Social Work or Social Control? The Political Economy of Health

The last few decades have seen a boom in globalization and the spread of the capitalist economic system across the world. Deeply and intimately intertwined with this capitalist system are the hegemonic cultural beliefs and social structures that back it up, deeming it “common sense” or the “only way” of doing things. If that fails, state structures such as policy and military can intervene, forcing individuals to conform or face the consequences. The political economy of health aids in the reproduction and continuation of these hegemonic beliefs using science and technology as a means of legitimizing actions and controlling populations.

In this paper I will use various theoretical frameworks of the political economy of health to argue that capitalism and biomedicine are in a dialectical relationship in which each one creates the conditions necessary to perpetuated the other.

            The greatest determinant of health of a population is socio economic status. The ability for individuals to adequately care for themselves depends on that individual’s access to resources such as quality food, clean water, safe shelter and medical technology. Wealthier groups tend to have better nutrition, suffer less from infectious disease, and live longer compared to those who belong to lower socio-economic groups. Oftentimes, this social inequality stems from historical processes that gave certain groups access to resources especially through the capitalist world system (Wiley & Allen 2013: 30).  Capitalism functions according to specific rules such as the constant accumulation of capital and the exploitation of natural and labor resources (Morgan 1987:133).  These rules make the system fairly predictable in the sense that those with most access to resources have the most power and as a result, receive the best care. Even further than that, though, those with access to resources have power over those who do not, giving them the ability to dictate the ways in which others receive medical treatment. 

            Through history, marginalized groups such as women, minorities and indigenous peoples have been controlled through the use of medicine and health care. Today we see this in the over-medicalization and commodification of the female body, the lack of rights of many foreign groups in the U.S. to practice their traditional medicine, and the use of minority groups as test subjects for new medical treatments. Cultural critics use the concept of social control to analyze the political economy of health, arguing that biomedicine works to replicate hegemonic systems of belief and actions in order to keep certain people subordinate based on gender, race and socioeconomic status (Morgan 1987:133). A critical medical anthropology approach compliments this with its position that illness is the body’s internalization of exploitative social relations.

             The state, which is difficult to define but for our purposed includes institutions of central and local government, the police, the army, schools, healthcare systems and the media, creates the conditions for working. They set the standards for wages and hours workable. Their main concern, of course being the maintenance of the capitalist system where the economic interests of capital dominate labor interests (Bambra 2011: 1). When laborers are overworked, which we have already discussed as a commonplace practice in this economic system, and they have little access to resources, they become sick. Depending upon the severity of sickness, those affected may have to miss work. In order to be excused for this absence, the ill must visit certified biomedical doctors and return back with a note. Those who do not risk job insecurity. The very act of visiting these doctors forces individuals with unique histories and cultural experiences to conform to certain labels. For example race and ethnicity are recorded, as well as gender and medical history. For many, these are not simple black and white responses however, for the sake of Western medicine, they must have something to fill in the blanks and thus conform to normative labels. When groups use traditional medicine, they run the risk of being arrested for unsafe practices and endangering others. So either conform to our way of doing things or be jailed.

            Women have been the victims of control vis-à-vis medicine for decades.  Labeled as hysterical, women were institutionalized and labeled crazy for experiencing gynecologic issues that were not quite understood yet. Today, most women are put on hormonal birth control in order to “control” menstrual cycles and side effects like cramps and PMS. Constantly creating new products for the market, birth controls change faces and shape to continually be fresh and new. Reproductive systems have become entities for doctors to examine on a regular basis, requiring annual check ups. Intimate details of a woman’s sexual life are shared with doctors on a regular basis, subjecting them to judgment and embarrassment. Pressure from doctors causes women to take medicine or go through operations they do not want or do not fully understand the repercussions of, which can result in unexpected issues.

            Peoples outside of the immediate state in question are also affected by the political economy of health. The dependency theory, used by many medical anthropologists, focuses on the unequal relationship between developed and undeveloped countries, positing that the development of a capitalist system in one geographic area necessitates the deliberate and continual underdevelopment of another country where resources can be extracted (Morgan 1987: 134). For example Texaco and indigenous groups of Ecuador have been in a legal battle for decades due to Texaco’s illegal drilling and dumping of toxic waste in the Amazon rainforest. Practices that would never be legal in the U.S. are easier to get away with in underdeveloped countries where regulations are not as strict, or don’t exist at all. As a result, Texaco made money from the natural resources extracted and the natives suffer from extremely high rates of cancer. Medical imperialism also affects undeveloped nations across the globe. According to capitalist theory, one must always find new ways to make a profit. This often results in a special-temporal fix where new markets can be created abroad for drugs, medical technology, pesticides, education and technical assistance. Despite the fact that these types of care may be more harmful than helpful, underdeveloped nations become reliant and thus perpetuate the hegemonic ideologies that capitalism forces upon them. Health services become a guise for social control, counterinsurgency and other military goals (Morgan 1987:137).

            Biomedicine uses science as a technology to define and manage populations both abroad and at home. Oftentimes, this is done under a guise of modernization and public health outreach however various different approaches to the political economy of health posit that Western medicine is a tool that works with capitalism in a dialectical way to reproduce hegemonic belief systems and to control populations. It is important to note that most human rights violations are committed by the state through structural violence that keeps certain groups protected and leaves others vulnerable (Farmer 199:1). The only way to truly solve the issue of health differentials is to destroy the social, cultural and political structures that maintain unequal access to resources. Any other attempt will work only as a band aid to an issue that is entirely structural.

                                                            Works Cited

Baer, Hans A.

            1982 On the Political Economy of Health. Medical Anthropology News Letter 14(1): 1.

Bambra, Clare

            2011 Work, Worklessness and the Political Economy of Health Oxford. Oxford University Press.

Csordas, Thomas J.

            1994 Introduction: the body as representation of being in the world. Embodiment and Experience: the existential ground of culture and self

Farmer, P

            1999 Pathologies of power: rethinking health and human rights. American Journal of Public Health 89(10): 1486-1496

Morgan, Lynn M.

            1987 Dependency Theory in the Political Economy of Health: An Anthropological Critique. Medical Anthropology Quarterly 131-154

Wiley, Andrea S. and John S. Allen

            2013 Medical Anthropology A Biocultural Approach Pp. 30-31 Oxford. Oxford Press.