2025 ANZAHPE Grant Submission
The quality of health equity learning in health professions education may benefit from a semiotic (sign process) theory of biological-environment relations termed biosemiotics.
Our research group aims to test this hypothesis by producing an online learning module of biosemiotic concepts relevant to social health determinants known to indirectly and adaptively produce chronic illnesses.
Key biosemiotic concepts include lifeworld, the species-specific field of sign perception from which living things make meaning of their ecological niche. Sign information in life- world is multisystem and dynamic; a sign being ‘a difference that makes a difference’. Semiosis is a process of sign sensing, perception of value difference, and interpretation of meaning of environmental changes. The structuration of health by powerful sign information from adverse social, political, and commercial determinants complexly model internal semiotic meanings of illness. The purpose of treatments and equity actions is to restore the imbalance of positive and negative signs communicating inequity of health outcomes between people differently and unfairly exposed to structural determinants. The biosemiotic process is theorised to cross biological barriers to internal organs, organelles, and the cell nucleus, that produce external symptoms and signs of illness. Biosemiotic theory links external sign processes to internal signalling and biomolecular mechanisms of illness, with psychological responses intermediating biomolecular and social changes.
Ethically, the impacts of external health determinants on patients’ illness presentation need to be fairly represented in a holistic clinical encounter and causal attribution. Biosemiosis, tied to lifeworld signs, may offer a tangible paradigm for representing systemic health determinants in clinical practice, equity advocacy, and research. The clinical goal is to make visible the invisible presence of additional, contextual burdens embodied in an equity patient’s or group’s illness.
To acknowledge external, structural causes of illness, people may use counterfactual reasoning to differentiate extrinsic, structural causes from intrinsic causes attributed to the individual e.g. genes, or cultural beliefs. In current human societies, the significant negative extrinsic signs are global crises in socioeconomic, climatic, and other systemic inequalities. These communicate and distribute inequities in individual and population health that are beyond patients’ control, e.g. by health behaviours.
Increased student visibility of inequities may be correlated with emotional empathy, and research of semiotic solutions with cognitive empathy. An inter-disciplinary health research project, to map an inequitable sign field or ‘semiosphere’, may identify sign targets for remodelling the lifeworld to be more health promoting.
Transformative teaching of social health injustice requires the wave-like weaving of content knowledge of biomedical illness with context knowledge of lifeworld health inequities, as in Maton’s Legitimation Code Theory. Patients’ social identities are less fundamental to the social determinants of health that operate to unfairly maldistribute vital health care resources. Chronic inequities in women’s, immigrants’ and Indigenous wellbeing may benefit from a 3-D perspective of illness causation inclusive of biological mechanisms, socio-political biosemiotic processes, and psychological intermediation. This may offer a stronger biopsychosocial account by which graduates reason illness causation, plan treatment, and promote health equity in times of rapid social change.
Kingsley Whittenbury PhD
