The Perils of Medicalization for Population Health and Health Equity

Abstract

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.

Clinical algorithms, racism, and “fairness” in healthcare: A case of bounded justice

“…Individualization of risk in this manner places the locus of control and therefore the target of intervention on the patient, with implications for data collection and algorithmic design (Boyd et al, 2020; Ferryman and Pitcan, 2018; Lantz, 2019). Even efforts that seemingly focus upstream on social determinants of health are frequently transformed into individualized strategies and interventions (Freij et al, 2019; Kasthurirathne et al, 2018; Lantz, 2019; Lantz et al, 2023). Instead of implementing policy change to address structures of racism, unaffordable housing, low wages, inaccessible nutrition, wealth inequality, and environmental risks, health systems collect data on patient-level social risk factors and social needs that are in turn integrated into and scope the design of individual level medical treatments (Lantz, 2019; Lantz et al, 2023).…”

“…Even efforts that seemingly focus upstream on social determinants of health are frequently transformed into individualized strategies and interventions (Freij et al, 2019; Kasthurirathne et al, 2018; Lantz, 2019; Lantz et al, 2023). Instead of implementing policy change to address structures of racism, unaffordable housing, low wages, inaccessible nutrition, wealth inequality, and environmental risks, health systems collect data on patient-level social risk factors and social needs that are in turn integrated into and scope the design of individual level medical treatments (Lantz, 2019; Lantz et al, 2023). Social needs themselves are also targeted for intervention and health systems may attempt to facilitate patient referrals to a social worker or community organization to address immediate social needs, such as emergency access to food (Lans et al, 2022; Zhao et al, 2021).…”

How Should Organizations and Clinicians Help Marginalized Patients Manage Loneliness as a Harm of Climate Change?

“…As Lantz et al argue, focusing on this one-on-one interaction confuses "upstream socioeconomic structural drivers of population health levels and patterns with individual patient social circumstances and needs." 11 Second, this approach places unfair burdens on already struggling patients, requiring them to manage their situation mainly on their own. At-risk patients attempting to access needed resources may experience obstacles, such as lack of transportation, immobility, limited English proficiency, stigma, and financial constraints.…”

“…Although individualistic approaches to systemic problems routinely fail or have, at best, limited effectiveness, 11 they persist. For instance, our basic utilities are not currently managed in a way that addresses the challenges of climate change.…”