Sociologists and their Work: Inter-Country Comparisons in the Sociology of Health and Medicine

Collyer

62

Sociologists and their Work: Inter-Country Comparisons in the Sociology of Health and

Medicine

Fran Collyer Abstract Since the 1980s, universities in all countries have become subject to the increasing pressures of globalisation and marketisation. Despite rising concern amongst academic workers about these new conditions, their impact on the production of scholarly knowledge has yet to be fully assessed. This study draws on an analysis of journal publications to ascertain some of the effects of this new employment context on sociological practices and production ‘outputs’. The field selected for examination is the sociology of health and medicine: an arena of sociological investigation which has continued to thrive since the beginning of its institutionalisation process in the 1950s. Comparing the publications of authors from the United Kingdom, the United States, Australia and New Zealand, findings suggest relationships between a sociologist’s location within the world knowledge system, their place in the university system and the knowledge they produce. Specifically, the study offers evidence for the impact of recent changes to the university system on sociological practices and the production of sociological theory. Some of the implications of these findings for the discipline are examined.

Introduction In the 1960s and 1970s, sociologists of health and medicine raised questions about whether employment within medical faculties might encourage the adoption of the perspectives and values of medicine and hinder their capacity to maintain a critical distance from their subject matter. The subject matter was the practice and professions of medicine, and the debate was usually configured as the ‘sociology of medicine’ versus ‘sociology in medicine’ (e.g. Freeman et al., 1963; Freidson, 1970, 1978; Straus, 1957; Gold, 1977; Greene, 1978; Cockerham, 1983). Although the employment of sociologists in medical schools, nursing faculties and public health departments in countries such as Britain, Canada, the United States and Australia increased throughout the

New Zealand Sociology Volume 28 Issue 1 2013

63

second half of the 20th century (Badgley, 1971; Bloom, 1986; Cockerham, 2005; Willis, 1982); such debates have become less frequent within the discipline. It is only with the emergence of a new literature about changes to the world’s university sectors, that it has become evident the issue has pertinence for the production, not just of sociological knowledge, but scholarly knowledge as a whole. While it is the case that the sociology of health and medicine has not been central to this newer debate, interest has nevertheless been gathering about the impact of globalisation and the changing academic market on sociology and the social sciences (e.g. Sanda, 1988; Akiwowo, 1988; Loubser, 1988; Willis, 1982; 1991; Baldock, 1994; Macintyre, 2010; Keim, 2011). ‘Academic capitalism’ has become a key concept of this literature, embracing the opening of the university sector to the logic of capitalism, documenting the growing ascendancy of market forces and the capacity of these to re-shape the disciplinary landscape. This process, increasingly apparent from the 1980s, has been characterised by the imposition of a specific neo-liberal world view, and a shift in academic competition from the national to the international arena where it operates between trans-national corporations (Kuraswa, 2002:335-6). For universities, this has heralded a new role. No longer envisioned as centres of scholarship, they are a source of human resources for national and trans-national enterprises and a means to gain a competitive edge in the global arena (Kuraswa, 2002:336). Moreover, university decision-making has been taken from the hands of academics and placed with a new breed of university managers and administrators. Restructuring and administrative ‘reform’ are now commonplace. Academics speak of ‘managerialism’ and the threat to scholarship in a new environment which favours easily monitored and documented activities (Currie and Vidovich, 1998: 115-6). As university budgets shrink and academics are pressured to apply for external research funds and collaborate with other disciplines, the state, the community and corporate sectors; concerns are raised about the pressures to avoid damaging the commercial interests of sponsors, to refrain from criticising capitalism itself, and instead produce results favourable to the sponsors (Kuraswa, 2002: 338; Martin, 1992). Such behaviour is contrary to the ideals of academic scholarship and an anathema to the pursuit of academic freedom (Kuraswa, 2002: 339). This re-orientation of the discipline towards external grant monies has provoked

Collyer

64

sociologist Graham Scambler (2005: 6) to suggest there has been a ‘taming, or colonisation of the academic imperative’. A second key concept is that of the ‘knowledge game’, a re-configuration of the market system whereby knowledge is not merely a means to power and market advantage, but the very ‘source of profits in modern global markets’ (Drahos and Braithwaite, 2002: 39, 52). Within this ‘game’, nation states structure the market by enacting national legislation but also by entering into international trade agreements concerning intellectual property rights and copyright access. And in regulating the system and protecting knowledge as ‘private property’, nation states ensure the benefits go not to the inventors of knowledge but to corporate players with the capacity to erect barriers around these knowledge products (e.g. through licencing arrangements) and fiercely defend these in both the legal and political arenas. The resultant ‘game’ is also one in which the countries behind the development of the intellectual property and copyright system are the major beneficiaries, with developing countries being net importers of knowledge. Australia, despite its developed country status and significant capacity for knowledge production, has nevertheless paid out more in licensing and patent fees than it has received (Drahos and Braithwaite, 2002: 11). Within this ‘knowledge game’, the academic market operates somewhat differently to other commodity markets such as the software or pharmaceutical industries, for scholarly knowledge is rarely ‘owned’ outright but endlessly recycled with each access incurring a cost. Even though much of the knowledge has been produced within public institutions, it is uploaded by corporations into privately owned journals and databases so that universities and other institutions must pay for access for policy makers, managers, academics and students so that they might undertake ‘knowledge work’: even where the knowledge they seek to build upon was initially produced within that institution (Drahos and Braithwaite, 2002: 4,15). Most of the claims about the potential for the corruption of academic knowledge have been made in relation to the natural sciences, and it is unclear whether the impact of the ‘knowledge game’ and its market pressures have been universally experienced across all disciplines. Disciplines are not simply discrete parcels of expert knowledge but ‘social things’, arenas of social action (Collyer, 2012a: 14), with their own sets of rules and intellectual power relations (Bourdieu, 1969). Disciplines also have the capacity to differentially


