http://www.medicalsociologyonline.org/current/bookrev.html

Dennis Raphael, Toba Bryant and Marcia Rioux (Editors)
Staying Alive: Critical Perspectives on Health, Illness, and Health Care.
Toronto: Canadian Scholars' Press. 2006. £26.99 (pbk) (ISBN 1551302969)
408pp


Reviewed by Fernando De Maio, Simon Fraser University, CA.



This useful text examines a broad range of issues related to medical
sociology using an overarching perspective based on political economy.  It
is a welcome addition to a growing body of literature on the social
determinants of health.  The book’s Canadian focus should be of interest to
medical sociologists in the UK; the book develops a useful comparison of
the origins and development of the Canadian and US health care systems,
along with important comparisons with Sweden and the UK based on regimes of
welfare capitalism.

    The book begins with four strong chapters which contrast
epidemiological, sociological, political economy, and human rights
approaches to health, illness and health care.  These chapters are written
in a way that makes the perspectives accessible to undergraduate students;
the authors clearly present the traditional foci of these perspectives and
draw attention to their respective limitations.  The chapter on
sociological perspectives includes discussion of the role of theory in
health research, including thoughtful sections on structural functionalism,
symbolic interactionism, conflict theory, feminism, and postmodernism.
Overall, these chapters provide a good foundational understanding of the
differences between approaching health issues at the cellular, organ,
individual, or population levels of analysis.

    However, although the book presents a useful comparison of
epidemiology, sociology, political economy, and human rights, it would have
benefited from a stronger discussion that acknowledges the common
methodologies employed by researchers working from these perspectives.  In
particular, the book would be strengthened by a more nuanced discussion of
the role of quantitative methods.  For example, the book includes a
critique of contemporary epidemiology for focusing too much on individuals
and suggests that this focus is due to the development of computers which
“keep many researchers stuck in the individual risk factory”.  Yet, it is
this same capability which enables the study of income distribution through
measures such as the Gini coefficient – measures that are central to more
critical research by sociologists or political economists, or indeed,
social epidemiologists.

    The book continues with a strong set of chapters on the social
determinants of health.  The roots of this field of research are correctly
traced back to the writings of Virchow and Engels, and important questions
about the effect of medical care on improvements in mortality rates since
the 1900s are raised.  The book’s Canadian focus strengthens these
chapters, which include discussion on the health status of Canada’s
Aboriginal peoples as well as Canada’s ‘healthy immigrant effect’, wherein
the health of immigrants (which is on average better than that of
Canadian-born people at the time of immigration) deteriorates after
settling in Canada.

    Three chapters examine Canada’s health care system – described by the
editors as the ‘crown jewel’ in Canada’s welfare state – in more detail.
In particular, this section of the book examines the political and social
factors that led to the development of Canada’s health care system, which
unlike the US system, is based on the principles of universality,
comprehensiveness, accessibility, and public administration.  These
chapters also examine some of the controversies apparent in current
discussions on health care reform in Canada, including issues of public
versus private financing, and the role of profit.  Readers from the UK will
find these chapters useful in understanding similarities and differences
with the NHS.  The book concludes with critical discussions of the social
construction of disability and illness, the pharmaceutical industry, public
health concerns in Canada, the US, the UK and Sweden, and the future of
health research in Canada.

    I have used this text in my undergraduate course on medical sociology.
The book has been well-received by students, and if used alongside
additional sources, I believe it can serve as a valuable introduction to
medical sociology.

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