The Sociology of Health in Terra Brasilis: a short genealogy of a field of knowledgeAbstract
The sociology of health is a recent fruit of an ancient tree of knowledge that goes back millennia. This study aimed to write an essay on the field of sociology of medicine and health in Brazil. The approach was qualitative, and the existing bibliography on the sociology of medicine and health was researched, especially in Brazil, by means of a narrative review. The database used was the Scientific Electronic Library Online (SciELO), using the descriptors “medical sociology” OR “sociology of health”. Thirty-six articles were analyzed out of the 165 found. It was established that the studies are divided into four main strands, origins and foundations, sociologies and medicine in the world; sociologies, training and education in health and sociology of health. The conclusion is that the replacement of current health intellectuals who occupy institutional positions, trained in postgraduate studies, by new health agents, will erase and blur the distinction of/within and already produces intellectuals with a new habitus. In addition, the future teachers of public health bachelor’s will not have been trained in disciplines in specific fields, which may reduce the depth of knowledge in those disciplines but will allow them to get closer to the field of health.
Keywords:
Sociology of Health; Medical Sociology; Sociology of Medicine; Collective Health.
Resumo
A sociologia da saúde é um fruto recente de uma árvore de conhecimentos antiga que remonta a milênios. O objetivo deste estudo foi elaborar um ensaio sobre o campo da sociologia da medicina e da saúde no Brasil. A abordagem foi qualitativa e pesquisou-se a bibliografia existente sobre a sociologia da medicina e da saúde, especialmente no Brasil, por meio de uma revisão narrativa. A base de dados utilizada foi a Scientific Electronic Library Online (SciELO), por meio de descritores “sociologia médica” OR “sociologia da saúde”. Foram analisados 36 artigos dos 165 encontrados. Estabeleceu-se que os estudos se dividem em quatro vertentes principais, origens e fundamentos, sociologias e medicinas no mundo; sociologias, formação e educação em saúde e sociologia da saúde. Conclui-se que a substituição dos atuais intelectuais da saúde que ocupam posições institucionais, formados na pós-graduação, pelos novos agentes da saúde, apagará e borrará a distinção da/na e já produz intelectuais com um novo habitus. Além disso, os futuros professores dos bacharéis em Saúde Coletiva não terão sido formados em disciplinas de campos específicos, o que pode diminuir a profundidade do conhecimento naquelas disciplinas, mas permitirá uma maior aproximação com o campo da saúde.
Palavras-chave:
Sociologia da Saúde; Sociologia Médica; Sociologia da Medicina; Saúde Coletiva.
Introduction
The genealogy of a specific body of knowledge, or more appropriately, of a field of knowledge, is not a simple task. However, from time to time, this task emerges as a means of self-understanding the limits of the field itself and current perspectives on the profession. This is what is currently happening with the Brazilian Sociology of Health. The timing is truly appropriate due to several events that we deem relevant.
In 2024, an adjunct professor position at the Faculty of Health Sciences and Technologies at the University of Brasília, Ceilândia campus, in the Collective Health course, created in 2008 and a pioneer in Brazil, was filled by a student who had graduated from the bachelor’s degree program. In the middle of the same year, the first author of this article became the first Full Professor (of many others to follow), having begun his career as a professor in this same undergraduate course in August 2008 - a pioneering degree in Brazil, in conjunction with the Federal University of Acre, showing a sign of culmination in his academic career. Both facts point to something that shows the maturity and relative practical autonomy of Collective Health. Furthermore, they point to other issues that we will discuss in this essay, whose theme we have taken the liberty of focusing on the historical genesis of the Sociology of Health.
The history of the definition of health and disease has evolved through diverse concepts in different eras. In ancient times, the religious-mythological context explained illness based on the cosmology of gods and spirits. In Hippocrates’ treatise “On the Nature of Man”, we find the humoral doctrine that served as the basis for all Western medical practice for almost two millennia, in which disease would stem from an imbalance in the body’s humors, which would affect the body’s functioning. Each of the humors would be associated with one of the four primordial elements (water, earth, fire, and air) and a specific internal organ (Castro; Landeira-Fernandez, 2011).
