Sociological Issues in Health and Wellbeing [70%, 2015]


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{CONTENTS: Introduction; Ken’s Statutory Sick Pay (SSP) entitlement; Ken – Employment and Support Allowance (ESA), Work Capability Assessment (WCA); WCA outcomes; Friedson – labelling theory and the sick role; WCA – history and changes; Ken – WCA in 2009 – ‘legitimate’ sickness; Ken – WCA in 2011 – ‘illegitimate’ sickness; Welfare-related deaths resulting from WCA changes; Right-wing media – attitude towards benefits claimants; Ken – reliance on Jobseeker’s Allowance; Hoschild and the ‘second shift’ (1989); Carol’s second shift; Hakim (2010) – women’s second shift is a myth; Feminisation of the medical profession – statistics and impact; Conclusion.}
With reference to the case study, Ken is a fifty-three-year-old lifelong building labourer, currently on long-term sick leave owing to back trouble. Increasingly worried about the family finances, Ken argues frequently with his wife, Carol. Carol is a forty-eight-year-old cleaner at a local school, who also works at a nearby hotel during the holiday season. She provides extensive childcare support, looking after her grandchildren on a daily basis. Carol regularly visits and helps her seventy-nine-year-old mother, Joan, relying on public transport to do so. Through a consideration of the current socio-political climate and the application of relevant sociological theory, this essay will examine labelling theory and the experience of illness and disability, as well as considering the gendered nature of formal and informal health work, relating these topics both to Ken and Carol’s individual circumstances and to society at large.[^]

Assuming that Ken has a contract of employment, earns at least £112 per week, and gave his employer a doctor’s ‘fit note’ seven days after becoming unfit for work, Ken is entitled to £88.45 per week in Statutory Sick Pay (SSP) for up to twenty-eight weeks, payable from the fourth day of his sickness (GOV.UK, 2015a).[^]

If Ken is still unable to work following the twenty-eight weeks of SSP, he will have to apply for Employment and Support Allowance (ESA) instead. Ken will undergo a Work Capability Assessment (WCA) while his claim for ESA is being assessed. The assessment period usually lasts thirteen weeks, during which time he will receive up to £73.10 per week (GOV.UK, 2015b).[^]

The result of his WCA will place him in one of two groups if his ESA claim is successful: the ‘work-related activity group’, where he will have regular interviews with an adviser and be expected to find new employment, receiving up to £102.15 per week while he searches for a job; or the ‘support group’, where he will not have such interviews nor be expected to find new employment, and will receive up to £109.30 per week. Recent changes to the WCA and the classification of ‘sickness’ are interesting from a sociological perspective.[^]

With recourse to labelling theory, Friedson (1970, cited in Nettleton, 2013) argues that the extent to which an individual is granted the privileges of the sick role is based on the socially-determined ‘legitimacy’ of the sickness. He distinguishes between three types of sickness legitimacy: unconditionally legitimate sickness, where the individual suffers from an incurable illness and cannot be expected to get better (for example, cancer); conditionally legitimate sickness, where the individual’s condition can be treated; and illegitimate sickness, where the individual’s condition is stigmatised by others, leading to the denial of the privileges of the sick role.

In Friedson’s conception of the sick role, an individual would be permanently released from employment obligations and receive substantial State support if suffering from an unconditionally legitimate sickness that is a ‘serious deviation’ from the healthy norm. In the current socio-political context, this automatic entrance into the sick role is no longer the case, as an examination of the history and changes to the WCA component of ESA will demonstrate.[^]

The WCA was introduced by the Labour government in 2008. All new claimants for disability-related benefits had to undergo a medical assessment in order to determine whether they were genuinely unable to work. Whether an individual was deemed as too sick to work- thus, legitimately sick- depended on them ‘scoring’ at least fifteen ill-health-related points during the assessment. The Conservative/Liberal Democrat coalition came into power in 2010, and dramatically tightened up the point-scoring sickness criteria (Read, 2011).[^]

If Ken had submitted his ESA claim in 2009, his self-completed ESA50 form, coupled with his doctor’s ‘fit note’ detailing Ken’s diagnosis, would have provided favourable evidence to support his ESA claim. Incapacitating back pain can reasonably be expected to impede his ability to: walk; stand and sit comfortably for long periods of time; kneel and bend; and comfortably use both arms to perform tasks of manual dexterity. All of these restrictions on his physical performance would have gained him points during a 2009 assessment (Department for Work and Pensions, 2015).[^]

However, in 2011 the following changes were introduced to the WCA that render it virtually impossible for an individual like Ken to successfully claim ESA: the ability to walk was replaced with the concept of ‘mobilising’ to take into account the possibility of wheelchair use; issues with standing or sitting were replaced with the broader ability to remain at a workstation; bending and kneeling functionality was removed from the assessment, since it was no longer deemed relevant to the modern workplace; and unilateral restriction of upper limb function was replaced with the category of bilateral upper limb restriction. Whereas in 2009 Ken’s back pain would have been labelled a legitimate disability, the changes made to the WCA in 2011 invalidate his claim and change its status to an illegitimate disability, barring him from the rights and privileges of the sick role.[^]

