CULTURE AND LEGITIMACY
IN U.S. HEALTH CARE
The chapters in this final section of the book focus on collective attempts to challenge the cultural meanings and systems of classification that sustain and reproduce the power and legitimacy of American health institutions. Many health-related social movements target not only institutionalized structures and practices, but the identities, beliefs, categories, and modes of thought that shape how we view health problems—and solutions. In the United States, health benefits and services are allocated and distributed according to a particular understanding of the relationship between classification of disease and treatment. According to the medical model for the treatment of health problems, the underlying biological basis for health problems must first be clearly identified and then curative treatments applied to eliminate the risk of disease. As the “dominant epidemiological paradigm” (Brown et al. 2006), the medical model confers legitimacy to those diseases that have been officially “discovered” or recognized by biomedical institutions. But in doing so, the medical model poses formidable obstacles to those constituencies seeking to mobilize around complex chronic diseases that lack a clear etiology, unexplained or poorly understood medical symptoms, and alternative or oppositional understandings of health problems. The chapters in this section seek to elaborate the challenges faced by health-related social movements in constructing, promoting, and legitimizing these oppositional understandings of health issues.
In chapter 15, Sabrina McCormick examines the conditions that lead to the emergence of “climate-induced illness movements” (CIIMs). Climate-induced illnesses, which include illnesses caused by vector-borne transmission, urban temperature and air pollution, and extreme weather events, are rising in number and in scope in the United States, but citizen responses to the proliferation of these illnesses have been hampered by the difficulty of establishing disease causation, identification, and treatment. Focusing on three cases—West Nile Virus, the displacement of Alaska Natives, and heat-induced illness in Philadelphia, McCormick finds that