The social construction of childhood asthma: Changing explanations of the relationship between socioeconomic status and asthma

Abstract

Hospitalization rates among children with asthma have been rising and are increasingly attributed to the effects of low socioeconomic status in epidemiologic research. A positivist viewpoint would assume that the relationship between socioeconomic status and asthma outcomes has always existed, but a postmodernist would argue that epidemiologic studies characterize populations by selecting discrete ‘risk factors’ for analysis and that these characterizations create images of a person with the disease. By describing ‘what kind of person’ is at risk for asthma, the medical literature serves to construct an image of the ‘asthmatic’. Taking a Foucauldian perspective to critically examine the historical evolution of the medical discourse on socioeconomic status and asthma over the past four decades, and to show how scientific understandings of asthma have been produced in a context of shifting social values about the disease, this paper has identified some remarkable shifts in the understanding of asthma. In the 1940s–1960s the ‘asthmatic’ child is portrayed as the victim of over-protective mothers in upper income families, changing to the asthmatic as ‘Other’, as a child from impoverished and disorganized families in the 1970s–1990s. It is proposed that this change in social construction has occurred subsequent to the transition to outcomes-based asthma research, which has been promoted by the vested interests of the medical profession, governmental bodies and the pharmaceutical industry. Clearly, the empirical link between socioeconomic status and asthma now promoted by the scientific community needs to be examined carefully for its discursive properties. Once an image of the ‘victim’ is firmly entrenched, further research is sometimes self-fulfilling.