Pub Date : 2026-01-16DOI: 10.1016/j.socscimed.2026.118998
Nicole Miriam Daniels
Contributing to critical health scholarship, this multi-sited ethnography into private sector obstetrics in Cape Town, South Africa generated comparative public sector data through observation and interviews with seven obstetricians and fourteen pregnant women between 2017 and 2019. Entrenched inequalities in the provision and access to quality obstetric care, provoked in the politics of birth, are significant for broader societal movements and governance approaches towards universal healthcare in Africa. With near universal maternity care, South Africa is an important case study for understanding possible private sector contributions to National Health Insurance reforms aiming to consolidate health services for all. Drawing on feminist new materialist theory and socio-material analysis, I outline a care continuum, which I use to interrogate the logics of care that articulate an interdependent yet dichotomized health system. Dichotomized as poles either end of the care continuum is a generalised public sector and individualised private sector. A continuum helps demonstrate that material, experiential and discursive differences in care are not pre-existing but intra-actively related, meaning their differences are produced and maintained through relatedness. I illustrate this looking at movements of obstetric practices, patients, and providers, spatialities of services, and temporalities in care to propose that that public-private maternity care boundaries are co-produced through their mutual entanglement.
{"title":"Towards a care continuum: A socio-material analysis of intra-acting public-private maternity care in South Africa","authors":"Nicole Miriam Daniels","doi":"10.1016/j.socscimed.2026.118998","DOIUrl":"10.1016/j.socscimed.2026.118998","url":null,"abstract":"<div><div>Contributing to critical health scholarship, this multi-sited ethnography into private sector obstetrics in Cape Town, South Africa generated comparative public sector data through observation and interviews with seven obstetricians and fourteen pregnant women between 2017 and 2019. Entrenched inequalities in the provision and access to quality obstetric care, provoked in the politics of birth, are significant for broader societal movements and governance approaches towards universal healthcare in Africa. With near universal maternity care, South Africa is an important case study for understanding possible private sector contributions to National Health Insurance reforms aiming to consolidate health services for all. Drawing on feminist new materialist theory and socio-material analysis, I outline a <em>care continuum</em>, which I use to interrogate the logics of care that articulate an interdependent yet dichotomized health system. Dichotomized as poles either end of the care continuum is a generalised public sector and individualised private sector. A continuum helps demonstrate that material, experiential and discursive differences in care are not pre-existing but intra-actively related, meaning their differences are produced and maintained through relatedness. I illustrate this looking at movements of obstetric practices, patients, and providers, spatialities of services, and temporalities in care to propose that that public-private maternity care boundaries are co-produced through their mutual entanglement.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"393 ","pages":"Article 118998"},"PeriodicalIF":5.0,"publicationDate":"2026-01-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146025873","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-14DOI: 10.1016/j.socscimed.2026.118987
Xiaqing Jiang , Yuying Zhang , Jiamin Gao
Objectives
This study examines how city-level socioeconomic status (SES) is associated with cognitive function among older adults in China, and explores the mediating role of healthcare resources and the moderating role of individual SES in this context.
Methods
We relied on data from the 2018 wave of the China Health and Retirement Longitudinal Study, which provided individual cognitive function and demographic characteristics. Area-level SES and healthcare resource indicators were obtained from national statistical sources. A total of 9520 individuals aged 60 years or older from 123 cities were included in the analysis. A multilevel moderated mediation model was applied, and subgroup analyses by gender were conducted.
Results
Both individual- and area-level SES were positively associated with cognitive function. Multilevel mediation models of healthcare resources showed that only physician density (i.e., not hospital or bed supply) partially mediated the association between area-level SES and cognitive function. After individual SES was introduced as a moderator, the cognitive benefits of healthcare human resources were greater for low-SES individuals than for high-SES individuals. However, evidence for this moderating effect was not consistently supported across variations in sample composition and cognitive measurement. Gender-stratified analyses further showed no clear evidence supporting an individual-SES-based moderating effect in either men or women.
