Disease

Even under the best of circumstances, human beings inevitably find themselves confronted with disease or illness. As it is for biomedicine, a central question for medical anthropology must be: What is disease? It is clear why this question is important to biomedicine. Medical anthropologists, however, have tended to avoid the question altogether by defining "disease" (i.e., clinical manifestations of ill health) as the domain of medicine and "illness" (i.e., the sufferer's experience of those manifestations) as the appropriate arena of anthropological investigation. From the perspective of CMA, however, defining disease as beyond the concern or expertise of anthropologists is a retreat from ground that is as much social as it is biological in nature. Disease varies from society to society in significant ways because of organic, climatic, or geographical conditions, but also because of the ways productive activities, resources, and reproduction are organized and carried out, and because of the living and working conditions that flow from the social distribution of resources. From the CMA perspective, discussion of specific health problems, apart from their social contexts, only serves to downplay social relationships underlying environmental, occupational, nutritional, residential, and experiential conditions. Disease is not just the straightforward result of a pathogen or physiological disturbance. Instead, a variety of social problems such as malnutrition, economic insecurity, occupational risks, industrial pollution, substandard housing, and political powerlessness contribute to susceptibility to disease (Baer, Singer, & Johnson, 1986). In short, disease is as much social as it is biological. In this light, the tendency, be it in medicine or in medical anthropology, to treat disease as a given, as part of an immutable physical reality, contributes to the tendency to neglect its social origins. CMA strives, in McNeil's (1976) terms, to understand the nature of the relationship between microparasitism (the "tiny organisms," malfunctions, and individual behaviors that are the proximate causes of much sickness) and macroparasitism (the social relations of exploitation that are the ultimate causes of much disease). For example, an insulin reaction in a diabetic postal worker might be seen in a very reductionist mode as an excessive dose of insulin that causes an outpouring of adrenaline, a failure of the pancreas to respond with appropriate glucagon secretion, etc. However, a critical perspective would tend to lead a researcher to investigate whether the postal work skipped breakfast because of being late for work, the psychobiological effects of the derisive demands of a supervisor, or the inability to break for a snack because of pressure from above to increase productivity, or, more broadly, the health consequences of the structure of class forces in U.S. society that ensures capitalist domination of production and the moment to moment working lives of working people like postal employees (Woolhandler & Himmelstein, 1989).

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