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February 26, 2007

Literature Review

Today's review will collate abstracts from:

Sociology of Health & Illness

Bulletin of the History of Medicine

Sociology of Health & Illness Vol 29, no. 1 (January 2007).

Gender, pregnancy and the uptake of antenatal care services in Pakistan

Zubia Mumtaz, Sarah M. Salway

Abstract:

An integrated analysis of detailed ethnography and large-scale survey data is presented to explore the gendered influences on women's uptake of antenatal care (ANC) services in Punjab, Pakistan. Pregnancy and its associated decisions were shown to be normatively the older women's domain, with pregnant women and their husbands being distanced from the decision-making process. Women who successfully claimed ANC did so not by overtly challenging the dominant construction of young femininity, but rather by using existing gendered structures and channels of communication to influence authority figures. The quality of a woman's inter-personal ties, particularly with her mother-in-law and husband, were found to be important in accessing resources, including ANC. Gendered influences were moderated by social class. Family finances were an important determinant of ANC use, as was women's education. Wealthier, higher status women also found it easier to circumvent gendered proscriptions against their mobility while pregnant. As well as illuminating the ways in which the sociocultural construction of gender acts to constrain women's access to ANC, the empirical findings are used to highlight significant inadequacies in the 'autonomy paradigm' that has dominated much of the research into women's reproductive health in South Asia.

Chronic illness, expert patients and care transition

David Taylor, Michael Bury

Abstract:

During the last century demographic and epidemiological transitions have had a radical impact upon health and health service provision. A considerable body of research on the sociological aspects of living with chronic illness has accumulated. Debate has focused on how social environments shape disability-related experiences, and the extent to which individual responses define health outcomes. Through the establishment of the Expert Patients Programme (EPP) in 2001, the Department of Health has sought to enhance NHS patients' self-management capacities. This paper discusses three areas relevant to this: the policy formation process leading up to the EPP's present stage of development; the evidence base supporting claims made for its effectiveness; and the significance of psychological concepts such as self-efficacy in approaches to improving public health. The conclusion discusses NHS developments in primary care and public involvement in health and healthcare, and the implications that initiatives such as the EPP carry for the future. It is argued that to facilitate a constructive process of 'care transition' in response to epidemiological and allied change, awareness of cognitive/psychological factors involved in illness behaviours should not draw attention away from the social determinants and contexts of health.

Avian flu: the creation of expectations in the interplay between science and the media

Brigitte Nerlich, Christopher Halliday

Abstract:

This paper examines the emerging cultural patterns and interpretative repertoires in reports of an impending pandemic of avian flu in the UK mass media and scientific journals at the beginning of 2005, paying particular attention to metaphors, pragmatic markers ('risk signals'), symbolic dates and scare statistics used by scientists and the media to create expectations and elicit actions. This study complements other work on the metaphorical framing of infectious disease, such as foot and mouth disease and SARS, tries to link it to developments in the sociology of expectations and applies insights from pragmatics both to the sociology of metaphor and the sociology of expectations.

The linear medical model of disability: mothers of disabled babies resist with counter-narratives

Pamela Fisher, Dan Goodley

Abstract:

This paper draws on the narratives of parents of disabled babies in order to conceptualise notions of enabling care. This analysis emerges from the Sheffield site of an ESRC research project Parents, Professionals and Disabled Babies: Identifying Enabling Care, which brings together the Universities of Sheffield and Newcastle-upon-Tyne. The linear heroic narrative is a dominant theme within Western culture. It is competitive and individualistic and tends to be future-orientated in that actions conducted in the present are evaluated according to later outcomes. This linear narrative places much store on modernist interventions such as medicine, and tends to uphold professional boundaries and hierarchies. In the lifeworlds of parents, usually mothers, of disabled babies, this narrative can reinforce disempowering interpretations of disability and impairment. On the basis of 25 in-depth interviews, accompanying stories and ethnographic data, this paper suggests that parents are developing counter-narratives which, at times, resist linear life models and free parents to enjoy their children as they are. If life is perceived as an open book rather than as a concluding chapter, parents are able to develop stories that are neither linear nor heroic but present and becoming.