65

‘translate’ the pressures for the instrumentalisation of knowledge coming from the political and economic fields (Albert, 2003: 149). Some, such as the applied branches of the natural sciences and engineering, appear to succumb more readily to the processes of academic capitalism (Slaughter and Leslie, 1997; Rhoades and Slaughter, 1998). The academic culture of the humanities and social sciences on the other hand, appears more resistant to such pressures. Albert (2003: 178) for instance, insists sociology has been protected by two of its significant features: its fragmentation into numerous sub-fields (which makes it difficult for one form of legitimation to be imposed across the whole discipline), and the tendency for large numbers of sociologists to engage in ‘dual production’ (i.e. research produced for peers as well as political or economic actors). Research is needed to fully investigate the relative impact of changes in the university sector on the various disciplines, but also on their specialities. It is possible that some disciplinary specialities (such as the sociologies of health and medicine, of education, social work, social policy, organisations or the labour market), may be more susceptible to market pressures given the requirement for their scholars to develop close relations with non-university partners to obtain access to these fields. Moreover, the applied nature of some of these fields, particularly that of medicine, may mean sociology’s specialities have a greater likelihood of displaying more of the features of academic capitalism than the parent discipline. Research is also needed to explore the relative impact of academic capitalism across the world. Given the markedly different experiences of developed and developing countries in the hierarchically-organised world system of commodity exchange (Wallerstein, 1974), it is highly likely sociologists from nations such as Australia, the United Kingdom and the United States would be differentially capable of marshalling the necessary resources to protect their discipline - or specialist field - from these political and economic forces. This article reports on an empirical study of the sociology of health and medicine as a small first step. The theoretical approach to the study is situated within the sociology of knowledge, where knowledge is regarded as a product of human agents, supported by institutions (Shils, 1982:10; Freidson, 1986: 685), and as such, influenced by social structures, cultures, and organisational forms. Although the association between the policy mechanisms applied in the funding of universities and the quantity of publication output has been much

Collyer

66

elaborated (e.g. Henkel, 2000; Slaughter and Leslie, 1997; Butler, 2003), rather less attention has been paid to how these, and other market relationships might shape the output of specific disciplines, or indeed, sub-disciplines. This article explores the impact of recent developments in the university sector on the production of sociological knowledge, and, through an investigation of some of the associations between knowledge and social context, provides insight into the social and institutional shaping of sociological knowledge and sociological practice. The Study The empirical study at the heart of this article compares and contrasts the publications of authors from Australia, New Zealand, the United Kingdom and the United States. The focus is the field of sociology, a large discipline and well-established in all four countries. Given its heterogeneous nature, one of its specialities was selected to ensure greater compatibility across the unit of analysis. This was the sociology of health and medicine, a field with many substantive similarities across these countries (Collyer, 2012b; Willis and Broom, 2004). Evidence for the association between context and knowledge production was sought through a quantitative analysis of refereed articles, published since 1990, in the journals closely associated with (though not necessarily owned by), the national professional associations of three of the countries: the Health Sociology Review (HSR) (Australia), the Sociology of Health and Illness (SHI) (United Kingdom), and the Journal of Health and Social Behavior (JHSB) (United States). Given the propensity of these journals to primarily publish authors from their own country (though this is changing in the case of HSR and SHI), publish papers with a specific methodological persuasion (qualitative in the cases of HSR and SHI, and quantitative for JHSB), and offer a set of contributions that may not be fully representative of the kind of work produced in each country; papers were also collected from the Journal of Sociology, Social Science and Medicine, the Australian and New Zealand Journal of Public Health, and refereed conference proceedings from The Australian Sociological Association. The proportion of articles from each journal and country is shown in table one, with an overall study population of 892 articles. Articles from these journals were selected if they could be regarded as refereed research articles. A few rejoinders or commentaries and research notes


67

were included, but only where these offered substantial, and fully referenced analyses of an issue. Book reviews and editorials were excluded. Codes were developed to capture each article as a ‘case’, with demographic Table 1: The Study Population – Journals and Countries, 1990-20111

The Journals

Number

of articles

New Zealand Australia United Kingdom United States

Health Sociology Review 14 28% 207 57% 17 7% 8 4%

Journal of Health and Social Behavior - - - - - - 89 40%

Sociology of Health and Illness 22 44% 30 8% 213 85% 41 18%

Social Science and Medicine - - 16 4% 18 7% 87 39%

Journal of Sociology 10 20% 57 16% 3 1% - -

Australian and NZ Journal of Public

Health

- - 8 2% - - - -

TASA Conference Proceedings 4 8% 48 13% - - - -

Total (n=892) 50 100% 366 100% 251 100% 225 100%

details taken from the manuscript (e.g. author name, country and university affiliation, source of funding) as well as manuscript content (e.g. method, use of theory2, orientation to medicine etc.). These two sets of variables – demographic and manuscript content – enabled cross tabulation between the independent variables (e.g. institutional location or funding status) and the dependent variables (e.g. use of theory). This method, now known as context-content analysis (Collyer, 2013), has been employed effectively elsewhere to map the effects of institutional context on knowledge production (Collyer, 2012a, 2012b, 2012c, 2009).

