This document discusses different frameworks for understanding disease: biological, bio-psycho-social, public health, and biopolitical perspectives. The biological perspective focuses on pathogens and transmission. The bio-psycho-social perspective considers physical, mental, and social factors. Public health seeks to prevent disease at the population level by defining normality. However, the biopolitical perspective critiques how public health normalizes populations to serve those in power, determining who is allowed to thrive or decline. Disease results as much from political and economic systems as from biological or human factors.

1. Disease
Pathology, Public Health, Biopolitics

2. Disease
• A disorder or abnormal condition that affects the structure or
function that affects all or part of an organism and which is not simply
a direct result of physical injury.
• Often construed as a medical condition associated with symptoms or
signs which cause a problem or threat to the individual, a population
or society more widely.

3. Outline
• Revisit conceptual framing from Systems theory
• Approaches to health and disease
• Bioscience/Pathology
• What are the biological agents that causes it? How do we get it?
• How do we cure it?
• Bio-Psyco-Social
• Biophysical aspects
• Mental aspects
• Social networks
• Public Health
• Population health
• Structural factors
• Biopolitics--Demography and Epidemiology (Traditional Public Health)
• Population patterns of mortality, incidence, distribution
• Disease prevention: Identify risk factors and interventions
• Biopolitical Critique (Foucault, Rose, Butler)
• boundaries between wellness/disease, normal/abnormal, threat/non-threat
• who has the power to decide what is to be allowed to thrive; what is normal/abnormal.

4. Ecologies-
• Defined as the relationship of living things to their environment
• Ecologies are multi-scaled—Scales are interconnected.
• Ecologies of the body—bodies are environments for other living things just as
humans also have relationships with our own environments.
As we work through this discussion think about what is the ecology that is the
focus of the discussion and which living things are we concerned with.

5. Conceptual framing (from systems theory)
Physical systems Social systems
Psychic systems
NATURE outside: Biology,
Chemistry, Physics, etc.
What happens, not
the words we use to
explain or
understand or how
we feel about it.
Physical
reactions/changes,
not emotional. May
happen, but not have
explanation.
Mental states: How
we feel or what we
think. Internal to us.
What we think or
experience, not how
we communicate
that experience to
one another, to
society more widely
or even to ourselves.
How we communicate or share
understanding with one
another and nature about
nature, about what’s going on
in our heads, and about society.
More than verbal, More than
person-to-person.

6. Disease: Bioscience explanations
• Communicable transferred from one organism to another—the passing of a
pathogen
• Zoonotic—transferred via zoonosis (from animals to people). Lyme disease (Tic), BSE/E.
Coli./Malaria. Animal is infected carrier and the disease is transferred to the human or
the animal carries the infection on its body and passes it to humans (i.e., flies).
• Coming into contact with the animal or what it leaves behind
• Begin bitten/stung by an infected animal
• Handling infected animals e.g., live chickens
• Non-zoonotic disease—transferred from one human to another
• Sexual contact
• Contact with bodily fluids e.g. being on the receiving end of a sneeze
• Transmission from parent to infant prior to birth (HIV, hepatitis B)
• Some communicable diseases started via zoonosis, but have become both zoonotic and
non-zoonotic—e.g. SARS, AIDS, COVID-19?

7. Disease: Biological explanations (cont.)
• Non-communicable disease—diseases not caused
by infectious agents.
• Examples: Diabetes, Heart disease, Asthma, Cancers, etc.
• Responsible for approx 70% of deaths world-wide (WHO
website). (until COVID-19)
• Relative importance is geographical
• Critique:
• Addresses the problem after the fact (Cure rather than
prevention)
• Ecology is the body (e.g., interventions within the body).
• Living organisms are the pathogen or the bio-chemical
bodily processes (e.g., fat, plaque, blood).
• Medicalizes: To identify or categorize (a condition or
behavior) as being a disorder requiring medical
treatment or intervention
Source European Environment Agency
http://www.eea.europa.eu/data-and-maps/figures/the-shift-in-global-disease

8. Bio-Psycho-Social Model
• Seeks to bring in the physical, psychic systems and social systems interact.
• Physical issues—biological model
• Mental health issues—mental responses--Berlant (2007, 2010) Risky Bigness, Against
Health (p26-39).
• Social relationships –social networks
• Ecology is centered on the individual and their relationships with
themselves and to others.
• Living organism is the bio-physical + individual
• What is missing?
• Does not engage with power and the role of wider society to discipline and segment
people into populations

