Research Committee on Sociology of Health (RC15) presents:
Differential Professional Regulation:
A New Perspective on Health Inequalities
Mike Saks
Health inequalities related to social position, whether of class, gender or ethnic minority status, are explained in many ways in the modern world, but are rarely directly linked to the regulation of professions themselves – which have traditionally been seen as a force for the good. More specifically, before the counterculture of the 1960s and 1970s the legally underwritten exclusionary social closure of professions was typically associated with an altruistic orientation. This is now viewed more cynically, as the spotlight has fallen on the deleterious operation of professional self-interests and the influence of the wider structures of power in which such groups are embedded in neo-liberal societies.
However, little has been written about the impact of professional hierarchies created as a result of differential patterns of social closure introduced by policy makers – as well as the related implications for non-professional groups. In the pecking order such marginalised professional and other occupational groups have a subordinated or excluded status as compared with ‘top dog’ professions. This is classically illustrated in health care by the position of groups like nurses, midwives and the professions allied to medicine relative to doctors, who are themselves in turn internally differentiated by status according to specialism and other factors.
In this think piece, it is argued that the effect of differentiation related to professionalisation is to create inequalities of access to services among the public. This is most accentuated in the health field by the case of complementary and alternative therapists – who are at best marginalised within, and at worst completely excluded from, the orthodox health care division of labour. As a result, they are frequently driven into the private as opposed to the publicly funded sector and their practice is not always covered by insurance schemes. This creates patterns of inequality linked to socio-economic and geographical location – with ramifications too for gendered and ethnic minorities.
The implication of this sociological commentary on the politics of health, whereby inequalities arising from the professional division of labour create inequalities of access without, is that governments need to be very mindful of the often unintended consequences of the regulatory policies that they enact. This clearly applies to the health professional area, but is by no means restricted to this field of professional work. In terms of the theme of the upcoming Third ISA Forum in Vienna in 2016 and the futures we want, therefore, it is vital that this hitherto relatively invisible insight forms part of the broader struggle for a better world.
For referenced elaboration of the argument outlined please see the following recent article: Saks, M. (2015) ‘Inequalities, marginality and the professions’, Current Sociology Review 63(6): 850-68.
Mike Saks is Research Professor in Health Policy at University Campus Suffolk, UK, and Visiting Professor at the University of Lincoln, UK, and the University of Toronto, Canada. He has published widely, including fourteen books on professions, regulation and research methods with particular reference to the health field. He has a strong international research profile and has undertaken commissioned work in health care for a number of professions and governments. He is an elected member of the Board of ISA RC15 (Sociology of Health) and Vice President and former President of ISA RC52 (Sociology of Professional Groups). Email: m.saks@ucs.ac.uk
Banner Image: Popular toy figurines of health professionals (photo: HCLDR).
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