I have been reading Health, Technology & Society. A Sociological Critique written by Andrew Webster, who has also written other articles and books about this issue. I would like to share my notes about the first chapter titled Understanding Innovative Health Technologies, partially based on other author’s paper Innovative Health Technologies and the Social: Redefining Health, Medicine and the Body.
The book explores fundamental changes in the way we understand and manage our health and our bodies, and how this understanding has been shaped by, and given expression through, developments in medical and related technologies (p.1) from a sociological perspective. This perspective argues that these technologies and the techniques, models and assumptions on which they are based, are given meaning through the way they are tied into other technologies ans social practices… The meaning of health technologies will also vary in different settings (from clinic, to the home, to the Internet), and vary in the way shape diverses notions of ‘health’ found within and between cultures. In this sense, technologies (not only the health but all fields) are best understood as an expression of, and thereby always expressed through, social relationship (p.1) .
The author states that medical technologies are two-sided: they provide new, more detailed, sources of information about our illness but at the same time new forms of uncertainty and risk. These relate not only to our understanding of the illness but also the expectations that inform and guide the social relationship through which we define and manage it. If technologies are congealed social relationship, those that disrupt existing relationship can be specially problematic.
Therefore, new health technologies not only disrupt relationship we have with other people, they can also redefine our relationship towards our own body and our sense of being well or ill, our sense of control over our body and its parts (p.2). A sociological perspective is also interested in the processes through which new health technologies are introduced in the first place, and what factors have shaped their introduction. Health and its definition depend not merely on a person’s sense of well being, but on powerful professional, commercial and institutional interests that captures health in order to define, control and exploit or deliver ‘it’ (p.3) .
New technologies, new health?
Webster identifies three innovative health technology based on those areas that are receiving disproportionately large levels of public and private funding upstream or those appearing in documents of health policy world that spends all its time scanning for the ‘horizon’ for ‘disruptive’ technologies…(p.6):
- Genetics-related developments
- Informatics-based systems and eHealth
- Tissue-related biomedicine
Even these three broad areas are strongly related with the development of the Information and Communication Technologies I wil just focus on Informatics-based systems and eHealth. The author refers to E-Health as a mix of digital technologies whose function is to diagnose, monitor, store and relay information about health, the patient, and the huge volumen of management data-flows that characterize national health systems today. They reflect a time of audit, standardization, technocracy and ambitions towards more efficient systems for managing health resources (p.11) . Based on the studies of other author, Webster describes some consequences of these technologies, talking about ‘citizen-terminals’, ‘virtual human’, ‘smart homes’, ‘health Internet seeker’ and ‘e-scaped medicine’.
Developing the sociological critique
The author remarks there had been a much longer tradition in social theory that located health squarely within the wider structural and cultural dynamics of society (p.15) and wonders How, we might ask are these structural patterns of health mediated by the new technologies sketched mentioned above: will, for example, the introduction of e-health exacerbate or ameliorate access to health care and advice? (p.16)
What then can we say provides the core issues that would inform a sociological critique of the relations between health, technology and society? Such a critique, he suggests, would explore and challenges the implications of medical technoscience with respect to:
- the socio-economic factors shaping innovation and how these affect the structuring of health care delivery;
- the patterns of inequality in morbidity and mortality;
- the public and the private institutions that are investing huge amounts of political and economic capital in existing and novel areas such as genetics, informatics and tissue engineering fields;
- the regulation and control of new medical technologies;
- embodied knowledge about experience of health and disease. (p.17)
These are the main issues, they need to be understood as part of a wider range of structural and institutional changes characterizing contemporary societies that are not restricted to the field of medicine and health (p.18)
- The growing individualisation of our lives;
- The changing relationships between lay and expert knowledge;
- The increasingly globalised contest over (health) rights and resources;
- The tension between the political regulation and economic promotion of innovation by the state. (p.18)
We can see developments in technoscience in terms of three broad but related changes that have opened up clinical medicine to new influences and actors:
- Socialisation of medical innovation refers to the ways in which lay people are enrolled as active participants in the development of new technologies from the very early stage of develpment.
- Socialisation of clinical diagnosis refers to the fracturing of the medical monopoly over the meaning of health and disease, specially through the arrival of what has been called a ‘new medical pluralism’.
- Socialisation of clinical implementation refers to the ways in which lay people are required, but also perhaps actively embrace a turn towards taking greater responsability for making new health technologies ‘work’.
These three processes have then redefined the spatial, experimental and epistemic boundaries of convetional medicine and clinic. The critique must be the attentive context of use of technologies to reflect any notion of technological determinism across different contexts. It must explore the ways in which users (patients, carers, clinicians, etc.) make sense of technologies and how re-order the meaning of health. It must examine the expectations and hopes that surround them, and the subtle and not so subtle forms of inequity and insecurity they create.