1 Totals may not add to 100% due to rounding. Nationality based on the country affiliation of the first author (as stated on the manuscript). 2 Journals vary in the information provided on the manuscript, particularly with regard to the source of funds for the research. Where data was missing from the manuscript, supplementary information was sought from institutional websites and, where necessary, authors themselves (via email).

Collyer

68

The originating country of each article is taken from the institutional affiliation of the first author as stated on the manuscript. This provides an indicator of ‘professional citizenship’ rather than personal nationality at the time of publication. A few of the more prolific authors appear on the data base on more than one occasion but less than 5% shifted (either temporarily or permanently) to new institutions in new countries, indicating the general reliability of this variable as a country indicator. Moreover while only 55% of the articles are sole-authored, 95.5% of collaborations are with authors from the same country. This strengthens the strategy of classifying articles by country. In many studies, New Zealand sociology is combined with productions from Australia, perhaps due to the close historic links between the two countries. Here the New Zealand case is treated separately to allow for comparative study. We note the small population of New Zealand articles and advise readers to treat the findings as indicative rather than fully representative of health sociology in that country. The relative strengths of the study’s method include its reliance on journal articles rather than books, as the former are thought to best reflect the majority of health sociology research (Willis, 1991: 49). While some have argued for the inclusion of books in any scoping study of sociology (e.g. Halpern and Anspach, 1993: 288), it should be pointed out that books and journals are written for different audiences and purposes, and thus not directly comparable. A second strength is found in the manual, rather than computer-generated data of the study. Studies relying on computer-generated key word analyses (e.g. Seale, 2008), or bibliometric data bases (e.g. Arvanitis et al., 2000, 1996), are unable to effectively interrogate the contents of articles or evaluate their scholarly contributions to the field. The method in use in this study, in contrast, relies on the careful reading and systematic coding of each article by a researcher with an appropriate familiarity with the field. Although this method introduces a subjective element of evaluation into the process, it is nevertheless more rigorous than review-based analyses containing personal selections of well-known texts (e.g. Willis, 1991, 1982). Finally, this study, with its alternative method of analysing evidence from the written manuscript, overcomes problems associated with questionnaires and the self-reporting of a participant’s academic practices (e.g. Connell et al., 2005). Coding reliability was ensured through the blind re-coding of a random selection of articles, and where necessary, the re-building of codes and re-coding until full reliability was


69

achieved. The statistical program SPSS was used to record and analyse the data. Ethical clearances were unnecessary, but the financial support of the School of Social and Political Sciences at the University of Sydney is acknowledged and appreciated. Workplaces and Research Funding Although there are many similarities between the employment conditions of sociologists in Australia, New Zealand, Britain and America, some aspects of their political and social context vary, specifically with regard to the kind of organisational work unit they are employed within, and the availability of research funding. Among the participants in our study, the American-based authors were more often located within named departments of sociology, with 52% (or 116/225) in these kind of work units compared with 21% (76/366) of Australian-based authors and 20% (51/251) of British-based authors. New Zealand authors publishing in the same journals largely come from sociology departments (58%), but a surprising number come from public health units. In Table two, the work units of the authors in our study are grouped into four categories to show their location within the university system relative to the schools and faculties of medicine. Readers will note the higher proportion of British authors employed within medicine, and a smaller proportion of American authors in the ‘non-allied’ disciplines. The terms ‘allied’ and ‘non-allied’ are employed in this analysis from an Australian perspective on the institutional organisation of disciplines. In this country, psychology may be found in proximity to the other social sciences but is often located among the natural sciences; epidemiology and public health are usually found within faculties or schools of medicine; and sociology within the arts or social sciences. This institutional organisation is similar to that of the United Kingdom but distinct from the United States, where psychology and epidemiology can be found within departments or schools of sociology. This indicates at least two rather different institutional settings, where various historical factors have encouraged specific scholarly alliances and led to the unique placement of disciplinary boundaries. Funding regimes also vary between the four countries (statistically significant using Pearson's chi square, χ2(1)=65.812, df=3, p<.000). The proportion of external funding is highest among the British authors at 65% (152/234), and lowest for the New Zealanders 33% (16/48). Next to the New

Collyer

70

Zealanders are the Australians at 35% (or 127/359), with the American authors closer to the British at 60% (or 131/218). The paucity of external funding for Australian social scientists has been noted elsewhere (e.g. Manderson, 1998: 265-6; and Academy of the Social Sciences in Australia, 1998), and it appears from this study that the New Zealand funding context is similar to that of its neighbour. Reflecting changes in the funding environment, the proportion of

Table 2: Type of Work Unit by Country3 New Zealand Australia Britain America

Sociology etc. 28 58% 197 54% 102 41% 145 64%

Non-Allied Disciplines 6 13% 102 28% 74 30% 26 12%

Public Health etc. 14 29% 41 11% 34 14% 29 13%

Medicine - - 24 7% 40 16% 25 11%

Total n=887 48 100% 364 100% 250 100% 225 100%

Articles across the study population based on externally funded research has risen from 39% of the articles between 1990 and 1999, to 57% since 2000 (statistically significant using Pearson's chi square, χ2(1)=26.425, df=1, p<.000). The sources of external funding are also noted, distinguishing between agencies with an interest in funding health or medical research and those which may otherwise be classified as ‘neutral’. Health or medical agencies include the World Health Organisation, the National Health and Medical Research Council or Royal College of Surgeons. ‘Neutral’ sources include the European Social Fund, the Australian Research Council Discovery Grant Scheme, and the National Census Data Collections Agency. As can be seen in table three, sociologists of health and medicine in each of the countries tend to attract

