AQA A-level Sociology (7192): Paper 2 – Health – Study Guide

This guide covers the Health topic of AQA A-level Sociology (7192), as set out in the AQA AS and A-level Sociology (7191, 7192) specification, Version 1.2 (14 October 2021). Health is section 4.2.3 of the A-level subject content (the specification at a glance also lists it as 3.2.3). It is one of the four option 1 topics in Paper 2: Topics in Sociology, and it is answered in Section A of that paper.

Use this guide with the Health revision notes and the Health practice questions. The AQA A-level Sociology hub and the AQA A-level Sociology checklist show where Health sits in the whole course.

Coverage table

Syllabus reference	What you must know or be able to do (from the document)	Where assessed
4.2.3, point 1	The social construction of health, illness, disability and the body, and models of health and illness	Paper 2, Section A
4.2.3, point 2	The unequal social distribution of health chances in the United Kingdom by social class, gender, ethnicity and region	Paper 2, Section A
4.2.3, point 3	Inequalities in the provision of, and access to, health care in contemporary society	Paper 2, Section A
4.2.3, point 4	The nature and social distribution of mental illness	Paper 2, Section A
4.2.3, point 5	The role of medicine, the health professions and the globalised health industry	Paper 2, Section A
Integral elements and core themes	Theories, perspectives and methods; research design and its strengths and limitations; socialisation, culture and identity; social differentiation, power and stratification	All papers

How Paper 2 works for this topic

The specification prints the Paper 2 rules as: Section A: one from option 1: 4.2.1, 4.2.2, 4.2.3 or 4.2.4. Section B: one from option 2: 4.2.5, 4.2.6, 4.2.7 or 4.2.8. If your school teaches Health, it is your Section A topic.

Paper 2 is a 2 hour written exam worth 80 marks and 33.3% of the A-level. Section A is “extended writing, 40 marks”, as is Section B. The document does not print question numbers or tariffs; your teacher will confirm the format.

The specification makes theories, methods and research design integral to every topic, so every study you quote should come with a comment on how it was done.

Point 1: social construction of health, illness, disability and the body

Key terms

• Biomedical model: ill health as a physical malfunction, diagnosed and cured by doctors using science.
• Social model of health: health shaped by social conditions, meanings and power, not only biology.
• Illness iceberg (or clinical iceberg): the idea that only a small share of cases of illness reach a doctor, so recorded illness is the visible tip.

Models of health. The biomedical model treats the body like a machine, locates illness in the individual and focuses on cure; the social model questions each of these. The World Health Organization’s constitution defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. That wider definition sits closer to the social model.

Lay definitions. Blaxter and Paterson (1982, Mothers and Daughters) studied health attitudes and behaviour across three generations of mothers and daughters. Last (1963), writing about general practice, described the “iceberg”: only a small proportion of cases of a disease, the tip of the iceberg, comes to the attention of health services.

Functionalism: the sick role. Parsons (1951) saw illness as deviance, because sick people cannot perform their normal roles, managed through the sick role. The sick person has two rights (exemption from normal duties; not being blamed) and two obligations (wanting to get well; seeking technically competent help and cooperating with it). The doctor acts as gatekeeper.

Evaluation. The sick role fits short, acute illnesses. It fits chronic illness badly, because the person may never “get well”, and it ignores stigmatised conditions where people are blamed.

Interactionism and stigma. Goffman (1963) showed how a “spoiled identity” can follow a visible or known condition, which people manage by controlling information.

Disability. In the 1970s the Union of the Physically Impaired Against Segregation (UPIAS) separated impairment (a physical difference in the body) from disability (the exclusion society creates by failing to adapt). Mike Oliver coined the phrase “social model of disability” in 1983 and developed it in The Politics of Disablement (1990).

Evaluation. Tom Shakespeare argues the strong social model does not match the everyday experience of many disabled people, who face real difficulties from impairment as well as social barriers.

The body. Sociologists of the body describe it in late modern society as a “body project” that people work on through diet, exercise and cosmetic surgery. Foucault, in The Birth of the Clinic (1963), described the “medical gaze”: the doctor’s practice of treating the patient’s body as an object, separate from the person. Oakley’s The Captured Womb (1984) is a history of the medical care of pregnant women, often used in debates about the medicalisation of childbirth.

