Key Social Processes and Institutional Forces in Health and Illness
Health policy is starting to acknowledge the complex nature of health and the power of the market in shaping social practices related to health and well-being (Marks, 2013). The physical, psychosocial and economic environments in which we live dramatically influence our health. These environments include dominant institutions and industries which shape particular understandings of health, illness, disease, health care and treatment processes. Biomedicine and the pharmaceutical industry are powerful domains that require critical examination. Researchers across a number of disciplines have investigated processes around medicalisation, the way in which the jurisdiction of medicine has extended into everyday life and converted human issues into medical conditions (Conrad, 2007). Researchers have also examined pharmaceuticalisation, the processes involved in transforming human conditions into possibilities for pharmaceutical interventions and ‘producing’ diseases overtly for profit-making (Gabe, Williams, Martin, & Coveney, 2015; Moynihan & Cassels, 2005). This is highly gendered and targets women more than men. For example, Moynihan (2003) uses ‘female sexual dysfunction’ to demonstrate how corporations (drug companies) create a phenomenon, turn it into a dysfunction, then into a disorder, and finally have it categorised as a disease. Cacchioni (2015) also recently highlighted the increasing medicalisation of female sexuality as part of the profit-driven motives of pharmaceutical companies. Along with other scholars (e.g., Tiefer, see http://newviewcampaign.org/) she has strongly argued against flibanserin, a drug popularly called ‘pink viagra’, claimed to treat low sexual desire in women. More generally, researchers highlight how pharmaceuticals in everyday life symbolise specific forms of governance and are tied to particular identities, roles and responsibilities (e.g., Dew, Norris, Gabe, Chamberlain, & Hodgetts, 2015).
Crawford (2006) argues that health has become central in our everyday lives, and the pursuit of health is one of the most salient features of contemporary living in Western societies. This has led to expansive professional and commercial spheres with associated products, services and knowledge commodified and offered to people as they pursue personal health. This “new health consciousness” (Crawford, 2006, p. 408) is linked to consumerism and the highly developed contemporary ideology that health is the responsibility of the individual. Pursuing and sustaining health thus becomes an indispensable aspect of being a good citizen. ‘Healthism’ is mobilised pervasively for commercial gain. Race (2012) provides an excellent example using the contemporary marketing of bottled water. His analysis demonstrates how companies “appeal to scientifically framed principles and ideas of health in order to position the product as an essential component in self-health and healthy lifestyles” (p. 72). The biomedical discourses drawn on in marketing bottled water are linked to “broader ways of conceiving and acting upon the self that have become prevalent in contemporary society” (p. 72), reinforcing ideologies of consumption and personal control. A similar process is apparent with personal digital devices (e.g., see Millington, 2014). Many hundreds of thousands of people in wealthy societies are now using wearable digital devices to self-monitor and self-track their daily biometric data and physiological functioning (Fox, 2015). Health professionals have also positively seized the opportunity such devices may provide for ‘mHealth’ (mobile health) promotion. However, as Lupton (2013) has cogently argued, such detailed self-monitoring has major consequences for our broader understandings of health, embodiment and identity, as well as reinforcing healthist and enhancement discourses.
These kinds of critical analyses of key social processes have traditionally been given limited attention in health psychology. However, critical health psychology aims to situate all research, scholarship and practice within its broader social and cultural contexts, and therefore theorising these contexts is essential. Theoretical contributions from many other disciplines (such as sociology, anthropology, human geography) are extremely valuable for critical health psychology work. Scholarship that strengthens critical approaches to health and illness needs to work across disciplines (Hepworth, 2006) and benefits from paying particular attention to social and cultural commentary and theory.