1. POSTMODERNITY

3. POSTMODERNITY/ISM Postmodernity – a historical period; current economic climate, structural changes – Implications for medicine & health Welfare state (liberalism) to remobilzation of liberal arguments for individual responsibility (neoliberalism) Reflected in epidemiology -ism – a “discourse”

4. Modern/ity/ism/ization Modernity -- historical condition, process, a characteristic period -- a post-traditional order – rupture Modernism -- a practice, usage, expression peculiar to modern times – Modernism as cultural project that renew symbolic practices with an experimental or critical sense Modernization as a socioeconomic process that tries to construct modernity; the act of modernizing; the state of being modernized reflexivity of modernity – the susceptibility of most aspects of social activity, and material relations with nature, to chronic revision in the light of new info or knowledge Implications for health

5. The promise of the enlightenment, the promise of the modern Unending era of material progress & prosperity Abolition of prejudice & superstition Mastery of the forces of nature based on the expansion of human knowledge Laws of development & social sciences The costs of becoming modern -- the discontents – alienation; estrangement; anomie; iron cage; neurotoxic effects of modern, urban life

6. Postmodernism Postmodern as incredulity (challenging) toward meta-narratives contemporary rejection of all overarching or totalizing modes of thought that tell universalist stories (Marxism, Christianity, ‘scientific progress’). Metanarratives operate through strategies of exclusion and inclusion, marshalling and homogenizing heterogeneity into ordered realms – Postmodernists are suspicious of authoritative definitions and singular narratives of any trajectory of events the increasing sound of a plurality of voices from the margins, with an insistence on difference, on cultural diversity and on claims of heterogeneity over homogeneity. – Fragmentation – celebrates the multiple, incompatible, heterogeneous, fragmented, contradictory nature of postmodern society No linguistic normality — we can only produce pastiche (heteroglossia), partial truths

7. Hasan: The Culture of Postmodernism Modernism Postmodernism Purposeplay Designchance Hierarchyanarchy art object, finished workprocess, performance, creation, totalizationdecreation, deconstruction Presenceabsence Centeringdispersal genre, boundarytext, intertext Semanticsrhetoric lisible (readerly)scriptible (writerly) Narrativeanti-narrative grande histoirepetite histoire master codeidiolect origin, causedifference-difference, trace Determinacyindeterminacy Transcendenceimmanence

8. Postmodernity Changes in capitlaist society over past 30 years Decline of industrial sector, working class, unionization, & occupation as source of identity Weakening of distinction between public & private sectors – With associated gender division of labor Increased focus on the individual Reflexivity of social identity – construct our own biographies

9. Liberalism, Neoliberalism, Health in Capitalist Society Liberalism & welfare state capitalism – Liberalism emphasizes individual rights and equality of opportunity – Different forms of liberalism may propose very different policies – Liberalism rejected many foundational assumptions that dominated most earlier theories of government, such as the Divine Right of Kings, hereditary status, and established religion Liberalism: two major streams of thought which compete over the use of the term "liberal" – Classical liberals: only real freedom is freedom from coercion state intervention in the economy as a coercive power that restricts the economic freedom of individuals and favor a laissez-faire economic policy oppose the welfare state – Social liberals: governments must take an active role in promoting the freedom of citizens real freedom can exist only when citizens are healthy, educated, and free from dire poverty Government ensures the right to an education, the right to health care, and the right to a minimum wage.

10. Liberalism, Neoliberalism, Health in Capitalist Society Structuralist basis of welfare state capitalism undermined by decline of industrial sector & globalization of capitalist investment strategies State policy now directed at control over costs (rather than provisions) & quantity of health care Medicine caught between state & market From production to consumption as foundation of class formation in capitalist society

11. Liberalism, Neoliberalism, Health in Capitalist Society Neoliberalism – move from a bureaucratic welfare-based society toward a meritocracy acting in the interests of business – based on individual and economic liberty Health & health care consequences – Individual centric – Achieved health – Decentralization in the organization/delivery of health care Privatization of costs & services

12. Postmodern health Social/economic/political cultural Inequality “increasing” Resurgence of patterns of infectious disease Increasing mortality rates among the poorist Dying of diseases of affluence in 20 th cent. now dying from poverty Individual risk and “risk society”

13. From Modern to Post-/Risk Society

14. epidemiology Originally a part of public health – “people’s health; the study of/the knowledge of the distribution of health in a population Used to plan & evaluate strategies to prevent illness Guide to the management of patients in whom disease has already developed

15. Epi- of Risk and Lifestyle Contemporary focus on “susceptibility” – Predisposition & risk Inherited flaw Aversion by adopting a careful/moderate way of life Epi & Risk – Prevalence of disorders & diseases among different sectors of the population – differentiated by age, gender, ethnicity, family, history, weight, diet, use of alcohol/cigarettes/drugs – Use of risk scales to assess likelihood of an individual developing a disorder The allocations of risk categories The dream of contemporary diagnostics of susceptibility – Identifications – way of life; genetics

16. Type 2 Diabetes – the quintessential postmodern condition Idea of susceptibility brings potential futures into the present The subject of calculation (biopower) The object of remedial intervention (education; reflexivity) Individual must optimize their life chances New forms of life taking shape in the age of susceptibility (risk society)