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, Judeo-Christian 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 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”

Jean-Jacques Rousseau Philosopher The Irony of Progress Negative impact of progress Degeneration into social inequality Harsh impact of private property, agriculture, mechanical arts Humans can exploit humans Jean-Jacques Rousseau Philosopher 1712 - 1778

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 Influenza and pneumonia Tuberculosis Gastritis Diseases of the Heart Cerebrovascular Disease Chronic Nephritis Accidents Cancer Certain diseases of infancy Diptheria 1998 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 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% Developing countries IHD 9.1% CVD 8.0% Respiratory infections 7.7% HIV/AIDS 6.9% Perinatal conditions 5.6% Pulmonary disease 5% Diarrhoeal diseases 4.9% Tuberculosis 3.7% Malaria 2.6% Road accidents 2.5% Although the epidemiologic transition is well advanced in all but the poorest countries, the institutional response to disease prevention and control is still based on the infectious disease paradigm. Consequently, the global and national capacity to respond to NCD epidemics is woefully inadequate and few countries have implemented comprehensive prevention and control policies. Beaglehole and Yach. Lancet 2003

Demographic Transitions and Health Transitions 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, re-emerging, 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”