The Perils of Medicalization for Population Health and Health Equity

Tags:
Centennial Issue
Topics:
Population Health Health Equity

Policy Points:

  • Medicalization is a historical process by which personal, behavioral, and social issues are increasingly viewed through a biomedical lens and “diagnosed and treated” as individual pathologies and problems by medical authorities.
  • Medicalization in the United States has led to a conflation of “health” and “health care” and a confusion between individual social needs versus the social, political, and economic determinants of health.
  • The essential and important work of population health science, public health practice, and health policy writ large is being thwarted by a medicalized view of health and an overemphasis on personal health services and the health care delivery system as the major focal point for addressing societal health issues and health inequality.
  • Increased recognition of the negative consequences of a medicalized view of health is essential, with a focus on education and training of clinicians and health care managers, journalists, and policymakers.

The World Health Organization defines health as the “state of complete physical, mental and social well-being, not merely the absence of disease or infirmity.”1 Anchored in this broad view of health, population health is a long-standing multidisciplinary science that examines the patterns and distributions of health outcomes and their causes in populations, primarily defined by geopolitical spaces and social characteristics such as age, gender, race/ethnicity, and socioeconomic position.2 Significant attention in the field of population health is devoted to understanding the upstream (structural and macrolevel), midstream (meso- or community-level), and downstream (micro- or individual level) social determinants of health, and the limits of medical care in both producing health and reducing socially driven health inequities within populations.2,3 An important focus of population health science is understanding the ways in which upstream structural factors—such as macroeconomic forces, cultural factors, social systems and institutions, and public policy and law—are the fundamental drivers of socioeconomic stratification in society, which in turn shape the more proximate psychosocial and material conditions for health, including food, shelter, safety, clean environments, and medical care.

Public health, a sister discipline, is also concerned with the causes of health, illness, and injury in populations, the unequal distributions of outcomes within them, and opportunities for prevention and other interventions at upstream, midstream, and downstream levels.4 As a field of practice and policy, public health is primarily grounded in the role of the government and partnering organizations in preventing disease and injury, prolonging life and health equity, and protecting, assuring, and improving the health of populations in geopolitical units at the local, state, regional, and national levels.5

Open Access

References

  1. Solar O, Irwin A. A conceptual framework for action on the social determinants of health. World Health Organization. https://apps.who.int/iris/handle/10665/44489. Published 2010. Accessed January 23, 2023.
  2. Lantz PM. Population health: definitions, tensions, and new directions. In: Boulton ML, Wallace RB, eds. Maxcy-Rosenau-Last Public Health & Preventive Medicine. 16th ed. New York, NY: McGraw Hill; 2022.
  3. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on Community-Based Solutions to Promote Health Equity in the United States. Communities in Action: Pathways to Health Equity. Baciu A, Negussie Y, Geller A, et al., eds. Washington, DC: National Academies Press; 2017.
  4. Castrucci BC. Meeting individual social needs falls short of addressing social determinants of health. Health Affairs Blog. January 16, 2019. https://debeaumont.org/news/2019/meetingindividual-social-needs-falls-short-of-addressing-socialdeterminants-of-health/. Accessed January 23, 2023.
  5. Banta HD, de Wit GA. Public health services and cost effectiveness analysis. Annu Rev Public Health. 2008;29:383-397.

Citation:
Lantz PM, Goldberg DS, Gollust SE The Perils of Medicalization for Population Health and Health Equity. Milbank Q. 2023;101(S1): 61-82.