Showing papers in "Health Sociology Review in 2012"

Understanding and addressing the stigma of mental illness with ethnic minority communities

Abstract: Higher income societies have moved from institutional to community-based care for people experiencing mental illness. However, stigma and discrimination persists and undermines help-seeking, recovery and life chances. Mental illness prevalence is higher amongst communities that face multiple prejudices and disadvantages within society, including Black and minority ethnic communities who may experience migration trauma, racism, acculturation and adverse social circumstances. This study examines beliefs, stigma and the effectiveness of existing national mental health campaigns with Pakistani, Indian and Chinese heritage communities in Scotland, UK, using community based participatory research. Community organisers were trained and supported to co-facilitate focus groups with 87 people using a range of languages. Whilst diversity within and between communities was apparent, important trends emerged. People with mental illness experience high levels of stigma from communities. Families experience sign...

Bringing our dying home: How caring for someone at end of life builds social capital and develops compassionate communities

Abstract: In this article we discuss the ‘bringing our dying home’ research project which contributes to an understanding of caring at end of life (EOL) as potentially increasing social networks and community capacity. The main aims of the research were to illuminate the quality and effect of informal caring networks that are established, or strengthened, as a result of caring for a person dying at home and to understand how being involved in such a caring network impacts family, friends and the wider community. Using photo voice and network mapping in focus groups and interviews we collected 94 visual and oral narratives of caring and support. We found: people who engaged in acts of resistance to the Western expert-based approach to EOL care; that carers successfully mobilised and negotiated complex webs of relationships; and, that embodied learning about caring contributed to the development of social capital and compassionate communities.

Aboriginal perspectives of child health and wellbeing in an urban setting: Developing a conceptual framework

Abstract: Health and wellbeing is defined internationally as a multi-dimensional and holistic concept, particularly within Indigenous worldviews. However, in Australia there is a lack of detailed frameworks supporting such definitions that are founded on Aboriginal knowledges. This study aimed to explore Aboriginal perspectives of child health and wellbeing in an urban setting. Qualitative interviews with 25 care-givers of Aboriginal children living in Melbourne, Australia were conducted. Aboriginal people and community controlled organisations were collaborative partners in all stages of the research. A conceptual framework of Aboriginal child health and wellbeing in an urban setting was developed comprising four main themes: Strong Culture; Strong Child; Strong Environment; and Strengths and Challenges. Aboriginal conceptions of culture are considered central to Aboriginal child health and wellbeing in an urban context. A holistic framework that privileges Aboriginal knowledge of child health and wellbein...

Death and Grief On-Line: Virtual Memorialization and Changing Concepts of Childhood Death and Parental Bereavement on the Internet

Abstract: ‘Virtual memorials’ intended to memorialize the lives of children imply significant shifts in the conceptualization of death, particularly for grieving parents. Created by parents in memory of their deceased children, on-line memorials constructed using templates reflect strong cultural beliefs about the nature of childhood deaths, grief and the development of a kind of digital afterlife. Virtual memorials create a new social value for the deceased, and shift death and bereavement from private into more public experiences. Building upon this work, we describe a kind of ‘on-line immortality’ created through virtual memorials where the virtual presence of the deceased in text and images, and practices intended to sustain a relationship with the deceased, can extend bereavement and the social lives of the dead indefinitely. While such memorials can offer solace, they also potentiate business opportunities for those hoping to create lasting customers. As such, they may also extend mourning indefinitel...

Towards a holistic understanding of poverty: a new multidimensional measure of poverty for Australia

Abstract: This paper draws upon literature from economics, and the human capital and equity fields in order to present a theoretical framework for a new multidimensional measure of poverty for Australia. Pov...

