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Journal of Health and Social Behavior 51(S)
improve an individual’s health status. While many
scholars are particularly interested in specific med-
ical
technologies, medical sociologists assert that
the delivery of health services is much more than
simply the application of scientific and technical
knowledge. Health care services are delivered by
people to people within various social environ-
ments, which can influence the way medical tech-
nology is delivered or received and, perhaps most
important, the clinical outcomes for people seeking
help. This review is necessarily selective. Our aims
here are to summarize a half-century of sociologi-
cal work and to call for
a renewed interest in the
sociology of health services. We conclude by out-
lining the policy implications of these findings for
future health reform efforts.
FINDINg 1. HEAlTH SERvIcES
IN AMERIcA ARE UNEqUAlly
DISTRIBUTED, cONTRIBUTINg
TO HEAlTH INEqUAlITIES
AcROSS STATUS gROUPS
One of the fundamental concerns of medical soci-
ologists over the past 50 years has been to docu-
ment and explain gender, socioeconomic, and
racial-ethnic differentials in health outcomes (see
Williams and Sternthal 2010 in this issue). Among
the early explanations for these patterns were dis-
parities in the distribution of health services among
social groups, and substantial attention was
devoted to documenting systematic differences in
access to health care. More recently, evidence has
emerged suggesting that the adverse impact of
health care disparities
on population health is
increasing, highlighting the need for additional
research (Lesser and Cunningham 1997). As a
result, sociologists have taken a renewed interest
and adopted a more complex and comprehensive
approach to health services research,
examining
the nature, quality, and timeliness of care received
under a variety of illness conditions.
Gender
Sociological research has documented significant
gender differences in help-seeking. Women are
more likely than men to visit a doctor for an array
of both physical and mental health problems
(Courtenay 2000; Green and Pope 1999; Kessler,
Brown, and Broman 1981). They are also more apt
to have a regular physician and to obtain preventa-
tive screenings (Bostick et al. 1993; Centers for
Disease Control 1998;
Powell-Griner, Anderson,
and Murphy 1997). However, men who do consult
a health professional may receive better treatment
than women for the same condition. The evidence
is particularly strong in the case of heart disease.
Women who present with symptoms of cardiac
disease are less likely to be referred for diagnostic
tests, given cardiac drugs, or instructed to make
lifestyle changes. Conversely, they are three to five
times more likely
to be sent home without any
treatment (Lockyer and Bury 2002; McKinlay
1996). These patterns delay diagnosis and contrib-
ute to higher mortality rates among women with
heart disease relative to men.
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