Review

Arguments for change

HEALTH AND SOCIAL CHANGE: a critical theory
Graham Scambler
Open University Press, 2002, £16.99

This book has been sitting on my desk awaiting review for many a month – as our patient editor will testify. It is not the most immediately appealing read: the writing is dense, and its sense often hard to glean as the author indulges his fondness for sentences with many parentheses, and even parentheses within parentheses, and for multiple allusions to social theorists you know you should know more about.

But at last, refreshed by a holiday, it seemed more approachable and I took heart from the introduction by series editor Tim May. He claims that the book calls for ‘social scientists to recover their political nerve when confronted by social problems’ and says that it ‘deserves to be read by all those…who seek to learn from the past in order to shape a better future’. Now that I have appreciated the purpose and arguments of the book, I can agree with him.

The scope of this work is wide and erudite, but the author remains true to his belief that critical theory has a primary pragmatic, not didactic, purpose, which is to bring about change. Thus the text is consistently oriented to an analysis of ‘experiential elements of health…and the systems through which health services are delivered’.

The reader is afforded analysis of many of the themes regularly aired in healthmatters: the relations of the state to citizens; doctor/patient relations; the widening health divide and health inequalities – and the continuing importance of socio-economic class to those; and the dialectic of expert/lay knowledge. The critical realist perspective ensures that the ‘life-worlds’ of people are kept in clear view throughout, and Part 2 in particular, ‘Structural divisions in health and health care’, provides systematic analysis of the contemporary political context for these.

The book offers a far-reaching critique of ‘disorganised capitalism’ and of the so-called third way in particular, identifying how medicine can be seen ‘as part of the neo-liberal consensus’. For instance, the lack of government action to implement the changes identified as necessary in the Acheson report is attributed to Blair, who sees ‘the answer to the crucial issue of material deprivation (as)… a matter of ‘personal responsibility’’.

Scrambler’s GBH – greedy bastard hypothesis – also makes lively reading, laying responsibility for widening health inequalities on to the ‘greedy bastards’ of our society, sanctioned by the state.

All in all, the book forms a convincing argument for the development of a ‘critical sociology’ to help us see what is going on and make sense, through historical reference and careful analysis, of the state of contemporary health. Now I wish I hadn’t waited so long to read it.