The biological and social determinants of illness: a study of iron-deficiency

Abstract

An attempt was made to distinguish the various levels of determination of deficiency anemia, as a public health phenomenon, on the basis of the biological and social relationships which define this health-disease process. By correlating the analysis of the specific processes of a sample population of pregnant women to the general processes characteristic of life in Greater São Paulo (Brazil), to which city the sample population belong, it was possible to observe how the conditions which lead to the occurrence of iron-deficiency anemia are linked to the social and economic conditions characteristic of the particular class contexts to which individuals are related, be it by qualitative and quantitative dietary deficiences, or by the poor conditions of environmental health, these factors typical of the areas inhabited by the lower social strata. In view of the singular biological processes involved and in order to bring into focus another hierarchical level of these determinations, the analysis of these deficiencies was applied to the concept of organic vulnerability, a concept taken as the concatenator of the distinguishing characteristics of specific biological groups in view of the differential risks of falling ill and dying through particular "causes" or processes leading to death, risks which are linked to the very conditions under which the social classes live. By characterizing the ultimate determining causes of iron-deficiency anemia on the basis of the low level of consumption of what the authors have decided to call "basic necessities", the analysis sought to identify characteristic elements of living standards in the city of São Paulo, capable of providing data of the establishment of possible "critical levels of consumption", that is to say, of a particular living standard below which individuals, in this case pregnant women, separated into specific social groups, would be ascribed to particular situations, simultaneously of an organic and social nature, "determinative" of levels of risk with regard to deficiency disease. The case study focused on the existing course between normal and anemic conditions, in terms of process, the intermediate phase of which, between the diseased and the normal states, was represented by non-anemic iron-deficiency, understood as a sub-clinical phase. In this phase, the three moments of the process were analysed, as a function of the socioeconomic conditions of the group under consideration. By constituting categories, in the light of the analytical process, in terms of income, as incompatible with the objective possibilities of the acquisition of defined minimum "basic necessities", the authors have succeeded in characterizing a particular social and economic condition below which the iron-deficiency anemia would, hypothetically, be more likely to occur, taking into consideration the various processes involved, whether of a social or a biological nature.