Castro RR 615

Implications of Individualization, Risk and Reflexivity for Health and Illness in Contemporaneity

Implicações da Individualização, Risco e Reflexividade para a Saúde e a Doença na

Ensaio Contemporaneidade

Implicaciones de Individualización, Riesgo y Reflexividad para la Salud y la Enfermedad en la Contemporaneidade

Rodrigo Rebouças de Castro1

Abstract Body of the essay: The change from the first modernity, characterized by an Introduction: The effects generated by industrial social order, to the second globalization, technological advances, modernity, was driven by the “reflexive gain in civil and political rights, modernization”. Many of the non- empowerment of minorities and wanted outcomes from the new process increase in global risks has made not are naturally global and it is not only changes in the way people see, but possible to predict, estimate or control also how they face and deal with the their impact. As an effect of the fear and new challenges imposed. Within the anxiety generated, the “health industry” contemporary society or “second has adopted strategies to make profits modernization”, the flexibilization, from risk. Another feature of the recent neoliberalism and transnationalism have modernity is the „individualization‟, a rearranged how people act social change in which people are economically, politically and socially. responsible to build their own lives, and

¹Graduando do Curso de Medicina da UFAL. Autor correspondente: Campus A.C. Simões. Av. Lourival Melo Mota, s/n. Tabuleiro dos Martins. CEP: 57072-900, Maceió, Al, Brasil. E-mail: [email protected] Recebido: Out/2017 – Aceito: Dez/2017. ______Revist. Port.: Saúde e Sociedade. 2016; 2(3):615-622. Castro RR 616 Implications of Individualization, Risk and Reflexivity for Health and Illness in Contemporaneity events are results of personal choices, transnacionalismo reorganizaram a no longer seen as natural or inevitable. forma como as pessoas agem Furthermore, an increasing phenomenon economicamente, politicamente e called „inverted quarantine‟, mass socialmente. Corpo do ensaio: A actions of self-protectionism, creates mudança da primeira modernidade, pretended illusions of individual caracterizada por uma ordem social solutions for threatening situations, industrial, para a segunda stopping society to look forward modernidade, foi impulsionada pela collective solutions. Therefore, it results "modernização reflexiva". Muitos dos increase in disparities and social resultados não desejados desse novo exclusion, also reflecting in the access processo são naturalmente globais e, to a decent public health assistance. portanto, não é possível prever, estimar Conclusion: the new forms of social ou controlar seu impacto. Como efeito interaction in all spheres has imposed a do medo e da ansiedade gerados, a shift in the way of thinking and "indústria da saúde" adotou estratégias approaching the recent challenges in para obter lucro com os esses riscos. health. Outra característica da modernidade recente é a "individualização", uma Descritores: Public Health; Disease; mudança social na qual as pessoas são Delivery of Health Care. responsáveis por construirem suas

próprias vidas, e os eventos são Resumo resultados de escolhas pessoais, não

são mais vistas como naturais ou Introdução: Os efeitos gerados pela inevitáveis. Além disso, um fenômeno globalização, avanços tecnológicos, crescente chamado "quarentena ganho em direitos civis e políticos, o invertida", uma ação em massa do auto- empoderamento das minorias e o protecionismo, cria ilusões pretensas de aumento dos riscos globais não somente soluções individuais para situações modificaram a forma como as pessoas ameaçadoras, impedindo a sociedade vêem, mas também como elas encaram de buscar soluções coletivas. Assim, e lidam com os novos desafios impostos. resulta no aumento das disparidades e Dentro da sociedade contemporânea ou exclusão social, refletindo também no "segunda modernização", a acesso a uma assistência pública de flexibilização, o neoliberalismo e o

