The Social Construction of Health

7 Between fathers and fetuses: the social construction of male reproduction and the politics of fetal harm Cynthia R. Daniels Political Science Department, Rutger University, New Brunswick, USA In contemporary American political discourse ‘crack babies’ have been treated as Wlius nullius – as if they had no biological fathers. With no link between fathers and fetuses, no inheritance of harm could be attributed to the father’s use of drugs. The absence of fathers in debates over drug addiction and fetal harm has had profound consequences for women, for it has dictated that women alone bear the burden and blame for the production of ‘crack babies’. Since at least the late 1980s, and in some cases far earlier, studies have shown a clear link between paternal exposures to drugs, alcohol, smoking, environmental and occupational toxins, and fetal health problems. Yet men have been spared the retribution aimed at women. In fact, while women are targeted as the primary source of fetal health problems, reports of male reproductive harm often place sperm at the centre of discourse as the ‘littlest ones’ victimized by reproductive toxins, somehow without involving their male makers as responsible agents. ScientiWc research linking reproductive toxins to fetal health problems reXects deeply embedded assumptions about men and women’s relation to reproductive biology. Critical analysis of the nature of fetal risks thus requires not only examination of the biology of risk, but also assessment of what Evelyn Fox Keller has called the ‘collective consciousness’ that fundamentally shapes scientiWc inquiry on gender diVerence – a consciousness that is constituted by ‘a set of beliefs given existence by language rather than by bodies’ (Keller, 1992: p. 25). In debates over fetal harm, the production of this collective consciousness takes place in many social locations: in science laboratories, where the priorities of research are deWned; in editorial rooms, where reporters decide which news warrants coverage and what slant to take on stories; and in courts and legislatures, where decisions are made regarding the deWnition of and culpability for social problems. This chapter examines the cultural characterizations of sperm and male reproduction in science, news stories and public policy, all of which have 113 shielded men from culpability for fetal health problems. (A more detailed discussion of the rise of the concept of fetal rights and fetal protectionism can be found in Daniels, 1993.) After a brief discussion of the social construction of maternity and paternity, I analyse the symbols of the ‘crack baby’, ‘preg- nant addict’ and ‘absent father’ as central to public discourse on fetal harm, particularly in the US. Finally, I explore the range of complex questions about biological gender diVerence generated by the politics of fetal risks, and the problematic nature of the idea of individual causality in discussions of fetal harm. Social constructions of maternity and paternity In Western industrial cultures, notions of masculinity have been historically associated with the denial of men’s physical The Social Construction of Health The Social Construction of Health Bởi: OpenStaxCollege If sociology is the systematic study of human behavior in society, medical sociology is the systematic study of how humans manage issues of health and illness, disease and disorders, and health care for both the sick and the healthy Medical sociologists study the physical, mental, and social components of health and illness Major topics for medical sociologists include the doctor/patient relationship, the structure and socioeconomics of health care, and how culture impacts attitudes toward disease and wellness The social construction of health is a major research topic within medical sociology At first glance, the concept of a social construction of health does not seem to make sense After all, if disease is a measurable, physiological problem, then there can be no question of socially constructing disease, right? Well, it’s not that simple The idea of the social construction of health emphasizes the socio-cultural aspects of the discipline’s approach to physical, objectively definable phenomena Sociologists Conrad and Barker (2010) offer a comprehensive framework for understanding the major findings of the last 50 years of development in this concept Their summary categorizes the findings in the field under three subheadings: the cultural meaning of illness, the social construction of the illness experience, and the social construction of medical knowledge The Cultural Meaning of Illness Many medical sociologists contend that illnesses have both a biological and an experiential component, and that these components exist independently of each other Our culture, not our biology, dictates which illnesses are stigmatized and which are not, which are considered disabilities and which are not, and which are deemed contestable (meaning some medical professionals may find the existence of this ailment questionable) as opposed to definitive (illnesses that are unquestionably recognized in the medical profession) (Conrad and Barker 2010) For instance, sociologist Erving Goffman (1963) described how social stigmas hinder individuals from fully integrating into society The stigmatization of illness often has 1/7 The Social Construction of Health the greatest effect on the patient and the kind of care he or she receives Many contend that our society and even our health care institutions discriminate against certain diseases—like mental disorders, AIDS, venereal diseases, and skin disorders (Sartorius 2007) Facilities for these diseases may be sub-par; they may be segregated from other health care areas or relegated to a poorer environment The stigma may keep people from seeking help