List of Contributors xi
Preface xiii
Acknowledgements xv
1 An Introduction to Social Sciences for Healthcare Professionals 1
Chris Allen
How to Use This Book 1
What Are the Social Sciences? 1
Sociology and Medical Sociology 1
Psychology and Health Psychology 1
Economics and Health Economics 2
So Why the Social Sciences? 2
A Patient's Journey: The Social Sciences in Action 2
Completing Barry's Story 3
References 5
Part 1 Understanding Health, Healthcare Systems, and the Healthcare Workforce 9
2 Social Theory, Social Research Methods and Health in the Context of Society and Care 11
Chris Allen and Assaf Givati
Introduction 11
What Is a Theory? 12
Understanding Theories Through Levels of Abstraction 13
Why Is This Needed? 13
Grand Theories 13
Mid- Range Theories 13
Programme Theories 13
How Grand, Mid- Range and Programme Theories Work Together 14
Macro, Meso and Micro Levels 15
Macro Approaches: How Does Society Work? 16
Functionalism 16
Talcott Parsons: The Sick Role 17
Conflict Theory 18
Micro Approaches: How Does Society Work? 18
Symbolic Interactionism 18
Social Research Methods 19
Positivism (Quantitative Methods) 20
Interpretivism (Qualitative Methods) 20
Conclusion 21
References 21
3 What Is Health and Disease Why Do Definitions and Classifications of It Matter? 25
Chris Allen
Introduction 25
What Is Health and Well- Being? 26
Shifting Perspectives on Health 26
Health as a 'Resource' 27
The Biopsychosocial Model 27
Salutogenesis and Positive Health 28
Salutogenesis 28
Capability Approaches 28
So How Should Health Be Seen and Understood? 29
Disease Classifications 29
The International Classification of Diseases (ICD) 30
Classifying Mental Health and the DSM 30
International Classification of Functioning, Disability and Health (ICF) 30
Medicalisation, Over Medicalisation and Overdiagnosis 31
Does Medicine Want to Be Dominant Through Medicalisation? 32
Medicalisation and Overdiagnosis 32
Invisible Illness: Felt but Not Seen 33
Health, Disability and Personal Independence Payments 33
Conclusion 34
References 34
4 The Social Science of Mental Health and Illness 39
Samuel Woodnutt, Simon Hall, and Chris Allen
Introduction 39
Stress, Vulnerability and Mental Health 39
Mental Health, Social Deviance and the Law 40
How Does Society Care for Those Who Are Mentally Unwell? 42
Mental Health, the Illness Framework and Psychiatry 42
A Brief History of Mental Healthcare as a Social Paradigm 43
Early Psychology Within Modern Society and Cognitive Behavioural Therapy 44
Psychoanalysis 44
Behaviourism 46
Critical Views on Psychiatry and Mental Health Treatment 47
Power Threat Meaning Framework 47
The Birth of the Recovery Movement 47
Modern (Integrated) Approaches in Current Health Contexts (4Ps Formulation) 48
Conclusion 51
References 51
5 Understanding the Organisation of Health Systems and Health Economics 55
Chris Allen, Robert Slinn, and Sam Woodnutt
Introduction 55
What Is Health Economics? 56
How Are Decisions Made About Who Gets What? 56
What Is the Political Economy and How Does It Relate to Health? 58
What Is a 'Health System' and What Health Systems Are There? 60
Out- of- Pocket Healthcare Expenditure 62
How Do We Measure Success and Why Should We? 64
Conclusion 67
References 67
6 The Global Healthcare Workforce and the Social Science of HealthCare Professions 71
Assaf Givati and Chris Allen
Introduction 71
The Global Healthcare Workforce 72
Globalisation and Brain Drain Amongst Healthcare Professionals 73
Gender Inequalities and Healthcare Professionals 74
The Global Healthcare Professional Workforce Crisis 74
Who Are Healthcare Professionals? 75
New Healthcare Professionals 76
Sociological Explanations in the Study of Healthcare Professionals 77
The Functionalist Perspective and the Traits Approach 78
Neo- Weberian Perspectives: The Monopoly and Power of the Professions 78
Occupational Closure and the Medical Profession 79
Deprofessionalisation 80
Conclusion 82
References 82
Part 2 Meeting Population Health Needs and Health Inequalities 85
7 Population Health Needs: Understanding the Care Transition 87
Chris Allen, Lindsay Welch, and Lynn Calman
Introduction 87
A Changing Society, with Changing Health Needs 88
Demographic Transition 89
What Can a Bath Tell Us About Population Health? 91
Demographic and Epidemiological Transitions: Why Increasing Chronic Illness, Multi- morbidity and Complexity Necessitates a Change in Care Paradigm 93
Not a Bath, but an Ocean 94
Increased Responsibilities and the Burden of Treatment and Disease 95
