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University of Toronto Scarborough
Health Studies
R Song

2012-09-25 Lecture 3 Social Origins of Illness and Disease Lecture: • Direct cultural factors that affect health as well as how structures of society are determinants of health • Biomedicine hierarchy in western medicine • The importance of context= social, cultural, economic, physical • Innate biological factors s/a age, sex, genetics • Social and psychological factors incl. behaviour • Helman 2007 o Economic situation has the capacity to affect behavioural and cultural factors that make individual more or less vulnerable to disease o The importance of diet/nutrition on health (short-term and long-term)  All factors co-occur • Proximate social factors= direct behavioural determinants of health • Distal social factors= macroeconomic contexts o Understanding how culturogenic stress can affect health through transnational spaces  Know and understand the case studies highlighted in the Helman article o In terms of looking at health and health difference, how methods of diagnoses or looking at certain diseases and how the various practices of biomedicine can vary and often times ignore subjective experiences of symptoms and onset of illness/disease  Different medical systems can over/under diagnose illness/disease in people depending on the society/culture of where treatment and diagnoses are being applied and vary according to society, culture, and country (i.e differences between UK, US, and Canada in terms of medical treatment for caesareans)  Overall society’s perspective on healthcare o Biomedicine has become a part of our daily living and the understanding that our health is in our own hands  Healthism= health is in the hands of the individual and is an outcome from the lifestyle behaviours (risks) that the individual takes  Economic engine behind it  Neoliberalism= blaming the individual for lack of responsibility rather than looking at macroeconomic entities that apply to one’s health  The notion of risk which also goes back to individual responsibility • Can be used to blame people for their circumstances that is often times purely not in the hands of the individual as we exclude the larger factors contributing to ill health o There is a difference how doctors perceive lay people’s definitions of disease and o Varying perception between science (western biomedicine) and “native” science (non-western science) o Differentiating between disease and illness o Cultural epidemiology= the layperson’s understanding of illness and disease such as susto in many Latin American cultures • Singer 2004 o Biomedicine= objective understanding of disease o Medical anthropology= disease/illness are social constructions of experience in a given culture  Medical technological advances influence how disease is looked at and treated • Patterns of inequality are reinforced with the introduction of advanced medical technologies within a population  There is always change; diseases change as well depending on who is defining them and how the disease and information is disseminated o 1) making of disease= how biomedicine defines something as disease (i.e. erectile dysfunction in middle-aged men)  How disease is constructed; sometimes in accordance to the interests of pharmaceutical companies o 2) making of individual of diseases= how disease can be tied back to individual behaviour and lifestyle; illness is defined as the patient’s subjective experience that is not recognized by doctors as a disease  Ideology of biomedicine= convinces people that their experiences are subjective and are of suspect and not scientific; while biomedicine is scientifically grounded  Creation of disease/illness is a cultural process  Medicalization o 3) making social of disease= alternative way of understanding health and constantly questioning the structure of disease and illness in terms of social roles and relationships • Hegemony= treating poor health through biomedicine rather than other methods of treating illness/disease Film Questions: As described in the film, (not according to Wikipedia), what is the wealth-health gradient? Give specific film examples/case studies of how this concept, combined with the importance of power, and control over one’s destiny, is demonstrated in the video. Describe examples from the film that illustrate how racism imposes an additional health burden on people of colour. Give examples of both “everyday” racism and “structural” racism, and describe how these might affect health in different ways. Film: In Sickness and In Wealth • We react and act according to how we interact with the environment and how genetics is influenced by the external social environment • Health in United States of America o $2 trillion o Rank 30 in life expectancies o High IMR o 47 million w/o health coverage which is not the cause of illness or disease o Individual behaviours are dependent upon economic status o Lifetime experience written by the social environment can lead to varying health statuses  Allocation of resources is distorted in United States o Understanding how the social determinants of health affect people in their
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