Social Science & Medicine最新文献_第10页

Policing and care in mental health crisis response: Boundary work and the politics of safety and authority 心理健康危机应对中的警务和护理：边界工作和安全和权威政治

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-17 DOI: 10.1016/j.socscimed.2026.118982

Mark D. Fleming , Dani MacVicar , Aoife M. McDermott , Amanda L. Brewster

Demands for alternatives to police responses to mental health crises have driven significant transformations in the frontlines of emergency care. This ethnographic study (2022-2025) analyzes how the boundaries between policing and behavioral health have been negotiated, contested, and reconstructed during the implementation of a large-scale crisis response initiative in California, USA. Taking an ethnographic approach, we demonstrate how boundary work among law enforcement, behavioral health professionals, and organizational leaders unfolds through intertwined dynamics of competition, collaboration, and reconfiguration. Our findings highlight how boundary work is embedded within broader socio-political contexts shaped by advocacy for racial justice, critiques of police violence, and demands for systemic reform. Specifically, we reveal how the frontline enactment of crisis response is characterized by ongoing negotiations around authority, legitimacy, safety, and care, reflecting and reshaping political and ethical debates on criminalization and police reform. This paper contributes to boundary work theory by illustrating how professional and institutional boundaries are dynamic sites of dialectical engagement that both respond to and actively shape contemporary struggles around race, violence, mental health, and justice.

对警察应对心理健康危机的替代方案的需求，推动了急救一线的重大变革。这项民族志研究（2022-2025）分析了在美国加利福尼亚州实施大规模危机应对计划期间，警务和行为健康之间的界限是如何协商、争议和重建的。采用人种学方法，我们展示了执法部门、行为健康专业人员和组织领导者之间的边界如何通过竞争、合作和重组的相互交织的动态展开。我们的研究结果强调了边界工作如何嵌入更广泛的社会政治背景中，这些背景是由倡导种族正义、批评警察暴力和要求系统改革所形成的。具体来说，我们揭示了危机应对的前线制定是如何以围绕权威、合法性、安全和关怀的持续谈判为特征的，反映和重塑了关于刑事定罪和警察改革的政治和伦理辩论。本文通过说明专业和机构边界如何成为辩证参与的动态场所，既回应又积极塑造当代围绕种族、暴力、心理健康和正义的斗争，为边界工作理论做出了贡献。

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引用次数: 0

Contraceptive autonomy of adolescents and young adults in the U.S. South: The influence of healthcare providers, partners, and parents 美国南部青少年和年轻人的避孕自主权：医疗保健提供者、合作伙伴和父母的影响。

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-17 DOI: 10.1016/j.socscimed.2026.118999

Kathleen Broussard , Laura D. Lindberg , Emily S. Mann

A growing body of research describes coercive experiences in contraceptive care in the clinic setting, a phenomenon that disproportionately constrains the contraceptive autonomy of women who are young, low-income, Black, or Latinx. Less research has examined how other social influences may constrain contraceptive use and decision-making. We examine contraceptive autonomy across three domains of interpersonal influence (healthcare providers, sexual partners, and parents) and by race (Black vs. White). Between July–September 2023, we surveyed 1207 Black and White adolescents and young adults (AYAs) assigned female at birth living in five southern states. Over half of all respondents reported feeling social pressure related to their contraceptive use. More respondents spoke with a sexual partner or healthcare provider than with a parent about contraception, but those who did speak with a parent were most likely to report contraceptive pressure. Furthermore, respondents who reported social pressure were less likely to be using their preferred method of contraception. Black (vs. White) AYAs were less likely to have conversations with healthcare providers and sexual partners about contraception; more likely to report social pressure across all interpersonal domains; and less likely to be using their preferred method. By examining social pressures beyond the clinic setting, findings reveal the multifaceted and socially patterned ways that bodily autonomy is constrained for AYAs assigned female at birth and how this is magnified for Black AYAs.

