Sociology of health & illness最新文献

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.

This paper investigates the impact of boundary spanning activities on building trust as a means of tackling health inequalities in hardly reached communities. Lack of trust has been identified as a barrier to engagement with healthcare services, resulting in poorer health outcomes. Engaging with hardly reached communities is challenging due to the social and symbolic boundaries prevalent in community healthcare settings. Drawing on empirical data from a recent year-long collaborative research project with communities from seven economically deprived areas in the City of Nottingham, we identify two boundary spanning activities that facilitate the development of trust: communication across boundaries and intergroup relationship building. By cross fertilising sociological accounts on trust with insights derived from philosophy, the study finds that for hardly reached communities, trusting relevant individuals is more potent and widespread than the trust they have in healthcare institutions. By developing individual trust, hardly reached communities are more likely to consequently perceive the existence of institutional goodwill and competence. This counter-intuitive finding invites us to regard trust as context specific and relational rather than as a binary choice between trusting individuals or institutions and to situate cross boundary activities focused on trust development within the power asymmetries in which they unfold.

A longstanding body of public enquiries and research identifies people living with dementia experience systemic inequalities within hospital settings, concluding a focus on improving care cultures is required. Drawing on a 3-year multi-sited hospital ethnography, this paper examines everyday cultures of care in NHS acute hospital wards to interrogate how ethnicity, gender and social class intersects to shape the care of people living with dementia. Drawing on Collins' concept of intersectionality and the relational nature of power, the analysis reveals that while cared for by diverse teams of healthcare professionals, a patients' age, ethnicity, gender and social class, as interconnected categories, influences the tightening of ward rules for some people living with dementia and the granting of significant privileges for others. Focussing on walking within the ward, with a large number of people living with dementia classified as 'wandering', we explore ways in which intersectional identities informed who was granted privileges to leave the bedside and 'wander' the ward, and who experienced further control. The paper concludes that institutional racism and attitudes to gender, social class and ageing permeate the routine organisation and delivery of care within NHS acute hospital wards to significantly impact people living with dementia, and in turn, increases the consideration of care pathways that emphasise their discharge to institutional settings.

Emerging technologies of artificial intelligence (AI) and automated decision-making (ADM) promise to advance many industries. Healthcare is a key locus for new developments, where operational improvements are magnified by the bigger-picture promise of improved care and outcomes for patients. Forming the zeitgeist of contemporary sociotechnical innovation in healthcare, media portrayals of these technologies can shape how they are implemented, experienced and understood across healthcare systems. This article identifies current applications of AI and ADM within Australian healthcare contexts and analyses how these technologies are being portrayed within news and industry media. It offers a categorisation of leading applications of AI and ADM: monitoring and tracking, data management and analysis, cloud computing, and robotics. Discussing how AI and ADM are depicted in relation to health and care practices, it examines the sense of promise that is enlivened in these representations. The article concludes by considering the implications of promissory discourses for how technologies are understood and integrated into practices and sites of healthcare.

There are persistent and profound racialised inequalities in maternal and reproductive health in the UK. Yet in multiple settings, these disparities have been blamed on class or ethnicity, individuals and communities rather than the structures within which they live. In this study, we draw on narratives told within a 'slow-stitch' craft workshop, organised in southern England for racialised women with reproductive trauma, to show how processes of racialisation and racism shape experiences of maternal and reproductive healthcare. Experiences of reproductive trauma were multiple and cumulative. The burden of knowledge of racialised disparities was carried into health-care spaces, with plans made in advance to self-manage in risky spaces. The constant management of racialised stereotypes and subsequent strategies of bodily and emotional containment ultimately was not protective and there was little agency over levels of care received in health-care spaces. Perceptions surrounding racialised bodies shaped treatment, whilst proximities to whiteness afforded alternative realities. Taking a phenomenological approach we analyse race as a sensory, spatial and relational constellation haunted by long-standing histories of fraught inequality. Bringing together in the crafting circle a group of women racialised in different ways enabled the sharing of "unspeakable" stories surrounding racism and reproductive trauma, and allowed race to be brought into being as a form of solidarity and connection.

