Sociology of Health and Illness

Tóm tắt Để hiểu về sự bất bình đẳng trong sức khỏe giữa các dân tộc, chúng ta phải xem xét mối quan hệ giữa tình trạng thiểu số dân tộc, bất lợi cấu trúc và quyền tự quyết. Đến nay, các tác động trực tiếp của áp bức chủng tộc đối với sức khỏe, cũng như vai trò của bản sắc dân tộc - một phần là sản phẩm của quyền tự quyết - đã bị bỏ qua. Chúng tôi đặt mục tiêu khắc phục sự thiếu sót này bằng cách sử dụng dữ liệu từ Khảo sát Quốc gia lần thứ Tư về các Dân tộc Thiểu số. Phân tích nhân tố cho thấy các chiều kích của bản sắc dân tộc là nhất quán giữa các nhóm dân tộc thiểu số khác nhau. Ban đầu, một số chiều kích của bản sắc dân tộc dường như có liên quan đến sức khỏe, nhưng trong mô hình đa biến, yếu tố liên quan đến bản sắc chủng tộc là yếu tố duy nhất thể hiện mối quan hệ với sức khỏe. Những phát hiện này cho thấy bản sắc dân tộc không liên quan đến sức khỏe. Thay vào đó, các phân tích đa biến được trình bày ở đây cho thấy mối quan hệ độc lập mạnh mẽ giữa sức khỏe và những trải nghiệm liên quan đến phân biệt chủng tộc, phân biệt chủng tộc cảm nhận được và tầng lớp xã hội.

In the last three decades, medical doctors have increasingly been exposed to management control measures. This phenomenon has been reflected in a number of studies in various disciplines, including sociology, organisation studies, management, and health service research. This article seeks to provide a comprehensive overview of the studies dealing with the impact of management on professional control. In particular, it seeks to bridge the diversity of assumptions, theoretical perspectives and conceptual underpinnings at play, by exploring synergies between them and opening up new horizons for research. The review shows how the relationship between clinicians and management has been analysed at an organisational level using two interconnected analytical frameworks focusing on the sociocultural and task‐related dimensions of professionalism. In the final discussion, we argue that comparative, longitudinal and cross‐sectional research is necessary, and there is a need to overcome the hegemony/resistance framework in current analyses of the impact of management on professionalism. Such an approach would contribute to the revision of macro theories of professionalism and stimulate emerging research by examining different perspectives towards management in medical specialisations. This approach might also stimulate a discussion of medical professionals’ relationships with members of other professional groups, including nurses and healthcare managers.

This article analyses how young people enrolled in drug addiction treatment in Copenhagen, Denmark, explain their cannabis careers and how they view their possibilities for quitting drug use again. Inspired by Mead and narrative studies of health and illness, the article identifies four different drug use ‘aetiologies’ drawn upon by the interviewees. These cover childhood experiences, self‐medication, the influence of friends and cannabis use as a specific lifestyle. A central argument of the article is that these explanations not only concern the past but also point towards the future by assigning the interviewee a more or less agential position in relation to drugs. Further, the drug narratives are viewed as interactional achievements, related to the social context in which they were produced, namely, the institutional setting of the treatment centres. The article is based on 30 qualitative interviews with young people in drug addiction treatment.

This paper examines the arguments presented at the Royal Commission of Inquiry into chiropractic, which took place in New Zealand in 1978. Drawing on the work of Potter, it suggests that the protagonists in the debate, the medical profession and its allies on one side and the chiropractic profession on the other, developed rhetorical strategies to counter competing versions of the world. An unusual feature of this debate was that it took place before ‘impartial’ judges. The paper demonstrates the delicate process of negotiation performed by chiropractic groups when confronting medicine in an open forum. The paper concludes that in order to resolve the competing rhetorics, the Commissioners sought for a compromise, which at once embedded chiropractic within the public health service in New Zealand and ‘de‐radicalised’ its claims.

Strategies of occupational control at the macro‐level have been described by many sociologists. This paper draws on a study of the division of labour in the treatment of musculo‐skeletal problems in New Zealand to look at micro‐level strategies of occupational control. These are rhetorical strategies used by individual practitioners to establish and maintain occupational boundaries. Practitioners used these strategies to distinguish their occupation from others, creating a sense of professional identity and enabling claims to jurisdiction over an area of work. Many of these strategies involved notions of limitation (i.e. other occupations are limited because they do not possess something we do), holism (we are holistic in our approach while others are not), and prevention (we prevent problems by treating the causes, while others treat the symptoms).

Abstract Observations on the effect of unemployment on health include note that the clustering in certain geographic areas of low income, job insecurity and poor housing are the experience of the same groups of people. Considerable difficulties exist in isolating the different aspects involved. Nonetheless, it is argued (1) that the effects of each separate strand are dependent upon and reinforced by the others; (2) that it is possible to clarify the ways in which the elements interrelate; and (3) that it is the whole pattern that most satisfactorily explains currently available data on unemployment and health.

The relationship between a psychotherapist and a client involves a specific kind of epistemic asymmetry: in therapy sessions the talk mainly concerns the client's experience, which is unavailable, as such, to the therapist. This epistemic asymmetry is understood in different ways within different psychotherapeutic traditions. Drawing on a corpus of 70 audio‐recorded sessions of cognitive psychotherapy and psychoanalysis and using the method of conversation analysis, the interactional practices of therapists for dealing with this epistemic asymmetry are investigated. Two types of epistemic practices were found to be employed by therapists while formulating and interpreting the client's inner experience. In the formulations, the therapists and clients co‐described the client's experience, demonstrating that the client's inner experience was somewhat similarly available to both participants. In the interpretations, the therapists constructed an evidential foundation for the interpretation by summarising the client's talk and using the same descriptive terms as the client. Clients held therapists accountable for this epistemic work: if they failed to engage in such work, their right to know the client's inner experience was called into question.

This article compares two practices for initiating treatment decision‐making, evident in audio‐recorded consultations between a neurologist and 13 patients in two hospital clinics in the UK. We call these ‘recommending’ and ‘option‐listing’. The former entails making a proposal to do something; the latter entails the construction of a list of options. Using conversation analysis (CA), we illustrate each, showing that the distinction between these two practices matters to participants. Our analysis centres on two distinctions between the practices: epistemic differences and differences in the slots each creates for the patient’s response. Considering the implications of our findings for understanding medical authority, we argue that option‐listing – relative to recommending – is a practice whereby clinicians work to relinquish a little of their authority. This article contributes, then, to a growing body of CA work that offers a more nuanced, tempered account of medical authority than is typically portrayed in the sociological literature. We argue that future CA studies should map out the range of ways – in addition to recommending – in which treatment decision‐making is initiated by clinicians. This will allow for further evidence‐based contributions to debates on the related concepts of patient participation, choice, shared decision‐making and medical authority.