Social science & medicine. Part A, Medical sociology最新文献

The place of the social sciences in dentistry has to be seen within the context of an evolving and constantly expanding dental division of labour. In the first phase of this evolutionary process the biomedical sciences were harnessed to the dental task and ruled virtually unchallenged for nearly fifty years, though the influence of the social sciences was evident at an early stage in the field of dental epidemiology.

In a second phase in the scientific maturing of dentistry the social sciences were increasingly drawn in to aid in certain specific areas, such as the management of patients and dental resources and the organisation and delivery of care. A third stage can now be identified in the relationship between dentistry and the social sciences, with the emergence of a tradition of more critical and reflexive research in the dental field.

In conclusion, it is argued that the present application of the social sciences serves largely to intensify the predominant personal service and treatment orientation current in dentistry. The greatest opportunity for a qualitative change in the impact of the social sciences, therefore, lies in the transition of dentistry from its predominant focus on individual treatment to a broader concern with the more global oral health needs of entire communities.

Social workers and general medical practitioners have suggested that differences in time orientations are a source of conflict in inter-occupational collaboration. Little attempt has been made to elaborate these differences. Arising from the author's development of a model of inter-occupational relationships, this article presents an analysis of the contrasting time orientations of these two occupations. Divided into three sections, the first deals with their manifestation in one aspect of the work orientation of social workers and general practitioners, the second with their relationship to the nature of work done in each occupation, and particularly to the nature of practitioner relationships with patients or clients, the third with their relationship to the type of income enjoyed by each profession and its impact on the development of effective inter-occupational collaboration. Illustrations of the manifestation and impact of these differences are derived from a social work attachment project conducted in Sydney, Australia.

The regional variations in age/sex standardized rates of common surgical operations in three countries are examined. Large differences between these countries are noted and possible explanations are examined. In England and Wales the extent to which particular surgical rates are related to indices of medical supply by Regional Health Authority are examined in detail. Overall hospital sector funding, relative to norms of medical “need”, are seen to be strongly positively related to many operation rates indicating a dependence on supply factors. The role of manpower levels in explaining utilization rates is examined in some detail to compare with empirical observations made in North America. Generally in a National Health Service context numbers of surgeons or general practitioners are not as strongly related as in the United States.

Finally these observations are examined in the context of previous work particularly on the role and nature of supply or induced demand.

This paper examines the structure and functioning of both the traditional Chinese and the modern Western medical care services in the rural areas of the People's Republic of China. Data were drawn from the in-depth interviews and non-participant observations during a field visit to the Toushan Commune of Kwangtung Province in May 1978.

It was found that a variety of Chinese and Western medical services were systematically organized in terms of the three-level principle of administration, and were made available for use by the peasants living in different regions of the commune. There is a constant flow of patients and health resources among the three levels, i.e. the commune health clinic, the brigade medical stations, and the auxiliary health workers of the production teams. It is argued that (a) some organizational principles of the rural commune have facilitated the mobilization and organization not only of the Western but also of the Chinese medical resources in the rural areas, and (b) the incorporation of Chinese medical care into the organized health system has political as well as technical, cultural and economic implications.

The paper is concerned with the WHO-UNICEF suggestion to train indigenous healers to be first-line deliverers of medical care. Rather than evaluate this proposal directly, the paper concentrates instead on the factors currently influencing the relationship between indigenous and Western medicine. A framework, viewing the potential health impact of the use of indigenous healers, is constructed through the comparative method [6]. Data reviewed consists of monographs, journal articles, dissertations. etc., and considers historical, cultural, and political theories of the status of native medicine. The paper concludes that the politics of health care is a greater impediment to the provision of “health care for all” in some types of political economic systems than in others. Thus events in the health care system as seen as influenced by the larger socio-political system.

An attempt is made to place the medical public health system of societies essentially in the political economic, rather than, cultural contexts of those societies. The ambiguity of efficacy is recognized both for modern (M) and traditional (T) medicine. Thus the definition of the medical public health situation is placed largely within the power structure of the nation state. In this structure, a medical public health cultural hegemony is seen as paralleling the overall hegemony which maintains social control and otherwise fosters the interests of the ruling class. The mix of M and T elements, their degree of integration, and their availability and use by different classes is seen as related to resource levels and whether a country is socialist or capitalist oriented. Whatever the medical mix, a set of social control functions are suggested: take over; system maintenance; control of actual or potential dissidents; and cooling out. In support of the liberation struggle, the medical public health system passes into new hands and takes on a new mix of T and M with a new emphasis. With the question of efficacy still open. it is suggested that the mix of T and M may not matter as much for health as the control and distribution of resources in society.

It is preferred to use the terms indigenous systems of medicine to traditional medicine and Western system of medicine to modern medicine. Interrelationships of these two categories are a function of the interplay of social, economic and political forces in the community. Western medicine was used as a political weapon by the colonialists—to strengthen the oppressing classes, and to weaken the oppressed classes by denying them access to the Western system of medicine and by contributing to the decay and degeneration of the pre-existing indigenous systems of medicine. This Western and privileged class orientation of the health services has been actively perpetuated and promoted by the post-colonial leadership of India. The issue in formulating an alternative health care system for India is essentially that of rectifying the distortions which have been brought about by various forces. The basic premise for such an alternative will be to start with the people. Action in this field will lead to a more harmonious mix between the indigenous and the Western systems of medicine.

After reviewing the wide variety of medical systems available to inhabitants of the Ivory Coast, the results of utilization surveys of town and village residents are presented. They support the position that the choice of therapy depends more on its accessibility than on any characteristics of the individual patient. The accessibility of the different kinds of medicine is analyzed in terms of time delay, cost, and communication problems, and reasons for the inaccessibility of Western services are discussed. The choice of Western medicine is inhibited not by “unscientific attitudes”, as many social scientists have suggested, but rather by the political and economic forces which limit the usefulness of these services and by the availability of attractive alternatives.

Employing an historical approach, the Navajo Indian Reservation is understood as an under-developed nation. The consequences are examined in terms of demographic response, organization and utilization of health services, and employment patterns within the service sector generally and in health care specifically. In some respects, the health and other services come to serve as a misplaced target for the Indians' anger and frustration which might be better directed toward more fundamental concerns such as control of natural resource extraction, control of local business and industry, etc. The focus on health may also teach people that their problems are personal, which they are not.

Malaysia has a large variety of traditional medical systems that are a direct reflection of the wide ethnic diversity of its population. These can be grouped into four basic varieties, namely, traditional “native”, traditional Chinese, traditional Indian, and modern medicine, examples of which are described. In spite of the great inroads made by modern medicine, the traditional systems are firmly established. Patients move from one system to another or use several systems simultaneously. The integration of the traditional Malay birth attendant into the health team is described. The forces influencing the development, acceptance, and integration of the medical systems are discussed.