In the Judeo-Christian context, healthcare is permeated by the religious imperative of preserving the body, conceived as a receptacle for the soul. This is how the books of Leviticus in the Holy Bible can be considered: a set of rules and teachings aimed at the purity of the self and the preservation of teachings, analyzed in depth by Mary Douglas (2002).
In the Modern Era, Medicine rationalized and became a science with an approach based on instrumental reason. At this time, Social Medicine develops, conceived as a form of intervention in society aimed at eliminating both physical and social ills. From the 19th century onward, social and environmental factors and individual behavior gradually gained prominence as determinants of the disease process (Montagner, 2008b).
In the late 20th century, with the advent of hypermodernity, health began to be understood from the macroand microsocial contexts related to situations of vulnerability and social inequalities. This new perspective allowed for the emergence of aspects related to social structure, focusing on inequality, inequity, and vulnerability. Thus, the approach to and understanding of health must prioritize the individual multidimensionality, encompassing macrosocial living conditions, the group, and individual subjectivity (Montagner; Montagner, 2018).
As outlined elsewhere (Montagner, 2008b), conducting a structural genealogy of Health Sociology in Brazil is a fundamental exercise. This essay revisits this earlier sketch and seeks to outline an ideal type of our Sociology of Health. It embraces the concept of the social field as defined by Pierre Bourdieu: “[...] the social cosmos is constituted by a set of relatively autonomous social microcosms, spaces of objective relations that are the locus of a specific logic and necessity, irreducible to those that govern other fields” (Bourdieu; Wacquant, 1992, p. 72, our translation).
Therefore, this article aimed to write an essay on the Sociology of Medicine and Sociology of Health in Brazil, especially the genesis of the latter, based on articles published by researchers in the field.
Methods
This qualitative study employed a narrative review, which provides a comprehensive and descriptive perspective on what has been investigated regarding a given event. Thus, it is suitable for discussing the development or “state of the art” of a given field of knowledge (Rother, 2007). The research was conducted on 14/12/2024 on the Scientific Electronic Library Online (SciELO) (<scielo.org>), a BVS platform, as it is the repository that encompasses countries in Africa, Brazil, and Latin America.
We adopted the Boolean sentences “Medical Sociology” OR “Sociology of Health”, which returned 165 records. Sixty-three duplicates were eliminated, leaving 102 articles for initial analysis of titles, keywords, and abstracts. After reading, 66 references that did not meet the criteria were excluded. Thirty-six articles remained in the final analysis.
The inclusion criteria applied were full articles discussing Social Medicine, Sociology of Health, or Medical Sociology, globally and in Latin America and Brazil; related to the field of Health; in Portuguese or Spanish. The exclusion criteria included commemorative articles or articles eulogizing an event; review articles addressing only the medical field; articles addressing exclusively Collective Health; and articles addressing exclusively research and teaching methodology, whose subject matter strays from the intended discussion. Sixty-six of the 102 articles were discarded after reading the abstracts and descriptions, covering the following topics, as shown in Table 1:
In the discussion of the 36 articles, all were analyzed and divided into three categories: Origins and Foundations (Sociology of Health), Sociology and Medicine in the world, and Sociology of Health.
Article discussion
Origins and foundations
An initial approach, and one that has always been fruitful, touches on the division between the Sociology of and in Medicine. In the material analyzed, we see that this discussion is recurrent and always revolves around the classic statement by Robert Straus in a lecture given at a meeting of the American Sociological Society in 19551. At that event, the author reported the results of a survey conducted by the Committee on Medical Sociology among the then 110 sociologists working in the field.
