Sociology news is published by the Medical Sociology Group‚ a study group cf the Eritish Sociological Association Subscription rates for 1987-88

and

Obstetrical

Ex

e r i e n c e s

H i i a r y

Thomas, Universxty

of

Cambridge

October

12

Changing

Druq

Cultures

-

HIV, syrinqe exchange‚

and the

injecting

drug-user.

Gerry

Stimson‚

Goldsm1ths'

Collage, London

November 9

Medical

Sociologists at

Work?

An

opportunity to

dfscuss

constraints

and

possibilities of

contract

research

An open

s e m i n a r

Decembet 7

The

Visibility of Men in

Health

Visiting

J a n e

Naish‚

warwick

University

Meetings

begin at

6.00pm and are

held

in

the 3rd

floor

seminar

room‚

Dept. of Community

Medicine,

University College

London,

66-67

Gower

Street,

London WC1.

Nearest

Tube:

Warren St.‚

Goodqe St.‚

Euston

Square,

Russell

Square.

Meetings

may

have

to

be

changed owing

to

circumstances beyond onr control and wo

cannot notify

everyone

by

mail.

If

in

doubt‚

contact

Mary

Bollam

on

387

7050

Ext.

5709

or 5706.

If

you would like to

receive

the 1989 proqramc, please send

a

stamped

addressed

envelope to

Ulla Gustafsson‚ 31 Hillfleld Avonuo‚ London N8 7DS

Bristol

and

South

west

Medical Sociology

Group

Since

its

creation

last Ju1y‚

the

Bristol

and

South

West group

has

built up a mailinq list

of

over 50 sociologists and associated

professionals concerned with health and

illnessy

suggesting that

the

future of

the group

is

set

fair.

In

December‚

the group

heard from

Dr.

Vieda Skultans‚

on

the

treatment of

the mentally ill in a Maharashtrian healing temple in

northern India.

Forthcoming meetings

J a n

14

To

be

confirmed

Feb 11

Norma

Daykin 'Young Women‚

health

and work'

March 10

Albert Osborn 'Changing family status and child

behaviour'

Meetings held at

5.10 pm, Seminar Room‚ Children's Hospital,

St. Michaels H111, Bristol.

It

has been proposed that the group hosts a day school early in the

summer on the topic 'Sociology‚ health and sexuality'.

Any

suggestions‚ or

offers

of

papers‚

as

soon as possible please

to:

Nick

Fox

15

Regent Street‚

C1ifton‚

Bristol

BS8

4Hw.

Scottish Medical Sociology

Groug

Details

of

the followinq meetings can

be

obtained from

Margaret Reid:

Jan

16

Medical

Ethmographx

March

4

-

6

Inequalities in Health

(weekend

conference)

May

Social Causes of

Illness

(one—day

meetlng)

55

Book Reviews

Rona Campbell and Alison Macfarlane

where to

be

Born:

the

Debate and the Evidence

Oxford,

National Perinatel Epidemiology

Unit‚

1987,

72pp.

€2.00

In

1927, when the General Registry Office first tabulated live

births in

England and Wales

by

place

of

de1ivery‚

10%

took

place in

institutions.

In

1987,

less than

1%

will

be

outside

hospital.

This

booklet

sets

out

to

review the,

mainly

statistica1‚

evidence

about the relative safety

of

different

places

of

birth accompanying this dramatic change for

women

( a n d

their

b a b i e s ) .

The

authors show that

it

is

extraordinarily difficult

to control

for

selection

biases which

confound place

of

delivery analysis; and conclude that none

of

the

stronger statements made

by

advocates

of

either

home or

hospital deliveries or

of

inteqrated

general practitioner units

can

be

supported

by

the evidence.

The

review

is

thorough and exhaustive

of

studies

in

the

UK.

even

for those

who do

not need a

wet

towel to

cope

with

Cartloads

of

corre1ations‚ it

is

however

sometimes difficult to

follow.

This

is

when

related

but different questions (e.q.

safety

of

home deliveries now‚ safety

of

consultant units

in

the

19605 and

1 9 7 0 5 )

are

addressed together with data from

different periods.

It

would probably help to read the

concluding section

(pp.

7 0 - 7 2 )

before

the body

of

the

review.

For non—statistiCians their discussion

of

the relation between

the debate and the evidence

is

probably more interesting.

They show how statements from

successive

Committees

-

up to

the

present day

-

encouraging/promoting the use

of

hospitals have

not

been based on

solid

evidence.

But their conclusion that

"policy has been formed with very

little

reference to the

evidence" (p.