The determinants of female circumcision among adolescents from communities that practice female circumcision in two Nairobi informal settlements

Abstract: Using data from the Nairobi Urban Health and Demographic Surveillance System (NUHDSS), this paper seeks to understand the characteristics of adolescent girls who are circumcised in Kenya. The paper discusses the determinants of female circumcision in two Nairobi informal settlements. It is based on detailed information collected from young persons aged 12-24 targeting major transition events such as first sex, childbirth, marriage, and circumcision. Out of 4058 adolescents and young people interviewed 2010 were adolescent girls and young women. Out of the total number of interviewees, the 527 girls and young women on whom this paper is based are from ethnic communities that practice circumcision. We used the life-table technique to estimate the median age at circumcision and logistic regression to analyse the relationship between female circumcision and adolescent sexuality, controlling for other characteristics. The type of stay within the demographic surveillance area (DSA), religion, ethnicity, residential location and mother's education were associated with being circumcised. Current school attendance was not associated with being circumcised but if one had never attended school then they were more likely to be circumcised. For policy making, it is imperative to explore the nature of social networks within which circumcision decisions are taken and enforced.

At special risk: Biopolitical vulnerability and HIV/STI syndemics among women

Abstract: Women are at special risk for HIV/AIDS infection and disease progression due to an inter-related set of biopolitical factors. Biological factors that contribute to women’s special vulnerability inc...

Older people's perceived health and wellbeing: The contribution of peer-run community-based organisations

Abstract: Qualitative research discussed shows that older people's peer-run community organisations can play an important role in promoting social engagement, which assists members to cope with the transitions and losses common to growing old. Findings revealed that perceptions of health and wellbeing appeared to be unrelated to living with various medical conditions. The study explored members' reasons for joining, their experiences in the organisation and whether what they experienced met their expectations. Companionship, mutual support, a choice of enjoyable activities, and the opportunity to contribute life-time knowledge and skills to the running of the group helped to foster feelings of wellbeing, resilience and coping. At a time when neo-liberal discourses in health policy are shifting the responsibility for ‘positive ageing' on to the consumer/citizen, community-based organisations, particularly those run by older people for their peers, may have an important role to play in promoting community health, and deserve greater government support.

Rethinking safety and fidelity: The role of love and intimacy in Hepatitis C transmission and prevention

Abstract: Hepatitis C (HCV) is a disease of the liver with a range of potentially debilitating symptoms, the severity of which differ from person to person HCV is a major public health challenge Globally an estimated one in 12 persons is affected by the virus, and substantial new transmissions occur each year The vast majority of new transmissions occur among people who inject drugs, particularly through practices such as sharing of needles, syringes and other injecting equipment Behavioural surveillance data suggest that the majority of equipment sharing occurs between intimate partners Despite this, very little research has focussed on intimate partnerships as a site of hepatitis C transmission or prevention This is in part because people who inject drugs are conventionally represented as lacking capacity for romantic love and intimacy; also, drug 'addiction' is produced as the antithesis of voluntarity, autonomy and authenticity, all of which feature strongly in Western understandings of romantic love This study aims to fill existing gaps in the literature about the relationship between romantic love and injecting drug use (IDU) and to explore injecting drug practices among partners in intimate relationships Fifteen people who inject drugs, currently in long-term heterosexual relationships, were recruited for in-depth interviews, which were recorded, transcribed verbatim and analysed thematically The main findings of this study are that romantic love and intimacy figure prominently in the lives of people who inject drugs, and that romantic notions such as commitment, trust, care and support shape how individuals who inject drugs talk about serostatus with their partners and how they account for injecting practices Moreover, injecting practices are co-produced within intimate relationships, shaped by perceptions of risk within and outside the relationship, ideas of intimacy, and the specific levels of skill and expertise within these relationships These findings have important implications for harm reduction strategies, which, we suggest, have largely failed to take into account the intimate relationship as a source of practice We conclude with suggestions for future work in this area

'Gaining the right amount for my baby': Young pregnant women's discursive constructions of health

Abstract: In Canada, obesity is increasingly emphasised as a ‘risk’ to the health of mother and foetus. At a time when pregnant women are under greater pressure to personally uphold the health of their foetus, understanding the impact of the discourse surrounding obesity and health on young pregnant women is critical. Using a feminist poststructuralist discourse analysis, we explore how pregnant young women construct their subjectivities either within dominant discourse on health and obesity or possibly resistant discourses. Open-ended interviews were conducted with 15 pregnant women between the ages of 18 and 28, coming from various socioeconomic and educational backgrounds in the Ottawa region. The analysis reveals that these women constitute themselves as complex, fragmented subjects who at times construct themselves within alternative and resistant discourses but generally reproduce dominant discourses of obesity, of individual and moral responsibility for health, and of maternal responsibility for foet...

