MATERIALIST APPROACHES: HEALTH AND SOCIETY

1. MATERIALIST APPROACHES: HEALTH AND SOCIETY

2. “It’s Not the Germs!” • Etiology – disease causation • Germs, nature, society, individual factors, super-nature • Ethnoetiology – local knowledge & practices related to theories of disease causation • Agents (personalistic): contextual (naturalistic) • Internalizing (physiological/internal mechanisms): externalizing (events outside the body/external pathogenic agencies)

3. The Blane Report (1977) • 4 explanations for patterns of inequality in health • Statistical Artefacts: modes of measurement • Outcome of natural or social selection (?) • Health experience upward mobility & unhealthy downward • Behavioral or cultural practices • Class and health are linked by structural factors

4. MATERIALIST/STRUCTURALIST • Emphasizes social, political, economic factors which adversely affect health • Forms of social/econ./pol. org., environment, health services, transport, economic conditions, work practices • We are born into society with a ‘material structure’ (ascribed status?) • ‘shapes us’ • Social org. rather than individual biology • Foundation for health inequalities/disparities/population health approaches

6. SOCIAL STRUCTURE, MOBILITY, HEALTH • Social mobility affected by health • Does not protect against class-based health backgrounds (ascribed status & health) • “individual lifestyle factors” & the social basis of behavior • Materialist explanations: link social inequality with biological • Stress & class/ethnicity/gender inequality • Stress & diabetes • Environment & health • Occupation & health • Food/nutrition & social inequality • Housing & health

7. Social class? • How to define? • Occupation, income & wealth, prestige, education, residence, ethnicity, gender, age, ? • The adjective “Class” – descriptive (many historically anchored) • collectively organized actors (from kinship to caste to class) • people become identified independently of kinship as a constituent of class • for example, biological differences or functions as defined in the culture rather than social identities become increasingly important • Class formation – the formation of collectively organized actors • Class consciousness – the understanding of actors of their class interests • Class struggle – the practices of actors for the realization of their class interests • In contest • Interrelationships of all these

8. How do we know social classes exist? • Social stratification • the unequal distribution of goods and services, rights and obligations, power and prestige • all attributes of positions in society, not attributes of individuals • there are significant breaks in the distribution of goods services, rights, obligations, power prestige • as a result of which are formed collectivities or groups we call strata or “class”

9. Capitalism, class, health care • Profit & safety; accident & industrial organization • Not psychological characteristics of the individual • Disease explanations & superstructure (culture & ideology) • Legitimates status quo as agent of social control • equates hospital care & consumption of drugs as health care • reproduces capitalist class social structure • Political economy & medicine • Capitalist societies & medicines (profession, technology, medications) • A class project (struggle) – realization of collective interests • Links economy & politics • Class based monopoloy & profit • Medical profession central to the control of labor

10. “health defined” • Disease – abnormalities • Illness – experience of • Suffering – sickness episodes • Health? • Ability to function • Independence • Both are crucial features of labor in capitalist society • Medicine works to restore & remedy labor disruptions

11. Liberalism, Neoliberalism, Health in Capitalist Society • Liberalism & welfare state capitalism • Liberalism emphasizes individual rights and equality of opportunity • Different forms of liberalism may propose very different policies • Liberalism rejected many foundational assumptions that dominated most earlier theories of government, such as the Divine Right of Kings, hereditary status, and established religion • Liberalism: two major streams of thought which compete over the use of the term "liberal" • Classical liberals: only real freedom is freedom from coercion • state intervention in the economy as a coercive power that restricts the economic freedom of individuals and favor a laissez-faire economic policy • oppose the welfare state • Social liberals: governments must take an active role in promoting the freedom of citizens • real freedom can exist only when citizens are healthy, educated, and free from dire poverty • Government ensures the right to an education, the right to health care, and the right to a minimum wage.

12. Liberalism, Neoliberalism, Health in Capitalist Society • Structuralist basis of welfare state capitalism undermined by decline of industrial sector & globalization of capitalist investment strategies • State policy now directed at control over costs (rather than provisions) & quantity of health care • Medicine caught between state & market • From production to consumption as foundation of class formation in capitalist society

13. Liberalism, Neoliberalism, Health in Capitalist Society • Neoliberalism • move from a bureaucratic welfare-based society toward a meritocracy acting in the interests of business • based on individual and economic liberty • Health & health care consequences • Individual centric • Achieved health • Class analysis?