The striking stability of disease prestige rankings
Department of Sociology and Human Geography University of Oslo Oslo, Norway
Investigations have shown that the prestige of diseases is ordered hierarchically. These results have been attributed to characteristics of the diseases, their typical treatment and their typical patients. Diseases associated with technologically sophisticated, immediate and invasive procedures in vital organs located in the upper parts of the body are given high prestige scores, especially where the typical patient is young or middle-aged. At the other end, low prestige scores are given to diseases associated with chronic conditions located in the lower parts of the body or having no specific bodily location, with less visible treatment procedures, and with elderly patients. Prestige differences is of sociological interest in itself as an aspect of medical culture, and also because prestige can affect informal decisions on allocation of resources in health care systems.
The paper discuss data from two cross-sectional surveys of disease prestige done in 1990 and 2002 with the same type of sample of Norwegian doctors and using the same questionnaire. Outcome measures were ratings on a 1-9 scale of the prestige these respondents believed most health personnel would accord to a sample set of 38 diseases. There were only minor differences in results between the surveys. This stability was unexpected, as there have been some changes in therapeutic practice over these years.
The paper aims at explaining the found stability. Findings in the first survey were much discussed in Norwegian medical settings, and it is necessary to ask whether this may have influenced answers in the second. Another question about research methods concerns the validity of data given by the opinion poll research design. Results are further compared to those of other studies of informal evaluations of medical practice and linked to theories of prestige and related concepts such as symbolic capital, cultural status and stigma. Changes in treatment in the period between the surveys are taken into account. The paper?s conclusion is that the pattern of informal evaluation of diseases is so solidly ingrained in medical culture, that only major changes in medical practice can affect it.