Chapter 1 Imagining Health Problems as Social Issues
Introduction: The Social Context of Health and Illness
Health and illness are also social experiences
Emile Durkheim acknowledged individual reasons for a person’s committing suicide, he found that
suicide rates varied between countries and between different social groups within a country.
The social context of health and illness is evident when we compare the life expectancy figures of
This life expectancy (LE) is not due to biological advantages in the Gene pool but is, rather a refection
of our distinctive living and working conditions.
o We can make such a case for two basic reasons.
First, LE can change in a short period of time, and in fact. Did increase from most
countries during the 20 century.
Second data complied over decades of immigration show that the health of immigrants
come to reflect that of their host country over time, rather than their country of origin.
(This tendency has been referred to as the ‘healthy immigrant effect’.”
The History of Social Origins of Illness: Social Medicine and Public Health
Recognition of the social origins of health and illness can be treated to the mid-19 century with the
developing of ‘social medicine’ (coined by Jules Guerin in 1848) or what more commonly became
known as public health (sometimes referred to as social health, community medicine, or preventive
During the 1800s, a number of people, such as Louis-Rene Villerme, Rudolf Virchow, John Snow,
Edwin Chadwick and Friedrich Engel, established clear likes between infectious diseases and poverty.
Engels, Karl Marx’s collaborator and patron, in The Conditions of the Working Class in England, made
a strong case for the links between disease and poor living and working conditions as an outcome of
Engels also noted the difference in the death rates between labourers and professionals, claiming that the
squalid living conditions of the working class were primarily responsible for the disparity and stating the
‘filth and stagnant pools in the working class quarters of the great cities have the most deleterious effect
upon the health of the inhabitants’.
John Snow, a medical doctor documented the cases of cholera epidemic with the results of 93 deaths. He
found that these people from drink water from the same source and once the water pump was removed
the epidemic ceased.
o This case id famous for being one of the earliest examples of the use of epidemiology to
understand and prevent the spread of disease.
Rudolf Virchow was significant advocate for public health care and argued that the state should act to
redistribute social resources, particularly to improve access to adequate nutrition.
The Social Origins of Health and Illness In Canada
Canadian health researchers have focused on he social origins of health and illness by examining how
people’s living conditions impact their health. These conditions are referred to as the social
determinants of health.
In Britain Edwin Chadwick was a key figure in the development of the first Public Health Act (1848)
based on his ‘sanitary idea’ – that disease could be prevented through improved waste disposal and
sewerage system, particularly by removing cesspools of decomposing organic matters from densely
populated areas, as well as, through the introduction of high pressure flushing sewers and food hygiene
laws against foods adulteration. In Canada the first Quarantine Act was adopted in 1872 and remained largely unchanged until the sever
acute respiratory syndrome (SARS) outbreak in 2003.
The Rise of the Biomedical Model
In 1878 Louis Pasteur developed the germ theory of disease, whereby illness is caused by germs
infecting organs of the human body: a model of disease that became the foundation of modern medicine.
Robert Koch refined this idea with the doctrine of specific etiology through ‘Koch’s postulates’: a set of
criteria for proving that specific bacteria caused a specific disease.
The central idea was that specific microorganisms caused disease by entering the human body through
air, water, food and insect bites.
This mono-causal model of disease, which came be known as the medical or biomedical model, became
the dominant medical paradigm by the early 1900s.
o The biomedical model is based on the assumption that each disease or ailment has a specific
cause that physically affects the human body in a uniform and predictable way, meaning that
universal cures for people are theoretically possible.
In the philosophical circles this view came to be known as mind/body dualism and was sometimes
referred to as Cartesian dualism, after the philosopher Rene Descartes.
o Descartes, famous for saying ‘I think, therefore I am’, suggested that although the mind and body
interacted with one another they are separate entities: the brain with the physical body and the
mind excited with the spiritual realm.
The Limits of the Biomedical Model
The major criticism is that the biomedical model underestimating the complexity of health and illness,
particularly by neglecting social and psychological factors. the criticism of biomedical model can be
o The fallacy of specific etiology
o Objectification and medical scientism
o Reductionism and biological determinism
o Interventionist bias
o Victim blaming
The Fallacy of Specific Etiology
As early as the 1950s, Rene Dubos argued that ‘most disease states are the indirect outcome of the
constellation of circumstances rather than the direct result of single determinant factors’.
Dubos noted that not all people exposed to an infectious disease contracted it.
Objectification and Medical Scientism
Since disease is viewed only in physical terms, as something that can be objectively observed, treating
‘it’ takes primacy over all other considerations and patients may become objectified as ‘diseased bodies’
or ‘case’ rather than treated as unique individuals with particular needs.
Fritjov Capra calls ‘medical scientism’ – a reverence for scientific methods of measurement and
observations as the most superior form of knowledge about understanding and treating disease.
Reductionism and Biological determinism The development of medical science has led to an increasing focus on smaller and smaller feature of
human biology for the cause and cure of disease – from organs to cell