'A politics of what': the enactment of peritoneal dialysis in indigenous Australians

Alexandra McCarthy, Kristine Martin-McDonald

Abstract:

This paper explores, on the one hand, the requirements of the technologies and practices that have been developed for a particular type of renal patient and health network in Australia. On the other, we examine the cultural and practical specificities entailed in the performance of these technologies and practices in the Indigenous Australian context. The praxiographic orientation of the actor-network approach – which has been called 'the politics of what' (Mol 2002) – enabled us to understand the difficulties involved in translating renal healthcare networks across cultural contexts in Australia; to understand the dynamic and contested nature of these networks; and to suggest possible strategies that make use of the tensions between these two disparate networks in ways that might ensure better healthcare for Indigenous renal patients.

Public health and the cult of humanity: a neglected Durkheimian concept

Kevin Dew

Abstract:

Public health researchers have used a number of concepts derived from the work of Durkheim, such as anomie and social capital. One concept that has not been deployed in public health discourses is that of the cult of humanity – Durkheim's religion in a society organised around organic solidarity. This paper discusses Durkheim's views on religion and science, and the cult of humanity. The cult of humanity is characterised as having humanity at the centre of worship and combining elements of religion and science. Medicine and complementary therapies are identified as possible candidates to fulfil the role of the cult of humanity, but the institution of public health seems to be a particularly apt candidate. The paper concludes by discussing the way in which this analysis provides insight into the dual advocacy and academic functions of public health, the tension between individual choice and constraint and the buffering role of public health in relation to other social institutions.

Unhealthy prisons: exploring structural determinants of prison health

Nick de Viggiani

Abstract:

Prisoner health is influenced as much by structural determinants (institutional, environmental, political, economic and social) as it is by physical and mental constitutions of prisoners themselves. Prison health may therefore be better understood with greater insight into how people respond to imprisonment – the psychological pressures of incarceration, the social world of prison, being dislocated from society, and the impact of the institution itself with its regime and architecture. As agencies of disempowerment and deprivation, prisons epitomise the antithesis of a healthy setting. The World Health Organisation's notion of a 'healthy prison' is in this sense an oxymoron, yet the UK government has signalled that it is committed to WHO's core health promotion principles as a route to reducing health inequalities. This paper reports on the findings of an ethnographic study which was conducted in an adult male training prison in England, using participant observation, group interviewing, and one-to-one semi-structured interviews with prisoners and prison officers. The paper explores how different layers of prison life impact on the health of prisoners, arguing that health inequalities are enmeshed within the workings of the prison system itself.

Diets and discipline: the narratives of practice of university students with type 1 diabetes

Myles Balfe

Abstract:

Type 1 diabetes is one of the most common chronic conditions of adolescence and young adulthood. It is characterised by a demanding and complex management regime. Individuals with diabetes must engage in continual self-care actions such as eating healthily and exercising if they are to minimise their risks of developing long-term diabetes' complications. Research has demonstrated, however, that many young adults experience difficulties with exercising and eating healthily. Narrative approaches could provide important insights into the reasons why young people do or do not experience difficulties here. In this article I examine the food consumption and exercise narratives of a particular group of young adults with type 1 diabetes, university students, to see what personal, social and cultural factors influence their practices.

________________________________________________________________

Bulletin of the History of Medicine Vol. 80, no. 4 (Winter 2006)

The Meaning of Signs: Diagnosing the French Pox in Early Modern Augsburg

Claudia L'Engle Stein

Abstract:

This article reconstructs the diagnostic act of the French pox in the French-disease hospital of sixteenth-century Augsburg. It focuses on how the participants in the clinical encounter imagined the configuration of the pox and its localization in the human body. Of central importance for answering this question is the early modern conception of physical signs. It has been argued that it was due to a specific understanding of bodily signs and their relationship to a disease and its causes, that disease definition and classification in the early modern period showed a high degree of flexibility and fluidity. This paper looks at how the sixteenth-century theoretical conception of physical signs not only shaped the diagnosis and treatment of the pox but also reflected the overall organization of institutions.

