1

Chapter Page

1.1 The History of the Changing

Concepts of Health and Illness:
Outline of a General Model of 03
Illness Categories
1.2 Social Theorizing About
Health and Illness 07

1.6 The Globalization of Health

and Disease: The Health
12
Transition and Global Change

1.7 The Social Causation of

Health and Illness 20

1.9 Gender & Health

23

3.1 The Medical Profession:

Knowledge, Power, and
29
Autonomy

3.4 Alternative Health Practices 39

and Systems
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1.1 The History of the Changing Concepts of Health and Illness: Outline
of a General Model of Illness Categories

Health is the state of being free from illness or injury. Ideas about health and sickness are closely linked to what
society thinks is good or bad. When we talk about health, we're often talking about what makes a good life.
Illness, which comes from an old word meaning discomfort, represents a lack of ease or comfort. In society, we
often use medical terms to describe things metaphorically, like saying a society is 'sick' or calling someone's
behavior a 'sick mind.'
In the past, people thought about health and sickness in terms of religious beliefs rather than science. They
believed illness came from breaking social rules or upsetting spiritual balance. Modernization changed this.
Now, we understand sickness more scientifically. Western medicine became more detailed, and traditional
healers became less important. We also started seeing a difference between physical and mental health. This
was influenced by the idea that the mind and body are separate. Psychology and psychiatry also developed,
helping us understand mental health better. Social sciences added to our understanding by looking at how
illness affects individuals, cultures, and societies as a whole.
The understanding of health and illness has changed over time. In the past, it was often linked to religion, but
as society progressed, scientific explanations became more dominant. Traditional healing methods were
replaced by scientific practices, although some religious connections remained. People used to believe that
illness was a punishment for moral wrongdoing, but now we understand it more in terms of natural causes like
germs or viruses.
Today, we see health and illness in two main ways: as individual problems or as issues affecting whole
communities due to things like poverty or environmental conditions. The nineteenth century saw a rise in public
health movements that focused on social issues like poor living conditions. Similarly, in the twentieth century,
some scholars connected health problems to social factors like capitalism
Different approaches to disease have emerged. Some focus on individualistic and scientific methods, treating
illness as consequences of bodily malfunctions. Others take a more collective and secular approach, looking at
broader societal issues. The debate between individual responsibility and collective action in healthcare
continues today, with some seeing socialized medicine as a threat to individual freedom.
In the past, medical beliefs were often tied to religious practices. Some religious groups, like monastic orders,
believed that strict diets and self-denial could benefit both the body and soul. Illness was seen as a result of
human sinfulness, but people were encouraged to take care of their bodies as a way to fight against evil.
Over time, Western societies shifted towards more individualistic and scientific views of medicine, starting with
the scientific revolution. This led to the rise of professional medicine as we know it today. However, alternative
medical beliefs still exist, drawing on religious traditions. Sometimes, people may even combine medical
treatments with spiritual practices in hopes of finding a cure for illnesses like cancer.
Throughout history, medical beliefs and practices have been shaped by various cultures and religions. Primitive
societies viewed disease symbolically, linking it to the sacred realm. Greek civilization introduced secular
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perspectives on health, such as the humoral theory of disease. This tension between individualistic and
collectivist approaches persisted through Greek influence. Judeo-Christian beliefs and Islamic science
transmitted Greek medical traditions, impacting medieval and contemporary medicine. Early Christianity's
ambivalence toward secular medicine influenced its approach to health care, but Christian institutions
established hospitals for the sick and poor. The Reformation challenged traditional practices, emphasizing
individualism and contributing to modern scientific medicine.

PRIMITIVE MEDICAL SYSTEMS

In primitive societies, disease holds symbolic significance, representing the connection between the ordinary
world and the sacred realm. Diagnosis and healing happen within a religious context, where illness is seen as a
revelation of sacred values through extraordinary states of consciousness. According to anthropologists like
Henry E. Sigerist, primitive people didn't distinguish between medicine, magic, and religion—they saw them all
as ways to protect against evil spirits.
However, this view has limitations. Even in so-called primitive societies, there were practical medical practices
alongside religious beliefs. For instance, in ancient Egypt, physicians used both religious cosmology and
empirical methods for healing. Similarly, anthropologists like Bronisław Malinowski and E. Evans-Pritchard
argued that primitive societies distinguished between magic, religion, and science. Magic was used to control
the environment, while religion expressed beliefs and values. Disease explanations often served social functions,
such as assigning blame or responsibility in times of uncertainty or conflict.

GREEK MEDICINE
Greek civilization, often seen as the birthplace of democracy and natural science, also heavily influenced medical
ethics and practice. The Hippocratic Oath, for example, laid the foundation for professionalism in medicine.
Greek medicine was generally secular, viewing health as a result of natural causes
One prominent theory in Greek medicine was the humoral theory of disease, which viewed the body as a
hydraulic system that needed balance. Illness was thought to occur when this balance was disrupted, such as
an excess of black bile causing melancholia. Treatments included bloodletting, diet, exercise, and rest to restore
equilibrium.
Greek medical traditions reflected a tension between individualistic and collectivist approaches. Hygeia
symbolized a rational life in a healthy environment, promoting communal and preventive health practices. In
contrast, Asclepius focused on individual treatments using plants and herbs, emphasizing interventionist
medicine. This division highlighted the importance of both collective and individual approaches to health and
wellness.
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MEDICINE AND THE WORLD RELIGIONS

The influence of Greek medical traditions, mediated through Judeo-Christian beliefs and Islamic science, shaped
medieval and contemporary medicine. Early Christianity had mixed attitudes toward secular medicine due to its
focus on the punishment of the flesh and anticipation of the Second Coming.
Christianity emphasized the importance of the soul over the body, viewing suffering and disease as
consequences of human sinfulness. However, Christian institutions also felt obligated to care for the sick and
the poor, leading to the creation of hospitals and institutions of charity.
Christian asceticism viewed the body as corrupt and a conduit of evil, especially emphasizing patriarchal
attitudes toward women inherited from Greek philosophy. This negative view of the body was regulated and
commercialized through practices like confession and indulgences.
The Reformation challenged these practices, emphasizing individualism and the authority of the written word,
contributing to the rise of scientific revolution and the erosion of medieval views on disease and sin.

The Origin And Development Of Health Studies In Social Sciences

The study of health within the social sciences has its origins in various disciplines and has undergone significant
development over time. Here's an overview of the origin and evolution of health studies in social sciences:
1. Origins in sociology and anthropology: The early foundations of health studies in social sciences can be
traced back to the works of sociologists and anthropologists who recognized the influence of social
factors, cultural practices, and societal structures on health and illness.
 Émile Durkheim's work on suicide rates and their connection to social integration laid the groundwork
for sociological perspectives on health.
 Anthropological studies of diverse cultures shed light on the role of beliefs, customs, and social norms in
shaping health behaviors and perceptions of illness.
2. Development of medical sociology and social epidemiology: In the mid-20th century, medical sociology
emerged as a distinct field, focusing on the social aspects of health, illness, and healthcare systems.
 Researchers began to investigate the impact of socioeconomic status, race, gender, and other social
factors on health outcomes, contributing to the field of social epidemiology.
 Concepts like the "sick role" and the influence of stress on health were introduced, highlighting the social
dimensions of illness experiences.
3. Contributions from psychology and social psychology: Psychologists and social psychologists explored
the relationship between mental health, stress, coping mechanisms, and physical well-being.
 The study of social relationships, support systems, and interpersonal dynamics shed light on their
influence on health behaviors and outcomes.
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4. Interdisciplinary approaches and health promotion: In the latter part of the 20th century,
interdisciplinary approaches to health studies became more prevalent, integrating perspectives from
various social sciences.
 The Ottawa Charter for Health Promotion (1986) emphasized the importance of social determinants of
health and the need for multi-sectoral collaboration.
 Researchers began to examine the role of social policies, environments, and community-based
interventions in promoting health and preventing disease.
5. Contemporary developments and emerging fields: Health disparities and health equity have become
major areas of focus, addressing the unequal distribution of health outcomes across different population
groups.
 The field of medical anthropology has grown, exploring the cultural dimensions of health, illness, and
healing practices.
 New areas such as social gerontology (the study of aging and older populations) and the sociology of
disability have emerged.
 Researchers are increasingly employing qualitative and mixed methods to capture the lived experiences
and social contexts of health and illness.

CONCLUSION: THE PHILOSOPHY OF MEDICAL SCIENCE

The history of medical concepts reveals the evolving understanding of disease and its societal implications. Lay
perceptions of health and illness are influenced by cultural norms and social interactions, while scientific
concepts are shaped by clinical observations and professional competition.
While some argue that clinical realities like fever or mumps remain constant over time, the theories and
concepts surrounding disease vary depending on social values and circumstances. Medical categories are not
neutral and often carry societal metaphors and ideologies.
Contemporary perspectives recognize that diseases have multiple causes and that the search for single cures
has been abandoned. The AIDS epidemic illustrates the complexity of disease etiologies.
At the everyday level, illness experiences are also shaped by cultural assumptions and social relationships.
There's often a tendency to view illness within a moral framework of blame and responsibility, as individuals
seek meaning in life and death despite the erosion of traditional religious beliefs.
In short, medical concepts evolve over time, influenced by societal norms and scientific discoveries, while
individuals grapple with illness within cultural and moral frameworks.
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1.2 Social Theorizing About Health and Illness

Social theorizing refers to the process of examining and interpreting social phenomena using theoretical
frameworks and concepts from the social sciences, such as sociology, anthropology, psychology, and political
science. In the late 18th century, a new model of illness emerged in Parisian hospitals, shifting from the fluid-
based explanations of humoral medicine to the idea that illness was caused by specific localized lesions in the
body. This model was supported by the development of clinical examination and autopsies in hospitals, allowing
for the identification of these lesions. Over the next two centuries, this framework evolved into the biomedical
view of health and illness we have today, which has become the dominant theory worldwide. This biomedical
perspective has greatly influenced social theorizing about health and illness, shaping the context in which such
theories developed.

The relationship between social theory and the biomedical model can be understood in 5 main forms.
i. Firstly, some views largely accept the biomedical model, with social theories providing support for
understanding patient behavior and social factors related to illness.
ii. Secondly, there's a less submissive stance where social theories seek independence but still don't
fundamentally challenge biomedicine's authority.
iii. Thirdly, social theories start to challenge aspects of biomedicine, such as professional power and
medicalization.
iv. Fourthly, there's a deeper questioning of the cognitive basis of biomedicine, viewing it as culturally and
historically situated.
v. Finally, there's a postmodern perspective where social theorizing about illness itself becomes a subject
of inquiry.

SOCIAL THEORIZING ABOUT HEALTH-RELATED PHENOMENA COMPLEMENTARY

TO BIOMEDICAL SCIENCE

The biomedical model views illness as resulting from specific pathological lesions within the body, like infection
or cancer. Clinical practice focuses on identifying and treating these lesions, often inferred from patient
symptoms and signs observed during examinations. Treatment aims to remove or alleviate the effects of the
lesion. Additionally, the model identifies biological factors as the main causes of illness, such as the germ theory
of disease. Social science initially worked within the framework of biomedicine, offering complementary
explanations and supportive models. Its contributions centered on helping to identify illness, assessing its
consequences, and discovering its causes.
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 Identifying Illness
The process of identifying illness involves patients reporting their symptoms to doctors, who then examine them
for signs of illness. Social science initially focused on why patients choose to visit doctors, leading to the
development of the Health Belief Model. The Health Belief Model (HBM) is a psychological framework
developed to understand and predict health-related behaviors. The model suggests that an individual's health
behavior is determined by their perceptions of the severity of a potential illness, their susceptibility to it, the
benefits of taking action to prevent or treat it, and the barriers to such actions. This model also suggests that an
individual's concerns, motivations, and past experiences influence their health-related behavior. Later, the
concept of illness behavior emerged, exploring why some patients fail to seek medical attention despite being
ill. Theories of illness behavior focus on the triggers and barriers to seeking medical help. Initially, symptoms
were viewed as biological indicators of underlying illness, but later studies delved into patients' experiences and
cognitions that influence their decision to seek medical care. Psychological studies examined how patients
communicate their symptoms to doctors and adhere to medical advice. Understanding help-seeking behavior
has become a significant area of research in social science, although it has also gained attention from health
psychologists and policy studies.

