Right to Health: A Buzzword in Health Policy in Indonesia

ABSTRACT

The “right to health” operates as a buzzword in Indonesia to frame health policies as beneficial to citizens. Right to health is equated with access to Western biomedical services. Within the policy on partnership between biomedical and traditional midwives, only the biomedical midwife can fulfill the right to health. The “traditional” midwife is reframed as her assistant. Right to health language hides underlying tensions in relationships between these two categories of midwives by presenting the policy as mutually beneficial. Right to health language is effective in the post-Suharto era as it aligns with other incontestable values, including democracy and modernity.     

Much More than a Clinic: Chicago’s Free Health Centers 1968-1972

ABSTRACT

Drawing on archival evidence, I document the emergence and florescence of three free health clinics in Chicago in the late 1960s. I trace the centers’ forceful removal by the city’s Board of Health, and their subsequent replacement by Federally Qualified Health Centers (FHQCs). I argue that the demise of the free centers is exemplary of a broader trend in US health policy of regulating and diminishing the health care options of poor Americans. By highlighting the stark contrast between Chicago’s free health centers of the 1960s and the health care services offered by contemporary FQHCs, I reveal a gradual shift from health care rights to accessing care in the US health care safety net.     

Race-ing Time: Clinical Temporalities and Inequality in Public Prenatal Care

ABSTRACT

Analysis of clinical temporalities, or the social organization of time in the clinic, offers insights into how racism coheres in pregnant bodies and institutions, with implications for health care experiences for patients and providers. Based on research at a public prenatal clinic, I argue that long patient wait-times and pressure on providers to speed up are temporal instantiations of the same racist structures that shape public health care in the US. Through these temporal experiences, racialized patient populations and staff who work in racialized systems of public health care encounter the lesser value assigned to their time, bodies, and labor.     

What are the factors affecting resilience in health professionals? A synthesis of systematic reviews

Abstract

Introduction: Health professionals often have cumbersome responsibilities, performing their roles in complex environments under stressful circumstances. Resilience has been recognized as an enabler of thriving in such adversity and remains vague in the health profession literature.

Aims: This paper aims to provide a synthesis of existing literature reviews of the evidence for resilience in health professionals, thematically integrating factors affecting resilience in health professionals.

Methods: Electronic databases were searched systematically using inclusion and exclusion criteria to include literature reviews that explored resilience in health care professionals using purposive sampling of primary research studies.

Results: Nine studies were identified. The definition of resilience varied across the studies. Four main themes of factors affecting resilience were found: (1) the influence of individual factors (e.g. individual traits, having a higher purpose, being self-determined), (2) environmental and organizational factors (e.g. workplace culture), (3) approaches that an individual takes when interacting with her/his professional circumstances (e.g. professional shielding and self-reflection), and (4) effective educational interventions (e.g. resilience workshops).

Conclusions: Resilience is multidimensional and can be affected by multiple factors. Interventions to improve resilience should consider context and focus on improvement of adaptive abilities of health professionals in adversity. A more uniformed definition and measurement of resilience can further research in this field.     

Undocumented Motherhood: Gender,Maternal Identity,and the Politics of Health Care

ABSTRACT

Undocumented Mexican immigrants have had to regularly confront a prohibiting health care system despite alienation, marginalization, and the threat of deportation. In this article, I explore the impact of political exclusion and alienating discourses on the health habitus of undocumented Mexican mothers through the narrative of one mother, Marta Garza, who finds herself at the painful intersection of political and medical alienation. Marta’s narrative reflects an analytical framework that centers undocumented motherhood as a space of necessary resilience and strain, wherein she is forced to advocate for her children’s health despite prohibitive barriers and dangerous potential consequences.     

Task-Shifting in Community Mental Health in Kerala: Tensions and Ruptures

ABSTRACT

Based on an ethnography of community mental health programs run by two NGOs in Kerala which have associated themselves with preexisting, locally grown, community-based palliative clinics, this article explores how professional NGOs bring a new culture to volunteer-based programs. Professionalizing volunteers through task-shifting results in the transformation of their philosophy of community care, which constrains and narrows understandings of mental health care. The state, in alliance with psychiatric NGOs, front-stages development through aggressive task-shifting which we argue is a socio-politico-moral process, disrupting the shared consciousness between volunteers and their own communities with fatal consequences for their most vulnerable citizens.     

Sovereign Rules and Rearrangements: Banning Methadone in Occupied Crimea

ABSTRACT

In 2014, Russian authorities in occupied Crimea shut down all medication-assisted treatment (MAT) programs for patients with opioid use disorder. These closures dramatically enacted a new political order. As the sovereign occupiers in Crimea advanced new constellations of citizenship and statehood, so the very concept of “right to health” was re-tooled. Social imaginations of drug use helped single out MAT patients as a population whose “right to health,” protected by the state, would be artificially restricted. Here, I argue that such acts of medical disenfranchisement should be understood as contemporary acts of statecraft.     

