Author: Tania Jenkins
On March 4, 2015 I will be giving a talk at UMD’s Program for the Study of the Environment’s Workshop that addresses how sociologists can become more active in the diagnosis of environmental health problems. The framework stems from an article I co-authored back in my first year of graduate school in 2011 with Phil Brown and Mercedes Lyson published in Social Science & Medicine . We make the case for a new approach to diagnosis that not only gives social scientists a role in the process, but also works to identify social structures and actors that contribute to disease and illness.
Sociologists therefore have been instrumental in shedding light on the social determinants of health. But that doesn’t mean they’re in the exam room next to the doctor explaining how that high cholesterol is probably due to the inability to exercise because of living in a dangerous neighborhood, or how that kid’s asthma is the result of living next to a chemical reactor. We may not be actually diagnosing patients in the clinic, but in the framework proposed by Brown et al. (2011), we suggest that social scientists ‘diagnose’ the social structures and actors that shape health and illness in our society. Social diagnosis is ‘social,’ then, for two reasons: 1) it links disease to a set of political, economic, cultural and social factors (like the distribution of chemical reactors in low SES neighborhoods), and 2) it involves multiple social actors with distinct interests, which include social scientists, the lay public and medical professionals. These actors both perform social diagnosis and contribute to it.
Take, for example, a ballet dancer who injures her foot. A traditional diagnosis approach might involve taking some x-rays and finding that the dancer’s pointe shoes did not offer enough support, or that a weak muscle gave way, leading to her injury. In contrast, a social diagnosis approach would adopt a much broader lens; it would look to the broader balletic art form which includes gender roles and anorexogenic notions of beauty. The diagnosis, then, would be of an unhealthy foot, in an unhealthy art form, in an unhealthy culture. To treat the dancer’s foot would be an individual solution to a collective problem. To really treat and prevent such injuries from happening, one would have to go beyond the dancer and seek to restore broader power structures in society. In this scenario, sociologists of gender might be involved in diagnosing the ambient social norms that contribute to injury. They might also identify social actors, such as demanding spectators and unforgiving choreographers, who operate within those structures and contribute to the likelihood of injury.
What does all of this have to do with environmental sociology? It turns out, a lot. Environmental sociologists help cast our collective gaze upstream (literally and figuratively) to the environmental and social problems that shape health outcomes. They study fracking and climate change and dam-building and food systems—all of which have important impacts on health. They interact with activists, tracing how their efforts lead to change and recognition of environmental causation of disease. They also scrutinize social actors, including policymakers, whose decisions and actions have great consequences on the environment and the sociopolitical landscape in which we live. In essence, they make it possible to adopt a broader lens and consider how social structures impacting the environment can also impact individual and community health. Armed with this knowledge, sociologists then can team up with clinicians to tackle health problems more holistically. Some doctors have already adopted this approach. Dr. Jack Geiger, a founding member of the Congress of Racial Equality (CORE) in 1943, famously wrote prescriptions for food (which he paid for) to poor children, as a means of bringing public attention to the health problems associated with poverty. “The last time I checked my textbooks the specific therapy for malnutrition was, in fact, food,” he was quoted as saying in 1965. Combining medical knowledge with social scientific understandings of structural causes can be a powerful tool for addressing inequalities. The framework of social diagnosis thus serves as a bridge between social scientists of all stripes and clinicians.
So the next time you think about your own research on the environment, take a moment to consider how it might impact health in some form or other – no matter how downstream. You may find that you have been performing social diagnosis all along.
Tania M. Jenkins is a PhD Candidate in the Department of Sociology at Brown University and a visiting Fellow at the Program for Society & the Environment at the University of Maryland