 Social Factors in the Cause of Illness

The relationship between social science and medicine has long centered on understanding how social factors
contribute to the causes of illness. While traditional medicine focused on identifying immediate physical causes,
social epidemiology emerged to explore the social distribution of disease. Historically, Marxism provided a
theoretical framework for understanding the link between poverty and illness distribution, but within
biomedicine, this connection was often overlooked. Despite challenges, health inequalities research, both
within medicine and sociology, has made significant steps in understanding how deprivation translates into
compromised health. The "McKeown thesis" and the "fetal origins hypothesis" have been influential in
highlighting the role of social conditions in health outcomes. The "McKeown thesis" posits that improvements
in public health and healthcare over the past two centuries are primarily attributable to better social and
economic conditions rather than medical interventions. On the other hand, the "fetal origins hypothesis,"
associated with David Barker, suggests that early environmental conditions, particularly during fetal
development and infancy, have significant long-term effects on adult health outcomes. Overall, ongoing
research aims to address persistent health disparities by exploring the complex interplay between social factors
and disease.

Social Consequences of Illness

The social consequences of illness extend beyond the biological impact, affecting the patient's social status and
interactions. Parsons' concept of the "sick role" highlighted how illness not only disrupts biological integrity but
also compromises social functioning. While criticized for its narrow view and assumptions of consensus, the sick
role remains influential in medical social science. It reshaped the doctor-patient relationship by framing illness
as a deviant status requiring social control mechanisms. Parsons' incorporation of psychoanalytic theory further
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enriched the understanding of patient behavior. The concept of the sick role provided a framework for studying
patients' responses to symptoms and medical interventions, shedding light on the complexities of illness
experiences and medical encounters.

SOCIAL THEORIZING ABOUT HEALTH RELATED PHENOMENA IGNORED OR

OVERLOOKED BY BIOMEDICAL SCIENCE
Biomedicine traditionally views health and illness through a biological lens, focusing on diseases' biological
causes and manifestations. However, social science broadens this perspective by recognizing the psychosocial
dimensions of illness. It identifies patients as more than just biological objects and highlights the influence of
psychosocial factors on illness. This reconceptualization involves viewing illness behavior and patient identity
beyond the confines of the "sick role" to encompass the holistic experiences of individuals dealing with chronic
illness.

 Psychosocial Threats
Research in social epidemiology and medical sociology has highlighted the impact of social factors on health.
Drawing on Durkheim's insights, studies have shown how social integration affects rates of mental illness and
suicide. Researchers have explored the role of social support as a protective factor against negative life events,
emphasizing its influence on health outcomes. Antonovsky's concept of sense of coherence further developed
these ideas, emphasizing individual resilience in the face of social challenges. Additionally, research has focused
on psychosocial (the creation of a conceptual field in which psychology, sociology, and clinical practice intersect)
threats like stress and life events, which have clear effects on mental and physical health. These studies, while
acknowledging the biomedical model of illness, underscore the importance of considering psychosocial factors
in understanding health and disease.

 Labelling
Parsons' concept of the sick role emphasized that illness affects both biological functioning and social status.
Labelling theory, developed in the 1960s, expanded on this idea by explaining how social reactions to individuals
could profoundly impact their lives. Goffman, a prominent figure in this field, focused on everyday interactions
and the stigmatization of individuals with illness or disabilities. His work highlighted the psychosocial challenges
faced by those labeled as ill or disabled, shedding light on the role of societal attitudes in shaping individuals'
experiences. This perspective led to the WHO's classification of impairment, disability, and handicap, recognizing
the social consequences of labeling. Further theoretical developments, such as the distinction between felt and
enacted stigma, have contributed to our understanding of how illness and disability are socially constructed.
Overall, labelling theory has become a widely accepted framework for understanding the social dimensions of
illness, emphasizing the active role of patients in shaping their experiences.

 Reasons and Experiences

In the 1970s, research on illness behavior faced a theoretical challenge as it struggled to explain patient
responses to symptoms. Ethnographic studies argued for understanding symptoms from the patient's
perspective, revealing lay explanatory models of illness. This approach highlighted discrepancies between
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biomedical explanations and patients' beliefs, offering insights into non-compliance with medical advice.
Simultaneously, sociologists began exploring patients' experiences of illness, focusing on how they made sense
of their condition. This emphasis on cognitions and experiences eventually influenced medical practice, leading
to a more patient-centered approach. Engel's biopsychosocial model attempted to integrate social science
findings into biomedicine, but social science had already moved beyond biomedical constraints by emphasizing
patients' explanatory models of illness, challenging medicine's monopoly on understanding disease.

SOCIAL THEORIZING IN OPPOSITION TO MEDICAL SCIENCE

Straus, writing in 1957, distinguished between two approaches: sociology in medicine and sociology of medicine.
Sociology in medicine aimed to support medical practices, focusing on improving healthcare and addressing
illness and disease from the patient's perspective. On the other hand, sociology of medicine sought deeper
insights but faced challenges due to the overwhelming dominance of the biomedical model. Initially, critiques
were aimed at medical practices and healthcare organization rather than directly challenging medical
knowledge itself.

 Professions
Initially, social theorists viewed the medical profession positively, considering it an ideal form of social
organization dedicated to public welfare and possessing specialized knowledge. Medicine was seen as the
epitome of a profession, against which others were measured. However, alternative views emerged, suggesting
that the medical profession attained its status through wielding power and creating a monopoly over healthcare
provision. Freidson's assertion that the profession's status resulted from political action sparked new studies
revealing self-serving behaviors within the medical field. These analyses highlighted medicine's success in
monopolizing healthcare and controlling entry into the profession. While recent literature suggests a decline in
professional power due to external factors like third-party payers and legal concerns, newer studies aim to
understand professions within broader healthcare systems and occupational contexts, though they lack the
theoretical depth of earlier works on professionalization.

 Medicalization
Medicalization refers to the idea that medicine, particularly biomedicine led by doctors, is expanding its reach
beyond treating illness and into aspects of everyday life. This includes convincing healthy people that they're at
risk and need medical advice, and even defining what is considered normal or abnormal behavior. Some argue
that this trend is concerning because it can make people more passive and susceptible to control by medical
authorities. Critics, like Illich, even claim that the medical establishment itself poses a threat to health. This
perspective focuses more on how medical care is delivered rather than questioning the scientific basis of
medicine itself. Overall, the concept of medicalization sheds light on the increasing demand for healthcare
services and its broader societal implications.

 Medical Knowledge
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Johnson described three phases of how professions, like medicine, organize themselves. Initially, in the 18th
century, patients held more power because they were usually from higher social classes. Then, in the 19th
century, as medicine became more institutionalized in hospitals and served more lower-class patients, doctors
gained control over medical knowledge. By the 20th century, with the involvement of governments and
insurance companies in healthcare funding, these third parties began influencing medical practices, marking the
third phase of professional organization. Starr's study suggested that medicine's autonomy in defining illness
has declined over time.
Jewson expanded on Johnson's ideas by examining how medical knowledge evolved under these different
phases. While medical knowledge was once seen as exclusive and scientifically superior, sociology started
challenging this notion. Sociologists began studying medicine, questioning its privileged status, and opening up
discussions about its knowledge and practices.

SOCIAL THEORIZING ABOUT MEDICAL THEORIES

In the realm of social theory about medicine, Freidson's book "Profession of Medicine" marked a shift toward
analyzing medicine from a cognitive perspective. He argued that medicine has the authority to decide who is
sick and what is normal or abnormal, asserting that illness is rooted in social reality rather than solely in biology.
This idea resonated with Parsons' concept of the sick role, suggesting that illness can exist purely as a social
construct, as seen in the antipsychiatry movement of the 1960s.
Another significant figure, Jewson, examined how medical knowledge changed over time. He proposed that
medical knowledge evolved through three phases: patronage, collegiate, and mediated. Initially, patients
influenced medical practices based on symptoms, but with the rise of hospital medicine, doctors' perspectives
dominated, focusing on pathology rather than symptoms. This shift led to the increasing alienation of patients
from their own illnesses.
On the other hand, Foucault offered a contrasting view, suggesting that medicine, particularly biomedicine,
constructs the very nature of the body. He argued that medical practices, such as clinical examinations and
autopsies, serve to create the perception of illness and shape societal norms. Unlike the Marxist perspective,
which sees human nature as predetermined, Foucault believed that medical practices shape our understanding
of the body and identity.
Recent social theorizing treats biomedical theories as descriptive languages that define health and illness.
Becoming a doctor involves internalizing and applying this biomedical knowledge, which has become dominant
in shaping societal perceptions of health and illness. Exploring biomedical theory opens up avenues for
fundamental discussions about health and illness in society.

Conclusion
There exist various social theories regarding health and illness, revealing both fruitful avenues and limitations.
While social theorizing about health and illness has flourished, it's important to recognize boundaries between
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this field and other areas of social theory, although some concepts like labeling have bridged these gaps.
Feminist theory has also significantly influenced discussions in this realm.
However, the flow of theory from health and illness studies to broader social theory has been less pronounced.
This is largely due to the dominance of biomedical paradigms, which have constrained the development of
theories that transcend medicine.
It's worth noting the significant empirical studies and the relationship between theory and method. The rise of
qualitative methodologies has changed the landscape of social theorizing, but there's a risk of getting stuck in
descriptive narratives without advancing higher-level theory. This could hinder the development of social
theorizing, which has historically provided frameworks for empirical studies.

1.6 The Globalization of Health and Disease: The Health Transition and
Global Change

GLOBALIZATION
Globalization means the world getting more connected. It's when countries, businesses, and people work
together across borders, sharing ideas, goods, and services. Globalization is the spread of capitalism worldwide,
connecting economies, cultures, and societies through trade, communication, and migration. It speeds up social
changes and links distant places, shaping local events globally and vice versa.
Regarding health, globalization affects the spread of diseases. Infectious diseases can now easily travel across
borders, posing a risk to everyone. While wealthier countries worry about these diseases, they often originate
from or affect poorer countries more severely due to economic and social factors.
Understanding how globalization impacts health is crucial. It involves considering factors like trade,
transportation, and urbanization, which can either help or harm public health efforts globally. So, addressing
global health challenges requires recognizing and managing these interconnected influences.
In summary, globalization brings interconnectedness across various aspects of life, including health, with both
positive and negative consequences. Understanding these dynamics is essential for addressing global health
challenges and fostering a broad-based understanding of the current health transition.

CONVERGENCE AND DIVERGENCE: HEALTH IN A CONNECTED WORLD

Convergence means things becoming more similar. In economics, it's when poorer countries catch up to richer
ones and everyone's income levels become closer. On the other hand, divergence means things becoming more
different. In economics, it's when some countries get richer while others stay poor, making the income gap
between them wider.
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The globalization of disease involves both convergence and divergence. Convergence means that as countries
develop, they start facing similar health issues, like heart disease and depression, instead of just infectious
diseases. This shift is partly due to factors like aging populations and lifestyle changes, including increased
tobacco use.
However, while some countries deal with these new health challenges, others still struggle with old ones like
HIV and tuberculosis. In poorer regions, communicable diseases remain a major problem, affecting more people
than in wealthier areas.
Globalization has made it easier for diseases to spread, causing concern worldwide. For example, malaria, once
thought to be under control, has resurged in tropical regions, affecting millions each year. Attempts to control
it have faced challenges, including the misuse of medications like chloroquine, leading to drug resistance and
confusion about when to seek medical help.
Financial difficulties in countries where malaria is common make it hard to use advanced treatments against the
disease. Many people can't afford the newer, more effective drugs for malaria because they're too expensive.
Even though there are quick tests available to diagnose malaria, they're too costly for many countries to use
regularly.
Historically, controlling malaria wasn't just about using pesticides like DDT. It also involved improving living
conditions and development in affected areas. Recent studies suggest that using bed nets and focusing on
community-based interventions might be more effective in preventing malaria deaths than vaccines. These
interventions require cooperation between health, economic, and social sectors, as well as active participation
and education from the community. However, because they're not easy to turn into profitable products, they're
not always prioritized in the global fight against malaria.
Overall, globalization has brought both progress and new challenges in combating diseases, highlighting the
need for global cooperation and innovative solutions.

'A WEB OF INTERCONNECTEDNESS?"

