Functional Epistemology in Health Equity

In the upcoming weeks we will travel through the different ways of knowing in the field of Health Equity. We will start with functionalism, then interpretivism, then radical humanism, then lastly radical structuralism. The model for radical change was created by Burrell & Morgan (1979). For a quick refresher, here’s a graphic of their model.

In discussing health equity through a functional paradigm, we turn to epidemiology. It has historical roots in determining micro causes for disease. It determines differing pathways for for the causes and spread of disease. This ranges from biology, genetics, individual behaviors. The key factor of this type of study is that it focuses on individuals. This approach is true to the positivist understandings of realities.

Some work has been conducted to bridge functional approaches to radical structuralist approaches. The work of Marmot has opened up the field of social epidemiology. This paradigm explores the social determinants of health. This acknowledges that social environment and economic have pathways to determine health. This is more easily thought of in terms of determinants of ill health (although social environment affect both positive and negative health).

The interesting aspect of Marmot’s work is that it is still primarily a functionalist paradigm. Nevertheless, it tips its hat to structuralist notions. Economic realities, social class, race, position in the cultural hierarchy all play roles in affecting a person’s health outcomes.

Overall, functionalist perspectives in Health Equity have proven to be crucial in the scientific and social discussion around distribution of social resources. Importantly, epidemiology both micro and social provides a body of work that attempt to reach understandings of causation. Prevalence of ill health through this paradigm can also be counted and measured. Counting and measuring the effects become crucial for public health initiatives and policy. Positivist approaches are crucial in the scientific and social discussion. However it is not the only approach. The next post will explore more subjective and interpretive approaches.