Conclusion
Our findings emphasize the fact that area-level SES and healthcare human resources shape late-life cognition, suggesting equity-focused policies that address structural disadvantage to reduce disparities in cognitive aging.
{"title":"Area-socioeconomic disadvantage and cognitive function among Chinese older adults: the mediating role of healthcare resources and the moderating role of individual socioeconomic status","authors":"Xiaqing Jiang , Yuying Zhang , Jiamin Gao","doi":"10.1016/j.socscimed.2026.118987","DOIUrl":"10.1016/j.socscimed.2026.118987","url":null,"abstract":"<div><h3>Objectives</h3><div>This study examines how city-level socioeconomic status (SES) is associated with cognitive function among older adults in China, and explores the mediating role of healthcare resources and the moderating role of individual SES in this context.</div></div><div><h3>Methods</h3><div>We relied on data from the 2018 wave of the China Health and Retirement Longitudinal Study, which provided individual cognitive function and demographic characteristics. Area-level SES and healthcare resource indicators were obtained from national statistical sources. A total of 9520 individuals aged 60 years or older from 123 cities were included in the analysis. A multilevel moderated mediation model was applied, and subgroup analyses by gender were conducted.</div></div><div><h3>Results</h3><div>Both individual- and area-level SES were positively associated with cognitive function. Multilevel mediation models of healthcare resources showed that only physician density (i.e., not hospital or bed supply) partially mediated the association between area-level SES and cognitive function. After individual SES was introduced as a moderator, the cognitive benefits of healthcare human resources were greater for low-SES individuals than for high-SES individuals. However, evidence for this moderating effect was not consistently supported across variations in sample composition and cognitive measurement. Gender-stratified analyses further showed no clear evidence supporting an individual-SES-based moderating effect in either men or women.</div></div><div><h3>Conclusion</h3><div>Our findings emphasize the fact that area-level SES and healthcare human resources shape late-life cognition, suggesting equity-focused policies that address structural disadvantage to reduce disparities in cognitive aging.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"392 ","pages":"Article 118987"},"PeriodicalIF":5.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979836","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-14DOI: 10.1016/j.socscimed.2026.118991
Jerzy Eisenberg-Guyot , Candace M. Cosgrove , Alex Azan , Samuel R. Friedman , Seth J. Prins , Audrey Renson
Introduction
Hazardous working conditions fuel inequities in accidental-poisoning, suicide, and chronic-liver-disease mortality. Relational theories suggest such hazards flow from power imbalances between workers, managers, and employers – social classes demarcated by power over property and labor. However, to our knowledge, no US studies using relational measures have analyzed class inequities in the cause-specific mortality.
Methods
We used the Mortality Disparities in American Communities dataset, which links the 2008 American Community Survey to the National Death Index through December 31, 2019. We classified respondents as incorporated business owners, unincorporated business owners, managers, workers, or not in the labor force based on their employment, occupational, and business-ownership status. Then, using an inverse-probability-weighted Aalen-Johansen estimator, we estimated risk differences in the cause-specific mortality across classes at the end of follow-up, including by sex, race/ethnicity, and education.
Results
Our sample included 2,304,500 respondents and 10,870 accidental-poisoning, suicide, and chronic-liver-disease deaths. Compared to incorporated business owners, those not in the labor force, workers, and unincorporated business owners had, respectively, 8.9 (95 % CI: 8.0, 9.7), 0.9 (95 % CI: 0.4, 1.5), and 1.1 (95 % CI: 0.3, 1.9) greater 12-year age- and sex-adjusted risks of the cause-specific mortality per 1000. Managers' risks resembled incorporated business owners’. Inequities largely persisted after thorough sociodemographic adjustment. Among workers, risks were elevated among the unemployed and those with blue-collar or service occupations. Finally, inequities were greater among men and less-educated respondents than among women and more-educated respondents.
Discussion
We estimated considerable class inequities in the cause-specific mortality, adding to research connecting class relations to mortality inequities and worsening population health.