for their illness, making it worse than it needs to be Contested illnesses are those that are questioned or questionable by some medical professionals Disorders like fibromyalgia or chronic fatigue syndrome may be either true illnesses or only in the patients’ heads, depending on the opinion of the medical professional This dynamic can affect how a patient seeks treatment and what kind of treatment he or she receives The Social Construction of the Illness Experience The idea of the social construction of the illness experience is based on the concept of reality as a social construction In other words, there is no objective reality; there are only our own perceptions of it The social construction of the illness experience deals with such issues as the way some patients control the manner in which they reveal their disease and the lifestyle adaptations patients develop to cope with their illnesses In terms of constructing the illness experience, culture and individual personality both play a significant role For some people, a long-term illness can have the effect of making their world smaller, more defined by the illness than anything else For others, illness can be a chance for discovery, for re-imaging a new self (Conrad and Barker 2007) Culture plays a huge role in how an individual experiences illness Widespread diseases like AIDS or breast cancer have specific cultural markers that have changed over the years and that govern how individuals—and society—view them Today, many institutions of wellness acknowledge the degree to which individual perceptions shape the nature of health and illness Regarding physical activity, for instance, the Centers for Disease Control (CDC) recommends that individuals use a standard level of exertion to assess their physical activity This Rating of Perceived Exertion (RPE) gives a more complete view of an individual’s actual exertion level, since heart-rate or pulse measurements may be affected by medication or other issues (Centers for Disease Control 2011a) Similarly, many medical professionals use a comparable scale for perceived pain to help determine pain management strategies 2/7 The Social Construction of Health The Mosby pain rating scale helps health care providers assess an individual’s level of pain What ...CASE STUD Y Open Access Towards the construction of health workforce metrics for Latin America and the Caribbean Gustavo G Nigenda Jr 1* , Maria H Machado 2 , Fernando F Ruiz 3 , Victor V Carrasco 4 , Patricia P Moliné 5 and Sabado S Girardi 6 Abstract Introduction: One of the components of the Health Observatory for Latin American and the Caribbean (HO-LAC) is the design and implementation of metrics for human resources for health. Under the HO-LAC initiative, researchers from nine countries in the region formed the Collaborative Community on Human Resources for Health in Latin America and the Caribbean to identify comm on metrics applicable to the field of human resources for health (HRH). Case description: The case description comprises three stages: a) the origins of an initiative in which a non- governmental organization brings together researchers involved in HRH policy in LAC, b) a literature search to identify initiatives to develop methods and metrics to assess the HRH field in the region, and c) subsequent discussions held by the group of researchers regarding the possibilities of identifying an appropriate set of metrics and indicators to assess HRH throughout the region. Discussion and evaluation: A total of 101 documents produced between 1985 and 2008 in the LAC region were identified. Thirty-three of the papers included a variety of measurements comprising counts, percentages, proportions, indicators, averages and metrics, but only 13 were able to fully describe the methods used to identify these metrics and indicators. Of the 33 articles with measurements, 47% addressed labor market issues, 25% were about working conditions, 23% were on HRH training and 5% addressed regulations. Based on these results, through iterative discussions, metrics were defined into three broad categories (training, labor market and working conditions) and available sources of information for their estimation were proposed. While only three of the countries have data on working conditions, all countries have sufficient data to measure at least one aspect of HRH training and the HRH labor market. Conclusions: Information gleaned from HRH metrics makes it possible to carry out comparisons on a determined experience in space and time, in a given country and/or region. The results should then constitute evidence for policy formulation and HRH planning and programs, with improved health system performance ultimately contributing to improved population health. The results of this study are expected to guide decision making by incentivizing the construction of metrics that provide information about HRH problems in LAC countries. Background This paper describes the initial efforts of a regional non- governmental initiative in laying the foundation of a fra- mework to analyse the field of human resources for health (HRH) in Latin America and the Caribbean. It provides information about the origins of the initiative, preliminary collection of information by means of a literature search and the ensuing discussions leading to a set of metrics and indicators to be used in monitoring HRH policies in the region. Historically, as in other RESEA R C H Open Access Harm reduction, methadone maintenance treatment and the root causes of health and social inequities: An intersectional lens in the Canadian context Victoria Smye * , Annette J Browne, Colleen Varcoe and Viviane Josewski Abstract Background: Using our research findings, we explore Harm Reduction and Methadone Maintenance Treatment (MMT) using an intersectional lens to provide a more complex