The biological and the social: or where we look for answers and who we ask
I’ve been thinking a lot lately about the concept of complexity. Complexity thrills and challenges me, especially social complexity. Two of my favorite scientists, Richard Lewontin and Richard Levins, persuasively argue in their (incredible, must-read) book Biology Under the Influence: Dialectical essays on ecology, agriculture, and health, that the social and the biological are inextricably linked; how we frame questions and who we ask in many ways predetermines the answers. This is the primary reason why I don’t believe that neutrality in science is possible; as Lewontin and Levins themselves state, “as a product of human activity, science reflects the conditions of its production and the viewpoints of its producers or owners” (2007, p. 90). When we’re faced with a complex problem, what questions do we ask to elicit understanding, and who do we ask? Different starting points lead us to very different conclusions.
Type 2 Diabetes is a great example. If you consult the Canadian Diabetes Association website they will define type 2 diabetes as “a disease in which your pancreas does not produce enough insulin, or your body does not properly use the insulin it makes. As a result, glucose (sugar) builds up in your blood instead of being used for energy.” In my work as a Registered Midwife, we are taught to talk to women about risk factors ranging from family history of the disease, age, and body weight to lifestyle and ethnicity. Some of these risk factors are completely ascientific – purely social categories. If a woman has abnormal post-fasting glucose levels, we send her to an endocrinologist and a diabetic counselor; we may be able to help women normalize their blood sugars, but how are we impacting the disease? After many years of witnessing predictable patterns of whom amongst my patients were diagnosed with gestational diabetes, and hundreds of hours leading popular health education workshops with the Alliance for People’s Health (APH) it became increasingly obvious to me that diabetes is a disease of colonialism and capitalism. Through the People’s Health Series at the APH I heard dozens of stories of the impacts of gross food injustice on exploited communities. Through community mapping we collectively identified almost-impossible access to land and fresh foods and ubiquitous access to cheap junk foods. The poor are often living enforced sedentary lifestyles. I changed the way I talk to women about the disease out of frustration at both the narrow biological construction and medical orientation of the disease as well as the blaming and shaming that accompany diagnosis. I now ask very different questions about diabetes and look to lay communities for the answers.
As it turns out that there are many others out there who agree with this perspective; those who seek to challenge narrowing complex social phenomena as diseases biological in origin. There are many out there who critique a narrow, Western, biomedical framework for understanding disease – not just diabetes, but other diseases, too. This is not to say there isn’t a role for medicine, but that bio-medicine should not be our starting place. Embracing the complexity of diabetes requires confronting major social and economic challenges: the generational impacts of colonial occupation and privatization of the land, forced human migration, mass death from unknown diseases, loss of traditional healing methods and forced separation from traditional plants, commodification of food, and separation from traditional and natural food sources (Davis, 2013; Waldstein, 2010). Some are even asking: how does diagnosing someone with type 2 diabetes contribute to harm? In her excellent paper Coping with diabetes and generational trauma in Salish tribal communities, Renee Davis remarks, “bio-medical rationale and methods often mimics the ideologies of government policies of early colonialism” (p. 57). Through my own midwifery work at the Strathcona Midwifery Collective and through my popular work with the Alliance for People’s Health I have learned first-hand that we can harm people with our narrow views; structural racism is embedded in Western medicine and science. This is why I was drawn to my own questions of the harms caused by Western prenatal practices within working class and historically and systemically-oppressed communities.
When tackling complex problems, social, biological, or ecological, one final question worthy of consideration: who is going to benefit from proposed solutions? Directly benefit, in economic and social terms: prestige, status, income, and material comforts – not just biomedical outcomes as in reduced disease incidence. Parting words from Lewontin and Levins, “[t]here is, then, a growing conflict between the urgent need of our species for the integration and democratization of science, and the economics and sociology of commercialized knowledge that impedes such development. We might attempt merely to predict, detect, or to tolerate the outcome of that conflict. Or we could join the struggle to affect what happens.” (p. 217).
Davis, R. (2013). Coping with diabetes and generational trauma in Salish tribal communities. Fourth World Journal, 12(1), pp. 45-78.
Lewontin, R.C., and Levins,R. (2007). Biology Under The Influence, Dialectical Essays on Ecology, Agriculture, and Health. New York: Monthly Review Press.
Waldstein, A. (2010). Popular Medicine and Self-Care in a Mexican Migrant Community: Toward an explanation of an epidemiological paradox. Medical Anthropology, 29(1), pp. 71-107.