Global trade brings both benefits and drawbacks, but these aren't spread evenly. Poorer countries often bear
the effect of negative effects like job loss and environmental damage, without enough safety nets to protect
vulnerable groups like women and children. This unequal sharing of costs and benefits extends to healthcare
and technology too. While some believe globalization will eventually make healthcare more fair, others worry
it will widen the gap between rich and poor countries even more.
Globalization has stirred up unrest among various groups worldwide, from factory workers in the US and Europe
to indigenous communities in rural areas. Many people feel they're not getting their fair share of the global
economy's benefits. Economic growth affects health in many ways, from exposure to risks to access to
healthcare resources. This can lead to inequalities in health outcomes, as noted by Navarro, who emphasizes
that globalization policies often worsen global inequalities.
Yach and Bettcher see globalization in a positive light, believing it strengthens our connections to others.
However, they may overlook the uneven distribution of benefits and the inadequate response to poverty. Simply
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being aware of poverty isn't enough to solve it, and using globalization as an excuse for inaction falls short of
addressing the real issues.
Globalization has mainly been driven by a few wealthy countries in Europe and North America, encouraged by
capitalism and technology. However, this global expansion is also tied to cultural ideas like the pursuit of endless
growth and individualism.
Interestingly, even though globalization breaks down national boundaries, it can weaken the sovereignty of
nations. It shifts power away from traditional institutions toward personal networks, making individual
connections more important than ever. This shift toward valuing personal identity and relationships can also
elevate the significance of illnesses, which affect individuals directly.
The most common aspect of globalization we think about is its economic impact. It involves the international
flow of money, goods, and services, with production often outsourced to cheaper labor markets in developing
countries. This can lead to economic instability in local economies, with currency and market speculation causing
problems. While financial globalization is widespread, social, political, and cultural globalization isn't as
advanced.
economic globalization brings risks like the movement of people, trade of harmful products, and differences in
safety standards. The United Nations also highlights the problem of under-consumption in developing countries,
suggesting that increasing access to goods and services could improve health and living conditions.
Traditionally, discussions about the economy have focused on money, but Nobel Prize winner Amartya Sen
changed the conversation by emphasizing well-being and capabilities instead of just income.
Globalization isn't just about money—it also affects institutions and local communities. It creates a clash
between local and global forces, where global influences can overwhelm local communities. For example, in
Bhopal, India, the local community couldn't handle the global impact of a health crisis like the Bhopal gas
tragedy.
Globalization also brings everyday risks, like using insecticide bags to store food, which can harm health. Local
communities struggle to adapt to these changes while global tools for understanding health lag behind. Overall,
globalization presents challenges that need to be understood and addressed at both local and global levels.

GLOBALIZATION AND THE EPIDEMIOLOGICAL TRANSITION

the transformation of health conditions over time, known as the epidemiological transition, describes societies
moving from high childhood infectious disease mortality to concerns about chronic diseases like heart disease
as they develop. However, this transition isn't linear or complete—many societies still face infectious diseases
alongside chronic ones, and sometimes chronic diseases are linked to infections.
Epidemiologic polarization is important to understand how globalization affects health differently. It describes
a situation where chronic diseases increase while infectious diseases remain prevalent among lower-income
populations. Globalization can bring rapid improvements in health for some, but it can also lead to economic
problems that worsen health for others.
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While the epidemiological transition focuses on changes in disease patterns, the health transition considers the
broader social and economic factors driving these changes. However, understanding how these factors interact
and affect health in the future is still a challenge.

A SHRINKING WORLD: OUR PHYSICAL AND ELECTRONIC CONNECTIONS

The rise in global diseases is closely linked to increased travel and trade. For example, in 1994, over 97 million
people traveled by air between the US and other countries, making it easy for diseases to spread across borders.
Stories like the one about an airline steward being blamed for spreading AIDS highlight the fear around disease
transmission through travel.
However, diseases don't just spread through air travel. Large-scale migration, often due to political or social
unrest, can also lead to disease outbreaks. For instance, the mass movement of people during the Rwandan
genocide in 1994 resulted in a devastating cholera epidemic. Similarly, economic migration can spread diseases
like malaria and HIV.
Trade can also bring health risks. Hazardous products like tobacco and contaminated food can be unintentionally
exported, leading to health problems in other countries. Instances like the discovery of BSE-infected beef and
cyclospora-infected raspberries highlight the need for international cooperation to address health threats in
global trade.

COMMUNICATION
While global transportation has indeed made the world smaller, the impact of communication technology on
health is even more far-reaching. Communication transcends borders, spreading not only money and culture
but also health messages. For instance, consider the popular TV show "Breaking Bad." The show, which
originated in the United States, gained a global audience through communication channels like television and
the internet. However, its portrayal of drug manufacturing and distribution glamorized illegal activities,
potentially influencing viewers' perceptions and behaviors related to substance abuse. This highlights how
communication can contribute to health problems, such as drug addiction and crime.
Nevertheless, communication technology also has positive aspects for health. It can facilitate health education
and disease surveillance on a global scale. For example, online platforms like Pro-MED gather reports of disease
outbreaks worldwide, allowing experts to share insights quickly and effectively. Moreover, equal access to
communication technology is essential for addressing global health issues. Without adequate investment in
communication infrastructure, the gap between developed and developing countries widens, hindering efforts
to combat health challenges on a global scale. Thus, ensuring equitable access to technology is crucial for
promoting global health and well-being.
technology like Pro-MED, an online platform, helps gather reports of disease outbreaks worldwide, allowing
experts to share insights quickly. However, access to this tool is limited to those with internet access.
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On the other hand, global communication can also spread harmful messages, like tobacco and alcohol
advertising, especially in vulnerable communities. Additionally, the portrayal of certain diseases and lifestyles in
the media can influence local beliefs about health.
Despite the potential for science and the public to collaborate through communication, it's important to
remember that messages are not just information—they also carry cultural meanings. Understanding these
cultural aspects is crucial for effective communication.

GLOBAL ENVIRONMENT IMPACT

Environmental change poses significant risks to global health, and it's an area where various risks converge.
Despite its global nature, efforts to address environmental degradation often remain confined to national
policies, even though multinational cooperation is necessary. Environmental changes like global warming,
pollution, species extinction, and desertification have profound effects on human health, representing a new
scale of impact on the world.
Globalization has altered communities' relationship with the environment, leading to unpredictable
consequences. For example, migration and increased production can result in negative outcomes, particularly
when production disregards local needs and preferences. Environmental degradation, exacerbated by
expanding economies and populations, may ultimately have the greatest impact on global health.
Instances of disease outbreaks linked to changes in land use are numerous. For instance, Lyme disease in the
northeastern United States stemmed from shifts in housing patterns and forest encroachment that increased
human exposure to ticks carrying the disease. Similarly, outbreaks of diseases like Lassa fever and hantavirus
were associated with increased interaction between rodents and humans, driven by human activity.
As global climate change progresses, vectors carrying diseases may expand beyond their current tropical
habitats. However, the spread of disease depends on various factors like rainfall and temperature. High
reproductive rates of vector-borne diseases among populations with no prior exposure could lead to epidemic
spread. In summary, environmental change has profound implications for global health, and addressing these
challenges requires coordinated international efforts.

Border Economics, Environment, and Health

Economic policies like the privatization of government-held land in Mexico have significant impacts on health
and the environment. For example, the sale of land previously used by farming communities led to rural-to-
urban migration, providing labor for factories but also creating shantytowns with poor living conditions. This
rapid change, driven by economic needs, outpaces local communities' ability to adapt, leading to environmental
degradation and health risks.
The industrial development and agricultural runoff have polluted the Rio Grande, raising concerns about toxic
waste dumping. However, national governments often prioritize economic growth over environmental
protection. While migration decisions are made locally, they are influenced by global economic forces, limiting
local choices for action.
 17

In the context of Bangladesh’s Sajek, a scenic hill area in Bangladesh, economic activities such as tourism and
deforestation have significant implications for health and the environment. The influx of tourists, while
contributing to the local economy, can also lead to environmental degradation through increased waste
generation and pollution, impacting the health of both residents and visitors. Additionally, deforestation for
infrastructure development and accommodation facilities can disrupt local ecosystems, leading to soil erosion,
loss of biodiversity, and changes in water availability, which in turn affect the health and livelihoods of
indigenous communities living condition.

URBANIZATION A CONFLUENCE OF MIGRATION AND ECONOMIC CHANGE

Urbanization, a key aspect of globalization, refers to the growth of cities due to economic development, drawing
more people to urban areas. Mega-cities, with populations exceeding 10 million, have become common,
especially in developing countries like Bangkok, Delhi, and Lagos. However, this rapid urban growth often
outpaces infrastructure development, leading to overcrowding and strain on resources.
Historically, cities have shown mixed health outcomes. In the nineteenth century, rural areas had lower infant
mortality rates than urban areas. But in the twentieth century, cities saw improved health due to better access
to services. However, modern cities face new health risks like pollution, high population density, and unhealthy
lifestyles.
Urbanization exacerbates health inequalities, with the urban poor facing the highest risks. Squatter settlements
often lack basic services, leading to higher infant mortality rates compared to wealthier areas. In cities like Porto
Allegre and Quito, disparities in infant mortality rates between affluent and poor areas are stark, highlighting
the link between poverty and health outcomes.

Urban areas in developing countries face significant challenges, with about half of urban residents living in
poverty and many lacking access to basic necessities like safe housing, clean water, and sanitation. These
conditions contribute to a range of health problems, including tuberculosis, acute respiratory infections, and
cholera, which are more prevalent in overcrowded and poorly serviced urban areas.
Urban environments also facilitate the spread of diseases like HIV/AIDS, with urban populations initially
experiencing high rates of HIV incidence. Factors like urbanization and migration create opportunities for mixing
populations and spreading sexually transmitted infections. Young people, particularly women, are at high risk,
often engaging in risky behaviors like commercial sex work due to economic disparities and breakdown of
traditional barriers.
The global movement of labor and goods, along with policies promoting free-market economic development,
exacerbates the spread of diseases like HIV/AIDS. Urban populations are also vulnerable to natural disasters due
to their concentration in finite areas. Despite these challenges, urbanization is expected to continue due to
economic growth and the desire for better opportunities, highlighting the complex interplay between
globalization and local urban dynamics.
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THE FUTURE OF GLOBAL RESPONSE TO HEALTH AND DISEASE

The dominance of biomedicine in health policy during the 20th century has given rise to the belief in humanity's
control over nature. Advances in biochemistry have promised to revolutionize disease prevention and treatment
in the 21st century. While once many regions, especially in Africa, were isolated due to disease, vaccines and
treatments have opened them up to global connections, although local residents often don't benefit as much.
The eradication of smallpox, often seen as a triumph of technology, was actually more about effective disease
control strategies. It was achieved through improved surveillance, rapid response to outbreaks, and
international cooperation, rather than solely relying on new vaccines. This approach, focused on targeting
diseases and enhancing delivery strategies, has been applied to other public health interventions.
However, not all diseases are suitable for eradication like smallpox. The success of smallpox eradication was
unique to its historical context and benefited from significant resources and global cooperation during the Cold
War. Today, we still prioritize disease control efforts, focusing on major childhood diseases like diarrhea, acute
respiratory infections, and malaria.
The response to the global burden of disease has been complex. The initial goal of achieving "health for all by
the year 2000" through primary health care (PHC) programs proved overly ambitious, especially for developing
countries. A more focused approach, called selective primary health care (SPHC), emerged. SPHC targeted
specific, severe diseases that could be addressed with biomedical interventions like immunizations and oral
rehydration therapy. These interventions were often effective but relied heavily on external funding and didn't
necessarily strengthen overall community health.
SPHC programs highlighted the contradiction of globalization: while they addressed immediate health needs,
they didn't address underlying issues or provide long-term solutions. They also underscored the challenge of
balancing health needs with economic constraints. Instead of asking "How much health do we need?" we've
focused on "How much health care can we afford?" which prioritizes economics over health and yields different
outcomes globally.

What Does it Mean if Health Is a Commodity?