{"title":"Following the power: social-class inequities in mortality from accidental poisonings, suicide, and chronic liver disease in the United States","authors":"Jerzy Eisenberg-Guyot , Candace M. Cosgrove , Alex Azan , Samuel R. Friedman , Seth J. Prins , Audrey Renson","doi":"10.1016/j.socscimed.2026.118991","DOIUrl":"10.1016/j.socscimed.2026.118991","url":null,"abstract":"<div><h3>Introduction</h3><div>Hazardous working conditions fuel inequities in accidental-poisoning, suicide, and chronic-liver-disease mortality. Relational theories suggest such hazards flow from power imbalances between workers, managers, and employers – social classes demarcated by power over property and labor. However, to our knowledge, no US studies using relational measures have analyzed class inequities in the cause-specific mortality.</div></div><div><h3>Methods</h3><div>We used the Mortality Disparities in American Communities dataset, which links the 2008 American Community Survey to the National Death Index through December 31, 2019. We classified respondents as incorporated business owners, unincorporated business owners, managers, workers, or not in the labor force based on their employment, occupational, and business-ownership status. Then, using an inverse-probability-weighted Aalen-Johansen estimator, we estimated risk differences in the cause-specific mortality across classes at the end of follow-up, including by sex, race/ethnicity, and education.</div></div><div><h3>Results</h3><div>Our sample included 2,304,500 respondents and 10,870 accidental-poisoning, suicide, and chronic-liver-disease deaths. Compared to incorporated business owners, those not in the labor force, workers, and unincorporated business owners had, respectively, 8.9 (95 % CI: 8.0, 9.7), 0.9 (95 % CI: 0.4, 1.5), and 1.1 (95 % CI: 0.3, 1.9) greater 12-year age- and sex-adjusted risks of the cause-specific mortality per 1000. Managers' risks resembled incorporated business owners’. Inequities largely persisted after thorough sociodemographic adjustment. Among workers, risks were elevated among the unemployed and those with blue-collar or service occupations. Finally, inequities were greater among men and less-educated respondents than among women and more-educated respondents.</div></div><div><h3>Discussion</h3><div>We estimated considerable class inequities in the cause-specific mortality, adding to research connecting class relations to mortality inequities and worsening population health.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"392 ","pages":"Article 118991"},"PeriodicalIF":5.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146012788","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-14DOI: 10.1016/j.socscimed.2026.118970
Cameron W. Rasmussen , Mimi E. Kim
Carceral paradigms and practices of punishment are widely understood to have devastating consequences for individual and community health. In response, abolitionist practitioners, organizers, and scholars have conceptualized forms of non-punitive accountability as a remedy to harm and violence, primarily through the practices and politics of restorative and transformative justice. Despite clear evidence punishment harms health and wellbeing, virtually no research has explored if and how accountability-based approaches may impact health and wellbeing for people who have caused harm. This conceptual article examines and theorizes accountability as one basis of how abolitionist politics and practice function as an affirmative social determinant of health. We argue that non-punitive accountability – understood through the theoretical, political and practice frameworks of abolition, and restorative and transformative justice – has the potential to positively impact health and wellbeing. Specifically, we assert that accountability practices adopted by groups and communities grounded in abolitionist politics and guided by principles of agency and self-determination, and commitments to challenging both state and interpersonal violence, can act as affirmative social determinants of health. Abolitionist frameworks for considering health and wellbeing are explored followed by a critical analysis of how agency in restorative justice and self-determination in transformative justice function both theoretically and practically — not only as key distinctions between accountability and punishment, but as foundational elements for improved health and wellbeing. We then analyze existing practice-based research that suggests a positive correlation between accountability and health and conclude with implications for practice, discourse, and future research.
