HEALTH (ILLNESS AND MEDICINE)
AND SOCIETY
Medicine as a Cultural System
• all human groups develop some set of beliefs,
patterns of thought, perceptions consistent
with their cultural systems for defining &
conceptualizing disease
• all societies have medical practices and beliefs
based on theories of diseases & disease
causation with an internal logic of their own,
and should not be dismissed as bizarre,
esoteric, illogical, & irrational bits and pieces
of belief & practice in exotic cultures
Medicine as a Social System
• all human groups develop methods & allocate roles congruent with
their resources & structures for coping with or responding to
disease
• norms governing choices and evaluations of treatment - the types
of treatment they believe in, and to whom they turn if they do
become ill
• social statuses, roles, power relationships
– patients & healers - basic components of health care system
– embedded in specific configurations of cultural meaning and other
social relationships
• interaction settings - clinic, hospital, with healer, family, society-atlarge
• institutions related to health and healing
Local Health Care Systems
• The health care system is a concept and an
entity
• The models of and for health care systems
• Models for -- the structure that underlies the
Models of – the many manifestations
– derived by the researcher
– by examining how people think about health care,
the ways people act in it and use its components
Local Health Care Systems
• health care as a system that is social and cultural
in origin, structure, function, and meaning
• Health care systems are forms of social reality
• Clinical practice occurs in and creates particular
social worlds – clinical reality
– the health related aspects of social reality – attitudes
and norms concerning sickness, clinical relationships,
and healing activities
Hierarchies of Resort & Medical Pluralism
• agency - "patients... are reflective actors who
review information about health and illness
and make decisions based on what makes
sense given their experience of bodily
changes, the framework of their prior
knowledge, and the everyday life situation in
which illness is lived and treatment is used."
Materia Medica:
Therapies & Medicines
• Transformative power put to different purposes
– From therapeutic to toxic
– Simultaneous noxious & beneficial
• Material things used intentionally to achieve and
effect in some body
• change minds, situations and modes of
understanding
• Material things that have social lives and cultural
biographies
• Material things that have the power to transform
bodies/minds – the significations of efficacy
Medical Pluralism and the Cultural
• Richard Fox - culture is in a constant state of becoming/inthe-making
• unitary set of rules & meanings continually are in-themaking through oppositions & struggles among groups,
where groups themselves & the rules that regulate their
interactions only develop in the process of ongoing social
relations
• culture often is taken as a constant & long - lived cultural
pattern, a coherent set of cultural meanings is only a
momentary & localized product of human action &
contest, culture always "is," but it has always just become
so
Medical Pluralism and the Cultural
• "culture as... the fabric of meaning in terms of
which humans interpret their experience and
guide their actions... "man is an animal
suspended in webs of significance he himself
has spun, I take culture to be those webs, and
the analysis of it to be therefore not an
experimental science in search of law but an
interpretive one in search of meaning."
ANTHROPOLOGIES OF THE BODY
• Scheper-Hughes & Lock – “the mindful body”
• Phenomenology & embodiment
• Bourdieu – Structure, habitus, practice
Scheper-Hughes & Lock: anthropology of
the body
• “The body as simultaneously a physical and symbolic
artifact, naturally and culturally produced, anchored
in a particular historical moment”
• Four bodies – individual body, social body, and body
politic, the mindful body
• separate but overlapping units of analysis
– different theoretical approaches
– phenomenology, structuralism and symbolism, poststructuralism (practice theory – structure & agency)
The Individual Body
• lived experience of the body-self, body, mind,
matter, psyche, soul
The Social Body
• representational uses of the body as a natural
symbol with which to think about nature,
society, culture
The Body Politic
• regulation, surveillance, & control of bodies
(individual & collective) in reproduction &
sexuality, in work & leisure, in sickness & other
forms of deviance
The Mindful Body
• the most immediate, the proximate terrain
where social truths and social contradictions
are played out
• a locus of personal and social resistance,
creativity, and struggle
• emotions form the mediatrix between the
individual, social and political body, unified
through the concept of the 'mindful body.'