understanding of Harm Reduction and MMT, particularly how Harm Reductio n and MMT are experienced differently by people dependent on how they are positioned. Using the lens of intersectionality, we refine the notion of Harm Reduction by specifying the conditions in which both harm and benefit arise and how experiences of harm are continuous with wider experiences of domination and oppression; Methods: A qualitative design that uses ethnographic methods of in-depth individual and focus group interviews and naturalistic observation was conducted in a large city in Canada. Participants included Aboriginal clients accessing mainstream mental health and addictions care and primary health care settings and healthcare providers; Results: All client-participants had profound histories of abuse and violence, most often connected to the legacy of colonialism (e.g., residential schooling) and ongoing colonial practices (e.g., stigma & everyday racism). Participants lived with co-occurring illness (e.g., HIV/AIDS, Hepatitis C, PTSD, depression, diabetes and substance use) and most lived in poverty. Many participants expressed mistrust with the healthcare system due to everyday experiences both within and outside the system that further marginalize them. In this paper, we focus on three intersecting issues that impact access to MMT: stigma and prejudice, social and structural constraints influencing enactment of peoples’ agency, and homelessness; Conclusions: Harm reduction must move beyond a narrow concern with the harms directly related to drugs and drug use practices to address the harms associated with the determinants of drug use and drug and health policy. An interse ctional lens elucidates the need for harm reduction approaches that reflect an understanding of and commitment to addressing the historical, socio-cultural and political forces that shape responses to mental illness/ health, addictions, including harm reduction and methadone maintenance treatmen t. There is considerable evidence that harm reduction approaches are effective in reducing the harms associated with drug use [1-3]. As Pauly notes, “harm reduction as a philosophy shifts the moral context in health care away from the primary goal o f fixing individuals towards one of reducing harm“ (italics ours) (p.6) [4]. However, although harm reduction opens opportunities for promoting the health of people who often are stigmatized through social r esponses to problematic substance use, harm reduction interventions do not necessarily address the root causes of substance use and attendant social conditions that influence inequities in health and ac cess to health care for this population - “inequities [that] are exacerbated by lack of quality housing, poverty, une m- ployment, lack of social support and education” (p.8) [4]. Harm reduction approaches that fail to address the multiple intersections t hat influence peoples’ health and * Correspondence: victoria.smye@nursing.ubc.ca University of British Columbia, School of Nursing. T201-2211 Wesbrook Mall, Vancouver, B.C. V6T 2B5, Canada Smye et al. Harm Reduction Journal 2011, 8:17 http://www.harmreductionjournal.com/content/8/1/17 © 2011 Smye et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which perm its unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. well-being and their experiences of and responses to mental health BioMed Central Page 1 of 17 (page number not for citation purposes) Globalization and Health Open Access Review Globalization and social determinants of health: The role of the global marketplace (part 2 of 3) Ronald Labonté 1 and Ted Schrecker* 2 Address: 1 Department of Epidemiology and Community Medicine, Faculty of Medicine and Institute of Population Health, University of Ottawa, Canada and 2 Department of Epidemiology and Community Medicine, Faculty of Medicine and Institute of Population Health, University of Ottawa, Canada Email: Ronald Labonté - rlabonte@uottawa.ca; Ted Schrecker* - tschrecker@sympatico.ca * Corresponding author Abstract Globalization is a key context for the study of social determinants of health (SDH): broadly stated, SDH are the conditions in which people live and work, and that affect their opportunities to lead healthy lives. In the first article in this three part series, we described the origins of the series in work conducted for the Globalization Knowledge Network of the World Health Organization's Commission on Social Determinants of Health and in the Commission's specific concern with health equity. We identified and defended a definition of globalization that gives primacy to the drivers and effects of transnational economic integration, and addressed a number of important conceptual and methodological issues in studying globalization's effects on SDH and their distribution, emphasizing the need for transdisciplinary approaches that reflect the complexity of the topic. In this second article, we identify and describe several, often interacting clusters of pathways leading from globalization to changes in SDH that are relevant to health equity. These involve: trade liberalization; the global reorganization of production and labour markets; debt crises and economic restructuring; financial liberalization; urban settings; influences that operate by way of the physical environment; and health systems changed by the global marketplace. Background Globalization is a key context for the study of social deter- minants of health (SDH): broadly stated, SDH are the conditions in which people live and work, and that affect their opportunities to lead healthy lives. In the first article in this three part series, we described the origins of the series in work conducted for the Globalization Knowledge Network (GKN) of the World Health Organization's Commission on Social Determinants of Health and in the Commission's