{"title":"Accountability as Self-Determination: Abolitionist conceptions of health, wellbeing, and safety","authors":"Cameron W. Rasmussen , Mimi E. Kim","doi":"10.1016/j.socscimed.2026.118970","DOIUrl":"10.1016/j.socscimed.2026.118970","url":null,"abstract":"<div><div>Carceral paradigms and practices of punishment are widely understood to have devastating consequences for individual and community health. In response, abolitionist practitioners, organizers, and scholars have conceptualized forms of non-punitive accountability as a remedy to harm and violence, primarily through the practices and politics of restorative and transformative justice. Despite clear evidence punishment harms health and wellbeing, virtually no research has explored if and how accountability-based approaches may impact health and wellbeing for people who have caused harm. This conceptual article examines and theorizes accountability as one basis of how abolitionist politics and practice function as an affirmative social determinant of health. We argue that non-punitive accountability – understood through the theoretical, political and practice frameworks of abolition, and restorative and transformative justice – has the potential to positively impact health and wellbeing. Specifically, we assert that accountability practices adopted by groups and communities grounded in abolitionist politics and guided by principles of agency and self-determination, and commitments to challenging both state and interpersonal violence, can act as affirmative social determinants of health. Abolitionist frameworks for considering health and wellbeing are explored followed by a critical analysis of how agency in restorative justice and self-determination in transformative justice function both theoretically and practically — not only as key distinctions between accountability and punishment, but as foundational elements for improved health and wellbeing. We then analyze existing practice-based research that suggests a positive correlation between accountability and health and conclude with implications for practice, discourse, and future research.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"392 ","pages":"Article 118970"},"PeriodicalIF":5.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979834","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-14DOI: 10.1016/j.socscimed.2026.118992
Kimberley Kinder
Scholars in public health, urban planning, and social work embrace the notion that contact with nature promotes health and wellness, including in the context of trauma. This article analyzes the lived experiences of women recovering from Intimate Partner Violence (IPV) to explore two propositions: (a) contact with nature promotes trauma recovery for women and (b) access to nature as a healing aid is compromised by experiences of gender and trauma. Based on qualitative interviews with eighty IPV survivors, I found significant support for the first proposition: many participants experienced nature as an important source of support during the recovery process. However, I also found significant evidence for the second proposition: because access to nature is mediated by gender and violence, IPV creates negative feedback loops where the people most likely to experience IPV also have reduced access to nature as a wellness aid. Examining these gendered and trauma-related experiences reveals how power and inequity are woven into the natural environments often associated with healing.
{"title":"Nature, gender, trauma: The role of nature in recovering from intimate partner violence","authors":"Kimberley Kinder","doi":"10.1016/j.socscimed.2026.118992","DOIUrl":"10.1016/j.socscimed.2026.118992","url":null,"abstract":"<div><div>Scholars in public health, urban planning, and social work embrace the notion that contact with nature promotes health and wellness, including in the context of trauma. This article analyzes the lived experiences of women recovering from Intimate Partner Violence (IPV) to explore two propositions: (a) contact with nature promotes trauma recovery for women and (b) access to nature as a healing aid is compromised by experiences of gender and trauma. Based on qualitative interviews with eighty IPV survivors, I found significant support for the first proposition: many participants experienced nature as an important source of support during the recovery process. However, I also found significant evidence for the second proposition: because access to nature is mediated by gender and violence, IPV creates negative feedback loops where the people most likely to experience IPV also have reduced access to nature as a wellness aid. Examining these gendered and trauma-related experiences reveals how power and inequity are woven into the natural environments often associated with healing.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"392 ","pages":"Article 118992"},"PeriodicalIF":5.0,"publicationDate":"2026-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979839","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-13DOI: 10.1016/j.socscimed.2026.118986
Mhorag Goff , Patrick Burch , Jonathan Hammond , Kath Checkland , Sally Jacobs
In many well-developed primary care systems patients increasingly receive care from multiple clinicians within networks of providers rather than a single general practice clinician. This makes formal coordination between clinicians and providers necessary and requires informal ‘articulation work’ from both clinicians and patients to organise coordination of tasks across episodes of care. This is often hidden ‘behind the scenes’.
We used qualitative data from interviews with patients (n = 55) and healthcare professionals and other practice staff (n = 57) from two linked studies in English general practice. These studies investigated aspects of implications of the organisational shift to primary care networks. Using these datasets, we explored expectations about the articulation work involved in coordinating care.
