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Cockerham2005 PDF
Cockerham2005 PDF
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What is This?
An important but undeveloped area of theo- agency accentuate the capacity of individual
retical discourse in medical sociology pertains actors to choose their behavior regardless of
to the relative contributions of agency and struc- structural influences. When applied to health
ture in determining health lifestyles. Medical lifestyles, the question is whether the deci-
sociologists have paid little attention to the sions people make with respect to diet, exercise,
agency-structure problem, yet it is clearly central smoking, and the like are largely a matter of
to theoretical discussions of health and lifestyles individual choice or are principally shaped by
(Pescosolido, McLeod, and Alegra 2000; structural variables such as social class position
Williams 1995). No contemporary theoretical and gender?
perspective denies that either agency or struc-
ture is unimportant; rather, the debate centers
on the extent to which one or the other is THE NEED FOR A
dominant. Proponents of structure emphasize HEALTH LIFESTYLE THEORY
the power of structural conditions in contouring
individual dispositions and behavior along It is the purpose of this article to examine the
socially prescribed lines, while advocates of agency-structure debate as a framework for
constructing a health lifestyle theory. No such
theory currently exists. The need for a health
* An earlier version of this article was presented at
the 2003 American Sociological Association meeting
lifestyle theory is underscored by the fact that
in Atlanta, Georgia, and the 2004 joint meeting of the many daily lifestyle practices involve consid-
European Society of Health and Medical Sociology erations of health outcomes. Perhaps this is truer
and the Italian Society of Health Sociology, Bologna, today than in the past. Whereas people may have
Italy. The author would especially like to thank more or less taken their health for granted in
Michael Hughes for his considerable insights previous historical eras, this is presently not the
concerning this article, along with Mark Tausig and case. Health in late modernity has become
three anonymous reviewers for their comments on an
viewed as an achievementsomething people
earlier version. Address correspondence to William
C. Cockerham, Department of Sociology, Univer- are supposed to work at to enhance their quality
sity of Alabama at Birmingham, 237 Ullman Building, of life or risk chronic illness and premature death
1530 Third Avenue South, Birmingham, AL 35294- if they do not (Clarke et al. 2003). According to
3350 (email: wcocker@uab.edu). Giddens (1991) and Turner (1992), lifestyle
Downloaded from hsb.sagepub.com at UNIV OF PITTSBURGH on June 21, 2014
51
#2102Jnl of Health and Social BehaviorVol. 46 146105-cockerham
vidual choice, but to a large extent depended Elsewhere, in Russia and Eastern Europe,
upon a persons social and material environment middle-age male members of the working class
for its success. Other research in Britain also have been identified as the major social carriers
found major distinctions in the health lifestyles of a particularly unhealthy overall lifestyle
of the various classes, with less positive lifestyles featuring heavy alcohol consumption and binge
practiced the lower the rung a person occupies drinking, smoking, high fat diets, and an absence
on the social ladder (Adonis and Pollard 1997; of exercise (Cockerham 1997, 1999, 2000b;
Jarvis and Wardle 1999; Reid 1998). A decline Janec^kov 2001; Ostrowska 2001). This lifestyle
in smoking, for example, has been far greater pattern, associated with traditional male social-
among the affluent, but very little change has izing and limited life opportunities, is norma-
been observed among the British poor (Jarvis tive for many men. The result is high levels of
and Wardle 1999). premature male mortality due to increased heart
William C. Cockerham is professor of sociology, medicine, and public health and co-director of the
Center for Social Medicine at the University of Alabama at Birmingham. He is the 2004 recipient of the
universitys Ireland Prize for Scholarly Distinction.