Medical power and the rise of surveillance

medicine

Week 15Sociology of Health and Illness

Recap

• Thought about how health and illness are structured by society

• Considered the power relationship between patients and professionals

• Introduced the concept of the ‘sick role’

Outline

• Looking at how medical power and knowledge shape our understanding of bodies

• Consider the concepts of medicalisation and biopower

• Consider how surveillance medicine forms part of power relationships

Medical Model

• The medical model represents a common-sense way of thinking about health and illness– Being sick is a physical problem– Caused by a body malfunction (virus/bacteria)– Solution is to seek medical advice– Medication will ‘cure’ the problem

• Medicine is thus the technical fix of ‘broken bodies’

• What is medicalisation?

Defining Medicalisation

• The medical profession have control over bodily matters related to health and illness

• They are also have the power to define what is a medical matter

• Medicalisation is said to occur when the medical profession re/defines a bodily or social condition as a medical one

Medicine as social control

• Zola argued that the way that diseases are defined and labelled is a form of social control

• Patient’s problems are individualised rather than being seen as social in origin

• Failure to conform to societies

norms may lead to a label of

being diseased or sick

‘Drapetomania’

• White gives the example of ‘drapetomania’– This ‘mental disease’ was suffered by

plantation slaves in the South US– Main symptom was running away from your

master– It was diagnosed by doctors and

written up in medical textbooks

Medical or Social Problems?

• Addictions such as to alcohol or gambling

• Shift-work sleep disorder

• Jet-lag

• Attention-Deficit Hyperactive Disorder

• Is medicalisation a problem? Discuss this with the person sitting next to you

The Birth of the Clinic

• Foucualt argued that the body became a key site of controlling populations during the 18th and 19th centuries

• The hospitals like schools and prisons were ways of disciplining populations

• Biopower seeks to control populations through discourse and productive power

Biopower

• Biopower works though surveillance and the production of self discipline

• Metaphor of the panopticon

• Medicalisation defines normal

and abnormal bodies and behaviours

Power/Knowledge

• Foucualt argues that the everyday working of power is important

• Bodies are measured as a way of understanding populations

• Although this is overtly for welfare reasons– Like reducing overcrowding in households

• Strengthened the control over the population

Power/Knowledge

• Power and knowledge are interdependent

– ‘It is not possible for power to be exercised without knowledge, it is impossible for knowledge not to engender power’

• Foucault (1980) ‘Prison talk’ in Gordon C (ed) Power/Knowledge, Brighton: Harvester

• Knowledge is an integral part of power relationships and

• Producing knowledge makes a claim for power

National Child Measurement Programme

• Pilots then Policy from November 2007

• Children in reception and year 6 are to be weighted and measured in schools

• Outcomes will not be given to children, but initially could be requested by parents

• Not linked to any interventions

National Child Measurement Programme

• The measurements will:

‘inform local planning and delivery of services for children; and gather population-level surveillance data to allow analysis of trends in growth patterns and obesity. ( It will) increase public and professional understanding of weight issues in children and is a useful vehicle for engaging with children and families about healthy lifestyles and weight issues’ 

• http://www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Healthyliving/DH_073787

• Using the NCMP as an example, discuss the concepts of biopower and power/knowledge.

National Child Measurement Programme

• The Programme strengthens the requirement to self-regulate diet and exercise

• Children identified as at risk will not be referred so no individual benefit but high

risk of stigmatised

National Child Measurement Programme

• Children are a powerless group, they have little capacity to resist.

• The programmes reaffirms this status by the imposition of the measurements

Surveillance Medicine

• Medicine used to confine itself to those it counted as ill

• The rise of surveillance medicine includes everyone

• It refers to the notion that bodies require constant monitoring for their own good– Child development clinic, screening

programmes– Health promotion and lifestyle

Surveillance Medicine

• Surveillance medicine is advocated as a way of staying healthy

• But it also constructs bodies as diseases prone and in need of constant monitoring

• It reaffirms the power relationships within medicine and re/constructs the ways in which we come to understand our bodies

Summary

• Consider how normal bodily processes have been defined as medical matters

• Considered how biopower is an exercise in power/knowledge

• Considered the rise of surveillance medicine

Next week

• Consider ‘lay’ understandings of health

• Look at the way that how people conceptualize health impacts on their behaviour

• Consider the relationship between patients and professionals