Self- Management to Support Individuals 95
Conclusion 96
References 97
8 Social Determinants of Health and Inequality 101
Chris Allen and Lindsay Welch
Introduction 101
What Determines Health? 102
Models of Health Determinants 102
Constitutional Factors - Modifiable or Unmodifiable? 103
Individual Lifestyle Factors 104
Social and Community Networks 105
Living and Working Conditions 105
Housing 105
Work Environment and Unemployment 105
Education 106
Health Services 106
Social Position, Social Class and Social Status 107
Intersectionality 108
What Are Health Inequalities? 108
Explanations for Health Inequalities 110
Material Explanations 110
Psycho- social Explanations 111
Cultural Explanations 111
Life Course Explanations 112
How Are Health Inequalities Experienced? 112
Conclusion 112
References 113
9 Stereotyping, Bias and Health- Related Stigma 119
Chris Allen
Introduction 119
Understanding Our Bias: Stereotyping and Unconscious Bias 119
What Is a Stereotype? 120
What Is Stigma? 121
Implicit and Unconscious Bias 123
Health- Related Stigma 124
Mental Health- Related Stigma 124
Human Immunodeficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) 125
Addressing Stigma and Reducing Implicit Bias in Healthcare 125
Addressing Stigma 125
Addressing Unconscious Bias 126
Conclusion 127
References 127
10 Meeting the Needs of Those Experiencing Social Exclusion and Significant Inequality 133
Lindsay Welch, Jasmine Snowden, and Chris Allen
Introduction 133
What Is Social Exclusion and Marginalisation? 134
Inclusion Health 135
Forced Displacement, Migration and Health 136
Place- Based Marginalisation, Nested Deprivation and Homelessness 139
Racial Inequalities in Cancer Care 141
Inclusive Healthcare Design and Research 143
Conclusion 143
References 144
11 Disability, Society and Health 149
Chris Allen, Simon Hall, Erica Goddard, and Neil Summers
Introduction 149
Embodiment 149
What Is Disability? 150
Attitudes Towards Disability 151
How Is Disability Understood? 151
The Medical Model 152
The Social Model of Disability 152
Disability and Discrimination 154
Children and Young People with Disabilities 154
Learning Disability 156
Inclusive Healthcare Provision for Those with a Learning Disability 157
Mental Distress 158
Conclusion 159
References 159
Part 3 Understanding Health Behaviours, Health Behaviour Change, and Public Health 165
12 Understanding Unhealthy Behaviour 167
Chris Allen, Sam Woodnutt, and Gilly Mancz
Introduction 167
What Are Unhealthy Behaviours? 167
Diet 168
Activity Levels 168
Alcohol Consumption 168
Smoking 169
Why Do We Engage in Unhealthy Behaviour? 170
Structure and Agency 170
Social Structure 171
Habitus and People's Cultural and Social Environments 171
The Commercial Determinants of Health 172
Personal and Individual Level Factors 172
Addiction and Habits 172
Hedonism and Affective Responses 173
Personality and Behaviour 174
Theoretical Models of Health Behaviour 174
Health Belief Model 176
Social Cognitive Theory 176
The Social Ecological Model 176
Conclusion 178
References 178
13 Evidence- Based Behaviour Change Approaches 183
Chris Allen and Gilly Mancz
Introduction 183
A Science of Behaviour Change 183
Healthcare Professionals Roles in Promoting Behaviour Change 184
Models and Theories of Behaviour Change 184
Transtheoretical/Stages of Change Model 185
Social Cognitive Theory 185
COM- B and The Behaviour Change Wheel (BCW) 186
Behaviour Change Techniques 188
Behaviour Change Interventions 188
Motivational Interviewing 189
Making Every Contact Count (MECC) and Healthy Conversation Skills 191
Digital Behaviour Change Interventions 193
The Limits of Individual Approaches to Behaviour Change 194
Conclusion 194
References 194
14 Public Health Interventions through the Lens of the Social Sciences 199
Chris Allen
Introduction 199
Upstream Prevention 200
What Is Public Health? 200
What Is a Public Health Intervention? 201
The Political Philosophy, and (Bio)ethics of Public Health 201
The Harm Principle 201
Nanny or Nurture? 202
The Stewardship Model 202
The Nuffield Ladder of Interventions 202
Healthy Cities 204
Active Living 204
Greenspace and Active Transport 204
Parkrun, Free Exercise Classes and Gym Memberships 205
Diet 206
Calorie Information 206
Sugar Tax and Levies 206
Smoking 206
Swap to Stop 206
Smoking Bans and Smoke- Free Generations 206
Drinking 207
Minimum Unit Pricing (MUP) of Alcohol 207
Getting Rid of the Pint! 208
Nudging and Liberal Paternalism 208
