Health Sociology Review最新文献

Integrating palliative care into the trajectories of patients with incurable cancer has been a priority for years. Yet, the intended outcomes of this integration remain elusive. Many patients with advanced cancer continue to receive so-called aggressive treatments in the end-of-life phase or miss out on specialised palliative care entirely. To examine this impasse in the Danish context, we employ the concept of professional value scripts to analyse policy documents and guidelines aimed at guiding professionals working with this patient group. The three identified scripts - cancer treatment, medical palliation and holistic palliative care - embody a distinct understanding of integration, contributing to the challenges of forging an integrated approach. We argue that the central role of the cancer treatment script in patient trajectories creates an obligatory passage point, influencing both the symbolic and practical enactment of integrated palliative care throughout these trajectories.

ABSTRACTComfort is a central aspect of palliative care, encompassing the management of pain and symptoms, as well as how people feel and experience care. Comfort has been argued to be especially tenuous or transient in palliative care, as a constantly shifting set of bodily sensations and relations are anticipated and cared for. In this article, drawing on in-depth interviews and photo elicitation, we explore the accounts of patients, family carers, staff and volunteers from a palliative care service in Australia, to understand how care is configured and facilitated through everyday gestures of comfort. We unpack how comfort (and comforting) is understood, sought, and done, to reveal how it is experienced as a set of social, relational, processual, and dynamic relations between bodies and environments. Our findings reveal how comfort for those nearing the end of life and those who care for them is brought about variously in the familiarity and reliability of things and surroundings, as well as through gestures of intimacy, recognition, and flexibility. We find that while predominantly considered as intentional and momentary, comfort has lasting effects. These lingering affective resonances, we argue, are key to recognising the diversity of what matters to people in palliative care.

This study explored how people who use drugs (PWUD) experience and respond to stigma in biomedical chronic non-cancer pain management. Thematic analysis of in-depth interviews with PWUD (n = 26) who had sought care for chronic non-cancer pain in public hospitals in Uyo, Nigeria, drew on the idea of stigma as process of social reproduction and the concept of borderwork. Accounts framed stigma as a normalised feature of healthcare that emerged under different circumstances and operated to position chronic non-cancer pain patients who were PWUD as illegitimate subjects underserving of care. Stigma was widely seen as something to be expected, and was often tolerated by PWUD due to its ubiquity. However, they enacted borderwork marking-off stigma experiences that violated values of fairness and humaneness as well as those that spurned traditional gender norms. Participants responded to intolerable stigma through various acts of resistance, including dropping out of care. Stigma creates barriers to adequate pain management and establishes a context where basic care is accessed at the cost of fundamental human rights and dignity. Routine toleration of stigma helps to naturalise the phenomenon and render it invisible. Resistance to stigma provides a basis for interventions to address all forms of stigma in healthcare.

The consumption of performance and image-enhancing drugs (PIEDs) is commonly pathologised in public health discourse as stemming from an unhealthy relationship to masculinity, and is often framed as intrinsically 'risky' and fundamentally at odds with 'good health'. This article examines Australian health promotion materials on PIEDs to analyse their role in shaping notions of good health, normal gender and appropriate self-improvement. To do so, it draws on the work of Butler, Law and Latour to consider how these materials co-constitute men and their health, often in problematic ways. First, we examine the ways in which PIEDs are constituted via a politics of the 'natural', then consider how the health promotion materials on PIEDs participate in the regulation of appropriate, healthy masculinity, and conclude by examining how adolescent masculinity is co-constituted with PIEDs. We observe a key tension between health promotion's avowed interest in improvement and optimisation and its treatment of PIED consumers as aberrant, vulnerable and insecure subjects whose drive to enhance and optimise is characterised by pathology and addiction. We conclude by arguing that health promotion materials on PIEDs fail to acknowledge the exceedingly normative character of enhancement practices in contemporary society.

Global drug policy is in a period of change. Human rights can play an important role in such change, but more work is needed to understand the how rights work and why they might come to matter. Drawing on insights from a major study on drug policy and human rights, I argue that important new dynamics in respect of how drugs are thought to relate to health are emerging, including a conceptualisation of some drugs as capable of generating or improving health, rather than undermining it. Drugs are in some cases coming to be understood not as the origin of social problems but as the solution for them. I introduce the concept of 'solutionisation' as a tool for understanding the mechanisms by which human rights shapes ontologies, positioning 'solutionisation' as corollary and counterpart to Carol Bacchi's work on policy 'problematisation' (Bacchi [2009]. Analysing Policy: What is the Problem Represented To Be? Pearson). I argue that both 'problematisation' and 'solutionisation' have value for sociological analyses of human rights and that we need to pay careful attention to the co-constitutive dimensions of drugs and human rights, to understand how norms about health, self and subjects are made, sustained, and brought under pressure.