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Castro RR 617 Implications of Individualization, Risk and Reflexivity for Health and Illness in Contemporaneity saúde decente. Conclusão: as novas globales y, por lo tanto, no es posible formas de interação social em todas as predecir, estimar o controlar su esferas impuseram uma mudança na impacto. Como efecto del miedo y la forma de pensar e abordar os recentes ansiedad generados, la "industria de la desafios na saúde. salud" adoptó estrategias para obtener beneficios con esos riesgos. Otra Descriptores: Saúde Pública; Doença; característica de la modernidad Assistência à Saúde. reciente es la "individualización", un cambio social en el que las personas Resumen son responsables de construir sus propias vidas, y los eventos son Introducción: Los efectos generados resultados de las elecciones personales, por la globalización, los avances ya no son vistas como naturales o tecnológicos, la ganancia en derechos inevitables. Además, un fenómeno civiles y políticos, el empoderamiento creciente llamado "cuarentena de las minorías y el aumento de los invertida", una acción masiva del auto- riesgos globales no sólo modificaron la proteccionismo, crea ilusiones forma en que las personas ven, sino pretendidas de soluciones individuales también cómo se encaran y se ocupan para situaciones amenazadoras, de los nuevos desafíos. Dentro de la impidiendo a la sociedad buscar sociedad contemporánea o "segunda soluciones colectivas. Así, resulta en el modernización", la flexibilización, el aumento de las disparidades y exclusión neoliberalismo y el transnacionalismo social, reflejando también en el acceso reorganizaron la forma en que las a una asistencia pública de salud personas actúan económicamente, decente. Conclusión: las nuevas formas políticamente y socialmente. Cuerpo del de interacción social en todas las ensayo: El cambio de la primera esferas impusieron un cambio en la modernidad, caracterizada por un forma de pensar y abordar los recientes orden social industrial, para la segunda desafíos en la salud. modernidad, fue impulsada por la "modernización reflexiva". Muchos de Descriptores: Salud Pública; los resultados no deseados de este Enfermedad; Prestación de Atención nuevo proceso son naturalmente de Salud.

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Castro RR 618 Implications of Individualization, Risk and Reflexivity for Health and Illness in Contemporaneity

represent aspirations of social Introduction movements. Social life used to be organized The term society may be in a collective lifestyle, in which the characterized as an economic, cultural stronger determinant of social action and political infrastructure made up of was the beliefs and expectations of the people. This ever-changing term family, community and religion. These contributes and, at the same time, institutions used to rule the individual‟s results from its interaction with the life, creating pre-conceived forms of an environment, with other societies and ideal “way of living”, for example: have all the institutions created to rule them. a good job, marry and raise your As a result of the globalization process, children. At this point, environmental the technological revolution, the gain in issues were out of everyone‟s concern. civil and political rights, the gender However, as time passed, old familial revolution and the increase of global and organizational structures were no risks, there has been a transformation in longer appropriate to the modern world. the way people see and respond to these In addition to the reasons stressed in the changes in the environment, which now first paragraph, gender revolution, is seen globally, and within different secularization, neoliberalism and the communities. These interdependencies rise of science have contributed for this have emerged as a consequence of the changing in the previous conceptions. „second modernity‟, in which the The change from the first modernity, increased flexibility, liberalization of characterized by an industrial social market and heightened transnationalism order, to the second modernity was have led to changes in social life, for driven by the “reflexive both individual and family, within the modernization”, term that was launched community and also in the political, by three well-recognized sociologists economical and institutional spheres(1). (Ulrich Beck, Anthony Giddens and It is important to understand that the Scott Lash) (2) and which concept and individual now possess essential role on aspects will be explored in this essay. the responsibility for his or her acts towards health maintenance and the Body of the essay politics contained in their lifestyle

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Castro RR 619 Implications of Individualization, Risk and Reflexivity for Health and Illness in Contemporaneity

Differently from the problems green style of living and identity, being confronted by past generations, the activist and daily practicing. It is worst problems the current society has becoming even more common to see to deal with are human made, for people expressing their political or instance, the disastrous effects of the ecological beliefs when consuming global warming, air-pollutants, terrorist products. Nonetheless, it has been attacks, food and water poisoned with questioned if reflexivity is enough to chemicals, and world financial crises. lead such new practices for a more These non-wanted outcomes are sustainable environment, yet is a good naturally global, they go beyond beginning for taking responsibilities, national boundaries therefore cannot be making considerations and being restricted to a local area or group. They precautious(2). have reached a level in which is not There are tremendous risks in the possible to predict, estimate or control modern society created by social and their impact. As a result, a economic processes associated with distinguishing feature of risks in the industrialization. Danger is everywhere second modernity is the fact that they and many times is hard to see, for are coupled with a type of “systemic- example: air pollution, radiation in the reflexivity”. Human-kind has always soil and pesticides in foods and tried to combat traditional threats to chemicals in the water people consume. their lives, such as starvation, disasters Thus, at the same time the „successful‟ and violence from enemies. However, modernity is providing us comfortable the modern scientific rationality has and practical lives, it is ruining the created new more multifaceted hazards environment we live and bringing back to control those threats, such as to people the effects of their overcropping, increased use of consumerism habits 4. Therefore, the pesticides and mass production of second modernity has generated a „risk weapons. They are examples of some of society‟, in which hazards are the many types of reflexivity created by everywhere and people have to tackle the emergence of new risks in the late with the unintended results of their own modern era(3). The perception of actions. Nonetheless, as a consequence reflexivity for most of the of the fear and anxiety generated, the environmental studies is the idea of a “health industry” has employed