A Whole Systems Approach to Public Health 210
Population and Planetary Health 210
Conclusion 212
References 212
Part 4 Social and Community Networks, Loneliness, and Social Prescribing 217
15 Understanding Support Networks and Influence Across the Life Course 219
Chris Allen, Jasmine Snowden, Janine Hall, and Ellen Kitson- Reynolds
Introduction 219
The Life Course Perspective 220
'Linked Lives': What Are Personal Networks and Why Are They Relevant to Health? 221
Preconception and Maternity 222
The First 1,000 Days and Childhood 223
Adolescence and Emerging Adulthood 225
Working Age Adult Life 226
Retirement and Later Life 227
Conclusion 228
References 229
16 Social Isolation and Loneliness in Contemporary Society 237
Chris Allen
Introduction 237
Social Isolation and Loneliness 237
Who Is Affected, Where and Why? 239
Global Loneliness Trends 239
Personal Characteristics of Loneliness 240
Loneliness and Age 240
Loneliness and Inequality 240
Loneliness and the Lived Environment 241
Digital Communication Technology and Loneliness 241
How Is Loneliness Measured? 241
What Are the Health Impacts of Loneliness? 241
Physical Health 242
Unhealthy Behaviours 242
Mental Health 242
Reduced Social Contact 243
What Interventions Have Been Considered? 244
Conclusion 244
References 245
17 Social Prescribing and Health and Well- Being 251
Louise Baxter and Chris Allen
Introduction 251
Creative Health and Health Inequalities 252
Heritage and Museum- Based Activities 252
Physical Activity - Football Fans in Training (FFIT) 253
Nature - Blue Care Interventions 254
What Is Social Prescribing? 254
What Is a Social Prescribing Link Worker? 255
Does Social Prescribing Work? 255
The Role of the 'Social Prescribing Link Worker' 256
The Role of the Voluntary and Community Sector 256
How Social Prescribing Is Experienced by Those Accessing Support 257
Conclusion 257
References 258
Part 5 Leading Safe and Effective Care in Increasingly Changing Healthcare Systems 261
18 Leading Safe and Effective Healthcare Teams: Leadership, Management and Complexity 263
Matt Flynn and Chris Allen
Introduction 263
Complexity and Contemporary Healthcare 263
Complex Systems: When Things Go Wrong 264
Human Factors and Ergonomics 264
Reasons Swiss Cheese Model (Theory of Active and Latent Failures) 265
The Systems Engineering Initiative of Patient Safety (SEIPS) Models 265
What Is Leadership and How Is It Different to Management? 267
What Makes a Leader? 269
Self- Leadership and Emotional Intelligence 269
The Evolution of Leadership Theories and Approaches 270
Traits Approaches to Leadership 271
Leadership Behaviours and Styles 271
Situational Leadership 271
Transformational Leadership 272
Leader- Member Exchange Theory 273
Authentic Leadership 273
Servant Leadership 273
Distributive and Shared Leadership 274
Team Leadership 274
Taking One Last SEIP 274
Conclusion 274
References 275
19 Healthcare Teams, Team Effectiveness and Team Training 279
Chris Allen and Matt Flynn
Introduction 279
What Is a Team, and Why Do We Work in Them? 279
Healthcare Teams 281
Team Effectiveness: Inputs, Processes, Outcomes 283
Team Inputs 284
Team Member Characteristics 284
Diversity 284
Social Categorisation Perspective and 'Fault lines' 284
Teamwork Processes 285
Communication 285
Psychological Safety and Conflict 286
Incivility 286
Group Think 287
Reflexivity 287
Understanding Team Performance (Outputs) 287
Teamwork Training and Teamwork Interventions 288
'Huddle Up' - Team Huddles 288
Teamwork and Innovation 288
Conclusion 289
References 289
20 Digital and Technological Innovation in Complex Healthcare Systems 293
Chris Allen, Eloise Monger, and Cheryl Metcalf
Introduction 293
The Social Sciences, Technology, Innovation and Digital Health 294
The Case for Innovation in Health 294
What Is a Health Technology? 294
What Is a Digital Health Technology? 295
Understanding What Makes Us Unwell 296
A Helping Hand: Decision Support, Artificial Intelligence (AI) and Machine Learning (ML) 296
Health and Self- Management Tools 296
Remote Access, Video Consultations and Virtual Wards 297
Preparing Healthcare Professionals for the Digital Future 298
What Does Success Look Like? Needs Led and Responsible Innovation 299
Intended User and Stakeholder Engagement 300
Adoption: Moving Beyond Creation 301
Healthcare Systems Readiness for Innovations 302
Contingency Planning 302
Interoperability 303
Security 303
Technologies, Inequality and Their Impact on Health 303
Conclusion 305
References 305
Index 309