Optimizing resilience and wellbeing for healthcare professions trainees and healthcare professionals during public health crises – Practical tips for an ‘integrative resilience’ approach

Abstract

Public health crises, including pandemics, are associated with significant health risk and concomitant stress, fear, decreased sense of control, and uncertainty. Deleterious impact on both physical and mental health can result, including for healthcare professionals and health professions trainees. Changes in governmental policies and hospital protocols for healthcare professionals as well as disruption of educational formats and requirements for trainees can ensue. Difficult anxiety-provoking realities of public health crises including pandemics which involve caring for many seriously ill patients, moral distress including difficult care decisions, personal health risk, and/or potential risk to one’s family can take a dire toll on the mental health of healthcare professionals at all stages of the professional lifecycle. Educational disruptions can create significant anxiety for trainees about completing requirements and achieving competencies. Within this, coping skills may be challenged and strengths may be elucidated as well. Such crises create an imperative for medical educators to support trainees’ wellbeing through adaptive flexibility for curriculum innovation and culturally sensitive resilience and wellbeing interventions. Strategies (‘tips’) to optimize resilience and wellbeing with an integrative resilience approach of individual, learning environment, and organization/systems factors are presented.     

Mental Health and the Maintenance of Kinship in South Africa

ABSTRACT

At the turn of the millennium, people with mental disturbance often lived in circumstances of economic marginalization in South Africa. The historical material of one low-income urban area reveals the place of kin relations and reciprocity in enabling negotiation of a more fluid set of responses to mental illness. In this sociocultural context, “stigma” was not an inevitable reaction to mental illness, and a more complex set of social dynamics could mitigate marginalization. Research on how changing informal care practices relate to state-based community care continues to be important to inform contemporary health reforms.     

School Employees as Health Care Brokers for Multiply-Marginalized Migrant Families

ABSTRACT

Structural vulnerability illuminates how social positionings shape outcomes for marginalized individuals, like migrant farmworkers, who are often Latino, indigenous, and/or undocumented. Furthering scholarship on negotiating constraints, we explore how school employees (here, Migrant Advocates) broker health care access for migrant farmworker families. Ethnographic research in central Florida showed that Advocates perform similar functions as community health workers while experiencing similar dilemmas. We propose combining medical anthropological insights with the CDC’s Whole School, Whole Community, Whole Child model, conceptualizing schools as an important site for families’ wellbeing, recognizing brokerage roles of staff, and offering new directions for migrant health scholars.     

“Human Life is Inviolable”: Costa Rica’s Human Rights Crucible

ABSTRACT

The Costa Rican Constitutional Court banned in vitro fertilization in 2000, citing the inviolability of life. Conservatives hoped the ban would initiate a hemispheric movement to protect the unborn. But in 2012 the Inter-American Court of Human Rights ruled that reproductive rights are human rights and that women’s rights take precedence over embryo rights. The episode precipitated a national identity crisis: how could a country that supports universal health care be labeled a human rights violator as a result of its efforts to protect nascent human life? Expanding the health and human rights framework helps us appreciate how IVF became Costa Rica’s human rights crucible.     

Health providers’ communication skills training affects hypertension outcomes

Objective: Hypertension is a common cardiovascular risk factor within the Iranian population, and this may be improved through changes in lifestyle. We aimed at improving hypertension outcomes and health literacy skills among hypertensive patients through communication skills training targeting health providers.

Methods: A randomized controlled trial method was used to enroll 35 health providers and 240 hypertensive patients attending community-based healthcare practices in the Mashhad, Iran. We evaluated the effects of a communication skills intervention for primary care providers compared to usual care controls, on the hypertension outcomes, patient medication adherence, and self-efficacy, assessed at baseline and post-intervention. Bivariate analysis and the regression model were used to assess whether the health provider training improved outcomes.

Results: Majority of participating patients were female (77.3%), less than high school education (80.3%), married (82.3%), and low income (82.3%), with mean age of 37?years. Following the educational intervention, there was a significant improvement (p?Conclusions: The brief communication skills training for health care providers appear to be an efficient way to improve patient–provider communication skills and hypertension outcome among patients with uncontrolled BP.     

Paces of Costly Care: Rare Disease Drug Access in Canada

ABSTRACT

Pharmaceutical industry representatives and public drug plan managers hold competing visions of drug access, ones I theorize as “fast” and “slow” care paces. The relationship between free market imaginaries and population-based biopolitics is negotiated through these paces from within the flexible political category of rare disease. In this article, I explore expensive rare disease drug access in Canada’s universal health system through a temporal lens. I show how two families navigate these powerful negotiations, asserting themselves as deserving of resources while finding ways to consider life and death outside of this clash between health system pragmatics and pharmaceutical promise.     

Impacting Health through Cross-Border Pharmaceutical Purchases

ABSTRACT

Annually, retirees known as Winter Texans travel to spend the winter along the Texas/Mexico border and while there, many purchase medicine in Mexico. However, strategies that are used when purchasing Mexican medicine and the health implications of doing so have not been adequately explored. The results of the study we report illustrate that Winter Texans are knowledgeable about their healthcare and act more as choice-making consumers than patients seeking care. Furthermore, the use of Mexican medication did not increase rates of adverse drug events or decrease health-related quality of life scores.     

