In order to grasp a full-bodied understanding of American medicine, one must use a variety of theoretical approaches because American medicine not only is the study of science but the study of society, social constructs, and socialization. In other words, one must approach American medicine with the mind of a sociologist because health is social, because it is affected by social influences such as socioeconomic status, neighborhood, life stage, etc. An example of this ‘social health’ phenomenon is the difference between societal preferences of body type. In the United States, a slim body is labeled as healthy, while in Senegal, bulkier bodies are deemed as healthy. However, in reality, a person’s true healthy state can be measured more accurately by blood tests, measures, etc. Another example displaying the social nature of health in America is medicalization. For example, only fifty years ago doctors believed addictive diseases like alcoholism were just the result of bad character, rather than what we now know as a serious disease. Medicalization changes both the meaning of the condition and the individual at hand. Someone who has once been pushed aside and labeled as weak, crazy, or stupid could be recognized a century later as someone who endured a serious disease. Two theoretical approaches that can be useful in understanding American medicine are structural functionalism and conflict theory. Although both provide different perspectives, when used hand in hand, they are useful in obtaining a rich understanding.
The structural-functionalist perspective argues that health is the core of a stable society, and therefore, sickness is a ‘sanctioned form of deviance’. In other words, disease is a threat to social order, so the healthcare system must return patients back to health to keep society stable. In practice, this perspective can be used to logically conclude a sick person will inevitably make society unstable (even in micro ways), and therefore, to ensure a stable society, they must be nursed back to health. This perspective offers a macro lens because it focuses on the mechanics of society in order to promote social stability and solidarity. For example, a pro hockey player who just shattered his leg was prescribed opioids by his doctor to monitor the pain he endures. He eventually becomes addicted to these pain meds after his leg heals. Based on a structural-functionalist perspective, this problem arose from a hole in society (in this case, it is the prescription of heavy opioids), and it must be resolved to ensure social stability by providing the man with medical treatment. Talcott Parsons (1951) coined the term the ‘sick role’, which means anyone labeled with this term led patterns of expectations for people who are sick (like sleeping all day or eating soup) and expectations for the one caring for them, like someone providing soup, medication, blankets, etc.
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On the other hand, the conflict theory perspective is used to expose and analyze the inequalities within society. In terms of American medicine, this could take the form of healthcare resources being unequally distributed or available across the United States due to location, individual’s socioeconomic status, and more. Critical theorists argue that capitalist society and the pursuit of profit rather than human well-being leads to the commodification of health. Powerful people in large companies have a tremendous influence on the current healthcare system and even the future of the system by deciding what research to fund. Furthermore, conflict may arise among different groups seeking access to these resources. In practical application, like analyzing drug and alcohol addiction, conflict theory would use the logic that people of lower socioeconomic status have far less access to healthcare resources than those in power, and thus are more likely to be labeled as the problem rather than the addictive disease being the problem. The conflict theory perspective is used in various contexts. In terms of medicine, it can be used when studying social epidemiology, the study of the causes and distribution of diseases. For instance, “The availability of doctors and nurses in low-income countries is one-tenth that of nations with a high income. Challenges in access to medical education and access to patients exacerbate this issue for would-be medical professionals in low-income countries” (World Health Organization 2011). While health is a commodity, individuals of low socioeconomic status are far more likely to experience illness than wealthy individuals due to deprivation amplification. Living in food deserts, being exposed to diseases, and severe elements, or working physically strenuous jobs all day can influence the probability of illness tremendously. Conflict theory helps provide awareness of these inequalities that exist within the United States.
Both structural functionalism and conflict theory offer great strengths, while also having some weaknesses. First, functionalism assumes the individual that plays the sick role voluntarily accepted that role, however, this may not be the case. For example, as a child when I was sick, I was okay with it because I knew it meant I could sleep all day, but now if I get sick, I really just want to continue my normal lifestyle because I know I would have to catch up on school work. Functionalism also tends to ignore solving conflicts or inequalities within societies, focusing more on just ensuring the stability of the society. On the other hand, conflict theory has been criticized for solely focusing on revolutionary change within society, rather than stability as the goal.
While the structural-functionalist perspective focuses on how health plays a part in the stability of a society, the conflict theory perspective focuses on the inequalities that exist, and the lack of recourse people of a lower socioeconomic status experience. Both perspectives have their shortcomings, but when used hand-in-hand, they can provide a rich lens and can even be helpful in paving the future of humanity. We must understand the inequalities that exist in our society, even if they don’t affect us personally, because of the greater good of humanity beyond our lifetimes. We must also understand the importance of societal stability in order to have a society that can lead future generations.
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