Sociology of health & illness最新文献

Digital health technologies increasingly promise to alleviate the burden of chronic illness work by automating aspects of care. Rather than demanding constant self-monitoring, automated devices claim to deliver therapy with minimal involvement by patients. This article critically examines such claims through a study of Quell, a wearable neurostimulation device marketed for chronic pain relief in the United States. Drawing on interviews, user diaries and company documents, the article shows that rather than replacing illness work, automation reconfigures it. Patients remain deeply engaged in maintaining, tuning, deciphering and tracking their pain care, all while the device actively participates in it. This reflects a distinctly interfacial relationship between technology and people living with chronic pain. By conceptualising this relationship as chronic interfacing, the article argues that smart health technologies portend a shift away from neoliberal forms of governance. What emerges is a regime of digital health convenience, which partly dis-engages the patient from the chore of chronic living all while re-engaging them in managing the technological milieu required for this very delegation.

In this paper, we call for more attention to be paid to what we call ordinary contributions to public health policies: the propensity of ordinary citizens to actively influence others to follow or reject a health policy. Shifting the focus from personal compliance to active participation (i.e., ordinary contribution) raises distinct questions pertaining to self-empowerment, personal network composition and the public denunciation of antivaccinationism. We draw on a survey conducted during the summer of 2022 among a representative sample of the French public (n = 4004) to understand what made some people try to bear on other people's behaviours regarding COVID-19 vaccination. We asked respondents whether they tried to convince people in their various social circles to get vaccinated or to not get vaccinated. We found that a significant share of French people-especially the most vaccine-hesitant-kept their opinions to themselves. Controlling for vaccine hesitancy and concern regarding COVID-19, the propensity to engage in ordinary contributions was heavily influenced by relationship to politics. We discuss the overlapping between political competence and health literacy and the tensions that can arise in everyday discussions of issues at the interface of health and politics.

Persistent adolescent smoking in China presents a paradox within the context of advancing nicotine control. Moving beyond social-environmental explanations, this study employs Mills' sociological imagination to conceptualise this persistence as an agentive response to constrained realities and futures, enacted through peer-curated lay epidemiology. Its core argument is that adolescents cultivate a folk sociological imagination-a vernacular system of sense-making-to manufacture agency and reframe smoking risk. Qualitative data from 21 adolescent smokers in Shenzhen, including 208 health diaries and 17 interviews, reveal how this is achieved through three practices: the selective valorisation of healthy smoker exemplars; folk attribution of causality to external or individual factors; and prevalence-as-safety normalisation. This folk process reconfigured the public issue of smoking risk into a series of manageable private troubles, transforming statistical harm into a matter of individual circumstance. Findings highlight three gaps in current efforts: an epistemic gap in policy, which dismisses peer-validated evidence; an intervention gap in health education, which fails to engage with lay reasoning and a structural hope gap, which generates a form of cruel optimism that overlooks the need for alternative avenues for agency and belonging.

Public health crises such as the global epidemic of so-called 'lifestyle diseases' are often framed as the failure of individuals to make the right health-related choices or to take responsibility for managing their bodies in ways that promote the health of present and future selves. Through his early writings on healthism, Robert Crawford was one amongst a number of scholars who documented the emergence of neoliberal logics of self-care in response to these perceived failings. Although these debates are well covered in the critical literature, less attention has been paid to the ways in which the central tenets of healthism were and are received as ideology travels from place to place. This paper seeks to address this lacuna through a detailed analysis of the discourse surrounding the World Health Organization's 'Global Strategy on Diet, Physical Activity and Health'. Chosen for its framing of lifestyle diseases as a global public health problem whose causes are rooted in the spread of the 'western lifestyle', the paper argues that a focus on the strategy and the international response to it is revealing for what it tells us about what happens when ideas and theories travel.

This paper explores the role of the capitalist state in promoting the commercial and corporate provision of healthcare (CCPH). First, it reviews the breadth of CCPH in contemporary liberal democracies and identifies its strengths and weaknesses for the delivery of public health. It then explores the part that the capitalist state plays in supporting and extending the private provision of healthcare in the era of globalising capitalism. This is achieved through a secondary analysis of data from a recent study of the United Kingdom state's efforts to enhance overseas trade in private healthcare. This paper concludes with a discussion of the privatisation and commodification of healthcare, the role of the liberal democratic state in promoting both public and private healthcare and what this means for health inequalities and social justice, both within developed countries and globally.