Changing focus from Ken as an individual to the disabled community at large, the WCA modifications also included more stringent criteria in regard to sensory function, continence, consciousness, and mental function. The stress of having to attend a WCA and deal with the subsequent ESA claim rejection has resulted in the exacerbation of serious conditions, leading to death either through ill health or suicide in a large number of cases. Seventy-one such welfare-related deaths are listed by JJ (2014), noting that individuals with the following conditions have been placed in back-to-work groups (conditionally legitimate sick role access) or had their ESA claim rejected entirely (illegitimate sickness): ‘complex mental health problems‘; blindness and agoraphobia; HIV and Hepatitis C, coupled with a history of severe depression and self-harm; double heart and lung transplant; awaiting major heart surgery (later dying of a heart attack one month after being found fit for work); paralysed down one side following a brain haemorrhage; schizophrenia (committing suicide two months after being found fit for work); partial amputee; grand mal epilepsy; breast cancer; a stroke, a brain haemorrhage and a fused leg; degenerative lung condition; ischaemic heart disease; cancer (found fit for work in 2012, before losing his eyesight, hearing, mobility and ultimately dying); Hughes Syndrome; a brain tumour and a heart defect, awaiting a transplant; Barrett’s Oesophagus; terminally-ill with pulmonary fibrosis; Addison’s Disease; and Fibromyalgia Syndrome.[^]

Labelling (or ‘societal reaction’) theory can also be drawn upon to explain the lack of a widespread revolt against this holocaust of the welfare-dependent. At the time of the 2011 WCA changes there was a widespread right-wing media drive towards painting benefits claimants in a negative light. Kirsty Walker (2011) describes claimants as ‘the shirking classes’ in the headline for an article that states that only one in fourteen claimants are genuinely unfit for work, with thirty-nine per cent actually fit for work. Typical of reports of this type, no mention is made of the restrictive WCA sickness criteria.

Similarly, the first series of Channel Four’s documentary Life on Benefits Street focussed on a narrow range of individuals claiming unemployment benefits who were engaged in petty criminal activities, leading the public to generalise this poor behaviour to everybody in receipt of benefits (Claire Hodgson, 2014). Conversely, the second series was delayed until after the 2015 election as its focus on families struggling to survive on the benefits they received could have influenced the electorate (Jeremy Armstrong, 2015).[^]

As Ken’s ESA claim is almost certain to be rejected in the current socio-political climate, he will have to rely on Jobseeker’s Allowance (JSA) for financial support. If we assume that Ken managed to work for twenty-six weeks at a rate of pay at least equal to the lower earnings limit in one of the previous two tax years, and paid sufficient Class 1 National Insurance Contributions during those years, Ken will be entitled to up to £73.10 per week in JSA (GOV.UK, 2015c). Given this level of financial assistance, and considering the stress incurred during the claim process, it is unsurprising that Ken frequently argues with his wife.[^]

A further source of contention between Carol and Ken could be Carol’s dissatisfaction with the division of responsibility between herself and her husband. Hochschild (1989) coined the term ‘second shift’ to describe the life of women who work one shift in full-time employment and a second shift working for the benefit of children, husband, and home. Analysing the existing major studies on time use, Hochschild found that such women work approximately fifteen hours longer than men per week, taking into account the demands of paid employment, childcare, and housework.

Following intensive interviews with fifty couples and extensive observations carried out in a dozen homes, Hochschild concluded that women: do two-thirds of the daily jobs at home; have to juggle the competing demands of employment, childcare, and household chores, as opposed to the male juggling of employment and childcare; do far more of the undesirable household chores; and spend more time in maintenance, feeding, and bathing provision, while men do more ‘special activities’, such as taking the children on day trips. As a result, women were far more likely to report feeling overtired, emotionally-drained, sick, and sleep-deprived.[^]

As a female who both works and fulfils the majority of domestic caring activities, Carol is living a permanent ‘second shift’. It is reasonable to assume that the time gap between Carol’s life of responsibility and Ken’s life on long-term sick leave is far greater than Hochschild’s postulated fifteen hours per week. The case study states that Carol is constantly exhausted owing to the pressures of work and family, a report in line with Hochschild’s above-mentioned conclusions.[^]

However, it could be argued that Ken and Carol’s circumstances are not representative of the average European couple. Hakim (2010), drawing on extensive time budget studies, declares that women’s ‘second shift’ is a myth. She finds that both men and women across Europe spend approximately eight hours per day in productive work activities, with men spending substantially longer in paid employment and women dividing time more equally between paid and unpaid jobs. These figures hold true for couples aged between twenty and forty, as well as those (like Ken and Carol) aged between forty and sixty.[^]

Moving from the provision of informal health work to gender issues in the formal healthcare sector, Thomas (2014) highlights the fact that by 2017 there will be more female than male doctors in the United Kingdom. Citing statistics provided by the General Medical Council, Thomas states that sixty-one per cent of doctors under the age of thirty are female, declaring that this will have a detrimental effect on the National Health Service since female doctors tend to end up working part-time in order to accommodate family life, before taking early retirement. He believes that it is necessary to train two female doctors to cover the same amount of work undertaken by a male colleague. Since Borland (2014) states that it costs the taxpayer up to £610,000 to train a doctor, it is clear that the feminisation of the medical profession is a financially-expensive social trend.