We found differing experiences of primary care coordination and differing expectations about who bears responsibility for the articulation work involved. Patients tend to assume a cyclical care process in which care coordination continues between interactions with the practice, maintaining a care cycle. In contrast, contemporary primary care processes are structured to be ‘acute by default’, with patients responsible for re-initiating care after each care episode. Increasing responsibilisation of patients adds to their burden of treatment. Without the knowledge or capacities for such work patients may experience failures in care coordination. Better aligning expectations about responsibilities for articulation work requires explicit communication, sensitivity and flexibility in identifying patients who may find this difficult, facilitated by an ongoing patient-clinician relationship.
{"title":"Empowerment or responsibilisation: Articulation work in English primary care coordination from the perspectives of patients and clinicians","authors":"Mhorag Goff , Patrick Burch , Jonathan Hammond , Kath Checkland , Sally Jacobs","doi":"10.1016/j.socscimed.2026.118986","DOIUrl":"10.1016/j.socscimed.2026.118986","url":null,"abstract":"<div><div>In many well-developed primary care systems patients increasingly receive care from multiple clinicians within networks of providers rather than a single general practice clinician. This makes formal coordination between clinicians and providers necessary and requires <em>in</em>formal ‘articulation work’ from both clinicians and patients to organise coordination of tasks across episodes of care. This is often hidden ‘behind the scenes’.</div><div>We used qualitative data from interviews with patients (n = 55) and healthcare professionals and other practice staff (n = 57) from two linked studies in English general practice. These studies investigated aspects of implications of the organisational shift to primary care networks. Using these datasets, we explored expectations about the articulation work involved in coordinating care.</div><div>We found differing experiences of primary care coordination and differing expectations about who bears responsibility for the articulation work involved. Patients tend to assume a cyclical care process in which care coordination continues between interactions with the practice, maintaining a care cycle. In contrast, contemporary primary care processes are structured to be ‘acute by default’, with patients responsible for re-initiating care after each care episode. Increasing responsibilisation of patients adds to their burden of treatment. Without the knowledge or capacities for such work patients may experience failures in care coordination. Better aligning expectations about responsibilities for articulation work requires explicit communication, sensitivity and flexibility in identifying patients who may find this difficult, facilitated by an ongoing patient-clinician relationship.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"392 ","pages":"Article 118986"},"PeriodicalIF":5.0,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145999365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-13DOI: 10.1016/j.socscimed.2026.118981
Elizabeth J. Pfeiffer, Sara Mendez
Social scientists have long noted the influence of social, economic, and political factors—or the social determinants of health (SDOH)—that influence people's health. Healthcare providers and insurers, hospital administrators, clinicians, government, social services, and research agencies have put great efforts into developing policies that create knowledge and awareness, and promote social-risk screening and social-care programs in the United States. These programs screen patients for risks so health professionals can refer them to resources for help with their health-related social needs (HRSN). Federal policies have constructed the socioeconomic conditions of individuals as health problems—and driven SDOH medicalization. While commendable, such programs have not significantly improved patients' health, and the open questions are how and why this is the case. Our qualitative data help answer these questions and inform arguments about the benefits, limitations, and consequences of SDOH medicalization. In our research, we explore study participants' lived experiences of SDOH medicalization in one social-risk-screening-and-care program—from focus-group discussions with clinic staff, patients, and social service leaders collected in 2020–2021. Data provide empirical evidence that medicalization offered benefits but played a role in some unintended negative consequences, including the reproduction of already existing inequities that limited program effectiveness. Efforts to address the HRSN of individuals will be enhanced by policy and clinical work that tackle the intersecting social, economic, and political forces that create and sustain conditions that are harmful to human lives.