Rural Australian youth exhibit high rates of mental ill-health, exacerbated by reduced access to mental health services. While the need for innovative solutions is well-established rural youth themselves are frequently excluded from the dialogue, creating a significant gap in evidence and the development of relevant service provision that reflects young people's lived experiences. Drawing on the concepts of individualism and healthism and research highlighting the continuing importance of relationships and trust in the lives of young people in a digital society, we aim to better understand how rural youth understand mental health and navigate mental health services and information. Using a qualitative methodology, we held 2 small focus groups with a total of 8 young people in rural Tasmania to identify aspects of rural mental healthcare that require improvement and to contribute to developing new and innovative solutions. Findings indicate that rural Tasmanian youth face numerous structural, social, and cultural barriers to positive mental health. Rural self-reliance and generational differences in attitudes towards mental health can negatively affect youths' help-seeking behaviours. Findings from this study suggest a need to combine technology-and community-based approaches creating a multi-generational approach to combat mental ill-health among rural youth.

This article aims to explore pharmaceuticalisation processes in professional work contexts. The approach focuses on identifying patterns of medicine and dietary supplement use for managing work performance, and on discussing the relationship between these consumption practices and work-related pressure factors. This analysis adapts the notions of 'normalisation' to understand the extent of cultural acceptability of these practices, and the notion of 'differentiated normalisation' to capture the tension between the trend towards normalisation of such consumption and its partial social (in)visibility within work settings. Empirical support for this analysis is based on a sociological study conducted in Portugal on professions under high performance pressures. The study involved three professional groups - nurses, journalists and police officers. A mixed methods approach was used, including focus groups, questionnaires and semi-structured interviews. Overall, the results show a trend towards the use of medicines and supplements for performance management, which reveals itself as a cultural response to work-related social pressures. Such consumption coexists with irregular patterns of either occasional or long-term use, as well as heterogeneous processes of 'normalisation' and 'hidden' consumption. Conclusions point to a social interconnection between the intensification of work pressures and the pharmaceuticalisation of work performance.

Established research supports collaborative patient-clinician communication as a means of improving pain management and decreasing opioid use by patients with chronic pain. However, much of this scholarship emphasises clinicians' capacities to shape and improve communication; limited research investigates patients' roles in this process. Drawing on 40 ethnographic observations of patient-clinician interactions, clinical spaces and case conferences within one specialist pain clinic in Brisbane, Australia, this paper investigates how and why patients present themselves in particular ways within consultations. Our theoretical lens combines concepts from Goffman on patienthood and stigma with Foucauldian theories of pastoral and disciplinary power. Findings suggest that elements of the clinical environment - namely posters - usher patients towards presenting in what we conceptualise as the 'good pain patient' role. In this role, patients demonstrate that they are moral, responsible, and contributing members of society. Yet, such a role is problematic to opening communication, with the role constraining what is socially acceptable for patients with chronic pain to say, do, or feel. In recognising how clinical contexts facilitate problematic good pain patient presentations, this paper directs attention to the spatial and relational nature of implicit clinical expectations and constrained good pain patient presentations.

Language is important in health policy development. Policy changes in Australia to increase cervical screening offers a timely case example to explore the function of inclusive language in health policy. Gender and sexuality diverse people with a cervix have been largely invisible within health promotion programs, which has led to reduced awareness of, and access to, cervical screening. Twenty-eight semi-structured interviews were conducted with 29 key informants between April and October 2022 about the role of inclusive language in cervical screening policy, promotion, and delivery in the context of a national program to promote cervical screening. Three themes were identified from what key informants believed to be the role of inclusive language: (1) the common goal of inclusive language as policy advocacy for broader inclusivity; (2) the inevitable partiality of inclusive language in policy as an opportunity to start conversation; and (3) policy as a bridge between essential but diffuse components of the health sector with multidirectional influences. Inclusive language was seen to operationalise equity in health policy within the broader aim of eliminating cervical cancer among under-screened populations.