Medical power and the rise of surveillance medicine

1. Medical power and the rise of surveillancemedicine Week 15 Sociology of Health and Illness

2. Recap • Thought about how health and illness are structured by society • Considered the power relationship between patients and professionals • Introduced the concept of the ‘sick role’

3. Outline • Looking at how medical power and knowledge shape our understanding of bodies • Consider the concepts of medicalisation and biopower • Consider how surveillance medicine forms part of power relationships

4. Medical Model • The medical model represents a common-sense way of thinking about health and illness • Being sick is a physical problem • Caused by a body malfunction (virus/bacteria) • Solution is to seek medical advice • Medication will ‘cure’ the problem • Medicine is thus the technical fix of ‘broken bodies’

5. What is medicalisation?

6. Defining Medicalisation • The medical profession have control over bodily matters related to health and illness • They are also have the power to define what is a medical matter • Medicalisation is said to occur when the medical profession re/defines a bodily or social condition as a medical one

7. Medicine as social control • Zola argued that the way that diseases are defined and labelled is a form of social control • Patient’s problems are individualised rather than being seen as social in origin • Failure to conform to societies norms may lead to a label of being diseased or sick

8. ‘Drapetomania’ • White gives the example of ‘drapetomania’ • This ‘mental disease’ was suffered by plantation slaves in the South US • Main symptom was running away from your master • It was diagnosed by doctors and written up in medical textbooks

9. Medical or Social Problems? • Addictions such as to alcohol or gambling • Shift-work sleep disorder • Jet-lag • Attention-Deficit Hyperactive Disorder

10. Is medicalisation a problem? Discuss this with the person sitting next to you

11. The Birth of the Clinic • Foucualt argued that the body became a key site of controlling populations during the 18th and 19th centuries • The hospitals like schools and prisons were ways of disciplining populations • Biopower seeks to control populations through discourse and productive power

12. Biopower • Biopower works though surveillance and the production of self discipline • Metaphor of the panopticon • Medicalisation defines normal and abnormal bodies and behaviours

13. Power/Knowledge • Foucualt argues that the everyday working of power is important • Bodies are measured as a way of understanding populations • Although this is overtly for welfare reasons • Like reducing overcrowding in households • Strengthened the control over the population

14. Power/Knowledge • Power and knowledge are interdependent • ‘It is not possible for power to be exercised without knowledge, it is impossible for knowledge not to engender power’ • Foucault (1980) ‘Prison talk’ in Gordon C (ed) Power/Knowledge, Brighton: Harvester • Knowledge is an integral part of power relationships and • Producing knowledge makes a claim for power

15. National Child Measurement Programme • Pilots then Policy from November 2007 • Children in reception and year 6 are to be weighted and measured in schools • Outcomes will not be given to children, but initially could be requested by parents • Not linked to any interventions

16. National Child Measurement Programme • The measurements will: ‘inform local planning and delivery of services for children; and gather population-level surveillance data to allow analysis of trends in growth patterns and obesity. ( It will) increase public and professional understanding of weight issues in children and is a useful vehicle for engaging with children and families about healthy lifestyles and weight issues’  • http://www.dh.gov.uk/en/Policyandguidance/Healthandsocialcaretopics/Healthyliving/DH_073787

17. Using the NCMP as an example, discuss the concepts of biopower and power/knowledge.

18. National Child Measurement Programme • The Programme strengthens the requirement to self-regulate diet and exercise • Children identified as at risk will not be referred so no individual benefit but high risk of stigmatised

19. National Child Measurement Programme • Children are a powerless group, they have little capacity to resist. • The programmes reaffirms this status by the imposition of the measurements

20. Surveillance Medicine • Medicine used to confine itself to those it counted as ill • The rise of surveillance medicine includes everyone • It refers to the notion that bodies require constant monitoring for their own good • Child development clinic, screening programmes • Health promotion and lifestyle

21. Surveillance Medicine • Surveillance medicine is advocated as a way of staying healthy • But it also constructs bodies as diseases prone and in need of constant monitoring • It reaffirms the power relationships within medicine and re/constructs the ways in which we come to understand our bodies

22. Summary • Consider how normal bodily processes have been defined as medical matters • Considered how biopower is an exercise in power/knowledge • Considered the rise of surveillance medicine

23. Next week • Consider ‘lay’ understandings of health • Look at the way that how people conceptualize health impacts on their behaviour • Consider the relationship between patients and professionals