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HLTA02H3 (137)
Chapter 1&2

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Health Studies
Michelle Silver

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 medicine  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 disease  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 conditions  there is a long history of research and analysis with focus on social and material conditions, most notably in the work of 19 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 resources  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 individuals  Another kind of analysis focuses on the behavior of the provider of services and health care institutions  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 complex From health to Well-Being and Health Population  The traditional definition of health as the absence of disease and sickness has come under increasing scrutiny, this definition seems to individualize the concept of health care  A broader re-conceptualization of health encompasses a state of complete physical, mental, emotional and social well-being  The shift in the scope and theme of sociological inquiry as a transformation of medical sociology into a sociology of health, which has a broader focus on health related topics including population health, health behavior and health promotion Research and Practice  The first challenge we face is to find ways of reducing inequities in health of low versus high- income groups in Canada  Men in the upper income group live six years longer
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