Selling Sickness 2013

is global health too medicalized?

Although I (L.T.) have thought and written for years about medicalization (especially the medicalization of sex), the application of this concept to issues of global health is new to me.

Jocalyn Clark, a PhD public health scientist who formerly worked at the BMJ and PloS Medicine, has corrected this blind spot with 4 brief pieces published this year in Global Health Action, a peer reviewed open access journal from Sweden. I recommend them to you for their insights on essential issues of SELLING SICKNESS: Overtreatment, Conflicts of Interest, Misleading Marketing.

I will try to give a taste of the material Jocalyn Clark offers in her concise and compact essays.

Clark’s first essay introduces medicalization as “a process by which human problems come to be defined and treated as medical problems” and describes why this often produces biases that steal attention and resources away from more important social perspectives. She is concerned that the new global philanthropies like the Gates Foundation, for example, are overly attracted to technological fixes such as access to new drugs and neglect the conditions that create the risk for infections and disease.

Global Mental Health is the focus of the second piece, and Clark shows how the popular current focus on brain pathology lends a false universalism to the mental health discussion, obscuring huge cultural variation in how mental health is understood and treated.

Next is a piece showing how the ongoing medicalization of the non-communicable diseases (NCD) agenda (diabetes, hypertension, common cancers, respiratory diseases) focuses on magic bullet interventions and health promotion agendas instead of looking upstream at structural drivers such as trade agreements, taxation policies, transnational corporations, deregulation, and urban design. Framing the growing prevalance and projected costs of the NCD problem in biomedical ways excludes the involvement of many social constituencies that could exert grassroots pressure for social change in, say, living standards and education.

Finally, Clark takes on Universal Health Coverage as a mistaken “rallying cry” for many global health leaders. Why mistaken? It confuses “health” with “health care” which inevitably medicalizes and narrows the field of analysis and intervention. It turns out, she argues, that the evidence suggests that “health care on its own does not directly improve health outcomes.”

In these papers (which can be combined with Nick Freudenberg’s terrific new book, “Legal but Lethal: Corporations, Consumption and Protecting Public Health”), Clark shows how the lens of medicalization can disclose some unexpected developments and dilemmas in the burgeoning area of global health. We are dismayed but not surprised, of course, to see our friends Overtreatment, Conflicts of Interest, and Misleading Marketing cropping up in new places wearing interesting new disguises. It’s a credit to Dr. Clark to have taken on this landscape so forcefully.

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