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
Sociology of health: medicine
• Focus on “medicine”
• Social aspects of medicine, health, disease
• Social factors shaping medicine
– Social structure
– Social labelling & social control
– Sick role
– Patient-doctor relationship
– Disease-illness distinction
– Medicalization
The social production of health
• Shift from disease focus of medicine
• Shift from focus on medicine
• Same emphasis on power, inequality, social
relationships/organization/structure
• Social characteristics play a predominant role
in determining sickness and health status
• Occupation related to health
• Social position: class, ethnicity, gender, age
• disease & feelings of sickness not determined
solely by underlying biology
Society and health
• Social relations of sickness which produce
forms and distributions of sickness in society
• Sickness is the process through which
worrisome behavioral and biological signs,
particularly ones originating with disease, are
given socially recognizable meanings resulting
in socially significant outcomes
• Sickness is a process for socializing disease
and illness
• The social order is embedded in medical
beliefs
Society and health
• choices & forms of medical interventions &
transactions are determined by sickness (not
illness or disease)
• Medicine continues to divorce disease from its
social relations of production
– Ignoring power differentials that originate and
reside in arrangements between social groups and
classes
• Symbols of healing are equated with power
• Medicine is an ideological practice
“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”
Critical Theory, Social Structure,
Medicine
• Questions about the neutrality/objectivity of
medicine, use of technology, science
• Ideology -- a system of shared beliefs that
legitimize particular behavioral norms &
values at the same time they claim & appear
to be based on empirical truths
• ideologies transform power (potential
influence) into authority (legitimate control)
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.
Health and society
• Relational
– comparing the health status of different population groups
within…
– social, economic and environmental conditions and marked
disparities among population groups;
– To see health in its social context is to look beyond the limits of
medicine as we know it, to a much wider set of questions that
engage social, cultural, political and moral aspects of human
experience;
– the ways in which globalizing economies shape both illness and
health care;
– the role played by social forces and cultural change in shaping
individual well-being.
• Process – meaning and action