The Social Causes of Health and Disease. William C. Cockerham. Читать онлайн. Newlib. NEWLIB.NET

Автор: William C. Cockerham
Издательство: John Wiley & Sons Limited
Серия:
Жанр произведения: Социология
Год издания: 0
isbn: 9781509540372
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      The relegation of social factors to a distant supporting role in studies of health and disease causation reflects the pervasiveness of the biomedical model in conceptualizing sickness. The biomedical model is based on the premise that every disease has a specific pathogenic origin whose treatment can best be accomplished by removing or controlling its cause using medical procedures. Often this means administering a drug to alleviate or cure the symptoms. According to Kevin White (2006), this view has become the taken-for-granted way of thinking about sickness in Western society. The result is that sickness has come to be regarded as a straightforward physical event, usually a consequence of a germ, virus, cancer, or genetic affliction causing the body to malfunction. “So for most of us,” states White (2006: 142), “being sick is [thought to be] a biochemical process that is natural and not anything to do with our social life.” This view perseveres, White notes, despite the fact that it now applies to only a very limited range of medical conditions.

      However, as a challenge to the biomedical model, McKeown’s thesis is considered rather tame since a rise in living standards – as would be expected – naturally improves health and reduces mortality. Moreover, McKeown has been criticized for his focus on the individual when an analysis of various social structural factors, such as changes in health policies and reforms, would have been insightful (Nettleton 2020). Nevertheless, general improvement in living standards and work conditions combined with health policies and the biomedical approach to make significant inroads in curbing infectious disease. By the late 1960s, with the near eradication of polio and smallpox, infectious diseases had been largely curtailed in most regions of the world. The limiting of infectious diseases led to longer life spans, with chronic illnesses, which by definition are long-term and incurable, replacing infectious diseases as the major threats to health. This epidemiological transition occurred initially in industrialized nations and then spread throughout the world. It is characterized by the movement of chronic diseases such as cancer, heart disease, and stroke to the forefront of health afflictions as the leading causes of death. As Porter (1997) observed, cancer was familiar to physicians as far back as ancient Greece and Rome, but it has become exceedingly more prevalent as life spans increase.

      This theory seemed a representative summary of epidemiological trends until the 1970s and 1980s when there was a surprisingly rapid decline in deaths from cardiovascular disease, followed by the arrival of new infectious diseases in the late 1990s and early 2000s – such as West Nile, SARS, Ebola, and Zika (Armelagos and Harper 2016). These changes led some to propose modifications in the theory. This included adding newly emerging infectious diseases to the third stage, since these diseases had made an unexpected and deadly appearance, and creating a new fourth stage, such as a “Hybristic [or Mixed] Age” in which individual behaviors and lifestyles are added to heart disease and cancer as another major cause of mortality (Rodgers and Hackenberg 1987), an “Age of Delayed Degenerative Diseases” in which chronic diseases like heart disease and cancer do not result in death until increasingly older ages (Olshansky and Ault 1986), or the “Age of the Cardiovascular Revolution” during which improvements in medicine pertaining to heart disease continue to reduce mortality and improve life expectancy (Meslé and Vallin 2006).

      In a yet to be decided Stage Four, social factors are especially relevant regardless of whether it is a case of “Hybristic (Mixed) Causes” featuring risky behaviors (i.e., lifestyles) as a major cause of death, “delayed degenerative diseases” in which the biological effects of aging or the physical “weathering” of the body caused by social stress and the consequences of unhealthy lifestyle practices are postponed as life expectancy increases, or the “cardiovascular revolution” where health lifestyles are again paramount in mortality outcomes because of their close association with heart disease. In this new fourth stage, smoking, obesity, and unhealthy behavior, along with the addition of climate change, will likely be important, along with newly emerging infectious diseases like Zika and especially the coronavirus (COVID-19). The addition of newly emerging infectious diseases suggests a partial return to Stage 1 and the “Age of Pestilence,” further signaling a much needed revision of epidemiologic transition theory. What is obvious is that this current stage of epidemiological transition needs to take cognizance of the fact that good or bad behavioral practices cause good or bad health.

      The transition to chronic diseases meant medicine was called upon to confront the health problems of the “whole” person, which extend well beyond singular causes of disease such as a virus that fit the biomedical model. As Porter pointed out, even though the twentieth century witnessed the most intense concentration of attention and resources ever on chronic diseases, they have nevertheless persisted. “It can be argued,” states Porter (1997: 594), “that one reason why there has been relatively little success in eradicating them is because the strategies which earlier worked so well for tackling acute infectious diseases have proved inappropriate for dealing with chronic and degenerative conditions, and it has been hard to discard the successful ‘microbe hunters’ formula.”

      Consequently, modern medicine is increasingly required to develop insights into the social behaviors characteristic of the people it treats. According to Porter, it is not only radical thinkers who appeal for a new “wholism” in medical practice that takes social factors into consideration, but many of the most respected figures in medicine were insistent that treating the body as a mechanical