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Book part
Publication date: 1 October 2013

Christine Vatovec, Laura Senier and Michael Mayerfeld Bell

Millions of people die of chronic diseases within inpatient settings annually in the United States, despite patient preferences for dying at home. This medicalization of…

Abstract

Purpose

Millions of people die of chronic diseases within inpatient settings annually in the United States, despite patient preferences for dying at home. This medicalization of dying has received social and economic critiques for decades. This chapter offers a further analysis to these critiques by examining the ecological impacts of inpatient end-of-life care on the natural environment and occupational and public health.

Methodology

We compare the ecological health outcomes of medical care in three inpatient units (conventional cancer unit, palliative care ward, and hospice facility) using ethnographic observations, semi-structured interviews, and institutional records on medical supply use, waste generation, and pharmaceutical administration and disposal.

Findings

Care provided on all three medical units had significant socioecological impacts. Cumulative impacts were greatest on the conventional unit, followed by palliative care, and lowest on the hospice unit. Variations in impacts mirrored differences in dependence on material interventions, which arose from variations in patient needs, institutional policies, and nursing cultures between the three units.

Practical implications

Social and economic concerns have been major drivers in reforming end-of-life medical care, and our analysis shows that ecological concerns must also be considered. Transitioning terminal patients to less materially intensive modes of care when appropriate could mitigate ecological health impacts while honoring patient preferences.

Originality

This chapter describes how the medicalization of dying has converged with institutional policies, practices, and actors to increase the negative consequences of medical care, and recognizes that the far-reaching impacts of clinical decisions make the provision of medical care a socioecological act.

Details

Ecological Health: Society, Ecology and Health
Type: Book
ISBN: 978-1-78190-323-0

Keywords

Book part
Publication date: 16 July 2015

Laura Senier, Matthew Kearney and Jason Orne

This mixed-methods study reports on an outreach clinics program designed to deliver genetic services to medically underserved communities in Wisconsin.

Abstract

Purpose

This mixed-methods study reports on an outreach clinics program designed to deliver genetic services to medically underserved communities in Wisconsin.

Methodology/approach

We show the geographic distribution, funding patterns, and utilization trends for outreach clinics over a 20-year period. Interviews with program planners and outreach clinic staff show how external and internal constraints limited the program’s capacity. We compare clinic operations to the conceptual models guiding program design.

Findings

Our findings show that state health officials had to scale back financial support for outreach clinic activities while healthcare providers faced increasing pressure from administrators to reduce investments in charity care. These external and internal constraints led to a decline in the overall number of patients served. We also find that redistribution of clinics to the Milwaukee area increased utilization among Hispanics but not among African-Americans. Our interviews suggest that these patterns may be a function of shortcomings embedded in the planning models.

Research/Policy Implications

Planning models have three shortcomings. First, they do not identify the mitigation of health disparities as a specific goal. Second, they fail to acknowledge that partners face escalating profit-seeking mandates that may limit their capacity to provide charity services. Finally, they underemphasize the importance of seeking trusted partners, especially in working with communities that have been historically marginalized.

Originality/Value

There has been little discussion about equitably leveraging genetic advances that improve healthcare quality and efficacy. The role of State Health Agencies in mitigating disparities in access to genetic services has been largely ignored in the sociological literature.

Book part
Publication date: 4 July 2016

Abstract

Details

50 Years After Deinstitutionalization: Mental Illness in Contemporary Communities
Type: Book
ISBN: 978-1-78560-403-4

Book part
Publication date: 16 July 2015

Abstract

Details

Genetics, Health and Society
Type: Book
ISBN: 978-1-78350-581-4

Book part
Publication date: 1 October 2013

Abstract

Details

Ecological Health: Society, Ecology and Health
Type: Book
ISBN: 978-1-78190-323-0

Abstract

Details

Genetics, Health and Society
Type: Book
ISBN: 978-1-78350-581-4

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