Inheriting Vice, Acquiring Virtue: Hereditary Disease and Moral Hygiene in the Medicine of the French Enlightenment

Sean M. Quinlan

Abstract:

This essay examines the medical debates over hereditary disease and moral hygiene in France between 1748 and 1790. During this time, which was marked by two formal academic exchanges about pathological inheritance, doctors critically studied the existence of hereditary diseases—including syphilis, arthritis, phthisis, scrofula, rickets, gout, stones, epilepsy, and insanity—and the problems that heredity might pose for curing and preventing these diseases. Amid public debate, doctors first treated heredity with formal skepticism and then embraced the idea. Their changing attitudes stemmed less from epistemological or cognitive reasons than from new cultural beliefs about gender, domesticity, and demographic policy. Fearing moral degeneracy and demographic decline, they argued that a number of social pathologies were truly hereditary and that these diseases spread within the family itself. These beliefs were seemingly confirmed by new clinical studies on tuberculosis. Though doctors conceded that hereditary diseases might limit Enlightenment hopes to perfect society, they also suggested that sexual hygiene and physical education could cure hereditary degeneracy and transcend genealogy and descent. Consequently, they stressed that physical regeneration was a dynamic process, one that stretched from the conjugal bed to weaning and beyond. Rather than accepting the accidents of birth, physicians believed that their patients could self-consciously overcome inherited defects and thus regenerate themselves and even all of society itself. Heredity thus gave doctors an idiom with which to diagnose a felt social crisis and to prescribe appropriate hygienic responses.

Idiocy in Virginia, 1616-1860

Parnel Wickham

Abstract:

Like the English, Virginians tended to think that idiocy, a condition analogous to intellectual disability in the twenty-first century, was congenital, untreatable, and incurable, and they adopted legal remedies that corresponded closely to the laws of England. In addition, concepts of idiocy reflected some of the unique aspects of Virginia's social system, which was dominated by a coterie of powerful men. With a need to preserve social order and maintain decorum, the Virginia legislature established in 1769 the Eastern State Hospital to house unruly and objectionable people who were mentally disabled. Although idiots were among the hospital's first patients, they were eventually banished due to their presumed failure to respond to treatment. The social stigma attached to idiocy extended from Virginia's city streets and jails to the private homes of prominent families. Personal reticence regarding shameful family matters hid the identity of people thought to be intellectually disabled. Even Thomas Jefferson, a prolific author, entered only cryptic notes about the limitations of his sister, Elizabeth. In summary, Virginians' response to idiocy suggests a two-tiered approach: public disclosure and disdain of poor and dependent people with intellectual disabilities, and silent avoidance of the problem in prominent families. In both situations, idiocy represented images of shame and humiliation that threatened the social order.

Parliament, Physicians, and Nuisances: The Demedicalization of Nuisance Law, 1831-1855

James G. Hanley

Abstract:

In Britain in 1830, nuisances legally comprised a heterogeneous collection of irritants, united by their ability to cause hurt, inconvenience, or damage. The only legal remedies for nuisances that applied to the entire country were provided through the common law. Though respected, common-law procedure was time consuming, costly, uncertain, and intended to protect the enjoyment of property, not of health. Dangers to health could be removed if they were a nuisance, yet health hazards were not conceptualized separately from nuisances in general, nor were they dealt with differently in practice. This paper demonstrates that during the 1831–32 cholera epidemic, and again in 1846, the executive and the legislature created a strictly medicalized health hazard as part of the transformation in nuisance law and practice. The paper argues, however, that the creation of a medicalized health hazard was a defensive reaction on the part of central authorities. Indeed, after 1846 Parliament retreated from a strictly medicalized health hazard in the face of local resistance and skepticism, and by 1855 physicians played only a marginal and supporting role in nuisance practice. The development of nuisance law thus illustrates the local inspiration for sanitary reform and the often highly contested nature of central interventions.

Babies and Bacteria: Phage Typing, Bacteriologists, and the Birth of Infection Control

Kathryn Hillier

Abstract:

During the 1950s, Staphylococcusaureus became a major source of hospital infections and death, particularly in neonates. This situation was further complicated by the fact that Staphylococcus quickly gained resistance to most antibiotics. Controlling these infections was a pressing concern for hospital workers, especially bacteriologists who tackled it through the use of a new epidemiologic tool: phage typing. This article argues that during the mid- to late 1950s a series of staphylococcal hospital and nursery epidemics united phage typers, brought international recognition to the usefulness of their technique, and, in the process, contributed to the establishment of the new field of infection control. Through the use of this new tool, phage typers established themselves as experts in infection control and, in some places, became essential members of newly formed infection-control committees. The nursery epidemics represent a particularly important test for phage typing and infection control, for this staphylococcal strain (80/81) was especially virulent and spread rapidly beyond the hospital to the wider community. The epidemiologic information provided by phage typers was vital for devising practical advice on how to control this deadly strain of Staphylococcus and also for transforming the role of the hospital bacteriologist from mere technician into infection-control expert.

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