3 Country classification based on the national affiliation of the first author as provided on the manuscript. Country by Work Unit is statistically significant using Pearson's chi square χ2(1)=64.674, df=9, p<.000. The work unit of the first author, regardless of whether it is named as a school, department or faculty, is placed as accurately as possible within the following discipline clusters: (a) Sociology etc. refers to sociology, anthropology, demography, political science, cultural studies, gender studies, policy studies and the general social sciences or social studies, sociology of science studies, plus allied disciplines (such as geography, social or human geography, social work, education and criminology and law), history and the other humanities (including medical humanities) (b) The non-allied disciplines include psychology, business, management, forestry, computing, statistics), socio-health, nursing/midwifery, CAM, pharmacy, dentistry, other allied health, and general health sciences. (c) The category of public health etc. includes public health, epidemiology, sexual health, mental health, health financing, health services and planning. (d) Medicine includes medicine and the natural sciences such as biology, plus other health and medical units and community medicine.


71

external funding from different sources. The American contributors are primarily funded by health or medical agencies; British contributors obtain the majority of their external funds from health and medical agents; and contributors from Australia attract funding more evenly between the two kinds of agencies. New Zealand contributors appear to attract more of their funding from medical agencies than from neutral agencies, differentiating them from their Australian counterparts.

Table 3: Source of Funding by Country4 New Zealand Australia Britain America

Neutral Funding 2 13% 59 47% 51 34% 22 17%

Medical or Health Funding 14 88% 67 53% 101 66% 109 83%

Total n=425 16 100% 126 100% 152 100% 131 100%

Impacts on Sociological Practice These variations in the organisational and funding contexts of the authors in our study are associated with certain changes in sociological practices across the four countries. One of these is the rising incidence of ‘team work’ in the sociology of health and medicine. Although there has long been a propensity among sociologists to research and publish on their own, the practice of collaborating with other individuals is on the rise. In this study, 15% (56/366) of the articles in the period 1990-1999 were published with three or more authors. By the second decade (2000-2011), 24% (or 127/526) of the articles had three or more authors (statistically significant using Pearson’s chi square, χ2(1)=10.352, df=1, p<.001). This change is most noticeable among the British and the American authors, with rises of 16% to 32% among the former, and 24% to 34% among the latter. Among Australian authors there has been no significant shift towards very large teams, though a change is evident from single to double authorship (from 16 to 23%) by the second decade. New Zealand authors show a similar shift toward collaborative work, with no teams of authors in the first decade, but a rise to 18% of the articles in the second. 4 Country classification based on the national affiliation of the first author as provided on the manuscript. Funding information provided on the manuscript or clarified with author by email. The population of this table is only 425 as it excludes cases where funding was not required or provided. Statistically significant using Pearson’s chi square χ2(1)=29.803, df=3, p<.000.

Collyer

72

Associated with the rising incidence of collaborative publishing is the increase in external funding in this specialist field. In all four countries, larger authorship teams are found where the research is externally funded (statistically significant using Pearson’s chi square, χ2(1)=81.176, df=1, p<.000). Thus among articles with external funding, 34% have large authorship teams compared with only 9% of articles without external funding. Larger teams are also associated with health and medical rather than neutral funding (statistically significant using Pearson’s chi square, χ2(1)=9.688, df=1, p<.002), with 78% of articles with three or more authors funded by health or medical agencies compared with only 64% of the articles with only one or two authors. This is particularly noticeable among the publications from Australia and the United States. Impacts on Sociological Knowledge There are a number of other associations within the data which call out for analysis. Most important are those providing indications of a potential impact from the organisational and funding contexts on the production of sociological knowledge. Articles were coded to reveal their primary aim, whether this be an evaluation study, the exploration of a theory or an issue, a methodological piece or a report of an empirical study. In this field of the sociology of health and medicine, funded research tends to be associated with the last of these aims: the reporting of an empirical study (statistically significant using Pearson’s chi square, χ2(1)=284.160, df=1, p<.000). This suggests sociological knowledge production in all four countries may be directed toward more utilitarian purposes through the application of external funding into the university environment. Thus, given the overall growth in external funding in this field, one of the outcomes has been a proportional increase in directed research (relative to other potential aims) during the second decade, with more articles primarily reporting on empirical research. A second possible indication of the changing academic environment is reflected in the theoretical content of the articles. Articles were coded to indicate the presence of explicit statements about their theoretical content. Articles without explicit statements were coded as ‘no framework stated’, even where the theory might be deduced from the use of particular theorists or the logic of the argument. An example of a article without a stated framework is Collyer (2007). This article applies several sociological concepts (e.g. ideology,


