Hierarchy and Power in Australian Health Care System; Social Theories

This essay explores the deep rooted aspects of medical dominance and hierarchy in the Australian health care system using social theories. It discusses the role of sociology in health care, the Australian Health Care System and the biomedical model. It also delves into social theories for hierarchy and dominance in the Australian health care context and their impact on health practitioners and the nursing profession.

Running Head: MEDICAL DOMINNACE AND HIERARCHY 1
Hierarchy and Power in Australian Health Care System; Social Theories
Student’s Name
Institutional Affiliation

MEDICAL DOMINNACE AND HIERARCHY 2
According to Fair (2011), health is multidimensional concept that regards the social,
physical or mental wellbeing. Some of the sociological theories and perspectives on theories in
health are Marxism, feminism, Weberianism, conflict theory, functionalism and social
interactionism. Dominance is defined as the disposition of a person to show control in their
dealings with other people (Willis, 1989). Medical dominance (power) is as a result of the
clinical position doctors take in diagnosis and treatment. It is maintained through economic,
political and clinical autonomy. Doctors perform their work without direction from other health
professions-autonomy (independence) (Willis, 1989). This is exerted in four distinct approaches;
subordination, limitation, exclusion, and incorporation over the other health providers like
nurses, and allied health providers. These characteristics are a clear reflection of the Australian
health care system. It is a truism that occupational hierarchy is a representation of the Australian
health care system. Doctors in Australia enjoy the most prestige as defined Braithwaite et al.
(2016).
This essay is going to explore these two deep rooted aspects of the health care systems
(medical dominance and hierarchy) in the Australian context borrowing reference and concepts
from various sociological theorists and showing how they impact myself as a health practitioner.
The outline of this essay is as follows; first it will be a discussion on sociology and the
role of perspectives in health care. That will be followed by a discussion of the Australian Health
Care System and the biomedical model. Social theories for hierarchy and dominance (power) in
the Australian health care Contexts will be discussed.
Sociology is learning about groups of people and societies and their social interactions
starting from the very small groups to a very broad and large groups (Norbert, 1980). What
sociologists do is exploring all aspects and micro and macro levels of society. Sociology is an
important factor in health in that it focuses on the occurrence of health conditions and how they
can be treated in different societal and locational settings (Norbert, 1980). In the case of Ebola in
West Africa Nations in 2014, for example, sociological perspectives and aspects can prove
important in the best way to respond to the virus to prevent its spread to other regions. Countries
like Australia and America who could have some of their citizens or medical providers in Liberia
or DRC had fears on how to prevent importation of the virus, and at the same time identify and
treat present or potential cases in the shortest time possible.

MEDICAL DOMINNACE AND HIERARCHY 3
Sociology in health care is comprised of social epidemiology, mental health, disability,
medicalization or disease (Pescosolido, Martin, McLeo & Rogers, 2010). Perception of health is
an evolving aspect and that necessitates continuous control of new diseases as they develop. This
is supported by the fact that society continues to evolve as a result of globalization and
consequently disease spread also do evolve with it (Cockerham, 2015).
Some of the questions answered through sociology the definition of health from different
people within the society, addiction to sex or gabbling, conditions previously regarded as
diseases but currently taken for normal conditions or conditions now regarded as diseases and
were previously identified as a symptom of laziness or character, and the reason for children
vaccination among other questions ("Introduction to Health and Medicine · Sociology 2e",
2018).
This brings in the role of perspectives in the understanding of issues of this nature. Using
the functionalist perspective, for example, which is macro-level analysis and takes concern on
the bigger picture in order to concentrate more on the way societal aspects are integral to
persistence in health and viability of the whole society ("Theoretical Perspectives in Sociology |
Sociology: Understanding and Changing the Social World", 2018; Stolley, 2005). This
perspective regards the contribution of the healthy population to influence a stable society like
ensuring that the sick regain their health (like in the case of Ebola above).
The conflict perspective is too a macro-level analysis that aims at eliminating the social
inequality between people within a health and a health care system (Andersen & Taylor, 2016).
People from disadvantaged backgrounds are vulnerable to poor quality care whereas they are the
most people who fall sick. Disparities in race, age, gender and tribe are among the factors that
need to be considered (Livesey, 2014). Interactionist perspective is concerned about how people
understand personal health and how the status of their health impacts the other people
(Rubington, & Weinberg, 2015). A practical example is a person with Ebola virus and being
secluded to avoid transmission while socializing with members of the society.
A healthcare system works towards promoting and restoring or maintaining health
(WHO, 2009). Both formal and informal services are characteristics of healthcare systems.
Health care systems are not systematic but are still operational. The present day health care
systems like that one of Australia is a large economic sector. Australian Health Care System
(AHCS) comprises of both the private and the public sectors. These two sectors are overseen by

