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The scientific approach of Sociétés, Santé, Développement (SSD) combine two angles : the study of the social dimensions of health matters, and the material and biological dimensions of the functioning of social systems. Our fundamental aim, basing our research on medical facts and on collaboration between the social sciences and medical disciplines, is to look at interactions between social and biological dynamics. To do this, we must reconcile several complementary angles of analysis which represent so many possible approaches to relationships between societies and health.
The human body in all its various functions, whether considered in their normal capacity or in what we might call an abnormal way as a result of illness, represents the very matter of which a social system is made up. A society is first and foremost the population of which it is composed, so that, in some cases, social change and biological dynamics can go hand in hand.
Thus if we consider, for example, the individuals that make up the available labour force and its "quality", the ratio between the active and inactive populations, fertility and mortality rates, the proportion of males to females, all these parameters are linked in part with state of health and may have a decisive effect on the way in which a social system organises itself, functions and transforms itself.
If we take a historical perspective and consider major health events and their impact on demography, this can give us essential information in understanding social change. In this respect, the intensity of the shock exerted by AIDS on certain African societies, as happened in earlier times with other deadly epidemics, provides a particularly convincing example.
We in no way intend to introduce a deterministic dimension into our study of relationships between societies and their biological basis. On the contrary, our aim is to explore openly the triangular relationships that exist between:
From its many aspects, this approach using health and illness as factors of social change opens up collaboration between the social sciences and medical disciplines in a very rich field of research which is still not exploited to any great extent.
It is not only by the objective constraints that they represent that health variables can be agents of change. At individual, as well as community level, health and illness represent social issues of a vital kind, on the basis of which a society makes sense of itself: and this meaning, sometimes for the society alone, can generate social change. Thus the threat introduced by the triggering of an epidemic, the emergence of a new illness or the scientific identification of a health risk not before realised may be the starting point for imagined fears, reactions of rejection, of political argument, of various types of behaviour change – all of which can result in a recomposition, at least partial, of the social relationships system.
On a wider scale, based on social and cultural representations of the body and health, it is often entire sections of social reality, sometimes otherwise inaccessible, which are revealed. In certain "traditional" or rural societies interpretations of illness will be an expression of the tensions and conflicts that run through them. In others, through prophetism and its promise of radical solutions to all ills, new forms of power begin to manifest themselves. Everywhere, the study of traditional nosological systems is bringing to light fundamental logical and symbolic categories through which societies comprehend nature, the human body and society.
But this "signifying" function of the body and illness is not confined to the more exotic societies. In industrial societies too, health is an "expression" of social features inasmuch as we approach it from a different angle from that used by medicine. As we have said, illness has the same function as a metaphor and when we search for a meaning which the bio-medical explanation cannot entirely satisfy, what often emerges is an image of the identity of a person in his relations with society as well as a glimpse of deviance and guilt.
It is not only in social representations that health and illness are indicators opening up perspectives for research in the social science field. They can also give access to more objective levels of social reality. Heterogeneity in relation to health matters between population categories, or in specific areas, or over a certain period of time can also reveal certain characteristics of a social situation. For example, a study of health disparities may provide a particularly profitable angle of attack for the analysis of social inequalities and their socio-economic and political basis.
Here again, collaboration with medical disciplines can open up to the social scientist new areas in the context of theoretical and methodological study methods.
After being disregarded throughout this century by the effect of rapid technological progress in the field of curative medicine, a global and less exclusively technical approach to human health problems is once again necessary. The medical profession is now rediscovering the need to resituate the human body in its broader context (social community, socio-economic categories, also geographical areas or ecosystems) as this in turn has constraints which can affect biological functions.
With a revival in public health and epidemiology, an approach which contributed considerably to improving the general level of health in the emerging industrial nations of the eighteenth and nineteenth centuries has once again found its legitimacy. It is based on the following fundamental principles:
A notion such as that of health risk is central to the analysis models used by health disciplines adopting this approach. What they then require from the social sciences is the identification of social determinants of situations that they have pinpointed as generating a bio-medical risk.
The most simple example is where a specific type of behaviour – food consumption, smoking, alcoholism, sexual practices – is associated with a specific pathology: cancer, cardio-vascular disease, transmission of STDs. It is then necessary to analyse the cultural, social and economic context which can lead to or promote the emergence of the behaviour responsible.
However, the model becomes much more complex when it is not possible to associate in a linear fashion a given pathology with a specific behaviour, as the pathogenic situation is the result of a series of complex interactions between social and biological processes.
In both such instances, collaboration with the social sciences can help the medical disciplines to broaden their approach and to integrate into their analysis some non-medical components of health situations on which they are working.
Collaboration between medical disciplines and the social sciences can take a totally different direction by looking into the social treatment of health, the different ways of socialising functions of the body and the responses elaborated by a society to respond to or prevent an illness.
This wish to understand health treatment systems can lead us to examine not only existing institutions in a given society, but also the practices of the actors involved. This may be through studies devoted to medical practice: to medical standards and the values on which they are based and which are not exclusively technical or scientific and the types of decision taken on this basis. It may also concern studies, in a given social and cultural context, of individual and collective practices relating to the body, to biological functions (food, reproduction etc.) to changes (growth, ageing) or attacks on the body’s integrity (accident, illness).
Central to this approach are notions of the treatment itinerary and medical pluralism which recognise the existence of several options to which a person, whether healthy or ill, might resort in order to keep or recover his health. In cultures where there is a very clear-cut distinction between a very active "traditional" form of care (there may be several of these) and a "modern" medical institution which has been in existence a relatively short period of time, then doctors are often faced with this very reality, in the form of rivalry. They therefore turn to the social sciences, to anthropology in particular, hoping for information that will enable them better to understand their patients’ behaviour and to provide a suitable response. A similar study of those seeking medical care could also be carried out in our own societies where self-medication, the existence of different medicines, (with a whole series of treatments ranging from the official to the "alternative"), and competition between medical institutions (especially private v. public) offer a wide range of solutions.
These are the approaches we use in our unit to try and explore interactions between the social and the biological: our starting point is a clear definition of the body and health. The combination of these two is the broad frame of reference around which we organise, precisely and selectively, our activities in various areas of intervention: training, research, publications and documentation.
