health/medicine

American Public Media’s Marketplace posted a short animated video summing up the potential problems with health care as an economic development strategy. Many cities are building large, fancy medical facilities with the hopes of drawing “medical tourists,” patients from other areas who would travel to receive care at state-of-the-art facilities, thus creating jobs and injecting money into the surrounding community. Given that we hear that the need for health care providers will grow greatly in the future, this seems like a risk-free plan. But as the video shows, these development strategies can lead to over-supply of services and increased overall cost of health care, without the promised benefits to local economies:

Oh The Jobs (Debt?) You’ll Create! from Marketplace on Vimeo.

For another example of economic development fads that don’t necessarily pay off, see our previous post about sports stadiums.

According to a 2008 market research study, 72% of yoga practitioners in the U.S. are women; 71% are college educated and 27% have postgraduate degrees; and 44% have annual incomes of $75,000 or more.  Yoga practitioners, then, do not reflect the general population.

So how inclusive is yoga?  A collection of covers from the magazine Yoga Journal, spanning the years 1975 to 2010, sent in by Janet T., gives us a clue.

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Christie Barcelos is a doctoral student in Public Health at the University of Massachusetts who rarely sees anyone who looks like her in yoga class.

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In 1922 the American Social Hygiene Association, funded by the American Public Health Service, created a social marketing campaign aimed at American teenagers. While it was predominantly about sexually transmitted infections, it also taught about good health and hygiene in general. And maintaining health, then as now, is not only about health but also about conforming to social norms–especially gender norms.

The posters aimed at boys were titled “Keeping Fit”:

And the girls’ posters were titled “Youth and Life”:

Comparing the boys and girls’ posters, you can see that fitness is not just about physical health; it is also about particular character traits. For boys, those traits are will power, courage, and self-control–traits that are based on a puritan work ethic that we value in a competitive capitalist society.

While courage and endurance were important for both boys and girls, fitness for girls was less about power and self-control, and more about grace, beauty, and friendship.

TEXT:

Paint your cheeks from the inside out. Outdoor exercise, baths, regular meals, and plenty of sleep will help. Most girls could be prettier than they are because most girls could be healthier.

TEXT:

Copy the pose but not the shoes. Correct posture gives attractive figure, straight back, freedom of action for heart and lungs, good muscle tone. Stand tall — chest up, not out — toes straight forward when walking or standing. A well-poised body develops self-respect, and wins the regard of others.

Men were taught how to grow up to be honorable husbands and fathers, while women were taught how to grow up to be good wives and mothers.

For boys:

TEXT:

The youth who achieves self-control can go joyfully and clean into marriage with the one girl he is willing to wait for, and become a husband and father without the danger of causing suffering to wife and child.

For girls:

TEXT:

A woman physician who is also a mother. The girl of today will be the woman of tomorrow. She will need brains, vitality, and sound training, if she is to take her place in the world as a mother and a useful citizen.

It may be tempting to think that we know more now than we did back then and that with progress we make fewer mistakes today than they did in the past. However, controversy surrounding many health topics such as obesity, circumcision, and the way we screen, treat, and fundraise for breast cancer should tell you that we still have many assumptions behind our health recommendations that are based on ideology.

The posters are held at the Social Welfare History Archives at the University of Minnesota Libraries

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Christina Barmon is a doctoral student at Georgia State University studying sociology and gerontology.

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The World Health Organization (WHO) defines neurological disorders as physical diseases of the nervous system and psychiatric illnesses as disorders that manifest as abnormalities of thought, feeling, or behaviour. In fact, however, there are longstanding unresolved debates on the exact relationship between neurology and psychiatry, including whether there can be any clear division between the two fields.

Related to this, Brandy B. sent us a figure from the blog Neuroskeptic graphing the proportion of journal articles on various disorders included in The American Journal of Psychiatry versus the journal Neurology over the past 20 years. The image is interesting from a sociological standpoint in that, as Brandy writes, “it says far more about the sociology of these fields than about which disorders can be considered neurological or psychiatric.”

While debates regarding the neurological roots of psychiatric illnesses such as depression and schizophrenia are far from settled, the graph shows that the two disciplines have maintained varying levels of intellectual authority over different disorders. Some fall clearly into one domain or the other, while others are covered in both. Depression, for example, receives more attention than mania in Neurology, despite the fact that mania often occurs alongside depression as a symptom of bipolar disorder.

The information in this graph serves as a reminder that what gets published in academic journals, and the topics over which disciplines exercise authority, are the results of social processes. Disciplines are artificial categories of knowledge, solidified through the creation of institutional structures like university departments, degree programs, and academic journals. Psychiatry, for example, didn’t emerge as a discipline until the 19^th century; this emergence was rooted in a social context in Western Europe where rising numbers of people were being institutionalized and attitudes regarding the treatment of mental illness were changing. By claiming membership in disciplines based on common academic backgrounds, research methodologies, and topics of study, scholars contribute to the reproduction of these disciplinary boundaries.

