Sociology of health & illness最新文献

Contested illnesses such as long COVID or post-COVID syndrome create heightened uncertainty for patients as they navigate diagnosis and treatment. To lessen this uncertainty, patients in the United States and Europe have relied on patient activism and patient-led research to seek recognition from medical, scientific and political institutions. However, patients in other countries rely on different sets of strategies. Drawing on a survey (n = 144) and interviews (n = 32) of patients with post-COVID syndrome recruited via social media in Brazil, we found common experiences of psychologisation and dismissal of patient experiences. To combat this dismissal, some patients turned to each other online. However, patient groups showed a preference for advice from credentialled experts rather than asserting the embodied expertise of patients. Similarly, in the construction of alternative expertise networks, patients continued to rely on credentialled experts in the private healthcare system and from foreign and nonstate experts. We discuss how these alternative expertise networks may diminish the possibility of collective mobilisation and how those who are more socioeconomically disadvantaged and under-represented in our study will likely endure additional challenges.

This paper explores the interrelations between medical specialisation, the changing division of medical labour and the technologies that have emerged to coordinate and integrate patient care. Drawing on the examples of the United Kingdom and the United States, countries whose health systems provide important points of commonality and distinction, I explore the intersections between the rise of medical specialisation and the creation of new medical and paramedical roles. These roles have often emerged as a palliative to the increasing fragmentation and atomisation of medical labour, to 'assist' overburdened clinicians and provide better coordinated and integrated patient care. However, as they have proliferated, these new roles have challenged the very nature of work itself. Technology has long held promise as a means of integrating the workforce, service provision and care in ways that might enhance the patient experience and outcomes. Turning to the example of the electronic patient record as one such coordination technology, I explore the travails of its implementation with respect to the healthcare workforce trends and patient care. In so doing, I aim to further contribute to recent scholarship on healthcare workforce trends, role proliferation, 'taskification' and strategies to manage the negative externalities of these on patient care.

Healthcare systems in many international contexts have been rapidly digitalised in recent years. Yet, despite the significant transformation of such systems and well-documented evidence of ethnic inequalities in the use of health services, the consequences of such changes on fairness in decision-making processes or procedural justice for racially minoritised people have been under-explored. Further, little attention has been paid to the influence of social determinants of health and systems of oppression, such as racism and patriarchy, on digital healthcare and the ways in which these intersect with each other. We developed a novel critical realist intersectional theoretical and analytical framework to interrogate procedural justice in digital primary care as experienced by racially minoritised people, employing the widely used criteria of voice, trust and impartiality. Analysis of interviews with 100 people from racially minoritised communities in the United Kingdom revealed serious shortcomings with respect to all three criteria, which need to be urgently addressed. We propose a multi-pronged approach, which recognises high levels of digital poverty, variations in digital literacy and proficiency in English and the need for more attention to the design of digital services and workforce training, along with proactive use of digital services to address existing ethnic inequalities.

Immunotherapy cancer treatments stimulate individuals' immune systems to target and kill cancer, with the potential to extend survival time for individuals living with some forms of advanced cancer. Immunotherapies, however, generate uncertainties in relation to predicting prognosis and managing toxicities and the emergence of side effects during and post-treatment. Drawing on interviews with practitioners and patients in an oncology clinic in the United Kingdom, this paper examines how these uncertainties, defined as epistemic and temporal, are articulated and negotiated in a wider context of shifting treatment expectations. Extending theorisation in the sociology of 'low' expectations, this paper demonstrates how practitioners and patients oscillate between high and low expectations of treatment to negotiate uncertainty. Patients are not passive consumers of hope and hype and do not always articulate high expectations of a pregiven and distant future, which requires recalibration in conditions of uncertainty. Instead, both practitioners and patients craft modest and personalised expectations and visions of the future, which at times involve anchoring to the present. Foregrounding both practitioners' and patients' accounts in theorising (re)calibration is important for understanding how expectations unfold and relate to uncertainties and with what consequences for the making of contemporary patienthood in the present.

