Social research in health and the American sociopolitical context: the changing fortunes of medical sociology.

The fortunes of medical sociology, like other public policy-relevant disciplines, are shaped by political dynamics and prevailing values and attitudes. In the 1980s the field, which views disease and disability as consequences to a substantial degree of material conditions, social stratification, and inequalities among varying strata, lost ground to economics as societal attention focused on cost containment issues. Sociological concern with social structures clashed with dominant conservative and individualistic perspectives and the increased focus on personal responsibility and market strategies. There was decreasing tolerance in policy circles for the view that health, and the problems affecting disenfranchised groups such as the poor, the homeless, the uninsured and people with disabilities, were more due to our politics and social arrangements than the personal characteristics of those affected. Thus, little attention has been given in public health discourse to how life imperatives and social opportunities and constraints shape behavior. The paper documents the important role of the social sciences in health services research with special attention to examining the social context of the RAND Health Insurance Experiment. Although many of the questions medical sociology address sit on the periphery of policy-makers' concerns, a strong case is made for the revitalization of a critical scholarly role in medical sociology. I conclude, given the short and longterm problems we face in medicine and health, that we would have to invent a vigorous critical medical sociological enterprise if we did not already have one.