This article explores the relationship between the principle of solidarity and the challenge of setting priorities in health. It addresses an analytical gap that arises from frameworks for fair priority-setting that are inundated with discussions of technical and ethical criteria to help prioritise services, but that do not explicitly consider notions of solidarity. The article employs a categorisation scheme as a heuristic device to descriptively explore the identified research gap. Priority-setting decisions are divided into three categories to reflect the outcomes of prioritisation processes: (1) To fund a treatment, service or infrastructure project; (2) Not to fund or prioritise a treatment, service or infrastructure project; (3) To disinvest or stop funding a treatment, service or infrastructure project. Using Prainsack’s and Buyx’s practice-based definition of solidarity, the article discusses the extent to which different categories of priority-setting outcomes can be labelled acts of solidarity, or not. It concludes that while solidarity is an important principle for designing and financing health care systems, it is not a concept that helps address the complexities of priority-setting because the sacrifices and losses patients are asked to accept are often too high to be justified from a solidaristic point of view.
Senescence in fiction has been rarely studied in the cultural gerontological tradition in India. While later life associated with intergenerational authority, or enhanced religiosity or as a cultural process of worldly renunciation, have been themes in the phenomenological corpus of gerontology in India, studying the aging feminine body has remained outside the intellectual sensibilities of this field. In this paper, we analyze the short story, Boodhi Kaki (old aunt) by noted Hindi and Urdu writer, Munshi Premchand (1880–1936) to explore the cultural construction of the abject, an ambiguous liminal stage that is distinct from notions of “Third” or “Fourth” age in life-course studies. As such, by focusing on food and (a devouring) appetite of the older female protagonist, we complicate the entanglements of desire and disgust in aging studies. Ultimately, we explore the transgressive potential of the abject as a self-reclaiming device that upends cultural understandings of age(ing) and gender.
The invention of the human papillomavirus (HPV) vaccine occurred at a moment when academic life science research was becoming increasingly reoriented toward market-driven goals. This transformation, shaped by policy shifts promoting the commercialisation of academic research, altered traditional forms of scientific competition. Economic value came to structure not only research agendas but also the institutional logic of academic practice. Intellectual property rights played a key role in materialising this shift, with powerful market actors influencing the outcomes of scientific contests to secure monopolistic control. The case of the HPV vaccine illustrates how upstream innovation processes, especially decisions about ownership, licensing, and legal structuring, determine downstream outcomes such as pricing and access. This challenges prevailing approaches in public health that treat access inequalities as isolated or downstream issues, instead highlighting how the architecture of biomedical innovation itself shapes the terms of inclusion and exclusion in global health.
In global studies, the Covid-19 pandemic has been associated with the return of national protectionism at the expense of a human rights-based approach to health. While this may be partially true, this article will shed light on a different aspect of national security. Context plays a key role here. In the context of Western liberal democracies, a securitized approach to health is seen as detrimental to basic constitutional rights such as right to work and mobility. However, from the perspective of low-income countries, national security implies the urgency of a global solidarity in the name of enhanced human rights such as right to food and shelter. This article develops this argument by comparing national security to other competing policy frameworks such as human security, human rights, and global goods in the context of the Covid-19 pandemic.
Existing sociological theories of the positive relationship between resources and health emphasize the fundamental causes and social-structural forces that shape health outcomes, but focus less on intervening mechanisms and the processes by which those resources ‘become’ health. We present the theoretical framework of ‘chains of exchange’: iterative processes of transformation that resources undergo along a causal pathway to ultimately affect embodied health for better or for worse. The choice to pursue a particular chain of exchange is conceptualized as a function of several interactive factors: the inherent characteristics of resources, the individual’s life course history and resource endowment, the gatekeeping practices of institutions, and the social desirability of the exchange. The chains of exchange framework explicitly incorporates countervailing mechanisms and choice architecture into the resource-health relationship by emphasizing individual agency in the process of selectively using resources to affect health. Our aim is to provide a tool, for social determinants of health research and practice, to facilitate the investigation of how interventions at different points of resource exchange and causal proximity to health can have varying levels and kinds of success in shaping health outcomes.
The integration of peer support workers (PSWs) in mental healthcare challenges not only the prevailing medical model in practice but also its underlying attitudinal structures. This paper develops a theoretical framework based on Ortega y Gasset’s philosophy of belief to conceptualize disease models as attitudes that shape how stakeholders perceive mental health issues, and secondarily, act with regard to them. Understanding the medical model as an embodied system of beliefs allows for an analysis of resistance to PSWs, as beliefs regarding their usefulness may conflict with stakeholders’ previous attitudes and therefore force attitudinal transformation. We argue that PSW integration can foster a shift from a hierarchical, deficit-based system to a co-productive model that values lived experience and recovery and loosens fixed medical categories. However, this process may not only require structured training, institutional support, and collaborative engagement, but also necessitate professionals to self-reflect on their own attitudes and belief systems. Our proposed theoretical framework posits that attitudinal change, rather than policy reform alone, is key to making peer support a meaningful component of mental healthcare.