The increasing number of women working part-time in general practice will continue to have a negative impact on individuals like Ken and Carol in terms of continuity of care. As noted by Freeman and Hughes (2010), the majority of patients dislike having to repeat their medical history to different doctors, preferring to establish a close doctor-patient relationship with a single general practitioner whom they trust to treat them in a consistent manner.[^]

In conclusion, dramatic changes in the socio-political climate during the past five years have resulted in a far more negative experience of illness and disability for individuals like Ken. Not only do members of the disabled community have to deal with crippling physical and mental conditions, they have to do so in an increasingly unsympathetic, almost hostile, society, in which labelling theory has been employed by right-wing media to stigmatise individuals unable to work and justify the illegitimation of sickness. Sick individuals frequently receive discontinuous care as a result of the rise in part-time general practitioners, stemming from the feminisation of the medical profession. Although there is no longer a gap in productive work hours between the male and female members of an average European couple, the medical profession is representative of the fact that women spend longer in unpaid caring activities related to childcare and housework, while men are engaged in longer hours of paid employment. Carol’s unremitting ‘second shift’ existence is an unfortunate and unrepresentative deviation from the modern-day European norm.[^]


Armstrong, J., 2015. Benefits Street delayed in case ‘poverty porn’ influences General Election voters. Daily Mirror, [online] (Last updated 22:00 on 6th April 2015). Available at: [Accessed 18 May 2015].

Borland, S., 2014. The doctors’ exodus: They cost us £610,000 to train – but 3,000 a year are leaving us for a life in the sun in Australia and New Zealand. Daily Mail, [online] (Last updated 07:59 on 8th October 2014). Available at: [Accessed 18 May 2015].

Department for Work and Pensions, 2015. Work Capability Assessment (WCA) handbook. [pdf] London: Department for Work and Pensions. Available at: [Accessed 18 May 2015].

Freeman, G., and Hughes, J., 2010. Continuity of care and the patient experience. [pdf] London: The King’s Fund. Available at: [Accessed 15 May 2015].

GOV.UK, 2015a. Statutory Sick Pay (SSP). [online] Available at: [Accessed 18 May 2015].

GOV.UK, 2015b. Employment and Support Allowance (ESA). [online] Available at: [Accessed 18 May 2015].

GOV.UK, 2015c. Jobseeker’s Allowance (JSA). [online] Available at: [Accessed 18 May 2015].

Hakim, C., 2010. (How) can social policy and fiscal policy recognise unpaid family work? Renewal: a Journal of Social Democracy, 18 (1-2). pp. 23-34.

Hochschild, A., and Machung, A., 1989. The Second Shift. New York: Penguin Books.

Hodgson, C., 2014. Benefits Street slammed by senior MP for being a “misrepresentation” of life on benefits. Daily Mirror, [online] (Last updated 12:12 PM on 10th January 2014). Available at: [Accessed 18 May 2015].

JJ, 2014. UK Welfare Reform Deaths ~ Updated List ~ October 21st 2014. Black Triangle Campaign, [online] Available at: [Accessed 18 May 2015].

Nettleton, S., 2013. The Sociology of Health and Illness. 3rd ed. Cambridge: Polity Press.

Read, C., 2011. ATOS: Notes On A Neoliberal Scandal. New Left Project, [online] Available at: [Accessed 18 May 2015].

Thomas, J.M., 2014. Why having so many women doctors is hurting the NHS: A provocative but powerful argument from a leading surgeon. Daily Mail, [online] (Last updated 10:01 AM on 2nd January 2014). Available at: [Accessed 18 May 2015].

Walker, K., 2011. The shirking classes: Just 1 in 14 incapacity claimants is unfit to work. Daily Mail, [online] (Last updated 7:37 AM on 27th July 2011). Available at: [Accessed 18 May 2015].

Copyright 2016 Permission to use quotations from this sociological essay is granted subject to appropriate credit being given to Chris Larham and as authorial and website sources, respectively.
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Forty-year-old father of three wonderful children [William, Seth, and Alyssa]. Works as an Assistant Technical Officer in the Sterile Services Department of Treliske Hospital, Cornwall. Enjoys jogging, web design, learning programming languages, and supporting Arsenal FC. Obtained a BA degree in English from the University of Bolton in 2008, and has continued to gain qualifications in a diverse range of subjects thereafter.

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