LECTURE 3 Public Health to Modern Medicine
Mar 28, 2015
LECTURE 3
Public Health to Modern Medicine
Overview.
McKeown- medicine and public health development of modern medicine and the hospitalwhy did public health became such an important issue?The question of progressive emancipatory ideals.The question of the ‘nation’ the bureaucratisation, rationalization and professionalisation of medicinethe medicalization of everyday life.
Public Health to Modern Medicine
The taming of diseaseMcKeown -medicine played no role before 18th centuryfor most of history medicine about helping to maintain health and comfort the sick Medical ‘expert’ opinion unreliable and unscientific for much of human history Enlightenment changes this increasing confidence Idea that we have increased control over our health
Public Health and Public Awareness.
Increased awareness of relationship between diseases and their causes. importance of hygiene application of this knowledge to organising society 1860s a watershed. between 1870 and 1914 issue of public health linked to preventing disease. city life and health since (John Hogg 1830) Charles Booth (1880) - one quarter of London living in poverty Joseph Rowntree (1890s) - calorific intake and health.– Gender and childhood inequality
Health as a National Concern 1
Boer War 1899
Manchester 8000 out of 11000 volunteers lacked basic fitness
Chronic malnourishment-35% unfit to fight
leads to idea of racial degeneration (Neo Darwinist ideas)
Health as a National Concern 2
Issue of physical degeneration put the public health administration on the defensive
Govt committee on physical degeneration
committee report in 1904
Health as a class issue
Health as a national/racial concern
Emergence of NHS
New scientific approaches to public health
19th Century Epidemiological surveys, disease surveillance, and statistical analyses integral part of managing public health. Epidemiology and causes of disease Looking for patterns.certain segments unusually vulnerableMeasles most common among children, lung cancer among smokers, Until recently it was thought AIDS among gay men or drug users
Early epidemiological Discoveries 1
Percival Pott in 18th Century- chimney sweep and cancer of scrotum
James Lind (1716-1794) and scurvy
(But what could it be – sea water? Touching sails? Millions of things – shows the difficulty)
But often difficult to isolate ‘causes’
The Broad Street Pump
John Snow (1813-1858) -Cholera. His study pointed to drinking water as the cause The Broad St pump is an obligatory part of medical education nowUse of statistics/ experiments and observationsIn modern world- rarely a mono-causal explanationso many variables.Environment an example
James Le Fanu
against epidemiological studies of small hazards“The simple expedient of closing down most university departments of epidemiology could both extinguish this endlessly fertile source of anxiety-mongering while simultaneously releasing funds for serious research” (Le Fanu 1999: 3).
The Role of Medical Technology
Stethoscope (1819)
thermometer use widespread by 1920s.
x rays (1895)
electrocardiagraph (1901)
a new objectivity?
Story of x-Rays
X-rays discovered 1895 - Wilhelm Roentgen (Bleich 1961). important innovation for the whole future of medicine, Impact was hugeBut ambivalence around this technology Scientific American described a breakthrough so revolutionary that it: “almost dangerously increases our power of belief” (cited in Knight 1986: 13). Frankenstein technology!
Was Mc Keown Wrong?
Developments in surgery in late 19th century Chloroform anesthesia (1850s)invention of artery clamp and antiseptic Before 1860s surgery essentially an emergency procedureAfter 1860 became increasingly constructive by 1900 performing operations that enhanced quality of life
Medicine and the Wars
role of medicine in the war effort. new preventative medicine changes patterns of mortalityemergence of reconstructive surgery. post WW2 period the transformation even more marked than around WW1. transformation in organization of medical services hidden legacy of war- eg German and Japanese P.O.W camps and medical
Medicalization of Society.
changes in social attitudes
The Health Society?
Health obsessed in modern world
Everyone as expert
greater uncertainty and anxiety
Is this about health or beauty?
'Fear of Ageing' report (2002 Datamonitor) -average spending on 'fountain of youth products’ £75 per head
`Getting better’ but ‘feeling worse' ?
more people register at gyms but life more sedentary
not leading to better contentment
Question of ever-increasing demands
Dalyrymple ‘greater supply leads to greater demand’
Impact on medical profession.
Doctors are also unhappy.
‘The BMJ's editor has argued that doctors are profoundly disaffected from the character of modern medicine ‑1'000's of respondents to the editorial in BMJ in May 2001 indicated that even American doctors are very unhappy with the profession’
( Nigel Edwards, policy director of the NHS Federation, writing in the BMJ on 5/4/02).
Professional Perspectives
Heavy workloadless autonomy in group practice government regulation,a growing blame cultureless respectDoctor as ‘monster’anxiety and alarm around medical treatment.
The Role of Sociology 1
Questions around issues of power
Questions around roles
suspicion of the claims of progress.
Postmodern theory
Erosion of trust
The Role of Sociology 2
For Parsons a central role for medicine in maintaining the stability of society. Positive functions of medicine for society.Medicine no longer seen this wayFor Marxists an institution of the superstructure.Interactionist and labelling theorists object to the power of the medical establishment their ability to determine who or what constitutes sickness Weberian sociology links medicine, power and status
Freidson
‘medicine’s success in gaining power and recognition over competing approaches to healing such as homeopathy had little to do with it possessing essential or particularly valid knowledge. It achieved success by having it's definitions of health and illness and treatment accepted as being the only legitimate ones’.
Medicine, medical experts and Professional Monopoly
1858 medical Registration Act
1911 health Insurance Act
1946 National health act -all 'unqualified' professionals squeezed out of practicing.
process of professionalisation central to consolidating medical power.
medicalization from above
Health As the new religion (Dalrymple).
Zola doctors as the new priests
Gym is the new church?
Link to consumption and lifestyle
Consuming health
a secular theodicy
Modernity and Medicine
Undermining of traditional religious discourse.Scientific explanations over supernaturalLittle concept of a great scheme of things- deconstruction of whatever scheme we have held in our minds.Desire to calculate, predict, control aspects of human behaviourWeber Disenchantment of the world- loss of magic, mystery, prophecy and the sacredAffects private as well as public livesSociety more atomised- broken down to it’s smallest parts rather than everything having meaning in a wider context.
Health Obsession as a panacea
Self help attract the powerless.Gives meaning/message, offers compensation.looser affiliations to fit with modern life.Need for community in individualistic world.Crystal healing/spiritual healing/divination/tarot- You can buy into health Pseudo spiritually- pick and mix approach, supermarket of ideas, fits with consumerist ethos of mod societyGreater choice/autonomy/ Not dogmaticCan be more flexible about what you believe.Belief has become more significant than belonging