Health and the medicalization of inequality

Answer

Social work scholars and researchers hold varying and diverse perspectives regarding the factors, frameworks, ideas, decisions or choices and actions that promote societal wellness. Drawing from various social work concepts as well as from my personal understanding of the field, this paper offers a critical analysis of three pertinent course readings: Thompson (2018) and Germov (2014), and McMurray’s and Clendon’s (2015)

Thompson, N. 2018, Chapter 5: ‘Health and the medicalization of inequality’, in Promoting equality: working with diversity & difference, Palgrave Macmillan, London.

Thompson (2018), in the fifth chapter – “Health and Medicalization of Inequality” – looks at public health from the perspective of sociology with greater emphasis on health inequalities, social construction of health and the social determinants of health. Our understanding of what constitutes health, illness and sickness seems inadequate as the overall concept of health is a function of complex political and social processes. Health issues in most societies, as Thompson (2018) emphasizes are strongly linked with power, discrimination and oppression, where the powerless and the less privileged are denied access to quality care.

It emerges from this reading that medicalization of inequality occurs when the oppressed and marginalized groups, such as the physically disabled, the elderly, LGBT (lesbian, gay, bisexual and transgender) people are portrayed ideologically as sick or ill. This idea is consistent with my prior understanding of medicalization as medicalization as the process of taking social behaviors and factor that are within a typical range and redefining them as health or medical conditions that need to be addressed. Notably, while old age is generally a normal process of aging, it is often linked to ill-health and thus regarded by the society as an illness. This not only makes the victims to develop a mentality that they are actually sick, but it also serves to further their oppression. As such, I support Thompson’s argument that today’s society is causing more harm to disadvantaged individuals, particularly the aged, aboriginals and those with disabilities by medicalizing inequality.

One of the intriguing concepts in Thompson’s (2018) reading is the social construction of health. Citing Jones (1994) who referred to health as a physiological, psychological and social state, Thompson maintains that is socially constructed. In other words, social processes influence our health and wellbeing throughout our lives, and what one considers healthy varies markedly depending on age, gender, social class, ethnicity and race among other social factors. This observation aligns with that of Senior and Viveash (1998). In their investigation of the social construction of illness and health, the authors aptly state that; “the terms health and illness mean different things to different people” (p. 3). For instance, whereas an elderly with arthritis might consider walking around the house without much pain as healthy, a person with a goal to become physically fit or cut weight may regard the practice as unhealthy.

I have realized that Thomson is not the only sociology scholar and researcher who maintain that health is constructed around other social factors, and not just age. For example, Conrad and Barker (2010) came up with three key findings about social construction of illness: some illnesses are rooted in cultural and historical meaning; illnesses are socially constructed at an experiential level depending on how people understand, cope and live with illnesses; and medical knowledge is not formed or obtained naturally, but is instead constructed by individuals and policy makers based on their interests. It can be inferred from these findings that health care systems have both social and cultural components, and that the ability of people to seek and access suitable healthcare is determined by their caste, social class, race, social institutions, cultural beliefs and ethnicity as well as by the underlying political and socio-economic factors. I personally find the social construction of health a major barrier to our ability to achieve the required level of wellbeing because it engenders false assumptions and makes generalizations about our health. For example, until the 1990s, bisexualism and homosexuality were considered mental health disorders in many societies. Thompson Parrott and Nussbaum (2011) also describe a case where a 20-year-old female student was falsely accused by patrol police for driving under the influence of alcohol, yet the problem with her eyes was due to an underlying neuromuscular condition.

Thompson’s “health and medicalization of inequality” could have been considered shallow and incomplete, should he not have brought the concept of health inequalities to light. Unequal access to health care, is perhaps one of the most overarching topics in the health sociology literature I have read. For Thompson, factors such as race, social class, ethnicity, education level, age and disability challenge equal access to quality healthcare. People with higher income, occupational status and education have been found to have longer life expectancies and lower morbidity compared to their counterpart illiterates living in poverty (Eikemo et al. 2016). When people are educated and are in a good financial position, for example, they can purchase health covers and seek regular screening services to keep their health in check. While Thompson discussed health inequalities exhaustibly, he fails to make policy recommendations to eliminate the inequalities and promote social justice.

Germov, J., 2019. Imagining health problems as social issues. In Second opinion: An introduction to health sociology (pp. 2-23). Oxford University Press, USA.

Germov attempts to uncover the various aspects and perspectives of health sociology and how they shape our today’s understanding of health and illness. Illness and health issues, according to Germov, have a social origin. In other words, the concepts of health and illness are formed largely by social patterns such as caste and inequality as well as by the beliefs maintained by social institutions. For example, health problems that affect an entire nation or state are believed to have social origins whose solution calls for social action. However, this might not be the case when the problem affects an individual, family or marginalized social groups. This implies that health sociology transcends the biological, medical and psychological explanations of health, and instead encompasses the social patterns that influence health and illness such as gender differences, social class disparities, ethnicity (indigenous vs non-indigenous) and disability. Germov’s argument is in line with that of Thompson (2018) which the medical model of health and illness.