5 9 )

seems

less

true

in

this

area

than

in many

others: indeed the Committees seem to

delight in

displaying

figures,

graphs and tables

whilst

iqnoring

o r ‚

more

often‚

misinterpreting their own

analyses.

It

looks as

if

all the

Committees

have been packed

by

se1f—promoting obstetricians

-

somc interesting material there for

an

analysis

of

the relation

between evidence

and policy formation.

There

are other questions a non-statistician would have liked

to

see

addressed.

First

there

is

a throwaway remark on page

12

that

"There

has been an increasing tendency to see pregnancy

and childbirth

as hazardous

events

in which medical assistance

and intervention

are often

required".

Probably

true

—

b ut ‚

given

the almost

disappearance of maternal mortality and the

rapid decline in perinatal mortality wherever

the

place of

birth‚

whose

interests have

been served

by

such a tendency?

This is

especially intriguing in

the light

of

their Fiqure

5

showing

how

the

rise in

the percentage of

births in

hospital

in

the

19705 coincided

with

the decrease

in

the percentage

of

beds

occupied.

Perhaps the main reason for the pressure from

consultants was/1s simply to

fill

hospital beds!

second‚

they should have followed up

the interestinq

clues

from

their

oun

Home

Birth

Survey

which showed high

rates for

unbooked

deliveries

and

deliveries

where

the 'intended

place of

delivery' was

unknown.

Strong

associations

have

been

reported

in

many fields between observations with data

of

poor or

unknown quality and

poor

outcome;

an-

example in this specific

area

is

the

relation

between

uncertain gestation

and

perinatal

morbidity

tsee Hall

and Carr-H111,

1 9 8 5 ) .

In

policy terms‚

these

qroups

might

be

the

most

important.

Third‚

there

is

the contemporary question of 'customer

satisfaction'.

The

authors briefly review recent studies of

parents'views which

are

usually hiqhly selective.

But

perhaps

more

could

be

learnt from

a

study

of

the rapid decline of the

length of

postnatal

stay between

1950

and

1968.

Did

mothers

simply

not

like hospitals?

Fina11y‚

I

share

their complaint that 'focussing

on

the place

of

birth“

-

forced

upon them

by

the nature

of

the

statistics

—

ignores

the

crucial question

of

who

actually provides the

care.

Midwives probably provide the majority

of

care

and

supervision

during

pregnancy‚

yet are

rendered almost

entirely invisible

by

the

statistics.

The social organisation

of

care matters.

Roy

Carr-Hi11‚

Centre

for

Health Economics,

University

of

York.

Reference

Hall, M‚H.

and

Carr-H111,

R.A. “The

significance of

uncertain

qestation

for obstetric

outcome‚ "British Journal of

Obstetrics

and

Gynaeco1ogy'‚

May

1

‚

__‚

5

-60.

Neil

P.

Mckeganey

and

Sarah

Cunningham—Bur1ey

( e d s )

_

Enter the

Sociologist.

Reflections

on the Practice of Socxoloqy

Aldershot:

Avebury 1987,

203pp

when it

comes

to

looking

at

themselves

from

a

socioloqica}

point of view‚ sociologists

are not

usually known

for

ghgnr

sense

of witty

self-presentation

or circumspect ref1ex1v1ty.

Yet

this slim

volume

manages

to

unite these

two

in

a most

aqreeable

fashion‚

“Enter

the Sociologist" introduces the

problems of professional identity and

research

focusing

on

quite

a

few

of

the hats which the sociologist

is

made

to

wear

or

chooses

to

wear

when

embarking

upon

presenting him/herself

to

a

professional or

lay audience.

Encountering the former

is

focused upon in McKeganey's "Publish

or

be

Damned" and Mil1s'

"In

Conference

:

Among the

BSA and

ASA"‚ and,

to

a certain

extent‚

in

Hepworth's "Becoming a

Sociologist".

Encountering

a

lay audience

is

explored in more

varied

nuances.

On

the

one hand‚ the problem

of

"fittinq"

with

the objects

of

participant observation

and

appearinq as

trustworthy in

interviewing

is

explored in a stimulating

comparison between male in

Scotland and female in Greece

(ßoulay

G

w i l l i a m s ) ;

along the same

line‚

a nude-Camp study

reveals

a

remarkable capacity for “qoing native" (Parry).

On

the

other hand‚ the experience that

interviewees'‚

as

it

were‚

can

react

to the researcher

with

the

same cunningness

with which they seemingly are approached

is

discussed in

an

honest-soundinq

account

of

research eventually

cominq

to

nothing

-

an attempted study

of

violent

nationalism

( B a r b o u r ) .

