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Critical analyses of health policies and practices may appear to lack practicality during unprecedented times that demand immediate solutions. This paper aims to use critical social science theories to help improve essential service delivery during a public health crisis.

This study is based on qualitative content analysis of government and scholarly sources between 2008 and 2021 to identify strengths and gaps underlying the Canadian Federal Government’s evidence-based solutions to the opioid death crisis. Key questions examined are: What constitutes best-evidence practices underlying the Canadian Drugs and Substances Strategy?, Is biomedical evidence the only legitimate framework to substantiate feasible interventions? and Because the opioid death crisis affects disproportionately vulnerable populations, what is the potential merit of considering diverse knowledges and practices as valid forms of intervention despite lacking biomedical evidence bases?

While overdose reversing drugs, drug replacement approaches, biologically focused harm reduction options and pharmacological regulatory and surveillance initiatives help reduce premature opioid-related morbidity and mortality across provinces, this study’s findings demonstrate that these individualizing, biomedical magic bullets are temporary solutions, not comprehensive plans to solve a societal problem. This study’s theoretically informed analysis shows that the Canadian Federal Government responses detract attention from issues of social justice, social inequities and the biomedical dominance of health care as broader forces of the opioid death crisis. To address these analytical omissions, broader evidence-based solutions must build upon meaningful intraventions, the insiders’ perspectives or voices of the afflicted communities alongside meaningful interventions – going beyond distal, clinical-based and proximal, home-based interventions.

By highlighting the biomedical and social embeddings of the opioid death crisis, this study underscores structural conditions rather than individuals’ physical bodies as the catalysts for change. A deeper theoretical understanding of why certain issues exists, as they do and how they occur, can provide the basis for prediction of their (re)occurrence and for informing meaningful intervention efforts.

As biomedicine becomes increasingly enmeshed in modern life, biomedicalization processes have implications for reproductive policy, including abortion policy. Informed consent provisions have been a prominent trend in state-level abortion lawmaking in the United States in recent years. Modeled on the practice of securing informed consent for medical procedures, informed consent provisions stipulate the information a person must receive before they can consent to an abortion. Informed consent provisions purportedly require that this information be objective, scientifically accurate, and non-judgmental. Through an analysis of informed consent provisions in Texas abortion legislation from 1993 to 2015, this chapter explores how such provisions employ medical and biomedical tropes to frame regulations that restrict access to abortion care as ostensibly protecting women’s health and safety. I find that informed consent legislation in Texas selectively borrows from medical and biomedical lexicons, cites strategic empirical evidence, and co-opts medical techniques and experts in ways that encumber abortion access.

Epidemiology is often described as “the basic science of public health” (Savitz, Poole & Miller, 1999; Syme & Yen, 2000). This description suggests both a close association with public health practice, and the separation of “pure” scientific knowledge from its application in the messy social world. Although the attainability of absolute objectivity is rarely claimed, epidemiologists are routinely encouraged to “persist in their efforts to substitute evidence for faith in scientific reasoning” (Stolley, 1985, p. 38) and reminded that “public health decision makers gain little from impassioned scholars who go beyond advancing and explaining the science to promoting a specific public health agenda” (Savitz et al., 1999, p. 1160). Epidemiology produces authoritative data that are transformed into evidence which informs public health. Those data are authoritative because epidemiology is regarded as a neutral scientific enterprise. Because its claims are grounded in science, epidemiological knowledge is deemed to have “a special technical status and hence is not contestable in the same way as are say, religion or ethics” (Lock, 1988, p. 6). Despite the veneer of universality afforded by its scientific pedigree, epidemiology is not a static or monolithic discipline. Epidemiological truth claims are embodied in several shifting paradigms that span the life of the discipline. Public health knowledges and practices, competing claims internal and external to epidemiology, and structural conditions (such as current political economies, material technologies, and institutions) provide important contexts in which certain kinds of epidemiological knowledge are more likely to emerge.

How is medical knowledge produced and what are the implications of that knowledge production for medical practice? Using theoretical ideas on evidence-based medicine, standardization in medical research and practice, and biopower, I examine the relationship between medical knowledge and medical practice through the case of pelvic pain care in the US.

Data from ethnographic observations at two medical conferences as well as interviews with healthcare providers inform a critical analysis of the medical discourse.

The analysis reveals how evidence-based medicine is practiced in the context of medical conditions that lack objective evidence, as well as the unintended consequences of such practices. I provide an alternative approach to medical practice for conditions lacking traditional evidence through presenting outlier cases in the data.

In doing so, I make the broad theoretical argument that biomedical paradigms must emerge through the critical process of negative dialectics in order to reach past the limits of standardized medical care.

In sociologically analyzing the case of pelvic pain care, I reveal dire limits in the evidence-based approach to medical care for conditions and symptoms that may be deemed medical anomalies, demanding an alternative approach to care for such conditions.

To examine how clinicians navigate providing treatment to Borderline Personality Disorder (BPD) in the context of the DSM 5, deinstitutionalization, and the biomedical model.

We conducted 39 interviews with mental health providers in the United States in a two-year period preceding and following the release of the DSM 5. Using Constructivist Grounded Theory, we analyzed the data for themes that emerged.

