Medical Sociology: Exploring Power and Hierarchy in Healthcare Systems

This essay delves into the intricate relationship between power and hierarchy within the Australian healthcare system, employing sociological theories and concepts to analyze its impact. It explores the functionalist, conflict, and interactionist perspectives, highlighting how these frameworks shape our understanding of healthcare delivery and social stratification. The essay examines the biomedical model's influence, its limitations, and the role of power dynamics, including the Marxist perspective, and its critique of capitalist healthcare systems. It further discusses social inequalities, access to resources, and the impact of socioeconomic status on health outcomes. The essay also considers the role of social capital and the importance of understanding health disparities through a materialist approach, using the NS-SEC classification to analyze employment and power dynamics in the labor market. Overall, the essay provides a comprehensive overview of the complex interplay between power, hierarchy, and health within the context of medical sociology.

Running head: ROLE OF POWER AND HIERARCHY IN MEDICAL SOCIOLOGY 1
IMPACTS OF POWER AND HIERARCHY IN MEDICAL SOCIOLOGY
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Hierarchical arrangement in the society refers to how people are classified based on their
wealth and power (Grusky & Weishaar, 2014). One of the critical aspects of sociology is to study
different kinds of social stratification and types of inequality. Inequity refers to a situation in
which people have unequal access to resources in the society. The resources can either be
economic and political, such as healthcare, education, jobs, housing (Bottomore & Nisbet, 1978).
The study of the sociology helps in understanding the changing social aspects within
communities, the source of conflict and problems within the same settings, and finally the
possible solutions to the challenges affecting the community. The sociological study is essential
in the understanding interaction between different classes and why such stratifications exist. This
essay focuses on the power and hierarchy in the healthcare sector (Australia) based on the
sociological theories and concepts.
Healthcare is one industry that people frequent throughout their lives. Every culture and
group view health care differently based on the respective people's belief (Allen et al., 2016).
Sociologist view health care from three perspectives: the functionalist, conflict and interactionist
points of view. These three theories can be easily implemented in the healthcare sector.
According to the In Allen et al. (2016), sociology is defined as the scientific study of sociological
behaviors in human groups. Sociology is concerned with the relationships in human groups, how
the interaction affects human behavior and generally, how society develops and evolve (Allen et
al., 2016). These are the basis of development of functionalist, conflict and interactionist theories
in healthcare.
A sociological approach based on the functionalist perspective clarifies the way in which
the society is stratified to preserve its ability (Cooke & Philpin, 2008). A functionalist
perspective maintains that being sick must be regulated so that not too many individuals are

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released from the societal role within the same period (Cooke & Philpin, 2008). If at all situation
like this occur, society will lose balance, interfering with its stability and functionality. Talcott
Parsons, a renowned sociologist for its contribution to the functionalist theory, explained the
behavior that sick people should demonstrate (Cooke & Philpin, 2008). It is also regarded as the
sick role. In everyday occurrences, when people are suffering, they request for permission either
in their workplaces or school to go home or seek medical intervention. When people have a role
to play in the real world, they are obliged to recover from their sickness and get back to work or
school. If in any case, the sick person fails to take the responsibility of trying to get better, either
by not following the medical advice or is reluctant to get better, then the person is perceived as
not sick, and therefore, do not fall under the ill role (Cooke & Philpin, 2008). According to the
Parsons theory, physicians are the gatekeepers for the sick role, whereas the doctors are
responsible for checking the ill role and confirm the illness, and afterward, help them get well.
(Rothman et al., 2008) At the end of the day, it is really up to the patient to seek physician's
assistance and follow the doctor's instructions in order to get better (Rothman et al., 2008).
In conflict perspective, sociological approach shoulders that social behavior is best
comprehended when there is a struggle over limited resources between human groups (Rothman
et al., 2008). From this perspective, inequities exist in the healthcare industry regarding service
delivery. Most often than not, wealthy people would get better health care compared to the less
fortunate in the society. Also, people from poor backgrounds are likely to contract illnesses,
compared to their wealthy counterparts due to the environmental factors. When they seek
medical assistance, the kind of poor service they receive makes it even harder for them to
recover quickly. In some cases, the poor do not have the finances to seek for treatment (Cooke &
Philpin, 2008).