I agree with Germov’s observation that our health is shaped principally by the conditions in which we live and work in; namely, the social origins of our health and illness. Notably, in Australia, members of indigenous communities have considerably lower life expectancies (67 years), and tend to be more vulnerable to infectious diseases compared to non-aboriginals whose life expectancy is approximately 80 years (Germov 2018 p. 7). This not because non-indigenous people have superior biological genes. Instead, the differences in life expectancy reflects the distinctive conditions in which different social groups live and work in.    

While Germov discusses several concepts, the concept that deeply attracted my interest is that of sociological imagination. Germov borrowed the expression, “sociological imagination” from sociologist C.W Mills (2000) who used the phrase to describe “a quality of mind that seems most dramatically to promise an understanding of the intimate realities of ourselves in connection with larger social realities” (p. 15). The realities Mills talks about are the historical, social, biographical, institutional and structural dimensions that shape different aspects and issues in our social lives (Smiley 2013). With sociological imagination, we are placed in a position to develop firm understanding of the larger historical, economic and socio-cultural scenes in terms of their meaning for our inner lives and careers. Moreover, it gives us unique opportunities to consider how people in our everyday experiences develop and hold on false ideologies of their social positions (Mills 2000). Since the shaping of history seems to outpace people’s ability to align themselves with socially-defined and acceptable values, it is through sociological imagination that one better understands biography and history, and consequently identify their relationships within the society.

Many people, especially those from marginalized groups, individualize their social problems and even self-blame for their current situations because they lack the ability to think sociologically. However, I have learnt that thinking sociologically enables people to see the world around them from the lens of sociological imagination, and link their individual problems with the issues affecting the entire society. In this way, they realize that their personal problems are shared by other community members and even societies, and thus implement and support collective action to address them. I believe this is the most appropriate way that the social problems we experience can be best addressed. In Mill’s (2000) words, as cited in Germov (2018), “many personal troubles cannot be solved merely as troubles, but must be understood in terms of public issues” (p. 7). In developing countries, for example, the problem of unemployment can only be addressed if looked at from a larger societal context, rather than regarded as a personal problem. The concept of sociological imagination, just like other sociology frameworks, is not without criticism. Notably, Smiley (2013) criticizes the concept for having overlooked biology and its role, despite it being one of the essential elements of health sociology.

McMurray, A. and Clendon, J., 2015. Community health and wellness-e-book: Primary health care in practice. Elsevier Health Sciences.

McMurray’s and Clendon’s (2015) chapter on “Creating and Maintaining a Health Community” looks at health from the standpoint of the community. A comprehensive review of this chapter provides a reader with a solid understanding of ecological relationships; namely, the links between individuals, families, communities and their environments, and how the relationships influence health and value in communities. This way, McMurray and Clendon manage to convince us to think of health as not only a social and biological phenomenon, but also as an ecological phenomenon, that is engendered in the setting of “community life”.

By discussing health in the context of community, the authors have bolstered my understanding of the role that I, together with social institutions and environmental factors, have to play towards the promotion of health and wellness in communities. Specifically, I learnt that there is a growing need for ongoing surveillance, continuous monitoring, implementation of health intervention and evaluation strategies, and advocacy for community support. McMurray and Clendon have also enlightened me on the concept of health and what it actually entails. Prior to reading the chapter, I thought that our health is an explicit function of biological factors. I can comfortably conclude that the chapter’s deconstruction of health has shaped my understanding of health as a multilayered concept formed by the reciprocal interactions between people and environmental factors or conditions such as history, genetic predisposition created by early environments, nutritional status and past experiences and events. By discussing health from this dimension, McMurray and Clendon moves closer and closer to Germov’s (2019) discourse on “imagining health as social issues” and the concept of sociological imagination. For instance, it is until individuals visualize their personal health problems from a wider societal context that they can work together as a community to promote public health.

While McMurray and Clendon uncover multiple concepts, one of the concepts I found quite informative as far as my knowledge in health sociology is concerned relates to the social determinants of health. Indeed, although this area has attracted the interest of many sociologists and researchers, it seems least understood due to cross-cultural differences on what constitutes healthy behavior and the ever-evolving health issues. Marmot and Wilkinson (2005), WHO (2008) and Raphael (2009) argue in unison that the underlying drivers of health include education/literacy, social class, ethnicity, employment and working conditions, gender, age, economic status, social support networks, cultural beliefs, health practices and the physical environment in which one lives. I have learnt that health inequalities ensue when access to these factors is disproportionate. For example, most immigrants and indigenous people take on menial jobs where they are exposed to hazards such as toxic chemicals and injuries, which in turn shortens their life-expectancy. They also make meagre earnings, and thus find it difficult to obtain quality health care services or enroll in health insurance. McMurray and Clendon’s discussion of social determinants of health was, therefore, of fundamental importance to my understanding as why some people are free from illnesses and live longer than others.

Conclusion

This essay is a critical review of three readings: McMurray and Clendon (2015), Thompson (2018) and Germov (2019). The concept of sociological imagination seemed to overarch the three readings since they both placed health in a wider societal context, rather than at an individual or biological level. Reading Thompson and McMurray was foundational to my understanding why the aboriginals and other marginalized or disadvantaged groups tend to have poor health. I realized that medicalization of health and other social structures have created conditions that engender and perpetuate health inequalities.