The Theory Behind “Factors that Influence the Health of Northeastern Ontarians: Policy Implications”
My research project is an investigation into the demographic and infrastructure factors that affect the health of Northeastern Ontarians, and of young Northeastern Ontarians.
I plan to determine which factors have the greatest impact on adult and child health in Northeastern Ontario by using various data from existing sources. I want to determine whether it is the availability of health professionals (or a particular kind of health professional) or demographic factors—such as income, education, metro-adjacency of a person’s community, etcetera—that more greatly impact the health of Northastern Ontarians. There may be different factors affecting the health of adults and children in this region—this is the reason for the separate analysis of data from children and adults. Additionally, children are not included as respondents in the CCHS dataset, and it is important, I feel, to be able to present findings relating to the health of children as well as the health of adults.
Further to identifying the factors, I will investigate the factors affecting the health of Northeastern Ontarians through secondary analysis of data from Statistics Canada, the Canadian Institute for Health Information (CIHI) and the NOPCHS Consortium. Following from the results of data analysis I will proceed with qualitative analysis of the government policies surrounding identified significant demographic and/or infrastructure factors that influence the health of Northeastern Ontarians.
My Problems With Grand Theory
The notion of grand theory I find both threatening and liberating. This is somewhat paradoxical. On the one hand, I readily accept that the human animal has behaviours that are normative or generalisable to most, if not all, of the species. On the other hand, the pervasive ethnocentrism that permeates the discourse of classical sociology causes me a great deal of unease, because there are many behaviours that are not normative across human cultures. I recognise too that sociology developed following the enlightenment and focused (as well as continues to focus) primarily on Western societies.
I identified with readings that I did on C. Wright Mills while studying undergraduate sociological theories. My understanding of Mills is that he largely rejects the notion of Grand Theory but encourages the linking of micro and macrosociologies to improve our understanding of how the macrosociological world can affect the lives of individuals—their microsociological world (Mills, 1959). In examining government-level policies, I hope to uncover what some of the macro-realities are that affect the micro-realities of day-to-day life for those who experience poorer health.
Structural functionalism is an attempt at Grand Theory. Structural Functionalists look upon a society as a system of integrated parts. Change is viewed as a gradual process rather than as a series of upheavals or revolutions. The premise of this type of society working is that its members share at least some common beliefs, norms and values. The main problem I have with Structural Functionalism is that it seems to want to accept that inequities exist and that it’s okay for these to exist because societies require different people to fulfill different functions.
Conflict Theory and the Notion of Ruling Relations
When initially applying to the program, I had been considering examining people’s subsistence competencies. There are few things that people living in our climate truly require to survive. Those include shelter (because of somewhat harsh winters), food, and good health. Because of society’s proclivity for segmenting aspects of labour into smaller and smaller portions of the overall task at hand, my belief is that we have lost the ability to provide for ourselves the basic necessities of life in this climate. Most people would not know how to construct a sound shelter—we have contractors, construction labourers, bricklayers, roofers, plumbers, electricians, and other building technology specialists do that work for us. Many people garden, but there are few who garden and hunt or gather sufficient foodstuffs to sustain them without the supply chain of the grocery store (and transportation industry upon which our vast selection of available foods depends, and the massive farming industry that provides the raw goods to grocery stores and to processed foods companies that refine it and produce value-added foodstuffs). Finally, we have created heavily medicalised the process of obtaining or maintaining health of our bodies and minds. We have various regulatory bodies charged with the task of ensuring that health professionals have the requisite education and skills to perform their specific function with respect to our health and well-being. Self health care has somewhat fallen by the wayside as we have chosen to rely not on ourselves for minor medical care, but instead on myriad professionals who have been trained to handle our health conditions.
Lately, though, I’ve been thinking about why this was important to me, and challenging my previously held ideas. Questions about the nature of the state and why states exist have been occupying my thoughts. Marilyn French sees the state as having arisen from the need for males to dominate or control the females in their culture (French, 2002). The state functions as a means of controlling what happens to those under its domination. Her theory of the state as a structure of domination is a lot bleaker than what I envision as the state’s function.
If the state functions by controlling what happens to those under its domination, we should expect more of states or nations that allow poverty and ill health for its citizens to continue. I have what I would describe as a socialist orientation and an idealistic notion of a socialist eutopia that would see the state as a system striving for equity for its entire people. Such a system would function optimally by ensuring that capitalism could not run rampant and further wound the socioeconomically disadvantaged. It should serve to redistribute the wealth of the nation among all of its citizens, ensuring that basic human needs are met and the basic level of quality of life enjoyed by all citizens is good rather than poor. The responsibility for the well-being of a nation’s citizens should rest with the state itself. If people live in poor conditions, it has to do with the failure of state policies and services, not with the people themselves. I look upon the health and welfare of a nation’s people as a sign of the eufunctionality or dysfunctionality of a state.
I realise that through the above description of how state affects individuals I am describing the impact of ruling relations on individuals. According to Dorothy Smith, with the “rapid development of capitalism as a mode of production” also came “forms of consciousness and agency that were no longer identified with individuals. . . . ruling relations objectify consciousness” (Smith, 2005). I do not want to remove the agency from the people whose health and demographic information I will be studying, however I do at all costs want to avoid blaming them for any shortcomings they might have with respect to health, education, income level, or other variables that some might infer could be influenced by the individual as agent in their own life. The problem here is that the larger state presents myriad factors that regulate and affect people’s access to services provided by state institutions (and, in many cases, services that should be provided equally to all have flawed delivery systems—or what have you—that produce inequalities among citizens).