The peer-review process is one facet of this social reproduction of disciplinary boundaries that is particularly relevant to the image above. Research and papers that are submitted, accepted, and funded must appeal to reviewers and conform to the criteria set out by the journal or discipline within which researchers wish to publish. In the case of neurology and psychiatry, it appears based on this graph that the peer-review process may uphold disciplinary boundaries, as reviewers for each discipline’s journal appear to favour articles on certain disorders.

The divisions between neurology and psychiatry suggested in the image above stir up lots of interesting questions not only about what we consider to be “neurological” or “psychiatric”, but more generally about the social production of knowledge.

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Hayley Price has a background in sociology, international development studies, and education. She recently completed her Masters degree in Sociology and Equity Studies in Education at the University of Toronto.

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If I ran the Federal scary anti-smoking image warning program, I might show smokers the list of health-related terms that show up most in the states with the highest cigarette smoking rates.

If you take the smoking rates by state, and throw them into the Google Correlate hopper, you can see the 100 search terms that are most highly correlated with that reported smoking behavior. That is, the terms that are most likely to be used in high-smoking states and least likely to be used in the low-smoking states.

Is the result just a lot of noise? Maybe, but I don’t think so. Here are the smoking-related terms in the top 100:

• camel no 9
• cigarette coupon
• cigarette coupons
• marlboro coupons
• my time to quit
• safe cigarettes
• stopping smoking
• time to quit
• fire safe cigarettes
• ways to stop smoking

So that’s good for face validity — a list of random search terms isn’t likely to have all those smoking terms on it.

But after the smoking terms, the thing that jumps out is the health-related terms. We know from the Google flu tracker that people search for their symptoms. So these caught my eye.

Here is a screen shot of the first page of results:

I selected “stages of copd” as the term to map. The map on the left is the smoking rates; the one on the right is the relative frequency of searches for “stages of copd.” That is, chronic obstructive pulmonary disease, a nasty disease the most common cause of which is smoking.

Here is the complete list of health-related terms among the top-100 correlates with smoking rates:

• stages of copd
• abnormal mammogram [the association between smoking and breast cancer remains controversial]
• aneurysm symptoms [more common among smokers]
• hardening of the arteries [exacerbated by smoking]
• jaw swelling
• red rash on legs [could be psoriasis, which smoking increases the risk of]
• swelling in neck
• swollen lymph node in neck
• pilonidal cyst pictures

Lymph node swelling, which is implicated in the jaw and neck searches, most often reflects infection — which smoking causes.

How strong are the connections? They’re not the strongest I’ve seen on Google Correlate. The “stages of copd” search is correlated with smoking rates at .77 on a scale of 0 to 1. It’s not uncommon to find correlations of .93 (which is the relationship between “quiche” and “volvo v70 xc”).

But considering the smoking rates come from a sample survey (the National Survey on Drug Use and Health) which includes random error, and states are somewhat arbitrary geographic units, that correlation seems pretty high to me. Here’s the scatterplot:

What is the correlation causality story here? I can’t say. But the simplest explanation is that these are the terms smokers (and maybe those who know or care for them) are most likely to Google relative to non-smokers — not that they are the most common searches smokers do, of course, but the searches that differentiate them from non-smokers. The simplest explanation is the best place to start.

I like this list of conditions because in my experience smokers sometimes have the attitude of “you have to die of something.” But it’s not just the chance of dying that smoking increases — it’s a lot of possible forms of suffering along the way.

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The Google Correlate tool is showing the great potential for using Internet search activity to investigate layers of behavior and meaning behind other observable social phenomena, such as race/ethnic composition, health behavior, and family patterns.

The “Let’s Move” campaign is Michelle Obama’s initiative to curb the childhood obesity epidemic in the United States.  According to the campaign website, its goals include “creating a healthy start for children” by empowering their parents and caregivers, providing healthy food in schools, improving access to healthy, affordable foods, and increasing physical activity.  Here is an example of the kind of “social marketing” that the campaign is releasing:

This campaign video is particularly notable for 1) its raced, classed, and gendered assumptions about the responsibility for promoting physical activity among young people; 2) the way it emphasizes personal responsibility while ignoring structural determinants of health; and 3) its Foucauldian implications (for the real social science nerds out there).

First, the video portrays a middle-aged white mother (in the kitchen, no less) who encourages her daughter to get exercise by having her running around their (apparently large, middle-class suburban) home in order to find the $1 she asked for.  It ends by stating: “Moms everywhere are finding ways to keep kids healthy.”  Not only does this assume that “moms” (not “parents”) have responsibility for keeping their kids healthy through intensive mothering practices, it fails to account for the fact that the childhood obesity epidemic (itself a social construct in many ways) is greatly stratified by race and socio-economic status.  It is not clear to the viewer how they might encourage their children to exercise if they live, say, in a small apartment or a neighborhood without safe places for kids to play outside.