{"title":"Medicalizing the social determinants of health and the inadvertent reproduction of inequities through social-care program implementation in the United States","authors":"Elizabeth J. Pfeiffer, Sara Mendez","doi":"10.1016/j.socscimed.2026.118981","DOIUrl":"10.1016/j.socscimed.2026.118981","url":null,"abstract":"<div><div>Social scientists have long noted the influence of social, economic, and political factors—or the social determinants of health (SDOH)—that influence people's health. Healthcare providers and insurers, hospital administrators, clinicians, government, social services, and research agencies have put great efforts into developing policies that create knowledge and awareness, and promote social-risk screening and social-care programs in the United States. These programs screen patients for risks so health professionals can refer them to resources for help with their health-related social needs (HRSN). Federal policies have constructed the socioeconomic conditions of individuals as health problems—and driven SDOH medicalization. While commendable, such programs have not significantly improved patients' health, and the open questions are <em>how</em> and <em>why</em> this is the case. Our qualitative data help answer these questions and inform arguments about the benefits, limitations, and consequences of SDOH medicalization. In our research, we explore study participants' lived experiences of SDOH medicalization in one social-risk-screening-and-care program—from focus-group discussions with clinic staff, patients, and social service leaders collected in 2020–2021. Data provide empirical evidence that medicalization offered benefits but played a role in some unintended negative consequences, including the reproduction of already existing inequities that limited program effectiveness. Efforts to address the HRSN of individuals will be enhanced by policy and clinical work that tackle the intersecting social, economic, and political forces that create and sustain conditions that are harmful to human lives.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"392 ","pages":"Article 118981"},"PeriodicalIF":5.0,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979837","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-13DOI: 10.1016/j.socscimed.2026.118985
Ana Cerezuela González, Carolina Remorini, Diana Marre Cifola
This study examines how obstetric risk is constructed and negotiated through interactions between healthcare professionals and pregnant women during the first trimester screening ultrasound consultation in a public maternity hospital in Spain. This pivotal consultation serves as both a key diagnostic tool for gestational complications and a significant emotional milestone for families. Through ethnography, primarily observations and informal conversations conducted between March and June 2023, the research explores how “risk” shapes decision-making in obstetrics.
Findings showed that the first trimester ultrasound consultation is a complex social space where medical risk assessment coexists with emotional and social implications of the first visual encounter with the unborn baby. While medical professionals prioritize formalized risk assessment, they also engage in emotional labor and communicative strategies, including subtly redirecting interactions. They also actively participate in the symbolic appropriation of the fetus, which helps bridge women's and clinician's realities through the acknowledgment of the ultrasound's social and emotional significance. Decisions are made under high uncertainty, where expert knowledge plays a central role, and social, cultural, and emotional contexts are not always fully integrated.
The study highlights communication gaps due to the disparity between professionals' and patients’ knowledge, particularly in high-risk scenarios, where statistics often fail to convey the deep personal meaning of potential adverse outcomes. Biomedicalization of pregnancy risks can introduce new forms of existential uncertainty for women, potentially limiting their autonomy. These findings illustrate the complexity of obstetric risk communication and the need to integrate social, emotional, and cultural dimensions into prenatal care.
{"title":"Dialogues of obstetric risk in the first trimester of pregnancy: Insights from a hospital ethnography","authors":"Ana Cerezuela González, Carolina Remorini, Diana Marre Cifola","doi":"10.1016/j.socscimed.2026.118985","DOIUrl":"10.1016/j.socscimed.2026.118985","url":null,"abstract":"<div><div>This study examines how obstetric risk is constructed and negotiated through interactions between healthcare professionals and pregnant women during the first trimester screening ultrasound consultation in a public maternity hospital in Spain. This pivotal consultation serves as both a key diagnostic tool for gestational complications and a significant emotional milestone for families. Through ethnography, primarily observations and informal conversations conducted between March and June 2023, the research explores how “risk” shapes decision-making in obstetrics.</div><div>Findings showed that the first trimester ultrasound consultation is a complex social space where medical risk assessment coexists with emotional and social implications of the first visual encounter with the unborn baby. While medical professionals prioritize formalized risk assessment, they also engage in emotional labor and communicative strategies, including subtly redirecting interactions. They also actively participate in the symbolic appropriation of the fetus, which helps bridge women's and clinician's realities through the acknowledgment of the ultrasound's social and emotional significance. Decisions are made under high uncertainty, where expert knowledge plays a central role, and social, cultural, and emotional contexts are not always fully integrated.</div><div>The study highlights communication gaps due to the disparity between professionals' and patients’ knowledge, particularly in high-risk scenarios, where statistics often fail to convey the deep personal meaning of potential adverse outcomes. Biomedicalization of pregnancy risks can introduce new forms of existential uncertainty for women, potentially limiting their autonomy. These findings illustrate the complexity of obstetric risk communication and the need to integrate social, emotional, and cultural dimensions into prenatal care.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"392 ","pages":"Article 118985"},"PeriodicalIF":5.0,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979729","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-13DOI: 10.1016/j.socscimed.2026.118968
Eurwen H. Williams , Christopher W.N. Saville
Background
Deaths of despair (suicide, drug poisoning, alcohol-specific mortality) have been framed either as demand-side phenomena driven by social and economic dislocation or as driven by supply-side changes in access to harmful substances. We assess these explanations in England and Wales by testing whether deaths of despair are higher in places shaped by historical coal mining and whether any association persists beyond current deprivation.