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An interactionist perspectives in sociology is based on the daily forms of social relations
to clarify society as a whole (Cooke & Philpin, 2008). From this point of view, patients are
active, regularly seeking the service of a healthcare professional. Interaction perspective also
takes into consideration how doctors became who they are to be in the healthcare profession
(Cooke & Philpin, 2008). Doctors go to medical school to gain medical facts before being
acknowledged as "Doctors." As such, they command respect from the patients. This makes it
convenient for the patients to follow the instructions of the doctor. (Cooke & Philpin, 2008).
An essential perspective in healthcare is the biomedical model, sometimes called
biomechanical model of health. The model is defined as a precise extent of health and defines a
disease as the inability of the body to perform its function normally due to a biological
breakdown. The model considers the patient as a body distinct from the mind and external
consideration that can be handled and explored for treatment, according to the United States
National Research Council (1997). The treatment, therefore, lies dominantly in the hands of the
medical professionals and takes place in a medical set up.
The biomedical model considers biological factors such as smoking, unhealthy diet and
lack of exercises as absolute causes of ill health. The model insists that medical practitioners
with proper training are the only proper personnel that can deal with sick people (Gaharian et al.,
2017). Doctors have power in the biomechanical model and are in a position to maintain it that
way. The primary advantage of the model is that it shows a clear guidance for treatment of the
patient. Also, much scientific research support this model, most of which are unbiased and
verified beyond reasonable doubt. Based on the interactionist perspective of sociological study,
patients and doctors negotiate a diagnosis (Cooke & Philpin, 2008). This may lead to a conflict
(conflict perspective) between doctor's and patient's views regarding a proper diagnosis. From

ROLE OF POWER AND HIERARCHY IN MEDICAL SOCIOLOGY 5
the functionalist point of view, the doctor is obligated to confirm the sickness; therefore, the
doctors have social control, and this approach fits well with the biomedical model (Gaharian et
al., 2017).
However, environmental and social changes also contribute to illness, which is not
accounted for in the biomedical model. Social and ecological factors are important in pointing
out the real source of diseases, hence, preventing re-occurrences of the same illness (Wade &
Halingan, 2004). The biomedical model is ineffective in a way that a patient may recover from
the sickness through medical intervention, while the underlying problem still exists. For instance,
treating cholera without improvement in sanitation and hygiene.
Power and hierarchy are also left out in the biomedical model. According to the Marxism
movement established by Karl Max Frederick Angels in 1880s, medicine operates in favor of the
controlling groups in the society (Pelzang, 2011). Marxist believes that capitalist society profit is
more valued than the people and healthcare they are given. The objective of the medicine is just
to keep people fit enough to continue working for the capitalist (Pelzang, 2011). Also, the
government does not address core social aspects and inadequate healthcare, and industries are
allowed to continue making profits from the products that are harmful to the health of people,
such as tobacco, alcohol, and cigarettes (Wade & Halingan, 2004). Furthermore, unequal
distribution of resources among the societal groups, place the wealthy individuals at upper hand
of getting better health care.
Although structural functionalism perceives social hierarchy as a practical feature of a
multifaceted society in which a standard value regulates stability and social command, conflict
theory reasons that scarce resources is the leading cause of competition. Social structures explain
that people who have access to the scars resources will seek to keep the hierarchy, hence, conflict

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theorists predict that social occur due to revolution instead of evolution (Cockerham, 2014).
Cockerham (2014) points out that conflict theory emphasizes the causes of illness in the
economic setup and also on the competition about conflicting interest in the healthcare facilities.
It is evident that conflict theory focuses its attention on the relationship between medicine and
the social order. Conflict theory also brings out the disadvantaged position of women in the
medical field regarding chauvinist treatment of women by physicians (Conrad et al., 2010).
Another healthcare sector where privilege and power reside in the therapeutic division of labor
and an imbalanced patient's outcome in marginalized groups in the society (Currie et al., 2012).
Although analysis of racism, sex, and class in an individual analytic setup is perfect, the
propensity to do away with all types of inequity and go back to the class-based understanding of
power and hierarchy is better explained in the political economy approach (Weiss & Lonnquist,
2015).
A political economy perspective maintains that under capitalism, an individual relation to the
means of production is not only crucial in understanding the position they occupy in the
hierarchy, but also estimating their health and wealth (Weiss & Lonnquist, 2015). The research
establishes that etiology and spread of infectious and non-infectious diseases are directly related
to the means of production. This social- class plotting of diseases occurrence, created the core of
socio-economic stratification in understanding the living conditions of different societal groups,
and the fact that treating the disease in itself cannot eradicate the re-occurrence of the illness.
The purpose of the political economy approach is to help health professionals understand the
illness as caused by also social factors and not to rely solely on the biomedical model for the
complete eradication of the disease (Boyer & Lutfey, 2010).