73

neo-liberalism, social action) and theoretical frameworks (e.g. Weberian, Marxian), but makes no explicit statement about the overall theoretical approach. In contrast, an example which contains a specific theoretical framework is the article by Swain and Harrison (1979: 274), where the authors’ contend that a ‘symbolic interactionist perspective is used to examine the effects of institutionalisation on residents at a Sydney nursing home’. In this specialist field, we find the use of explicit statements about the theoretical approach to be highest among the New Zealand articles, with 80% containing statements about the use of sociological theory. Second in line are the British articles, with 74% containing such statements. The number of Australian articles with these statements was somewhat fewer (66%), while the American articles contained the least number of declarations at 57% (statistically significant using Pearson’s chi square, χ2(1)=18.589, df=3, p<.000). These differences are associated with variations in their funding regimes, for there is a close relationship between theory and funding. Indeed funded research is much more likely to be bereft of explicit statements about theoretical content (statistically significant using Pearson’s chi square, χ2(1)=6.004, df=1, p<.014). The source of funding is statistically significant only in the USA, where 68% of articles with neutral funding contain explicit statements about theory, compared with only 42% of those with health or medical funding (statistically significant using Pearson’s chi square, χ2(1)=4.966, df=1, p<.026). The place of work of the sociologists also has relevance for the presentation of sociological knowledge. Employment within the faculties of medicine – rather than the arts and social sciences – are associated with a somewhat lower likelihood of explicit statements about the theoretical content of the articles. We find 69% of articles from authors working in sociology and allied disciplines containing such statements, compared with 60% from their colleagues working in public health, the non-allied disciplines and medicine (statistically significant using Pearson’s chi square, χ2(1)=5.216, df=1, p<.022). This feature of sociological knowledge production varies from country to country, with it being least evident in the UK and most pronounced among authors from the United States. In the latter country, 61% of authors employed in sociology and its allied disciplines (and publishing in this speciality field), use explicit statements about theory, compared with only 44% of those from public health and medicine (statistically significant using Pearson’s chi square,

Collyer

74

χ2(1)=4.825, df=1, p<.028). This in turn may well be a feature of the association between workplace and the funding of research, for it is evident that sociology and the allied disciplines are less likely to receive funding for their research than public health and medicine. In Australia, funding is most commonly found among the authors working in faculties of medicine, whereas in the UK and the USA, higher levels of funding are apparent in faculties of public health. A third indication of the effects of the academic environment on the production of sociological knowledge comes from the authors’ orientations towards medicine. ‘Medicine’ can be defined as an institution, a set of practices, a series of occupations, an interest group, or a body of knowledge offered by orthodox practitioners and central to prestigious research and teaching institutions such as Johns Hopkins in the United States, Guy’s in Britain or the Royal North Shore in Australia. In this study, articles were coded according to the author’s perspective on one or more of these aspects of medicine. This variable refers to the debate popularised by Strauss over the potential ‘capture’ of sociologists by medicine and discussed in the opening paragraphs of this article. The ‘capture’ of sociologists has been interpreted variously in the literature. Kendall (1963) regarded it as the level of independence of the sociologist, Pflanz (1975) as the adoption of ‘medical values’, Gold (1977) as the presence of a ‘medical bias’, and Cockerham (1983: 1513) with reference to applied rather than theoretical sociology. In this study we measure this rather ambiguous concept by the extent to which the articles exhibit a critical distance from the medical context. Some articles are excluded from this part of the analysis because they focus on methodological issues, are highly ambiguous in their orientation to medicine, or do not include or discuss the role of medicine (e.g. Li et al., 2008; Airey et al., 2007; Jones, 2008). The remaining articles have been coded as either critical or generally sympathetic towards medicine. Articles displaying a critical approach towards medicine may examine the negative impact of orthodox medicine, medical knowledge or medical research on the patient or wider population (e.g. Henderson, 2008; Campbell et al., 2007); explicitly point to the failure of the medical profession to produce policy or alter practices to better protect the health of the patient or wider population (e.g. Greaves, 2007; Broom, 2008); or criticise the cultural or institutional power of the medical profession (e.g. Allsop, 2006; Xanthos, 2007). Alternatively, articles displaying a sympathy towards medicine may encourage increased access to orthodox health services or medical technologies without


75

reservation (e.g. Barr and Rose, 2008; Doley et al., 2008); examine the medical system from the perspective of medical practitioners and other professionals who work within it (e.g. Collyer, 2007); or adopt medical rather than sociological definitions of a problem (e.g. Måseide, 1991; Mallinson and Popay, 2007). Within this specialist field, more sociologists from Australia are critical, rather than sympathetic, towards medicine, followed by those from New Zealand, America, and then Britain (92%, 83% 77% and 75% respectively) (statistically significant using Pearson’s chi square, χ2(1)=25.342, df=3, p<.000). Over the two decades, there is a small decline in the proportion of sociologists who are critical of medicine in Australia (from 95-90%) and in Britain (from 81% to 72%), while the level of criticism remains stable in the USA, but rises from 80 to 85% in New Zealand. The extent to which sociologists are critical rather than sympathetic towards medicine is shown to be associated with external funding, for funded research is more likely to be sympathetic research in all countries (statistically significant using Pearson’s chi square, χ2(1)=18.883, df=1, p<.000). Moreover, as can be seen in table four, one’s stance toward medicine is associated also with workplace. Here it is evident that while the pattern of orientation is a complex one due to differences in the national placement of disciplinary boundaries; sociologists employed within medicine tend to be more sympathetic to the values or practices or knowledge paradigms of their host discipline. Thus the highest proportion of sociologists expressing criticism of medicine are found in sociology departments in all four countries. Some Reflections on the Study The empirical material offered in this article suggests certain sociological work practices and the production of sociological knowledge are being re-shaped in the presence of global changes to the university sector and the broader expert knowledge system. Two concepts were offered to assist with analysing the relationships between knowledge production, knowledge-related practices, and the material, institutional and cultural conditions of this changing environment. ‘Academic capitalism’ denotes an increasing shift toward market forms of practice and regulation in the university sector. This phenomena is expressed in the study by the growing pressure on academics to seek external funding and forms of collaboration beyond their own discipline: a pressure indicated, for

Collyer

76

instance, by the number of author names attached to a manuscript and changes in the source of research funding over time. The ‘knowledge game’ on the other hand, which also refers to the operation of market forces in the 21st century, is an additional concept essential for the completion of this analysis because it attends to the ‘rules’ determining the hierarchically organised system of knowledge exchange. Acknowledging the uniqueness of the expert knowledge system where ownership is problematic and thus bypassed in favour of a market exchange of access and usage rights;

Table 4: Criticism of Medicine by Work Unit by Country5 Sympathetic to Medicine Critical of Medicine Total

New Zealand

Sociology etc.