Straus defined the Sociology of Medicine as that which concerns the study of organizational structures, role relationships, value systems, rituals, and functions of Medicine as a behavioral system, studies conducted by professionals outside the medical field. Conversely, Sociology in Medicine would be that which unites, in research or teaching, concepts, techniques, and personnel from several disciplines (Straus, 1957; 1999). These two types would be incompatible, as the former would tend to lose objectivity if it became internal to the field, and the latter could lose acceptance if it insisted on investigating peers.
According to Straus, for the sociologist in Medicine, typically involved in teaching within medical school, this type of activity leads the medical sociologist to assume a chameleon-like role, as it “provides a great test for the applicability of sociological content and concepts to the processes and problems of Medicine and requires the sociologist’s huge flexibility and adaptability” (Straus, 1957, p. 203).
Some authors in this review have addressed this dichotomy (Castro, 2016; Montagner, 2008b; Nunes, 2007c). Castro affirms that duality is helpful to a certain extent, as he uses it in his research to discuss more recent concepts in Collective Health, such as the determinants of health-disease. The author concludes that Collective Health has already recognized the critical potential of Social Sciences and perceives the harmful consequences if they are applied without an emancipatory horizon (Castro, 2016).
At that stage of health demands, in agreement with many other sociologists, the boundaries between the Sociology “of” and “in” Medicine needed to be erased, as the objectives of Medicine and Sociology converged (Levine, 1987). This was the proposal of Michael Bury (1986), Horobin (1985), and other peers to conduct a Sociology “with” Medicine. A proposal that Straus (1999) himself had already embraced, recognizing the current changes in American Medical Sociology. However, we should remember that this was still a Sociology “of/in” Medicine, replaced by Sociology “with” Medicine, as the idea of the Sociology of Health was not yet clearly conceived.
Most of the articles in this review address the history of either Medical Sociology/Medicine or Sociology of Health/Medical Sociology, and in general, the authors aimed to outline the role of sociology in the field of Health. After Gilberto Freyre published his founding book, “Sociology of Medicine”, in 1967, medical sociology, with this explicit name, can be declared inaugurated in Brazil.
Bertolli Filho (2003) presents and evaluates Gilberto Freyre’s proposals in Medical Sociology and health education initiatives. Freyre’s work “Sociology of Medicine” (1967) focuses on describing people’s daily lives, addressing several aspects of health in Brazil, such as diet, clothing, sleeping, and defecation habits, and bridging culture and biology. According to Bertolli Filho (2003), in Freyre, we can see the confluence between medical knowledge and the Human Sciences. Indeed, as Freyre defines in his book, “the Sociology of Medicine is Sociology: it is the application of sociological criteria and methods of analysis and interpretation of social processes, interpersonal relationships and intergroup relationships” (Freyre, 1967, p. 25).
From a similar perspective, Carlos Fiúza Moreira (2019) revisits a thesis by Gilberto Freyre, found in “Sociology of Medicine” and health training, that medical training should be guided by sociology, given that health is embedded in the sociocultural world and its causality is multiple. From this perspective, the author discusses training regarding undergraduate health programs.
Another pioneer was Nelly Candeias (1971), with her article “Sociology and Medicine”. The University of São Paulo (USP) scholar represents a movement of social scientists’ interpenetration into medical schools, as occurred at UNICAMP and some other universities. At this same USP, Maria Cecília Donnangelo would defend her thesis and publish her classic books (Donnangelo, 1975; Donnangelo; Pereira, 1976), landmarks in the integration of Marxist thought into Collective Health.
Candeias (1971) discusses the state of Medical Sociology in Great Britain, highlights some of its contributions to Medicine, proposes a categorization of research areas within Medical Sociology, and thus justifies the sociologist’s presence within the field of Medicine. She analyzed pedagogical programs, research, and teaching, including publications authored by doctors and sociologists.