Men's participation is critical to improving antenatal care (ANC) utilisation and mother and child health in sub-Saharan Africa (SSA). Additionally, current reviews typically examine sociocultural determinants narrowly as barriers or facilitators of men's direct involvement in biomedical ANC activities. We aimed to consolidate existing literature on sociocultural factors shaping fatherhood and men's participation in ANC in rural SSA to inform tailored interventions. We conducted a scoping review, searching 10 online databases (African Index Medicus, Africa Journals Online, CINAHL, Cochrane Library, EMBASE, MEDLINE/PubMed, PsycINFO, Sociology Collection, Social Sciences Abstract and Social Sciences Citation Index) for peer-reviewed articles that reported studies on fatherhood and men's participation in ANC in rural SSA, systematically analysed primary or secondary data, employed a qualitative, quantitative or mixed methods design and were published between January 2000 and October 2024 in any language. We included 77 articles reporting 58 qualitative, 6 quantitative and 13 mixed-methods studies conducted in 15 SSA countries. We identified 12 themes demonstrating that local sociocultural conceptions, norms, dynamics and experiences intricately shape fatherhood and men's participation in many different forms of ANC in rural SSA. We recommend interventions that reflect local realities and research that employs Afrocentric approaches to centre marginalised perspectives in rural SSA.

Existing scholarship has examined community outreach workers' vital role as an essential, effective public health workforce in underserved communities. Less attention has been paid to how such workers have experienced this rhetorically praised yet materially undervalued labour in the context of the COVID-19 pandemic. Drawing on interviews with 43 community outreach workers who facilitated health and well-being services for immigrant communities in California's Central Valley, we find that the pandemic created a unique 'community of fate' among community outreach workers in the region. This community of fate, in turn, exacerbated an existing care penalty rooted in the gendered, racialised and legally stratified nature of their labour. Taking both a micro- and macro-level analytical approach, we argue that the symbolic value of this 'essential' labour-often expressed in terms of a calling, vocation or destiny-intensified its material devaluation despite the importance of their work in mitigating pandemic harms.

In the health sector, social movements have achieved notable success in certain counter-hegemonic struggles against neoliberalism. In South Korea, the 'publicness' discourse has been central to such movements. Through discourse analysis, this study examines two cases in which civic participation played a key role in successfully resisting privatisation. Our contribution includes a detailed contextualisation of for-profit hospital cases and a comprehensive analysis of antagonistic discourses, agents, and ideologies, grounded in the discourse theory developed by Ernesto Laclau and Chantal Mouffe. Against neoliberal and developmental hegemony, a 'publicness' empty signifier articulated to public health institutions had hegemonic power, and the values of the health sector, including the right to health and health equity, served as a cross-sectoral unifying bond. Our findings present an account of a counter-hegemonic movement, which could contribute to power formation within and beyond a single sector and state. To conclude, we claim that although neoliberalism seems to dominate the health sector in South Korea and other national contexts, there are critical conjunctures which can challenge it and provide alternatives.

Despite a growing body of research about the negative impacts of an unlawful documentation status on immigrants' wellbeing, limited studies have examined immigrants' documentation status from a dynamic perspective. This study analyses data from the New Immigrant Survey to investigate the relationships between racial-ethnic identity, exposure to a precarious documentation status, and self-rated health. Using linear probability and inverse probability weighted models, this study finds that having been previously in a precarious documentation status and spending more years in this circumstance are associated with poorer self-rated health at the baseline survey period (2003). In the follow-up period (2007-2009), the relationship between previous individual-level exposure to a precarious documentation status and self-rated health attenuated and became statistically insignificant after controlling for demographic and socioeconomic factors. Latinx and Asian immigrants disproportionately spend longer periods of time in precarious documentation statuses and tend to have worse self-rated health in the follow-up period compared with White immigrants. Overall, this study points to the importance of conceptualising documentation status as dynamic and to study it acknowledging the racialized nature of this exposure.

This article analyses the health effects of discrimination experiences across several minority groups in Europe. Despite a broad literature advancing the idea that discrimination is a focal point for the social determinants of health among minority groups, research attempting to disentangle the health effects of interpersonal forms of discrimination and harassment from structural forms of discrimination is underexamined. Furthermore, these experiences may impact different minority groups to a greater or lesser extent due to that group's position in the social hierarchy. We address this gap in the literature by analysing the Second European Union Minorities and Discrimination Survey (EU-MIDIS II), including 19,179 respondents in six minority groups across 25 countries. We show that experiencing interpersonal discrimination and harassment has a large and consistent negative effect on the health of respondents across all groups, with some variation across different minority groups. This finding is concerning given how common these experiences are in the European context. We also show a small but consistent relationship across groups between living in segregated neighbourhoods and poorer health, whereas a negative relationship between health and living in overcrowded housing exists only for the Russian minority.