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The observation that a person's experience of illness and possibility of succumbing to death are
directly related to the individual's position in the socio-economic hierarchy is the center of
sociological inequities study. Marx anticipated a social class as a group of people who share
similar conditions and situations, which might end up having an environmental effect on health.
Familiarization with the group's interest enables class-consciousness, which can lead to a
collective bargaining and therefore, action to upgrade group's attention (Weiss & Lonnquist,
2015).
Marxist classified people into workers and owners while pointing out historical changes
that resulted from the industrial revolution (Weiss & Lonnquist, 2015). This seems to be an out-
of-date way to study health inequalities. A materialist approach insists on the ongoing interest in
class-related health imbalances, but it has been upgraded a Weberian approach which sides with
status rather than economic superiority should be used as a measure of social status (Boyer &
Lutfey, 2010). The primary guide to social classification is the one used in the Australia's
national statistics office; ‘National Statistics- Socioeconomic Classification' NS-SEC. According
to NS-SEC, classification is determined by features of an individual's employment together with
their place in the labor market (Boyer & Lutfey, 2010). This guide tries to establish whether the
job is skilled, casual or professional and the measure of power compared to other employees.
This is regarded as an improvement of its antecedent. Which mainly relied on the person's
referral's ranking given to a specific profession about their general standing. (Weiss &
Lonnquist, 2015).
Social capital is defined as a collective investment of persons in a society based on
membership in groups, institutions, and networks, which serves as a measure of the degree of
trust reciprocity in society (Gabe & Monaghan, 2013). A high degree of income disparities

ROLE OF POWER AND HIERARCHY IN MEDICAL SOCIOLOGY 8
among members of the societal groups reduces trust among the citizens, consequently degrading
the social environment, and finally a person's health. A materialist approach emphasizes that a
high degree of income inequity is directly related to poor health results due to minimal
investment in infrastructures such as schools, hospitals, and housing that are important in
sustaining the people's well-being (Gabe & Monaghan, 2013).
Over the past years, capitalism has modernized to an accident that the relevance of
Marxist approach to the capitalism is jeopardized. Marxism movement approach is founded on
the use-value, which should be modified to include the analysis of the production of services and
products without favoring one party. In 1970, neo-conservative economic revolutions interfered
with the initial groupings of the harmony, making it increasingly challenging to define people
based on family, occupation, class or geographic origins (Alegria et al., 2011).
In Australia, hierarchy, and power has influenced the enactment of tobacco smoking
policy. The policy was put in place to regulate health complications such as liver cirrhosis that
results from excess smoking. However, the implementation process has faced a lot of challenges,
primarily from tobacco industries and its allies, who continue with the business at the expense of
health complications the consumers are experiencing (Chapman & Wakefield, 2001). This is
fuelled by those in power, leaving the tobacco users at a great danger of health problems.
Australian health practitioners are doing their best to treat these complications, but the fruit of
their labor is not appreciated as the underlying problem (Tobacco distribution) remains unsolved.
It is upon the government and the people holding a high position in the hierarchy to ensure that
tobacco-free policy is fully executed in Australia (Studlar, 2005). This is a perfect example of the
impact of power and stratification in medical sociology and the limitation of biomedical model in
addressing health issues.

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In conclusions, it is evident that hierarchy and power play a fundamental role in
healthcare industry according to the sociological theories and concepts covered in this essay. The
central part of this paper was seeking to understand the social processes that lead to inequalities
in the healthcare industry and society in general. Despite significant changes in medical
sociology since its introduction to the clinical field, many things remain unchanged regarding
socio-economic configuration hierarchies, legislative and commercial medicinal functions.
Medical sociology merit should have freedom of experiencing the excitement of scientific and
technological innovation, without being limited by its constructive potential and keeping in
check social justice implications.

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