Under an economic framework, decisions about health are often based on maximizing economic gain. However,
this approach doesn't fully account for the complexities of public health. For example, certain health
interventions, like childhood vaccinations, are necessary for the well-being of society as a whole, regardless of
individual preferences or financial ability. Additionally, the cost of advanced medical technology often puts it
out of reach for most people.
Translating this approach to the global stage can be problematic. Decision-makers in both health and other
sectors may overlook investments in health, leading to negative consequences like disease outbreaks. For
instance, neglecting to expand and maintain water systems in certain regions can lead to water contamination
and disease outbreaks. Similarly, trade practices can contribute to the spread of diseases like dengue fever.
 19

Governments and international organizations must weigh the trade-offs between investing in health and other
sectors. However, quantifying the impact of health investments can be challenging, and short-term political
influences often prioritize immediate crises over long-term health development. This cycle perpetuates a
pattern of responding to emergencies without adequately addressing underlying health issues.
The widespread availability of antibiotics, fueled by the commodification of health, has led to their misuse.
Although antibiotics have improved health over the past few decades, they are often misused. Patients may
stop taking antibiotics when symptoms disappear or when side effects occur, and antibiotics are sometimes
taken without proper prescription. This misuse has led to the rapid development of drug-resistant infections.
The pharmaceutical industry, driven by profit, focuses on drug development for lucrative markets, often
neglecting diseases prevalent in poorer countries. Research for diseases like malaria, which disproportionately
affect low-income populations, lacks commercial support. Additionally, the global spread of biomedicine has
displaced local knowledge of traditional remedies, which could have provided valuable alternatives.
Some companies, like Merck and Smith Kline, have taken steps to support drugs for neglected diseases. For
example, Merck's distribution of Ivermectin for onchocerciasis control in Africa and Latin America is subsidized
by its sale for veterinary use in the United States. This collaborative effort between pharmaceutical companies,
organizations like the World Health Organization, and affected countries demonstrates a positive approach to
addressing health disparities.

CONCLUSION
This examination of globalization highlights the significant costs, both in human and environmental terms,
associated with the current world system. Despite remarkable advancements in human population growth and
medical technology in the 20th century, widespread ill health persists, particularly among vulnerable groups
such as children, women, the elderly, and the poor. Pathogens' ability to adapt challenges our reliance on purely
technological solutions.
The emergence of infectious diseases is influenced by social factors such as human behavior, technology,
economic development, international travel, and public health measures. These factors are interconnected with
globalization dynamics, contributing to the spread of diseases, both infectious and chronic.
While there is concern about the possibility of a new global epidemic, this is just one aspect of the broader
picture of globalization and health. Without significant changes beyond the health sector, the burden of
infectious and chronic diseases will continue to grow among vulnerable populations. As long as poverty and
poor health persist among large segments of the population, addressing these challenges remains a formidable
task with no signs of reversal in current trends.
Addressing the challenges mentioned earlier, it requires a holistic approach and collaborative efforts at both
global and local levels. Here are some potential solutions:
1. Public/Private Partnership in Health: Health initiatives should involve both public and private sectors,
with the global economy recognizing its role in disease spread and investing equitably in health
infrastructure.
 20

2. Ethical Economic Development: Economic expansion should not come at the expense of public health.
Investments in health infrastructure should be prioritized, and decisions regarding acceptable disease
levels should involve open debate and community participation.
3. Global Disease Surveillance: Establishing effective disease surveillance systems is crucial. This can be
achieved by linking national institutions and leveraging technology such as remote sensing to monitor
disease outbreaks, substance abuse, violence, and environmental violations.
4. Reform of Multilateral Institutions: Existing global institutions like the United Nations and the World
Health Organization need to adapt to new priorities or be replaced by more effective bodies. This
requires increased budgets, authority, and innovative approaches.
5. Support for National Institutions: Local training and research institutions should be sustained and
encouraged. Developed countries should foster partnerships with their counterparts and provide long-
term support for research programs.
6. Utilization of Communication Infrastructure: Global communication networks should be utilized for
educational purposes, particularly in newly urbanized areas where there is a need for health education
about risks and treatments.
7. Global Authority for Epidemic Control: A global authority is needed to coordinate travel restrictions
during epidemics and address other global health threats such as biological weapons and mass
destruction.
8. Paradigm Shift in Understanding Health: The globalization of disease offers an opportunity to rethink
health paradigms. It requires recognizing changing vulnerabilities and understanding the multifaceted
outcomes of development and technological advances.
In summary, addressing global health challenges requires a proactive approach that considers the interplay
between economic, social, and technological factors. By leveraging the promises and realities of globalization,
we can shape a healthier future for all.

1.7 The Social Causation of Health and Illness

The field of sociology focuses on describing and explaining societal phenomena and how they impact both
populations and individuals. Within sociology, there are specialized sub-disciplines that systematically study
particular areas of societal life. One such sub-discipline is the sociology of health, which examines how social
factors influence well-being, health, illness, and disease.
Traditionally, this field was called sociology in medicine, but it's now understood that health and disease are not
purely biological entities; they're often intertwined with social and psychological processes. Sociology aims to
 21

contribute to our understanding of what causes health and illness by integrating biomedical and social science
information.

CONCEPTS OF SOCIAL ACTION

In sociology, there's ongoing debate about whether the discipline can apply scientific methods, such as studying
regular patterns and causality. Many sociologists believe that these principles can indeed be applied to
sociology. For example, various theories describe how societal exchanges, social order, and individual
socialization work. This suggests that there are regular patterns in different levels of societal life.
However, determining causality in sociology isn't as straightforward. Causality implies that one phenomenon
causes another, but proving this in social phenomena can be tricky, especially when both are social in nature.
For example, when studying health and illness, it's challenging to show how one social factor directly causes
another.
One theory, called labeling theory, suggests that societal reactions to deviant behavior can lead to mental illness.
According to this theory, when someone behaves oddly, society's response and psychiatric diagnosis can
actually create or reinforce mental illness. While this theory has raised awareness about social control and
stigma, empirical evidence supporting it is lacking, so it's not widely accepted as a complete explanation for the
social causes of health and illness.
Another explanation for the social causes of health and illness focuses on intergenerational processes and social
heritage. For example, genetic epidemiology shows that factors like short height are more common among
people in lower socioeconomic groups. Short height is associated with higher risks of certain chronic diseases,
which can sometimes mask the association between low socioeconomic status and poor health outcomes.
Similarly, a person's health risks in adulthood can be influenced by their mother's health during pregnancy or
even by the social circumstances experienced by previous generations. This suggests that poor health can be
passed down through generations due to biological processes.
Another aspect is the social environment's impact on health. Society exposes individuals to various health risks,
such as poor housing, pollution, and dangerous workplaces, which can disproportionately affect those in
poverty. Additionally, access to coping resources like healthcare and healthy food is unequal across society.
There are two versions of this paradigm: the material version, which focuses on physical, chemical, and
biological risk factors, and the psychosocial version, which emphasizes the impact of stressful experiences on
health. Long-term exposure to stressful social environments can lead to negative emotions and physiological
responses, which, without adequate coping resources, can contribute to illness.
Modern stress research has provided evidence supporting the link between exposure to stressful social
circumstances and subsequent illness susceptibility, highlighting the importance of coping resources like social
support and psychological skills.
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Overall, many theories of social causation of health and illness today combine elements of stress theory with
traditional explanations based on physical and environmental factors.
At this point, it's important to approach the discussion with caution. The evidence regarding causal pathways in
health and illness largely relies on statistical associations from observational studies. Experimental evidence in
humans is limited due to ethical concerns, and findings from animal studies may not directly apply to humans.
Furthermore, human health is incredibly complex, involving interactions between genetic, environmental,
behavioral, and psychosocial factors. Despite efforts to simplify and analyze these complexities, challenges
remain in developing and testing theories in sociomedical research.
To determine if a statistical association can imply a causal link, epidemiologists have developed several criteria:
1. Temporality: Exposure to a risk factor should precede the development of disease.
2. Strength of association: The magnitude of the association between exposure and disease risk.
3. Consistency: Findings should be replicated in independent studies.
4. Biological gradient and plausibility: Higher exposure to risk should lead to a higher risk of disease, with
clear biological mechanisms linking exposure to disease.
5. Coherence: Evidence from different types of studies should support the same conclusion.
6. Specificity: If a risk factor is specific to a particular disease, it strengthens the likelihood of causality.
7. Interventional evidence: Reducing exposure to a risk factor should lead to a reduction in disease
vulnerability.
While there's limited definite evidence linking specific social circumstances to specific physical or mental
illnesses, research in this area is progressing rapidly. Before delving into current research, it's worth briefly
examining the history of sociological studies on the social causes of health and illness.

How health and Illness is socially constructed

Health and illness are not just biological states but are profoundly influenced by social, cultural, economic, and
historical factors. This perspective, known as the social construction of health and illness, emphasizes that what
is considered "healthy" or "ill" is not fixed but varies across different societies and historical contexts. Several
key points contribute to understanding how health and illness are socially constructed.

i. Firstly, societal norms, values, and beliefs play a significant role in shaping perceptions of health and
illness. Cultural beliefs about the body, disease causation, and healing practices influence how
individuals and communities understand and respond to health-related issues. For example, in some
cultures, mental illness may be viewed as a spiritual or moral failing rather than a medical condition,
impacting help-seeking behaviors and treatment outcomes.
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ii. Secondly, social determinants of health, such as access to healthcare, education, socioeconomic status,
and living conditions, profoundly impact individuals' health outcomes. Health disparities rooted in
systemic inequalities contribute to differential access to resources and opportunities, leading to varying
levels of health and well-being within populations. For instance, individuals from marginalized
communities may face barriers to accessing quality healthcare services, leading to disparities in health
outcomes compared to more privileged groups.
iii. Thirdly, the process of medicalization further shapes perceptions of health and illness by defining certain
conditions or behaviors as medical problems requiring intervention. Medicalization expands the domain
of medicine into areas previously considered non-medical, influencing individuals' experiences and
understandings of health-related issues. For example, the medicalization of childbirth has led to
increased medical interventions in the birthing process, impacting women's autonomy and experiences
during childbirth.
iv. Furthermore, the media, healthcare institutions, and pharmaceutical companies also contribute to the
social construction of health and illness by shaping public discourse and promoting certain health
behaviors or treatments. Messages about what constitutes a "normal" body or lifestyle can influence
individuals' perceptions of health and illness, leading to the adoption of certain health practices or the
stigmatization of certain conditions.

Overall, understanding health and illness as socially constructed highlights the need for holistic approaches to
health that address the complex interplay of biological, social, cultural, and environmental factors. By
recognizing the social determinants of health and challenging dominant narratives about health and illness, we
can work towards creating more equitable and inclusive healthcare systems and promoting health and well-
being for all members of society.

1.9 Gender & Health

Gender affects health from both social science and public health angles. The main idea is to understand how
cultural ideas about gender interact with biological outcomes. Gender shapes various aspects of life, including
roles and decisions across different stages like reproduction, aging, and even survival. It's important to note that
there's a lot of variation both across cultures and within them, so gender's influence on health can differ
significantly depending on the specific circumstances.

APPROACHES TO THE STUDY OF GENDER AND HEALTH

The study of gender and health encompasses 2 main approaches.
1. The first explores how cultural norms shape gender roles and affect health perceptions, policies, and
research. This perspective highlights the diverse ways gender roles manifest across societies and how
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they impact health-related behaviors and risks. Feminist scholarship has particularly delved into the
social disadvantages faced by women and girls.
Within this cultural analysis, various aspects are examined, such as the influence of gender roles on
health behaviors, illness perceptions, and access to healthcare. For instance, women's traditional roles
in caregiving may lead them to prioritize health practices for their families, sometimes at the expense of
their own health. However, these behaviors aren't always beneficial; cultural practices like frequent
douching among infertile women can have adverse effects. Additionally, societal norms around sexuality
can expose women to higher HIV risk. Some scholars focus on amplifying women's voices, using
narratives to understand their experiences with healthcare and societal challenges.
Critical medical anthropology scrutinizes biomedical systems, questioning how medical discourse and
technology control women's bodies. It critiques medical narratives that often portray female
reproductive functions negatively compared to male counterparts. Moreover, it highlights how
reproductive processes like menstruation and childbirth have been medicalized, creating economic
opportunities for pharmaceutical companies and physicians.
Another critical perspective, political economy, examines how gender intersects with resource
distribution at local, national, or international levels. It sheds light on inequalities in household resource
allocation, with women often disadvantaged. It also exposes instances where women's health needs are
neglected, such as in clinical trials where female participants face discomfort without recourse.
Additionally, it highlights how economic disparities affect women's access to safe abortion, leaving poor
women at greater risk of injury or death when ending unwanted pregnancies.

