Entangled Bodies: Jews, Bedouins, and the Making of the Secular Israeli.

Taking Israel's National Health Insurance Law as a point of entry, in this article I probe how notions of equality and citizenship, secularism, and religion become entangled in the experience of Negev/Naqab Bedouins, who are Palestinian citizens of Israel. Drawing on ethnographic and archival research, I show how Jewish citizens have come to represent the secular and modern citizens in the region, while Bedouins, although mandated and claimed by policy and providers to be the 'same' and 'equal,' are always already imagined and characterized as other. Universal health care and the daily manner in which biomedicine is practiced in southern Israel provides an avenue for examining the Jewish valences medicine carries in southern Israel, Israel's boundaries of inclusion, and the connection between biomedicine and secularism

Entangled Bodies: Jews, Bedouins, and the Making of the Secular Israeli.

Taking Israel's National Health Insurance Law as a point of entry, in this article I probe how notions of equality and citizenship, secularism, and religion become entangled in the experience of Negev/Naqab Bedouins, who are Palestinian citizens of Israel. Drawing on ethnographic and archival research, I show how Jewish citizens have come to represent the secular and modern citizens in the region, while Bedouins, although mandated and claimed by policy and providers to be the 'same' and 'equal,' are always already imagined and characterized as other. Universal health care and the daily manner in which biomedicine is practiced in southern Israel provides an avenue for examining the Jewish valences medicine carries in southern Israel, Israel's boundaries of inclusion, and the connection between biomedicine and secularism

Producing Equality: Citizenship, Science, and Medicine in the Negev/Naqab

In 1994 Israel passed the National Health Insurance Law (NHIL), guaranteeing universal and equal healthcare services to all citizens. Universal healthcare, while unprecedented in Israel, did not have a significant impact on the country's Jewish majority. Yet for minority citizens such as the Bedouin community in the southern Israel, the NHIL transformed access to medical services, increasing insurance coverage from 60% to 100%, and changing the patient demographic in the regional hospital. Nonetheless, since 1995 when the law was implemented, disparities in health outcomes between Jewish and Arab citizens in the country have widened. Healthcare reform took place within a geo-political landscape that continues to marginalize its Arab citizens. Thus the paradigm of equality of healthcare intersects with national policies that create a differential citizenship in Israel. This dissertation, Producing Equality: Citizenship, Science, and Medicine in the Negev/Naqab, examines the impact of Israel's National Health Insurance Law as a site to understand how Israel's policies of inclusion and exclusion of Bedouin Arab citizens become entangled. My work highlights the tensions that exist between expansive and technical medical care that the state allocates to its Bedouin citizens, and the limited financial and political support the Bedouin community receives from the government in other spheres. Healthcare in southern Israel provides an important site to study the active production of the boundaries of citizenship, medicine, and reconfiguring of discrimination. I argue that the emphasis on scientific discourse in the medical arena ignores the social and political problems that place much of the Bedouin community in poor health. Therefore social, political, and historical questions that are central to understanding health disparities in the region remain beyond the scope of what providers view as relevant to their work. This bounding of medical care allows for the continuation of discriminatory policies towards the Bedouin citizens, while permitting the state and healthcare providers to assert they provide equal care to all patients

How Hypertension Guidelines Address Social Determinants of Health: A Systematic Scoping Review.

BackgroundPatient-level and community-level social and economic conditions impact hypertension risk and control. We examined adult hypertension management guidelines to explore whether and how existing guidelines refer to social care activities.ObjectiveThe objective of this study was to explore how hypertension guidelines reference social care activities.Research designA systematic scoping review of clinical guidelines for adult hypertension management. We employed a PubMed search strategy to identify all hypertension guidelines published in the United States between 1977 and 2019. We reviewed all titles to identify the most updated versions focused on nonpregnant adults with hypertension. We extracted instances where guidelines referred to social determinants of health (SDH) or social care activities. The primary outcome was how guidelines covered social care activities, defined using a framework adapted from the National Academies of Sciences, Engineering, and Medicine (NASEM).ResultsSearch terms yielded 126 guidelines. Thirty-six guidelines met the inclusion criteria. Of those, 72% (26/36) recommended social care activities as part of hypertension management; 58% recommended clinicians change clinical practice based on social risk information. These recommendations often lacked specific guidance around how to directly address social risk factors or reduce the impact of these risks on hypertension management. When guidelines referred to specific social factors, patient financial security was the most common. Over time, hypertension guidelines have included more references to SDH.ConclusionInformation about SDH is included in many hypertension guidelines, but few guidelines provide clear guidance for clinicians or health systems on how to identify and address social risk factors in the context of care delivery

"Far More than Just a Prescription": Focus Groups With U.S. Family Planning Providers and Staff About Integrating PrEP for HIV Prevention Into Their Work.

BackgroundCisgender women in the United States use pre-exposure prophylaxis (PrEP) for HIV prevention at lower rates relative to other groups. Advocacy groups and patients identify family planning clinics as the preferred sites to lead PrEP implementation for women in the United States. However, limited qualitative exploration exists of U.S. family planning practitioners' attitudes toward integrating PrEP into their work.MethodsWe conducted qualitative focus groups with a convenience sample of family planning clinicians, counselors, and clinic managers to explore barriers and facilitators to PrEP provision in U.S. family planning clinics.ResultsWe conducted six focus groups (total participants = 37) with respondents who worked in family planning clinics in San Francisco, California; Kansas City, Missouri; and Philadelphia, Pennsylvania. Key themes emerged highlighting how PrEP at times runs contrary to other family planning agendas, including efficient clinic visits, condom promotion, and long-acting reversible contraception counseling. Throughout these discussions, participants expressed discomfort with HIV vulnerabilities rooted in social and structural determinants of health.ConclusionsFindings suggest that those seeking to implement PrEP for U.S. cisgender women may benefit from exploring 1) how to integrate patient/provider conversations about the structural determinants of health and their relationship to HIV and other sexual and reproductive health outcomes and 2) how to foster person-centered prevention conversations in the context of busy family planning visits

Adjusting for Patient Economic/Access Issues in a Hypertension Quality Measure

IntroductionThe American Heart Association and American College of Cardiology have proposed adjusting hypertension-related care quality measures by excluding patients with economic/access issues from the denominator of rate calculations. No research to date has explored the methods to operationalize this recommendation or how to measure economic/access issues. This study applied and compared different approaches to populating these denominator exceptions.MethodsElectronic health record data from 2019 were used in 2021 to calculate hypertension control rates in 84 community health centers. A total of 10 different indicators of patient economic/access barriers to care were used as denominator exclusions to calculate and then compare adjusted quality measure performance. Data came from a nonprofit health center‒controlled network that hosts a shared electronic health record for community health centers located in 22 states.ResultsA total of 5 of 10 measures yielded an increase in adjusted hypertension control rates in ≥50% of clinics (average rate increases of 0.7-3.71 percentage points). A total of 3 of 10 measures yielded a decrease in adjusted hypertension control rates in >50% of clinics (average rate decreases of 1.33-13.82 percentage points). A total of 5 measures resulted in excluding >50% of the clinic's patient population from quality measure assessments.ConclusionsChanges in clinic-level hypertension control rates after adjustment differed depending on the measure of economic/access issue. Regardless of the exclusion method, changes between baseline and adjusted rates were small. Removing community health center patients experiencing economic/access barriers from a hypertension control quality measure resulted in excluding a large proportion of patients, raising concerns about whether this calculation can be a meaningful measure of clinical performance