Biopower and Biomedical Dominance

This lecture covers:
- Dominant culture and the biomedical model in Australia.
- Principles and priorities of biomedicine.
- Critical exploration of the challenges of biomedicine to culturally safe and person-centred care.
Reading resources:
- Germov chapter (Week 7 readings).
- Willis and Elmer text (Week 8 readings).

Sociology: The study of societies and people, focusing on interactions and social circumstances.
Sociological perspective: Helps understand health issues in depth.
Health sociology: Focuses on social patterns of health and illness, examining differences between groups (e.g., gender, wealth, indigenous status).
Challenges the conventional medical view based on biological and physiological explanations.
Explores living and working conditions that shape health outcomes.

Social origins of health have been recognized for a long time.
Formal study traced back to the mid-century with the development of social medicine (later public health).
Driven by recognition of diseases like cholera, typhus, smallpox, tuberculosis, and diphtheria, running rampant in Europe and globally.
Clear links were found between these diseases and poverty.
Early to mid-century: Growing recognition of the impact of living and working conditions on health.
1878: Louis Pasteur's germ theory of disease demonstrated that illnesses were caused by germs invading the body - the foundation of modern medicine.
Robert Koch refined this theory further, introducing the concept of specific etiology.

Theory of mono-causal disease: a Specific cause for every disease.
Became the dominant medical paradigm in the early century.
Conventional approach to Western medicine, based on diagnosing and explaining illness via biological mechanisms.
Detracted focus from social origins of health.
Underpins most health professions and health service delivery in Western societies.
Assumption: Every disease has a specific cause affecting the body predictably.
Universal cures are theoretically possible.

Body as a machine: Views the body as made up of interrelated parts (circulatory system, skeleton).
Doctors act as mechanics, identifying and repairing broken parts.
Focus on identifying and eliminating specific diseases in individuals.
Shifted focus away from social origins of disease.
Significant turn away from religious or spiritual views of health and illness.
Mind-body distinction: The mind and body are separate entities.
- The brain is part of the physical body and the soul remains a separate entity.
- Mental state less important than physical parts that can be fixed.
Medicine as neutral and objective: Seen as a scientific process lacking in effects of power.
Medical science focuses on smaller features of human biology (biological, cellular, molecular, genetic levels) to understand disease.
Disconnect from social and psychological aspects of illness.
Health is narrowly defined as the absence of disease, requiring a definition of a normal healthy body.
Individualistic: Illnesses act upon individual bodies, with causes understood as developing within the body.
Treatment given primacy over prevention.
Treatment imperative: Medicine is the primary mechanism for addressing poor health.

Origins of health and illness assumed to come from within the body.
Overlooks social, structural, and systemic barriers to health and well-being (e.g., access to health care, stigma, racism).
Victim blaming: People blamed for their own poor health, tying health to lifestyle choices.
Perpetuates harmful stereotypes and prejudices, justifying social inequality and discrimination.
Normal human processes overmedicalized (e.g., aging, menopause, pregnancy, childbirth).
People's biology determines their inferior social, economic, and health statuses, leading to elitist, sexist, and racist beliefs.
Biological determinism is used to justify exploitation and inequality.
Objectification of patients: Treating the body as a machine dismisses the person's agency and unique experience of disease.
- Threat to informed consent.
- Individuals become passive objects of procedures.

Individuals in Western societies often believe they control their own destiny.
Ignores the considerable influence of societal structures.
We are products of our environment and upbringing.
Culture influences our behaviors and social interactions.
Need to question to what extent we are shaped by society.
Considers the structural elements that influence health.
Both structure (societal structure) and individual agency contribute to health and well-being.

A body of knowledge that shapes our thoughts.
Influence what we know or take to be the truth.
Dominant discourses are reflected in national conversations.
Exposed to discourses through news, social media, and day-to-day conversations.
The biomedical model shapes the discourse around health.
Medicine is an extremely important discipline but a partial body of knowledge.
Has implications for power sharing between health professionals and between providers and consumers of health care.

Who gets to define what a normal healthy body is?
Who decides where the health budget is spent?
Who dictates what risks people can take with their bodies and their health?
Need to consider the biomedical and social models of health.
What had more influence on the evolution of Australia's health and hospital systems, and why?
Biomedical dominance has consequences for cultural safety and person-centred care.

Definitions of health and illness vary between cultures and change over time.
Cultural beliefs, social practices, and institutions shape the ways health and illness are understood and dealt with.

The biomedical model dominates Western medicine, diagnosing and explaining illness as a malfunction of the body's biological mechanisms.
The social model of health challenges individualistic and biological explanations of health and illness by examining the influence of society and inequality.
Health problems with social origins require social action alongside medical interventions.
Biomedical dominance has implications for the delivery of culturally safe care.
Health professionals can use their sociological imagination to challenge biomedical dominance and consider the factors that influence a health issue.