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-at- large 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 % 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