The Science of Society - Dr Andy Guise PDF

The science of society (and why we need social science for medicine) Dr Andy Guise, March 2024 "Medicine is a social science” Dr Rudolf Virchow Founder of modern pathology This lecture 1 Why medicine is a social science including that health is tied to social factors and processes (but not just a...

The science of society (and why we need social science for medicine) Dr Andy Guise, March 2024 "Medicine is a social science” Dr Rudolf Virchow Founder of modern pathology This lecture 1 Why medicine is a social science including that health is tied to social factors and processes (but not just a social science, obviously) (and useful to recognise how the role for these social factors and processes is often complex and contested) 2 Why social science is important for medicine NOW Medicine is a social science? Rudolf Virchow, 1821-1902; Founder of modern pathology; Charite, Berlin  Medicine is a social science? Study of typhus outbreak in Upper Silesia 1847 Epidemic reflected social problems: typhus appeared when people were crowded or hungry Virchow’s report available here - https://ajph.aphapublications.org/doi/10.2105/ajph.96.12.2102?url_ver=Z39.88- 2003&rfr_id=ori%3Arid%3Acrossref.org&rfr_dat=cr_pub++0pubmed& ‘‘Medicine is a social science, and politics nothing but medicine at a larger scale’’ Why medicine is a social science 1 Because health is shaped by big social processes, and so any good practice of medicine needs to be aware of this Patients and the many meanings of illness Cornwall, J. (1984) Hard earned lives The meanings of health and illness in East London in the 1980s, and how that shapes behaviour Hard copies in KCL library What do we mean by meaning? Patients And these can attach can be very multiple different to a meanings doctor’s to health (although and illness doctors’ meanings also varies) Meanings of health in 1980s east London Illness, like unemployment, has particular meanings – it means to be morally discredited. And so illness is denied, or health-seeking delayed Certain practices, like smoking, make sense within a ‘hard earned life’; they have particular meanings of relaxation and a break within otherwise hard lives Why medicine is a social science 1 Because health is shaped by big social processes, and so any good practice of medicine needs to be aware of this 2 and because health is shaped by how people understand health and health care, which is shaped by their social setting Providers and their approaches to care Study of the asylum – psychiatric hospital Ethnographic study Didn’t assume the psychiatric hospital was the best or only way of treating patients; didn’t assume psychiatry would cure patients Available online at KCL library - https://ebookcentral.proquest.com/lib/ kcl/detail.action?docID=5042442 Questioning the ‘taken for granted’ and apparently natural Necessary process of asking why something is like it is Even if it is ‘obvious’ that it should be done like that (not often a popular thing And looking at it critically to do, even if can lead to great change) The harms of the asylum Harmful effects of large psychiatric hospitals Create institutionalisation among patients Individual loses social/identity, required to adopt role and routines prescribed by institution Asylums were once considered the right or best thing to do. But not now. What will medical students in 100 years be shocked by about our standard medical practice now? Why medicine is a social science 1 Because health is shaped by big social processes, and so any good practice of medicine needs to be aware of this 2 and because health and use of health services are shaped by how people behave and think (which is also shaped by the big social processes) 3 and also because how health services operate are shaped by how health care professionals and policy makers understandings, which is also shaped by their social setting With a social science perspective you can… Adopt different approaches to tackling epidemics Understand barriers to health care access Find better ways to deliver health care Why medicine is a social science AND why that is important 1 Because health is shaped by big social processes, and so any good practice of medicine needs to be aware of this 2 and because health and use of health services are shaped by how people behave and think (which is also shaped by the big social processes) 3 and also because how health services operate are shaped by how health care professionals and policy makers understandings, which is also shaped by their social setting 4 And so with that perspective we can think of effective ways of providing medical care Why medicine is a social science AND why that is important 1 Because health is shaped by big social processes, and so any good practice of medicine needs to be aware of this 2 and because health and use of health services are shaped by how people behave and think (which is also shaped by the big social processes) 3 and also because how health services operate are shaped by how health care professionals and policy makers understandings, which is also shaped by their social setting 4 And so with that perspective we can think of effective ways of providing medical care (Some clarifications) A it is not just a social science Medicine and health are bio-psycho-social Bio-psycho-social perspectives on health Health is biological - particular bodily processes misfunction or change, or particular disease causing agents (viruses, bacteria) might cause disease Health is psychological - particular ways of thinking or behaving might cause or prevent disease (by affecting bodily processes or changing exposure to disease causing agents) or reflect disease (ie mental ill-health) Health is social – particular features of society (its structures, its norms) might cause or prevent ill-health by affecting behaviour, and/or exposure to disease agents Bio-psycho-social perspectives on health Cycle lanes are built  people might cycle more  less risk of heart disease / higher risk of cycling injury (Some clarifications) A it is not just a social science; medicine and health are bio-psycho-social B role for social factors is often defined by complexity and contest; our scientific knowledge of the role for these social processes and factors is ever improving and always provisional (as in any area of science) Complex causality of health Not, or very rarely, cast iron and certain laws of linear causality (if X, you get Y; e.g. if you cycle you won’t get heart disease – not the case) Causality is often multi-layered, long- running, and with complex feedback loops (X might cause Y, if Z is there; Z is in turn dependent on A and B) Understanding role of social factors (indeed, biology, psychology) is about complexity, and of increased risk and probability Contested causality of health These processes of causality can be contested, for the uncertainty involved, and because they support of question differing ideologies and perspectives on how society operates (including beliefs on morality) Medicine is a social science 2 The history of social science and why it matters for health now One history of social science Comte, Durkheim, Weber, De Tocqueville (maybe Marx and Engels) Remember these faces - lecture 3 on stigma and discrimination for more on who writes social science Revolutions Changes in how countries are governed Industrial, Political, Social, Cultural Local, national and global What caused them? Where would they end? Emile Durkheim, 1858-1917 Why are people richer but more miserable? Living through change in France from agricultural to urban, industrial society Studies on labour, law, education, religion Studied why suicide rates rise as countries industrialise  Suicide (1897) Suicide as individual phenomenon – to be studied using psychology, psychiatry? Also ‘social fact’ to be understood using sociology Suicide shaped by: Social integration– feeling connected to society, sense of belonging Social regulation – implicit and explicit rules governing social behaviour And both of these changing due to industrialisation and urbanisation Revolutions now? Artificial intelligence War Which of these are important? What are the Cost of living health consequences? Climate change What are the priorities for practicing medicine now? Housing crisis And in the future? Racism and other forms of discrimination Which revolutions do you want to know more about? Summary Medicine is a social science? Social science is essential for medicine Social science can help to understand processes of social change (with implications for health) Social science can help us think about medicine and health at a range of levels: patient behaviour, professional behaviour, organisational issues and then at the level of political systems  Questions, comments [email protected]