2. The second approach quantifies morbidity and mortality among males and females, providing data for
comparisons and policy considerations. While this approach has raised awareness about women's health
issues, aggregate statistics often lack detailed information for effective interventions. Additionally,
debates persist over whether traits or risk factors are biologically or culturally determined.
The distinction between sex (biological) and gender (social roles) is important in understanding health
behaviors and risks. Culturally patterned gender expectations influence health behaviors, such as the
drive to be thin, and access to healthcare services. Both culturally shaped behaviors and biological risks
interact to affect health outcomes.
Few studies link the cultural construction of gender with actual morbidity and mortality rates. Landmark
studies by Lock on menopause and by Inhorn on infertility demonstrate how cultural and political factors
influence health experiences and outcomes. Lock's work highlights differences in menopausal
experiences between Japan and the United States, while Inhorn's research shows how cultural
imperatives affect infertility treatments and outcomes, often with detrimental effects.

Power & Policy

Discussions on gender and health often revolve around the concept of power, which is often unequally
distributed between genders. Power can take various forms, including authority, access to resources, or control
over discourse. This power dynamic shapes health outcomes and access to healthcare.
In many societies, cultural norms and practices reinforce gender disparities in power. For instance, societal
preferences for sons over daughters may lead to skewed sex ratios or affect women's reproductive choices.
 25

Women in gender-stratified societies often navigate strategies to enhance their access to power and resources,
but they are often constrained by societal expectations, leading to health consequences such as pregnancy-
related risks.
Power dynamics also influence policy debates on gender-related issues, particularly in areas concerning
reproduction and sexuality. Policies on issues like family planning or abortion can spark contentious debates,
reflecting deeper societal beliefs about gender roles and identity. Shifts in policy often coincide with changes in
the balance of power, such as when women gain positions of influence in health professions and policymaking
Internationally, efforts to address women's health needs have evolved from a focus on population control to a
more holistic approach centered on reproductive health. This shift, exemplified by the Cairo International
Conference on Population and Development in 1994, emphasizes women's reproductive rights, dignity, and
access to quality healthcare.
In the United States, initiatives like the creation of the Office of Research on Women's Health at the National
Institutes of Health (NIH) demonstrate efforts to address gender disparities in health research and funding.
These initiatives aim to prioritize women's health needs and promote gender equity in healthcare.

MORBIDITY AND SURVIVAL

Women tend to report more health issues than men across various age groups and regions worldwide. They
also utilize healthcare services more frequently, especially excluding reproductive-related care. Emotional
distress and depression are significant contributors to women's higher morbidity rates globally. Studies suggest
that factors like multiple roles and employment status can influence women's mental health, with employed
women generally experiencing lower risk of affective disorders.
However, recent research has challenged some earlier findings, indicating that gender differences in reported
health issues may be less prevalent when demographic variables are properly controlled. Nonetheless, men
consistently have higher mortality rates than women across all age groups and regions. Causes of male mortality
include homicide, lung cancer, suicide, accidents, and various diseases like chronic obstructive pulmonary
disease and heart disease.
While women traditionally have had a survival advantage over men, this gap is narrowing due to factors like
increased smoking rates among women. Overall, male death and disability rates tend to be higher than those
of females in most regions, except for certain countries like India and China, where female death rates are higher
for specific reasons.

Why the Male Disadvantage in Survival?

 Biological and Cultural Factors: Male mortality rates are influenced by both biological susceptibilities
and culturally driven behaviors.
 Genetic and Hormonal Differences: Genetic diseases and hormonal disparities contribute to the higher
mortality rates among males, reflecting biological influences.
 26

 Risky Behaviors: Cultural norms and gender roles lead to risky behaviors such as accidents, suicides, and
smoking, contributing to male excess mortality.
 Socialization and Gender Roles: Men are socialized to embrace physical risks and engage in behaviors
like smoking and reckless driving at higher rates, aligning with masculine norms.
 Intrinsic to Masculinity: These behaviors are seen as intrinsic to masculinity, with men facing stigma for
not adhering to adventurous norms.
 Nature vs. Nurture Debate: There's a debate on whether these behaviors stem from culturally shaped
gender roles or genetic predispositions.
 Genetic Vulnerability vs. Cultural Reinforcement: While there's evidence of genetic vulnerability to risky
behavior among males, culture also plays a significant role.
 Preventive Measures: Addressing male mortality from accidents, especially among adolescents, requires
understanding both biological and cultural influences.

GENDER LINKED HEALTH RISKS

In many societies worldwide, the enactment of gender roles, rites of passage, or gendered behavior exposes
women and girls to considerable harm or death. Two examples of gender-linked health risks will be examined:
(1) family and sexual violence, and (2) female genital injury. An important caveat is that males also experienced
gender-linked harm, such as the primary responsibility to fight in wars.

1. Family and Sexual Violence

Domestic violence is a prevalent issue globally, particularly affecting women, with alarming rates of abuse
reported in various countries. In the United States, around two million women experience domestic violence
annually, resulting in four to five female deaths per day at the hands of their male partners. Pregnancy does not
exempt women from abuse, as approximately 16% of adult pregnant women and 22% of pregnant teens report
being physically assaulted by their partners during pregnancy, leading to adverse health outcomes for both
mother and child.
Internationally, domestic violence rates remain high, with surveys indicating significant levels of physical abuse
against women in countries such as Canada, Costa Rica, Thailand, Africa, Latin America, and Asia. Moreover,
certain regions exhibit culturally specific forms of family violence, such as "bride burning" or "dowry deaths" in
India, where dissatisfaction with dowry payments can lead to the murder of brides by their husbands' families.
Additionally, honor killings represent another form of culturally patterned violence primarily observed in the
Arab world, where females are murdered by their own family members to restore the family's honor in cases
where their reputation is compromised.
Sexual pressure and rape also pose significant gender-linked health risks, with high rates reported among female
college students in various countries. Forced sex not only contributes to the transmission of sexually transmitted
 27

diseases but also increases the risk of adolescent pregnancy. Unfortunately, stigma and underreporting continue
to obscure the true extent of these issues, hindering efforts to address and prevent gender-based violence
effectively.

2. Female Genital Mutilation

Female genital mutilation (FGM), also known as female circumcision, encompasses traditional surgical
procedures that involve the partial or total removal of the external genitalia of women, primarily practiced in
African, Middle Eastern, and Asian regions. These procedures are typically conducted during childhood and are
divided into 2 main categories:
i. reduction operations, which involve partial or total clitoridectomy, and
ii. covering operations, such as infibulation and pharaonic circumcision.
Estimates suggest that between 80 to 114 million women in 27 Eastern and Western African countries, as well
as parts of Yemen, India, and Malaysia, have undergone FGM. The most prevalent form of FGM worldwide is
clitoridectomy, accounting for about 85% of cases, while infibulation represents approximately 15% of
procedures.
The practice of FGM is often associated with cultural beliefs and norms surrounding virginity, marriageability,
and male sexual satisfaction. It is sometimes viewed as a religious requirement or considered a normal tradition
due to its longstanding history in certain communities. FGM may be performed to provide physical evidence of
virginity, diminish sexual desire in women, or serve as a rite of passage into adulthood.
Despite its cultural significance, FGM poses significant health risks to women. The procedures are frequently
performed without anesthesia or sterile instruments, leading to immediate complications such as
hemorrhaging, infection, pain, and urinary retention. Long-term consequences include urinary tract infections,
scar tissue formation, obstructed labor, infertility, and maternal mortality. Additionally, FGM can result in sexual
and psychological problems such as painful intercourse, diminished sexual response, depression, and anxiety.
Chronic infections stemming from FGM can lead to pelvic inflammatory disease and infertility, while scar tissue
blockage may cause vesico-vaginal and recto-vaginal fistulae, contributing to maternal morbidity and mortality.
The practice of FGM continues to be a significant public health concern, requiring concerted efforts to raise
awareness, promote education, and advocate for its abandonment.

Conclusion
Gender significantly influences health outcomes, social roles, culturally patterned behaviors, and access to
nutrition and healthcare. These factors are deeply intertwined with biological, social, cultural, political, and
economic aspects of life, making it essential to consider them collectively.
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Gender stratification, which often favors males, negatively impacts the health of females across various societies
and levels of society. This disparity is evident in resource allocation for women's health, where cultural
assumptions and the representation of women in positions of authority play significant roles. Additionally,
unequal distribution of food and resources within families can critically affect the health of women and girls.
Despite facing less access to power and higher rates of poverty, women generally exhibit lower mortality rates
and longer life expectancies compared to men in most countries. Male risk behavior, including reckless driving,
substance abuse, and intentional injury, contributes significantly to excess male mortality, while male violence
is a leading cause of female death and disability. Addressing these issues through policies that target male risk-
taking and violence can improve overall health outcomes.
Cultural factors, economic disadvantage, and racism intersect to amplify health risks among certain groups.
Economic disparities, particularly between developed and developing countries, significantly contribute to
differences in health status. Even within less developed areas like Egypt, where gender stratification favors male
survival, disparities in wealth can mitigate health impacts. Similarly, among marginalized groups like African
Americans in Syracuse, poverty exacerbates social disadvantages, particularly affecting men in their productive
years.
In conclusion, addressing gender concerns requires considering resource allocation, equity, and the impact of
ethnic and racial discrimination. Understanding and addressing these factors holistically are essential for
improving health outcomes and reducing disparities in society.

Parson's Doctor-Patients relationship

The Parsonian tradition of medical sociology, rooted in the work of Talcott Parsons, offers a comprehensive
framework for understanding the dynamics of the doctor-patient relationship and the broader social
construction of health and illness. Parsons, drawing inspiration from influential sociologists like Emile Durkheim,
Max Weber, and Sigmund Freud, sought to elucidate how medical professionals contribute to social harmony
and the maintenance of conventional social roles.
Central to Parsons' theory is the concept of the doctor-patient relationship, which he analyzed through the lens
of Weberian sociology. Parsons highlighted the various forms of authority wielded by medical professionals,
including traditional, legal, rational, and charismatic authority. He argued that while doctors possess these
sources of authority, their roles are ultimately contingent upon a structural legal authority that legitimizes their
qualifications in defining sickness. Moreover, Parsons emphasized the importance of the doctor's rationality in
determining the diagnosis and treatment of patients, positioning doctors as gatekeepers who regulate access
to medical care.
Building on Freudian psychoanalytic theory, Parsons characterized the doctor-patient relationship as analogous
to that of a parent and child, with the doctor assuming a nurturing role over a passive patient. He argued that
individuals adopt the sick role when they passively accept medical treatment, navigating conflicting desires
between the expectation of recovery and the secondary benefits of being sick.
 29

Parsons' seminal contribution to medical sociology is his development of the "sick role theory," which delineates
the rights and obligations associated with illness. According to Parsons, sick individuals are granted certain
privileges, such as exemption from normal social responsibilities, but are also expected to adhere to certain
norms, such as seeking medical care and striving to recover. He proposed a "sick role mechanism" wherein
doctors and patients interact within a set of rights and obligations, aimed at restricting the proliferation of a
subculture of malingerers in society.
The key elements of Parsons' model include:
i. Sick Role: Parsons viewed illness as a form of deviant behavior that disrupts normal social functioning.
The "sick role" defines the rights and obligations of the patient, including the obligation to seek
competent help and follow medical advice.
ii. Technical Competence: The doctor is expected to possess specialized technical competence and
knowledge to diagnose and treat the patient's illness.
iii. Universal Service: The doctor has an obligation to provide services universally, without discrimination
based on personal characteristics or ability to pay.
iv. Functional Specificity: The doctor-patient relationship is focused specifically on the medical problem,
and should not extend beyond this realm.
v. Affective Neutrality: The doctor should maintain an emotionally neutral and objective stance towards
the patient, avoiding excessive emotional involvement.
Despite its significance, Parsons' theory has been subject to criticism, particularly from feminist scholars who
argue that it fails to adequately account for gender differences in the experience of illness. Additionally, critics
have pointed out limitations in Parsons' conceptualization of sick roles, particularly in chronic illnesses and non-
Western contexts. Nonetheless, Parsons' framework continues to inform contemporary medical sociology,
providing valuable insights into the complexities of the doctor-patient relationship and the social construction
of health and illness worldwide.