If we keep doing what we’re doing we’ll keep getting what we’re getting: A need to rethink “academic” medicine

Purpose: For generations there have been warnings of the need to reform medical education at all levels. Today the voices pushing reform are louder, the need is greater, and there is an urgency not seen before. Approaches that have worked in the past to train physicians are no longer as relevant today as demographics, disease patterns, human resources, practice behaviors, technology, and attention to costs demand new collaborative approaches to clinical practice. To prepare for this practice tomorrow’s doctors will need a different type of educational model, a different type of learning, in different environments, often taught by different faculty. This paper provides one innovative approach to redefine “academic medicine”.

Methods: After reviewing current trends in medical education, this paper describes one approach being taken by a large nonprofit American health care system to move medical education and discovery (research) out of traditional academic universities and placing it within a health care delivery system.

Conclusions: The creation of a learning laboratory in a high functioning health care delivery system allows for leveraging the successes in quality health care delivery to transform medical education with a focus on prevention, improving health care quality, reducing disparities in health, and promoting practical evidence-based clinical and outcomes focused research.     

Towards Communicative Justice in Health

This article approaches care from a different angle by looking ethnographically at how it is shaped by structural differences in the power to control the circulation of knowledge. I focus on an investigation conducted by people classified as “indigenous”, of an epidemic that killed 38 children and young adults in a Venezuelan rainforest. I trace how health/communicative inequities structured clinical interactions, documents, epidemiological investigations, news stories, and dialogues with healers, thwarting the identification of the epidemic, clinically identified as rabies. Although the Bolivarian socialist government provided access to care, professionals denigrated parents’ contributions to care and communication and reduced complex, unequal relations between languages to practical problems of translation. Pointing to parallels with US social movements, I suggest that responding to demands for communicative justice in health requires seeing how health inequities are entangled with health/communicative inequities. The typographical slash points to importance of challenging the subdisciplinary boundary-work that relegates their study to non-overlapping conversations in medical and linguistic anthropology.     

‘12 tips for teaching environmental sustainability to health professionals’

Abstract

Background: As recognition of the health impacts of climate change and other environmental challenges increases, so too does the need for health care professionals to practice healthcare sustainably. Environmental sustainability in healthcare extends beyond our traditional understanding of environmental health, which is often limited to environmental hazards and disease. Health services, professional organizations, and training institutions are increasingly forming climate and sustainability position statements and policies accordingly. To prepare future health professionals for global environmental change, environmental sustainability must be meaningfully integrated into health curricula.

Aim: To provide educators with 12 tips for integrating environmental sustainability into health professional education.

Methods: The authors reviewed the literature relating to climate change, environmental sustainability and health, and health professional education. By combining findings from this search with reflections on their own experience in clinical and public health teaching across nursing and midwifery, paramedicine, medicine, and public health, the authors developed recommendations for integrating environmental sustainability into health professional education.

Results: These 12 tips can be used to teach students and qualified health professionals in nursing, allied health, and medicine to practice healthcare in an environmentally sustainable manner.

Conclusions: Empowering health professionals to practice environmentally sustainable healthcare has economic, social, health, and environmental benefits. Teaching environmental sustainability to health professionals enhances existing learning by updating curricula with the latest evidence of how environmental determinants of health are rapidly changing and enables both educators and students to make an important contribution to safeguarding human health, the environment, and healthcare for future generations.     

Green Bioethics and Hope

Many environmental problems are now more serious and urgent than ever. In high-income countries, health care is part of the problem. In Principles of Green Bioethics: Sustainability in Health Care, Cristina Richie focuses on medical developments, techniques, and procedures, and she proposes four principles for green bioethics: distributive justice, resource conservation, simplicity, and ethical economics. Richie is right to emphasize the need for green bioethics, and I admire her aim to bring environmental concerns back into bioethics, but I was disappointed with this book. Since Plato, much of ethics has focused on the characteristics or principles of the ideally just society. This work in ethics seeks to transcend the culture in which we live in order to provide guidance about what we should do. I think it would be better to start with the messy, problematic, and unjust situations in which we are enmeshed.     

Employment-Based,For-Profit Health Care in a Pandemic

The emergence of Covid-19 in the United States has revealed a critical weakness in the health care system in the United States. The majority of people in the nation receive health care via employment-based health insurance from providers in a competitive market. However, neither employment-based health care nor a competitive health care market can adequately provide treatment during a global pandemic. Employment-based health care will fail to provide care for a large number of people in any destabilizing economic event, including a pandemic. Competitive for-profit health care systems distribute limited goods based on markets rather than health care needs. If a global pandemic results in unusually high demand for specific medical supplies, then these will be distributed suboptimally. The combined risk of suboptimal distribution of needed goods and a significant drop in health care access in a global pandemic indicates that the U.S. health care system has serious vulnerabilities that need to be addressed.