Lecture 2: Lecture 2 Medicine as social science


Medicine as ‘social’ science: Medicine as ‘social’ science Disease vs Illness Sickness vs Health The politics of health Medicine as social control Access and availability of health care The body as a social construct


Disease vs Illness: Disease vs Illness Illness not a state which exists in nature it can only be understood and defined socially and culturally. Different cultures define pathology in different ways at different times Even disease does not exist as independently of culture as obviously as we might think since definitions of ‘disease’ are produced by human beings (e.g. viruses)


Illness behaviours: Illness behaviours “Illness behaviors arise from complex causes, including biological predispositions, the nature of symptomatology, learned patterns of response, attributional predispositions, situational influences, and the organization and incentives characteristic of the health care system that affect access, responsiveness and the availability of secondary benefits" (Mechanic, 1995)


Sickness vs Health: Sickness vs Health Health as ‘a state of complete physical, mental and social well-being’ (WHO, 1946) Health status:present state of wellness/illness in a given community. rates of death and illness…the prevalence of good and poor health practices, rates of death and disease…and the prevalence of symptoms/conditions of well-being (Doorley, 1998, p.17)


Sickness vs Health: Key terms: Sickness vs Health: Key terms Incidence: The known number of cases of a given illness in a society at any time Prevalence: The total number of cases of a given illness in a society at any time Morbidity: The total amount of illness in a society at any time


Sickness vs Health: Key dimensions: Sickness vs Health: Key dimensions Limitations in physical activities due to health problems Limitations in role activities due to physical health Bodily pain General health perceptions Vitality (energy and fatigue) Limitations in social activities due to physical and emotional problems Limitations in role activities because of emotional problems Mental health (psychological distress and well-being) Ware et al SF36


The Politics of Health: The Politics of Health …all definitions [of health] have a politics associated with them; all try to persuade us to a particular perspective on the person who is healthy or ill (Fox, 1998, p.11) …it is one of the characteristics of the modern biomedicine that it has hegemonic designs and it has consistently discredited, marginalised or suppressed other systems and practices (Tucker, 1997 p.31)


Medicine as social control: Medicine as social control On numerous occasions medical science is called upon to define and limit the boundaries of ‘normalcy’ (e.g. homosexuality, mental illness). Medical knowledges are used to preserve the coherency of the social order, to identify ‘deviants’ and to police the marginal (e.g. Eugenics, The ‘great confinement’)


The Politics of Health: The Politics of Health Medicine as surveillance science (Foucault) Doctors define and police the boundaries of social pathology (e.g. ‘Drapetomania’) Biomedical priorities often determined by socio-economic priorities (e.g. Viagra vs anti-diarrhetics)


Medicalisation and professionalisation: Medicalisation and professionalisation Professionalisation is the process whereby a group can claim special status for itself through access to specialised knowledge and training, a monopoly over certain practices and the ability to exclude competing groups (Tovey & Share, 2000 p251)


Medicalisation and professionalisation: Medicalisation and professionalisation The prestige associated with professionalisation is facilitated by the transformation or incorporation of aspects of nature or society into areas under professional control Childbirth (Pregnancy as ‘illness’) Madness (Moral disorder becomes disease) Deviance (Attention deficit disorder)


Access and availability of health care: Access and availability of health care Who gets access to care and what care is available is often determined in by cultural, political and economic factors rather than by medical priorities Amniocentesis in Ireland HIV/Aids therapies Privatised health systems