In this sense, it is clear that Everardo Duarte Nunes, from the outset, more than a theorist, played the role, albeit a murky one, of historian of the field and trainer of healthcare professionals, introducing Brazilian readers to several relevant authors in North American medical sociology and teaching in medical schools. Nunes (2007c) also discussed Straus’s articles. Nunes’s articles total about ten on the subject of these authors and works.
In the earliest of these, Nunes (2003b) introduces Mrs. Tomasetti, Bloom, and a pioneering teaching project, critically reviewing Samuel W. Bloom’s book2. Nunes comments on the author’s biography and, at the end, makes notes on the forms of teaching social sciences proposed in the work. Continuing this line of analysis, Nunes (2007b) reviews another book3 in which Bloom narrates the history of Medical Sociology in the postwar United States, with the development of the social sciences and research involving the themes of health, illness, and mental illness.
Merton’s Medical Sociology was also presented by Nunes (2007a), who narrated the sociologist’s life story and his main contributions, under the aegis of Parsonian structural-functionalism. Nunes discusses Merton’s book4, in which he shows how medical school molds students so that they build the professional status and values of their group, to be recognized among peers and, most importantly, by society.
A discussion of researchers August de Belmont Hollingshead (1907-1980) and Frederick Carl Redlich (1910-2004) is the subject of the following article by Nunes (2010), which analyzes the authors’ books and the importance of their research for Sociology and Psychiatry, emphasizing studies of social class5. This book describes an empirical study of mental illness and its relationship to class structure, opening up new fields of knowledge such as Social Psychiatry, Medical Sociology, and Psychiatric Epidemiology.
The following year, the scholar featured was Margot Jefferys (Nunes, 2011), a researcher and professor of Social Sciences in Health at the London School of Hygiene and Tropical Medicine. The author highlights two texts: one on the relationship between Epidemiology and Sociology and the other on Medical Sociology. A groundbreaking aspect of her research was the incorporation of feminist critiques of Medical Sociology, which they believed perpetuated male domination over women’s health experiences.
Roger Bastide (1898-1974), an anthropologist known in Brazil for his studies of religion, was the subject of research on his discussions of health by Nunes (2015b), who describes his biography and contributions to General Sociology. Although not within the field of Health, he worked with Social Psychiatry, Cultural and Psychiatric Anthropology, magical mentality and morbid consciousness, immigration, and mental illness.
Finally, Nunes (2019b) introduces another pioneer, Jack Elinson, through an analysis of his education and professional career. Elinson was of Russian and Jewish descent and championed the term “Sociomedical Sciences”, the name of the Department of Sociomedical Sciences he founded at Columbia University. According to Nunes, Elinson created a widely recognized method for assessing quality of life, called the “Five Ds: death, disease, disability, discomfort, and dissatisfaction” (2019b, p. 612).
In this historicist vein, André Pereira Neto (2009) conducts a biographical analysis of Eliot Freidson, coincidentally a researcher of Russian and Jewish origin, considered a founder of Medical Sociology, with his book Profession of Medicine, whose content had the merit of proposing an approach to Medical Sociology that changed the perspectives and ways of explaining questions of health and illness.
Freidson is a central and contemporary author in Marie Jaisson’s (2018) discussion of the sociology of professions. Talcott Parsons established this sociology by publishing a specific chapter (the tenth) on the medical profession, understood as a model of profession, in his famous book The Social System. In contrast, Everett C. Hughes and Howard Becker, at the University of Chicago, developed research that challenged the Parsonian model. Eliot Freidson, a graduate of the University of Chicago, changed the perspective of studies on professions, seeking to synthesize these two dominant currents.
Erving Goffman, a well-known sociologist from outside the medical field, is presented by Nunes (2009a): his biography, his main works, and theoretical contributions to the field of Sociology of Medicine or Health, such as studies of disease and the patient, the total institution, strategic interaction, and formal instrumental organizations.