4

20%

16

80%

20

100%

Non-Allied Disciplines - - 6 100% 6 100%

Public Health etc. 2 25% 6 75% 8 100%

Medicine - - - - - 100%

Australia

Sociology etc.

5

4%

116

96%

121

100%

Non-Allied Disciplines 4 6% 62 94% 66 100%


Medicine 4 22% 14 78% 18 100%

Britain

Sociology etc.

7

12%

50

88%

57

100%



Medicine 10 35% 19 66% 29 100%

America

Sociology etc.

13

17%

65

83%

78

100%



Medicine 5 29% 12 71% 17 100%

Total 91 446 n=571

5 Country classification based on the national affiliation of the first author as provided on the manuscript. Organisational and institutional affiliations similarly sourced. Criticism of Medicine by Work Unit statistically significant using Pearson's chi square χ2(1)=21.307, df=3, p<.000. Population of table equals 571 as articles concerned with other issues (e.g. methodology) were not included.


77

the ‘knowledge game’ highlights the processes through which expert knowledge is given value in a market economy; the status attached to certain forms of knowledge and methodologies; and a ranking system of prestige applied to the journals, disciplines and institutions in which knowledge originates and remains associated. In most commodity markets, leadership refers to corporate giants such as Microsoft or DuPont. In the trade in knowledge goods, leadership resides with those who have set the terms of the contest and become its main beneficiaries. Thus leadership in the ‘knowledge game’ is (unequally) shared by the ranking and indexing companies (such as Thompson’s Scientific); the publication conglomerates (such as Sage or Oxford); the wealthy, established universities (such as Harvard and Cambridge); the wealthier countries of Europe, the United Kingdom and the United States; and the highly positioned disciplines (medicine and law). In this study we see the presence of the ‘game’ in differential access to research funds according to discipline, department and country. Sociologists working in the countries or disciplines at the top of the hierarchy - in British or American universities – are significantly more likely to procure external research funding than the Australian or New Zealand sociologists whose countries of employment are major importers of knowledge products. The operation of the ‘game’ is likewise evident in all four countries where research funding is more consistently available to academics employed within public health or other medical faculties than it is to those working within sociology and its allied disciplines. The growth of academic capitalism, and the imposition of the knowledge game into the field of sociology have led to a set of ambiguous consequences. Additional resources have sustained the discipline as an academic field, enabled sociological concepts to become part of everyday language and lay knowledge, and aided sociologists to gain access to the policy and community sectors. At the same time, the acceptance of external research funds, the opportunities for collaboration and the greater role in public affairs have begun to negatively effect other aspects of sociological knowledge and practice. In this study for instance, there is evidence of an association between these practices: a down-grading of the importance of sociological theory in sociological manuscripts and the adoption of less independent perspectives on the institutions of medicine. The question of immediate concern is the extent to which such changes might be welcomed. For some sociologists of health and medicine, increased collaboration with the institutions of medicine bring funding opportunities for

Collyer

78

large scale research that can ‘make a difference’. It may also offer the possibility of a greater role in the policy arena for the development of more effective health policies or programs; and it opens a pathway to medical reform, for encouraging practitioners to consider alternative clinical strategies and be more sensitive to the social needs of their patients. This group of sociologists share a tendency towards a ‘sociology in medicine’ approach to their field, where the main concern is the improvement of the health of the population and the reform of medical practices. Less optimistic about the changes pointed to in this article might be individuals adhering to a perspective best characterised by the term ‘the sociology of medicine’. Here a highly critical and independent perspective on medicine is considered essential if disciplinary knowledge is to be preserved, refined or extended. From this stance, developments which increase the privatisation of knowledge and thus inhibit access to knowledge, discourage critical thinking and dampen innovation, threaten the very principles of scholarship. Sociologists falling into this category may share their colleagues’ interests in the reform of health services or improving the health of the community, but nevertheless place a high value on the health of the academic system itself. These contrasting positions have previously been explained in terms of different value-sets about medicine brought about through working either in a medical setting (such as a hospital or a university department of medicine) or a sociological setting (Straus, 1957; Freeman et al., 1963; Freidson, 1970: 42). Elliot Freidson (1978: 128) for instance, argued ‘it would take an extraordinary person to be able to work full time in a medical setting and at the same time define his [or her] problems sociologically rather than medically’. What becomes apparent from this empirical study is that the ‘sociology in medicine’ versus the ‘sociology of medicine’ debate is not fully explicable as a contrast of sociological perspective, as a group’s capacity to maintain a critical distance from their subject matter, nor even as an individual’s need to be socially accepted within the workplace. Instead, the seductive pull of a particular perspective or the demands inherent in social interaction need to be seen as part of a larger story about the production of sociological knowledge. While an academic’s location within an institution places that individual in interactive proximity to others with similar or contrasting values and perspectives; location also subjects an individual to a set of institutional requirements, demanding


