AQA A-level Sociology (7192): Paper 2 – Health – Revision Notes

These notes condense the Health study guide; go there first if a term or study is new to you.

They follow the AQA AS and A-level Sociology (7191, 7192) specification, Version 1.2 (14 October 2021), A-level section 4.2.3 Health (the specification at a glance also lists it as 3.2.3). Health is an option 1 topic, assessed in Section A of Paper 2: Topics in Sociology, a 2 hour, 80-mark exam worth 33.3% of the A-level, in which Section A is extended writing worth 40 marks.

Practise with the Health practice questions. The AQA A-level Sociology hub and the AQA A-level Sociology checklist show the full course.

The five content points

1. The social construction of health, illness, disability and the body, and models of health and illness.
2. The unequal social distribution of health chances in the UK by social class, gender, ethnicity and region.
3. Inequalities in the provision of, and access to, health care in contemporary society.
4. The nature and social distribution of mental illness.
5. The role of medicine, the health professions and the globalised health industry.

Paper 2 rule, as printed: Section A is “one from option 1: 4.2.1, 4.2.2, 4.2.3 or 4.2.4”; Section B is “one from option 2: 4.2.5, 4.2.6, 4.2.7 or 4.2.8”.

Key terms

Term	Meaning
Biomedical model	Illness is a physical fault in the individual body, diagnosed and cured by doctors using science
Social model of health	Health and illness are shaped by social conditions, meanings and power
Lay definitions	How ordinary people, not doctors, define health and illness
Illness iceberg	Only a small share of cases of illness reach a doctor (Last)
Sick role	Parsons’s set of rights and duties for the sick person
Stigma	A discrediting mark that spoils a person’s social identity (Goffman)
Impairment / disability	A bodily difference / the exclusion society creates around it (social model)
Body project	The idea that people shape their bodies as part of their identity
Health chances	The likelihood of good or poor health over a lifetime
Social gradient	Health worsens step by step down the social scale
Inverse care law	Good care tends to be least available where need is greatest (Tudor Hart)
Psychosocial explanation	Stress from low status and low control damages health
Medicalisation	Ever more areas of life come under medical definition and control
Iatrogenesis	Harm caused by medicine itself (Illich)
Social closure	A group restricts entry to protect its rewards (Weberian)
Deprofessionalisation	Loss of professional monopoly as lay knowledge grows (Haug)

Theories and studies at a glance

Who	What	Key point	One evaluation
Parsons (1951)	Sick role	Illness is deviance managed by rights and duties; doctor is gatekeeper	Poor fit for chronic illness and stigmatised conditions
Last (1963)	The “iceberg” in general practice	Only the tip of illness in the community reaches health services	Recorded illness statistics understate real illness
Blaxter and Paterson (1982)	Mothers and Daughters	Health attitudes and behaviour compared across three generations	Mothers and daughters only, so men’s lay ideas are missing
Goffman (1963)	Stigma	Conditions can spoil identity; people manage information	Says little about where stigma comes from
UPIAS; Oliver (1983, 1990)	Social model of disability	Society disables people with impairments	Shakespeare: does not match many disabled people’s everyday experience of impairment
Black Report (1980)	Class and health inequality	Saw economic inequality as the main cause	Some argue it underplayed behaviour and choice
Acheson Report (1998)	Health inequality	Reached the same conclusions as the Black Report	Inequalities were not reduced in the years that followed
Whitehall studies (Marmot)	Civil service grades	Lowest grade had three times the death rate of the highest; risk factors explain only part	Whitehall I studied men only
Wilkinson and Pickett (2009)	The Spirit Level	More unequal rich societies do worse on health and social indicators	Critics question the choice of countries and whether inequality causes the link
Nazroo (1997)	The Health of Britain’s Ethnic Minorities	Links ethnic health differences to socio-economic disadvantage and racism	Ethnic categories group very different people together
Tudor Hart (1971)	Inverse care law	Care varies inversely with need	NHS reduces cost barriers that markets keep
Navarro (1993)	Marxist view	Health care under capitalism serves profit and hides social causes	Ignores real gains from medicine
Szasz (1961)	Myth of mental illness	Psychiatry turns ordinary difficulties of living into “illness”	Understates real distress
Scheff (1966)	Being Mentally Ill	Labelling rule-breaking as mental illness can reinforce it	Does not explain the first behaviour
Rosenhan (1973)	Pseudopatients	Diagnosis can stick regardless of behaviour	Cahalan (2019) found inconsistent data and misleading descriptions
Brown and Harris (1978)	Depression in Camberwell women	Severe life events plus vulnerability factors; working-class women more likely to become depressed after a severe event	Retrospective recall; women only
Busfield (1996)	Men, Women and Madness	Gender shapes how mental disorder is understood	Hard to separate labelling from real difference
Freidson (1970)	Profession of Medicine	Professional dominance over its own work and other health occupations	Strict entry also protects patients
Illich (1975)	Medical nemesis	Clinical, social and cultural iatrogenesis	Overstates harm; ignores clear benefits
McKeown (1976)	Role of medicine	Mortality fell mainly from better living standards, especially nutrition	Szreter: underplays public health measures
Goldacre (2012)	Bad Pharma	Negative trial results often go unpublished, distorting evidence	Focuses on drug trials, not the wider health system