Finally, Montagner (2008a) discussed Pierre Bourdieu’s work through research on the Sociology of Health, Medicine, or the body published in his journal, Actes de la recherche en sciences sociales. The author mapped the emergence of Health and Medicine in Bourdieu’s works and in the studies of those who worked under his guidance or published in his journal. The author discusses how the issue of the body and the Sociology of Health were intertwined with Bourdieu’s theoretical concepts, primarily through the sociology of the body.
Sociology and Medicine in the world
At this point, we aim to elucidate how Medical Sociology or Sociology of Health is established in different countries. Balarezo-López (2018) affirms that constructing this field began with American physician Charles MacIntire’s original use of the term “Medical Sociology” in 1893, during a lecture at the Milwaukee Academy of Medicine (United States). He mentions that the pivotal moment in the flourishing of research and publications on American Medical Sociology occurred in the 1970s and that it seems irreversible that the Sociology of Medicine will become institutionalized, whether in medical schools or departments, or within Sociology (Balarezo-López, 2018).
Antunes and Correia (2009) point out that the first research on Sociology of Health in Portugal was Graça Carapinheiro’s 1989 doctoral thesis at ISCTE: “Knowledge and Power in the Hospital. A Sociology of Hospital Services”. According to the authors, the term Sociology of Health was coined in Portugal, albeit belatedly, by Carapinheiro. They conducted an academic analysis of the production of Sociology of Health and concluded that “the Sociology of Health domain is in a clear process of differentiation in its relationship with the sociological field in Portugal [...], evidencing a consistent implementation in the national academic institutional territory” (Antunes; Correia, 2009, p. 118).
In Mexico, Roberto Castro (2003) analyzes the three main streams of Health studies: Medical Anthropology, Social Medicine, and Public Health Sociology. The first has a long tradition in Mexico and sought to elucidate the logic and characteristics of pre-Hispanic Medicine, the different Medicine models, and medicalization, and questioned the centrality of explanations in medical concepts. In turn, Social Medicine was developed in the mid-1970s, with significant influence from the Marxist analysis proposed by Asa Laurell, showing the specific way in which capitalism determines the occurrence of the health-disease process.
Another article by Roberto Castro and Mario Bronfman (1993) explores the perspective of feminist science, analyzing concepts such as patriarchy, gender, and the sex/gender system, and seeks to develop new knowledge in medical sociology. The author concludes that, in recent years, debates between different schools have diminished, but this could also be a warning of a possible abandonment of the spirit of discussion, under penalty of “condemning our efforts to a mediocrity that our discipline and our social reality do not deserve [our translation]” (Castro, 2003, p. 57).
Regarding France, Claudine Herzlich (2004) developed an essay on how the Social Sciences studied and analyzed the personal experience of illness, while also outlining how this topic was explored particularly in French sociology. Claudine affirms that, until the 1970s, sociologists studied health from a medical perspective. From the 1970s onward, criticism turned to the medicalization and social control of Medicine, focusing on the “patient’s voice”, revolving around themes such as gender, body, and emotions. Patient discourse began to be explored as a relationship between the individual and the social group, in some ways countering the holistic Marxist view. In the 1980s, sociological studies turned to the lay experience of illness, with a greater emphasis on the prevalence of chronic and “degenerative” diseases in modern society, closely linked to the body and social stigma. Finally, in the 1990s, sociologists of illness turned their attention to the new theme of first-person narrative (diaries, letters, personal testimonies, and novels about illness), taken not only as testimonies but also as documents.
A similar landscape was outlined by Miguel Montagner and Everardo Nunes (2004) on the production of the journal Actes de la recherche en sciences sociales, primarily focusing the analysis on issue 143, a special edition from June 2002, entitled Médecines, patients et politiques de santé (Medicines, patients, and health policies), when the journal once again gave special space to Health, which had occurred only once before, in 1987.
Regarding the United States, Cockerham (2014) analyzed trends in the Sociology of Health, considering that the field has reached maturity, and that modern Sociology of Health utilizes middle-range theories and addresses topics such as fundamental causes, medicalization, social capital, local disadvantages, and lifestyle in health. These new theoretical perspectives tend to take on a neostructural nature, thus signaling a return to explanations of the effects of structural entities on health.