SOCIAL STRATIFICATION
• the unequal distribution of goods and
services, rights and obligations, power and
prestige
• all attributes of positions in society, not
attributes of individuals
• universality of stratification
Stratification & Status
• status - ascribed & achieved
• ascribed status - social positions that people
hold by virtue of birth
• achieved status - social positions attained as a
result of individual action
• shift from kin based societies to modern
society involves growth in importance of
achieved status
Elements in Social Stratification
• Roles -- tasks & activities that a culture assigns
to people
• Stereotypes -- oversimplified strongly held
ideas about the characteristics of people
• Stratification -- unequal distribution of
rewards (socially valued resources, power,
prestige, personal freedom) between people
reflecting their position in the social hierarchy
Stratified Society
• stratification means
– there are significant breaks in the distribution of
goods services, rights, obligations, power prestige
– as a result of which are formed collectivities or
groups we call strata
Class Society
• Unequal access to all 3 advantages, economic
resources, power, prestige
• Open & closed class systems
– the extent to which mobility occurs allowing people to
pass through inequalities
• Closed system
– No mobility
– tend to persist across generations
• Open system
– ease of social mobility permitted
Caste Systems
• caste systems
– closed, hereditary systems of stratification often dictated
by religion
– hierarchical social status is ascribed at birth, people locked
into their parents social position
– legal & religious sanctions, occupation, commensality
applied against people who seek to cross them
• apartheid - caste like system, legally maintained
hierarchy based on skin color (the color bar)
Open Class Systems
• facilitates mobility
• individual achievement & personal merit
determining social rank
• hierarchical social status is achieved on the basis of
people's efforts
• ascribed status (family background, ethnicity, gender,
religion, skin color) less important
• blurred class lines & wide range of status positions
Ascribed Status & Open Class Systems
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•
•
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Phenotype
Age
Gender
“Race”
Age & Social Stratification:
Age as “difference”
• AGE-SETS, AGE GRADES, AGE MATES
• differentiation of social role based on age
• Age sets are a type of sodality
– nonresidential groups that cut across kinship ties and thus
promote broader social solidarity
• Age grades may be marked by changes in biological state,
such as puberty
– Or by socially recognized status changes such as marriage, the
birth of a child, menopause, retirement
• Persons of junior grade may defer to those of more senior
grade who in turn teach, test, or lead their juniors.
AGE & CULTURE in N. AMERICA: AGESETS/GRADES & THE LIFE-CYCLE
• Age Sets
– ‘Childhood’
– ‘Youth’
– ‘Middle-aged’
– ‘Elderly’
• Age Grades/Classes & Social Power
– Elderly & children – dependent
– Youth & Middle-Age – independent
• economic, political, social power
– Elderly -- dependent
AGE CLASSES
• The social production and cultural
construction of age & aging
• In class and state formation people’s functions
in the division of labor come to be discernible
with reference to categories of gender, age,
and skill abstracted from their particular
kinship connections and meanings
AGE CLASSES
• Where people become identified
independently of kinship as a constituent of
class for example, biological differences or
functions as defined in the culture rather than
social identities become increasingly
important
AGEISM
• "ageism" -- like other forms of bigotry such as
racism and sexism
• a process of systematic stereotyping and
discrimination against people because they
are old.
• any prejudice or discrimination against or in
favor of an age group
AGEISM in NORTH AMERICA
• Older persons are constantly "protected" and their thoughts
interpreted.
• Older persons falter for a moment because they are unsure of
themselves and are immediately charged with being 'infirm.‘
• Older persons forget someone's name and are charged with senility
and patronized.
• Older persons are expected to 'accept' the 'facts of aging.'
• Older persons miss a word or fail to hear a sentence and they are
charged with 'getting old,' not with a hearing difficulty.
• Older persons are called 'dirty' because they show sexual feelings or
affection to one of either sex.
• Older persons are called 'cranky' when they are expressing a
legitimate distaste with life as so many young do.
• Older persons are charged with being 'like a child' even after society
has ensured that they are as dependent, helpless, and powerless as
children."
The “Dark Age”
• intensified by certain dominant values in
American culture
– individualist tradition
– Independence & dependence
– productive achievement
AGEISM, Social Mobility & Open Class System
• Ascribed status of age
• Achieved status and aging
– Viagra
– Working
“SOCIAL FORCES AND PROCESSES
EMBODIED AS BIOLOGICAL EVENTS”
THE CRITICAL PERSPECTIVE
• Paul Farmer:
• “Inequality itself constitutes our modern
plague – inequality is a pathogenic force”
• “Social inequalities often determine both the
distribution of modern plagues and clinical
outcomes among the afflicted”
Life Expectancy & Ethnicity in the US
Canada, Health, & Inequalities
Non-Medical Determinants of Health
• In First Nations communities only 56.9% of homes were
considered adequate in 1999--00.
• 33.6% of First Nations communities had at least 90% of
their homes connected to a community sewage disposal
system.
• In 1999, 65 First Nations and Inuit communities were
under a boil water advisory for varying lengths of time-an average of 183 days of boil water advisories per
affected community.
• Many communicable diseases such as giardiasis and
shigellosis (both acute infectious diseases characterized
by diarrhea, fever and nausea) can be traced to poor
water quality
Cultural Capital & Health
World-Wide Health Inequalities
WORLD SYSTEMS
World Systems (I. Wallerstein)
• A world-system is a social system
– one that has boundaries, structures, member groups, rules
of legitimation, and coherence.
• made up of the conflicting forces which hold it
together by tension and tear it apart as each group
seeks eternally to remold it to its advantage.
• a life-span over which its characteristics change in
some respects and remain stable in others.
• its structures -- at different times strong or weak in
terms of the internal logic of its functioning.