MATERIALIST APPROACHES: HEALTH
AND SOCIETY
“It’s Not the Germs!”
• Etiology – disease causation
– Germs, nature, society, individual factors, supernature
• Ethnoetiology – local knowledge & practices
related to theories of disease causation
– Agents (personalistic): contextual (naturalistic)
– Internalizing (physiological/internal mechanisms):
externalizing (events outside the body/external
pathogenic agencies)
The Blane Report (1977)
• 4 explanations for patterns of inequality in
health
– Statistical Artefacts: modes of measurement
– Outcome of natural or social selection (?)
• Health experience upward mobility & unhealthy
downward
– Behavioral or cultural practices
– Class and health are linked by structural factors
MATERIALIST/STRUCTURALIST
• Emphasizes social, political, economic factors
which adversely affect health
• Forms of social/econ./pol. org., environment,
health services, transport, economic conditions,
work practices
• We are born into society with a ‘material
structure’ (ascribed status?)
– ‘shapes us’
• Social org. rather than individual biology
• Foundation for health
inequalities/disparities/population health
approaches
SOCIAL STRUCTURE, MOBILITY,
HEALTH
• Social mobility affected by health
• Does not protect against class-based health backgrounds
(ascribed status & health)
• “individual lifestyle factors” & the social basis of behavior
• Materialist explanations: link social inequality with
biological
• Stress & class/ethnicity/gender inequality
– Stress & diabetes
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Environment & health
Occupation & health
Food/nutrition & social inequality
Housing & health
Social class?
• How to define?
– Occupation, income & wealth, prestige, education, residence, ethnicity,
gender, age, ?
• The adjective “Class” – descriptive (many historically anchored)
– collectively organized actors (from kinship to caste to class)
– 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
• Class formation – the formation of collectively organized actors
• Class consciousness – the understanding of actors of their class
interests
• Class struggle – the practices of actors for the realization of their class
interests
– In contest
• Interrelationships of all these
How do we know social classes exist?
• 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
• 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 or “class”
Capitalism, class, health care
• Profit & safety; accident & industrial organization
– Not psychological characteristics of the individual
• Disease explanations & superstructure (culture & ideology)
– Legitimates status quo as agent of social control
– equates hospital care & consumption of drugs as health care
– reproduces capitalist class social structure
• Political economy & medicine
– Capitalist societies & medicines (profession, technology,
medications)
– A class project (struggle) – realization of collective interests
– Links economy & politics
– Class based monopoloy & profit
• Medical profession central to the control of labor
“health defined”
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Disease – abnormalities
Illness – experience of
Suffering – sickness episodes
Health?
– Ability to function
– Independence
– Both are crucial features of labor in capitalist society
• Medicine works to restore & remedy labor
disruptions
Liberalism, Neoliberalism, Health in
Capitalist Society
• Liberalism & welfare state capitalism
– Liberalism emphasizes individual rights and equality of opportunity
– Different forms of liberalism may propose very different policies
– Liberalism rejected many foundational assumptions that dominated most
earlier theories of government, such as the Divine Right of Kings, hereditary
status, and established religion
• Liberalism: two major streams of thought which compete over the use
of the term "liberal"
– Classical liberals: only real freedom is freedom from coercion
• state intervention in the economy as a coercive power that restricts the economic
freedom of individuals and favor a laissez-faire economic policy
• oppose the welfare state
– Social liberals: governments must take an active role in promoting the
freedom of citizens
• real freedom can exist only when citizens are healthy, educated, and free from dire
poverty
• Government ensures the right to an education, the right to health care, and the right
to a minimum wage.
Liberalism, Neoliberalism, Health in
Capitalist Society
• Structuralist basis of welfare state capitalism
undermined by decline of industrial sector &
globalization of capitalist investment strategies
• State policy now directed at control over costs
(rather than provisions) & quantity of health care
• Medicine caught between state & market
• From production to consumption as foundation
of class formation in capitalist society
Liberalism, Neoliberalism, Health in
Capitalist Society
• Neoliberalism
– move from a bureaucratic welfare-based society
toward a meritocracy acting in the interests of
business
– based on individual and economic liberty
• Health & health care consequences
– Individual centric
– Achieved health
• Class analysis?