanding Health, Healthcare Systems and the Healthcare Workforce
In chapter 2, an overview of social theory and social research methods is provided. What you will see in this chapter, and alongside the rest of the book, is that social theory and social research methods are important to understanding how society works (Clark et al., 2021, Kislov et al., 2019) – and within the rest of this book, you will see diverse theories that have helped make sense of society and people's situations, as well as a range of methods that have been used to test or create these theories in many contexts with relevance to health. These can ultimately help us as a society to improve people's care and situations.
In chapter 3, we introduce you to the concept of ‘health’. Barry, in his story, is clearly unwell. But defining health and disease is tricky, but nonetheless important, as it guides societies in thinking about who needs care, as well as how health is understood and delivered (Larsen, 2021, Leonardi, 2018, Schramme, 2023). It also guides what societies should prioritise or focus on (Larsen, 2021, Leonardi, 2018, Schramme, 2023). In fact, as we show in this chapter, how we think about health might even be relevant in preventing Barry from becoming unwell in the first place, and what aspects of Barry's care are seen as most important. This chapter also discusses the various ways health has been classified, and why classifications of health and disease matter (Clark et al., 2017, Harrison et al., 2021).
In chapter 4, we move on to consider health in the context of mental ill health. This chapter tracks the social changes that relate to mental ill health, including its identification and management (Rogers and Pilgrim, 2021), alongside the concept of deviance (something that sets someone apart) (Henry, 2018). Barry is presenting with a physical health issue, but poor mental health makes it more likely for people like Barry to find themselves in this position (Fiorillo et al., 2023, Kivimäki et al., 2020). In addition, experiencing a stroke makes it more likely Barry will experience poor mental health and poor well‐being (Damsbo et al., 2020, Towfighi et al., 2017). The impact society has had on the various ways mental ill health has been viewed are considered, and how this might impact on how people like Barry are seen (Rogers and Pilgrim, 2021), alongside some prominent models in mental health practice (Beck and Fleming, 2021, Burns, 2020, Davidson, 2016, Middleton and Moncrieff, 2019), and how these relate to the care that those presenting with mental ill health receive from a diverse range of backgrounds and experiences.
In chapter 5, we turn our attention to health economics, and the political economy, and consider in more depth the health systems that provide care to people like Barry. This chapter looks at some different healthcare systems that exist around the world and considers how these differences relate to how care is financed, what care people can access and what people like Barry must pay for it (if anything) (Anandaciva, 2023, Braithwaite et al., 2020, Britnell, 2015, Papanicolas and Cylus, 2015). The importance of countries working towards universal health coverage to ensure periods of ill health such as that experienced by Barry do not result in catastrophic healthcare expenditure is also considered (Wagstaff and Neelsen, 2020). In chapter 6, we move on to consider the healthcare professionals that work within these healthcare systems to care for people like Barry, highlighting some of the current challenges that exist relating to global healthcare workforce shortages (Boniol et al., 2022), and the relevance of this to meeting current and future healthcare needs. This chapter also considers how people end up in positions of care and what it means to be a ‘healthcare professional’; how this has changed over time, as well as the differences in how professionals are seen and the differences in terms of the power and status that have been afforded to the different healthcare professions overtime (Saks, 2016).
Part 2: Meeting Population Health Needs and Health Inequalities
Various demographic and epidemiological transitions have made Barry's situation more common in most societies. In chapter 7, these demographic and epidemiolocal transitions are discussed, alongside the challenges they present global healthcare systems with (Omran, 2005, Weisz and Olszynko‐Gryn, 2010). These changes have meant that people are living longer, and more often with increased morbidity (Bury and Taylor, 2008, Taylor and Bury, 2007). The impact such changes are likely to have on health systems, and society more generally are considered, alongside the importance of people like Barry being supported to take on a greater role in the management of their own health once they have become unwell, alongside healthcare professionals (Bury and Taylor, 2008, Taylor and Bury, 2007).
Whilst anyone can find themselves in Barry's position, research consistently demonstrates increased early morbidity and mortality in those from lower socio‐economic status groups (Bartley, 2017, Marmot et al., 2020). Differences in longevity and health outcomes are unequally experienced, and in chapter 8, readers are introduced to the social determinants of health (Dahlgren and Whitehead, 2021), and health inequalities (Marmot et al., 2020). Various explanations are considered that explain why those from lower socio‐economic groups are more likely to experience early mortality and morbidity than those in higher‐status groups (Bartley, 2017, McCartney et al., 2019, Wami et al., 2020). In chapter 9, bias and stigma are introduced as concepts that explain why some within a society experience various forms of disadvantage, including poorer care, based on their real or perceived differences (Hatzenbuehler et al., 2013, Phelan et al., 2008, Scambler, 2009, Tyler and Slater, 2018). These differences can result in people like Barry being more or less likely to receive emergency care, as well as influencing the quality of care they are able to access, and these differences can amount to discrimination, leading to poorer health outcomes, alongside reduced social and economic opportunities (Hatzenbuehler et al., 2013).