specific concern with health equity. We identified and defended a definition of globalization that gives primacy to the drivers and effects of transnational economic integration, and addressed a number of impor- tant conceptual and methodological issues in studying globalization's effects on SDH and their distribution, emphasizing the need for transdisciplinary approaches that reflect the complexity of the topic. In this second article, we identify and describe several, often interacting clusters of pathways that lead from glo- balization to changes in SDH that are relevant to health equity and provide an analytical starting point for more Published: 19 June 2007 Globalization and Health 2007, 3:6 doi:10.1186/1744-8603-3-6 Received: 31 October 2006 Accepted: 19 June 2007 This article is available from: http://www.globalizationandhealth.com/content/3/1/6 © 2007 Labonté and Schrecker; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0 ), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Globalization and Health 2007, 3:6 http://www.globalizationandhealth.com/content/3/1/6 Page 2 of 17 (page number not for citation purposes) context-specific research. These involve: trade liberaliza- tion; the global reorganization of production and labour markets; debt crises THE SOCIAL CONSTRUCTION OF WHAT? Copyright © 1999 The President and Fellows of Harvard College Copyright © 1999 The President and Fellows of Harvard College IAN HACKING THE SOCIAL CONSTRUCTION OF WHAT? HARVARD UNIVERSITY PRESS CAMBRIDGE, MASSACHUSETTS AND LONDON, ENGLAND Copyright © 1999 The President and Fellows of Harvard College • 1999 Copyright ᭧ 1999 by the President and Fellows of Harvard College All rights reserved Printed in the United States of America Library of Congress Cataloging-in-Publication Data Hacking, Ian The social construction of what? / Ian Hacking p cm Includes bibliographical references and index ISBN 0-674-81200-X (alk paper) Knowledge, Sociology of I Title BD175.H29 1999 121—dc21 98-46140 CIP Copyright © 1999 The President and Fellows of Harvard College CONTENTS Preface vii Why Ask What? Too Many Metaphors What about the Natural Sciences? Madness: Biological or Constructed? Kind-making: The Case of Child Abuse Weapons Research Rocks The End of Captain Cook Notes 36 163 186 207 227 Works Cited Index 239 257 Copyright © 1999 The President and Fellows of Harvard College 63 100 125 For Catherine Copyright © 1999 The President and Fellows of Harvard College PREFACE Social construction is one of very many ideas that are bitterly fought over in the American culture wars Combatants may find my observations rather like the United Nations resolutions that have little effect But a lot of other people are curious about the fray going on in the distance They are glad to hear from a foreign correspondent, not about the wars, but about an idea that has been cropping up all over the place I have seldom found it helpful to use the phrase ‘‘social construction’’ in my own work When I have mentioned it I have done so in order to distance myself from it It seemed to be both obscure and overused Social construction has in many contexts been a truly liberating idea, but that which on first hearing has liberated some has made all too many others smug, comfortable, and trendy in ways that have become merely orthodox The phrase has become code If you use it favorably, you deem yourself rather radical If you trash the phrase, you declare that you are rational, reasonable, and respectable I used to believe that the best way to contribute to the debates was to remain silent To talk about them would entrench the use of the phrase ‘‘social construction.’’ My attitude was irresponsible Philosophers of my stripe should analyze, not exclude Even in the narrow domains called the history and the philosophy of the sciences, observers see a painful schism Many historians and many philosophers won’t talk to each other, or else they talk past each other, because one side is so contentiously ‘‘constructionist’’ while the other is so dismissive of the idea In larger arenas, public scientists shout at sociologists, who shout back You almost forget that there are issues to discuss I have tried to get Copyright © 1999 The President and Fellows of Harvard College viii PREFACE some perspective on established topics in the field More interesting are some openings to new ideas that have not yet been examined Labels such as ‘‘the culture wars,’’ ‘‘the science wars,’’ or ‘‘the Freud wars’’ are now widely used to refer to some of the disagreements that plague contemporary intellectual life I will continue to employ those labels, from time to time, in this book, for my themes touch, in myriad ways, on those confrontations But I would like to register a gentle protest Metaphors influence the mind in many unnoticed ways The willingness to describe fierce disagreement in terms of the metaphors of war makes the very existence of real wars seem more natural, more inevitable, more a part of the human condition It also betrays us into an insensibility toward the very idea of war, so that we are less prone to be aware of how totally disgusting real wars really are And now for acknowledgments Usually I work for years on something, pretty much by myself, aided by ... kind of treatment he or she receives The Social Construction of the Illness Experience The idea of the social construction of the illness experience is based on the concept of reality as a social. .. issues of health? What other examples of “pinkwashing” can you think of? 4/7 The Social Construction of Health Summary Medical sociology is the systematic study of how humans manage issues of health. .. social construction In other words, there is no objective reality; there are only our own perceptions of it The social construction of the illness experience deals with such issues as the way