"Public Health" focuses on the upstream causes of poor health, particularly those related to social and environmental factors that impact health status. However, biomedical advances in the last century have shifted the public's health to another aspect of care: individual causes and manifestations of illness and disease. This transition has led to what we call medicalization or “the process by which previously nonmedical problems become defined and treated as medical problems.” The medicalization of human conditions releases a ripple of effects, one being whether a consumer of health care recognizes a health problem that needs to be medically addressed. These problems are generally the result of failures in biology, hygiene, and behaviors, and they are resolved through biomedical treatments delivered by providers.
If such is the case, two significant questions surrounding health care arise: what is the relationship between medicalization and health care spending and health policy, and is the medicalization of human conditions generally justified at the public health level? The answers to these questions, as we shall see, warrant implicative actions that shift the direction of public health interventions to a more social, community-based effort in attacking the heart of poor health. Put simply, we have to translate the knowledge gained and lessons learned from medicalization of human conditions into preventive measures that go beyond what we may think is beneficial for health not just at the individual-level but ultimately at the population-level.
Individual problems of ill health have attracted the attention of money and manpower, lending to increasing concerns of medicalization driving up health care costs in the U.S. It is essential then that we take a further look into these estimations. For example, a study that estimated medical spending in the U.S. of identified medicalized conditions generated the following sum: $77.1 billion or 3.9% of total domestic expenditures on health care costs. Although it is a relatively minor portion of national health care expenditures, such an amount implies a substantial cost to private and public sectors as well as consumers. Whether this spending is inappropriate depends on the economic, social, and political dimensions of health care. Conversely, one can look to managed care, a major type of health insurance, as another major driver of U.S. health care. Conditions that are covered by health insurance fuel medicalization whereas the lack of coverage may slow it down; for example, Medicare and other medical insurance plans decided to consider obesity a reimbursable illness while some insurance plans do not cover certain conditions such as infertility. Furthermore, the only way to get human services paid for/reimbursed is to define a condition as a medical problem, thereby creating an incentive to medicalize more problems. The medicalization of human conditions therefore influences health care spending indefinitely, with increasing costs yielding unknown results.
Policymakers have focused on increasing financial and geographic access to personal health services because of the assumption that health status problems are fixed by medical care. As the health problems of vulnerable populations became more medicalized, public policy started expanding access to individualized medical care. This approach may broadly help to achieve some public health goals, but key social and economic causes of health vulnerability and disparities lose attention. For instance, Medicaid provides a funding umbrella through which states finance expanded services and social supports that extend beyond medical treatment but services only become available or accessible after an individual is diagnosed with the health problem. On top of health care spending, the political drivers behind it have relied on medicalization to address health vulnerabilities by increasing access, but again, policy may lose sight of the root of the problem.
When looking at patterns of health, patient/doctor ratios, the availability of tools for the job, and numbers of hospital beds may bear little relation to improvements in public health, and even disease and disability continues to directly result from medical intervention. Medicalization can also negatively affect how populations manage health problems in the following ways: the creation of ill-informed demand, enforcement of the belief that one has to spend more on medical services to secure a healthier population, and dependence on a system for medical help from womb to grave. Disease prevention then looks like a reliance on authoritative systems that give insufficient consideration for empowering people themselves to take responsibility for their health, giving people no choice but to support the system.
The medicalization of human conditions have spurred the “individualization of social problems,” making social or environmental interventions either ignored or secondary and reinforces technical fixes for complex problems. One complex problem in which medicalization may be at odds with public health is alcoholism: is it truly a disease or is it just deviant social behavior? Not a single cause of alcoholism has been established or likely will be as patterns of alcohol abuse vary individually and are influenced by social structure and external events. Another surprising proposition is that prevention itself has become a key driver of over-medicalization. Certain diseases and conditions have a long lead-time, leading people to opt for treatment that possibly lengthens their “disease survival” without lengthening their lifespan. If screening was not enough to halt disease progression, physicians may intervene earlier or screen for “pre-disease” (e.g. pre-hypertension) that may or may not pay dividends in the end. In all truthfulness nonetheless, the medicalization of certain conditions and behaviors may surely benefit certain individuals more so than others. These others then unfortunately miss the intended benefits.
In summary, several conclusions can be inferred from what we know regarding medicalization and its effect on health care: medicalization influences health care spending indefinitely, policy has focused on increasing health access, prevention may have promoted reliance on authoritative systems, and medicalization may benefit some more than others. What remains common among these assumptions is the neutral yield of both benefits and losses, thereby calling for further research and analysis of such data. However, the implication raised here is to return to the public health view of upstream causes of health. This means policy action in income security, education, housing, nutrition/food security, and the environment to improve health among all populations, especially among socially disadvantaged groups. Accompanying this step is the transition from medicalization to “healthization” – lifestyle and behavioral causes and interventions – turning health into the moral rather than the moral into health. Doing so creates efficacious communities and stronger families, which serve as mediating institutions that can screen out the individual and social effects of disease. Put simply, the key could be a form of strong community self-help. The medicalization of human conditions is not an inherently negative asset of health care, but rather, it is a way for us improve our understanding of disease processes so that we may delve into deeper solutions that attack the root of the problem. In this case, the starting point is the holistic, societal unit of the individual: the community. References
Bastian, H. (2014). The disease prevention illusion: A tragedy in five parts. Scientific American Global RSS. Retrieved from http://blogs.
Conrad, P. (2013). Medicalization: Changing contours, characteristics, and contexts. In W.C. Cockerham (Ed.), Medical sociology on the move (pp. 195-214). Dordrecht, Netherlands: Springer.
Conrad, P., Mackie, T., & Mehrotra, A. (2010). Estimating the costs of medicalization. Social Science and Medicine, 70(12), 1943-7. doi:10.1016/j.socscimed.2010.
Lantz, P.M., Lichtenstein, R.L., & Pollack, H.A. (2007). Health policy approaches to population health: The limits of medicalization. Health Affairs, 26(5), 1253-1257. doi:10.1377/hlthaff.26.5.1253
Paton, A. (1974). Medical Nemesis – three views. “Medicalization” of health. British Medical Journal, 4, 573-577. doi:10.1136/bmj.4.5944.573
Walsh, D.C. (1991). Medicalization run amok? Health Affairs, 10(1), 205-207. doi:10.1377/hlthaff.10.1.205
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