越来越多的研究描述了诊所环境中避孕护理的强制性经历，这种现象不成比例地限制了年轻、低收入、黑人或拉丁裔妇女的避孕自主权。关于其他社会影响如何限制避孕药具的使用和决策的研究较少。我们在人际影响的三个领域（医疗保健提供者、性伴侣和父母）和种族（黑人与白人）中检查避孕自主权。在2023年7月至9月期间，我们调查了1207名出生时被分配为女性的黑人和白人青少年和年轻人（AYAs）。半数以上的答复者报告在使用避孕药具方面感到社会压力。与父母相比，更多的受访者与性伴侣或医疗保健提供者谈论避孕问题，但那些与父母交谈的人最有可能报告避孕压力。此外，报告社会压力的受访者不太可能使用他们首选的避孕方法。黑人（相对于白人）助理医生不太可能与医疗保健提供者和性伴侣就避孕进行对话；更有可能在所有人际关系领域报告社会压力；而且不太可能使用他们喜欢的方法。通过检查诊所环境之外的社会压力，研究结果揭示了多方面和社会模式的方式，即出生时被指定为女性的AYAs身体自主权受到限制，以及黑人AYAs如何放大。

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引用次数: 0

Energy poverty consequences of aggressive tobacco tax policies 激进的烟草税政策造成的能源贫困

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-17 DOI: 10.1016/j.socscimed.2026.119002

MohammadHossein Hadi , Dennis Petrie , Umair Khalil

This paper presents the first empirical evidence linking tobacco tax policies to unintended social consequences in the form of increased energy poverty. We focus on Australia, where smokers face some of the world's highest cigarette prices. We analyse an unanticipated aggressive tax regime implemented in 2010 using a difference-in-differences approach with a nationally representative panel dataset covering 14 years. Our findings indicate significant increases in the incidence of energy poverty among smoking households. Relative to the smoking cohort's pre-policy mean, subjective reports of heating difficulties rose by 24 %, while objective measures increased by 38 % (10 % energy-burden threshold), 15 % (twice-median burden), and 26 % under the Low-Income High Costs (LIHC) measure. Mechanism analyses indicate that reduced energy expenditures and compromised financial stability exacerbate the observed energy poverty. The impacts were particularly pronounced among lower-income families, heavy smokers, and individuals who find quitting hard. This research highlights the complex trade-offs involved in aggressive tobacco taxation and emphasises the need for targeted measures to mitigate the negative consequences on the energy well-being of vulnerable smokers and their families.

本文首次提出了将烟草税政策与能源贫困加剧的意外社会后果联系起来的实证证据。我们关注的是澳大利亚，那里的吸烟者面临着世界上最高的卷烟价格。我们对2010年实施的一项出人意料的激进税收制度进行了分析，采用了差异中的差异方法，并采用了涵盖14年的全国代表性面板数据集。我们的发现表明，在吸烟家庭中，能源贫困的发生率显著增加。相对于吸烟队列政策前的平均值，供暖困难的主观报告增加了24%，而客观测量增加了38%（10%的能源负担阈值），15%（两倍中位数负担），在低收入高成本（LIHC）测量下增加了26%。机制分析表明，能源支出减少和金融稳定受损加剧了所观察到的能源贫困。这种影响在低收入家庭、重度吸烟者和难以戒烟的个人中尤为明显。这项研究强调了积极征收烟草税所涉及的复杂权衡，并强调需要采取有针对性的措施来减轻对弱势吸烟者及其家庭能源健康的负面影响。

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引用次数: 0

Engaging patients in blood systems: A qualitative study on immune globulin recipient perspectives 参与患者血液系统：免疫球蛋白受体视角的定性研究。

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-16 DOI: 10.1016/j.socscimed.2026.118997

Umair Majid , Quinn Grundy , Stephanie Kelly , Kelly Holloway

Background

Plasma-derived medical products (PDMPs) can represent life-saving treatments for immunodeficiencies, autoimmune diseases, and other health conditions. Immunogloublin (Ig) is a PDMP used to treat a large number of inherited or acquired diseases. As the beneficiaries of a highly complex supply chain, recipients of Ig can illuminate the practical implications of supply challenges and policy initiatives on their health and well-being. This study explores the perspectives of Ig recipients.

Methods

This paper stems from a study based on Narrative Inquiry, which delved into the experiences and perspectives of Ig recipients. A two-interview format was employed to capture 1, the recipient's diagnostic journey and challenges, reported elsewhere; and 2, their knowledge, awareness, and engagement in Ig production and distribution. The second interviews were analyzed with reflexive thematic analysis and are reported in this manuscript.

Results

Participants in this study described access to Ig as variable and uncertain. The uncertainty was shaped by the relationships that they negotiated with the other social actors in the blood system. They described feeling bound to their physician as the gatekeeper to a diagnosis, and therefore treatment, and to navigate a complex health system on their behalf. They were deeply grateful for the plasma donor, but when access felt precarious, the reliance on the donor was unsettling due to uncertainty around product availability. Finally, participants felt removed from the process in which decisions were made about treatment.