Strengths and Challenges for Koori Kids: Harder for Koori Kids, Koori Kids doing well – Exploring Aboriginal perspectives on social determinants of Aboriginal child health and wellbeing

Abstract: This study explored Aboriginal perspectives of child health and wellbeing in an urban area in partnership with Aboriginal people and organisations. In depth interviews were conducted with 25 grandparents, parents, aunties or uncles of Aboriginal children. Interviews were transcribed and thematically analysed. A major conceptual theme was related to social, historical, and political factors seen by participants as influencing urban Aboriginal child health and wellbeing. This theme was called ‘Strengths and Challenges: Harder for Koori Kids/Koori Kids Doing Well’. Increased challenges to achieving good health and wellbeing faced by Aboriginal children due to factors in their social, historical and political environment were emphasised. Many of these factors can be related back to historical and contemporary forms of racism. On the other hand, there was also a clear call to recognise and celebrate that many Aboriginal children were doing well in the context of these added challenges.

New age orientalism: Ayurvedic ‘wellness and spa culture’

Abstract: The branding of ayurveda as a market strategy for the health consumer has become an important factor in the creation of ‘New Age orientalist desire’. Using Vedic Village as a case, this paper shows...

Seventeen and stressed - Do gender and class matter?

Abstract: Despite concerns about stress levels in young people, research about stress and stressors among boys and girls that apply an intersectionality approach is scarce. This cross-sectional study explored gender, class (indicated by academic orientation) and multi-group (gender/class) patterning of perceived stress and reported stressors in a sample of 1,663 17-year-old Swedish students. The students, especially girls, were highly stressed. No class differences were found. Performance-related stressors were predominately indicated by students in academic programmes and girls (regardless of class). Looks-related stress was more common among girls than boys, whilst economic and relational stressors were mostly indicated by vocational programme students, particularly girls. There was a complex gender and class patterning of stress due to demands and lack of money. The interplay of gender and class should be acknowledged in identifying determinants of stress in young people. Possible implications for mental health are discussed.

Differential ratings and associations with well-being of character strengths in two communities

Abstract: Strengths are presumed to be universal characteristics that are possessed by all people and explain wellbeing. However, a few previous studies have demonstrated cultural differences in endorsement of certain strengths and in the contribution of certain strengths to well-being. These studies suggest that sociological factors may differentially affect strength endorsement and associations with well-being. In this study, we examined differences in personal strength endorsement and associations with well-being between two distinct Israeli community samples: (1) 97 religious female youth-leaders aged 18-20; and (2) 100 secular male police investigators aged 23-50. All participants completed the Virtues in Action survey and the well-being scale of the Mental Health Inventory. Results revealed significant differences between the samples on the ratings of eight strengths, and on the strengths most highly associated with well-being. The differential relevance of certain strengths to specific communities and their members' well-being is discussed.

Cochrane reviews and the behavioural turn in evidence-based medicine

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Tracking the career decisions and experience of migrant elites: The case of South African-trained medical professionals in the Australian labour market

Abstract: Our paper analyses and explains the migration decision and labour market experience of migrant elites, by drawing on the case of South African-trained doctors in Australia. In doing so, we expand on the limited conceptualisation of skilled migration to which we offer a different interpretation by drawing on a multi-scale and integrated model of analysis tracing the experience of this group over a 60-year period. The research is informed by a sample of almost 500 culturally diverse South African-trained male and female medical practitioners migrating to and working in Australia from the 1950s through to 2009. Through an iterative process of analysing empirical findings and simultaneously examining the policy and scholarship on medical migration, we refine the concept of migrant elite as a category of skilled migration and respond to an absence we have identified in the scholarship and policy terrain.