Must-know distinctions

• Disease vs illness vs sickness: a biological condition; how the person feels it; the social status of being sick.
• Impairment vs disability: the body difference vs the barriers society builds.
• Morbidity vs mortality: illness rates vs death rates.
• Cultural/behavioural vs material/structural: lifestyle choices vs living and working conditions.
• Material vs psychosocial: lack of money and resources vs stress from low status and control.
• Provision vs access: what services exist vs who actually uses and benefits from them.
• Realist vs social constructionist views of mental illness: real conditions with causes vs labels applied by the powerful.
• Medicalisation vs iatrogenesis: medicine’s spread into life vs harm caused by medicine.

Mini essay plan

Question type: “Evaluate sociological explanations of class inequalities in health” (an extended response).

1. Intro: define health chances and the social gradient; name the four explanations: artefact, social selection, cultural/behavioural, material/structural.
2. Artefact and selection: explain each; evaluate (the gap remains under different class measures; drift explains only a small share).
3. Cultural/behavioural: smoking, diet, alcohol; evaluate (risk of blaming the victim; behaviour shaped by stress and income).
4. Material/structural: housing, income, hazardous work; the Black Report saw economic inequality as the main cause, and Acheson reached the same conclusions; evaluate (does not explain gradient among the non-poor).
5. Psychosocial: Whitehall, Wilkinson and Pickett; evaluate (hard to measure stress; critics question the evidence that inequality itself causes ill health).
6. Theory link: Marxist view of capitalism and health; New Right emphasis on individual responsibility.
7. Methods comment: official statistics on death certificates and occupation; strengths and limits.
8. Conclusion: a judgement on which explanations work together, backed by your strongest evidence.

Quick self-test

1. Name the two rights and two duties of Parsons’s sick role.
2. What is the illness iceberg?
3. Who separated impairment from disability, and how?
4. Give four sociological explanations of class inequalities in health.
5. What did the Whitehall studies find?
6. State the inverse care law.
7. What is the difference between a realist and a social constructionist view of mental illness?
8. Name two vulnerability factors from Brown and Harris.
9. Name Illich’s three types of iatrogenesis.
10. What was McKeown’s main argument?
11. What does Freidson mean by social closure in medicine?
12. Give two features of the globalised health industry.

Answers

1. Rights: exemption from normal roles; not being blamed. Duties: want to get well; seek and cooperate with competent help.
2. Last’s (1963) idea that only a small proportion of cases of illness reach health services, so recorded illness is only the visible tip.
3. UPIAS in the 1970s; Oliver coined “social model of disability” in 1983. Impairment is the bodily difference; disability is the exclusion society creates.
4. Artefact; social (natural) selection; cultural/behavioural; material/structural.
5. The lower a civil servant’s grade, the higher the death rate; the lowest grade had three times the death rate of the highest, and risk factors such as smoking explained only part of the gap.
6. The availability of good medical care tends to vary inversely with the need for it in the population served.
7. Realists see mental illness as real with identifiable causes; constructionists see it as a label applied by those with power to define.
8. Any two: no intimate confiding relationship; no paid work outside the home; loss of mother before age 11.
9. Clinical, social and cultural.
10. Death rates fell mainly because of better living standards, especially nutrition, not medical treatment.
11. Freidson describes professional dominance: doctors control their own work and other health occupations. Weberians call this social closure, protecting status and income.
12. Any two: transnational drug companies; medical tourism; international patent rules on medicines; migration of health workers.

Where marks are usually lost

• Naming the four explanations but not linking each one to evidence or evaluation.
• Writing “the poor are unhealthy because of bad choices” with no sociological explanation of why choices differ.
• Mixing up provision (services that exist) with access (who uses them).
• Treating gender patterns as simple: women live longer but report more illness, and you need to explain both.
• Using “ethnic minorities” as one block instead of noting differences between groups.
• Describing Rosenhan as proof without mentioning Cahalan’s later doubts about his data.
• Leaving out the global part of point 5 when a question on medicine invites it.
• Offering no conclusion in an extended answer. Evaluation should lead to a judgement.
• Ignoring research design. The specification makes it an integral element of every topic.

For labelling ideas you can reuse here, see the AQA Crime and Deviance revision notes. For method evaluation, use the Methods in Context revision notes. Health inequality links to the Work, Poverty and Welfare revision notes and the Stratification and Differentiation revision notes.

Official syllabus

These notes follow the AQA AS and A-level Sociology (7191, 7192) specification, Version 1.2 (14 October 2021), A-level section 4.2.3 Health, and the Paper 2 assessment information in the same document.