Clinicians faced pressures from insurance companies, the DSM categories, and their professional training to focus on biomedical treatments. These treatments, which emphasized pharmaceuticals and short courses of care, were ill-suited to BPD, which has a strong evidence base recommending long-term therapeutic interventions. We term this contradiction a “biomedical mismatch” and use Gidden’s concept of structuration to better understand how clinicians navigate the system of care. Providers ranged in their responses to the mismatch: some championed biomedicine, others were complicit, and a final group behaved as activists, challenging the paradigm. The sum of the strategies had downstream effects which included crisis reinstitutionalization and a discourse of untreatability. Ultimately, we discuss how social factors such as gender bias, stigma, and trauma are insufficiently represented in the biomedical model of care for BPD.

BPD fits poorly within the biomedical underpinnings of the current system. Accordingly, it illuminates the structuration of health care and where the rules of care break down. More precisely, deinstitutionalization was designed to remove patients from long courses of inpatient care. Many patients with BPD have failed to experience this outcome, with some patients now cycling through long courses of short-term crisis reinstitutionalization instead of having effective outpatient care over long periods. This unintended consequence of deinstitutionalization calls for a more biopsychosocial response to BPD.

The purpose of this paper is to investigate the role of creative activity and storytelling in assisting development of students’ reflective ability and critical thinking.

Eight biomedical science students undertaking year-long work-based placements took part in this action research study. A coding scheme was designed to assess students’ reflections initially and at each stage of the study. Intervention activities involved students using mood boards, images and storytelling to assist development of creative learning spaces with a thematic approach employed to analyse both personal and collective reflections. Post-intervention evaluation considered possible long-term impact on students’ reflective ability.

Students’ pre-intervention reports showed little reflection focusing mainly on competence demonstration and descriptive situation summaries. During the intervention workshops, all students demonstrated both identification of self as a practitioner and a critically reflective approach. However, this was not maintained long term as initial post-intervention reports tended to revert to a more descriptive style of writing suggesting longer-term support is required.

The importance of further research into the long-term usefulness of creative collaborative learning spaces in work-based programmes is suggested.

This is the first study investigating the approach to supporting critical reflection during work placement in biomedical scientists. It is suggested that the current competence-based training programme provides limited opportunities for developing and embedding critical reflection. Where opportunities are provided, such as creative learning spaces, students’ critical reflection was greatly enhanced. However, it appears essential that this approach is maintained throughout training as critically reflective skills developed during collaborative learning have limited transferability to subsequent reflective report writing.

The purpose of this chapter is to offer reflections on conventional theories concerning causes and determinants of diseases. It also intends to examine both theoretical and empirical bases for adopting an Integrated Social-Ecological Systems (ISES) lens as a tool for understanding complexities related to drivers, determinants and causes of diseases.

We assessed the theoretical underpinnings of a range of historical and contemporary lenses for viewing infectious disease drivers and the implications of their use when used to explain both personal (i.e. individual) and population health. We examined these issues within the empirical context of the City of Dhaka (Bangladesh) by adopting an ISES lens. Within this study an emphasis has been placed on illustrating how feedback loops and non-linearity functions in systems have a direct bearing upon various aspects of infectious disease occurrences.

A brief triumph over microbes during the last century stemmed in part from our improved understanding of disease causation which was built using disciplinary-specific, monocausal approaches to the study of disease emergence. Subsequently, empirical inquiries into the multi-factorial aetiology and the ‘web of causation’ of disease emergence have extended frameworks beyond simplistic, individualistic descriptions of disease causation. Nonetheless, much work is yet to be done to understand the roles of complex, intertwined, multi-level, social-ecological factors in affecting disease occurrence. We argue, a transdisciplinary-oriented, ISES lens is needed to explain the complexities of disease occurrence at various and interacting levels. More theoretical and empirical formulations, with evidence derived from various parts of the world, is also required to further the debate.

Our study advances the theoretical as well as empirical basis for considering an integrated human-nature systems approach to explaining disease occurrence at all levels so that factors at the individual, household/neighbourhood, local, regional and global levels are not treated in isolation.

Having a baby is a sensitive matter and the child's body occupies a relevant space within the imaginary and the concerns of the intentional, biomedicalized contemporary reproducers. Besides, the myth of ‘the perfect child’ claims specific moral injunctions about making bodies since the body conveys social recognition codes both through flesh or genetic matrix and embodied practices. So, having a child with an unexpected ‘defective’ body becomes a stressful challenge for the reproductive experience of the intentional parent(s). In any case, both parent(s) and biomedical professionals enact a hierarchization among the ‘damaged’ materials of the child's body based on the perceived and/or the classified degree of physical or mental abnormality, on its behavioural embodiments and on the possibility to re-order, fix and control the (biosocial) disorder of an abnormal unable and/or undisciplined body.

Based on recent investigations on reproduction and disability in two regions of Italy, this essay comparatively investigates the experiences of two associations of parents with asthmatic and ADHD children.

Specifically, I tried to explore how parents of children with misleading bodies emotionally, practically and morally face their unexpected reproduction, and if and how they are being entrapped in or resist the pressure of neuro-biomedical governance, schooling disciplining techniques and social blame. I tried to articulate some suggesting concepts, such as ‘delegate biopolitics’ and ‘discursive surveillance’ (Memmi, 2008), and ‘self-constraint behaviours’ (Elias, 1998), in order to analyze ethnographic material.