While hospital beds are at the heart of healthcare delivery, they have received little conceptual attention within the socialsciences. Instead, the focus has tended to be on explaining their changing numerical characteristics and the consequences of this for patient care, health systems functioning and the practices of the healthcare professions. While the number of beds iscertainly of critical importance, this paper pushes beyond this to examine the work that these numbers do and perform. In sodoing, it argues that beds are best thought of as a barometer in both a material and fi gurative sense. As such, beds can gauge system pressure, they act as ‘sentinel’ or warning devices should this change and are responsive to the viscosity (or flow) of health systems. And, in a figurative sense, they are refl ective of shifts in prevailing public or political opinion, as well aseconomic or biomedical trends. Beds are therefore woven into a tight web of system inter relationships and interdependencies which makes the calculation of any ‘optimum’ number of beds, either now or in the future, fraught with challenge.
Through a novel analogy, this article suggests how one might undertake coherent and defensible qualitative health research. It is argued that prospective researchers might create their methodological framework as a spider forms its foundational ‘dry lines’; the logic of their study may develop when each previous step informs the next, and each is also informed by the overall needs of the research. Though the spider cannot ‘envision’ its final product while it is weaving, it is through an iterative process that its work achieves coherency and therefore functionality. Similarly, researchers must negotiate changing research contexts, theory, personal motivations, and various challenges, building–but also cutting–dry lines, constantly refining their project to ensure that it eventually ensnares its prey–findings which might answer the research’s question(s). This article details how an Institutional Ethnography of a healthcare organisation developed in this way, to demonstrate how one might undertake their own coherent inquiry.
In response to calls for medicine, sociology, the university, and healthcare to be decolonised, this article considers the role of sociologists working in medical education in decolonising medicine. Efforts to decolonise medicine have largely focussed on biomedical knowledge and practice, while work to decolonise sociology has under-explored issues of health or medicine. Sociology in medical education sits between these two lines of work and has yet to be thoroughly scrutinised through a decolonial lens. Consequently, we respond to (Bhambra’s in Critical times 4(1):73-89, 2021 and Meghji’s in Sociology 56(1): 131-147, 2021) invitation for all forms of scholarship, regardless of how critical they perceive themselves to be, to examine their histories and entanglements with colonialism and racism. We grapple with the history and contemporary practice of medical sociology, reviewing its disciplinary identity and relationships with medicine, sociology and medical education. We argue that, as sociologists in UK medical education, we have been socialised into an embattled position as ‘critical friend’ to medicine, and an ‘applied’, ergo lesser, form of sociology, requiring us to continually assert our relevance. In turn, this preoccupation has, until recently, prevented us from confronting our own colonial roots and entrenched white solipsism.
Uncertainty is a structural condition of psychiatry, yet it is routinely concealed by practices that transform ambiguity into apparent clarity. Diagnostic categories remain provisional and culturally variable, but health systems demand resolution. This article develops the concept of strategic certainties to describe how institutions perform knowledge where doubt persists but cannot be admitted. Complementing McGoey’s notion of strategic ignorance, the concept highlights a parallel logic of legitimacy: ignorance manages accountability by suppressing knowledge, while certainty manages authority by asserting it under conditions of indeterminacy. Drawing on two ethnographic studies in Catalonia (community-based care for psychosis and psychiatric responses to workplace harassment) the analysis shows how certainty is enacted through diagnostic anchoring and pharmacological routines in the first case, and through the reframing of structural violence as individual pathology in the second. Across both settings, strategic certainties operated as expressions of an epistemic habitus that channels ambiguity into forms compatible with institutional order and social control. They render action possible and sustain institutional order but often foreclose recognition. The findings show that strategic certainties are patterned institutional mechanisms rather than isolated errors. Understanding certainty as a socio-epistemic practice opens possibilities for care cultures able to sustain uncertainty ethically.
The biopolitics of identity-centered religious movements has been a primary source of conspiracy theories in recent decades. This paper explores the shared characteristics of three examples of identity-centered religious and political movements with biopolitical agendas from three different parts of the world: Christian nationalism in the United States, Hindu nationalism in India, and political Islam in Iran. All these political religious movements rely on and advocate for pro-fertility norms and lifestyles, propagate health disinformation and conspiracy theories, and pursue political power to promote their biopolitical agendas. During the COVID-19 pandemic it became evident that such biopolitical agendas and their conspiracy theories can become popular and cause severe damage. Civil society and bioethical institutions can address this issue as a part of the problems posed by infodemics, resulting from the propagation of disinformation and conspiracy theories at local, national, and global levels.
