HEALTH, MEDICINE, SOCIETY

HEALTH, MEDICINE, SOCIETY

PROCEEDINGS OF THE INTERNATIONAL CONFERENCE ON THE SOCIOLOGY OF MEDICINE WARSAW (JABLONNA), AUGUST 20-25, 1973 organized by the Polish Academy of Sciences, Institute of Philosophy and Sociology and co-sponsored -by the Research Committee on the Sociology of Medicine, International Sociological Association

HEAL TH, MEDICINE, SOCIETY Editors: MAGDALENA SOKOLOWSKA Polish Academy of Sciences JACEK HOL6wKA University of Warsaw ANTONINA OSTROWSKA Polish Academy of Sciences D. REIDEL PUBLISHING COMPANY DORDRECHT - HOLLAND / BOSTON - U.S.A. PWN-POLISH SCIENTIFIC PUBLISHERS WARSAW-POLAND

Library of Congress Cataloging in Publication Data International Conference on the Sociology of Medicine, Jablonna (Warsaw), 1973. Health, medicine, society. "Organized by the Polish Academy of Sciences, Institute of Philosophy and Sociology and co-sponsored by the Research Committee on the Sociology of Medicine, International Sociological Association." Bibliography: p. 1. Social medicine - Congresses. I. Sokolowska, Magdalena. II. Ho16wka, Jacek. III. Ostrowska, Antonina. IV. Polska Akademia Nauk. Instytut FiIozofii i Socjologii. V. International Sociological Association. Research Committee on the Sociology of Medicine. VI. Title. RA418.I53 1973 301.5 76-7916 ISBN-13: 978-94-010-1432-8 e-isbn-13: 978-94-010-1430-4 DOl: 10.1007/978-94-010-1430-4 Distributors for the U.S.A., Canada and Mexico D. REIDEL PUBLISHING COMPANY, INC. Lincoln Building, 160 Old Derby Street, Hingham, Mass. 02043, U.S.A. Distributors for all other countries D. REIDEL PUBLISHING COMPANY P.O. Box 17, Dordrecht, Holland All Rights Reserved Copyright 1976 by PWN-PoIish Scientific Publishers-Warszawa Softcover reprint ofthe hardcover 1st edition 1976 No part of the material protected by this copyright notice may be reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording or by any informational storage and retrieval system, without written permission from the copyright owner

PREFACE This volume contains a selection of papers presented at the International Conference on the Sociology of Medicine, held between August 20th and 25th, 1973 in Warsaw (Jablonna).* The Conference was organized by the Institute of Philosophy and Sociology of the Polish Academy of Sciences in collaboration with the Research Committee on the Sociology of Medicine of the International Sociological Association. The participants included medical sociologists from the United States, and from the countries of Western and Eastern Europe, including a delegation,of general sociologists and physicians and also a group of young medical sociologists from Poland. Dr. Leo Kaprio, Director of the Regional Office for Europe of the Wodd Health Organization, together with a member of his staff, was also present. The Conference was opened by the Deputy Minister of Health and Social Welfare of the Polish People's Republic, Dr. Ryszard Brzozowski. The first Chairman was Prof. Jan Szczepanski, Vice President of the Polish Academy of Sciences and Director of the Institute of Philosophy and Sociology. The first speech was delivered by Prof. Jivko Oshavkov from Bulgaria, then Vice-Chairman of the International Sociological Association. The Conference had several objectives which, we believe, were successfully achieved. It was intended first to provide an occasion to bring participants of East and West together, and give them a chance to exchange information on the state of medical sociology in different countries. They found an opportunity to discuss their views in a relaxed and informal atom sphere. The second objective was to review with general sociologists and physicians the different theoretical sources from which the sociology of medicine has evolved. These discussions covered a wide area of problems concerning applied health care and their connection with social research, social planning and social engineering. A longer account of the Conference written by Maria Bartnik and Barbara Uramowska was published in Medical Sociology Newsletter edited by Research Committee on Medical Sociology of the International Sociological Association (October 1973, No.3) - and in Social Science and Medicine 8 (1974) 469-472.

VI PREFACE The third objective was to lay foundations for possible international collaboration in the future. Several projects for comparative or joint international studies were outlined and discussed during the Conference. In order to achieve these goals the participants were asked to contribute a written paper. A number of additional papers were also received from scholars who were unable to be present. Altogether fifty-six papers were submitted to the Conference. They comprised research reports, theoretical analyses, teaching programs, policy studies, and, occasionally, historical investigations. The Editors of this volume had a difficult task in selecting a limited number of these papers for publication. First of all, we had to forego publishing those short factual contributions which presented current developments and achievements in various scientific establishments in Poland. We also had to exclude a number of full-length papers in order to comply with the demands of the publisiler concerning the size of this volume. * We decided, therefore, to present only those papers which can most adequately represent the five problem areas which we regard as most important and to which, in consequence, this book has been primarily devoted. The first part of this volume concerns health and society. A consistent picture of the health status of a given society involves a number of complementary viewpoints. We tried to emphasize the complexity of this subject by including here epidemiological (Kostrzewski, Jablensky) and demographic (Klonowicz) studies, articles on attitudes of the society at large to problems of health and disease (Tahin et al.), a comprehensive analysis of health problems of immigrants to a new country (Haavio Mannila) and a study of various aspects of medical behaviour of city inhabitants (Titkow). * The materials which have not been included in this book are to appear in other publications. Two volumes in Polish we currently prepared. One will be published by PWN - Polish Scientific Publishers under the title Socjologia a zdrowie (Sociology and Health) and will embrace several papers presented in this volume together with reports on research programs in medical sociology conducted in this country and presented at the Conference as well as a bibliography of Polish literature on medical sociology published in years 1969-1974. The other volume Polityka spoleczna a zdrowie (Social Policy and Health) to be published by Ksillzka i Wiedza will comprise Conference papers devoted primarily to general sociological topics and questions of social policy.