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Castro RR 620 Implications of Individualization, Risk and Reflexivity for Health and Illness in Contemporaneity strategies to make profits from risk. The responsible for calculating and possible hazards have become an managing risks. Furthermore, there is an economic factor to be applied in the increasing phenomenon, called production of goods that can minimize „inverted quarantine‟ caused by the those risks, such as air-pollutant and mass actions of self-protectionism, in water filters and vitamin-enriched food which society creates pretended 5. Once again, science is turning illusions of individual solutions for towards the management of the threatening conditions, originating a problems itself creates. mass complacency that stops people Another feature of the recent from looking for substantive reforms 8. modernity is the fact that people are Consequently, it is predictable that this now required to construct their own lack of motivation to solve problems, lives; this social change is called sometimes intended by privileged social „individualization‟. People have to classes, leads to an increase in actively make their lives based on the disparities and social exclusion, also possibilities that are available to them, reflecting in the access to a decent and their decisions may bring public health assistance. Therefore, inconvenient consequences, which are there is a complementary meaning for now regarded as a result of their „individualization‟, which is when choices, thus there has been a shift from individuals are excluded from pre- the level of the „inevitable‟ and „natural‟ existing social relations and sources of to the level of the personal social identity without a re-inclusion in responsibility(6). Nowadays, for a new social formulation(9). This example, lifestyle represents a crucial meaning can better exemplify health predictor of good health, since even inequalities, in which there is a though medicine has improved in contradiction between the combating many diseases, its individualized society people are achievements in long-term illness has building and the ever-increasing class- been modest(7). From the perspective of based disparity in health. In a study of the reflexive modernization, the individualization of class identity and individual is understood as an health conducted in a southern English autonomous rational ego, who uses city, it was found an inverted expert systems reflexively and are relationship between social class and

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Castro RR 621 Implications of Individualization, Risk and Reflexivity for Health and Illness in Contemporaneity health, concluding that the more involves his or her lifestyle and social privileged the social class, the lower the determinants(7). rate of morbi-mortality Referências Conclusion 1. Mayer H, Knox, P. Small-town sustainability: Prospects in the second modernity. Planning (Europe) [internet Finally, all the new forms of newspaper]. 2010 [cited 2017 jun. 17]; social construction, economic and 18(10):1545-65. Available from: https://doi.org/10.1080/09654313.2010. political positioning has imposed a shift 504336. in the way of thinking and approaching 2. Boström M, Lidskog R, Uggla Y. A the new challenges in health. The reflexive look at reflexivity in emergence of chronic illness has shown environmental sociology. Sociology (London) [internet newspaper]. 2017 that individuals are more and more [cited 2017 jun. 25]; 3(1):6-16. responsible for their own health, and Available from: http://dx.doi.org/1 0.1080/23251042.2016.1237336. this greater responsibility has reassigned health to be set as a goal, sometimes 3. Lyng S. Existential transcendence in late modernity: edgework and might be through consuming healthy hermeneutic reflexivity. Human Studies products, consequently symbolizing (Europe) [internet newspaper]. 2012 [cited 2017 ago. 10]; 35(3):401-14. status. This epidemiological transition Available from: https://doi.org/10 reveal a significant change into .1007/s10746-012-9242-0. reflexive modernity, where chronic 4. Nettleton S. The Sociology of Health diseases became leading causes of and Illness Cambridge, Malden: Polity Press; 2006. mortality due to the successful approach of the modern medicine, since the there 5. Annandale E. The Sociology of Health and Medicine: A Critical was a shift in the burden of infectious Introduction, Cambridge: Polity Press; diseases towards long-term, 1998. manageable, rarely curable, illness. The 6. Ferguson H. Social work, panorama of the later modernity is individualization and life politics. Social Work (England) much more complex, possibly due to [internet newspaper]. 2001 [cited 2017 the greater variety of risks that surround ago. 21]; 31(1):41-55. Available from: https://doi.org/10.1093/bjsw/31.1.41. an individual and also the complexity of their disease process, which does not 7. Hinote B, Wasserman J. Reflexive modernity and the sociology of health. involve a pathogen anymore, but 2013. In: Cockerham WC, organizer.

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Medical sociology on the move: New Directions in Theory. Dordrecht: Springer; 2013; 1: 215-20.

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