In this paper, I examine key milestones in the expansion of mental health care in Chile, showing how it has evolved within the public health system and gained broader visibility and influence in society. To do this, I draw on historical primary and secondary sources, alongside scholarship from historians and other disciplinary specialists, and relevant official policy documents. I analyse how mental health care has changed in meanings, practices and places. From an explicitly coercive response, directed at groups of people seen as disrupting the social and classified using a limited set of medical labels, to a response increasingly framed around the professional responsibility to care for mentally ill persons, drawing on an ever-expanding range of diagnostic categories and experts. From being located in asylums and later in closed psychiatric institutions, to being situated within community-based institutions, and particularly within public primary health care. I argue that these different problematisations of mental health have contributed to the expansion of medical jurisdiction in everyday life. This has mainly occurred through the development and entrenchment of a top-down, expert-led strategy. Although reconfigured across changing normative frameworks, such epistemic, institutional, and clinical solutions have evolved and endured in Chilean policy and are reflected in formal mental health care provision. Consequently, there remains an ongoing risk that epistemological and cultural diversity may be marginalised or selectively reformulated in ways that align with a dominant framework – one that tends to absorb political contestation into an individualised, biomedical approach. Traces Chile’s shift from asylums to primary care in mental health provision. Examines how medicalisation shaped psychiatric expansion across historical phases. Shows how community psychiatry was reconfigured into expert-led policy frameworks. Reveals enduring top-down logics in Chile’s mental health policies and practices. Contributes a sociological analysis linking medicalisation to policy problem framings.
Through Institutional Ethnography (IE), one can explicate how people’s lives are being socially organised. The ethnographer creates an empirical account of what happens within a complex of institutional order, moving iteratively between data collection methods to see how the ‘institution’ occurs through people’s work, how texts are used to coordinate it, and how these texts reproduce ideology. They follow findings as they arise, with reference to the perspectives of ‘standpoint informants’. However, because this process is iterative, descriptions of IE studies vary greatly. Guidance on how to undertake IE’s methods is often specific to the institution being studied. To aid prospective ethnographers, the article describes a step-by-step process through which IE was interpreted and implemented in practice in a healthcare setting. Though it references research at an Opioid Substitution Treatment (OST) service, the account is not prescriptive; rather, it illustrates how one might undertake IE-informed data collection and analysis while being consistent with what is expected of an IE.
Umbilical cord blood (UCB) is a source of hematopoietic stem cells used as an alternative to bone marrow transplantation for the treatment of hematological malignancies, blood disorders, and bone marrow failure. UCB is particularly valuable for patients from ethnic minorities who are underrepresented in international bone marrow donor registries. In response, national public UCB banking systems have developed strategies to increase the number of UCB units with human leukocyte antigen (HLA) haplotypes compatible with those of minority populations. This article examines the social implications of the strategies adopted in Italy to capture HLA variability through UCB banking. It argues that the country’s dispersed, territorially distributed network of UCB collection sites operates on a principle of generalized solidarity that enables the capture of HLA variability while mitigating the biases associated with residential segregation and healthcare inequalities. The article ultimately demonstrates that the UCB collection network is not merely a biomedical infrastructure, but a socio-political one.
Addressing health and social care disparities is an individualistic, organizational, and systemic endeavor. The root cause of disparities is collectively our individualistic unjust behaviours towards others, structural determinants, and systems of power, resulting in oppression of populations. The purpose of this paper is to propose social intersectional compassion framework for promoting social justice in health and social care. Drawing from intersectionality theory and literature about compassion, social intersectional compassion is defined as identifying, understanding, and alleviating individuals’ suffering through intentional and shared examination of their intersecting multiple identities and the impact of social systems and institutional structures on their well-being. The actionable ways to practice social intersectional compassion are: (a) understanding the meaning of suffering from individuals’ perspectives, (b) recognizing the root intersecting identities, structures, and processes contributing to suffering, (c) developing a relational connection with the individuals to attempt to alleviate suffering, and (d) embracing self-vulnerability to be affected by individuals’ suffering. The proposed framework of social intersectional compassion attempts to offer direction on how to alleviate individuals’ suffering and promote social justice and equity during individual interactions and when interacting with underserved communities in everyday life.