3.1 The Medical Profession: Knowledge, Power, and Autonomy

INTRODUCTION

The portrayal of doctors in the media often swings between two extremes: either as compassionate healers or
as heroic figures in high-tech emergency rooms. Meanwhile, there's constant coverage of disputes over fees,
malpractice, and the rise of alternative medicine. Despite the hype about medical advancements, the reality is
more complex.
On one hand, there's a shift towards mass-market health care, where medicine becomes more industrialized.
On the other hand, in social theory, there's a growing view of medicine not as a unique profession but as subject
to similar processes as other occupations.
 30

Doctors, we argue, aren't immune to the pressures of capitalist production. Their rise to power and recent
decline are seen as contingent on social structures in advanced economies.
It's important to note that we focus mainly on the medical profession, which has become highly segmented with
differing interests. Even the relationship between individual doctors and medical organizations is complex.
In simpler terms, we're looking at how medicine has evolved within changing healthcare systems and through
the lens of social theory. We'll focus on the shifts in medical power over time, mainly in English-speaking
countries.

PROFESSIONS AND POWER

Theory: When sociologists study health and medicine, they see medicine as a powerful force that shapes
and is shaped by society. They focus on understanding how much power medicine has, where it comes from,
and what it means for people's lives. This involves looking at things like how much authority doctors have,
how independent they are in their work, and how they control medical practices.
However, sometimes they focus too much on the power of doctors and don't pay enough attention to what
doctors actually do or how being sick affects patients and doctors alike.
Medicine's story isn't just about doctors; it's also about how medicine fits into larger social trends, like the
growth of professional jobs and changes in government support for healthcare. So, talking only about
medicine might miss the bigger picture.
And because people see medicine in different ways, there's no one right answer about how to understand
it. Different experts have different ideas, which can lead to different views on what medicine means for
society.
Think about it like this: Imagine you're looking at a big, intricate puzzle. Some people focus only on one
piece, like how doctors hold power. But to really understand the whole picture, you also need to look at how
doctors work, how patients experience illness, and how medicine fits into the larger world of jobs and
government. And even then, people might see the puzzle differently depending on where they're standing.

Social and Health-Care Trends: The field of medicine has undergone significant changes over time,
reflecting broader societal shifts. Once dominated by individual doctors operating in small-scale settings,
healthcare has evolved into a massive industry, with most services provided by paid professionals within a
large market.
Today, healthcare is a major part of the economy, with spending comparable to industries like steel and
automobiles. Physicians now work within large institutions, both public and private, and their profession is
influenced not only by government policies but also by broader economic forces and global trends.
 31

The current landscape of medicine is shaped by globalization, corporate power, and conservative ideologies,
which have led to attempts to control costs and increase efficiency in healthcare delivery. This often involves
encroaching on areas traditionally controlled by doctors.
However, medicine is also influenced by grassroots movements like the women's movement and patient
advocacy groups, as well as by changes in medical knowledge and technology. These forces have led to shifts
within the profession, such as more women entering medicine and increased specialization.
Overall, while medicine still retains significant autonomy, its power and authority have diminished
somewhat in the face of changing social, economic, and political dynamics. Understanding these changes
requires looking at medicine within the broader context of society and considering its relationships with
other professions and institutions.

STATE OF THE FIELD, OR HOW DID WE GET HERE FROM THERE?

In the 18th and 19th centuries, medicine wasn't highly regarded, and many people believed they knew as much
as doctors about treating illnesses. Medical training was basic, focusing on classical studies and apprenticeships.
However, by the mid-20th century, medicine gained immense public prestige, authority, and power. Doctors
were now seen as highly trained experts, replacing classical training with rigorous scientific education at
universities.
After World War II, medicine ranked at the top in assessments of occupational prestige. Doctors not only
controlled medical practices but also influenced healthcare policies. They became authorities on health matters
in society.
This rise in medical authority wasn't solely due to improved medical treatments. Sociologists and historians, like
McKeown, argued that social conditions played a bigger role in improving public health than medical
interventions. Historians noted that medicine gained power before it became truly effective. So, while medical
efficacy contributed, social conditions were the main driver behind the rise of modern medical authority.

THEORIES OF THE PROFESSIONS

The study of professions, often illustrated by medicine, has evolved through various theories over time.
Initially, analysis focused on traits, like skills and knowledge, associated with professions. Then, functionalist
theories emerged, highlighting the societal roles and functions of professions, followed by theories emphasizing
power dynamics within professions.
Recently, challenges to power theories have arisen, particularly from feminist and Foucauldian perspectives.
These challenge traditional views and offer new insights into the origins and evolution of professions.
Foucault and Krause suggest professions have roots predating the Industrial Revolution, tracing back to
medieval guilds, challenging assumptions about their emergence.
 32

Trait and Functionalist Theories: Early "trait" theories of professions, like those of Carr-Saunders and
Wilson, focused on specific characteristics believed to define professions, such as specialized knowledge,
ethical codes, and altruism. These theories suggested that professions developed by acquiring these traits
over time.
Later, functionalist theories, led by scholars like Parsons, shifted the focus to the societal roles and functions
of professions. They suggested that professions, including medicine, gained power by exploiting patients
financially, sexually, or otherwise. This was seen as part of an implicit agreement between society and the
professions, where the professions were given autonomy in exchange for self-regulation.
Both trait and functionalist theories viewed professionalization positively, contrasting with Marxist critiques
of capitalism's impact on work and Weber's pessimistic analysis of bureaucratic rationalization. For
Durkheim, professionalization offered an alternative to increasing work alienation, presenting a future of
self-directed and autonomous work organization.

Power Theories: Power theories emerged as a challenge to earlier trait and functionalist perspectives on
professions, particularly medicine. Analysts from various traditions, including symbolic interactionism,
questioned the altruistic traits attributed to professions like medicine, highlighting their exploitative
tendencies.
Freidson's influential work argued that medicine held dominant power in healthcare, controlling both
medical practices and healthcare policies. He suggested that medicine's application of knowledge was
influenced more by self-interest than by pure scientific principles, leading to efforts to maintain control and
resist changes like universal healthcare insurance.
This shift in focus from socialization to structural factors redirected attention to the influence of the situation
in which doctors practiced. Johnson also contributed by developing a typology of profession-client
relationships, placing medicine within a framework of collegiate control where practitioners defined client
needs and methods of meeting them.
Neo-Weberian power theorists viewed medicine as just one of many professions using exclusionary tactics
to maintain market monopolies. This monopoly granted unprecedented control over healthcare, reinforcing
medicine's authority and influence.

Neo-Marxist Theories: Neo-Marxist theories critique earlier perspectives, like Freidson's, for not
adequately addressing the class dynamics inherent in the relationships between professions, particularly
medicine, and the capitalist state. These theories emphasize the influence of capitalism on shaping medical
power and healthcare systems.
According to neo-Marxists, the capitalist system and class struggle affect all aspects of society, including
healthcare. They argue that medicine's rise to dominance is tied to its alignment with the interests of the
capitalist class. For example, the shift towards scientific medicine coincided with the needs of industrialists,
who sought to justify mass production methods using the ideology of science.
 33

Healthcare, viewed as a profitable industry, is influenced by corporations that shape medical practices and
control healthcare institutions. This corporatization leads to the proletarianization of healthcare providers,
where efficiency drives often dehumanize and exploit workers.
Neo-Marxists highlight instances where state or corporate interests supersede medical input in healthcare
policy decisions, such as the implementation of health insurance schemes or attempts to rationalize
healthcare. They argue that professions like medicine have less influence over major decisions, increasingly
confined to shaping existing policies in their favor.
In summary, neo-Marxist theories emphasize the interplay between capitalism, class struggle, and medical
power, challenging earlier views that portrayed professions as altruistic or purely self-regulating entities.

Neo-Weberian Closure Theory: This theory suggests that the relationship to the market, rather than
the means of production, is crucial in understanding societal divisions. Parkin's theory, influenced by Weber,
focuses on the conflict between groups aiming to maintain or improve their market position and those
seeking to challenge the dominance of others.
Applied to healthcare, this perspective led to the development of theories focusing on interoccupational
competition, known as closure theory. Closure theory suggests that different groups or professions use
various criteria to exclude or undermine others. While descriptive, these theories often lacked explanations
for why certain groups succeeded over others.
Murphy attempted to address this by proposing principal, derivative, and contingent forms of exclusion.
According to this view, within capitalism, legal ownership of property was the primary form of exclusion,
tying medical power partially to its position within the class structure.
Closure theory appeared promising because it allowed for the consideration of various non-class factors,
such as gender or race, in occupational competition. However, it also faced challenges, including the
tendency to overlook the relationship between closure and class theory and the risk of circular reasoning.
In summary, while closure theory attempted to integrate multiple factors into the analysis of occupational
competition, it sometimes devolved into a study of interest groups. Conversely, neo-Marxist theory
appeared more persuasive when emphasizing the influence of class dynamics, despite its initial rejection of
neo-Weberian perspectives.
 34

Trait and
Neo-Marxist Neo-Weberian
Aspect Functionalist Power Theories
Theories Closure Theory
Theories

Focus Characteristics of Power dynamics Class dynamics Market relationships

professions within and capitalism's and occupational
professions and influence on competition
society professions

View of Professions Positive Questioning Questioning Questioning

View of Positive Positive Positive Neutral

Professionalization

Key Theoretical Carr-Saunders, Freidson, Johnson Neo-Marxist Parkin

Figures Wilson, Parsons scholars

Explanation Acquisition of Structural factors Influence of Interoccupational

traits over time and societal capitalism and competition
dynamics class struggle

Critiques Overlooks Overly Limited focus on Tends to

exploitation, fails deterministic, non-class oversimplify, may
to address power lacks attention to factors, abstract lack explanatory
dynamics individual agency analyses power

Main Contributions Early Highlighted Emphasized Explored market

understanding of power dynamics, class dynamics, relationships,
professions, structural capitalism's occupational
societal roles influences influence competition

The Proletarianization of Medicine Debate: The debate over the proletarianization of medicine
originated from neo-Marxist perspectives, questioning whether medicine's power had declined or merely
changed form. Proletarianization refers to the process by which individuals or groups are transformed into
proletarians, who are members of the working class. Historically, medicine's power varied across time and place,
prompting studies examining its rise and potential decline. Some argued that medicine had never been as
dominant as believed, with its power contingent on external factors. Others suggested that industrialization had
led to the proletarianization of medicine, where it lost autonomy and became more like a working-class
profession. The debate was clouded by differing interpretations of "proletarianization" and national examples.
Some argued that medicine's power had crystallized due to state regulation, embedding its control over other
health professions. However, others believed that new legislation created new challenges for medicine. While
some writers claimed medicine remained dominant, others argued it had declined to a position of "responsible
autonomy" or worse. Observers from various countries suggested that medicine was on the defensive.
 35

Differences in the debate centered on whether medicine's power was declining or being maintained, with some
viewing the glass as half-full and others as half-empty. Changes in the broader political economy, such as the
rise of competing power centers, contributed to the fragmentation of medicine internally. Marxists emphasized
external challenges as fundamental, seeing them as interactions between wider structural changes and internal
shifts within medicine. Overall, the debate highlighted ongoing struggles over control within the medical
profession.
The debate over the challenges to medicine revolves around two main concepts: deprofessionalization and
proletarianization. Deprofessionalization refers to a process in which the traditional characteristics and status
associated with a particular profession decline or diminish. Some argue that medicine's authority over patients
is declining, while others focus on increasing state or corporate surveillance over medical work.
Recent interpretations suggest that deprofessionalization and proletarianization are distinct processes, with the
former related to the demystification of medical knowledge and the latter tied to occupational control.
Understanding medical dominance requires considering various dimensions of control and autonomy. The
notion of self-regulation, often seen as a measure of professional autonomy, is evolving, with some suggesting
a shift towards "state-constrained self-regulation." Despite this, medicine continues to exert power, though it
faces challenges from external actors and attempts to protect its privileged position. The decline in medical
power is evident in areas like healthcare policy, where states and corporations intrude on medical territory.
Legal systems increasingly favor patient rights, reflecting a broader questioning of medical authority. Changes
in society towards postmodern values, including skepticism towards science and technology, also challenge
medicine.
Debates on medicine often focus on whether individual physicians or the profession as a whole are declining.
While some argue that the profession retains power corporately, others suggest that states influence medicine
through cooptation or constraint. National differences further complicate the discussion, with varying roles of
medicine and different theoretical perspectives across countries. Overall, political analyses of healthcare often
overlook broader structural forces, instead focusing on individual personalities or specific political events.

