1. Social Constructions

2. Sociology of knowledge
Economic & social arrangements shape knowledge
Ideology and knowledge
Social structure/stratification : power
Administrative apparatus, forms of governance and knowledge
Concepts we use to think with reflect social organization of society
Social constructions

3. Constructing Facts & other Social Constructs
Facts & Fictions
facts are things done
fiction is about action yet implicated in a dialectic of the “true” (natural) & the “counterfeit” (artifactual)
the act of fashioning
Facts & fiction -- embedded in social forms & practices
entangled within interpretation & language

4. Knowledge and Ideology
Knowledge – systematic, diagnostic, neutral, objective, analytic, clarity, facts, useful
Positive image
Ideology – justificatory, defensive of belief & values, biased, emotive, political, murky/cloudy, caught up in life situations
Both are concerned with the definitoon of a problem situation
Both are responses to felt lack of needed information

5. Knowledge and Ideology as Cultural Systems
Both are critical and imaginative works
Symbolic structures
Differing symbolic strategies for encompassing situations
Science names situations with an attitude of disinterestedness
Ideology names a situation with an attitude of commitment
Stylistic differences
Different enterprises but not unrelated

6. Knowledge as Power/Power as Knowledge
F. Nietzsche – “knowledge works as a tool of power”
M. Foucault – knowledge/power
Power is based on knowledge and makes use of knowledge
power reproduces knowledge by shaping it in accordance with its anonymous intentions
Power (re-) creates its own fields of exercise through knowledge

7. Discourse: Foucault
ways of constituting knowledge, together with the social practices, forms of subjectivity and power relations which inhere in such knowledges and relations between them
a form of power that circulates in the social field and can attach to strategies of domination as well as those of resistance
questions of how some discourses have shaped and created meaning systems that have gained the status and currency of 'truth', and dominate how we define and organize both ourselves and our social world

8. Deconstructing Social Constructs
uncover the ways in which individuals and groups participate in the creation of their perceived social reality
looking at the ways social phenomena are created, institutionalized, and made into tradition by humans
Socially constructed reality is seen as an ongoing, dynamic process
reality is reproduced by people acting on their interpretations and their knowledge of it.

9. Deconstruction: Derrida
A strategy of critical analysis
understanding language as writing and how this leads to the impossibility of a straightforward theory of intentional meaning
concepts in terms of their structure and genesis
Individual language users operate within a system of meaning that is given to them from outside
Meaning is therefore not fully under the control of the individual language user

10. Scientific paradigms
Kuhn shows scientific paradigms as assumptions about the social world & reality often grounded more in practice than in theory (Thomas Kuhn PhD Harvard physics)
science does not progress via a linear accumulation of new knowledge
periodic revolutions: "paradigm shifts"
anomalous results build up, science reaches a crisis, at which point a new paradigm
it is not possible to understand one paradigm through the conceptual framework and terminology of another rival paradigm (relativism)
theory choice is fundamentally irrational: if rival theories cannot be directly compared, then one cannot make a rational choice as to which one is better
criteria admittedly determine theory choice, they are imprecise in practice and relative to individual scientists

11. Science as Story
Donna Haraway -- story of scientific progress (primatology)
From misty sight prone to invention to sharp eyed quantitative knowledge rooted in experiment
Stories with a particular aesthetic (realism) & a particular politics (progress)
Nature is constructed & reconstructed in the bodies & lives of 3rd world animals serving as surrogates for man
Stories of race, gender, class, romance, Judeo-Christian science

12. Medicine as Social Construct
Medicine is a set of categories that filters and constructs experience
Medicine produces its own objects and subjects (subjectivity & subject positions)
i.e. body mind dualism – nature is separate from society

13. Diabetes and the epidemiological transition
Demographic transition & health transition
Story of the irony of progress (Rousseau)
Story of the modern (Rousseau)
19th century evolutionary paradigms of social and cultural evolution and social development
Modern, modernity, modernization
Important categories
“tradition” & “modern”

14. Jean-Jacques Rousseau Philosopher
The Irony of Progress
Negative impact of progress
Degeneration into social inequality
Harsh impact of private property, agriculture, mechanical arts
Humans can exploit humans
Jean-Jacques Rousseau Philosopher

15. The Irony of Progress Redux
Jared Diamond
a society can "choose to fail."
Collapse
climate change
hostile neighbors
trade partners
society's response to its environmental problems.

