Feminism and the sociology of gender, health and illness

This editorial considers how the study of gender and health has played out in the pages of the Sociology of Health and Illness over the past quarter century, paying particular attention to how a theory of gender has informed empirical work and the relevance of gender studies for the feminist challenge to sexism and the patriarchal order. Work in this journal on gender and health has considered the invisibility of women, grappled with the conflation of sex and gender and interrogated polarised binary thinking, attempting to use sociological approaches to the body and novel post-structural metaphors to analyse both gendered roles and their relationship with gendered bodies and states of health and illness

Narratives in health and social care: truths in context; truths in contest?

This paper offers a brief consideration of how narrative, in the form of people’s own stories, potentially figures in health and social care provision as part of the impulse towards patient-centred care. The rise of the epistemological legitimacy of patients’ stories is sketched here. The paper draws upon relevant literature and original writing to consider the ways in which stories can mislead as well as illuminate the process of making individual treatment care plans

Race, ethnicity and health: The costs and benefits of conceptualising racism and ethnicity

http://dx.doi.org/10.1016/j.socscimed.2012.03.00

Cultural strategies of young women of South Asian origin in Glasgow, with special reference to health

Patterns of food use and of social support and alliance are significant for the constitution of boundaries between religious and ethnic groups and the status hierarchies within them. Food and social support are also significant for health. In the case of British Asian communities, control of food intake has been identified as the key to overcoming their current epidemic of heart disease. Level of stress and social support have also been thought important for understanding levels of psychological distress among British Asians. The present study focuses on young British Asian women with ancestry in the Indian subcontinent, their patterns of food use and social support and how their choice of cultural strategies affects the likelihood of change to these patterns. The rationale for concentrating upon young women is twofold. First, middle aged women appear to suffer from a number of health disadvantages, including aspects of coronary risk and psychological distress. By focusing on a younger generation of women, factors involved in the biographical development of these problems might be ascertainable. Second, in terms of the sociology of ethnic boundaries, young women are in a pivotal position with regard of the continuation of the culture, occupying a role as daughters of migrants on the one hand, and as the first generation of British role models for British Asian children on the other. Comparison with the majority ethnic group is treated as a question about how respondents view with similarities and differences between themselves and the general population. The study addresses a range of research questions from health-related issues at one extreme to issues about the social construction of ethnic groups at the other. The first group of questions concerns the role that health plays in food choice: how health is conceptualised, how far folk ideas (possibly) deriving from biomedical, Unani and Ayurvedic conceptualisations are integrated with one another, and in what social contexts health concerns are overridden by the symbolism of ethnic identity

Ethnicity and health: key themes in a developing field

Ethnicity is a social division that is increasingly difficult to ignore. Ethnicity has to be considered alongside other social divisions including socioeconomic status which is crucial to explaining minority disadvantages in health. Identity is a key dimension of ethnicity, which encompasses self-ascribed and externally-imposed elements. The stigma associated with particular conditions, combined with the effects of racism and economic marginalization, can be central to some minority groups' ability to discuss disease and seek treatment. In a world where human rights are taken seriously, minority ethnic groups' presence in research has to become a routine consideration, rather than an optional extra. In research, as in service provision, planning for linguistic and cultural diversity represents additional work and will require extra resources

Locating ethnicity and health: exploring concepts and contexts

With the rapid development of ethnicity and health as a field of sociological research, this paper seeks to re-evaluate the development of ideas around ethnicity, 'race' and culture and consider how they have been applied to the question of health. Ethnicity as a social characteristic is contingent on the situation in which it is manifest. The process of marking 'other' ethnic groups includes stereotyping and racialisation, a process through which 'racial' or ethnic differences predominate to the exclusion of a consideration of social, economic and power relations. In the British context, the history of empire and medicine's justification of racist treatment of enslaved and colonised people, is relevant to understanding how ethnic and cultural differences have come to be essentialised and pathologised. Immigration to Britain only became a mass phenomenon after World War II, with settlement patterns following employment opportunities and kinship alliances. The state has a longstanding history of 'managing' diversity, sometimes essentialising differences between groups, at other times tackling disadvantage and discrimination experiences through policy action. Sociologists of health were slow to study ethnicity, with initial research coming from tropical disease specialists. The tendency of medicine to pathologise minority cultures is explored through case studies of the approach to rickets and the assessment of health risks associated with consanguineous marriage. Anti-racist approaches have encouraged the consideration of discrimination against and socioeconomic position of minorities. The field has developed with work on nomenclature and the operationalisation of ethnic identity, necessary to study health inequalities between ethnic groups and paying due heed to the contribution of socioeconomic position and racism to group experiences. Research into chronic conditions with complex analysis of a number of distinct contributory variables has been published of late. However, the excessive focus on South Asians and the record of measuring, analysing, but not necessarily tackling health disadvantage, are problems that remain to be addressed