Medical Knowledge
The power of medicine is closely tied to its control over specialized knowledge, which has historically been held
by a relatively small and homogeneous group within the medical community. This control over medical
knowledge has been a crucial factor in maintaining medical power and authority. Medical knowledge is primarily
produced within institutions like medical schools and hospitals, where physicians have significant influence and
access to resources. This control over knowledge production serves as a barrier to research by other professions
and reinforces the authority of physicians in healthcare.
However, recent trends towards the rationalization of healthcare have challenged the monopoly of medicine
over knowledge. Planners, managers, and economists now claim expertise in healthcare systems, and new
approaches like evidence-based medicine have emerged to guide clinical practice. These developments have
eroded the traditional authority of medicine by increasing the role of non-physicians in determining healthcare
practices and standards.
 36

As a result, the focus has shifted from simply assessing medical knowledge to examining the factors that
influence claims to knowledge within the healthcare field. This highlights the political nature of setting
knowledge boundaries and suggests that medical power may be more vulnerable to external influences than
previously thought.

ALTERNATIVE VIEWS
Alternative views of the medical profession have emerged in response to the dominant paradigms of neo-
Weberian and neo-Marxist power theories. These alternative perspectives include feminist theory, Foucauldian
analysis, and postmodernist or relativist viewpoints.
Feminist theory offers a critical lens through which to examine power dynamics within the medical profession,
particularly in relation to gender. It highlights issues such as the marginalization of women within medicine, the
gendered nature of medical knowledge and practices, and the unequal distribution of power and authority along
gender lines.
Foucauldian analysis, inspired by the work of Michel Foucault, emphasizes the interplay between knowledge
and power in shaping social institutions like medicine. It focuses on how medical knowledge is produced,
disseminated, and used to regulate individuals and populations, often through mechanisms of surveillance and
discipline.
Postmodernist or relativist perspectives challenge the idea of fixed truths or universal explanations, instead
emphasizing the plurality of experiences and interpretations. These views question the authority of traditional
knowledge systems, including medicine, and highlight the importance of context, discourse, and subjectivity in
shaping understandings of health and illness.

Medicine and Feminism: Feminist perspectives have brought attention to gender disparities within the
medical profession and healthcare systems. Historically, women were marginalized as healers, and the rise of
male-dominated medicine displaced many female practitioners. Traditional approaches to healthcare
professions overlooked gender biases, leading to the exclusion of women from medical roles.
The resurgence of midwifery in some countries challenges the idea of continued male dominance in healthcare.
Closure theory is used to explain how gender discrimination operates within healthcare professions, with
women often being excluded or marginalized. Female-dominated healthcare roles, such as nursing, reflect
societal expectations of women's caregiving roles.
While the number of female medical students has increased, women still face barriers in accessing high-status
medical specialties or leadership positions. Medicine is viewed as reflecting patriarchal ideologies, with women
relegated to lower-status roles or masculinized to fit into male-dominated fields.
Feminist analysis also sheds light on the intersection of gender with healthcare practices, particularly in areas
like women's reproductive health. The women's health movement, exemplified by publications like "Our Bodies
Ourselves," seeks to reclaim healthcare for women and emphasize self-care and empowerment.
 37

By highlighting gender biases in healthcare, feminists have contributed to a deeper understanding of how
patriarchal structures shape medical practice and influence women's health. The distinction between patriarchy
and patrism helps contextualize changing dynamics of gender in the medical profession and healthcare systems.

Foucault: Foucault's perspective diverged from traditional theories by focusing on how power operates in
everyday practices, rather than large-scale societal structures. He argued that power and knowledge are closely
linked, with the act of theorizing about something also serving to exert power over it.
Foucault highlighted how the shift from punishment to medical care, known as medicalization, can also be a
form of social control. Practices like public health and health promotion extend the influence of medicine into
people's daily lives, shaping their behaviors and habits.
According to Foucault, professions like medicine are part of a broader system of governance within society. They
play a role in exerting control over individuals and shaping social norms.
Recent scholars, like Lupton, have expanded on Foucault's ideas, suggesting that power can be more nuanced
than simply a matter of dominance. Both patients and doctors can wield power in interactions, and power
dynamics can be complex and multifaceted.
Overall, Foucault's perspective highlights the intricate ways in which power operates within the interactions
between patients, doctors, and the institutions of healthcare.

Future Possibilities: In considering future directions for theories of the medical profession, it's evident that
current sociological theories, particularly those of Foucault and feminist perspectives, have had significant
influence. However, the evolving landscape of sociological theory suggests potential shifts in focus.
Postmodernist and social constructionist perspectives, with their skepticism toward knowledge, including
medical knowledge, could become more relevant in understanding medicine. Similarly, theories characterizing
high modernity as the "risk society" may gain importance, emphasizing the centrality of expert knowledge,
including medical expertise, in navigating ambiguous health risks.
There's also growing interest in the neo-institutionalist view of professions, which examines how different
institutional contexts shape the values, attitudes, and actions of practitioners. For example, physicians in public
service versus the private sector may develop distinct perspectives on various aspects of healthcare provision.
This perspective reinforces the notion of the increasing fragmentation within the medical profession.
However, these newer theoretical trends sometimes diverge, with postmodernism questioning scientific and
medical authority while risk theory elevates medical knowledge and expertise. Despite these differences, the
influence of culturally and phenomenologically oriented viewpoints on theories of medicine remains largely
untapped, suggesting a dynamic future for the field.
 38

Aspect Feminist Theory Foucauldian Analysis Future Possibilities

Focus Gender dynamics within Interplay between power and Emerging trends and
medicine and healthcare knowledge in shaping social potential shifts in
systems institutions theoretical focus

Key Gender disparities,

Emphases marginalization of women
in medicine, gendered
nature of medical
knowledge
Postmodernist, risk
Power/knowledge nexus,
society, neo-
medicalization, disciplinary
institutionalist
mechanisms
perspectives

Insights Highlights how power

Reveals gender biases and Explores new theoretical
operates in everyday
inequalities within directions, acknowledges
practices, challenges
medical practice and fragmentation within the
traditional notions of power
healthcare systems medical profession
dynamics

Contributions Provides critical analysis of

Offers nuanced understanding Points towards potential
gender dynamics in
of power dynamics in future shifts in theoretical
medicine, emphasizes
healthcare, sheds light on frameworks, considers
empowerment and self-
societal control mechanisms diverse perspectives
care

Relevance Considers emerging

Addresses historical and
contemporary gender
issues within medicine
Examines power relations and
theoretical trends and
disciplinary practices within
their implications for
healthcare
understanding medicine

CONCLUSION
The evolving landscape of the medical profession suggests a departure from traditional views of medicine as a
unique occupation with inherent power and autonomy. Instead, medicine is increasingly subject to regulation
and standardization, similar to other professions. While medicine still holds clinical autonomy, its dominance is
less convincing, particularly amidst growing medicalization and scientific innovation.
The idea of medical knowledge as inherently powerful is challenged, with its authority rooted more in social
practices and institutional structures than in any unique properties. The rise of neoliberalism has introduced
tensions within the medical profession, as it navigates pressures for rationalization alongside ambiguous
relationships with neoliberal ideologies.
Neo-Weberian and neo-Marxist theories offer useful insights into inter-occupational struggles and class
structures, but newer perspectives like Foucauldian analysis and feminist theory highlight overlooked dynamics
of power and gender within medicine. However, these perspectives are not yet complete alternatives and
require further development.
 39

Foucault's perspective underscores the pervasive influence of power in everyday medical practices, while
feminist theory sheds light on gender disparities within the profession. Postmodernist views challenge
traditional notions of medical authority and knowledge, emphasizing their constructed nature.
Despite these theoretical advancements, medicine remains complex, with contradictory roles as both a service
profession driven by altruism and an organized entity with specific interests. The profession operates within
healthcare systems that may impede the rational application of medical expertise. Addressing these
contradictions requires understanding and confronting the complex intersections of politics, society, and
economics within which medicine operates.

3.4 Alternative Health Practices and Systems

INTRODUCTION
In modern times, biomedicine has become the primary form of healthcare in many advanced societies. This
began in the 19th century when governments started supporting and regulating biomedical services.
Sociologists note that society increasingly views issues through a medical lens, granting significant power to the
biomedical profession. While some countries made non-biomedical healing illegal, alternative healing methods
persisted, particularly among rural populations, the urban poor, and ethnic minorities. Alongside biomedicine,
alternative healing methods like homeopathy, chiropractic, and osteopathy emerged and gained popularity in
different parts of the world.
Non-biomedical forms of healing, though experiencing decline during the interwar period, never disappeared
entirely. Since the 1960s, they've regained popularity, with increased research and professionalization. New
methods like aromatherapy and reflexology emerged during this time. While alternative medicine isn't new,
interest surged among educated middle classes, expanding to broader demographics later. Surveys from Europe
in 1994 showed 20-49% of people using alternative medicine, with growing interest in the 1980s. Before the
1960s, it's hard to gauge the role of non-biomedical healing.
However, debates emerged in the late 1960s, focusing on its legitimacy. Some governments reconsidered
restrictive laws, funded research, or considered registration for alternative therapies. Doctors started exploring
collaboration with alternative practitioners, despite opposition from medical associations. The rise of alternative
medicine raises questions about the status of biomedicine and its dominance. Is it declining in favor of a more
diverse healthcare system, or does biomedicine still hold power in defining legitimate practices? This varies
across different healthcare systems, whether market-oriented or state-organized.
The relationship between biomedicine and alternative medicine is complex, ranging from rejection to
incorporation by the medical establishment. Patient perceptions play a significant role, with a growing number
of people using alternative medicines and sharing their experiences through various channels. These therapies
have evolved over time, with many becoming more professional and politically know-how.
Some doctors practicing alternative medicine have become more vocal in promoting these therapies within
medicine. This shift has prompted calls for policy reform, though actual legal changes have been limited.
 40

However, there's a noticeable relaxation in attitudes towards alternative therapies, with some countries
showing interest in integrating them into state-funded healthcare provision.
While it is acknowledged that there are other angles to explore, such as the role of insurance companies and
pharmaceutical companies, we focus on these four viewpoints due to their significance in understanding the
challenges and opportunities facing alternative medicines today. The term "alternative medicine" itself is
debated, with some preferring "complementary medicine" to reflect how these therapies often complement
biomedical care rather than replace it. Boundaries between alternative and orthodox medicines are becoming
blurred, especially when doctors themselves practice nonbiomedical healing. The term "alternative medicine"
encompasses a diverse range of practices, and various other terms like "complementary" or "holistic" medicine
are also used. We use "alternative medicine" for simplicity, recognizing the complexities in defining and naming
these healing practices.

USERS OF ALTERNATIVE MEDICINE

Around 20-25% of people in Western countries have tried alternative medicine within the past year, with
popular choices including osteopathy, chiropractic, homoeopathy, herbalism, acupuncture, relaxation therapy,
and therapeutic massage. Typically, these users are middle-aged, middle-class women, reflecting similar
demographics seen in traditional medicine usage.
Users of alternative medicine tend to prioritize healthy living and may be skeptical of traditional medical
approaches. Access to alternative medicine can vary by location, with more practitioners available in some
regions compared to others. Despite skepticism towards traditional medicine, most users still consult traditional
doctors before seeking alternative treatments.
Interestingly, while many users are skeptical of traditional medicine, they rarely completely abandon it. Instead,
they often integrate both types of care, particularly for chronic illnesses, resulting in a high overall usage of
healthcare services. Some users are discerning in their choice of alternative practitioners and may shop around
for different treatments. As users gain more knowledge about alternative medicine, they may even choose it as
their primary option for certain health issues.
Overall, the rise of alternative medicine doesn't mean people are turning away from traditional medicine
entirely. Instead, it suggests a more pluralistic approach to healthcare, where users integrate both traditional
and alternative treatments based on their individual needs and preferences.