16. Modernity & the Discourse of Irony
Émile Durkheim
Anomie
Karl Marx
Alienation
Charles Dickens
Ugly social truths of modern life
Dystopia or anti-utopia

17. Modernity & Modernism Marshall Berman
To be modern, I said, is to experience personal and social life as a maelstrom, to find one's world and oneself in perpetual disintegration and renewal, trouble and anguish, ambiguity and contradiction: to be part of a universe in which all that is solid melts into air. To be a modernist is to make oneself somehow at home in the maelstrom, to make its rhythms one’s own, to move within its currents in search of the forms of reality, of beauty, of freedom, of justice, that its fervid and perilous flow allows.(All That Is Solid Melts Into Air, The Experience of Modernity, 1988: )

18. Epidemiological/Health Transitions
complex change in patterns of health and disease
the interactions between these patterns and the demographic, economic, and sociological determinants and consequences.

19. Transitions & Disease Profiles
pestilence and famine
receding pandemics
degenerative and man-made diseases

20. Life Expectancies as Measure of Health Transitions

21. From Infectious to Chronic Diseases

22. 10 leading causes of death in US
1900
Influenza and pneumonia
Tuberculosis
Gastritis
Diseases of the Heart
Cerebrovascular Disease
Chronic Nephritis
Accidents
Cancer
Certain diseases of infancy
Diptheria
1998
Heart Diseases (31.4% )
Cancer (23.3%)
Cerebrovascular diseases (6.9%)
Pulmonary disease (4.7%)
Accidents (4.1%)
Pneumonia and Influenza (3.7%)
Diabetes (2.7%)
Suicide (1.3%)
Diseases of Arteries (1.2%)
Nephritis (1.1%)

24. Ten leading causes of death (2000)
Developed countries
IHD (arteries) 22.6%
CVD (heart/stroke) 13.7%
Lung Ca. 4.5%
Respiratory infections 3.7%
Pulmonary Disease 3.1%
Colon Ca 2.6%
Stomach Ca 1.9%
Self-inflicted injuries 1.9%
Diabetes 1.7%
Breast Ca 1.6%
Developing countries
IHD 9.1%
CVD 8.0%
Respiratory infections 7.7%
HIV/AIDS 6.9%
Perinatal conditions 5.6%
Pulmonary disease 5%
Diarrhoeal diseases 4.9%
Tuberculosis 3.7%
Malaria 2.6%
Road accidents 2.5%
Although the epidemiologic transition is well advanced in all but the poorest countries, the institutional response to disease prevention and control is still based on the infectious disease paradigm. Consequently, the global and national capacity to respond to NCD epidemics is woefully inadequate and few countries have implemented comprehensive prevention and control policies.
Beaglehole and Yach. Lancet 2003

25. Demographic Transitions and Health Transitions
Decreased fertility rates
Decreased infant mortality rates
Increased life expectancies at birth
Reflect shifts in social and economic patterns
Changes in health conditions
Changes in health care

26. Population and demographic changes

27. Human Determinants of Transitions
technological change
alterations in the environment
alterations in food type, availability, production, preparation, and consumption
alterations in patterns of energy expenditure
interplay of environmental factors and the genetic pool of a community

28. MULTIPLE EPIDEMIOLOGIC TRANSITIONS
recent resurgence of infectious disease mortality marks a third epidemiologic transition
characterized by newly emerging, re-emerging, and antibiotic resistant pathogens in the context of an accelerated globalization of human disease ecologies

29. Human Determinants of Transitions REDUX
technological change
alterations in the environment
alterations in food type, availability, production, preparation, and consumption
alterations in patterns of energy expenditure
interplay of environmental factors and the genetic pool of a community
Social inequality? Where is it?

30. “SOCIAL FORCES AND PROCESSES EMBODIED AS BIOLOGICAL EVENTS” THE CRITICAL PERSPECTIVE
Paul Farmer:
“Inequality itself constitutes our modern plague – inequality is a pathogenic force”
“Social inequalities often determine both the distribution of modern plagues and clinical outcomes among the afflicted”