Medicine and power
The role of medical education
Angelo Stefanini
Centre for International Health
University of Bologna
Centro Studi e Ricerche in
Salute Internazionale e Interculturale
DIMEC - Università di Bologna
“Medicine, like science, is a mode of power"
“Medicine, as science tout court, is not neutral, it is not
pure cognitive activity, it is not the result of a
disinterested investigation of reality, but it is at the
service of capital. Its very beginning is in response to
a need expressed by the capital and its future
development will be instrumental to the preservation
and reproduction of the latter.”
G.A. Maccacaro (1924-1977)
A. Stefanini - Unibo
Centro Studi e Ricerche in
Salute Internazionale e Interculturale
DIMEC - Università di Bologna
Current medical education
• Largely irrelevant
• Focused on the biology of the body
• Undervaluing those disciplines that link with
the social context
• Split between “scientific” (“hard”) and the “less
scientific” (“soft”, humanities) disciplines
A. Stefanini - Unibo
Centro Studi e Ricerche in
Salute Internazionale e Interculturale
DIMEC - Università di Bologna
Resulting in…
• Shielding future doctors from the social reality
• Obscuring the social determinants of disease
• Ruling class/political system not accountable
for social production of disease
• Health professionals
• distant from social reality
• conformed with the logic of for profit / marketoriented health care
A. Stefanini - Unibo
Centro Studi e Ricerche in
Salute Internazionale e Interculturale
DIMEC - Università di Bologna
The medicine capitalism needs
• Human being as part of the physical nature
• Nature as the enemy of man
• Social causes of disease easily ignored
• Tb = mycobacterium Koch
• Blocking the journey back along the etiological
chain
A. Stefanini - Unibo
Centro Studi e Ricerche in
Salute Internazionale e Interculturale
DIMEC - Università di Bologna
University as a “factory of consent"
• Provides information, or rather notions,
completely detached from the real context
• Discourages any critical attitude
• Creates myth of neutrality of pure science as
unquestionable objectivity
“…systematic concealment of how the
organization of work and social life leads to
suffering and disease." (F. Ongaro Basaglia 1982)
A. Stefanini - Unibo
Centro Studi e Ricerche in
Salute Internazionale e Interculturale
DIMEC - Università di Bologna
Rudolf Virchow’s “Medicine is a social science
and politics is medicine on a large scale “
=
“Normalization" and "legitimisation" role of
medicine within social organization
A. Stefanini - Unibo
Centro Studi e Ricerche in
Salute Internazionale e Interculturale
DIMEC - Università di Bologna
Two medicines
• Either intrinsically political, i.e. challenging
situations and structures potentially
pathogenic
• Or the mere job of repairing body failures
A. Stefanini - Unibo
Centro Studi e Ricerche in
Salute Internazionale e Interculturale
DIMEC - Università di Bologna
Changing medical education
• Cannot be separated from social reality
• Objectives of transformation defined by
students/faculty AND community
• Universities not to replace but support the
community to take control of its own health
A. Stefanini - Unibo
Centro Studi e Ricerche in
Salute Internazionale e Interculturale
DIMEC - Università di Bologna
A trans-disciplinary, multi-professional, participative
unit dedicated to teaching, research and practice in the
field of “social determination of disease”
www.csiunibo.org
(CSI)
Centro Studi e Ricerche in
Salute Internazionale e Interculturale
DIMEC - Università di Bologna
Lessons we are learning
1. Cross-contamination
2. Different and innovative perspective
3. Activists’ attitude
A. Stefanini - Unibo
Centro Studi e Ricerche in
Salute Internazionale e Interculturale
DIMEC - Università di Bologna
“An upside-down faculty of medicine”
(Maccacaro 1977)
A. Stefanini - Unibo
Centro Studi e Ricerche in
Salute Internazionale e Interculturale
DIMEC - Università di Bologna