Violence in family caregiving, once a social taboo, is now emerging as a topic of scientific inquiry. Engaging with a non-normative approach to care and critical reflection on research of abusive caregiver behaviour and elder abuse, this study argues that as caregiver violence is increasingly addressed in research, it is crucial to understand it as a complex issue within its social context. The study adds to this understanding by conducting a discourse analysis of violence prevention programmes in Finland, where third sector organisations have taken the initiative in addressing caregiver violence. Based on analysis of project materials, media texts and expert interviews related to two such violence prevention programmes, the study illuminates how caregiver violence is made intelligible through a combination of three kinds of understanding: institutional, humane and therapeutic. It is suggested that these understandings offer a way forward in thinking about the complex, sensitive topic of caregiver violence in sociological research on care.

In a study of post-primary students in Northern Ireland, Bourdieu's concepts of cultural capital, habitus and fields are used to explore attitudes towards help-seeking from general practitioners (GPs). Findings from Grammar and Secondary Modern School students are compared using the role of educational fields in influencing help-seeking behaviours for mental health problems. Focus groups were conducted of 54 students at 10 post-primary schools in Northern Ireland, each consisting of 5-7 pupils, stratified by age (13-17 years) and gender. The data were analysed thematically to assess attitudinal and belief patterns within school environments. Participants from both types of schools expressed reluctance to seek help from GPs for mental health concerns. However, the attitudes towards help seeking differ between grammar schools (GSs) and secondary modern schools with regards to (a) the act of help-seeking; (b) service knowledge and medical professionalism; and (c) trust and disclosure. The field of GSs appears to produce students who feel more able and, importantly, more entitled to mental health support from health professionals. While this apparent conference of cultural norms increases some individuals' access to services, work is required to build help-seeking pathways which are responsive to diverse young people.

Young people coming of age amidst widespread socioeconomic uncertainty have a unique vantage from which to interpret how social, economic and environmental factors might influence health and the generation of health inequalities. Despite this, only a small number of existing studies of 'lay' understandings of health inequalities have focused on young people. This arts-based qualitative study builds on that body of research, in the context of the UK, to explore how young people make sense of health inequalities. Across two sites, Glasgow and Leeds, six groups of young people (39 in total) took part in online workshops to explore their perspectives. Throughout they engaged with population health research evidence; contributed to group discussions and responded creatively, via visual and performance art and by articulating their own views and experiences. In this paper, we explore how individual and structural explanations for health inequalities emerged, employing concepts from sociological studies of youth to shed light on these accounts. In particular, we argue that the concept of 'austere meritocracy', the persistence of narratives of aspiration and hard work as key to success against an increasingly hostile socio-economic backdrop, helps explain young people's perspectives on health inequalities in the UK.

Preimplantation Genetic Testing (PGT) is used to select in vitro embryos for distinct clinical contexts and purposes. PGT for monogenic conditions (PGT-M), also known as Preimplantation Genetic Diagnosis (PGD), enables the prevention of passing on a known genetic disorder to one's offspring. Conversely, PGT for aneuploidies (PGT-A), or Preimplantation Genetic Screening (PGS), is used to improve IVF success rates in fertility patients and increase confidence about the health outcomes of potential offspring. Using discourse analysis, we examine how Spanish fertility clinic digital platforms frame these techniques and their associated subjectivity processes. We find: first, an excessively unproblematic portrayal of experimental innovations such as PGT; second, a linguistic, semantic and clinical overlap between 'diagnosis' and 'screening', which increases the genetic responsibility of couples or women without known genetic conditions regarding their prospective children; and third, the use of genomics as a modulator of female fertility and as a means to control maternal age-related decline. Ultimately, this discourse positions PGT as a routine IVF component, serving as an assurance tool for both treatment success and the health of the potential baby. This narrative reflects the speculative turn in assisted reproduction, emphasising new forms of responsibility and choice of would-be mothers.