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HLTA02H3 (200)
Chapter 1&2

HLTA02H3 Chapter Notes - Chapter 1&2: Chevrolet Hhr, Health Care In Canada, Flexner Report

Health Studies
Course Code
Michelle Silver

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Chapter 1
Evolution and the Dominant Paradigm of Scientific Medicine
Modern scientific medicine is founded on the work of Koch, Pasteur and other bacteriologists
The germ theory of disease, is the isolation of specific bacteria as the etiologic agents in several
infectious diseases that created a profound change in medicines diagnostic and therapeutic
assumptions, it is also a uni-factorial model of disease
The paradigm of specific etiology and specific therapies is that people can be made healthy by
medical technologies and technological fixes, it is a mechanistic/robot model
Philosophers like Descartes established the philosophical base for a machine model of the human
Disease is an alteration, a pathological change in the body machinery that must be “fixed”
This approach basically ignores social causes of much ill health
Localized pathology is that ill health could be caused by the malfunctioning of one particular
part of the body machinery, which led to the medical fragmentation of the delivery of health care
and this shift toward localized pathology had a profound impact on the “specialization” in
The form and nature of medicine is determined by class and power relations in the society and not
by scientific imperatives
The Flexner Report was critical of the medical schools that did not have the facilities to teach
laboratory-based scientific medicine. It called for the reorganization or, failing that, closure of
such institutions, this report was highly critical of alternative medicines such as herbalism and did
not want them being more important than allopathic medicine
The norm for medical education and practice became laboratory-based scientific medicine
The Flexner report made it possible for working-class people to afford medical education,
reduced competition and gave higher incomes for the doctors
Health and Illness
health is a normal condition of body and mind
disease is a definite morbid process having a characteristic strain of symptoms
in a capitalist society doctors are only seen as producers and that they do not really care about its
doctors, capitalists believe that doctors only produce for the accumulation process, they only keep
the doctors “healthy” to protect their investments
this capitalist view resembles that of the white master and black slaves back in the day
under capitalism, health is also defined as individualistic, which means that it is always
individuals who become sick, rather than social, economic or environmental factors, which
allows for a more profitable health care industry
Reductionism in Medicine
the mechanistic-individualistic conception of disease, which attributes disease to malfunctioning
of the human body, absolves the economic and political environment from responsibility to
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these reductionist tendencies in scientific medicine shifted the focus of research from societal
problems to individual problems which benefits the capitalist structure
the new reductionist view introduces the idea that the causes of disease lie in individual lifestyles
and behaviors while the clinical model attributes disease to the malfunctioning of the human body
both approaches obscure the nature of disease and fail to recognize the important relationships
between social and material conditions and health and sickness
Social Production of Illness
social medicine is primarily concerned with conditions in society that produce illness and death
historical materialistic epidemiology is that death and disease can be derived from social
there is a long history of research and analysis with focus on social and material conditions,
most notably in the work of 19th century scholars Friedrich Engels and Rudolf Virchow
Engels research was aimed at describing working-class life and how their roots of illness was
due to poor environmental conditions and the contradictions between profit and safety
Virchow’s research focused on class inequalities in social distribution and the consumption of
The new diseases often labeled lifestyle diseases, are actually diseases of circumstances
Mode and Types of Analysis
Many sociological and behavioral studies are devoted to analyzing the medical behavior of
Another kind of analysis focuses on the behavior of the provider of services and health care
Socio-psychological models often overlook the importance of class inequalities, the availability
of medical services and other structural factors
The limitations of the existing system have also become apparent due to its inability to contend
with the complexity of many contemporary chronic conditions
Illich believes modern medicine is ineffective and that it does more harm than good. Illich’’s
analysis consists of three categories (clinical, social and structural) of iatrogenesis (the causing or
inducing of a disease by a physician or medical treatment). Clinical is when sickness and death is
a result of overuse of medical care. Social when policies reinforce an industrial organization
which generates dependency and ill health. Structural when society is restricted from being
autonomous and competent
Illrich believes that medical dominance has led to loss of autonomy and creation of dependency
for patients
The contradictions in medicine reflect the contradictions in society, that is, the health sector is so
integral to the broader society that the attempt to study one without attention to the other will be
misleading, for instance one of the contradictions in this society is between profit and safety
The corporate invasion of the medical sector is usually referred to as the medical-industrial
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