In a similarly inspired study, Moschkovich (2024) seeks to articulate Sociology and Health in Brazil, proposing a reflection on how knowledge can advance at the intersection of these two areas regarding new sociological problems. He examines some contributions of Sociology of Health, particularly in the second half of the 20th century, based on a characteristic Sociology of Health perspective. He concludes by posing new questions for considering health as a contemporary sociological problem in the current political context.
Now, using Candeias’s (1971) article as a basis, Nunes and Felice (2009) analyze British Medical Sociology and Education and Research in both countries. According to Russell (cited in Barros; Nunes, 2009), the main themes developed in Social Sciences teaching in undergraduate medical programs in the United Kingdom were social inequality, social categories, health models, different forms of knowledge and the social construction of common sense, popular and medical culture, different understandings of the social, and evidence-based medicine.
Finally, the same type of analysis was conducted on the United States, Great Britain, and France (Nunes, 2003a), outlining a general outlook and the milestones of principal authors and publications on the terms Medical Sociology/Sociology of Health, understood as synonyms.
Sociology, training, and education in health
Another traditional line of study in Medical Sociology is that of health education and training, as cited in the pioneering study by Nelly Candeias. Nunes (2000) is a consistent author in this line, focusing on the history of the Social Sciences course applied to Medicine at the School of Medical Sciences of the State University of Campinas (Unicamp) between 1965 and 1990. The author defines this history in three periods: the initial experiments from 1965 to 1969, the pursuit of a social project in health in the 1970s, and the consolidation of the social project in the 1990s.
Regarding the most recent education experience, Nunes et al. (2003) conducted a study on teaching Social Sciences in several countries, from 1960 to 2000, using the technique of document analysis of studies on the topic in the LILACS, Medline, and Sociological Abstracts databases. They concluded that this teaching sought to establish an interaction between biomedical and sociomedical knowledge, situated in the initial Medical School years, and seeking to apply Social Science theories to different situations, such as clinical or community settings.
An analysis of postgraduate programs in Public/Collective Health was conducted by Nunes and Costa (1997), with the curricula of 17 Master’s and 9 Doctoral programs, presenting: areas of concentration, location, institution, start date, number of mandatory courses, clientele, and minimum and maximum duration for completion. The following subareas of knowledge stood out: Epidemiology, Health Planning and Administration and Biostatistics, Methodology, Sociology of Health, and Epistemology.
Regarding teaching, Nunes (2016) studied 11 classic Medical Sociology/Sociology of Health textbooks from 1900 to 2012, produced in the United States and England, and classified them as doctor-centered, interdisciplinary, pedagogical, analytical, quasi-autobiographical, critical, and synthetic-reflective. The author concludes that these textbooks can be helpful in the teaching process because they show the accumulated knowledge of leading researchers and give identity to the field.
Another tool to support the teaching of Human Sciences in Health can be literary classics, as shown by Nunes (2015a), when discussing the concept of classics based on literature, bringing the theme into Sociology and ending up expanding the discussion to the Medical Sociology/Sociology of Health, concluding that the so-called classics have a crucial role in the interdisciplinary field of Collective Health and Sociology of Health.
Narrative, as a heuristic device, has become a valuable tool in Sociology and Health, as Nunes (2019a) points out in an article analyzing two texts from the 1980s and their narrative constructions: the first, by José Carlos M. Pereira, “A explicação sociológica em medicina social” (Sociological Explanation in Social Medicine), a thesis for his postdoctoral degree defended in November 1983 (published in 2006), examines the use of sociological theories in Social Medicine; and the second, by Maria Cecília Minayo, “O desafio do conhecimento. Pesquisa qualitativa em saúde” (The Challenge of Knowledge. Qualitative Research in Health). The author concludes by emphasizing the importance of the Sociology of narratives in Health.
