9.3: Theories and Concepts - Approaching Global Health Inequities from a Variety of Theoretical Perspectives

Learning Objectives

By the end of this section, you will be able to:

• Differentiate between the three major theoretical perspectives in studying global health inequalities
• Apply how globalization can reveal global health inequalities around the world

Theories and Concepts

Global health inequities expose many intersections of other societal issues. Disparities in income and wealth and access to food and technology all enhance health inequality.  There are three major theoretical perspectives that help to understand these inequalities. 

Theory of Unintended Consequences of Social Action

Sociologist Robert Merton illustrated the theory of unintended consequences of social action by examining how medical advancements can have unintended consequences. The medical community vows to do no harm to anyone, but medical decisions have in fact harmed individuals and sometimes entire communities. Kleinman (2010) provides an example of the smallpox vaccination campaign in India, which resulted in the disease becoming more resistant to the vaccine. There are similar issues within the United States, as there is an overuse of antibiotics which cause a viruses to mutate and become more resistant to antibiotics. This creates so-called superbugs, which include some strands of gonorrhea, urinary tract infections, pneumonia, and skin infections. Due to antibiotics being overly prescribed to people and animals because of its effectiveness, antibiotics have lost the potency in the fight against certain viruses. Due to this, the National Institute of Health now recommends washing hands and sanitizing the areas you come into contact with as a means to prevent the spread of bacteria, rather than taking antibiotics for everything. Scientists are trying to find new ways to combat viral infections without utilizing antibiotics. The problem is, advancements in medicine often come at a price. This is a price that not all communities can afford. Vaccines and antibiotics were developed as a means of helping humanity, but unintentionally they have made some illnesses and medical conditions worse.

Theory of Social Construction of Reality

In the 1960s, Peter Berger and Thomas Luckmann developed the theory of the social construction of reality. This theory asserts that the real world is socially and culturally constructed through our interactions and communications with others. How this is understood in the discussion of health inequality, certain viruses and diseases become stigmatized based on country of origin and/or the countries that are most affected.  Kleinman (2010) provides the example of the scientifically named H1N1 influeza strain which in the media is popularized as the swine flu epidemic and then associated with its origins in China. Due to the challenges in the geo-political relationship between the U.S. and China, all of a sudden the innocuous H1N1 becomes the much more threatening swine flu. We have continued to witness this stigma during the COVID-19 pandemic, as the disease was labeled as a Chinese (and in some cases, an Asian) disease. Do to people attributing the spread of COVID-19 to members of the Asian community, this led to a significant growth in hate crimes toward Asians within the United States. In response, on May 20, 2021, President Joe Biden signed S.937 - COVID-19 Hate Crimes Act that was to protect all minority groups and the LGBTQ+ community from harm. Though its protections were aimed broadly, the bill was labeled the anti-Asian hate crimes bill due to 3,800 reported cases of hate crimes against Asian-American and Pacific Islanders. Legislation does not mean an end to socially-constructed negativity though. In an attack in 2023, in Monterey Park, California eleven people were killed and another nine injured during Chinese New Year celebrations. This development of socially constructed negativity can also include certain medical procedures, such as abortion. From a cultural perspective, abortion is a controversial topic in the United States of America especially in rural areas that tend to lean towards social conservatism, whereas, in Japan, abortion is not controversial at all. This means that due to how abortion is seen culturally, not medically, it becomes less available to those that might need it in the U.S.

Theory of Social Suffering

The third theory, social suffering, explores how social, political, economic, and institutional forces can cause, worsen, or alleviate human suffering. It argues that socioeconomic and sociopolitical forces can actually cause disease or at least exacerbates the spread of disease. For example, poverty causes many people to not have access to medical care, which causes people to die of curable viruses and diseases. In the U.S., we see this often with dental care. Even though dental care costs much less than most medical procedures, dental insurance tends to be more restrictive that causes the co-pay to be much higher. Thus, many Americans neglect their teeth, and their overall health, due to these restrictions. The way the system is set up keeps people from getting the care that they need. Through the theory of social suffering we can also see that social institutions can be barriers to executing healthcare. Globally, this could large institutions, such as the United Nations, or even non-profit organizations that disburse aid. Within the U.S., the Veterans Administration has harmed veterans due to the bureaucracy that often stands between veterans and the ability to receive care. We can also seen this more generally in the population with health-care bureaucracies who may have to approve certain procedures and/or have policies that patients may have to follow before the care can be executed. We have to remember that pain and suffering effects much more than just the individual. Everyone in the patients’ network experiences the pain and suffering as well. Families and friends are also effected after a family member is diagnosed with a major illness, such as cancer or Alzheimer’s (a cognitive ailment). 

Health problems and social problems are so intertwined that it is often difficult to untangle the two. Those who live in impoverished areas have a higher propensity to be malnourished. Malnourishment makes the population more susceptible to disease. However, these areas also tend to be the regions that have inadequate, or non-existent, health infrastructure in place. It is hard to provide medicine when people also need a well-balanced meal on a consistent basis. All the medicine in the world will not help if the population cannot fight off new illnesses in the future. It is very onerous to tackle health problems when the societal issues need to be addressed first. But it is hard to address societal issues when a population is dying from illness. Political can also either help or hinder access to health care. Michel Foucault coined a term of biopower that asserts how political governance effects its population. Governments assert their influence over their citizens through determining the types of services that they will provide. In this case, some countries provide more access to healthcare; whereas, other countries will provide no access. Thus, those with money will be able to see a doctor, as the rest of the population will depend on the benevolence of other countries to provide aid, or receive no aid at all. There are also exceptions to this dichotomy. The U.S. is a wealthy state, however, it primarily depends on private health care companies to service the needs of its population. In this way, wealthy Americans are like the wealthy in poorer countries, those with more money have access to better healthcare. The U.S. also struggles with healthcare inequities based on state. Some states provide more health and social services to their residents than other states. It is a system that favors those with wealth, and highlights that health inequality exists even in the wealthiest countries.