Worked paragraph. Knowledge: Parsons claims the sick role keeps society stable by limiting time off work. Application: a warehouse worker with long-term back pain may not fit this, because he cannot meet the duty to get well. Analysis: this shows the sick role assumes acute illness and a cooperative patient. Evaluation: Goffman shows that some conditions bring blame rather than exemption, so the model describes an ideal, not real experience.

Point 2: unequal health chances by class, gender, ethnicity and region

Key terms

• Health chances: the likelihood of good or poor health across a lifetime.
• Social gradient: health gets steadily worse at each step down the social scale, not only at the bottom.

Social class. The Black Report (1980), chaired by Sir Douglas Black, examined class inequalities in health. Sociologists use four main explanations:

1. Artefact: the gap is a product of how class and death are measured.
2. Social (natural) selection: ill people drift down the class scale.
3. Cultural/behavioural: lower classes smoke, drink and eat in less healthy ways.
4. Material/structural: poverty, poor housing and hazardous work cause ill health.

The Black Report saw economic inequality as the main cause, favouring the material/structural explanation, and the Acheson Report (1998) reached the same conclusions. In the Whitehall studies of male British civil servants (from 1967), led by Michael Marmot, men in the lowest grade had three times the death rate of those in the highest. Risk factors such as smoking and blood pressure explained only part of the gap. Whitehall II examined low control at work, a psychosocial explanation: low status and control cause harmful stress. Wilkinson and Pickett (The Spirit Level, 2009) argue that unequal societies have worse health overall.

Evaluation. Cultural explanations risk blaming the victim, because behaviour is often a response to stress and low income. Material explanations struggle to explain why gradients exist among people who are not poor, which is where psychosocial ideas help.

Gender. Women in the UK live longer than men on average but report more illness. Explanations include biology, masculine risk-taking, women’s greater willingness to seek help, and (for feminists) women’s lower incomes and double shift of paid work and care.

Ethnicity. Explanations of differences between ethnic groups include genetics (for example, sickle cell disorder), culture, material deprivation and racism. Nazroo (1997, The Health of Britain’s Ethnic Minorities) linked ethnic differences in health to socio-economic disadvantage and racism.

Region. Health is generally worse in deprived areas, and on average worse in the north of England than in the south. The Marmot Review 10 Years On (2020) reported that life expectancy was falling among the poorest people, particularly women in some English regions.

Worked paragraph. Knowledge: materialists argue poor housing and insecure work cause ill health. Application: a family in a damp private flat may suffer repeated chest infections however carefully they eat. Analysis: this suggests behaviour is shaped by circumstances, not freely chosen. Evaluation: the Whitehall gradient shows that even secure, salaried workers in lower grades die earlier, so material factors alone cannot be the full answer.

Point 3: inequalities in provision of and access to health care

Key terms

• Inverse care law: Tudor Hart’s (1971) observation that “the availability of good medical care tends to vary inversely with the need for it in the population served”.

The NHS was founded in 1948 to give care free at the point of use, yet access is still unequal. Deprived areas, with the greatest need, tend to have more stretched services. Middle-class patients may gain more from the same service, because they have the time, confidence and cultural capital to push for referrals. Private care lets those who can pay avoid waiting lists. Some minority ethnic patients face language barriers or racism; some disabled people face physical barriers.

Theoretical views. Marxists such as Navarro (Dangerous to Your Health: Capitalism in Health Care, 1993) argue that health care under capitalism serves profit and keeps workers fit for work, while ignoring the social causes of illness. New Right thinkers argue that markets and choice would make services more efficient.

Evaluation. Critics of Marxism note that the NHS has removed financial barriers that market systems keep.

Worked paragraph. Knowledge: the inverse care law says need and provision run in opposite directions. Application: in a coastal town with many older, low-income residents, GP lists may be longest where illness is highest. Analysis: so a free service can still produce unequal results. Evaluation: yet Tudor Hart said the law works most fully under market forces, so without the NHS the gap could be wider.

Point 4: the nature and social distribution of mental illness

Two approaches to the nature of mental illness

• Realist approach: mental illnesses are real conditions that cause genuine distress and have identifiable, often social, causes.
• Social constructionist approach: what counts as mental illness reflects the judgements of those with power to define it. Szasz (1961, The Myth of Mental Illness) argued that psychiatry turns ordinary difficulties of living into “illness”.