Institutional racism in mental health services: The consequences of compromised conceptualization

Abstract Inequalities in mental health service use and outcome in the British NHS have been attributed to institutional racism. Institutional racism is widely understood in terms of the definition published in the Macpherson report, despite critique of its inability to differentiate the role of individual and institution in discrimination, and weakness in distinguishing racism from other forms of discrimination. The inquiry into David Bennett's death declared the NHS to be institutionally racist, and, although still contested, this has been widely accepted. Poor conceptualisation and the endemic failure to demonstrate how institutional racism leads to iniquitous outcomes can be seen in recommendations to tackle it through individual education. Policy based on a compromised conceptualisation of institutional racism is unlikely to reduce racialised inequalities and, in the face of progress for ethnic minorities else-where, may lead to the conclusion that discrimination is no longer a problem. In the light of recent shifts in what is implied by institutional racism, suggestions for research towards a re-conceptualisation are made

British Asian families and the use of child and adolescent mental health services: a qualitative study of a hard to reach group

We explored attitudes to and experiences of Child and Adolescent Mental Health Services (CAMHS) among families of South Asian origin who are underrepresented as service-users in an area of a Scottish city with a high concentration of people of South Asian origin. Six community focus groups were conducted, followed by semi-structured interviews with families who had used CAMHS and with CAMHS professionals involved in those families’ cases. Lastly, parents of children who had problems usually referred to CAMHS but who had not used the service were interviewed. Qualitative analysis of transcripts and notes was undertaken using thematic and logical methods. Participants consisted of 35 adults who identified themselves as Asian and had children; 7 parents and/or the young service users him-herself; 7 health care professionals involved in the young person's care plus 5 carers of 6 young people who had not been referred to CAMHS, despite having suitable problems. Focus groups identified the stigma of mental illness and the fear of gossip as strong disincentives to use CAMHS. Families who had been in contact with CAMHS sought to minimise the stigma they suffered by emphasising that mental illness was not madness and could be cured. Families whose children had complex emotional and behavioural problems said that discrimination by health, education and social care professionals exacerbated their child's difficulties. Families of children with severe and enduring mental illness described tolerating culturally inappropriate services. Fear of gossip about children's ‘madness’ constituted a major barrier to service use for Asian families in this city. Given the widespread nature of the concern over the stigma of children's mental illness, it should be considered in designing culturally competent services for children's mental health

Is Superdiversity a Useful Concept in European Medical Sociology?

Medical sociology has a poor track record of researching diversity in theoretically innovative ways. This paper notes usage of the term superdiversity in migration and urban studies, to ask about its utility in general and more specifically for researching the social production of health and illness. Referring to a multi-country interview study about healthcare seeking strategies, the need to understand the diversification of diversity and the challenges for multi-method health research are described. Six interviews each were conducted in Germany, Spain, Sweden, and the UK, to give a diversity sample of 24 adults who described their strategies and practice when seeking healthcare. In discussing how far superdiversity can help to model socioeconomic and cultural changes already identified as challenging health policy and service provision, the paper draws on case study material. The complex intersecting dimensions of population diversity to which superdiversity draws attention are undoubtedly relevant for commissioning and improving healthcare and research as well as policy. Whether models that reflect the complexity indicated by qualitative research can be envisaged in a timely fashion for quantitative research and questions of policy, commissioning, and research are key questions for superdiversity’s ongoing usefulness as a concept

Researching health in diverse neighbourhoods: critical reflection on the use of a community research model in Uppsala, Sweden.

OBJECTIVE: A community research model developed in the United Kingdom was adopted in a multi-country study of health in diverse neighbourhoods in European cities, including Sweden. This paper describes the challenges and opportunities of using this model in Sweden. RESULTS: In Sweden, five community researchers were recruited and trained to facilitate access to diverse groups in the two study neighbourhoods, including ethnic, religious, and linguistic minorities. Community researchers recruited participants from the neighbourhoods, and assisted during semi-structured interviews. Their local networks, and knowledge were invaluable for contextualising the study and finding participants. Various factors made it difficult to fully apply the model in Sweden. The study took place when an unprecedented number of asylum-seekers were arriving in Sweden, and potential collaborators' time was taken up in meeting their needs. Employment on short-term, temporary contracts is difficult since Swedish Universities are public authorities. Strong expectations of stable full-time employment, make flexible part-time work undesirable. The community research model was only partly successful in embedding the research project as a collaboration between community members and the University. While there was interest and some involvement from neighbourhood residents, the research remained University-led with a limited sense of community ownership