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Section 2. Hospitals as social institutions

The social role of hospitals extends far beyond their function in the treatment of patients and has been the subject of some of the best-known work in the sociology of healthcare. To a large degree, the current social role of hospitals reflects their historical development over time, which – it has been argued - passed through four phases (Cockerham, 2014):

  1. Centres of religious practice: many of the earliest hospitals were established by religious orders, and treatments administered by monks, nuns and members of the clergy. A primary function of these establishments – besides the treatment of patients – was the extension of charitable and welfare services to those in “need”;
  2. Poorhouses: the secularisation of hospitals during the Renaissance led to a change in their role beyond simply treatment, to provision of food and shelter to the poor;
  3. Death houses: the development of medical knowledge and technology from the 17th century onwards spurred a change in the way hospitals operated and a rising role for physicians within them. By the 19th century they had adopted their present role as institutions for the provision of medical care, but conditions were often unsanitary and clinical outcomes poor;
  4. Centres of medical technology: by the end of the 19th century, hospitals were regarded as places where individuals of all social classes could receive high quality medical care (provided an ability to pay for that care).

Advances in hospital medicine have not been without disadvantage, however. One of the principal theoreticians of hospitals’ modern social function and its potentially detrimental effects was the sociologist, Irving Goffman. Goffman described hospitals as “total institutions” (referring in particular to asylums for those with mental health problems, but also to hospitals more generally), in which people were isolated from society over a period of time and led life an in enclosed and formally administered way (Goffman, 1968). He argued that, as a result of this experience, people often formed new relationships and attachments dependent on these institutions (i.e. underwent a process of “institutionalisation”) that could make re-integration into the community on discharge very difficult. Goffman’s contention was that medicine – through its reliance on hospitals – was complicit in this process of institutionalisation, which could be quite damaging for individual wellbeing.

Positive social functions of hospitals are understood to include, first and foremost, their role as employers. Hospitals are often among the largest single employers in any given area (of both clinical and non-clinical staff). They also contribute to the local economy as large-scale purchasers of healthcare-related products, services and other goods (food and drink for example). Finally, they perform an important function as a resource for the wider community: function rooms on hospital sites may be used for public meetings; and sports grounds may be opened to the public (among other examples).

However, hospitals also bring with them a number of negative impacts. First, they can be major direct, and indirect polluters of the environment. Directly, hospital sites produce large volumes of clinical waste that are difficult to dispose of by conventional methods. Much of it must be incinerated. Indirectly, hospitals contribute to pollution through the impact of transport to and from work by staff. Secondly – in line with Goffman’s theory above – they can function as agents of isolation and exclusion for patients from the wider community.


© I Crinson 2007, S Ismail 2017