Medical gaslighting is a term that is frequently found in gray literature but rarely found in formal literature. Thomas However, Gaslighting is a term that has been examined in scientific literature, typically in relation to intimate partner relationships. I compare the concepts gaslighting and medical gaslighting in literature to identify critical distinctions and develop the following conceptual definition for medical gaslighting: Medical gaslighting is an interpersonal phenomenon involving a healthcare professional and a patient within which the healthcare professional trivializes, psychologizes, or dismisses the patient’s subjective bodily symptoms and health concerns. This leads to delays in care, medical mistrust, doubt in the reality of one’s bodily experiences, and medical trauma. Habermas’ Theory of Communicative Action and Foucault’s conceptualizations of power are proposed as theoretical underpinnings to the phenomenon of medical gaslighting in order to contextualize the antecedents which make the phenomenon possible and lay the groundwork for future studies that I hope will aim to quantify and mitigate its effects on the health of marginalized populations.
Epistemic injustice argues that people can be unfairly discriminated against in their capacity as a ‘knower’. While the concept has been widely promoted, and perceived injustice is addressed within research studies, little work to advance the conceptual development of epistemic injustice with reference to empirical practice has been undertaken. In this article, a systematic review and narrative synthesis of the literature pertaining to the role that epistemic injustice, and the related concepts, plays in the health and healthcare experiences of people with chronic physical health conditions in the UK was undertaken to evaluate epistemic injustice as a theoretical resource to help inform healthcare research. This resulted in the identification of the following themes: threats to concept of self; navigation of awareness contexts; perception of burden; constructions of acceptability. Drawing on the narrative synthesis it was identified that dimensions of epistemic injustice can be developed and applied within empirical healthcare research. The inductive insights from empirical research can then, in turn, help to shape and mould the dimensions of epistemic injustice as flexible and pragmatic middle-range theory. Importantly, this can support insight into the lived experience of people with chronic health conditions.
While the statement “patients face barriers” is prevalent in healthcare-related literature, barrier is seldom conceptualized. While reviews of the concept suggest the term is conceptually and methodologically weak, its utility is more nuanced. This article contributes to an emerging critical health literature conceptualizing barriers by outlining their discursive effects in healthcare discourses on HIV-PrEP in England between 2017 and 2020. A Situational Analysis of the alliances and positions taken by English stakeholders in debates over PrEP illustrates how designating something as a barrier facilitates a power struggle about how healthcare is provided and used. In addition to imparting significance on a problem to patient’s uptake and use of a healthcare intervention, barriers align the patient’s problems with groups of experts. Once integrated into an expert discourse, barriers facilitate the transformation of healthcare services by objectifying the values, preferences and abilities of a patient community and aligning them with their shared political and governmental aims. Barriers, therefore, play an indispensable and strategic role in evidence-based activism and in the broader domains of biological and sexual citizenship with implications for policy and systems management.
In an era frequently marked by positivist approaches to public health research, contemporary epidemiology continues to center scientific inquiry while ignoring the embodied ramifications of intimate power relations. Drawing on interdisciplinary scholarship, this theoretical article critically engages with the genealogies of epidemiology to highlight the importance of queering prevailing discourse surrounding global disease containment. By interrogating epidemiology through a feminist Science and Technology Studies (fSTS) lens and abolitionist perspective, we highlight how knowledge production in public health is often entangled with systems of oppression, and how these systems (re)produce structural violence. Using COVID-19 as our case study, we question normative understandings of contagion by destabilizing the boundaries between the bio-, geo-, and necropolitical domains of disease transmission. Additionally, we explore how epidemiological approaches reinforce carceral logics that lead to the slow death of systematically-marginalized communities under techno-colonial regimes of violence. We contribute an anti-colonial and abolitionist feminist approach to epidemiology that embraces the erotics of uncertainty and situated knowledges by disrupting normative understandings of ‘contagion.’ Our goal is to destabilize and rigorously challenge the hegemonic biomedical paradigm foregrounding epidemiology, imagining instead alternative futures characterized by compassion and relational care.
Power relations between clinical volunteers and professionals within health services constitute a key determinant of role relationships and boundaries. Community First Responders (CFRs) are trained lay volunteers who respond to emergencies, interacting with patients and ambulance professionals. We aimed to explore the power relationships between CFRs and ambulance clinicians. We conducted 40 in-depth interviews with 4 ambulance clinicians, 21 CFRs and 15 CFR-leads from six ambulance services in England. Thematic analysis, guided by theories of subordination and boundary work, enabled the identification of themes and subthemes. The analysis revealed experiences of power relations, hierarchy and negotiations of role boundaries, characterised by subordination of CFRs and development of collaborative relationships between ambulance clinicians and CFRs. A collaborative relationship was established when clinicians recognised the voluntary nature of CFR roles and their significant contributions to ambulance services. Ambulance clinicians had the professional power to influence these relationships and negotiations of role boundaries. Power dynamics between professional ambulance clinicians and volunteer CFRs affect their relationship and CFR roles. These power relations were consistent with subordination and role boundaries and demonstrated how power theories relate to CFRs.
