JasonBeckfieldPolitical Sociology and The People's HealthNew York: Oxford University Press, 2018. 173 p. $29.95 (hardcover)

Abstract

This book is part of a series titled Small Books with Big Ideas and it certainly lives up to this title. Over the past two decades, health disparities research has received significant attention in the field of public health, including special funding from the US National Institutes of Health. Much of this research has generated useful data documenting differences in morbidity and mortality, according to race and ethnicity, social and economic status, sex, and age. Instead of adding to this compendium of health disparities, this book focuses on the nature of the social organization that shapes, and public policies that may ameliorate, them. The first chapter identifies key concepts in political sociology—such as institutions, polity, nation states, and political economy—and examines ways in which race, gender, and social class interact with them. Trends in unionization and the way in which the strength of unions affects the collective bargaining power of workers—and thereby affects relative economic status of workers and access to health care—provides an interesting example. The second chapter provides more concrete examples of the way in which institutional and political process translate into population health. It argues that disease is distributed unequally within populations according to socioeconomic position (SEP), even after controlling for the many behavioral and other factors that affect health and are also—variably across institutional contexts—correlated with SEP, like diet, exercise, smoking, excessive drinking, and health care access. The Whitehall study provides a perfect illustration in which the health of male public employees is strongly related to their position. All civil servants had access to the British National Health Service, equalizing health care access, but in spite of controlling for usual behavioral suspects (cholesterol, smoking, exercise, and other factors), civil servants in lower positions were two to four times as likely to die of heart attack as upper-level civil servants. Since position in British civil services are linked to socioeconomic class of origin, this health gradient is seen as a result of childhood health conditions. The third chapter identifies some of the challenges faced by the field by trying to empirically link institutional and political stratification with health outcomes to develop policies for addressing health disparities. The broad schema presented in the book is useful for scholars in various fields but particularly those studying health disparities. It focuses on five key processes: redistribution (shifting social determinants of health like income and wealth); compression (institutional arrangements that provide health care directly, thereby lowering rates of the most common illnesses); mediation (institutional arrangements that reduce educational inequality); imbrication (the overlap among safety net policies across different age groups and political defined populations); and selection (policies that make it more or less likely that this category of people will have been selected from some social origin over others). If the goal of the book was to present big ideas in a small package, it undoubtedly succeeds. It covers vast terrain in the landscape of political sociology and tries hard to provide some concrete examples. However, this also makes it somewhat dense and adding some empirical examples would have strengthened its impact. Nonetheless, it is clear that this book is destined to be a key text for students of health disparities.