MEDICAL DOMINNACE AND HIERARCHY 4
3 ranks of the government; commonwealth, territorial and local providers. The system is
comprised of private insurance. This system is influenced by a range of factors like social,
technical, legal, constitutional, political and economic. The ideologies of equality and freedom in
a big percentage fuel health care in Australia. Equality regards the collective duty for equal
health outcomes without discrimination on disparities previously identified (Annandale, 1998;
Duckett, & Willcox, 2015). The biomedical model is predominant from the 19ty Century and
has all along been applied in the diagnoses of diseases. It has a curative focus (Mazzotta,
2016).This model comprises freedom from pain, defects or diseases to bring about health. The
role of social factors or personal subjectivity are not considered in process of the biomedical
model such as pathology, physiology and biochemistry. Under this model, only the biological
factors are taken into considerations excluding the psychosomatic, ecological and social
influences (Mythen, & Walklate, 2006).
Medical dominance is explained by social theorists. The concept depends on the interests
of the medical profession that coincide with those of the dominating class (Willis 1989).There
are two views of medical dominance can be explained from their distinguished understanding of
autonomy and the extent to which the autonomy may apply in health care (Ovretveit, 1985).
Autonomy in the medical fields is expressed not only in the clinical fields, but also in the
political and economic domain (Willis 1989).
An example of medical dominance is the medicalization of childbirth (Naidoo & Wills,
2016). Doctors in Australia gain and maintain their dominance by use of political approaches.
They have formed association and enticed the government to abolish the practicing of other
health professions. This is clear in history when the Australian government only held the role of
signing death certificates, holding appointments with the government, using medical titles and
suing for non-payment only to the doctors (Furze, 2014; Oths & Hinojosa, 2004). The
functionalist theorists maintain that the interaction between doctors and patients is a complex one
and thus demands similar complex analyses of the passivity of the patient ("Social theory and the
sociology of health and medicine", 2011).
According to Friedson (1988), the organization of healthcare depends on the relations
between occupations in the division of labour in the health sector. Friedson explains that the
medical profession is occupies a dominant position establishing a monopoly in that domain. The
medical profession preserves legal and formal rules and regulations to dominate. He stated that

MEDICAL DOMINNACE AND HIERARCHY 5
medicine has the power to direct and evaluate the work of others without being and not in a
subjective manner to the other professions. Friedson also advocated for the development of a
well distinct kind of medical sociology that would apply structural points of view to medical
institutions but still being afar from medicine’s assumptions and points of standpoints (Conrad,
2008).
The medical profession demonstrates dominance over the nursing profession in Australia.
In the hierarchy of medicine. The medical field is explained to be subjected to professionalism
with doctors standing at the peak of the hierarchy in medicine. This domination of doctors in
Australia limits the nursing profession and the performance of nurses. Nurses’ roles in decision
making and other aspects in their job are limited and there is no that wide context where nurses
can portray in health care services. Medical dominance in Australia is therefore a boundary of
clinical knowledge and proficiency of the professional doctors from nurses (Willis 1989). This is
captured by the Profession of Medicine (1970) which clearly explained the boundaries of the
medical sociology on the examination of the sociological perspectives on the practice and
occupation of medicine (Freidson, 1988).
In Australia, dominance of the doctors over nurses and other health occupations result
from the doctors’ professionalism. From it, doctors have a higher status and wealth as compared
to nurses and allied health providers. The dominance has also restricted the opportunities
affordable to other health workers. The medical field is thus more legitimized. The legitimacy of
doctors as experts is via political and legal systems (Furze, 2014). In Australia, the stiff increase
in the demand for health care and the lucrative market for pharmaceuticals cures assisted in
bolstering the profession to its present dominant state. According to Michel Foucault, a theorist,
medical dominance is a historical concept that transformed from how power is exercised and
from it the professional form of medical status gained origin. In Australia therefore, when there
is superiority in decision making, there is dominance as that overpowers the other health
professions.
The division of labour in the health domain is a clear proof of medical dominance in
nursing in Australia and other countries too (Willis 1989). The context within which labour is
divided in Australia is within the capitalist structure (Andrews & Hale 2000). Willis maintains
that the superiority of medicine is as a result of state patronage. The consequence of that is other
domains becoming subjective to the medical profession.