Second, a growing body of research points to the fact that structural-level inequalities, not individual-level health behaviors, account for the majority of poor health outcomes.  This research illuminates a disconnect in most health promotion initiatives — people have personal responsibility (engage in physical activity) for structural problems (poverty; the high price of nutritious food; safe, well-lit, violence-free places for kids to play).

Finally, the video illustrates what some social scientists have noted about new forms of power in modern public health practice — for example, health promotion campaigns such as this one can be thought of as the exercise of “biopower,” or Foucault’s term for the control of populations through the body: health professionals and/or the government are entitled by scientific knowledge/power to examine, intervene, and prescribe “healthy lifestyles.”  In this example, the campaign uses marketing strategies to remind the (very narrowly defined) audience of their duty to engage with dominant health messages and concerns (i.e., childhood obesity) through the control of bodies (that is, their children’s).

In the “Let’s move” campaign video, then, we see that (white, middle-class) moms have a responsibility for encouraging their children to get physical activity without an acknowledgement of the gendered expectations of caregiving, structural determinants of health that effect childhood obesity, and the implications of top-down control of the body.

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Christie Barcelos is a doctoral student in Public Health/Community Health Education at the University of Massachusetts Amherst where she studies social justice and health, critical pedagogy, and epistemology in health promotion.

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Societies are permeated with visual images. This means that images dominate our lives. However, no other images confront us so frequently as advertising images. They belong to the moment. We see them as we turn a magazine page, as we drive past a billboard, and as we visit a website.  However fleeting, they are powerful agents of socialization.

Sociologist Erving Goffman described and exhibited subtle features of gender displays in his book Gender Advertisements. One significant feature that he noted was the ritualization of subordination in which women are portrayed in clowning and costume-like characters. This still rears its ugly head in today’s advertisements.

According to Goffman, “the use of entire body as a playful gesticulative device, a sort of body clowning” is commonly used in advertisements to indicate lack of seriousness struck by a childlike pose (p. 50).

Images reproduced in Gender Advertisements (Goffman, 1979, p.50)

Advertisement found in a file-hosting web site:

The clownish poses represent in these images clearly remind us some photos of female hysterics taken by Jean Martin Charcot (1825-1893) who was not only a neurologist but also an artist.

Charcot was the inventor/discoverer of the female psychic affliction of “hysteria” at the Salpêtrière asylum in Paris that confined four thousand incurable or mad women. For delving into the nature of hysteria, Charcot armed himself with photography. He extensively photographed the different stages and forms of hysteria and calibrated them into a general type called “the great hysterical attack.” Charcot believed that this attack proceeds in four phases, the second of which is called clownism or so-called illogical movements.

Image taken by Charcot and reproduced in Invention of Hysteria (Didi-Huberman, 2003, p.147)

Charcot used the clowning to delegitimate so-called hysterical women, and Goffman saw such representations for what they are, a way to portray women as inferior, emotionally childlike, unserious.  Over 100 years later, images of clowning women are still used to reinforce gender discrimination and position females as inferior.

References:

Didi-Huberman, G. (2003). Invention of Hysteria: Charcot and the Photographic Iconography of the Salpêtrière, translated by Alisa Hartz. Cambridge, Mass: MIT Press.

Goffman, E. (1979). Gender advertisements. Cambridge, MA: Harvard University Press.

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Zahra Kordjazi earned her M.A. in Teaching English as a Foreign Language, with a special interest in social semiotics, gender, visual literacy, and sociolinguistics. This post is based on her thesis, Images Matter: Gender Positioning in Contemporary English-Learning Software Applications, a semiological content analysis of gender positioning.

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My wife introduced me to two television shows, both built on a similar premise but with radically different results.

First, check out this clip from Clean House, airing on the Style Network.

Now, compare that to this ad for Hoarders, airing on the A&E Network.

This is a wonderful example of medicalization. We have people engaging in almost the exact same behavior, but their actions are interpreted in two diametrically opposed ways. Clean House generally (though not exclusively) frames their subjects as having poor habits that, with a little tough love, can be corrected. Hoarders, on the other hand, frames their subjects as having serious mental illnesses. Indeed, they regularly bring in clinicians to treat their subjects. The former invokes judgment (note the eye-rolling and smirking in the first clip), while the latter invokes sympathy (hear the dire music).

Our behaviors do not come with meaning necessarily embedded in them. We have to made sense of them, and the way that we ultimately do so has consequences. We did this in the past with the behavior of children, particularly of little boys. Is Johnny being rambunctious? There once was a time when Johnny was sent to the principal’s office for a spanking, but today, he is much more likely to be diagnosed with ADHD and given a pill. As we medicalize more and more in our society, our acceptance of and reaction to our behaviors change.

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