79

adherence to rules about the ‘correct’ value of certain kinds of work, methodologies and publication forms and outlets. Many decades ago, Max Weber (1949: 85-6) wrote of the growing power of the new experimental, laboratory sciences to legitimately define and solve human problems, and of their threat to impose an ahistorical, acritical, reductionist, mono-causal perspective on the moral and cultural disciplines. Weber saw this as a critical moment for the cultural sciences: the ‘final twilight of all evaluative standpoints in all the sciences’ (Weber, 1949: 86). The tension between these paradigms has for many years been played out within and between the disciplines, and its implications have largely remained confined to the university sector. The imposition of capitalism into academia has transported the dominance of the natural sciences into the global, transnational arena where it has become embedded into the rules of the ‘knowledge game’. Thus these rules not only favour the market but the experimental sciences. Within this ‘game’, expert knowledge is progressively produced in a form capable of being uploaded and put to the service of the state and the corporate sector, but also in a manner that assures ‘success’ to its leaders: the positivist disciplines, and those universities and nations favouring this form of knowledge. The perversity of the system, unfortunately, is that its newly forged processes are unable to protect and reproduce the traditional structures which once nurtured sociology as an alternative perspective on the world.

References Academy of the Social Sciences in Australia (1998) Challenges for the Social Sciences in

Australia. Volume 1. Australian Research Council and the National Board of Employment, Education and Training.

Airey, L.; McKie, L. and Backett-Milburn, K. (2007) Women’s experiences of combining eldercare and paid work in the Scottish food retail sector. Health Sociology Review, 16(3-4), 292-303.

Akiwowo, A. (1988) Universalism and indigenisation in sociological theory. International Sociology, 3(2), 155-60.

Albert, M. (2003) Universities and the market economy. Higher Education, 45(2), 147-82. Allsop, J. (2006) Medical dominance in a changing world. Health Sociology Review, 15(5),

444-457. Arvanitis, R.; Waast, R. and Gaillard, J. (2000) Science in Africa: A bibliometric panorama

using PASCAL database. Scientometrics, 47(3), 457-73. Arvanitis, R.; Russell, J.M. and Rosas, A. (1996) Experiences with the National Citation

Reports Database for measuring national performance: the case of Mexico. Scientometrics, 35(2), 247-55.

Badgley, R. (1971) The sociology of health: some questions. The Milbank Memorial Fund Quarterly, 49(2), 133-157.

Collyer

80

Baldock, C. (1994) Sociology in Australia and New Zealand. In R. Mohan and A. Wilke (Eds.), International Handbook of Contemporary Developments in Sociology (pp 587-622) Greenwood Press: Westport.

Barr, M. and Rose, D. (2008) The great ambivalence. Sociology of Health and Illness, 30(6), 944-958.

Bloom, S. (1986) Institutional trends in medical sociology. Journal of Health and Social Behavior, 27(3), 265-276.

Bourdieu, P. (1969) Intellectual field and creative project. Social Science Information, 8, 89-119.

Broom, D. (2008) Hazardous good intentions? unintended consequences of the project of prevention. Health Sociology Review, 17(2), 129-140.

Butler, L. (2003) Modifying publication practices in response to funding formulas. Research Evaluation, 12(1), 39-46.

Campbell, D.; Pyett, P. and McCarthy, L. (2007) Community development interventions to improve Aboriginal health: building an evidence base. Health Sociology Review, 16(3-4), 304-314.

Cockerham, W.C. (1983) The state of medical sociology in the United States, Great Britain, West Germany and Austria. Social Sciences and Medicine, 17(2), 1513-1527.

Cockerham, W. (2005) Medical sociology and sociological theory. In Cockerham, W. (ed.), The Blackwell Companion to Medical Sociology (pp 3-22) Blackwell: Victoria.

Collyer, F.M. (2013) The production of scholarly knowledge in the global market arena: university ranking systems, prestige and power. Critical Studies in Education, DOI:10.1080/17508487.2013.788049

Collyer, F.M. (2012a) Mapping the Sociology of Health and Medicine: America, Britain and Australia Compared. Palgrave Macmillan: Houndmills, Basingstoke.

Collyer, F.M. (2012b) The birth of a speciality: the sociology of health and medicine in Australia. Health Sociology Review, 21(1), 116-130.

Collyer, F.M. (2012c) Sociology, sociologists, and core-periphery reflections. Journal of Sociology, DOI: 10.1177/1440783312448687.

Collyer, F.M. (2009) The rise and fall of theoretical paradigms in health and medical sociology: 1960-2009. In S. Lockie; D. Bissell; A. Greig; M. Hynes; D. Marsh; L. Saha; J. Sikora and D. Woodman (Eds.), The Future of Sociology: 2009 TASA Refereed Conference Proceedings, Australian National University, Canberra, 1-4 Dec 2009. TASA, Canberra. Available online at: http://www.tasa.org.au/conferences/conferencearticles09/

Collyer, F.M. (2007) A sociological approach to workforce shortages: findings of a qualitative study in Australian Hospitals. Health Sociology Review, 16(3-4), 248-262.

Connell, R.W.; Wood, J. and Crawford, J. (2005) The global connections of intellectual workers. International Sociology, 20(1), 5-26.

Currie, J. and Vidovich, L. (1998) The ascent toward corporate managerialism in American and Australian universities. In Martin, R. (ed.), Chalk Lines (pp 112-44) Duke University Press: Durham.

Doley, A., Sibly, C., Wigg, C., Crawford, P., Cowper, L., Barker, C. and Gale, P. (2008) Doctor on campus: a general practice initiative for detection and early intervention of mental health problems in a rural Australian secondary school. Health Sociology Review, 17(1), 53-63.