Conclusions

Our study engaged Ig recipients as important social actors in the systems responsible for collecting and distributing Ig. Participants offered specific and thorough recommendations for meaningful change. Such guidance holds the potential to foster a more integrated environment in which all interest-holders collaborate to meet patient needs more equitably and sustainably.

背景：血浆源性医疗产品（PDMPs）可以代表免疫缺陷、自身免疫性疾病和其他健康状况的救命疗法。免疫球蛋白（Ig）是一种用于治疗大量遗传或获得性疾病的PDMP。作为高度复杂供应链的受益者，Ig的接受者可以阐明供应挑战和政策举措对其健康和福祉的实际影响。本研究探讨了Ig接受者的观点。方法：本文以叙事探究为基础，深入研究Ig接受者的经历和观点。采用两次访谈的形式来捕捉1，接受者的诊断过程和挑战，报告在其他地方；第二，他们在Ig制作和发行方面的知识、意识和参与度。第二次访谈用反身性主题分析进行分析，并在本文中报告。结果：本研究的参与者将获得Ig描述为可变和不确定的。这种不确定性是由他们与血液系统中其他社会参与者谈判的关系形成的。他们认为医生是诊断和治疗的把关人，并代表他们在复杂的卫生系统中导航。他们对血浆捐献者深表感激，但当获得血浆感到不稳定时，由于产品供应的不确定性，对捐献者的依赖令人不安。最后，参与者感到被排除在决定治疗的过程之外。结论：我们的研究将Ig接受者作为负责收集和分发Ig的系统中的重要社会行为者。与会者为有意义的变革提出了具体而彻底的建议。这种指导有可能促进一个更加一体化的环境，在这种环境中，所有利益相关者合作，更公平和可持续地满足患者的需求。

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引用次数: 0

‘They're big and I is small’: The precarious identity reconstruction process of a low-status occupational group “他们大，我小”：低地位职业群体不稳定的身份重建过程。

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-16 DOI: 10.1016/j.socscimed.2026.119000

Marieke van Wieringen

This paper studies how certified nursing assistants (CNAs), as members of a low-status occupational group, engage in identity reconstruction as they attempt to alter their marginalized position within long-term care organizations. Micro-level process data consist of 160 h of participant observations of a professional development programme for CNAs and 130 in-depth interviews with programme participants and their colleagues in care organizations. The findings show that the identity reconstruction process involved four micro-processes: 1) recognizing the dominance of marginalized identity, 2) seeking an upgraded identity, 3) grappling with identity validation and dissociation, 4) experiencing disillusion when struggling to sustain upgraded identity. By capturing these micro-processes, this research contributes, first, by showing that identity reconstruction in low-status occupational groups begins not from a coherent identity under threat but from a fractured, self-diminishing identity, making the recognition of marginality itself a pivotal catalyst for upgrading identity. Second, it conceptualizes how identity reconstruction centers on identity upgrading, surfacing and legitimizing undervalued forms of knowledge, rather than acquiring new roles or competencies. The third contribution lies in revealing that early affirmations can create a false sense of establishment, even complacency, and deter further proactive “work” in asserting and enacting a reconstructed identity within broader organizational contexts, thereby undermining previous identity work done. Taken together, this study offers a more comprehensive understanding of identity reconstruction processes by members of low-status occupational groups, showing its precariousness.

本文研究了注册护理助理（CNAs）作为低地位职业群体的成员，在试图改变其在长期护理组织中的边缘化地位时，如何进行身份重建。微观层面的过程数据包括160小时的参与者对CNAs专业发展计划的观察和130次对计划参与者及其护理组织同事的深入访谈。研究结果表明，身份重建过程包括四个微观过程：1)认识到边缘化身份的主导地位；2)寻求升级的身份；3)与身份验证和分离作斗争；4)在努力维持升级的身份时经历幻灭。通过捕捉这些微观过程，本研究的贡献如下：首先，表明低地位职业群体的身份重建并非始于一种受到威胁的连贯身份，而是始于一种断裂的、自我削弱的身份，这使得对边缘地位的认识本身成为身份升级的关键催化剂。其次，它概念化了身份重建如何以身份升级为中心，使被低估的知识形式浮出水面并合法化，而不是获得新的角色或能力。第三个贡献在于揭示早期的肯定会产生一种虚假的建立感，甚至自满，并阻止在更广泛的组织环境中主张和制定重建身份的进一步积极的“工作”，从而破坏之前所做的身份工作。综上所述，本研究对低地位职业群体成员的身份重建过程提供了更全面的理解，显示了其不稳定性。

