Sociology of health & illness最新文献

Current discussions about gender identity are increasingly politicised, particularly in the UK. An individual's body becomes a site of competing interests that attempt to regulate the physical, social and moral boundaries between biological sex and a socially realised gender. Care becomes defined within this context. The emerging biopolitics generates dividing practices that classify and regulate rather than situate a knowing subject, who is creatively and actively responsive. In response, our paper explores the value of biographical narratives when understanding how young adults negotiate their identity, within the context of social relationships and normative conventions, when experiencing (and articulating) gender questioning. Using testimonial experience from 18 young adults, aged between 19 and 30 years old, our analysis discusses participants' response to gender questioning before engaging with their exploration of gender, from childhood through to the present day. We consider how these young adults resolve gender questioning through reflexive engagement, seek legitimation and negotiate the response of others, as they seek care. Our conclusion, by providing insights into an actively constituted biographical experience, assesses the possibilities associated with more inclusive caring practices, in which an individual can flourish.

The National Institute for Health and Care Excellence (NICE) was established a quarter of a century ago in 1999 to regulate the cost-effectiveness of pharmaceuticals (and other health technologies) for the NHS. Drawing on medical sociology theories of corporate bias, neoliberalism, pluralism/polycentricity and regulatory capture, the purpose of this article is to examine the applicability of those theories to NICE as a key regulatory agency in the UK health system. Based on approximately 7 years of documentary research, interviews with expert informants and observations of NICE-related meetings, this paper focuses particularly on NICE's relationship with the interests of the pharmaceutical industry compared with other stakeholder interests at the meso-organisational level. Consideration of the interaction between the UK Government and the pharmaceutical industry in relation to NICE is presented together with the analysis of revolving doors and conflicts of interest of NICE experts/advisors. The nature of policy changes over time (e.g. accelerated assessment pathways and industry fees for regulatory appraisals) and how they relate to the relevant stakeholder interests is also investigated. It is concluded that NICE is largely characterised by neoliberal corporate bias, though some elements of its organisation are also consistent with theories of capture, pluralism and polycentricity.

First-person representations of illness have been studied as key to the cultural fabric disrupting dominant practices of ill health or disease regimes. However, the role that digital platforms play in shaping this fabric in contemporary societies has been mostly overlooked. We address this gap by investigating how mainstream social media, as mundane spaces modelled by corporate-driven techno-commercial structures, frame specific forms of visuality or ways to see ill health. We reflect on how these forms of visuality relate to existing disease regimes. The article presents an investigation of popular images of BReast CAncer (BRCA) hereditary cancer syndromes posted on Instagram, Twitter (now X) or Facebook over the course of 12 months. By combining cultural analytics, visual network analysis and interpretive techniques, we explore the emergence of platform-specific visual vernaculars and the visual genres of ill health emerging from these vernaculars. Our analysis suggests that, in the context of BRCA hereditary cancer syndromes, popular social media images primarily exacerbate existing racialised and gendered practices. Where alternative views emerge, in their being shaped by platforms' attention economies, they often operate in what we define as a 'liminal space' of imagination - one that hints at renewed, but not necessarily disruptive and certainly not radical ways to imagine ill health.

The health policies imposed by multiple national governments after the emergence of SARS-CoV-2 were publicly justified by official figures on the deaths that the new virus would have caused and could cause in the future. At the same time, however, groups of people from different countries expressed their scepticism about those figures. Although they were categorised as 'anti-science', 'spreaders of misinformation' or 'conspiracy theorists' in some media, many of those sceptics claimed to be based on scientific evidence. This article qualitatively analyses a sample of the content published by sceptics on their social media between 2020 and 2022. More specifically, it examines the shared documents supposedly coming from the scientific community. We find very diverse content ranging from unsubstantiated assumptions to documents produced by prestigious scientists inviting questions about the fatality rates, the mathematical models anticipating millions of deaths, and the real numbers of people who died from COVID-19. The disputes surrounding the official figures lead us to a reflection about the relationship between, epistemic diversity, the dissemination of science, censorship, and new forms of political opposition. We also touch upon the nature and ethics of scientific controversy in times of a 'war' against 'misinformation'.

The conceptualisation of 'care deserts' has gained increased public attention in recent years. This paper engages a reproductive justice framework to investigate the (mis)alignment of a maternity care desert within a predominantly Black rural community in the United States. I draw on a case study of Gadsden County, Florida-a community that is perceived by its members to be a maternity care desert but that is not technically defined as one-to demonstrate how Black birthing people are cultivating a reproductive liberatory consciousness. Semi-structured interviews with birthing persons and reproductive health experts reveal three overarching processes-naming barriers to health equity, resisting health inequity and cultivating health equity-that characterise a reproductive liberatory consciousness, which I identify as an analytical tool to outline how local social actors are identifying structural constraints as well as developing strategies of communal care and resistance. This work contributes to sociological research on reproductive justice and health equity by exploring the limitations of 'desert' frameworks. Pointing to the need to carefully consider the mechanisms that actively disrupt and potentially transform spatial stratifications and inequities, this paper advances a new understanding of birthing space that captures the layered movements of those living within a perceived maternity care desert.

