Global Health Action ISSN: 1654-9716 (Print) 1654-9880 (Online) Journal homepage: https://www.tandfonline.com/loi/zgha20 Medicalization of global health 1: has the global health agenda become too medicalized? Jocalyn Clark To cite this article: Jocalyn Clark (2014) Medicalization of global health 1: has the global health agenda become too medicalized?, Global Health Action, 7:1, 23998, DOI: 10.3402/gha.v7.23998 To link to this article: https://doi.org/10.3402/gha.v7.23998 © 2014 Jocalyn Clark View supplementary material Published online: 16 May 2014. Submit your article to this journal Article views: 1827 View related articles View Crossmark data Citing articles: 13 View citing articles Full Terms & Conditions of access and use can be found at https://www.tandfonline.com/action/journalInformation?journalCode=zgha20 Global Health Action æ MEDICALIZATION OF GLOBAL HEALTH Medicalization of global health 1: has the global health agenda become too medicalized? Jocalyn Clark1,2* 1Communications & Development Unit, icddr,b, Dhaka, Bangladesh; 2Department of Medicine, University of Toronto, Toronto, Canada Medicalization analyses have roots in sociology and have critical usefulness for understanding contemporary health issues including the ‘post-2015 global health agenda’. Medicalization is more complex than just ‘disease mongering’ Á it is a process and not only an outcome; has both positive and negative elements; can be partial rather than complete; and is often sought or challenged by patients or others in the health field. It is understood to be expanding rather than contracting, plays out at the level of interaction or of definitions and agenda-setting, and is said to be largely harmful and costly to individuals and societies. Medicalization of global health issues would overemphasise the role of health care to health; define and frame issues in relation to disease, treatment strategies, and individual behaviour; promote the role of medical professionals and models of care; find support in industry or other advocates of technologies and pharmaceuticals; and discount social contexts, causes, and solutions. In subsequent articles, three case studies are explored, which critically examine predominant issues on the global health agenda: global mental health, non-communicable disease, and universal health coverage. A medicalization lens helps uncover areas where the global health agenda and its framing of problems are shifted toward medical and technical solutions, neglecting necessary social, community, or political action. Keywords: Global health; medicalization; sociology; development Responsible Editor: Peter Byass, Umea˚ University, Sweden. *Correspondence to: Dr. Jocalyn Clark, Communications & Development Unit, icddr,b, GPO Box 128, Dhaka 1000, Bangladesh, Email: [email protected]; [email protected] To access the supplementary material for this article, please see Supplementary files under Article Tools online Received: 5 February 2014; Revised: 17 April 2014; Accepted: 21 April 2014; Published: 16 May 2014 edicalization is a process by which human changing drivers, particularly in the United States and problems come to be defined and treated as Europe: pharmaceutical industry interests, the rise of Mmedical problems. It involves the application biotechnology and genomics, and health systems like of a biomedical model that sees health as freedom from ‘managed care’ that limit provision or choice, all of which disease and is characterised by reductionism, individual- wield increasing power for defining ‘legitimate’ health ism, and a bias toward the technological (Box 1). Critical problems (8, 9). Some commentators have drawn upon examinations of medicalization and its limitations for un- insights from medicalization analyses to identify over- derstanding health owe much to a long tradition of study diagnosis and ‘disease mongering’, particularly by the by sociologists who have uncovered the ways that such pharmaceutical industry intent on creating new disease varied conditions as addiction, childbirth, infant feeding, categories to sell drugs (10). sadness, erectile dysfunction, and death have become Contemporary sociological analyses recognise complex- medical issues to be treated (1Á6). Traditionally, medica- ity in medicalization: the fact that medicalization is a lization was seen to be fuelled by the medical profession process not just an outcome, it can be both positive and and doctors, whose cultural authority and power allowed negative, partial rather than complete, and can be sought them to grow medical jurisdiction over people’s health by patients, doctors or other actors in the health field, and society, resulting in what Illich described as ‘medical as well as be resisted or challenged (8, 11, 12). Never- imperialism’ (7). More recent analyses affirm the medi- theless, the consequences of medicalization are largely calization of many aspects of life and identify the seen to be negative for both individuals and societies Global Health Action 2014. # 2014 Jocalyn Clark. This is an Open Access article distributed under the terms of the Creative Commons CC-BY 4.0 License 1 (http://creativecommons.org/licenses/by/4.0/), allowing third parties to copy and redistribute the material in any medium or format and to remix,transform,and build upon the material for any purpose, even commercially, provided the original work is properly cited and states its license. Citation: Glob Health Action 2014, 7: 23998 - http://dx.doi.org/10.3402/gha.v7.23998 (page number not for citation purpose) Jocalyn Clark Box 1. Forms of medicalization. Technological bias It has its roots in the biomedical precept of the body as Medicalization occurs when the biomedical model Á the machine, inspiring a focus on the curative elements of modern, dominant form of practice by Western health care medicine rather than preventative actions such as professionals Á is applied to the understanding of a pheno- changes in the environment (1). menon. A biomedical model sees health as freedom from Technological imperative favours drug, device, or other disease, and is characterised by reductionism, individ- medical technologies or other ‘magic bullets’ to treat ualism, and a bias toward the technological. problems. Reductionism For example, analyses of the medicalization of death Ignores or excludes context and reduces explanations show a natural state that has become more and more for problems to the physical realm, overlooking social, under the purview of medicine and biotechnology, which cultural, psychological, or environmental factors that now regulates the circumstances and exact moment of contribute to or influence why a phenomenon occurs (1). death (5). This control as been fought by proponents of Depends upon normative ways of thinking that exclude a more natural death, but across geography and class complexity, relativity, and multiplicity of experiences of the conditions of death and dying continue to be health. medicalized (5). Seeks causes and solutions in biology rather than in social or political forces, depending upon tests, (7Á13): pathologising normal behaviour, disempowering images, and diagnoses to treat deficiencies and restore individuals when subject to control by medical profes- health (2). sionals or models of care, decontextualising experience, For example, in the classic case of the medicalization of and depoliticising social problems. As Parens argues, alcoholism that saw the previously deviant problem go ‘insofar as medicine focuses on changing individuals’ from ‘badness to sickness’, medical responses framed bodies to reduce suffering, its increasing influence steals the problem not as moral weakness or a social problem attention and resources away from changing the social but as a failure of biochemistry or genetics, and structures and expectations that can produce such suffer- developed medical strategies to treat the brain-based ing in the first place’ (13). And medicalization incurs condition (3). Individualism substantial costs for health care treatments and side Places the responsibility and sometimes blame for effects: Conrad and colleagues recently estimated the costs problems with an individual rather than with structures of medicalization of 12 conditions to be $77 billion per that shape or determine that individual’s behaviour or year in the United States alone (14). experience. Medicalization can occur at multiple levels (12) Á for For example, Scott’s case of the medicalization of example, at the level of interaction where individual shyness shows how a biomedical approach to shyness patients or doctors seek a medical label or apply a medical ‘reinforces the belief that this is a problem of individual solution to a problem, or at a higher level where definitions, minds rather than a reflection of social norms and priorities, and agendas are set and recommended strategies values’ that expect assertiveness, self-confidence, and and resource allocations determined. Medicalization ana- gregarious participation in life; any deviation can and lyses are particularly valuable at this higher level (8), should be ‘treated’ (4). Another example: Analyses of helping uncover how certain issues in the health field get the medicalization of attention deficit hyperactivity defined, how others are excluded, how the solutions to disorder (ADHD) highlight medical values that cast problems are constructed, and what agendas are pro- disruptive, inattentive behaviour of children into a moted. This is where it comes in