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引用次数: 0

Residential segregation of Black and Latinx older adults and brain imaging outcomes 黑人和拉丁裔老年人的居住隔离与脑成像结果

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-16 DOI: 10.1016/j.socscimed.2026.118995

Lilah M. Besser , Sarah Forrester , Diana Mitsova , Pauline Maillard , Charles DeCarli , Rachel Whitmer , Oanh L. Meyer

Ethnoracial segregation has been associated with worse cognitive functioning among Black older adults, while its impact on Latinx individuals is less clear. We investigated whether Black and Latinx older adults living in segregated neighborhoods demonstrate worse magnetic resonance imaging (MRI) outcomes. We used data on participants from the University of California Davis Alzheimer's Disease Research Center. MRI outcomes included hippocampal and white matter hyperintensity (WMH) volumes. Black and Latinx segregation was defined using the Getis-Ord (Gi∗) statistic, which compares the proportion of Black or Latinx residents, respectively, in the participant's Census tract to surrounding neighborhoods and greater study region (higher Gi∗ = greater clustering/segregation). Multivariable linear regression analyses examined associations between Gi∗ segregation measures and MRI outcomes, stratified by the participants' ethnoracial group (Black, Latinx, or White). Participants (n = 269) were on average 74 ± 7 years of age and 24 % were Black, 25 % were Latinx, and 51 % were White. In adjusted analyses, Black participants in more Latinx segregated neighborhoods had lower hippocampal volumes, and Latinx participants in more Black segregated neighborhoods had lower hippocampal volumes. Latinx participants in more Latinx segregated neighborhoods had greater white matter hyperintensity volumes. Overall, Black and Latinx but not White participants living in segregated neighborhoods had worse MRI outcomes. Future studies are needed to replicate our findings in geographically diverse samples and to elucidate the potential psychosocial/social determinant and biological mechanisms that relate segregation to brain health (e.g., Latinx segregated neighborhoods may have fewer recreational and physical activity resources to promote healthy lifestyles).

种族隔离与黑人老年人的认知功能恶化有关，而其对拉丁裔个体的影响尚不清楚。我们调查了居住在隔离社区的黑人和拉丁裔老年人是否表现出更差的磁共振成像（MRI）结果。我们使用的数据来自加州大学戴维斯分校阿尔茨海默病研究中心的参与者。MRI结果包括海马和白质高强度（WMH）体积。黑人和拉丁裔的隔离使用Getis-Ord （Gi∗）统计来定义，该统计将参与者的人口普查区中黑人或拉丁裔居民的比例分别与周围社区和更大的研究区域进行比较（更高的Gi∗=更大的聚集/隔离）。多变量线性回归分析检验了Gi *隔离措施与MRI结果之间的关系，并按参与者的种族群体（黑人、拉丁裔或白人）分层。参与者（n = 269）平均年龄为74±7岁，24%为黑人，25%为拉丁裔，51%为白人。在调整分析中，居住在拉丁裔隔离社区的黑人参与者的海马体体积更低，而居住在黑人隔离社区的拉丁裔参与者的海马体体积更低。居住在拉丁裔隔离社区的拉丁裔参与者有更大的白质高密度体积。总体而言，居住在隔离社区的黑人和拉丁裔参与者的MRI结果更差，而白人参与者则没有。未来的研究需要在地理上不同的样本中复制我们的发现，并阐明隔离与大脑健康相关的潜在社会心理/社会决定因素和生物学机制（例如，拉丁裔隔离社区可能缺乏促进健康生活方式的娱乐和体育活动资源）。

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引用次数: 0

Kinlessness, sole family survivorship, and the mental and physical health of U.S. older adults 美国老年人的亲属关系、家庭唯一幸存者与身心健康。

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-16 DOI: 10.1016/j.socscimed.2026.118996