MEDICAL DOMINNACE AND HIERARCHY 6
In Australia, however, nursing profession aims at extending its image and role in the field
of health service. Nurses oppose the medical dominance and have showed progress in the
occupation of advanced roles in health service. Hegney is a theorist who deduces that the
emergence of advance practice and roles of nurses is a threat to the dominance of the medical
field (Paperdue, 2018).
Occupational hierarchy is a characteristic of the Australian health care system from the
early days. Hierarchy is an encrusted social construction that conceptualises sovereign and
subsidiary relationships transitively (Braithwaite et al., 2016). This hierarchy accounts for the
prestige that doctors occupy and the material awards they accrue.
The concept of hierarchy is captured by the conflict approach theorists. As already noted
earlier, medical dominance is closely related to the some social variables like gender. The health
domain, even in Australia, has historically portrayed a gendered health occupation with majority
of doctors being male and nurses being female. The conflict theory attaches itself to the quality
of health and how it is delivered, Disparities in the social class race, gender, and ethnicity reflect
so perfectly in the health care sectors (Andersen & Taylor, 2016). This approach contends the
efforts of physicians to control how medicine is practiced and in the definition of various social
challenges as medical ones. It is a truism for the theorists that a good diagnoses of problems and
treatment is to be a duty of the most qualified doctor. However, the continued classification of
social problems as medical problems and is monopolizing treatment and at the same time
neglecting the potential social causes of the problems (Conrad & Leiter, 2003).
In the division of labour in care facilities, the nurse is submissive to the doctors. Some
theorists reason that the superiority of medicine as a male dominated domain devalues nursing as
a female career and hence “women’s work”. Despite the fact that many males have entered the
nursing career since 1970’s, the very same nurses are at a better position of taking positions for
advancement into specialised areas and nursing education. This therefore cannot eliminate the
notion of nursing as feminine work (Willis, 1989).
The nursing career in Australia is yet to reach total professional status. This is so despite
the progress made so far in the alteration of the career structures. Division of labour in healthcare
is a process that is based on conflict. It is comprised of two features and one of it is its hierarchal
nature and the other one is dominance by the medical profession. The division of labour is

MEDICAL DOMINNACE AND HIERARCHY 7
differentiated on 2 different but interrelated bases. One is occupational division of labour and the
others sexual division. Both bases lead to a hierarchical structure that show a big gap in normal
income (Willis, 1989).
Friedson view of hierarchy as organizational but subordination to senior officers is also
based on the putatively superior knowledge of the professional expert. This argument by
Friedson is more of dominance than hierarchy and according to Larkin hierarchy is not just a
matter of health occupations but negotiated power (Willis, 1989). According to Hughes and
Allen (2017), bureaucratic hierarchy or collegial relations are what shape the experience of team
working and teamwork warrants that inform a solid aspect of labour division.
Feminist and Marxism theories are inclined towards the conflict theory in the
understanding of inequality in health. The feminist theorists are against for a reduced patriarchal
nature of the contemporary health domains (Henslin, Possamai, Possamai-Inesedy, Marjoribanks
& Elder, 2014). They are for advocacy against women oppression. They extend their concern to
the domination of medicine and the need for social control of the dominance in a move to protect
the inferior position occupied by women providers and their high level of contact with the
profession. Karl Marx did not look into the effects of the exploitative capitalist world on health
but subsequent Marxists like Friedrich Engels explained the impact of the nature and experience
of health and illness relating to the economic system (Henslin et al., 2014)

MEDICAL DOMINNACE AND HIERARCHY 8
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