Exam 1 Intro to health studies

What does it mean to be healthy/definiion of health

Health is not simply the absence of disease or having “good” biological measurements. Health can also involve well-being, pleasure, quality of life, and what is meaningful for the individual. Klein argues that society often treats “health” as a moral standard and that people should question one universal definition of what counts as healthy.

Medical uncertainty

When doctors and patients do not know for certain what the diagnosis, best treatment, or future outcome will be. Medicine often involves making decisions even when the consequences cannot be completely predicted.

Gawande’s article shows this through difficult treatment decisions where neither the doctor nor patient can know for sure which choice will produce the best outcome.

Management of uncertainty

How doctors and patients handle incomplete medical knowledge, including communicating risks, discussing options, and deciding what to do when there is no obviously correct answer.

This connects strongly to Gawande because he examines who should make difficult medical decisions and how much guidance doctors should provide.

Doctor-patient relationship

The relationship through which doctors and patients communicate, share medical information, and make decisions about care.

Gawande focuses especially on the tension between physician authority and patient autonomy: doctors have medical expertise, but the patient is the person who must live with the consequences of the decision.

His article describes how medicine moved away from a strongly paternalistic model, where doctors routinely made decisions for patients, toward greater patient involvement.

Biopsychosocial model of illness

A model that says health and illness result from the interaction of biological, psychological, and social factors, rather than biology alone.

Lewis, Cogburn, and Williams support this general idea because they show that a social experience—discrimination—is associated with both mental and physical health outcomes.

Bio + Psycho + Social

Biomedicine

An approach to medicine that primarily understands disease through biological processes in the body, such as pathogens, genes, organs, cells, and physiological abnormalities.

Rosenberg describes this kind of approach when discussing the tendency to understand disease through specific bodily mechanisms, while also arguing that disease cannot be understood through biology alone

Medical model of disease

The idea that disease can be understood as a specific biological abnormality or pathological process that can be identified, diagnosed, and treated.

Rosenberg warns that this is incomplete because disease also acquires social, cultural, historical, and personal meanings. He says disease is simultaneously biological and connected to social roles, policy, culture, and doctor-patient interactions

Health disparity

A difference in health outcomes between groups that is connected to social inequalities or disadvantages.

Lewis, Cogburn, and Williams show that discrimination is associated with poorer mental and physical health, making discrimination one factor that can contribute to health inequalities

Disease

The biological or pathological process occurring in the body.

Rosenberg acknowledges disease as a biological event but argues that it is also given meaning through medicine, culture, history, and society.

Illness

The personal experience of being sick—how disease affects someone's emotions, relationships, daily life, identity, and place in society.

This difference is especially important in Farmer and Kleinman: AIDS is not only a virus or biological condition; patients experience fear, poverty, shame, rejection, and other forms of suffering

Disease vs. illness

Disease = biological condition.
Illness = lived experience of that condition

Illness as metaphor

When society gives a disease symbolic meanings beyond its biology and uses the illness to represent things such as weakness, evil, punishment, invasion, or personal character.

Sontag argues that diseases such as tuberculosis and cancer acquired powerful metaphors that could produce fear, secrecy, shame, and blame. Her larger argument is that patients are better served when disease is treated as disease rather than surrounded by harmful symbolic meanings.

Disease frame

The way a society or medical system organizes, explains, and understands a disease.

Rosenberg intentionally uses “frame” to describe the explanatory schemes created around diseases. These frames can change as scientific knowledge, technology, culture, institutions, and social values change

Once a disease is diagnosed and socially recognized, that diagnosis can also change how a person is treated and how they understand themselves

Epidemic

An epidemic occurs when a disease appears in a population at a greater-than-expected frequency or incidence.

Farmer and Kleinman’s AIDS reading explicitly introduces epidemics in terms of unusually high disease frequency and then discusses AIDS as a global epidemic/pandemic

Suffering

The physical, emotional, social, cultural, and economic distress associated with illness.

Farmer and Kleinman argue that AIDS cannot be understood only through its biological effects. Suffering can involve poverty, stigma, fear, relationships, family, and social treatment, and it can extend beyond the patient to families and communities.

Pain can be physical. Suffering is broader.

Stigma

Negative social judgment attached to a disease or to people who have it, which can lead to shame, blame, fear, discrimination, or rejection.

This is extremely important in the AIDS readings. Farmer and Kleinman describe how people with AIDS were associated with shame and guilt and could be treated as socially threatening. Nolen’s stories also show people hiding HIV diagnoses because of fear of rejection and discrimination.

Social death

When someone is physically alive but is socially excluded, rejected, isolated, or treated as though they no longer fully belong to society.

It connects especially well to the AIDS readings because stigma can cause people with HIV/AIDS to lose relationships, community support, respect, or social belonging.

Stigma can lead to social death.

