Social Constructions
Sociology of knowledge
• Economic & social arrangements shape
knowledge
• Ideology and knowledge
– Social structure/stratification : power
• Administrative apparatus, forms of
governance and knowledge
• Concepts we use to think with reflect social
organization of society
• Social constructions
Constructing Facts & other Social
Constructs
• Facts & Fictions
– facts are things done
– fiction is about action yet implicated in a
dialectic of the “true” (natural) & the
“counterfeit” (artifactual)
– the act of fashioning
• Facts & fiction -- embedded in social forms &
practices
• entangled within interpretation & language
Knowledge and Ideology
• Knowledge – systematic, diagnostic, neutral,
objective, analytic, clarity, facts, useful
– Positive image
• Ideology – justificatory, defensive of belief &
values, biased, emotive, political,
murky/cloudy, caught up in life situations
• Both are concerned with the definitoon of a
problem situation
• Both are responses to felt lack of needed
information
Knowledge and Ideology as Cultural Systems
• Both are critical and imaginative works
– Symbolic structures
• Differing symbolic strategies for encompassing
situations
• Science names situations with an attitude of
disinterestedness
• Ideology names a situation with an attitude of
commitment
– Stylistic differences
• Different enterprises but not unrelated
Knowledge as Power/Power as
Knowledge
• F. Nietzsche – “knowledge works as a tool of
power”
• M. Foucault – knowledge/power
– Power is based on knowledge and makes use of
knowledge
– power reproduces knowledge by shaping it in
accordance with its anonymous intentions
– Power (re-) creates its own fields of exercise
through knowledge
Discourse: Foucault
• ways of constituting knowledge, together with the
social practices, forms of subjectivity and power
relations which inhere in such knowledges and
relations between them
• a form of power that circulates in the social field and
can attach to strategies of domination as well as
those of resistance
• questions of how some discourses have shaped and
created meaning systems that have gained the status
and currency of 'truth', and dominate how we define
and organize both ourselves and our social world
Deconstructing Social Constructs
• uncover the ways in which individuals and
groups participate in the creation of their
perceived social reality
• looking at the ways social phenomena are
created, institutionalized, and made into
tradition by humans
• Socially constructed reality is seen as an
ongoing, dynamic process
• reality is reproduced by people acting on their
interpretations and their knowledge of it.
Deconstruction: Derrida
• A strategy of critical analysis
• understanding language as writing and how
this leads to the impossibility of a
straightforward theory of intentional meaning
• concepts in terms of their structure and
genesis
• Individual language users operate within a
system of meaning that is given to them from
outside
• Meaning is therefore not fully under the
control of the individual language user
Scientific paradigms
• Kuhn shows scientific paradigms as assumptions about the social
world & reality often grounded more in practice than in theory
(Thomas Kuhn PhD Harvard physics)
• science does not progress via a linear accumulation of new
knowledge
• periodic revolutions: "paradigm shifts"
• anomalous results build up, science reaches a crisis, at which point
a new paradigm
• it is not possible to understand one paradigm through the
conceptual framework and terminology of another rival paradigm
(relativism)
• theory choice is fundamentally irrational: if rival theories cannot be
directly compared, then one cannot make a rational choice as to
which one is better
• criteria admittedly determine theory choice, they are imprecise in
practice and relative to individual scientists
Science as Story
• Donna Haraway -- story of scientific progress
(primatology)
• From misty sight prone to invention to sharp eyed
quantitative knowledge rooted in experiment
• Stories with a particular aesthetic (realism) & a
particular politics (progress)
• Nature is constructed & reconstructed in the bodies
& lives of 3rd world animals serving as surrogates for
man
• Stories of race, gender, class, romance, JudeoChristian science
Medicine as Social Construct
• Medicine is a set of categories that filters and
constructs experience
• Medicine produces its own objects and
subjects (subjectivity & subject positions)
– i.e. body mind dualism – nature is separate from
society
Diabetes and the epidemiological
transition
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Demographic transition & health transition
Story of the irony of progress (Rousseau)
Story of the modern (Rousseau)
19th century evolutionary paradigms of social
and cultural evolution and social development
• Modern, modernity, modernization
• Important categories
– “tradition” & “modern”
The Irony of Progress
Jean-Jacques Rousseau
Philosopher
1712 - 1778
• Negative impact of
progress
• Degeneration into social
inequality
• Harsh impact of private
property, agriculture,
mechanical arts
• Humans can exploit
humans
The Irony of Progress Redux
• Jared Diamond
• a society can "choose to
fail."