Methods
We linked 2015–2023 mortality data for all 7264 middle super output areas (MSOAs, units of census geography in England and Wales) to a four-level measure of coalfield exposure (none, last pit closed <1946; 1946–1979; ≥1980). Poisson generalised linear mixed-effects models estimated rate ratios with offsets for the at-risk population, adjusting for age, sex, and period. We (1) estimated the association between coalfield exposure and deaths of despair; (2) tested heterogeneity by cause and sex; and (3) evaluated whether associations remained after adjustment for area-level deprivation.
Results
Former coalfield MSOAs had higher rates of all three types of deaths of despair than non-mining areas. Associations were strongest for alcohol-specific and drug-poisoning mortality, and survived adjustment for socioeconomic deprivation, albeit attenuated. Associations with suicide were smaller and concentrated in areas with post-1979 closures. Patterns were broadly similar for men and women.
Conclusions
Findings align with demand-side interpretations: place-based legacies of deindustrialisation are associated with elevated mortality even after accounting for current deprivation, indicating complex structural pathways. Policies should pair clinical responses with place-focused regeneration, rebuilding social and economic infrastructure in historically industrial communities.
{"title":"Close a pit, kill a community: An ecological analysis of coal mining history and deaths of despair in England and Wales","authors":"Eurwen H. Williams , Christopher W.N. Saville","doi":"10.1016/j.socscimed.2026.118968","DOIUrl":"10.1016/j.socscimed.2026.118968","url":null,"abstract":"<div><h3>Background</h3><div>Deaths of despair (suicide, drug poisoning, alcohol-specific mortality) have been framed either as demand-side phenomena driven by social and economic dislocation or as driven by supply-side changes in access to harmful substances. We assess these explanations in England and Wales by testing whether deaths of despair are higher in places shaped by historical coal mining and whether any association persists beyond current deprivation.</div></div><div><h3>Methods</h3><div>We linked 2015–2023 mortality data for all 7264 middle super output areas (MSOAs, units of census geography in England and Wales) to a four-level measure of coalfield exposure (none, last pit closed <1946; 1946–1979; ≥1980). Poisson generalised linear mixed-effects models estimated rate ratios with offsets for the at-risk population, adjusting for age, sex, and period. We (1) estimated the association between coalfield exposure and deaths of despair; (2) tested heterogeneity by cause and sex; and (3) evaluated whether associations remained after adjustment for area-level deprivation.</div></div><div><h3>Results</h3><div>Former coalfield MSOAs had higher rates of all three types of deaths of despair than non-mining areas. Associations were strongest for alcohol-specific and drug-poisoning mortality, and survived adjustment for socioeconomic deprivation, albeit attenuated. Associations with suicide were smaller and concentrated in areas with post-1979 closures. Patterns were broadly similar for men and women.</div></div><div><h3>Conclusions</h3><div>Findings align with demand-side interpretations: place-based legacies of deindustrialisation are associated with elevated mortality even after accounting for current deprivation, indicating complex structural pathways. Policies should pair clinical responses with place-focused regeneration, rebuilding social and economic infrastructure in historically industrial communities.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"393 ","pages":"Article 118968"},"PeriodicalIF":5.0,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"146025677","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2026-01-13DOI: 10.1016/j.socscimed.2026.118984
Charlotte Clous , Hannah Jongsma , Anniek van Weeghel , Ria Reis , Wim Veling
In the Netherlands, terbeschikkingstelling (TBS) is a forensic psychiatric measure imposed on individuals who commit a criminal offence under diminished responsibility due to severe mental illness. For TBS patients without Dutch nationality, mandatory repatriation replaces resocialization as the final goal of TBS treatment, as they lose Dutch residency rights due to their offence. This article examines how this subgroup of TBS patients at a Dutch Centre for Transcultural Forensic Psychiatry reflect on and negotiate cultural identity at the intersection of criminal and migration law. Focusing on sociocultural identification, we adopt a dynamic and relational approach to cultural identity that attends to life histories, transnational social ties, institutional positioning and imposed categories of otherness reinforced by involuntary return policies. Data were gathered through in-depth life-course interviews, focus groups, and participant observation on four high-security wards between 2022 and 2024.
