Research on health and illness has, in the main, taken an implicit approach to historical context. This paper suggests that sociologists should adopt a more explicitly historical framework. In particular, it is argued that explanations of social change should be based on a realist philosophy of social science. Historical sociology is seen to be relevant here because it emphasizes the conception of social structuring as a process in time. The paper traces the definitions and lineages of historical sociology and recent developments in the field. It then moves on to consider the theoretical and methodological strengths of historical sociology. The paper then argues, in the wake of Abrams (1982), that the subject matter of historical sociology is highly relevant to the study of health and illness in four key areas of focus; (i) transitions, for example, from industrialism to post-industrialism and from organized to disorganized capitalism, (ii) micro-histories, for example, studies of the process of becoming ill and studies of life-histories and small-scale interactions in the context of illness, (iii) the development of state and welfare policy in the context of social change, (iv) models of power relations as explanations for social continuity and change. The paper makes a modest attempt to outline the possibilities of addressing these areas of concern and concludes by suggesting that a key to the understanding experiences of health and illness in late modern society is the operation of power at different interacting levels. Using the past only as wallpaper for research may still produce individualistic accounts of health and illness. An approach that takes account of the large-scale historical structures may be the antidote to this tendency.