Editorial: Bourdieu, capitals and health

Abstract

It is over twenty years since Simon Williams asked whether Bourdieu's writings could help us better understand the relationship between class, health and lifestyles and concluded that his work provided a useful counterweight to the dominant accounts of health and illness that focused on individual behaviour and reflexive control (Williams 1995). Since that time there has been an explosion in theoretical, methodological and empirical work that draws heavily on varied aspects of Bourdieu's oeuvre, not least within the pages of Sociology of Health & Illness. This trend has been viewed by some as a reflection of an increasing engagement with theoretical frameworks that address structure and agency (Cockerham 2013). Indeed, since Bourdieu's death his influence remains strong across a wide range of substantive research areas from education, to class and inequality and of course health. However, neither his work nor the uses it has been put to, have been free from criticism. Enthusiasm for the concept of habitus, for forms of capital, and for related notions of field and practice has been tempered by criticisms that point to an emphasis on the unity of habitus (Bennett 2007, Lahire 2003) to limited accounts of agency (Archer 2012) and to questions of method (see Jones 2011 for a detailed discussion). It is with the strengths and limits of Bourdieu in mind therefore that we are pleased to introduce this special themed section on #Bourdieu, capitals and health#. We begin with a systematic review of research on family social capital by Elena Carrillo Álvarez et al. Although their focus is on quantitative studies of social capital they argue that family relations were central to the way social capital was understood by both Bourdieu and Coleman (1991, Bourdieu 1996). They draw a distinction between social capital based around social cohesion and social capital based around social networks and argue that family social capital is an important lacuna across both approaches. Furthermore, they find that its multidimensional aspects are poorly understood and argue for a need to take account of the quality of family relationships, the role of children in family networks, social and cultural variations in family structures and norms as well as mechanisms through with family social capital affects health outcomes (including addressing the downsides of family social capital). While the review covers different approaches to social capital it also raises important questions about Bourdieu's emphasis on family and associated networks as key sites for the re-working and transmission of social capital between generations. In the field of medical sociology, many have drawn on Bourdieu's accounts of distinction and bodily dispositions (Bourdieu 1984) to examine lifestyles and practices that impinge on health. The paper by Georgie MacArthur and colleagues is an interesting contribution to this body of work, drawing as it does on a set of concepts (habitus, capital, field and practice) to frame an analysis of accounts of drinking culture among young people in England. Their research highlights that a desire for social and symbolic capital was a key motivator in adolescent drinking and that the accounts of young people revealed tacitly accepted rules to drinking and the strong influence of cultural norms. The authors take this analysis further and, drawing on the notion of ‘hysteresis’, argue that instead of focusing on interventions that address individual behaviours, public health policy should seek to disrupt the relationship between habitus, capitals and field through population based interventions that focus on the regulation and pricing and alcohol. The paper by Filippo Oncini and Raffaele Guetto focuses on diet and healthy eating, but this time their lens is Bourdieu's treatment of cultural capital. Their empirical work on school canteens and food policy in Italy utilises Bourdieu's distinction between institutionalised, embodied and objectified forms of cultural capital to suggest that class differences in the take up of healthy canteen food can be accounted for by measures of cultural capital. School canteen food can enhance children's diets and there is variation by mother's social class, but school canteen use does not counterbalance eating habits at home. They conclude that while healthy eating is driven substantially by cultural resources, economic capital may still play an important role in food choices and consequences follow for public health policies. Finally, the paper by Eeva Sointu brings Bourdieu to bear on medical education in the United States. Based on interviews with twenty seven medical students in five medical schools the paper focuses on distinctions made between ‘good’ and ‘bad’ patients. ‘Good’ patients where those who tend to have similar forms of cultural capital to the medics are seen to uphold biomedical knowledge and enable students to maintain their sense of becoming healers and experts. In contrast ‘bad’ patients tended to have different backgrounds, tended to question medical knowledge, to question the motives of the students and often did not comply with advice or treatment. Sointu extends Bourdieu's definition of cultural capital to cultural health capital which is viewed as a repertoire of skills and styles that can influence health interactions. The paper concludes that patients who share understandings with doctors tend to navigate medical encounters more easily but more importantly perhaps the author suggests that devices and forms of distinction and distancing based on notions of good and bad patients can be key mechanisms by which health inequalities are perpetuated. It is not possible to address the breadth and depth of Bourdieu's work in one section of a journal but we hope these papers provide a useful insight into how sociologists are mining the rich seam of his theoretical and empirical work to address important and varied aspects of medicine health and illness today. Simon Williams concluded his paper with the hope that it would serve as a catalyst for researchers to bring Bourdieu's work to bear on understandings of class and health. While many disagreements remain, we believe this special issue provides some evidence that the field is thriving.