Keeping social sciences in the MRC family
Scientific discoveries don’t improve human health by themselves — we must understand their social significance, says Sally Macintyre as she prepares to leave her post as Director of the MRC/CSO Social and Public Health Sciences Unit.
In a few weeks I’m stepping down as director of the MRC CSO Social and Public Health Sciences Unit after 30 years. Although I’m looking forward to handing over the directorship (five five-yearly reviews from MRC Head Office is quite enough), I look back with great affection on the MRC. The MRC has supported me in one way or another since 1970, when it funded my Masters course in “Sociology as applied to medicine”.
People are often surprised to hear that as a sociologist, I’ve been funded by the MRC for so long. They think the MRC only funds laboratory-based biomedical science — as exemplified by the MRC Laboratory for Molecular Biology — and clinical trials.
But the organisation has had a long-term interest in how social factors affect health and illness.
In 1948 it set up the Social Medicine Research Unit in London, under Jerry Morris, who led it until his retirement in 1975. He made a major contribution to the development of social epidemiology — the study of social determinants of health — and to research on the social inequalities that affect health. He had grown up in Glasgow and was aware of how the poverty he had observed there could have adverse consequences for health.
Another young man who grew up in Glasgow in the 1930s, the obstetrician Dugald Baird, later said: “the contrast between childbearing in the upper social classes and in the slum dweller set me thinking about social class differences in the whole field of reproduction and so my lasting interest in social research in the field of obstetrics began”.
Dugald was appointed as Regius chair of midwifery in Aberdeen in 1937. In 1948 he started seconding social scientists (sociologists, social workers, statisticians, psychologists and anthropologists) from Jerry’s unit, with funding from the MRC.
In 1955 these social scientists became the nucleus of a new research unit directed by Dugald, the MRC Obstetric Medicine Research Unit, and worked together with clinicians and physiologists to understand how social arrangements and living conditions influenced the survival and health of mothers and babies. Sir Harold Himsworth, then secretary of the MRC, frequently visited the Aberdeen unit, and took an interest in the development of sociology as applied to medicine.
When Dugald retired in 1965, the unit became the MRC Medical Sociology Unit under the head sociologist in Dugald’s unit, Raymond Illsley. With support from the MRC, this unit continued to address the important question: “By what routes, through what social processes, is social experience translated into health or illness?”
This question has continued to be relevant to all major public health issues, not just reproduction, and we’ve been addressing it in my unit since 1984, when I took up the directorship of the MRC Medical Sociology Unit, and moved it to Glasgow. The discoveries that tobacco smoking causes lung cancer, a retrovirus causes AIDS, or that cervical cancer is caused by a papillomavirus, do not by themselves improve human health. Human behaviours such as smoking, drug use, sexual activity and relationships, or uptake of screening do not change instantly in response to such discoveries.
Rather such behaviours are embedded in social relationships, and are subject to norms, values and social meanings, and the way we organise our society. If we are to improve population health and reduce inequalities in health, we need to understand these behaviours better, and how to change them.
We also need to understand that these behaviours are not a matter of simple or rational choices (“surely if we tell people to stop smoking, or to take more exercise, or have fewer babies, they will?”), and that research on social aspects of health and illness is therefore as important as studying the biological processes.
From time to time questions are raised about the MRC’s role in supporting health social sciences, and whether it should focus only on biological and clinical science. I think such a focus would be a mistake, and that the MRC has a key role to play in bringing together social, biological, and clinical sciences for the benefit of society.
Luckily, so far, the MRC has had the wisdom to agree. I’m delighted that it has decided to continue the work of my unit, and I wish my colleagues and successors well.
Sally Macintyre is also a member of the MRC’s governing Council.