The politics of American health care

The developments leading to the present American health care organization are traced. It is clear that hospitals have dominated at the expense of primary health care programmes. Health care costs have soared dramatically. There are particular problems inherent in a system shared between federal and state governments and a private health care industry. Attempts to provide a fully (or partially) tax-funded health service in the USA have been bedevilled by a number of factors. These include opposition from labour unions, politicians, vested-interest groups and, in particular, the American Medical Association. As part of its opposition, the AMA politicized itself in 1950. But, in the political literature, American nurses are not portrayed as being very politically active. Reasons for this are explored. The introduction of Medicare and Medicaid programmes is discussed and the legal, social and political implications. Recent attempts in the USA to control costs are assessed and new trends and new problems identified.     

The politics of belonging and intercultural health care

Belonging was one of the recurrent themes in an ethnography examining the social context of intergroup health care relations. Certain people, both patients and health care providers, were constructed as belonging in the social fabric of health care, whereas some were left on the margins and constructed as Other. In this article, the theme of belonging is explored through a multilayered analysis of the contexts of intergroup health care encounters. The macropolitics of belonging are situated in the larger societal setting, replete with practices that mark Other. Evidences of such Othering is then traced through organizational contexts, drawing on the exemplars of visiting hour policy, integration of alternative therapies, and provision of language services. Intergroup interactions are then reanalyzed in light of micropolitics at the individual nurse-patient level. The overall picture presented is one of a range of social, political, historical, and economic forces reproduced in everyday intercultural health care encounters.     

The "quality" system in health care

The evolution of the quality assistance care management, is contributing to create a new strategy toward the single operations responsibility. This program is based on efficiency improvements, based on a synthesis of scientific evidences translated with specifications and criteria, that represents the application of the progress of clinic methodology and of the scientific information in the clinics. The evaluation of new criteria, like the guidelines and evidence based medicine, are our goal of this work, because can be a continuous improvements of the healthy and care programs at all the levels of applications.     

The politics of knowledge: implications for understanding and addressing mental health and illness

While knowledge represents a valuable commodity, not all forms of knowledge are afforded equal status. The politics of knowledge, which entails the privileging of particular ways of knowing through linkages between the producers of knowledge and other bearers of authority or influence, represents a powerful force driving knowledge development. Within the health research and practice community, biomedical knowledge (i.e. knowledge pertaining to the biological factors influencing health) has been afforded a privileged position, shaping the health research and practice community's view of health, illness and appropriate intervention. The aim of this study is to spark critical reflection and dialogue surrounding the ways in which the politics of knowledge have constrained progress in addressing mental health and illness, one of today's leading public health issues. I argue that the hegemony of biological knowledge represents an ethical issue as it limits the breadth of knowledge available to support practitioners to ‘do good’ in terms of addressing mental illness. Given the power and influence inherent within the nursing community, I propose that nurses ought to engage in critical reflection and action in an effort to better situate the health research and practice community to effectively address the mental health of populations.