The Social Inequality of Disease Distribution

Seeking to move beyond the analysis of individual risk-taking behaviors and psychosocial variables in the study of epidemics, critical medical anthropologists (beginning in the 1980s) have called attention to the ways in which political economy, class, and gender create unequal vulnerabilities and responses to disease and death. Poverty, racism, and oppression are shown to shape the contours of morbidity and death statistics through the unbalanced distribution of medical services and political and economic barriers to prevention and care. In those studies, disease control programs are critically appraised. Linkages are made between global capitalism and individual affliction and between individual human agency and the structural factors that constrain it (e.g., Farmer, 1992, 2001; Farmer, Connors, & Simmons, 1996; Kim, Millen, Irwin, & Gershaman, 2000; Singer, 1998). This body of work extends the social medicine tradition of Rudolf Virchow into ethnographic practice:

Medical statistics will be our standard of measurement: we will weigh life for life and see where the dead lie thicker, among the workers or among the privileged. (Virchow, 1848, quoted in Farmer, 2001)

The social roots of mass death from disease and the conditions that place individuals at risk in the first place are structural. Power relations, an important source of disease affliction, are slow to be acknowledged in public health discourse and action.

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