Intercultural communications in remote Aboriginal Australian communities: What works in dementia education and management?

Abstract: Dementia education and management is a major challenge nationally. However in the remote Aboriginal context, where the prevalence of dementia is five times greater than the national rate, the challenge is made more complex by cultural and linguistic differences between providers and consumers. This paper presents findings from the evaluation of a targeted dementia awareness resource piloted in three Aboriginal languages as well as English. It focuses on the intercultural communication aspects of the evaluation adding to the limited body of knowledge about communications with speakers of Australian Aboriginal languages. It identifies elements of effective intercultural communication in dementia education, implications for health literacy and considers the difference that culturally safe intercultural communication can make to a single issue such as dementia awareness.

Chronic Illness and Informal Carers: 'Non-Persons' in the Health System, Neither Carers, Workers or Citizens

Abstract: I give an account of disquieting experiences in relation to my treatment and those with chronic illness in the acute system during my 5 years' experience as an informal caregiver. People with chronic illness (and their caregivers), particularly stroke survivors face a biased, frustrating and even dangerous acute care hospital system where they are second class. Well-being and stability from rehabilitation and self-management can be undermined. Dow and McDonald's (2007) concept: 'disenfranchised care contractors' within early discharge and 'hospital in the home' programs is generalised more broadly. The studies that initiated Hospital at Home programs are scrutinised. The Australian medical system relies on informal carers in a fundamental way but still does not identify or acknowledge them despite the presence of laws such as the Carers Recognition Act (2005). A new concept argues informal caregivers 'do social bonds' at a deep level, weaving the social fabric into a denser structure. But as part of the private world, the formal system treats them routinely with disrespect and they can be manipulated to obtain their participation in early discharge programs and long term care.

Health, wealth and poverty in developing countries: Beyond the State, market, and civil society

Abstract: Poor health and disease and the nature of interventions to ameliorate them typically generate opportunities and costs. What diseases are prevalent, which interventions are favoured and what factors fuel the nature of health interventions are recurrent concerns for political economists. This paper examines the prevailing viewpoints about what health policy works and what does not. Drawing on evidence from developing countries, it shows that there are many deficiencies in the prevailing orthodoxy which emphasises state, market, and civil society solutions. The paper suggests that health policy debate must be reframed around poverty and social inequality, constructs which are often subordinated to attaining grand ideological goals.

The Differential Incorporation of CAM into the Medical Establishment: The Case of Acupuncture and Homeopathy in Portugal

Abstract: This paper examines the differential incorporation of acupuncture and homeopathy into the medical establishment in Portugal. While the former has been incorporated into the medical establishment, the latter is still banned by the Medical Council, yet remains in practice by medical doctors in the country. Drawing on the insider viewpoints of medical doctors committed to these two therapies, the findings of this paper suggest that the rhetoric of insufficient scientific evidence of homeopathy still prevails within the medical establishment. However, two other factors were emphasised: the medical prejudice or 'resistance to innovation' of the Portuguese Medical Council and the idiosyncrasies of acupuncture and homeopathy, which have made them amendable to biomedicine (or not). This paper argues that the differential responses of the Portuguese medical establishment to acupuncture and homeopathy are due to reasons beyond that given of the medical rhetoric of insuffi cient scientific evidence for homeopathy, and which extend to issues of professional status and power. This paper suggests that the emerging commercial interest of the pharmaceutical industry in homeopathy's pharmacopeia worldwide could enhance homeopathy's status in the country and could therefore pressurise the medical orthodoxy to redress its position towards this therapy.

