Health Sociology Review最新文献

By applying a posthuman perspective to the analysis of care for older people (COP), we analyse the agential cuts (together/apart) enacted by humans (mainly caregivers and older people) and more-than-humans (a camera intra-acting with other objects) whose agential entanglement configures and reconfigures the political economy of the caring apparatus. Our study identifies 'targeting', 'monitoring', and 'aligning' as interrelated caring practices, thus contributing to advance a posthuman understanding of welfare technology, and advancing a critical use of the possibilities enacted by technologies.

In this paper, we examine person-centred care through a Deleuzian posthuman lens with the aim of exploring what becomes possible when the concepts of both person and care are de-centred. We do so through a consideration of the sets of relations that produce 'the client' in health care contexts. Our analysis maps particular entangled material-semiotic forces producing 'M/michael', a young man with a diagnosis of Duchenne muscular dystrophy, within a rehabilitation clinic. Drawing on Deleuzian notions of assemblage, affect, and becoming we explore 'person-care' as an active production that dynamically enacts persons-as-clients through clinical arrangements. Persons are thus reconceptualised in terms of locally produced subject positions and their care relations, rather than pre-existing beings who can be 'centred' within health services. Paradoxically, by de-centring persons and care, we work to conjure ways to strengthen the aspirations of person centredness to humanise health practices. In doing so, we consider different possibilities for re-imagining clinical work and contribute to debates regarding how healthcare conceptualises and addresses disability, health, and wellbeing. We suggest that such posthuman analyses can open up new ways of understanding and re/forming healthcare.

The COVID-19 pandemic has placed sexual relationships into sharp focus as strict containment measures, including physical distancing and 'stay at home' restrictions, were initiated to control the spread of the virus. Governments in some jurisdictions prevented contact between non-cohabiting sexual partners (except for couples in pre-existing relationships), while community organisations recommended people avoid casual sexual encounters. This article analyses Australian media articles, commentary and public health messages published during March to October 2020 to explore the normative assumptions underpinning these measures. Applying posthumanist perspectives and Warner's (2002) conceptualisation of 'publics', we consider how COVID-19 public health advice enacts the (human) subject of public health as monogamous, coupled, and living with their partner or nuclear family. Those in non-normative relationships and households are not only excluded from this narrow enactment of the 'ideal' public health subject, but are rendered potentially risky disease vectors by virtue of their alternative kinship arrangements. We explore the implications of these findings for the more-than-human relationalities that shape health inequalities and processes of marginalisation during public health crises, and we offer suggestions for public health measures that address the needs of diverse 'publics'.

ABSTRACTDomestic and family violence is a social and public health issue typically positioned in policy frameworks as a consequence of gendered social and economic structures. In this paper, we deploy an approach that draws on Hörl's neo-ecological thinking to propose that the home, as a site of domestic violence, can be usefully framed as an ecology of the domestic, a posthumanist hybrid matrix of bodies, spaces and objects in which various practices enact the smooth running of the domestic together with practices of domestic and family violence, including coercive control. Our interest is in coercive control and in the impact that the COVID-19 pandemic had on practices which enact this aspect of domestic violence. Our exploration of the practices that enact coercive control draws on the work of Law and others. We examine how practices, which are not compatible, or that do not cohere, are able to coexist in a domestic ecology and what occurs when there is a disruption as occurred with the pandemic.

Hepatitis C has long been a public health problem in Australia. 'Revolutionary' new drugs with the potential to cure hepatitis C have now emerged. The Australian government has invested heavily in them, and has an ambitious goal to eliminate hepatitis C by 2030. Numerous shifts in policy and practice are required if the elimination agenda is to be realised. This paper explores the significance of these shifts. We ask: what is the race to elimination doing with the subject? We argue that the race to elimination can be understood, simultaneously, as a product of posthuman forces, capable of being analysed using the theoretical tools made available via the posthuman turn; producing an intervention in what it means to be human; and generating a dilemma for people who use (or used) drugs, people with hepatitis C, and posthuman scholarship. In drawing out these issues, we aim to: trace the significant developments underway in hepatitis C medicine and raise awareness of them; encourage reflection on the consequences of these developments; and invite reflections on what might be lost when the human is remade by hepatitis C medicine.