The Value of Alternative Medicine to Users: Users of alternative medicine seek more than just effective
treatment; they desire treatments that are perceived as natural and have fewer side effects. They value the
qualitative differences in the therapeutic encounter, particularly the amount of time spent with the practitioner.
Alternative medicine consultations can last over an hour, allowing patients to discuss their medical problems in
depth and address underlying anxieties.
This holistic approach to health considers spiritual and emotional well-being as important as physical symptoms.
Patients are treated as experts on themselves, allowing for a sense of control over their healthcare program.
They appreciate a more participatory relationship with their practitioner, feeling positively about being treated
 41

as equals. However, this shared relationship can sometimes lead to confusion about the roles of the patient and
practitioner.
Despite feeling involved, many patients lack detailed knowledge about the medications prescribed or about
alternative medicine in general. This suggests that while patients desire a participatory role, they may not always
have the expertise to fully engage in their healthcare decisions.
Patients don't necessarily want full equality in health knowledge, but they do desire a more active role in their
healthcare decisions. With alternative medicine often being private, patients tend to choose their therapies and
practitioners independently, feeling like consumers rather than just patients.
Alternative medicine offers interpretations of illness beyond traditional medical views, aligning more closely
with patients' personal beliefs. Practitioners spend time understanding patients' lifestyles, families, and
environments, helping them make sense of their health issues.
Some patients seek alternative medicine for ideological reasons or to build a different relationship with their
practitioner, while others simply want symptom relief. Alternative practitioners often see themselves as
educators, helping patients understand their bodies and prioritize preventive health care.
Research suggests that users of alternative medicine are more knowledgeable about their bodies and more
focused on maintaining good health through lifestyle choices. Therapists may encourage patients to monitor
their bodies closely, which can change how patients perceive themselves.
People who use alternative therapies often become more focused on maintaining good health. This reflects a
cultural belief in "healthism," which emphasizes individual responsibility for perfecting health. Some see this
emphasis as empowering, while others view it as placing too much pressure on individuals.
Alternative medicine can seem to empower individuals by making them less reliant on traditional medicine, but
it also scrutinizes all aspects of their lives. This shift in health-seeking behavior could change the balance of
power in healthcare, with patients seeking more equality in their relationships with practitioners. Traditional
medicine may need to become more patient-centered to keep support.
As people become more skeptical of traditional medicine, it challenges the authority of orthodox doctors. The
medical profession is aware of this and has tried to understand why people are drawn to alternative medicine,
sometimes trying to limit its practice.

RELATIONS WITH THE MEDICAL PROFESSION

The relationship between alternative medicine and the medical profession is complex. Some doctors are open
to alternative therapies and may even refer patients to alternative practitioners. However, this referral might
be due to patient demand rather than personal conviction.
In countries like the United States, Great Britain, and parts of North Europe, there's a growing trend of
integrating biomedical and alternative medicines. This integration can happen through collaborations between
medical and alternative practitioners, forming holistic healthcare teams.
 42

There are different ways this integration can occur, such as having alternative practitioners work as ancillary
staff funded by health services, sharing premises with GPs and receiving referrals, or setting up referral centers
funded by local health authorities.
A more radical model involves both doctors and alternative practitioners jointly managing health center
resources and sharing accountability. However, this model requires doctors to give up more authority to
alternative practitioners, which might not be widely accepted in the medical community.
There are efforts to integrate alternative medicine into research and training, such as the "Munich Model" in
Germany and the inclusion of alternative therapy modules in medical school curriculums in the US, UK, and
other countries.
However, national medical associations have often resisted legitimizing alternative medicine. The biomedical
profession typically relies on scientific evidence for legitimacy, and critics argue that alternative medicine lacks
this scientific basis.
Some critics even view alternative medicine as a return to magic and superstition. The organized medical
profession has historically influenced government policies, often blocking attempts to legitimize alternative
practices.
Nonetheless, the influence of the medical profession varies by country. In some places like Sweden, despite
opposition from the medical profession, legislation supporting alternative medicine has still been passed, albeit
with delays.

The Case of Chiropractic: Chiropractic, founded by Daniel David Palmer, became popular in the US as an
alternative to conventional medicine. Patients liked its drug-free approach and eclectic practice, despite medical
profession's skepticism.
Despite opposition, chiropractors gained legal recognition and even sued medical organizations for antitrust
violations. Courts ruled in favor of chiropractors, leading to the establishment of research institutes promoting
cooperation between chiropractors and conventional medicine.
In countries like Australia, chiropractors faced opposition from the medical profession, but government
committees recognized their role in healthcare. In Britain, chiropractic practice was more limited, focusing on
back pain, and was supported by the medical profession.
This shows that while medical associations often oppose alternative medicine, their stance varies based on
whether they see it as a threat or a potential addition to conventional practice. Governments also take public
opinion into account, making doctors less certain their objections will be heard.
National medical associations are becoming less opposed to alternative medicine, but doctors' acceptance of
specific practices varies widely. While acupuncture and chiropractic are generally accepted, others like
herbalism or kinesiology may not be.
Conventional medicine is not rigid and can incorporate new ideas based on patient demand. The relationship
between alternative medicine and conventional medicine is evolving, with some cooperation and shared
knowledge.
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However, conventional medicine remains dominant, and alternative practices gaining recognition often have
some level of approval from the medical profession. The future of their relationship will depend on continued
dialogue and potential shifts in both fields.

THE RENOVATION OF ALTERNATIVE MEDICINE

After World War II, alternative medicine experienced a resurgence worldwide, but the types of therapies that
gained popularity varied by country. For instance, reflexology became popular in Denmark, while spiritual
healing saw an increase in Iceland and The Netherlands, and acupuncture and homeopathy became popular in
France.
In the United States, chiropractic, osteopathy, and naturopathy maintained a strong presence throughout the
century and saw further growth in the 1970s. However, these trends varied spatially and temporally across
Europe.
Different countries have different legal systems that affect the expansion of therapies. Some countries only
allow doctors or medically-oriented professionals like physiotherapists to practice alternative therapies. Even
within countries, each therapy group has its own history and perception of its role in healthcare. In Britain alone,
there are around 160 therapy groups, each organized differently and with different views on what they can
treat. The number of therapists and professional associations is increasing, leading to debates within therapy
groups about their role and scope. Despite these variations, some general trends can be identified.
The revival of alternative medicine in the 1970s was driven by non-medically qualified individuals who promoted
therapies like homeopathy, often with spiritual beliefs. Training was informal, lacking structure, and open to
anyone interested, regardless of background or qualifications.
However, by the late 1980s, there were significant changes. Alternative medicine began to be formalized with
the establishment of training colleges and efforts to achieve accreditation and degree status. This led to a
dramatic increase in student numbers.
In the United States, for example, within 10 years of the first naturopathy college opening, the number of
students increased from just three to over 130 per year. Similarly, in the UK, the number of reflexology schools
and trained practitioners grew exponentially.
During the 1980s, numerous colleges for various forms of alternative medicine emerged, leading to a significant
increase in training opportunities. For example, by the early 1990s, there were twenty homeopathy colleges
and over 100 reflexology schools in the UK alone.
The pluralization of colleges offering alternative therapies in the United Kingdom has led to changes in curricula
and qualifications, with many therapies now requiring at least four years of training and supervised clinical
practice, often linked to nationally approved credentials. Despite the initial radical ideas within some therapy
groups, there has been a shift towards more moderate practices, such as chiropractic and homeopathy.
Professional associations now emphasize that their practices are complementary rather than alternative to
biomedicine, with some therapies defining their scope modestly. Additionally, efforts have been made to
incorporate medical science into curricula, with a focus on biology, pathology, and physiology, recommended
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by organizations like the British Medical Association. There's also a growing openness to scientific research
methods, including randomized controlled trials, to assess treatment effectiveness. Overall, there's a trend
towards integration with orthodox scientific paradigms and a move away from radical claims.
In response to the growing demand for legitimacy, alternative medical groups have implemented stricter entry
requirements, longer training programs, and established registers of qualified practitioners. This reflects a
broader trend towards professionalization and controlled knowledge dissemination within the sector. Training
curricula now include more biomedical knowledge, aligning with established paradigms and acknowledging the
authority of biomedicine. This shift signifies a move towards conformity with mainstream medical practices
while maintaining autonomy within the alternative medicine field.

THE ROLE OF GOVERNMENT

Governments play a big role in how alternative medicine is accepted and regulated. In some places, like France,
only medically qualified therapists can practice healing. In other countries, like Britain and Germany, non-
medical therapists can practice with certain restrictions or qualifications. Even in countries where alternative
medicine is recognized, mainstream medicine usually gets more support and funding.
Recently, there's been a rise in alternative medicine, so governments are figuring out how to regulate this
growing market. Generally, there's more acceptance now, especially for therapies that have clear training
standards. However, there are still differences between therapies that are officially recognized by the
government and those that aren't.
In some places, governments are becoming more tolerant and even funding research into alternative medicine.
For example, in the US, Congress told the National Institute of Health to set up an Office for Alternative
Medicine. In the UK, the government is thinking about doing something similar. Some alternative therapies, like
chiropractic, are now officially regulated in several countries.
Governments have shifted their focus on healthcare due to financial crises, rising health costs, shortages of
biomedical personnel, and increased public interest in alternative medicine. Patient groups have also influenced
government decisions. Some governments have become wary of powerful medical groups and have promoted
competition and consumer power. However, government support for alternative medicine has limits. Only
certain therapies that have adapted their practices and made fewer medical claims have received statutory
regulation. For example, in the UK, only osteopathy and chiropractic are regulated. Government support mostly
doesn't include directly funding non-medically qualified alternative practitioners in state healthcare. Private
insurance may cover some alternative therapies.
Overall, there's been some change, but biomedicine still dominates, and alternative medicine must conform to
certain standards. The healthcare system hasn't radically transformed, but there's more acceptance of a variety
of medical practices within certain boundaries.
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CONCLUSION
Nonbiomedical healing practices have gained more recognition in Western healthcare systems since the 1960s.
The legitimacy of these practices can come from various sources like licensure laws, government funding for
research, academic support, efforts by therapists, social movements, and public demand. The process of gaining
legitimacy has been uneven and faced opposition. Different methods of healing gain popularity and legitimacy
in different places.
Looking at this process from four perspectives:
1. Patients: Many patients, especially those with chronic illnesses, prefer alternative medicine due to
dissatisfaction with certain aspects of conventional medicine and a desire for a more participatory role
in their healing. Some find alternative therapies align better with their personal beliefs about health and
illness. This shift in patient preferences has forced doctors and governments to take notice, suggesting
a move away from blindly trusting medical science and towards more individualized approaches to
healthcare.
2. The medical profession: While some doctors have practiced alternative medicine for a long time, more
are recognizing its popularity and potential benefits for certain chronic conditions or providing emotional
support to patients. However, many doctors still perceive alternative therapies as a threat to their
traditional medical practices. Overall, there's a shift towards cautious acceptance of alternative
medicine, focusing on therapies that show efficacy and cost-effectiveness
3. Alternative practitioners: To gain professional legitimacy, alternative practitioners have had to adapt
their practices and theories, often aligning more closely with biomedical perspectives. They've formed
professional associations to clarify their knowledge base, define competence, and modify their claims to
gain acceptance from both the medical profession and the public.
4. The state: Governments can't ignore the popularity of alternative medicine among the public. They've
faced pressure to relax laws against non-biomedical practices. While reforms have been made,
governments generally don't want to disrupt the relationship between biomedicine and the state.
Allowing certain forms of alternative medicine can help contain the power of the medical profession and
reduce healthcare costs, especially during times of funding crises.
The growth of alternative medicine might not continue indefinitely due to funding limitations and the
recognition of its efficacy limitations. While demand for healthcare seems endless, there are financial
constraints for governments, insurance companies, and individuals. In the short term, alternative medicine
offers cheaper treatments compared to many biomedical ones and often provides a holistic approach, which is
ideal but often not achieved in conventional primary healthcare. So, while alternative medicine will likely have
a significant role in Western healthcare systems, it will be limited.
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Perspective Medical Profession Alternative Patients The State

Practitioners

Recognition Increasing Seeking Preferring Acknowledging

of Popularity awareness of professional therapies that popularity and pressure
of Alternative popularity among legitimacy by offer relief or for relaxation of laws
Medicine patients; some aligning with emotional against non-biomedical
doctors biomedical support, despite practices.
incorporating perspectives. not always
alternative adhering to
therapies. biomedical views.

Attitude Shift from outright Adaptation of Preference for Facing pressure to

Towards rejection to practices and alternative accommodate
Alternative cautious theories to gain therapies that successful forms of
Medicine acceptance, professional offer more alternative medicine
focusing on legitimacy. participatory or while containing the
efficacy and cost- personal power of the medical
effectiveness. approaches to profession.
healing.

Response to Recognition of Efforts to gain Seeking Acknowledgment of the

Public patient preference professional alternatives that popularity and
Demand for alternative legitimacy and align with personal increasing use of
therapies. adapt to meet beliefs and alternative medicine
patient demand. experiences of among the public.
health and illness.

Role in Advising Forming Pressuring for Accommodating

Shaping governments on professional relaxation of laws successful forms of
Healthcare matters concerning associations to against non- alternative medicine
Policies alternative define biomedical while managing
medicines. competence and practices. healthcare costs.
claims.