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Social Science, Health and Medicine Foundations exam revision

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Revision tool - just some notes and a few questions/pointers and only on a few topics. It is unlikely to make much sense if you have no previous knowledge

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Social Science, Health and Medicine Foundations exam revision

  1. 1.  SSHM Exam Revision 1) Normal and Pathological 2) Theoretical Approaches 3) Risk Discourses 4) Global Health 5) Pointers and Questions
  2. 2.  The Normal and Pathological Canguilhem, Value Judgments, Normal The average – quantifiable What ought to be Ambiguous – has power Descriptive but has value judgment Pathological Not the opposite of normal Part of the same scale as normal – quantifiable differences Outside the average not always pathological (diversity) Changing norms is part of progress (Durkheim) Canguilhem Against medicine as a Science – medicine is an art Aim to reopen problems Lots of influence over 1960s thinkers e.g. Foucault Other Thinkers Broussais, Comte, Bernard – health and sickness not opposites Renan – psychological conditions available through exaggerating the normal Leriche – disease must be dehumanised in order to be studied Arguments The repressed always returns The pathological is a new form of life There can be no sickness without a sick person
  3. 3. The Normal and the Pathological Normal  The average  Quantifiable  What ought to be  Not stable – historical changes  Descriptive  Value judgment – not objective Pathological  Not the opposite of normal  Pathological and normal on the same scale  Matter of degrees – e.g. fever  Outside average not always pathological e.g. diversity  Changing norms is part of progress (Durkheim)
  4. 4. Canguilhem  Body not a machine  Medicine is an art  Mixture of sciences, not a science in itself  Aim to reopen problems  Influenced many key thinkers of the 1960s including Foucault
  5. 5. Other thinkers Broussais, Comte, Bernard  Pathological and normal are the same apart from quantifiable variations  A matter of degree e.g. fever  Made popular by Comte and Bernard Renan, Leriche  Renan  Psychological conditions available through the exaggeration of normal  Normal can always become pathological  Links with risk  Leriche  Disease must be dehumanised in order to be studied  The sick can advance knowledge of the normal through their deficiencies  Links with Positivism
  6. 6. Arguments 1. The repressed always returns  Scales of normal and pathological have to be in relation to each other – cannot be objective  Terms have value judgments e.g. excess and deficiency 2. The pathological is a new form of life  Change in the structure of an organ does not mean it should not be brought back to the norm (hypertension)  Infections change the human – they will have new antibodies etc., and therefore be a new/different 3. There can be no sickness without a sick person  Difference between disease and illness – the subjective and observable  Pain is subjective – relies on the human – but
  7. 7.  Theoretical Approaches Ontology, Epistemology, Positivism, Social Construction, Comte, Geertz Ontology and Epistemology Ontology – the study of being – what is reality? Epistemology – the study of knowledge – how do we know? Positivism Ontology – one reality outside human influence Epistemology – scientific study to achieve objective knowledge Coined by Comte and highly influential Problems with methodology being too reductive and ability to be objective Social Construction Ontology – there is no reality outside human influence Epistemology – understanding through perspectives Associated most with Geertz Problems with how far this can go – is there no truth? Everything constructed?
  8. 8. Ontology and Epistemology Ontology  The study of being  What is there?  What is reality?  How can we understand existence?  What is it? E.g. what is a rock? Epistemology  The study of knowledge  How do we know?  What is valid knowledge?  How can we obtain it?  Why is it? E.g. why is that a rock? How do we know that is a rock?
  9. 9. Positivism  Linked with Enlightenment thought and scientific methology  Ontology  There is one reality independent of humans  Epistemology  Through empirical scientific study  Reality can be known objectively  Coined by Comte  Sociology was to be the ‘queen of the sciences’  Assumes social facts can be measured like natural science facts  It can produce value-free and neutral understandings  Often seeks to explain how and why things happen  Associated with quantitative approaches
  10. 10. Problems with Positivism  Methodology  Social life considered more complex than biological life in laboratories  Experiences emerge from particular social, cultural, political, economic and historical context which cannot be easily quantified or separate  Too reductive  Objectivity  Impossible to describe something without using language which has value judgments attached  Researchers bring their own ideas and understanding to the research