Sociology of Health
Brazilian Collective Health is a field that developed from the 1960s onwards and arguably reached its peak with the success of the health movement, the inclusion of the right to health in the Federal Constitution, and the establishment of the Unified Health System (SUS). A similar movement occurred in the Social Sciences in Health, particularly the Sociology of Health. Until the advent of the politicization of Health in the 1960s and 1970s, Sociology emerged eminently as Medical Sociology or Sociology of/in Medicine. This is shown in the articles discussed so far regarding these nuances: it focuses on the historical study of the classic authors and founders of Medical Sociology, or the formation and teaching of Medical Sociology in medical institutions, and how this presence is institutionalized in medical and nursing schools.
We defend the thesis that the Sociology of Health, especially, is established as a specific heuristic in this movement of transformation of Public Health into Collective Health, for several reasons listed below.
The first is that it is a time when the epidemiological profile of global populations has already shifted predominantly toward chronic diseases over infectious diseases. However, Brazil, for many authors, displays a mixed model. This shift demands and requires the use of more refined and more precise analytical tools that include individual experience and perception - in short, qualitative methods replacing/integrating quantitative methods alone.
The second is that Leavell and Clark’s biomedical model of etiology and the Natural History of Disease, as Thomas Kuhn would say, has progressively shown irreducible anomalies, as it can no longer explain chronic illnesses, which in the Human Sciences take the form of illnesses rather than diseases. We thus move on to the Social History of Disease model, in which sociocultural aspects predominate or are relevant in the prevention and treatment of illnesses, or even more importantly, in the promotion of health.
The third is that, in the transition to postmodernity, subjective and individual aspects, especially those of identity construction, increasingly play a broader and exhaustive role in people’s lives, which leads to exalting individual subjective experiences with the body as an important factor in social praxis and the relationship with health, in addition to identity construction.
For these reasons, in this section, we analyze articles that specifically address the Sociology of Health and how this concept is understood or implied. Until recently, the Sociology of Medicine/Medical Sociology was confused with, or taken as equivalent to, the Sociology of Health. However, this would not be the best approach.
The first article on the relationship between Medical Sociology and Sociology of Health, which addresses the concepts as neither equivalent nor synonymous, is by Montagner (2008b). It noted the lack of a clear definition between the two sociologies, unlike what occurred in English-speaking countries. In other countries, there was constant fluctuation between the terms Medical Sociology and Sociology of Health, which indicated an inability of this theoretical duality to account for the actual activities of researchers (Montagner, 2008b, pp. 206-207). To achieve this, it was necessary to broaden the definition of Sociology of Health and erase this outdated dichotomy:
The Sociology of Health transcends the strict idea of health as the absence of disease and the perspective of doctors or other health professionals; it encompasses more than the biological body and interprets it as a space and a means for achieving well-being that allows the individual to express their full potential. The Sociology of Health exceeds the medical environment and incorporates rationales about healing and cognitive models of explaining illness that are alternative to the hegemonic model. Therefore, its studies encompass all bodies that interfere with and promote human well-being, such as NGOs, therapeutic groups, organizations for chronically ill people, and several social entities that work to promote health (Montagner, 2008b, p. 207).
This definition was corroborated by the observation of Timmermans and Haas (2008), who argued that “renaming Medical Sociology as the Sociology of Health and Illness thus manifested the recognition that experiences of illness extended to family, work, school, and other areas of life” (Timmermans; Haas, 2008, p. 661). In this same article, the authors advocate establishing a Sociology of Health, Illness, and Disease.
This proposal was addressed by Nunes (2009b) when he reviewed both the article by Timmermans and Haas and that by Clive Seale, both published in the commemorative edition of Sociology of Health and Illness, in 2008, in which Medical Sociology is addressed, whether in its history in the case of Seale, or its future, as in Timmermans.
