Health Is Still Social: Contemporary Examples in the Age of the Genome

I n 1999, Leon Eisenberg wrote an essay entitled, " Does social medicine still matter in an era of molecular medicine? " [1]. Anticipating the scientifi c discussion that would accompany the complete mapping of the human genome, followed by hubristic predictions of an end to disease through the introduction of gene-based therapy, Eisenberg reminded his readers of the inherent social basis of disease causation. " The developments in molecular biology highlight the salience of the social environment and underscore the urgency to rectify inequity and injustice. All medicine is inescapably social, " he wrote. In this Essay, we revisit those concerns and expand them to discuss the current state of scholarship on the social causes of, experiences of, and responses to disease. We contend that social medicine is as important now as it has ever been. The fi eld of social medicine includes various social and cultural studies of health and medicine [2], and in this article, we will focus on one domain of these studies—the social roots of disease—to illustrate the contemporary importance of social medicine. The fi nal sequencing of the human genome was announced in 2001 and greeted with great fanfare. Scientists have since cloned the embryo of a sheep, followed by a dog, cow, horse, mule, and mouse. With automated DNA sequencing, the genetic code may soon be cracked for nearly every major animal phylum. Many scientists are hopeful that these developments will eventually produce laboratory-based gene therapies that will cure many human diseases. What is invariably lost in these celebrations of scientifi c advances is awareness that human social organization is the primary determinant of how diseases are distributed in society, and that much of human disease results from preventable social factors. This inextricable link between social inequality and ill health is seen in nearly every fi eld of medicine. Environmental disasters. As a fi rst example, consider the recent global environmental disasters, which, natural or unnatural, laid bare the inequalities that cut across society. The years 2004 and 2005 were terrible years for " natural " disasters—the Asian tsunami Although nature triggered these events, there was nothing " natural " about the extent to which certain people were more likely to die. All disasters are shaped by the context and hierarchy of human social organization. The role of human behavior and social organization in determining who was at risk is an ignored but …