LIMPRINT: a sociological perspective on "chronic oedema"

Background: Chronic oedema is a condition that is biologically complex, distressing for patients and socio-politically weak. Like many other complex and chronic conditions, it has a low status within healthcare. The result is that it has a low priority in health policy and consequently is undervalued and under treated. While evidence based practice promotes a hierarchy of evidence, it is also the case that clinical practice is influenced by a hierarchy of social status. These are as much political as they are scientific. Methods: This paper will provide an explanation for why chronic oedema is a low priority. It will do this through a critical review of the literature. We examine this through the theoretical lens of Pierre Bourdieu. The sociology of Bourdieu frames an understanding of power relations through habitus, field and capital. We will employ these theoretical tools to understand the way that chronic oedema is situated within the policy arena. Results: We identify a number of social mechanisms that affect the status of chronic oedema including diagnostic uncertainty, social capital, scientific capital, cultural capital and economic capital. Conclusion: We argue that a whole system approach to care, based on human need rather than unequal power relations, is a pre-requisite for the delivery of good health care. The speciality of chronic oedema is not a powerless group and we identify some of the ways that the social mechanism, that acts as barriers to change, can also be employed to challenge them.