Sunday, October 29, 2006

Surveillance Medicine

In 1995, I came across an article that really made me stop and think. It was my first introduction to Foucauldian ideas, and related very much to the theme of Health Promotion, a subject that I was teaching back then. As I think back, this paper had a huge influence on my subsequent thinking.
The article was David Armstrong’s The Rise of Surveillance Medicine, published in The Sociology of Health and Illness 17:3, and you can access it here.

Armstrong discusses how medicine evolved from ‘Bedside Medicine’, located in the patient’s home and where the focus was on the symptoms described by the patient, to ‘Hospital Medicine’ located in the neutral hospital setting, where the focus is less on patients identified symptoms, but on signs detected by the doctor and laboratory tests performed by the medical staff.
He goes on to talk about how the focus of medicine has moved now, and that the focus is on the normal population – locating illness outside of the body. This is ‘Surveillance Medicine’ where illness is a permanent, nascent potential within and between us all and is managed by screening the population and mass immunisations.

What is ‘normal’ is defined by centile charts that define normal weight, height and so on for the population. This medical gaze is on all aspects of our lives – the entire continuum from birth to death has become medicalised.

Another manifestation of medical power is in our accepting and internalising surveillance medicine, the medical gaze is performed by ourselves in self-monitoring our lifestyles, including diet and weight, sexual behaviour, exercise and smoking.

Armstrong might not be surprised to find now that ordinary foodstuffs are becoming medicalised, for example yoghurts with ‘friendly bacteria’ and spreads with sterols to reduce cholesterol.
What our benevolent, paternalistic medical friends might not have appreciated is how harmful to people all this worry about being normal and healthy actually can be.

Perhaps, though, they do…