Myth #3: Causes of Ill Health are Physical and Personal

By now I have just about hammered home the point that, as a general principle, the health profession looks for causes that are physical and tied to the individual. This approach has led so many in the field to focus on diet (fat, cholesterol, salt; now carbs, transfats, etc.), personal habits (how much do you exercise, how long do you sleep, how much do you smoke, how many sexual partners do you have...), family medical history (in so far as "the family" represents a personal gene pool), exposure to disease causing agents, and the like.

On the contrary, emotional, social, political, and economic causes of disease are given secondary consideration, if any at all.

I remember reading Malcom Gladwell's book Outlier, which begins with the story of an American immigrant community who presented phenomenally low levels of heart disease. Gladwell recounts the investigative process undertaken by medical rsearchers to determine the cause of this felicitous situation, including all the many dead-ends and their ultimate conclusions. I found the discussion fascinating and began describing the scenario to my mother. Immediately, she began throwing out possible explanations, in pretty much the same order as the medical investigators considered them. "It must have been their mediterranean diet" (no, they had switched to a high-fat, high-carb diet). "They must have walked frequently and performed a lot of physical labor" (not a chance). etc. etc. What never occurred to my mother, and in fact, what only occurred to the researchers after they had pretty much exhausted all other possibilities was this: the community had very tight social bonds and spent a lot of quality time together, they regularly participated in religious activities, and they exhibited a general sense of emotional well-being. Is it possible that happiness, strong social relationships, and spirituality may promote health more than diet and exercise?

In Myth #2 I discussed the role played by inflammation in such conditions as high blood pressure and heart disease. This raises the possibility that stress is more of a "root cause" of these maladies than diet, exercise, and other personal habits. It would follow that the promotion of personal, social, and spiritual well-being may be a more effective way to nurture one's physical health than avoiding salt or constantly striving to lose 10 pounds. However, interventions aimed at the individual are easier to implement and control, and are infinitely more profitable.

Another example. It is often suggested that people with less money are more likely to be fat because healthier foods are more expensive. If you have a limited budget and work two jobs, then McDonald's is going to seem like a much more attractive option. This is a great argument for those who prefer to view health in terms of personal responsibility. It is the choices poor people are making (even if their options are limited) that cause them to be fat.

Yet, it is also true that living below the poverty line is significantly more stressful than living above it, and in the case of classic urban poverty, it generally entails fractured familial relationships and impoverished communal bonds. Could the political economic processes that create conditions of poverty be responsible for obesity among the poor? Is it more than simply a matter of the food they buy?

Similarly, a lot of noise is made about how African Amercians are "naturally" predisposed to high blood pressure, heart disease, diabetes, etc. This "medical fact" is convenient in two ways: not only does it locate the cause of these diseases in personal defects, it also sustains ideas about racial difference! How nice. Once again, we must consider: 1. African Americans are more likely to be poor (go back to above paragraph) 2. African Americans have to deal with racism, which is another significant stressor. Some medical researchers, in fact, have argued that the African American "predisposition" to high blood pressure is really caused by racism.

In the above cases, emotional status, social relationships, and political economic conditions are intertwined. It should also be underscored that in some instances political economic circumstances may play an even more direct role in health. Another book provides an example.

In Stories in the Time of Cholera, Charles and Clara Briggs recount their experiences with an epidemic of cholera that swept through a portion of Venezuela, and analyze the way in which this epidemic was represented by the media and government officials as eminating from a coastal indigenous population, as a result of their "primitive" behaviors. Yet, the Briggs' describe how cholera is a distinctly modern phenomenon, in fact, nurtured by particular forms of political oppression, marginalization, and economic alienation that have been instrumental to processes of state-making and market formation during the capitalist era.

Taking the same stance, physician-anthropologist Paul Farmer argues in Pathologies of Power that disease has distinct social, political, and economic causes which are very often ignored.  In order to legitimate the current world system, these factors must be ignored, because they represent a challenge to the status quo.  On the other hand, focusing on individual habits (particularly those labed "premodern" and "primitive") in the promotion of health is an important means of constructing the narrative of Progress that makes the desirability of the current state of affairs seem unquestionable.