Decisions about ethnic groups studied in health research shape recommendations. If a group is not included in research, its ability to call for policy change is limited. Despite health inequalities for the Irish in Britain in the 20th century, recent research on health is likely to combine the White Irish with White British, whereas Irish people of colour are not mentioned at all. This paper aims to understand why the interest in this group has declined. A state-of-the-art literature review of 140 papers on Irish health in Britain from 2001 to 2023 was conducted. Findings show the Irish are still disadvantaged in mortality, mental health and suicide, with important socioeconomic status and gender disparities. The shifting way the Irish are constructed over time is critically examined, paying attention to historical depictions and postcolonial identities. Sociological theories of migration are challenged by the Irish because this migrant group does not conform to theoretical assumptions. The Irish may have dropped from the agenda because of incorrect assumptions about assimilation and the relationship between Ireland and the UK. Given that the health outcomes of the Irish in Britain differ from those of the White British population, they should be recognised in health research as a distinct group.

By focusing on the experiences of employees living with coeliac disease as evidenced in UK employment tribunal cases, this paper interrogates the way practices of exclusion are performed in legal and organisational contexts that purport to promote values of inclusion. In paying attention to how differences are constructed and negotiated, the paper unpacks the way organisational practices mobilise an array of workplace mechanisms to produce complex dynamics of exclusion. Applying Laclau and Mouffe's logics of equivalence and difference, we show how questionable impulses and practices emerge in a workplace environment characterised by unclarity and vagueness. One impulse, for example, involves privatising and individualising the condition of employees with coeliac disease, giving rise to patronising and stigmatising attitudes that can turn them into victims. However, we also identify workplace mechanisms countering these tendencies, which can underpin forms of collective support in the struggle for recognition. Our study thus contributes to the body of sociological literature that pays attention to health-related workplace injustices by challenging the purported promotion of health-based inclusion through a focus on tribunal cases, leading to suggestions for further research into the way medical conditions are theorised and 'lived' at work.

In this article we explore how people who experienced a stroke, transient ischaemic attack, or heart attack sought health care during the COVID-19 lockdown periods. Semi-structured interviews were conducted with 27 patients admitted to hospital between March 2020 and May 2021, and one carer who was recruited from cardiac and stroke rehabilitation services in two large acute NHS trusts in England. Drawing on concepts of candidacy, illness and moral work, we discuss how people's sense-making about their symptoms fundamentally shaped both their decisions about seeking help and the impact of COVID-19 on help seeking. Risk perception and interactional ritual chain theory allow further exploration of constructing symbols of national identity in times of crises, managing risk and levels of acceptable risk and critique of ambiguous national messaging over accessing health-care services for people with emergency health-care needs. Our findings have wider implications for supporting access into health care for those with life-threatening conditions under highly publicised strain on the health system, including winter pressure and staff strikes, as well as policymaking and public messaging.

Fundamental Cause Theory (FCT) offers a unique middle range and longitudinal understanding of the lasting social causational relationships between certain social conditions and disease/death. In this research note, I argue that FCT should extend its outcome measures beyond physical disease and death into holistic health. I briefly review how FCT is evaluated, explore the proposed extension and discuss some operational and conceptual challenges using mental illness and positive mental health outcomes as exemplars. I conclude by discussing the benefits of extending FCT for 1) the theory's own validity, 2) social health inequalities research more broadly, and 3) public health policy.

Despite welfare state expansion in liberal democracies during the 20th century, health inequalities between socio-economic groups persist. Understanding individuals' lived experiences can inform policy for reducing unequal health outcomes in these lives. We build on Fundamental Cause Theory (FCT), which posits that low socio-economic status is the fundamental cause of health problems in (later) life. We argue that this theory is incomplete in developing policy interventions to tackle unequal health outcomes, because it assumes the relationship between socio-economic status and health to be linear and unidirectional. Based on our findings from biographic interviews of 15 disadvantaged individuals in the Netherlands, we propose a refinement of FCT by taking into account the complex life trajectories of individuals experiencing unequal health outcomes. Specifically, we argue that these individuals' trajectories can be broken down into at least five distinct patterns (ping-pong, snowball, escalator, quicksand and lever) between socio-economic and health issues. These patterns provide a theoretical addition to the existing FCT on the dynamics of life trajectories, the intensity with which problems develop and the importance of external factors. This helps not only to understand the emergence of health problems, but also to imagine more suitable policy responses.