Conflict Theory states that societies are always changing, and that conflict, lack of consensus, and coercion are always present. Some people have more power than others. The state tries to maintain order in society. The state is often biased in favour of the dominant economic group, and it sides with these groups because it’s the rational course of action. If the state tried to enact policies counter to the interests of these groups, it would have a difficult time enforcing its policies (Mills, 1956). What we must then do is make the problems of those who are disadvantaged become interests to those who are the dominant economic group in society. In my portion of the Zine that Tracy, Nada and I wrote, I talked about human capital. I did this without fully explaining the reasons behind it. If we live in a predominantly capitalist society, then productivity is a commodity that perhaps the dominant economic group will understand (as the dominant economic group benefits from capitalism and productivity is an essential part of the capitalist structure). We may have to speak the language of the dominant group in order to convince them that policy change is in their best interests (much as we tailor a cover letter to a prospective employer stating that hiring us is in their best interests).
Historical Materialism
Historical materialism, developed by Karl Marx, refers to the position that the material conditions of human life and the activities and relationships that produce those conditions “are the key factors that pattern human experience, personality, ideas, and social arrangements” (Ritzer, 1996).
Marxist Feminists have expanded on notions of historical materialism to include wide range of social inequalities, not only class. Both C. Wright Mills and Michel Foucault incorporate Marxian thought into their research. Like Marxist Feminists, they do not restrict themselves to studies of the economy. Rather, they focus on a range of institutions. C. Wright Mills insists that, “We cannot hope to understand any single society without the use of historical material—any given society is to be understood in terms of the specific period in which it exists” (1959). Michel Foucault used what he called the archaeology of knowledge to frame his research into discourse. As different as C. Wright Mills and Foucault’s work are, they both maintain that to fully understand what is happening in the present social world a researcher must also look at the past as it relates to the situation. Because of my agreement with the importance of historical materialism, I will be performing the policy analysis portion of my research to uncover (if possible) what social policies and government decisions may have affected the factors which most strongly affect health status, and to make recommendations as to how these policies or government actions perhaps should have rolled out to benefit the health of all rather than worsen the health of some.
Issues of Ontology and Epistemology
Noam Chomsky wrote a very strong critique of poststructuralist/postmodernist thought in an article he wrote for Z Magazine. He was charged with the task of reviewing several papers that challenged rational inquiry and urged the reader to “abandon or transcend” it (Chomsky, 1995). The article he wrote about this experience describes his refusal to accept the idea that rational inquiry can be abandoned. This is the same kind of resistance I seem to be having to many of the postmodernist/poststructuralist theories presented to me in Theory and Society, but I have as yet been unable to verbalise. When Chomsky writes:
Quite regularly, "my eyes glaze over" when I read polysyllabic discourse on the themes of poststructuralism and postmodernism; what I understand is largely truism or error, but that is only a fraction of the total word count. True, there are lots of other things I don't understand: the articles in the current issues of math and physics journals, for example. But there is a difference. In the latter case, I know how to get to understand them, and have done so, in cases of particular interest to me; and I also know that people in these fields can explain the contents to me at my level, so that I can gain what (partial) understanding I may want. In contrast, no one seems to be able to explain to me why the latest post-this-and-that is (for the most part) other than truism, error, or gibberish, and I do not know how to proceed. Perhaps the explanation lies in some personal inadequacy, like tone-deafness. Or there may be other reasons. (Chomsky, 1995).
I feel that my apprehension to postmodernist and poststructuralist theorising is somewhat validated. This is not to say that I envision a coordinated grand theory that can encompass all of the aspects of behaviour of humans in our society (and others—I’ve discussed that in the above), rather that I empathise with Chomsky’s inability to wholly reject the empirical, rational methodologies and theorising that science embodies.
As I said during my class presentation, my ontological perspective is that there is a knowable reality out there and that there are real relationships between individuals and state practices. State practices have implications for those who dwell therein.
In terms of epistemological perspective, I identify with Chomsky’s adherence to the principles that empirical observation yields useful, valid and reliable information about the world around us. Humans are not, to me, some great unknowable subject. I wholly reject the notion that there is some form of human ‘mystique’ that makes us less knowable or understandable than other animals that we study through science. I understand that as a human, we can only interpret things to the degree that we can interpret them. If indeed there is some broader knowable reality out there that can’t be understood by human brains, then perhaps I’ll only shed light on the portion that can be understood by us.
What Does It All Mean?
Truly, I am in a floodplain awash with ideas from numerous great thinkers. I by no means believe I am theoretically ‘armed’ to be able to know and truly understand all there is to know about factors affecting the health of Northeastern Ontarians. I hope, however, that with what knowledge I do have about how state programs effect changes to the lives of individuals through specialised funding initiatives and provision of targeted services, I might be able to suggest ways to make a positive impact on the health of those who live in this region.
My standpoint is that of a former public and rural health researcher. Given my situation within the world of health and health service provision, I do have some preconceived notions of what the data might tell me about what affects health status. I presume income will be quite a strong factor (based on research conducted previously by agencies for which I’ve worked and on research articles I’ve been reading for my literature review). I will attempt to put my own presumptions aside while I conduct the research through incorporating such reflexive activities as journaling and memoing on issues as they arise, but I recognise that we affect the research we conduct and my research will incorporate part of my own thoughts and ideas.
References
French, Marilyn (2002). From Eve to Dawn: A History of Women, Volume 1: Origins. Toronto: Transcontinental Printing.
Mills, C. Wright. (1956). The Power Elite. New York: Oxford University Press.
Mills, C. Wright. (1959). The Sociological Imagination. New York: Oxford University Press.
Ritzer, George. (1996). Sociological Theory, 4th Edition. New York: McGraw Hill.
Smith, Dorothy. (2005). Institutional Ethnography: A Sociology for People. Oxford: AltaMira Press.