9. Disease—Public Health
• A disorder or abnormal condition that affects the structure or function
that affects all or part of an organism and which is not simply a direct result
of physical injury.
• Often construed as a medical condition associated with symptoms or signs
which cause a problem.
• Problems with physical functioning—e.g. heart disease problems with heart function,
breathing, etc. Extreme examples are those that are a direct threat to life
• Problems with social functioning—e.g. inability to participate in the ‘normal’
activities of everyday life—We have all become diseased with ‘COVID-19’ even if we
didn’t have it physically.
• Disease burden—lost years of potential life, lost years of quality life, lost days of
work, cost to medical system. See Nicholas Rose article.

10. Traditional Public Health perspective
Disease can be prevented:
-Use statistics to help to
determine what is a normal or
average, create classifications
-Creates dichotomies between
normal and abnormal.
-e.g., premature death die
before age 70.
-e.g., weight and body mass
(see Guthman).
Preemptive – Identifies at risk
groups and targets them.
Interventions are managerial not curative:
• Communicable disease—
• Isolation/separation
• Behavioral changes (Hygiene)
• Mechanical/technical
• Non-communicable disease-
• Changes to behavior of the individual
to make them ‘normal’
• Denial of service
• Information campaigns (nudges)
• Incentives (e.g. tax)
• Focus on the individual not the
context or structural causes. E.g.,
does not address racism/sexism etc.

11. Social determinants of Health perspective
• Takes a more systems approach—What are the primary structural
problems?
• E.g., what is it about the wider social contexts (regulatory, economic, socio-
demographic) that contribute to the problem for specific populations (groups) of
people.
• Considers issues such as structural inequalities and how those play out.
• E.g., the ability to afford healthy food has an impact on what people are able to eat, which in
turn influences their dietary health.
• COVID—living in a small shared space with many others
• Ecology is the wider systems within which we are embedded
• Living organism is the population
• Doesn’t theorize the role that power plays to grant life in the first instance
as structures are considered as fixed and immutable rather than designed
in the service of some objective.

12. Foucault and Power
• Two types of power aimed at generating order
• Anatomo-power—at the scale of the body.
• Concerned with disciplining individuals to become “more normal”.
• Incarceration, force
• Soft power—persuasion—e.g., Traditional public health.
• Power to take life away or constrain life.
• Focus is on optimization and usefulness to the agenda of the state.
• Bio-power. At the scale of the group.
• Targets the population and its aggregated biological processes: births, deaths, levels of
health, longevity, reproductive health, etc.
• Power to determine life
• What is counted matters and what is not counted does not matter. COVID death counts did
not acknowledge BAME—fit with gov. narratives of we are all in this together.
• Government does not want to count those who are food insecure
• How we count makes a difference—e.g., different measures of poverty
• Being counted can be a double-edged sword—what we count can also be managed because
we can ‘see it’ and the extent to which it exists. E.g., it subjects groups to anatomo-power. It
also is used to create hierarchies and segregation—normalizes one group and externalizes the
other. E.g., everyone and the severely disabled.

13. Bio-political critique—
• Public health normalises while diverting our attention from questions
about:
• Who gets to decide what is…
• normal/abnormal?
• threat/non-threat?
• what/who is killable/non-killable?
• what/who is left to thrive/left to die?
• In service of those with power. Power gives itself permission to reproduce
life. Foucault

14. Disease and bio-power
• Disease is as much a product of the political-economic system and the
application of biopower as it is the result of activity within the physical
sphere and our human responses to both of these domains.
• Public health seeks to prevent disease for the security of the population. It
does so by defining what is normal for a population.
• What is counted is valued, what is not counted does not matter.
• What matters within neoliberal capitalism is the optimal functioning of
markets which need consumption and production, diseased bodies are
those who do not function optimally. (e.g., its ok to starve them; could be
argued that the lack of initial focus on care homes in COVID could be
described with these terms).
• Biopower enables those who are defined as normal to thrive, while those
who are alter are left to decline—What Agamben calls slow death or bare
life.

15. Conclusion
• Today’s lecture has identified the broad ways that we think about
disease and health.
• Each approach brings a different perspective and understanding with
regard to what causes poor health. Following Mol, it locates health in
a particular domain or type/scale of ecology.
• Each offers a different understanding of who or what the ‘living
organism’ is.
• Each approach suggests different interventions.
• Disease and health are as much political manifestations as they are
biological, mental, and interpersonal.