PREFACE VII The second part of this volume deals with the transformations which have taken place in the field of medical intervention. Its principal aim is to show that the basic repertoirs of medical techniques, skills, practices and norms changes with time under the influence of social events. This part includes papers that review the changing values and ideologies prevailing in medicine (Fox), the impact of scientific discoveries on medical practice (Wald), ramifications of epidemiological and ecological theories (Susser), and new ways of organizing medical care (Nagi, Herzlich). The third part is devoted to sociological insights in the health sciences, and illustrates the most important ways in which the sociologist is involved with the problems of health and medicine. It includes both papers which discuss characteristics of the medical profession (Kelus and Sikorska, Illsley, Springer), and those which seek to find appropriate definitions of health (Pflanz, Elinson) and related concepts (Ostrowska, Mauksch). The fourth part tackles the intricate problems associated with the functioning of the health system. It presents the difficulties connected with the proper delineation of the health system (Field), shows the dynamics of the health system in different social and historical circumstances (Bizon, Freidson), discusses certain examples of the existing health systems (Gill, Badgley) or policies and strategies that they involve (Gallagher) and reviews the problems encountered by those who undertake to plan their functioning (Holst, Reader). The fifth part has been devoted to teaching. It contains two trend analyses of the place that sociology has had in medical education in two countries with the longest tradition in this area - U.S.A. and G. Britain (Bloom, Jefferys), a paper on the development of the oldest institutions that teach sociology of medicine (Straus) and two articles discussing ideologies, methods and curricula of the sociology of medicine for undergraduate and graduate students of sociology in two European countries (Nuyens, Stacey). We are very grateful to all who have contributed to the Conference held in Summer 1973 with their papers. We feel also an obligation to all those who took part in the innumerable discussions held in the course of the Conference. We hope that their views and knowledge are also indirectly reflected in this volume. The Editors

TABLE OF CONTENTS Preface......................... V M. Sokolowska / The Development of the Sociology of Medicine in Poland...... 1 I. HEALTH IN SOCIETY J. Kostrzewski / Health and Social Planning........ 21 S. Klonowicz / The Influence of the Legalization of Abortion on the Demographic Reproduction in Poland 1956-72..... 37 A. Jablensky, J. Oshavkov / Health and Disability in a Total Population...................... 51 E. Haavio-Mannila, K. Stenius / Immigration and Mental Health 59 T. Tahin, Gy. K6czan, J. Porczi, K. Ozsvath, I. Kiss, B. Kezdi / Professional and Lay Attitudes toward Mental Illness and Mental Patients............... 99 A. Titkow / Social Differentiation of Medical Behaviour among Warsaw Inhabitants. Research Assumptions and Preliminary Results...... 113 n. THE TRANSFORMATION OF MEDICAL INTERVENTION R. C. Fox / Ethical and Existential Developments in Contemporaneous American Medicine: Their Implications for Culture and Society...................... 131 I. Wald / The Dilemmas of Genetics............ 159' M. W. Susser / Some Notes on the Epidemiological and Ecological Models....................... 169 S. Z. Nagi / Team Work in Health Care in the U.S.: A Sociological Perspective...... '.'.............. 185 C. Herzlich / Therapeutic Community and Psychiatry in the Community: a Comparative Study of the French and Anglo- Saxon Literatures '"................ 199

x TABLE OF CONTENTS III. SOCIOLOGICAL INSIGHTS INTO THE HEALTH SCIENCES J. Kelus, U. Sikorska I The Sociologist and the Problem ofvenereal Diseases...... 213 R. Illsley / Developments in the Role of Medicine in Relation to Reproduction.................. '. 231 A. Ostrowska / The Use of the Concept of Socialization in the Study of Rehabilitation................ 243 M. Pflanz / Social Structure and Health: Methodological and Substantial Problems without Solutions........... 253 J. Elinson / Towards Sociomedical Health Indicators... 267 H. O. Mauksch / A Social Science Basis for Conceptualizing Family Health... 281 E. Springer / Values in the Medical Profession........ 301 IV. THE HEALTH SYSTEM M. G. Field / The Health System and the Social System.... 315 Z. Bizon / The Adaptation Patterns of the Medical System and Social Change.................... 331 E. Freidson / Applications of Organizational Theory: Models of Organization and Service for Health Care....... 349 E. B. Gallagher / Consumerism and Health Care....... 363 D. G. Gill / The British National Health Service: Modernisation, and Change...................... 379 R. F. Badgley, C. A. Charles and G. M. Torrance / Shifting Social Power in the Canadian Health System.......... 395 G. G. Reader / Deprivation and Health Care Planning in the U.S. 409 E. Holst / Professional Health Planning and the Health Professions 423 v. TEACHING S. W. Bloom / From Learned Profession to Policy Science: A Trend Analysis of Sociology in the Medical Education of the United States................. 435 M. Jefferys / Social Science Teaching in Medical Education: An Overview of the Situation in Great Britain...... 449

TABLE OF CONTENTS XI Y. Nuyens / Teaching Medical Sociology to Graduate Students in Sociology: A Three-Year Experience.......... 471 M. Stacey / Teaching Medical Sociology to Sociology Students: a British View..................... 503 R. Straus / Goals and Functions of the Department of Behavioral Science in the University of Kentucky College of Medicine 511