In

such

research‚ it

adds to

the flavour if

not the fun

of

reading if

the

researcher

who investiqates beliefs

of

dirt

and

danger

is

herself a participant posing as observer rather than

vice

versa

( D e l a m o n t ) .

This

self—ref1ectiveness‚ is

in

turn‚

reflected upon in an autobiographical

account of

self-professed

cross:cultural ignorance turned into

a

revelation that being an

anti-hero

is

not the worst

of

a socio1ogist's self-images

( A t k i n s o n ) .

The

morale

of

it

all

is

not

so

much

formulated in

Cunningham—Bur1ey's concluding remarks as

in

her

considerations

on the

"data

fix"suitab1y

placed

in

the middle

of

the book.

There‚

after musinq on

some

male friends' reactions to

her

being "too much"

of

a socio1ogist‚ she goes on to discover some

value

in

not

converting the whole world into data.

If

only

she hastens

to

add‚

because

"this

may

help to

preserve

the

'sociologica1

imaqination'" while

it

may also "keep some

of

the

world

safe from sociologists".

In

any

case‚ I

hasten to

add‚

this

book makes a splendid Christmas gift for sociologists

as

well as

those who may always have wanted to know

why

they are

what they are.

Uta

Gerhardt

Abteilung Medizimsche Soziologie

Giessen.

W.

Germany.

M,

Calnan

Health and

Illness:

The

Lay

Perspective

Tavistock,

London,

1987

(pbk) €7.95

This

book provides further_evidence that we are becoming less

obsessed with illness as

a

focus

of

study and more concerned

w j t h

health.

In

a reasonably

slim

volume

of

9

chapters

and

just

gnder

200 pages, Calnan manages to

cover

a ranqe

of

important

1 s s u e s ‚

keep

it

readable, and still

provido

a

work

that

will bc

repeatedly

used

as

a

source

of

i n f o r m a f j o n .

S8

The

aim

of

the

book‚

says

Calnan‚ is

to redress

the

imbalance

of

Lheoretical

and

empirical work which has concentrated

OH

illness

behaviour

rather

than

health

behaviour.

To

achieve

this

he

illustrates the lay

perspective

on

health

es weil

as

illness

through

a ranqe

of

research‚ including bis

own.

The subject is examined

using

a

mainly

interpretive

frame of

reference,

but

taking into

account

as far

as possible

structural

and

cultural elements.

The

book is

in

two

parts, with

the

first

6

chapters

examining

lay

models

of hea1th‚ and the

last

two

(one

of

which

is

the

c o n c l u s i o n )

covering

lay

models

of

illness.

Inevitably

there

is

an

overlap

between

the

two

themes‚

so

the

division

is

far from

discrete.

The

main ‘angle’ of

the

book

is

to examine

the influence

of

social class on health

and illness beliefs.

In

this

Calnan

makes judicious

use

of

some

key

research

including

that

by

Pill

and

Statt,

Herzlich.

and

Blaxter and Paterson.

Not

surprisingly, however‚

many

of

the examples are

drawn

from his

own

research.

This consisted

of

a

sample

of

30

women

from

social

classes

IV

and

V

and 30

from

Classes I

and

II.

Curiously,

he

refers

to

the

latter

as

the 'midd1e'

rather

than

'upper' class

group.

In

looking at

lay

definitions

of

health and

illness

Calnan points

out

that

they have

at

least

to

some

extent

been influenced by

medical definitions

which

see

illness

as a

bioloqical

phenomenon

with

specific

aetiology.

Simi1ar1y‚

the

ideoloqy

of

individualism

has also

been

taken

on board

by

a

number of

the

population.

Class

differences are

shown

to

exist in relation to

a

number of

issues.

One surprising finding

is

that

many of

the

women

in

social

classes

IV

and

V

disbelieve the findings

cf

the

Black report, and although seeing

manual workers

as facing

greater

health

risks

because of

their

exposure

to occupational

hazards,

felt

that

'money has nothinq to

do

wich

hea1th'.

The book

has

many

strengths.

It

is

vety

readable for a

statt,

and centres on a

number of

important issues.

The

theories

regarding health and illness

are well

reviewed and applied to the

empirical data.

The

conclusion puts

forward

three models

relating to

lay

health

maintenance,

lay manaqement

of

i11ness‚

and

lay

evaluation

of

medical care.

These

are

illustrated

throuqh

the

use

of

evidence from

the previous chapters which

brings

many of

the themes together

for

the

reader.

weaknesses

are few.

Picking

up on the last point‚

I

would

have

liked

a

visual representation of the

models.

I spent

some

time

drawing my own before arriving at

two of

the

three which