  11. 11. Interpretivism/Social Construction  Linked with Post-Enlightenment thought in opposition to Positivism  Ontology  There is no reality independent of humans  Reality is always socially constructed  Epistemology  Understandings always dependent on the person’s perspective  Always subjective to a degree  Associated with Geertz  People always attach meaning to objects which then influence experiences and behaviours  Meanings are ‘intersubjective’ – existing between the minds of individuals  Culture should be approached in the literary approach to text  Assumes subjectivity/partiality of all knowledge  Seeks to understand how and why things happen  Linked with qualitative approaches
  12. 12. Problems with Social Construction  Could be taken to far  Nothing is real – everything is dependent of your view and perspective  There is no truth – only opinions
  13. 13.  Risk Discourses Beck, Normal/Pathological, Medicalisation, Protodiseases • Anticipation of catastrophe • Manufactured risks • Responsibility to act and manage risks Beck • Rose – mental health context, risk blurring the boundaries between normal and pathological • Hacking – risk tries to bring certainty to the future Other thinkers • Personalised medicine in order to manage risks • Preventative e.g. high blood pressure, cholesterol, cancers • Protodiseases (Rosenberg) – medicialisation of risks into diseases Risk in Medicine
  14. 14. Beck  Anticipation of catastrophe – not what is happening  Modernity – post-industrialisation, globalisation - contexts  Manufactured risks  Known, unknown, and unknown-unknown risks  Responsibility to act  To manage and reduce the risk  There is no such thing as zero risk
  15. 15. Other thinkers Rose  Mental health context  ‘Risky individuals’  Genomics and biomarkers as risk assessments  Risk blurs boundaries between normal and pathological Hacking  Trying to being certainty to the future
  16. 16. Risk in Medicine  Personalised medicine  Treatment more personalised so not to increase risks e.g. high risk of breast cancer and taking the pill  Preventative medicine  E.g. High blood pressure, cholesterol, cancers  Medicalisation of risks, making them into diseases/illnesses themselves  ‘Protodiseases’ (Rosenberg)
  17. 17.  Global Health What is Global Health • Goal to improve health inequity worldwide • Linked to public health and international health • Virchow - Health has pathological and political elements Inequality vs. Inequity • Health inequality • Differences in health experienced and health status • Health inequity • Differences in health for a significant number of people that is preventable and not a risk freely chosen Direct and Indirect Interventions • Upstream • e.g. factory polluting water/river • Downstream • e.g. giving technical solutions to clean water for village Approaches • Technological • Economic • Sociological • Bioethical • Existential
  18. 18. What is Global Health?  Linked to public health and international health  Goal is to enhance health equity among nations and for all people worldwide  Health inequality  Differences in health experienced and health status  Health inequity  Differences in health for a significant number of people that is preventable and not a risk freely chosen  Virchow  All diseases have two causes: one pathological, the other political
  19. 19. Institutions Involved  Governments  Bilateral organisations  Multilateral organisations  Global partnerships  Private foundations  Business/Corporate sector  Individuals
  20. 20. Direct vs. Indirect Interventions Direct interventions  Downstream  E.g. Access to medical care, vaccinations, equipment/technology to improve water conditions Indirect Interventions  Upstream  E.g. more equitable economic system, stop polluting rivers
  21. 21. Approaches to Interventions  Technological  Economic  Sociological  Bioethical  Existential
  22. 22.  Pointers and Questions What is the social? Practice Questions
  23. 23. Defining ‘the social’  Make it really clear what is spoken about – political, social, economic, cultural, historical – they are all different! Don’t just say ‘social’ to be all- encompassing  There is no one definition of the ’social’ but some schools of thought: 1. Social construction/interpretive – what meaning is given to actions. Associated with Weber 2. Social is defined by the ‘conflict’ between people and institutions. Associated with Marxist tradition 3. Social defined by ‘consensus’ – the creation of social norms and how societies bind together. Associated with ‘functionalist’ thought with Parsons and Habermas 4. ‘Hybrid’ social – binding psychology and biology. E.g. the environment shapes psychological dispositions. Associated with Simmel
  24. 24. Questions  What are the Normal and the Pathological? And What do the Tell Us about the History of Medicine?  With Reference to a Specific Case Study, Discuss how the Experience of Illness is Shaped by Larger Social-Cultural Contexts  What can a Study of the Subjective Experience of Illness tell us about Issues of Health, Disease and Medicine that Other Approaches Cannot? Discuss.  With Reference to a Specific Example, How Might the Concept of ‘Risk’ be Useful in Critically Evaluating Issues of Health and Disease in Modern Society?

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