The Epidemic as a Social Event

Abstract

The concept of disease causation has changed twice, first from natural to social determining factors, and, second, from determination by social conditions to determination by stressful social relations. These changes roughly parallel the emergence of industrial capital and its change from a highly individualistic and competitive process to a “social” process. In this article, “epidemics” are treated as social events that occur amidst these changes in disease and the economic organization of society. Nineteenth-century epidemics occurred when business attempted to solve its economic problems by creating dramatic gaps between the social needs of an expanding labor force and available goods and services. The coincidence of periodic crises in production and in health ensured that “epidemics” would be occasions for labor to struggle against injustice, not simply sickness. And workers demonstrated a capacity for self-organization during epidemics that forced municipal authorities to reform fundamentally their organization of work, the market, and social service. After 1900, “reform” was a permanent part of capital's developmental strategy. The new “social” capitalist sought to organize work politically, far beyond the factory, and to extract “value” not from blue-collar workers alone but from all social activity. These developments reduced mortality due to infectious and childhood disease. But they also created the new epidemics of chronic stress. Despite the mystification of social etiology by medicine, the identity of the disease process with more general means of social reproduction indicates that illness is now “endopolic,” the product not of nature but of historically specific political and economic decisions and processes.