Amphetamine Type Stimulants (ATS) are increasingly used drugs globally. There is limited evidence about what shapes ATS use at critical turning points located within drug using pathways. Using turning point theory, as part of a life course approach, the ATTUNE study aimed to understand which social, economic and individual factors shape pathways into and out of ATS use. Qualitative, semi-structured interviews (n = 70) were undertaken with individuals who had used ATS, or had been exposed to them at least once. Our findings show that turning points for initiation were linked to pleasure, curiosity, boredom and declining mental health; increased use was linked to positive effects experienced at initiation and multiple life-stressors, leading to more intense use. Decreased use was prompted by pivotal events and sustained through continued wellbeing, day-to-day structure, and non-using social networks. We argue that the heterogeneity of these individuals challenges stereotypes of stimulant use allied to nightclubs and 'hedonism'. Further, at critical turning points for recovery, the use of services for problematic ATS consumption was low because users prioritised their alcohol or opioid use when seeking help. There is a need to develop service provision, training, and better outreach to individuals who need support at critical turning points.

Although vasectomy is a safe and highly effective method of contraception, uptake is variable globally, with scope for increased engagement in high income nations. Very little qualitative research has been published in recent years to explore men's perspectives on vasectomy, which represents a key opportunity to better understand and strengthen men's contribution to reproductive and contraception equality. This paper takes a scoping review approach to identify key findings from the small but important body of qualitative literature. Recent masculinities research argues that, despite some expansion in ways of being masculine, an underpinning ethos of masculinist dominance remains. Extant research on men's attitudes to vasectomy supports this ambivalent picture, indicating that while there are extending repertoires of masculinity for men to draw on in making sense of vasectomy, many remain underpinned by masculinist narratives. There remains scope for education and health promotion ensuring vasectomy is viewed as a suitable and safe option by more men of reproductive age. Increased uptake of vasectomy may also help shift the longstanding social expectation that women take primary responsibility for contraceptive practices, challenging gender discourses on contraception.

This paper examines whether the use of blood pressure medication has an influence on social inequalities in blood pressure levels. In Norway, cardiovascular disease has for decades been associated with high mortality and social inequalities. High blood pressure is an important risk factor in this aspect, and prescription drugs have been established as a standard treatment of hypertension. We have seen population blood pressure levels fall, blood pressure inequality levels remaining stabile, and medication use increase. The paper uses panel data from the Nord-Trøndelag Health Study linked with registry data on education and income. Results from fixed effects regression analyses indicate that blood pressure medication overall has a levelling effect. The traditional social gradient is mainly found among non-users of medication. With blood pressure medication being plausibly at a late stage of its diffusion, these findings give some support to the hierarchical diffusion model, while they also imply the need for equal access to sufficient blood pressure treatment.

The discrimination faced by people understood to have alcohol or other drug addictions has been the subject of extensive research, with many studies documenting experiences of stigma within healthcare services. Building on this literature, we examine the role of stigma in shaping the healthcare expectations of people seen as affected by alcohol and other drug addictions. Our analysis draws on recent theorisations of stigma as a process of social production to analyse in-depth, qualitative interviews with 20 people who had recently attended an inpatient withdrawal management service. Participants describe as exceptional forms of care that are often taken for granted by other members of the community. We argue that routinised experiences of discrimination work to constitute basic care as exceptional. This finding is significant for two reasons: (1) people who consume alcohol and other drugs often have complex healthcare needs and already encounter obstacles to accessing the care they need, and (2) by positioning people who consume drugs outside the purview of healthcare, this dynamic obstructs their fundamental right to care. We conclude by reflecting on the implications of these findings for those who are often positioned as not entitled to high quality healthcare.