In chapter 10, some groups that are particularly vulnerable to being socially excluded are considered (Aldridge et al., 2018, Luchenski et al., 2018, Marmot, 2018, Tweed et al., 2022), alongside the consideration of how their needs can be better met by healthcare professionals, healthcare systems and society more generally. Those with a physical, mental, cognitive or sensory impairment are often excluded and disabled by society, and in chapter 11, the needs of those with impairments are considered, alongside the impact that society itself has on the lives of those living with such differences, often making it significantly (and unnecessarily) harder to participate fully in social and economic life, and access healthcare, through healthcare systems poorly accommodating the needs of those with impairments across their lives (Oliver, 2013).
Part 3: Understanding Health Behaviours, Health Behaviour Change and Public Health
Of course, people like Barry can just be unlucky, and many of those who engage in unhealthy behaviours do not go on to have a stroke. However, global burden of disease studies consistently highlights the impact of health behaviours on non‐communicable diseases and mortality (Afshin et al., 2019, Degenhardt et al., 2018, Katzmarzyk et al., 2022, Khan Minhas et al., 2024, Shield et al., 2020). Chapters 12 and 13 consider why people engage in behaviours (such as drinking too much alcohol, smoking, being physically inactive or having a poor diet) that they know are unhealthy and that may lead to poor health outcomes, as well as how we can support individuals through various behaviour change techniques and interventions that seek to elicit change at the level of individuals. In this chapter, approaches that are particularly common in clinical practice, such as motivational interviewing and making every contact count are considered alongside their respective evidence bases (Frost et al., 2018, Nichol et al., 2024, Parchment et al., 2023, Rodrigues et al., 2024). These techniques may be effective in supporting people like Barry to change behaviours that could be harming their health. Of course, behaviours, including Barry's occur within a social context (Christakis and Fowler, 2013, Kickbusch et al., 2016, McCartney et al., 2019Wami et al., 2020, WHO, 2023). This social context can make behaviour change difficult, especially where people lack the resources they need to change their behaviour and where behaviours are so often influenced by society, its institutions, as well as those within it. In chapter 14, we move beyond behaviour change at the level of individuals and consider how whole populations can be supported to change their behaviours through various population‐level interventions, that may work to incentivise, disincentivise, restrict and even ban certain unhealthy behaviours. As part of this chapter, a whole systems approach to public health is considered (Danielli et al., 2023, Davey et al., 2022), alongside consideration of the relationship between our health and well‐being and the health of our planet (Raworth, 2017, Raworth, 2018).
Part 4: Social and Community Networks, Loneliness and Social Prescribing
Our social networks influence our health and lives in a number of ways across the life course (Christakis and Fowler, 2013, Granovetter, 1973, Rogers et al., 2014). They give us access to needed social, material and economic resources in good and bad health and also shape our health behaviours. In chapter 15, we introduce the life course approach and highlight the importance of earlier life stages on later life health and opportunities. Preceding Barry's stroke are a set of social network circumstances that are unique to him. How well supported he was in his early years relates to how well he is able to build and maintain relationships later in his life, as well as the economic resources that he is able to accumulate. His social network also has a significant impact on the health behaviours that he himself follows, with evidence consistently highlighting that unhealthy behaviours spread through social networks (Christakis and Fowler, 2008, Christakis and Fowler, 2013, Rosenquist et al., 2010). In chapter 16, the public health issue of social isolation and loneliness is introduced. Prior to the stroke, Barry's lack of social contact, especially if more contact was desired, may have actually increased his risk of becoming unwell (Cacioppo and Cacioppo, 2018, Holt‐Lunstad, 2018). Of course, Barry's new situation also places him at an increased risk of experiencing social isolation and loneliness, with new impairments making it harder for him to reach out to maintain and connect with new social ties (Macdonald et al., 2018), and can also lead to poorer health, social and economic outcomes. In chapter 16, we turn to social prescribing as one approach that is being increasingly used to support those who are lonely, alongside those presenting with other social needs, through connecting people to a range of activities within their local communities (Chatterjee et al., 2018, Husk et al., 2020).
Part 5: Leading Safe and Effective Care in Increasingly Changing Healthcare Systems
When Barry first accessed healthcare following his stroke, he was very vulnerable and was reliant on healthcare professionals like you being able to meet his needs safely and effectively. He was reliant on healthcare systems having safe work systems (Carayon et al., 2020, Holden et al., 2013) and strong leadership (Wu et al., 2024), and this is the focus of chapter 18. Barry's needs are complex and cannot be met by one healthcare professional working in isolation (Kerrissey et al., 2023, Sanford et al., 2024, Shuffler and Carter, 2018). Even just getting to a hospital involved the coordinated efforts of multiple healthcare professionals working within a multi‐team system, where communication and other teamwork processes can have a significant impact on the quality and safety of care that Barry was able to receive (Salas et al., 2018b). It is the healthcare teams and teamwork processes that are the focus of chapter 19. Finally, Barry's care was reliant on healthcare professionals being able to use various health technologies effectively. In chapter 20, the place and importance of health technology and innovations are considered, alongside the importance of them being designed responsibly, and with the needs of intended users considered in their design to ensure that they can be used safely and effectively to enhance the care of people like Barry (Greenhalgh et al., 2017, Topol, 2019). Of course, Barry is just one person. The exact social influences and needs of those accessing care will vary from person to person, based on a range of complex and interrelated social processes and influences. This book is intended to help you give socially responsive care by considering social context, and across this book, you will have the opportunity to apply this learning to the diverse needs of a range of people across a wide range of settings and clinical contexts.
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