LAST Tuesday, this column attempted to draw the line between disease and illness that culminated in defining “illness” using one paradigm in sociology: structural-functionalism.
Under such paradigm, illness is seen as the inability to discharge one’s social function.
Another paradigm that is closely related to structural- functionalism is what is called the Political Economy Perspective, which is primarily derived from the thoughts of Karl Marx in terms of capitalism. Such perspective is similar to structural-functionalism in that both thoughts agree that the social structure of medicine is closely related to the concept of social control empowering physicians to define and determine who is healthy and unhealthy and then prescribe corrective or remedial interventions to “punish” the deviants and maintain social order.
The striking difference, however, is that the Political Economy Perspective sees medicine as operating on behalf of the controlling groups in society benefiting capitalism.
Specifically, it suggests that structuring society around capitalism as an economic system is the starting point in analysing illness.
How capitalism benefits from medicine is explained in great detail by political economist writer Vicente Navarro in his contributed piece to the “1986 American Medical Anthropology Quarterly”.
For Navarro, the success of capitalism in medicine is accomplished in three ways: (1) Medicine ensures the population maintains health so that they can contribute to the economic system, specifically by engaging in trade, working in offices or industries to produce profit for the ruling class.
How health and illness are defined is based on the ability to produce goods- products or services. A healthy member of the society generates something to benefit the economic system while the opposite holds for the ill.
Physicians, according to Navarro, ensure that people are fit enough to work so as not to disrupt the economic system; (2) Medicine draws an ideological function by masking the difference in health by social class, gender and ethnicity which are caused by difference in wealth, income, living and working conditions.
Navarro points that the medical profession does this by blaming the patient for being ill due to the latter’s engagement to health-risky activities while ignoring the wider social factors such “structural violence”, which promotes a “silent” or unostentatious coercion forcing the patient to engage in health-risky behaviours to begin with.
Further, he maintains that these wider factors causing ill health are a direct result of capitalism. For instance, industries generating pollutions that cause respiratory diseases and probably cancers is largely ignored for the sake of the economic system; and (3) Under the biomedical explanations of sickness, Navarro claims that such approach leads to curatives-pharmacologic, diagnostic or surgical-that promote production of these goods.
In turn, their mass production is highly profitable to capitalism. As put in the same light, not only does capitalism create the conditions for poor health, but also profits from the attempts to cure such poor health.
Overall, Navarro argues that medicine has been ineffective (pun, unintended) in that levels of ill-health for the working class have increased under capitalism and that medicine can do little about it to break the chain.
I must emphasize, however, that Navarro was neither questioning the clinical competence nor the managerial skills of the physicians. Rather, he argues that the ineffectiveness of the medical profession as a social structure lies in its incapacity to break the cycle of capitalistic exploitation to the working class by merely increasing provisions of healthcare to mask or pacify their high risk realities to maintain status quo.
For instance, an employee working for a construction firm will continue exposure to “high-risk” conditions for economic purposes on his end and for capitalistic motives of his employer. The medical profession as a social structure responds by providing personal protective equipment, deployment of a specially-trained occupational health nurse to the construction site and providing employees with hazard allowances and insurances whenever applicable.
But as a latent function, the medical structure can never eradicate completely the said high risk working conditions because it is meant or designed to be that way in the economic system so as to maintain a symbiotic relationship between how the employee benefits economically to the employer and vice-versa. And balance is maintained for the construction firm will not prosper without the construction workers and the latter without the employment offered by the said firm.
We can name one too many examples of this capitalistic relationships that in the end places the working class in a health risk positions as defined by capitalism with the structure of medicine cloaking the said “exploitation” in the grandiose attempt of maintain balance in our society.
It makes the role of medicine as modulating or minimizing disruption to the economic functioning of society even if it means supporting exploitative and oppressive economic and social relationships.
The Political Economy Perspective suggests that capitalistic societies are organized around the generation of profit, which is created by the exploitation of labour power.
In totality, the burden of “disease”- the physical and organic definition applies in this statement- is disproportionally distributed by those in the lower socioeconomic group.
Similarly, by combining the political economy perspective and structural functionalism paradigm, a peasant and unemployed woman with high unmet needs- that range from physiologic to self-actualization as defined by Abrahan Maslow- and has no significant social function to portray in the economic system other than being society’s liability is considered to be “ILL”.
So it boils down to the fundamental question related to illness: Do we have “sick” people or just “ill” society?
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The writer is a medical professional and has been writing as a health columnist of this paper since 2008. He is an alumnus of Xavier University Ateneo de Cagayan from Elementary to Graduate School. Currently he is a faculty member of the Medical Education Unit for the Doctor of Medicine Program of Southwestern University Phinma, where he is likewise finishing his Master of Public Health.
CORRECTION: Published date on SunStar Cagayan de Oro newspaper is on February 24, 2017
Published in the Sun.Star Cagayan de Oro newspaper on February 28, 2017.