Susan L. Brown , I-Fen Lin , Francesca A. Marino , Kagan A. Mellencamp

Limited family ties are increasingly common among U.S. older adults. Kinless individuals lack a family of procreation, namely a spouse/partner and children. Sole family survivorship refers to lacking family of origin kin, including parents and siblings. Familial ties are linked to health across the life course and, in line with socioemotional selectivity theory, play an increasingly salient role with age. Consequently, older adults who are kinless or sole family survivors may face worse health outcomes than their counterparts with kin. However, substitution of friends or relatives nearby may mitigate some of the health burden of limited family ties. Drawing on 191,146 person-waves of data from the 1998–2018 Health and Retirement Study, we assessed how these two forms of limited family ties were associated with chronic conditions, (instrumental) activities of daily living (ADL/IADL) limitations, self-rated poor health, and depressive symptoms. Among women, kinlessness was largely unrelated to women's health, only being associated with an increased rate of ADL/IADL difficulties. In contrast, sole family survivorship was positively associated with women's ADL/IADL difficulties, self-rated poor health, and depressive symptoms. Among men, kinlessness was not associated with worse health outcomes. Sole family survivorship was associated with more ADL/IADL difficulties and depressive symptoms among men. Social ties were not uniformly protective of women's and men's health, calling into question the viability of substitutes and underscoring the unique advantages of immediate family ties in later life. Our study demonstrates the utility of examining multiple forms of limited family ties which have distinct ramifications for older adult well-being.

在美国老年人中，有限的家庭关系越来越普遍。无亲属个体缺乏一个生育家庭，即配偶/伴侣和子女。孤家寡人是指没有亲生亲属，包括父母和兄弟姐妹。家庭关系在整个生命过程中都与健康有关，并且与社会情感选择性理论相一致，随着年龄的增长，家庭关系的作用越来越突出。因此，无亲属或唯一家庭幸存者的老年人可能比有亲属的老年人面临更差的健康结果。然而，附近的朋友或亲戚的替代可能减轻一些有限的家庭关系的健康负担。利用1998-2018年健康与退休研究中的191146人波数据，我们评估了这两种形式的有限家庭关系如何与慢性病、（工具性）日常生活活动（ADL/IADL）限制、自评健康状况不佳和抑郁症状相关。在妇女中，无亲属行为基本上与妇女的健康无关，只是与ADL/IADL困难率增加有关。相反，单独的家庭生存与女性的ADL/IADL困难、自评健康状况不佳和抑郁症状呈正相关。在男性中，冷漠与较差的健康结果无关。在男性中，单一家庭生存与更多的ADL/IADL困难和抑郁症状相关。社会关系并不能完全保护妇女和男子的健康，这使人们怀疑替代品的可行性，并强调了直系家庭关系在晚年生活中的独特优势。我们的研究证明了检验多种形式的有限家庭关系的效用，这些家庭关系对老年人的福祉有明显的影响。

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引用次数: 0

The impact of media coverage of a celebrity suicide on suicide and attempted suicide rates in Taiwan 媒体报导名人自杀对台湾自杀率及企图自杀率的影响。

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-16 DOI: 10.1016/j.socscimed.2026.118994

Ying-Yeh Chen , Vera Yu Men , Cheuk Yui Yeung , Kevin Chien-Chang Wu , Ying-Chen Chi , Paul SF. Yip

Media coverage of celebrity suicides can shape population-level suicidal behavior, yet most existing evidence focuses on mortality rather than non-fatal attempts. This study investigates the impact of media coverage following the suicide of Chiung Yao, an 86-year-old best-selling novelist and cultural figure in Chinese-speaking societies, on suicide mortality and suicide attempts in Taiwan.

We drew on suicide attempt data from Taiwan's National Suicide Surveillance System and mortality data from the Taiwan Death Registry. Using an interrupted time-series design with quasi-Poisson regression, we analyzed seven-day rolling counts of suicide attempts and deaths during the four weeks before and after her death (December 4th, 2024), stratified by sex, age group, and suicide method.

No significant overall changes in suicide attempts or mortality were observed. However, suicide attempts increased by 12.3 % among women aged 45–64 (IRR = 1.123; 95 % CI: 1.030–1.225), with a slight increase of the post-death trend among women aged 25–44. Suicide deaths by charcoal burning, the method used by the celebrity, increased by 47.0 % (IRR = 1.470; 95 % CI: 1.195–1.807), and mortality among men aged 25–44 and ≥65 rose by 35.5 % (IRR = 1.355; 95 % CI: 1.095–1.679) and 20.7 % (IRR = 1.207; 95 % CI: 0.992–1.468), respectively.

