Bio-power and Biomedical Dominance PDF

Bio-power and biomedical dominance Dominant culture and the biomedical model in Australia The principals and priorities of biomedicine The challenges of biomedicine to culturally safe and person-centred care  Germov, J. (2019). Imagining health problems as social issues....

Bio-power and biomedical dominance Dominant culture and the biomedical model in Australia The principals and priorities of biomedicine The challenges of biomedicine to culturally safe and person-centred care  Germov, J. (2019). Imagining health problems as social issues. In (J. Germov, Ed.) Second opinion : an introduction to health Key Readings: sociology; Sixth edition. Oxford University Press. Willis, K., & Elmer, S. (2011). Society, culture and health : an introduction to sociology for nurses (2nd ed.). Oxford University Press. Imagining health problems as social issues A sociological perspective can help us understand a wide range of health issues. Health sociology focuses on the social patterns of health and illness such as the difference in health status between groups of people, for example: men and women, the poor and the wealthy or Indigenous and non-Indigenous people. The sociological perspective provides a second opinion to the conventional medical view of illness derived from biological and physiological explanations. Explores the living and working conditions that fundamentally shape why some groups of people get sicker and die sooner than others. Social model of health Recognition of the social origins of health can be traced back to the mid–nineteenth century with the development of ‘social medicine’, or what later became known as ‘public health’. At this time, infectious diseases such as cholera, typhus and smallpox were major killers for which there were no known cures and little understanding of their transmission. Health scholars began establishing clear links between infectious diseases and poverty Public health is also known as social health, community medicine or preventative medicine. The Biomedical Model The conventional approach to medicine in Western societies, based on the diagnosis and explanation of illness as a malfunction of the body’s biological mechanisms. This approach underpins most health professions and health services, which focus on treating individuals and generally ignore the social origins of illness and its prevention Rise of the biomedical model Doctrine of ‘specific aetiology’ There is a specific cause for every disease The body as a machine The body made up of interrelated parts and the doctor is like a mechanic who can fix the parts Mind-body distinction Disease is located in the physical body, and the mental state of a person is considered less important Neutral scientific process Medicine is seen as a neutral and objective process, lacking in effects of power The limits of biomedicine Reductionist Reducing disease to biological, cellular, molecular, and genetic levels as if it occurs in a social vacuum, ignoring social and psychological aspects of illness Narrow definition of health Through this model, health is very narrowly defined as the absence of disease Individualistic Illnesses act upon people’s bodies therefore the causes of illness develop in the body Treatment versus prevention This point refers to the idea that health care is about curing, not necessarily about preventing illness Treatment imperative This point emphasises that medicine is taken-for-granted as the site through which one may find a cure  Implications of biomedical dominance for cultural safety Victim blaming Explaining social inequality solely in terms of individual responsibility and assumed inferiority Assuming everyone has equal access to opportunities and resources Oversimplifies the complexity of social and economic systems that contribute to social inequality ‘Lifestyle choices’ Implies that individuals are solely responsible for their choices around health and for changing health behaviours without considering social context Medicalisation of life processes Normal human processes such as ageing, menopause, pregnancy and childbirth come to be seen as medical problems that require intervention Unseen and unquestioned power? Implications of biomedical dominance for cultural safety Biological determinism An unproven belief that individual and group behaviour and social status are an inevitable result of biology. Social Darwinism The incorrect application of Charles Darwin’s theory of animal evolution to explain social inequality by transferring his idea of ‘survival of the fittest’ among animals to ‘explain’ human inequality. ‘Objectification’ of patients Treatment as a ‘rational procedure’ dismisses the person experiencing it and focuses solely on disease  Structure agency debate SOCIAL STRUCTURE The recurring patterns of social interaction through which people are related to each other, such as social institutions and social groups. SOCIAL INSTITUTIONS Formal structures within society—​ such as health care, government, education, religion, and the media—​ that are organised to address identified social needs. AGENCY The ability of people, individually and collectively, to influence their own lives and the society in which they live. STRUCTURE–​AGENCY DEBATE A key debate in sociology over the extent to which human behaviour is determined by social structure. Discourses Discourses are bodies of knowledge that shape our thoughts as members of the general public and influence what we take to be true. Dominant discourses are reflected in national conversations conducted between politicians, bureaucrats, academics and the general public through various forms of news and social media. Examples include: Gender roles Housing crisis People who use drugs Consider the influence of the biomedical model in shaping discourse around health. What institutions come to mind when you think about the best way to care for people’s health? Who do you think is the most powerful profession in healthcare? Why? Implications for power and power sharing Who gets to define a normal healthy body? Who gets to decide where the health budget is spent? Who dictates what risks people can take with their bodies and their health? Are individuals solely responsible for their own health? What about iatrogenic harm? (harm caused by healthcare practices) Considering biomedical and social models of health, which has had more influence on the evolution of Australia’s health and hospital systems? Why do you think that is? What are the implications for nurses as we interact within the health system? Rediscovering social origins of health and illness Biomedicine has contributed to significant advances in our understanding of diseases and their treatment – its good! BUT biomedical dominance has consequences for cultural safety and person-centred care in Australia The social model of health: Counteracts the dominant biomedical model and considers health holistically, including physical, mental, psychological, and social well- being. Focuses on the social production, distribution, and construction of health and illness, and the social organisation of health care Emphasises prevention of illness through community participation and social reforms that address living and working conditions A more balanced view? Nursing care is positioned at the biomedical and social interface Consider the biopsychosocial model of care  Using your sociological imagination When you think about a health issue consider these four things: 1. Historical factors: How the past influences the present 2. Cultural factors: How culture impacts on our lives 3. Structural factors: How particular forms of social organisation affect our lives 4. Critical factors: How we can improve our social environment Summary of main points Biomedical model is dominant in Western medicine, diagnosing and explaining illness as a malfunction of the body’s biological mechanisms Social model of health challenges individualistic and biological explanations of health and illness Social model seeks to explain patterns of health and illness by examining the influence of society and inequality Health problems that have social origins require social action (alongside medical interventions) to address them Biomedical dominance has implications for the delivery of culturally safe nursing care Challenging biomedical dominance requires us to use our sociological imagination and consider the historical, cultural, structural, and critical factors influencing a health issue