Narrative medicine

Your readings themselves demonstrate why this matters. 28 Stories of AIDS in Africa presents individual experiences of AIDS, Pale Horse, Pale Rider shows Miranda's lived experience of influenza, and Farmer and Kleinman argue that descriptions of suffering reveal aspects of disease that purely technical medicine may miss.

Richard Klein — “What Is Health - Contrarian hyperbole

A rhetorical strategy that exaggerates the value of the opposite of something widely accepted so that people will question an idea they normally take for granted

Richard Klein — “What Is Health - “Health” / Health with a capital H

The socially promoted idea of health shaped by institutions such as government, medicine, insurance, pharmaceutical interests, and the media, rather than simply an individual's physical condition.

Richard Klein — “What Is Health - Ideology of health

The beliefs and assumptions society promotes about what counts as healthy, which can contain moral and political judgments rather than being purely scientific. Klein wants these assumptions examined critically.

Richard Klein — “What Is Health - Iatric disease

Harm that is produced by medicine or health practices themselves. Klein expands the idea to include physical and moral harm caused by public-health practices intended to make people healthier.

Richard Klein — “What Is Health - Epicurean view of health

Health should take account of the individual body, pleasure, moderation, and personal well-being. There is not one identical path to health for everyone.

Richard Klein — “What Is Health - Epidemiology vs. individual health

Epidemiology describes what happens to groups or populations, but it cannot determine the health or fate of one particular person. Klein therefore argues that individual health involves more than population statistics.

Lewis, Cogburn & Williams — “Self-Reported Experiences of Discrimination and Health” - Self-reported discrimination

Experiences of unfair or discriminatory treatment reported by the person who experiences them. The authors review evidence linking these reports with poorer mental and physical health.

Lewis, Cogburn & Williams — “Self-Reported Experiences of Discrimination and Health” - Racial/ethnic discrimination

Discriminatory treatment that a person understands as occurring because of race or ethnicity. The authors distinguish this from general unfair treatment because the two are not necessarily identical experiences.

Lewis, Cogburn & Williams — “Self-Reported Experiences of Discrimination and Health” - Health disparities

Differences in health between social groups. The authors examine discrimination as one possible contributor to racial and ethnic differences in health rather than as the single explanation.

Lewis, Cogburn & Williams — “Self-Reported Experiences of Discrimination and Health” - Intersectionalities

The fact that people can occupy multiple social identities or statuses at the same time, and those identities can interact to shape both experiences of discrimination and their health consequences.

Lewis, Cogburn & Williams — “Self-Reported Experiences of Discrimination and Health” - Vigilance / anticipatory stress

The stress produced by expecting that discrimination might occur and remaining alert or prepared for it. The anticipation itself can affect mental and physical functioning.

Lewis, Cogburn & Williams — “Self-Reported Experiences of Discrimination and Health” - Perseverative cognition

Continued worry, rumination, and anticipation of a stressor, which can keep the stress response active even when the discriminatory event is not currently happening. The authors use this concept from prior research to explain how vigilance may affect health.

Gawande — “Whose Body Is It, Anyway?” - Medical paternalism

The traditional model in which the doctor decides what is best for the patient, sometimes controlling information and making decisions with little patient involvement.

Gawande — “Whose Body Is It, Anyway?” - Patient autonomy

The principle that patients should have control over decisions involving their own bodies and medical treatment rather than simply obeying the physician.

Gawande — “Whose Body Is It, Anyway?” - Informed consent

The process of giving patients information about a treatment, its risks, and alternatives so that they can knowingly agree to or reject it.

Gawande — “Whose Body Is It, Anyway?” - Burden of decision-making

Giving patients complete control can also place a heavy responsibility on people who are frightened, sick, uncertain, and unable to know what the outcome will be.

Gawande — “Whose Body Is It, Anyway?” - Physician guidance

Respecting autonomy does not mean that doctors must simply present choices and disappear. Gawande suggests that patients may still need a physician's judgment, advice, and guidance while making difficult decisions

Susan Sontag — Illness as Metaphor - Illness as metaphor

Treating an illness as a symbol for something beyond the disease itself, such as a person's character, morality, emotions, or condition of society.

Susan Sontag — Illness as Metaphor - Tuberculosis (TB) mythology

Historically romanticized and associated with sensitivity, passion, spirituality, and a person being gradually “consumed.”

Susan Sontag — Illness as Metaphor - Cancer mythology

associated with something hidden, invasive, shameful, and destructive inside the body, very different from the romantic image once attached to TB.

Susan Sontag — Illness as Metaphor - Blame / moralization of illness

When diseases are given psychological or moral meanings, patients can be made to seem responsible for causing their own illness, adding guilt and shame to physical disease.

Susan Sontag — Illness as Metaphor - Demythologizing illness

Removing the frightening, moral, and symbolic meanings attached to disease so that illness can be understood more directly as illness rather than as a judgment about the person who has it.

