Abstract
The American health care system is broken. Despite spending more money on health care than any other industrialized nation, the U.S. ranks among the lowest in many indicators of health care quality. Social Movements and the Transformation of American Health Care offers a glimpse into this complex system, highlighting the diverse issues and actors promoting change. The volume is diverse not only in the range of issues explored but in the perspectives from which these issues are examined. This edited volume consists of 16 chapters authored by scholars from fields ranging from medicine and health policy to sociology, history, and political science. As with any edited volume incorporating such diversity, the task of linking the studies together in a coherent framework is a challenge. In this regard, the editors must be commended for their adroit ability to provide an integrating framework that connects and synthesizes the distinct chapters. Much of this success can be attributed to a thoughtful introductory chapter that develops a multi-institutional framework that is reinforced throughout the volume in editorial introductions preceding each section and revisited in a synthesizing concluding chapter.
The book is structured in four main sections, each covering different aspects of health care movements. The first section consists of a series of five chapters that look at a familiar subject: social movements engaging in collective action targeted at the state. Although the study of movements targeting the state is well-trodden ground, many of these chapters move beyond prior work by incorporating a broader concept of social movements that considers loosely organized coalitions and interest groups. This more encompassing view is maintained throughout the book, including subsequent chapters that highlight the important role of coalition building among both elite and lay activists inside and outside of the establishment.
Although I enjoyed the first section, I found the subsequent three sections to provide a more theoretically novel perspective on movements by moving away from the focus on state-centered activism. For example, section 2 considers how social movements simultaneously are influenced by and seek to influence the institutional environment. Authors of the chapters in this section are careful to consider institutional fields not as homogenous settings characterized by a single dominant logic but as diverse fields composed of multiple actors and competing logics. A welcome dimension highlighted by Brown and colleagues (chap. 7) is the importance of considering the history of movements and how their structure and mission evolve over time with their environment. They also make use of policy ethnography to consider the multiple perspectives, sectors, and issues that vary over time and across multiple phases of mobilization.
Section 3 focuses on the role of professionals in social movements. Professionals have been called the “preeminent institutional agents of our time” (Scott, 2008: 219), yet studies of social movements often overlook the important role of professionals by focusing on outsiders and non-elites. Given the status of professionals, their central position in the field, and their unique access to resources, these chapters provide needed attention to a set of actors that are instrumental in crafting institutions. An interesting question raised in this section is how do professionals reconcile their role in changing the very institutions they have a vested interest in maintaining? Frickel (chap. 11) addresses this question by developing a concept of “shadow mobilization” in which experts engage in activism through loosely organized networks in which their actions are less visible to public view. By providing a sense of invisibility, these mobilization structures provide cover for vulnerable experts who risk sanctions and reprisal if their activism is made known. Archibald (chap. 14) proposes a similarly thought-provoking question, by asking “how . . . do health social movements acquire legitimacy to foster social change from their adversaries who are invested in preserving the status quo?” Using the case of the self-help movement, Archibald shows that the institutional fragmentation of the field allowed activists to draw on multiple sources of legitimacy and engage with a diverse set of sympathetic actors to simultaneously seek approval from the field and challenge its authority.
The final section looks at culture and legitimacy in health care. These chapters investigate how collective action can be marshaled in challenging the cultural meanings that shape our perception of health care. Cultural beliefs about diseases influence not only medical funding decisions and treatment options but also how we view the very individuals who suffer from those diseases. The chapters in this section investigate how social movements have shaped the cultural meaning of health-related issues such as climate-induced illness and postpartum psychiatric illness. Snow and Lessor (chap. 17) argue that effective health care relies on shared cultural understandings of health problems and agreed-upon methods for treating those problems. Through an examination of several cases, they demonstrate how inconsistencies in shared understandings, or “framing hazards,” create problems for doctors and other medical professionals in providing effective treatment.
This volume is a treasure chest of rich case studies illuminating the complex issues and multitude of actors shaping American health care. For readers looking for rigorous empirical studies utilizing formal statistical analysis or groundbreaking contributions to extant theory, this is likely not the book for you. That being said, these chapters do provide a wonderful collection of studies full of thoughtful nuggets that contribute not only to our understanding of health care movements but also to our knowledge of social movements and organizations more generally. I found several recurring themes throughout the volume to be particularly valuable. First, the articles highlight the need to study different levels and dimensions of health care movements as well as the historical evolution of movements and institutions. I also appreciated the attention paid to the battles that play out between movements and their allies and opponents. Related to this point, a running theme throughout the volume is that in the field of health care, effective change efforts require coalitions that bring together elites, experts, and insiders working together with lay people and outsiders. In this way, these studies take a more encompassing view that blurs the distinction between social movements and interest groups in a way that seems appropriate if we are to understand contemporary social movements.
Overall, I highly recommend Social Movements and the Transformation of American Health Care. This volume not only provides timely insights into some of the most critical challenges facing American health care, it also makes a meaningful contribution to the recent theoretical progress achieved by integrating the perspectives of social movements and organization theory (Davis et al., 2005). Although the chapters in this book do not provide a prescription to remedy American’s broken health care system, they do enlighten our understanding of this complex system and the challenges associated with changing it.