Participants' narratives reflect chronic uprootedness and cultural fragmentation, but also highlight forms of resilience, as identities are redefined through lived experiences of ‘having been places’ and situational forms of belonging within transnational social contexts. Cultural identity emerges as layered and fluid, dynamically shaped across multiple social fields, rather than anchored in fixed national or ethnic categories. By centring lived experiences from within a highly regulated institutional setting, this study offers qualitative insight into how cultural identity takes shape under conditions of constrained agency and prolonged uncertainty, and highlights the implications of these processes for forensic psychiatric care. Substantiated with the experiences of individuals whose voices are rarely heard, this article delivers a critical analysis of a system in which people risk being lost or caught between equally impossible future perspectives.
{"title":"Sociocultural identification of migrant forensic psychiatric inpatients facing mandatory repatriation – a hospital ethnography","authors":"Charlotte Clous , Hannah Jongsma , Anniek van Weeghel , Ria Reis , Wim Veling","doi":"10.1016/j.socscimed.2026.118984","DOIUrl":"10.1016/j.socscimed.2026.118984","url":null,"abstract":"<div><div>In the Netherlands, <em>terbeschikkingstelling</em> (TBS) is a forensic psychiatric measure imposed on individuals who commit a criminal offence under diminished responsibility due to severe mental illness. For TBS patients without Dutch nationality, mandatory repatriation replaces resocialization as the final goal of TBS treatment, as they lose Dutch residency rights due to their offence. This article examines how this subgroup of TBS patients at a Dutch Centre for Transcultural Forensic Psychiatry reflect on and negotiate cultural identity at the intersection of criminal and migration law. Focusing on sociocultural identification, we adopt a dynamic and relational approach to cultural identity that attends to life histories, transnational social ties, institutional positioning and imposed categories of otherness reinforced by involuntary return policies. Data were gathered through in-depth life-course interviews, focus groups, and participant observation on four high-security wards between 2022 and 2024.</div><div>Participants' narratives reflect chronic uprootedness and cultural fragmentation, but also highlight forms of resilience, as identities are redefined through lived experiences of ‘having been places’ and situational forms of belonging within transnational social contexts. Cultural identity emerges as layered and fluid, dynamically shaped across multiple social fields, rather than anchored in fixed national or ethnic categories. By centring lived experiences from within a highly regulated institutional setting, this study offers qualitative insight into how cultural identity takes shape under conditions of constrained agency and prolonged uncertainty, and highlights the implications of these processes for forensic psychiatric care. Substantiated with the experiences of individuals whose voices are rarely heard, this article delivers a critical analysis of a system in which people risk being lost or caught between equally impossible future perspectives.</div></div>","PeriodicalId":49122,"journal":{"name":"Social Science & Medicine","volume":"392 ","pages":"Article 118984"},"PeriodicalIF":5.0,"publicationDate":"2026-01-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145979823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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