Labelling. Scheff (1966, Being Mentally Ill) argued that rule-breaking which fits no other category can be labelled as mental illness, and that the label can then reinforce the behaviour it describes. Goffman’s Asylums (1961) described how total institutions strip away the patient’s former self. Rosenhan (1973) reported that “pseudopatients” with no mental health condition were admitted to psychiatric hospitals. Susannah Cahalan’s The Great Pretender (2019) found inconsistent data and misleading descriptions in the study, so use it with care.

Evaluation. Labelling explains the effect of diagnosis but not the original behaviour, and realists say it understates real distress.

Social distribution

• Class. Working-class people are more likely to be diagnosed with mental illness. In Brown and Harris’s (1978) study of women in Camberwell, south London, depression was linked to severe life events and long-term difficulties, plus “vulnerability factors” such as lacking an intimate confiding relationship, having no paid work outside the home, and losing one’s mother before age 11. Working-class women were much more likely to become depressed once a severe event had occurred.
• Gender. Women are more often diagnosed with depression and anxiety. Busfield (1996, Men, Women and Madness) examined how gender shapes the understanding of mental disorder. Labelling views say diagnosis reflects gendered ideas of normal behaviour; structural views point to women’s caring burdens. Men may be under-diagnosed because they are less likely to seek help.
• Ethnicity. Black people in England are more likely than White people to be detained under the Mental Health Act: in the year to March 2023 the official rate was 3.5 times as high. Explanations include racism and stress, ethnocentric diagnosis, and different routes into care.

Worked paragraph. Knowledge: Brown and Harris link depression to life events and vulnerability factors. Application: a woman with no one to confide in and no paid work outside the home may be more at risk after a severe event such as a bereavement. Analysis: this supports a realist, structural view: the illness is real and has social causes. Evaluation: the study relied on recall of past events and studied women only.

Point 5: medicine, the health professions and the globalised health industry

Functionalist view. Functionalists see professions as altruistic bodies with expert knowledge and a code of ethics, rewarded with high status because they serve society.

Weberian view. Freidson (1970, Profession of Medicine) argued that medicine has professional dominance: it controls its own work and the division of labour with other health occupations. Weberians read this as social closure, which protects doctors’ status and income.

Marxist view. Marxists argue that doctors serve capitalism by defining illness as individual and treatable, hiding its social causes.

Feminist views. Feminists argue that medicine long excluded women and placed nursing and midwifery in a subordinate position.

Critics of medicine’s effectiveness. Illich (Limits to Medicine: Medical Nemesis, 1975) argued that medicine causes harm, or iatrogenesis: clinical (injury from unsafe or wrong treatment), social (medicalisation of life and dependence on medical care) and cultural (loss of traditional ways of coping with suffering and death). McKeown (1976) argued that death rates since the late 18th century fell mainly because of better living standards, especially nutrition, not medical treatment. Simon Szreter later argued that McKeown underplayed public health measures such as clean water and sanitation.

Deprofessionalisation. Marie Haug suggested deprofessionalisation: as patients gain knowledge, doctors lose some of their monopoly.

The globalised health industry. Pharmaceutical companies are transnational corporations. Goldacre (Bad Pharma, 2012) argues that negative trial results often go unpublished, distorting the evidence doctors use. Critics also say research may favour profitable conditions in rich countries. Other global features include medical tourism, international patent rules on medicines, and the migration of health workers, which can leave poorer countries short of staff.

Worked paragraph. Knowledge: Weberians argue the medical profession uses social closure. Application: resistance to letting nurses or pharmacists take on prescribing and diagnosis can be read in this way. Analysis: the profession may protect status as well as patients. Evaluation: functionalists reply that strict entry rules protect patients, and nurse-led clinics show the closure is not complete.

Common errors

• Listing the four explanations of class inequality with no evidence or evaluation for each.
• Using the word “disability” when the social model would say “impairment”, and losing the key distinction.
• Quoting Rosenhan without noting the later doubts about the study.
• Saying “ethnic minorities have worse health” as one group. Patterns differ between groups.
• Describing studies with no comment on their research design.

Where to go next

• Labelling ideas here link to the AQA Crime and Deviance study guide.
• For evaluating surveys, interviews and official statistics, see Methods in Context.
• For how the three papers fit together, read AQA A-level Sociology course structure.
• Condense with the Health revision notes and test yourself with the Health practice questions.

Official syllabus

This guide is based on the AQA AS and A-level Sociology (7191, 7192) specification, Version 1.2 (14 October 2021), A-level subject content section 4.2.3 Health, and the Paper 2 assessment information in the same document.