Media coverage of the suicide of an older celebrity was not associated with population-level increases in suicide, but associated with method- and subgroup-specific changes in suicide attempts and mortality. These findings highlight the importance of monitoring media practices with attention to differential vulnerability following highly publicized suicides.

媒体对名人自杀的报道可以影响大众层面的自杀行为，然而，大多数现有证据关注的是死亡率，而不是非致命性的自杀企图。摘要本研究探讨台湾86岁畅销小说家、华语社会文化人物琼瑶自杀事件后，媒体报导对台湾自杀死亡率及自杀企图的影响。使用准泊松回归的中断时间序列设计，我们分析了她死亡前后（2024年12月4日）四周内7天的自杀企图和死亡滚动计数，并按性别、年龄组和自杀方式分层。在自杀企图和死亡率方面没有观察到明显的总体变化。然而，45-64岁妇女的自杀企图增加了12.3% (IRR = 1.123; 95% CI: 1.030-1.225)， 25-44岁妇女的死后趋势略有增加。名人使用的燃烧木炭自杀死亡人数增加了47.0% (IRR = 1.470; 95% CI: 1.195-1.807)， 25-44岁和≥65岁男性的死亡率分别增加了35.5% （IRR = 1.355; 95% CI: 1.095-1.679）和20.7% （IRR = 1.207; 95% CI: 0.992-1.468）。媒体对年长名人自杀的报道与人口自杀率的上升无关，但与方法和亚群体特定的自杀企图和死亡率的变化有关。这些发现强调了监测媒体做法的重要性，并注意高度宣传自杀后的不同脆弱性。

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引用次数: 0

Towards a care continuum: A socio-material analysis of intra-acting public-private maternity care in South Africa 迈向护理连续体：对南非公私产科护理的社会物质分析

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-16 DOI: 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.

2017年至2019年期间，通过对7名产科医生和14名孕妇的观察和访谈，这项针对南非开普敦私营部门产科的多地点人种志研究产生了比较公共部门的数据，为重要的健康学术贡献了力量。在提供和获得优质产科护理方面根深蒂固的不平等现象是由生育政治引起的，这对非洲实现全民保健的更广泛的社会运动和治理方法具有重要意义。南非几乎普及了产妇保健，是了解私营部门可能对旨在巩固全民保健服务的国民健康保险改革作出贡献的一个重要研究案例。借鉴女权主义新唯物主义理论和社会物质分析，我概述了一个护理连续体，我用它来询问护理的逻辑，阐明了一个相互依存但又一分为二的卫生系统。作为两极，护理连续体的两端是一般的公共部门和个性化的私营部门。连续体有助于证明护理中的物质、经验和话语差异不是预先存在的，而是主动相关的，这意味着它们的差异是通过相关性产生和维持的。我通过观察产科实践、病人和提供者的运动、服务的空间性和护理的临时性来说明这一点，从而提出公私产科护理的界限是通过相互纠缠而共同产生的。

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引用次数: 0

Area-socioeconomic disadvantage and cognitive function among Chinese older adults: the mediating role of healthcare resources and the moderating role of individual socioeconomic status 中国老年人的地区-社会经济劣势与认知功能：医疗资源的中介作用和个体社会经济地位的调节作用

IF 5 2区医学 Q1 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Social Science & Medicine

Pub Date : 2026-01-14 DOI: 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.

目的研究城市社会经济地位（SES）与中国老年人认知功能的关系，并探讨医疗资源的中介作用和个体社会经济地位的调节作用。方法采用2018年中国健康与退休纵向研究的数据，提供个体认知功能和人口统计学特征。地区一级的社会经济状况和保健资源指标是从国家统计来源获得的。来自123个城市的9520名60岁及以上的老年人被纳入分析。采用多水平调节的中介模型，并按性别进行亚组分析。结果个体和区域SES水平与认知功能呈正相关。医疗资源的多层次中介模型表明，只有医生密度（即医院或床位供应）部分中介了区域水平SES与认知功能之间的关联。在引入个体社会经济地位作为调节因素后，低社会经济地位个体的医疗人力资源的认知效益大于高社会经济地位个体。然而，在样本组成和认知测量的差异中，这种调节效应的证据并不一致。性别分层分析进一步显示，没有明确的证据支持基于个体的ses对男性或女性的调节作用。结论本研究结果强调了区域经济地位和医疗人力资源塑造老年认知的事实，提示以公平为重点的政策可以解决结构性劣势，以减少认知老龄化的差异。

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