Every day patients make informal complaints directly to care professionals. Although common in care encounters, the practice remains understudied. In this study, we focus on informal complaints through an analysis of interviews with 19 patients in Sweden, many living with chronic illness. We conceptualise these complaints as 'informal complaint biographies': not merely verbal expressions, but interwoven with people's lives, identities and care trajectories. As a lens through which to examine informal complaining, this study investigates 'dirty work': work that is considered a nuisance or even humiliating. We identify three different kinds of dirty work. 'Disgusting' refers to work with physical dirt entangled with the complaint. 'Drudging' describes patients' persistence, their effort to make healthcare function. Finally, 'disrupting' characterises work that challenges expertise from a vulnerable position. Our analysis shows how informal complaining can involve various types of undignifying work that cannot be separated from the complaint itself. By including work done by others than the traditional 'worker', namely patients, this study expands scholarship on dirty work. The study calls attention to how dirty work is shaped by systemic inefficiencies in healthcare and contributes new perspectives to complaints, research and policy, which is often wiped clean from any kind of dirt.

This reflective essay revisits the key interpretive concepts of 'medicalization' and 'healthism' that I employed in 'Healthism and the Medicalization of Everyday Life', published in 1980. The original article addressed the emergence in the United States of 'a new health consciousness' and related holistic health and self-help movements in the late 1970s. I clarify and extend my use of the concept of medicalization, supplementing my original discussion with insights from other scholars. Given that these concepts have been widely utilised in interpretations of health cultures in other countries, the specific historical location of the original work is further elaborated. The relevance of the larger historical contexts at work have also become more apparent with time. The essay concludes with a few brief observations about present developments in the United States and the continuing relevance of the concept of healthism for interpretation of contemporary health culture.

The predictive genetic clinic is a space where counsellors use non-directive counselling to facilitate asymptomatic patients at risk of carrying a dominantly inherited disease access a predictive genetic test. The social science literature has a history of examining practices within this clinic, but with little attention from the sociology of identity. In this paper, we highlight the importance of identity within these clinics by examining how currently healthy patients anticipate the prospect of a future identity of illness and death. We do this by examining how patients authenticate a decision to take a predictive genetic test for Huntington's Disease (HD). In deciding to take this test, a patient simultaneously asserts that they want the test, and they will be able to cope with a positive (bad news) test result. Positioning this as a claim to authenticity using Habermas, we explore authentic decision making through four themes-vouching, calibrating, reassuring and projecting. Non-directive counselling provides space for patients to articulate the authenticity of their decision while enabling counsellors probe their decision. However, counselling risks hindering authentic decision making and may devalue the social and familial as bases for efforts to authenticate.

Prompted by intense public debate and policy shifts, this study examines news media representations of gender-affirming care for transgender and gender diverse (TGD) youth in Sweden from 2019 to 2023. The analysis draws on Hall's theories of media representation and articulation, with a framework focussing on risk and temporality. Analysing media representations is crucial for understanding how societal discourses on gender dysphoria are shaped. The media articulates a dramatic rise in youth seeking gender-affirming care, and portrays a new group of patients, primarily young "girls" with neuropsychiatric conditions. This group is frequently articulated as vulnerable, mentally unstable and influenced by social contagion. The media representations draw on a risk discourse, centred on the threat of future regret, the irreversibility of medical interventions and suicidality. Both critics and supporters of gender-affirming care invoke suicide risk to justify their positions. The study highlights how TGD youths' voices are largely absent from the media representations. It critiques the simplified constructions of gender dysphoria and calls for more nuanced understandings of the rise of a diagnosis, care access and mental health. Finally, the paper illustrates shifting alliances and resistance within a broader conjuncture where professional and cultural tensions shape public discourse on gender-affirming care.

Algorithmic technologies such as machine learning, generative artificial intelligence (GenAI) and automated decision-making have become one of the frontiers of contemporary technoscientific innovation in healthcare. However, algorithmic technologies can never be seen in isolation from the networks in which they are embedded. Not only are they woven into situated sociotechnical assemblages of human and nonhuman entities-tools, objects and other technologies-but their entanglements also reach into regulatory institutions and markets. This paper conceptualises GenAI in healthcare 'in the making' at the rapidly changing intersection of three spheres: regulatory, market and healthcare delivery. Our study, conducted in conjunction with two nongovernmental social justice organisations, explores how this intersection is currently 'motored' by data justice concerns on the one hand and data capitalist objectives on the other. We draw health sociologists' attention to the technopolitics and market interests that lie behind AI promissories and implementations in healthcare. More importantly, we contribute to collective thinking around how we may steer this dynamic towards the empowerment of civic society, dynamic regulation and a push for public value-rather than enrichment of the few.