• Collapse
• climate change
• hostile neighbors
• trade partners
• society's response to its
environmental
problems.
Modernity & the Discourse of Irony
• Émile Durkheim
– Anomie
• Karl Marx
– Alienation
• Charles Dickens
– Ugly social truths of modern life
• Dystopia or anti-utopia
Modernity & Modernism
• Marshall Berman
• To be modern, I said, is to experience personal and social life
as a maelstrom, to find one's world and oneself in perpetual
disintegration and renewal, trouble and anguish, ambiguity
and contradiction: to be part of a universe in which all that is
solid melts into air. To be a modernist is to make oneself
somehow at home in the maelstrom, to make its rhythms
one’s own, to move within its currents in search of the forms
of reality, of beauty, of freedom, of justice, that its fervid and
perilous flow allows.(All That Is Solid Melts Into Air, The
Experience of Modernity, 1988: 345-346)
Epidemiological/Health Transitions
• complex change in patterns of health and
disease
• the interactions between these patterns and
the demographic, economic, and sociological
determinants and consequences.
Transitions & Disease Profiles
• pestilence and famine
• receding pandemics
• degenerative and man-made diseases
Life Expectancies as Measure of Health
Transitions
From Infectious to Chronic Diseases
10 leading causes of death in US
1900
1998
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Influenza and pneumonia
Tuberculosis
Gastritis
Diseases of the Heart
Cerebrovascular Disease
Chronic Nephritis
Accidents
Cancer
Certain diseases of infancy
Diptheria
Heart Diseases (31.4% )
Cancer (23.3%)
Cerebrovascular diseases (6.9%)
Pulmonary disease (4.7%)
Accidents (4.1%)
Pneumonia and Influenza (3.7%)
Diabetes (2.7%)
Suicide (1.3%)
Diseases of Arteries (1.2%)
Nephritis (1.1%)
Ten leading causes of death (2000)
Developed countries
Developing countries
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1. IHD 9.1%
2. CVD 8.0%
3. Respiratory infections 7.7%
4. HIV/AIDS 6.9%
5. Perinatal conditions 5.6%
6. Pulmonary disease 5%
7. Diarrhoeal diseases 4.9%
8. Tuberculosis 3.7%
9. Malaria 2.6%
10. Road accidents 2.5%
IHD (arteries) 22.6%
CVD (heart/stroke) 13.7%
Lung Ca. 4.5%
Respiratory infections 3.7%
Pulmonary Disease 3.1%
Colon Ca 2.6%
Stomach Ca 1.9%
Self-inflicted injuries 1.9%
Diabetes 1.7%
Breast Ca 1.6%
Beaglehole and Yach. Lancet 2003
Demographic Transitions and Health
Transitions
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Decreased fertility rates
Decreased infant mortality rates
Increased life expectancies at birth
Reflect shifts in social and economic patterns
Changes in health conditions
Changes in health care
Population and demographic changes
Human Determinants of Transitions
• technological change
• alterations in the environment
• alterations in food type, availability,
production, preparation, and consumption
• alterations in patterns of energy expenditure
• interplay of environmental factors and the
genetic pool of a community
MULTIPLE EPIDEMIOLOGIC TRANSITIONS
• recent resurgence of infectious disease
mortality marks a third epidemiologic
transition
• characterized by newly emerging, reemerging, and antibiotic resistant pathogens
in the context of an accelerated globalization
of human disease ecologies
Human Determinants of Transitions REDUX
• technological change
• alterations in the environment
• alterations in food type, availability,
production, preparation, and consumption
• alterations in patterns of energy expenditure
• interplay of environmental factors and the
genetic pool of a community
• Social inequality? Where is it?
“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”