Medical power
and the rise of surveillance
medicine
Week 15
Sociology of Health and Illness
Recap
• Thought about how health and illness are
structured by society
• Considered the power relationship
between patients and professionals
• Introduced the concept of the ‘sick role’
Outline
• Looking at how medical power and
knowledge shape our understanding of
bodies
• Consider the concepts of medicalisation
and biopower
• Consider how surveillance medicine forms
part of power relationships
Medical Model
• The medical model represents a commonsense way of thinking about health and
illness
– Being sick is a physical problem
– Caused by a body malfunction (virus/bacteria)
– Solution is to seek medical advice
– Medication will ‘cure’ the problem
• Medicine is thus the technical fix of
‘broken bodies’
• What is medicalisation?
Defining Medicalisation
• The medical profession have control over
bodily matters related to health and illness
• They are also have the power to define
what is a medical matter
• Medicalisation is said to occur when the
medical profession re/defines a bodily or
social condition as a medical one
Medicine as social control
• Zola argued that the way that diseases
are defined and labelled is a form of social
control
• Patient’s problems are individualised
rather than being seen as social in origin
• Failure to conform to societies
norms may lead to a label of
being diseased or sick
‘Drapetomania’
• White gives the example of ‘drapetomania’
– This ‘mental disease’ was suffered by
plantation slaves in the South US
– Main symptom was running away from your
master
– It was diagnosed by doctors and
written up in medical textbooks
Medical or Social Problems?
• Addictions such as to alcohol or gambling
• Shift-work sleep disorder
• Jet-lag
• Attention-Deficit Hyperactive Disorder
• Is medicalisation a problem? Discuss this
with the person sitting next to you
The Birth of the Clinic
• Foucualt argued that the body became a
key site of controlling populations during
the 18th and 19th centuries
• The hospitals like schools and prisons
were ways of disciplining populations
• Biopower seeks to control populations
through discourse and productive power
Biopower
• Biopower works though surveillance and
the production of self discipline
• Metaphor of the panopticon
• Medicalisation defines normal
and abnormal bodies and behaviours
Power/Knowledge
• Foucualt argues that the everyday
working of power is important
• Bodies are measured as a way of
understanding populations
• Although this is overtly for welfare reasons
– Like reducing overcrowding in households
• Strengthened the control over the
population
Power/Knowledge
• Power and knowledge are interdependent
– ‘It is not possible for power to be exercised without
knowledge, it is impossible for knowledge not to
engender power’
• Foucault (1980) ‘Prison talk’ in Gordon C (ed) Power/Knowledge, Brighton:
Harvester
• Knowledge is an integral part of power
relationships and
• Producing knowledge makes a claim for power
National Child Measurement
Programme
• Pilots then Policy from November 2007
• Children in reception and year 6 are to be
weighted and measured in schools
• Outcomes will not be given to children, but
initially could be requested by parents
• Not linked to any interventions
National Child Measurement
Programme
• The measurements will:
‘inform local planning and delivery of services for
children; and gather population-level
surveillance data to allow analysis of trends in
growth patterns and obesity. ( It will) increase
public and professional understanding of weight
issues in children and is a useful vehicle for
engaging with children and families about
healthy lifestyles and weight issues’
•
http://www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Healthyliving/DH_073787
• Using the NCMP as an example, discuss
the concepts of biopower and
power/knowledge.
National Child Measurement
Programme
• The Programme strengthens the
requirement to self-regulate diet and
exercise
• Children identified as at risk will not be
referred so no individual benefit but high
risk of stigmatised
National Child Measurement
Programme
• Children are a powerless group, they have
little capacity to resist.
• The programmes reaffirms this status by
the imposition of the measurements
Surveillance Medicine
• Medicine used to confine itself to those it
counted as ill
• The rise of surveillance medicine includes
everyone
• It refers to the notion that bodies require
constant monitoring for their own good
– Child development clinic, screening
programmes
– Health promotion and lifestyle
Surveillance Medicine
• Surveillance medicine is advocated as a
way of staying healthy
• But it also constructs bodies as diseases
prone and in need of constant monitoring
• It reaffirms the power relationships within
medicine and re/constructs the ways in
which we come to understand our bodies
Summary
• Consider how normal bodily processes
have been defined as medical matters
• Considered how biopower is an exercise
in power/knowledge
• Considered the rise of surveillance
medicine
Next week
• Consider ‘lay’ understandings of health
• Look at the way that how people
conceptualize health impacts on their
behaviour
• Consider the relationship between patients
and professionals