Drahos, P. and Braithwaite, J. (2002) Information Feudalism: Who Owns the Knowledge Economy? The New Press: New York.


81

Freeman, H.; Levine, S. and Reeder, L. (1963) Present status of medicine sociology. In Freeman, H.; Levine, S. and Reeder, L. (eds.), Handbook of Medical Sociology. Prentice-Hall: New Jersey, pp. 476-479.

Freidson, E. (1986) Knowledge and the practice of sociology. Sociological Forum, 1(4), 684-700.

Freidson, E. (1978) The development of design by accident. In Elling, R. and Sokolowska, M. (Eds.), Medical Sociologists at Work (pp 115-134) Transaction Books: New Brunswick, N.J.

Freidson, E. (1970) Professional Dominance. Atherton Press: New York. Gold, M. (1977) A crisis of identity. Journal of Health and Social Behavior, 18, 160-168. Greaves, L. (2007) Gender, equity and tobacco control. Health Sociology Review, 16(2), 115-

129. Greene, M. (1978) The crisis in medical sociology? Journal of Health and Social Behavior,

19(1), 117. Halpern, S. and Anspach, R. (1993) The study of medical institutions. Work and

Occupations, 20(3), 279-95. Henderson, J. (2008) Biological psychiatry and changing ideas about “mental health

prevention” in Australian psychiatry. Health Sociology Review, 17(1), 4-17. Henkel, M. (2000) Academic Identities and Policy Change in Higher Education. Jessica

Kingsley: London. Jones, K. (2008) In whose interest? relationships between health consumer groups and the

pharmaceutical industry in the UK. Sociology of Health and Illness, 30(6), 929-943. Keim, W. (2011) Counterhegemonic currents and the internationalisation of sociology:

theoretical reflections and an empirical example. International Sociology, 26(1), 123-45.

Kendall, P.L. (1963) Medical sociology in the United States. Social Science Information, 2, 20-34.

Kurasawa, F. (2002) Which barbarians at the gates? The Canadian Review of Sociology and Anthropology, 39(3), 323-347.

Li, J., McMurray, A. and Stanley, F. (2008) Modernity’s paradox and the structural determinants of health. Health Sociology Review, 17(1), 64-77.

Loubser, J. (1988) The need for the indigenisation of the social sciences. International Sociology, 3(2), 179-87.

Macintyre, S. (2010) The Poor Relation: A History of Social Sciences in Australia. Carlton: Melbourne University Press.

Mallinson, S. and Popay, J. (2007) Describing depression. Sociology of Health and Illness, 29(6), 857-871.

Manderson, L. (1998) Health, illness and the social sciences. In the Academy of the Social Sciences in Australia. Challenges For the Social Sciences and Australia (pp 251-277) Volume 2. Australia: Australian Research Council and the National Board of Employment, Education and Training.

Martin, B. (1992) Scientific fraud and the power structure of science. Prometheus, 10(1), 83-98.

Måseide, P. (1991) Possibly abusive, often benign, and always necessary. On power and domination in medical practice. Sociology of Health and Illness, 13(4), 545-561.

Pflanz, M. (1975) Relations between social scientists, physicians and medical organisations in health research. Social Science and Medicine, 9, 7-13.

Rhoades, G. and Slaughter, S. (1998) Academic capitalism, managed professionals, and supply-side higher education. In Martin, R. (ed.), Chalk Lines: The Politics of Work in the Managed University (pp 33-68) Duke University Press: Durham.

Collyer

82

Sanda, A. (1988) In defence of indigenisation in sociological theories. International Sociology, 3(2), 189-199.

Scambler, G. (2005) General introduction. Medical sociology: past, present and future. In Scambler, G. (ed.), Medical Sociology. Volume one. Routledge: London.

Seale, C. (2008) Mapping the field of medical sociology. Sociology of Health and Illness, 30(5), 677-95.

Shils, E. (1982) Knowledge and the sociology of knowledge. Knowledge: Creation, Diffusion, Utilization, 4, 7-32.

Slaughter, S. and Leslie, L. (1997) Academic Capitalism. Johns Hopkins Press: Baltimore. Straus, R. (1957) The nature and status of medical sociology. American Sociological Review,

22, 200-204. Swain, C. and Harrison, J. (1979) The nursing home as total institution. Australian Journal of

Social Issues, 14(4), 274-284. Wallerstein, I. (1974) The Modern World-System. New York: Academic Press. Weber, M. (1949/1922) The Methodology of the Social Sciences. New York: Free Press. Willis, E. (1991) The sociology of health and illness in Australia. Annual Review of Health

Social Science, 1, 46-53. Willis, E. (1982) Research and teaching in the sociology of health and illness in Australia and

NZ. Community Health Studies, 6(2), 144-153. Willis, E. and Broom, A. (2004) State of the art. Health Sociology Review, 13(2), 122-44. Xanthos, C. (2007) Delivering a patient-focused health service. Health Sociology Review,

16(3-4), 263-278.

Fran Collyer is a sociologist at the University of Sydney, National Convenor of the Health Section of The Australian Sociological Association, a member of the Health Governance Network, and former editor of the Health Sociology Review. Fran publishes in the sociology of knowledge, the history of sociology, and the sociology of health and medicine. She is co-author of Public Enterprise Divestment: Australian Case Studies (2001) and author of Mapping the Sociology of Health and Medicine (2012). [email protected]

Sociologists and their Work: Inter-Country Comparisons in the Sociology of Health and Medicine

Documents