Rosenberg — “Disease in History: Frames and Framers” - Disease as a biological event

Disease involves real pathological processes in the body that can exist regardless of whether people fully understand or recognize them.

Rosenberg — “Disease in History: Frames and Framers” - Disease as a social phenomenon

A biological condition becomes socially meaningful when people recognize it, name it, classify it, and respond to it.

Rosenberg — “Disease in History: Frames and Framers” - Social construction of disease

Medical understandings of disease are influenced by social and cultural values, so medical thought is never completely separated from the society in which it exists.

Rosenberg — “Disease in History: Frames and Framers” - Disease frame

An explanatory scheme used to make sense of a disease. Rosenberg prefers the idea of “framing” because medical understandings change as scientific knowledge, institutions, and society change.

Rosenberg — “Disease in History: Frames and Framers” - Disease as social actor/mediator

Once a disease has been defined and attached to an individual, the diagnosis can affect identity, relationships, social reactions, and the person's experience of being ill.

Rosenberg — “Disease in History: Frames and Framers” - Medicalization

The process of interpreting a behavior or condition through the category of disease or sickness, which can change its social, moral, or legal meaning.

Farmer & Kleinman — “AIDS as Human Suffering” - Rational-technical discourse of AIDS

The dominant way medicine discusses AIDS through disease control, molecular biology, epidemiology, pharmacology, policy, and treatment. Farmer and Kleinman argue that this language can overlook the human experience.

Farmer & Kleinman — “AIDS as Human Suffering” - AIDS and human meanings

AIDS acquires social and cultural meanings in addition to its biological effects, including ideas about fear, contagion, guilt, sexuality, and death.

Farmer & Kleinman — “AIDS as Human Suffering” - Human suffering

The experience of disease includes more than bodily symptoms. Can involve emotional distress, social relationships, stigma, poverty, cultural meanings, family, and community.

Farmer & Kleinman — “AIDS as Human Suffering” - Biomedical algorithm

A step-by-step medical approach that identifies the biological cause of symptoms and selects treatment. It may successfully address disease while still missing the patient's larger experience of suffering.

Farmer & Kleinman — “AIDS as Human Suffering” - Cultural context of illness

The meaning and experience of AIDS depend partly on a person's family, community, cultural expectations, and social environment; there is no single universal experience of suffering.

Farmer & Kleinman — “AIDS as Human Suffering” - Social death

The social rejection and isolation that can accompany AIDS, so that a person may lose relationships and social recognition before biological death occurs. This becomes another source of suffering.

Nolen — 28 Stories of AIDS in Africa - HIV vs. AIDS

HIV is the virus; AIDS describes the advanced illness that can develop when HIV has badly damaged the immune system. The stories show how important understanding this difference is for patients and families.

Nolen — 28 Stories of AIDS in Africa - HIV/AIDS stigma

Fear, shame, blame, or rejection directed toward people living with HIV/AIDS. In the stories, stigma often causes people to hide diagnoses or fear how others will react.

Nolen — 28 Stories of AIDS in Africa - Disclosure

Telling other people about one's HIV status. Disclosure can bring support, but it can also expose someone to rejection, gossip, discrimination, or loss of relationships.

Nolen — 28 Stories of AIDS in Africa - Antiretroviral therapy (ARVs)

Medicines that suppress HIV and allow people with HIV to live much longer and healthier lives when treatment is available and taken consistently.

Nolen — 28 Stories of AIDS in Africa - Drug resistance / second-line treatment

HIV can become resistant to a treatment regimen, requiring different drugs. Nolen's stories show that cost and access to second-line drugs can become a life-or-death inequality.

Porter — “Pale Horse, Pale Rider” - Liberty Bonds

Government bonds sold to civilians to help finance World War I. In the story, Miranda and others experience social and workplace pressure to buy them as proof of patriotism, even when they cannot easily afford them.

Porter — “Pale Horse, Pale Rider” - Influenza epidemic

The widespread influenza outbreak surrounding Miranda. The growing presence of illness, ambulances, death, and fear shows how an epidemic becomes part of ordinary daily life.

Porter — “Pale Horse, Pale Rider” - War and illness

Porter repeatedly places the influenza epidemic alongside World War I, so war, disease, fear, and death become intertwined in Miranda's experience.

Porter — “Pale Horse, Pale Rider” - Delirium / hallucination

As Miranda becomes severely ill, fever alters her consciousness and produces vivid dreams and distorted experiences. The story therefore shows illness from the patient's subjective point of view rather than only through medical facts.

Porter — “Pale Horse, Pale Rider” - Aftermath of illness

Recovery does not mean simply returning to the way life was before. Miranda survives physically, but her illness and Adam's death leave her grieving, detached, and changed by the experience.