It hinges on the door: Time, spaces and identity in Australian Aboriginal Health Services

Abstract: This paper explores how the structuring of places and time influence Aboriginal and Torres Strait Islander patient and carer experiences of health services. Face-to-face in-depth interviews were conducted with urban Aboriginal and Torres Strait Islander people with diabetes, chronic heart failure or chronic obstructive pulmonary disease as well as family carers (N = 19). Content analysis was undertaken. Participants report that each element of the time spent in Aboriginal Medical Services is seen as more valuable and worthwhile than in mainstream health services, from social and health sharing experiences in the waiting room to health care in clinical places; and that users feel they can rely on sufficient time and respectful care in their clinical consultation. Purposeful design of both physical and temporal aspects of health services is called for. We suggest re-introducing opportunities for spatiotemporal design in health care that have been limited by the segmented ‘person as illness’ design f...

Understanding parental health literacy and food related parenting practices

Abstract: Health literacy, which relates to the acquisition, understanding and application of health information, has become an increasingly important public health issue, particularly where parents and children are concerned. Given that the home setting comprises a strong influence on children's diets, this qualitative study explored the concept of health literacy using parents' experiences with health information seeking and food related parenting practices. Semi-structured focus groups and in-depth interviews were conducted with parents, with children aged from birth to 12 years, in a low socio-economic region of South Australia. The results of this study indicated that there were a number of perceived barriers to accessing, understanding and utilising health information related to children's nutrition. These findings contribute to a broader understanding of how parents obtain and process dietary information and the channels through which they appear to be accessible.

Death, working-class culture and social distinction

Abstract: Following Howarth (2007), this paper examines the relationship between class culture and social distinction in the empirical area of death and dying. For Howarth (2007), the sociological neglect of the end-of-life cultural practices of working-class people carries the danger 'of privileging middle-class agendas for change, ... [t]here is an urgent need for further studies ... and a refinement of existing research to draw out social class distinctions' (p. 433). Drawing on Howarth (2007), and Bourdieu (1984), it is argued below that the connection between death and class reflects and helps to reproduce class-based identities, advantages and conflicts. Whilst class culture can be a supportive resource for working-class people, for example, in ways which reflect solidarity, more typically the classed nature of death brings acute suffering. Relatedly, it is proposed that stereotypes of declining respectability are reflected in some middle-class conceptions of working-class practices and identity connected to death. Such thinking socially positions working-class tastes as objects of disgust, and working-class people as disgusting subjects. It is concluded that, whilst Howarth's call is much warranted, the debate also needs to problematise the normalisation of middle-class ways to die and grieve.

Dreaming the impossible dream : ordering risks in Australian maternity care policies

Abstract: Explaining the trajectory of Australian health policies over the last century requires an analysis of different political regimes and their dreams of order for managing risk. Crook reverses the Beckian axiom that risk is the unintended outcome of the failure of industrial societies, arguing for an understanding of risk within a Foucauldian and Actor Network Theory of governmentality. Risk becomes a mechanism for the realisation of different dreams of order. The welfare state was the risk management mechanism of organised capitalism. Individual aspirations of reflexive individuals form the risk management mechanism of neo-liberal regimes. As competing risk discourses destabilise the field of maternity care, key actors (including doctors, midwives, women and policymakers) form themselves into neo-traditional communities in ongoing struggles to have their risk claims institutionalised within policies and protocols that further legitimise their interests. These struggles around risk and power are evid...

From poverty to poor health: Analysis of socio-economic pathways influencing health status in rural households of Ghana

Abstract: The need for the poor, the marginalised and socially excluded to live healthier and longer lives has in recent times become paramount in the development literature and policy discussions seeking to achieve the Millennium Development Goals (MDGs). In response to this, attempts are being made to redirect the research focus to examine socio-economic factors underpinning disease occurrence and ill health for health planning policies and practices to benefit the poor and vulnerable in society. This paper explores the relationship between socio-economic conditions and health outcomes. It identifies and examines through participatory rural assessment techniques, basic socio-economic factors acting as significant pathways through which poverty increases the susceptibility of rural households to diseases. It seeks to address the reasons why the poor are poorer in health in rural communities of the Amansie West district of Ghana. This paper thus emphasises how social stratification and inequalities could af...