As of 2014, Nunes sought to revisit the theme of Sociology of Health, attempting a better distinction between the terms, as previously proposed. He discussed the theoretical contributions of the Social Sciences (Nunes, 2014a) to what he called the Sociology of Health, concluding that theoretical construction will be achieved through interdisciplinarity, given the diversity of research proposals in Health; and he sought to show the construction of this field and its identity (Nunes, 2014b).
Final considerations
At the outset, we should underscore that this article is limited in that it does not discuss Social Medicine and its ramifications, due to space constraints. This situation hinders the comparison of this European-based thinking, with its Latin American ramifications, with the Anglophilic Medical Sociology and its offspring, from which the Sociology of Health derives. We should recall that Social Medicine has been embraced by several physicians and other health professionals, with significant influence on Public and Collective Health in Brazil and Latin America. The same applies to Medical and Health Anthropology. A future study of these relationships between these fields would be necessary.
We started this article by citing two new developments in Collective Health. First, the replacement of the producers of symbolic health goods - former professional hygienists trained in postgraduate studies - by new health intellectuals, trained by them in undergraduate studies. This shift erases and blurs the distinction between “and” and “in” and places new intellectuals with a new habitus, with new dispositions to understand health and its promotion as an object of Collective Health, independent of medical schools and their institutions. The training of these new professionals occurs in Health faculties, in a much broader field than the medical field alone. Thus, every bachelor’s degree in Collective Health becomes a researcher in the Humanities and Social Sciences of Health by definition.
Another consequence is that the future trainers of health intellectuals will not have been trained in specific disciplines such as Sociology, Anthropology, Social Communication, Psychology, and many others. In short, they will not bring a habitus from their field of origin, which may reduce the depth of knowledge in those disciplines, but this will allow for a greater approximation with the field of Health, within a paradigm, in Kuhn’s terms, broader about health, illness, and disease; therefore, post-revolutionary and with new “puzzles” to be solved.
As Weber would say, with these changes, we may incur the rationalization of the original charisma of fundamental training, with a bureaucratized specific knowledge and the promotion of another, more general and consensual one in Collective Health. The irony would be that the original work of politicizing the field, with the increasing introduction of Social Sciences into health and, initially, Marxist thought, was so successful and accepted, bearing so many positive fruits in the expansion of biomedical thought in the field of the former Public Health, by establishing Collective Health and the undergraduate level in 2008, mortally wounded its very existence and future presence in this field, as autonomous sciences with their habitus (Montagner; Montagner, 2016). We will be the last ancestors and immigrants from other disciplinary fields who have produced fruitful descendants in Collective Health.
In this sense, adopting the term “hygienist” to characterize graduates in Collective Health seems like a remnant of health-related thinking, whether campaign-oriented or developmental, leaving a mark on the heart of this new professional, as the term, so dear to doctors and former professionals who worked in those logics, is reborn within Collective Health as a ghost that still haunts us.
Acknowledgments
The publication of this research was only possible thanks to Call for Proposals No. 001/2025 DPI/BCE/UnB - Support for the execution of scientific, technological, and innovation research projects.
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1
Straus, R. “The Development of a Social Science Teaching and Research Program in a Medical Center”. The author revisits and cites this discussion in his article “The Nature and Status of Medical Sociology” (Straus, 1957).
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BLOOM, S. W. The doctor and his patient: a sociological interpretation. Nova York: Russell Sage Foundation, 1963..
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BLOOM, S. W. Word as scalpel: a history of medical sociology. New York: Oxford University Press, 2002.
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MERTON, R. K.; READER, G.; KENDALL, P. L. The student-physician: introductory studies in the sociology of medical education. Cambridge: Harvard University, 1957.
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HOLLINGSHEAD, A. B.; REDLICH, F. C. Social class and mental illness: a community study. New York: John Wiley & Sons, 1958.
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Data Availability Statement
The research data are available within the main text of the article.
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Editors: Carinne Magnago, Aurea Ianni