Health, freedom and work in rural Victoria: The impact of labour market casualisation on health and wellbeing

Abstract: This paper presents the findings of a qualitative study of the impact of casualised and independent contractor work place arrangements on the psycho-social health of 72 workers in regional Victoria. It contributes to our understanding of the crisis in rural Australia in its use of qualitative methods focusing on the impact of work on health and well-being. There is some evidence in the literature that casualised work arrangement enhance the health and well-being of workers by giving them a sense of autonomy and freedom to negotiate their conditions of work. On the other hand, these arrangements may make an already vulnerable group even more vulnerable to uncertain work conditions, poor pay and uncertainty for their future with a significantly negative impact on their health and wellbeing. The results of these interviews support this latter perspective and show that these workers do not experience freedom and autonomy, but rather lowered social status, insecurity and serious limitations to their ability to manage their health, psychological wellbeing and social relations.

Health and functional capacity – Capturing capability limitations in measures of health

Abstract: This paper explores which measures of health accurately refl ect the functional capabilities of individuals - that is, in what measures of health do those classified as having poorer health actually have poorer functional outcomes. Using the 2003 Survey of Disability, Ageing and Carers, cross-tabulations, chi-squared analysis, and logistic regression models were used to identify the relationship between functional outcomes (core activity limitations and employment and education participation) and various measures of health and disability (composite disability measure, health utility scores and general health assessment). Both the composite disability measure and the health utility score accurately capture individual functional capacity - with both measures being related to employment participation, employment and education restrictions, and core activity imitations. The health utility scores can also be divided into a categorical measure and still reflect this functional capacity. The general health assessment measure is also related to functional capacity and can potentially be used in the place of both the composite disability measure and the health utility score.

Emotions and the research interview: What hospice workers can teach us

Abstract: Interviewing about death and loss can bring up unexpected emotions for respondents and interviewers. Positivist social scientific research methods often either ignore the emotions of the researcher, or argue that emotional expressions are to be avoided in research, even when the topic is thought to inspire intense feelings – like death and dying. This article argues for taking an alternative position toward emotions in death and dying research. Using data from over two years of participant observation and 34 semi-structured interviews with hospice workers, I illustrate one potential way to productively and ethically share emotions during a research interview. This approach includes learning and being open to the ‘moderated cry’, which involves minimal tears, the absence of sobbing, and an overt acknowledgment of the emotional reaction. This article illustrates the ways respondents in this research used the moderated cry as well as the value of reconsidering prohibitions on emotions in research.

The birth of a speciality: The sociology of health and medicine in Australia

Abstract: This paper offers a study of the specialist field of the sociology of health and medicine, and examines its institutional development in Australia. A thesis is developed about the relationship between the field and the parent discipline of sociology. The formation of the discipline and the specialist field are proposed to have occurred in stages: the formative years, a period of inter-disciplinarity and collaboration, a stage of intensification and organisation, the years of institutional growth and specialisation, the decade of consolidation and fragmentation, and, its most recent phase, a time of ‘new’ internationalisation. Moreover, the institutionalisation of the sociology of health and medicine has closely followed the developmental trajectory of its parent discipline, even though its disciplinary boundaries have been, and continue to be, less rigid.

Constructing the placebo effect in the placebo wars: What is the way ahead?

Abstract: The concept of placebo has had a long history in medicine, and has evolved over time with the introduction of randomized controlled trials for health treatments, the increasing research done around the psychotherapies, the development of complementary and alternative medicine (CAM) approaches to health, as well as the conceptual contributions from academic disciplines like psychology and anthropology. In recent years, discourses about placebo have pursued a number of key directions, and the current review paper explores these developments. For example, psychology has looked at placebo in terms of classical conditioning and the role of anxiety. Anthropology on the other hand has focused on the role of meaning and ritual in the placebo effect and psychotherapy research has encouraged an examination of the effects of the therapeutic relationship. Our review paper concludes by outlining directions ahead for future scholarship and research.