Editorial
Jane Shoebridge
Nursing (Social Science), Faculty of Health Sciences, Flinders University of South Australia, SA
Eileen Willis
Department of Palliative and Supportive Services, School of Medicine, Flinders University, Adelaide SA
PP: 1 - 4
Article Text
Announcing Health Sociology Review
This is the first issue under the new title, Health Sociology Review. Regular subscribers to the journal will see that we have carried on the traditions established by previous editors of the Annual Review of Health Social Sciences by using the same format as in previous issues.
Three commentaries in this first issue of Health Sociology Review follow up papers from the symposium 'Health IT Globalisation: changing worksites and practices in health care' published in Volume 10(1) of the Annual Review of Health Social Sciences in August of 2000/2001. Ian Watts and Nathan Pinskier from the Royal College of General Practitioners challenge Kevin White's analysis of the corporatisation of general practice. They take a much more optimistic view of GP independence than Kevin White allowed in his original article. In his rejoinder White clarifies the necessary sociological distinctions between patient-practitioner relationships, clinical independence and the proletarianisation of medicine. White agrees with the Watts and Pinskier prediction that Australian GPs are becoming 'subcontractors'; but, against their enthusiasm for GP contractual opportunities, White reads 'subcontracting' as an inevitable retreat from professional status.
In the second commentary David Legge takes both Kevin White and Eileen Willis to task over their failure to position their arguments within the global context and he outlines some of the ways in which this could have been achieved. This is done in some detail for the Willis paper and with some sympathy for management. Legge's analysis reminds us of the contradictory class locations of managers by revealing the fact that reform of the health care sector in Australia has not resulted in more power to management but increased control for the state. We extend our thanks to Nathan Pinskier, Ian Watts and David Legge. Informed responses from within the profession of medicine add bite to the debates and of course situate the issues explored in the real politics of medical practice.
Symposium on Indigenous Health
This issue sees two new areas for discussion and debate. The first symposium arises out of the Health Sociology Day at Coriole in December 2000, specifically the paper given by Ian Anderson on the challenge to sociologists to engage in Indigenous health. Sherry Saggers, Dennis Gray, Peter d'Abbs and Chris Cunneen have taken up the challenge. All four have been in the field for several years as their research displays and as editors we were delighted at the way in which the papers intersect. Ian Anderson sets the scene for a structural analysis of the relationship between Indigenous health and the state by exploring the position of Aboriginal people prior to, and subsequent to the 1967 referendum. He notes the impact of organised medicine's resistance to nationalised health care in Australia and the impact this had on Indigenous people. This is not to deny the fact that some individual doctors offered free health care to Aboriginal people prior to 1973/1975 when the first community controlled medical services began their magnificent work.
A careful reading of Anderson's paper provides ideas and outlines for further sociological research. Anderson's own paper illustrates the value of a social and historical analysis of the Constitution and other legal and quasi-legal regulations as factors in the provision or lack of health care for Aboriginal people. While he notes the fact that state governments would have provided some care, much of this in remote areas would have been funneled through missionary institutions bringing other cultural and structural factors into the charitable provision of health care. It was an institutional response, but of a particular kind. In the post-referendum period the provision of health care shifted to state, federal and community controlled services. As Anderson notes little has been written on these various institutional responses to the health needs of Aboriginal people. Anderson raises questions about the impact of specific health professional groups and their professional structures on the kinds of health care provided. He mentions doctors, but the position of nurses is also pertinent, as is the professional relationship between these two groups and the impact this has on the social relations between both groups and Aboriginal health workers. The ebb and flow of power between these three providers of health care says much about the way Indigenous health and health beliefs and practices are constructed and understood.
Anderson points to the influence of policies of self-determination and the impact of community controlled health services. The ability of these services to resist incorporation, mainstreaming and budget cuts presents an intriguing account of a robust social movement. Contrary to 'popular myth' the continued growth of these robust organisations says much about the importance Aboriginal people give to equity and access to Western biomedical care and to shaping the way they wish to receive this care. The history of this movement and the many concrete services provided under this rubric is a refreshing anomaly in twenty-first century community health.
The three other papers deal with the present situation. Sherry Saggers and Brian Gray provide a forceful argument for state intervention and prohibition over access to alcohol. Their paper is persuasive and at a theoretical level illustrates the value of classical explanations of the issues. Peter d'Abbs provides a further sociological challenge by reminding us that social and behavioural changes require more than the imposition of laws and regulations from outside agencies. He brings further illumination to that fundamental principle: community control. D'Abbs' review of relevant research weighs up the relative strengths of anthropology (including ethnography), psychology, psychiatry, social epidemiology, social history and political science before arriving at a sociologically informed model of both causation and beneficial social change. He deals usefully with concerns that researchers working in this field should themselves be Indigenous Australians. Cunneen asks how successful was the Royal Commission into Aboriginal Deaths in Custody, shows its failures, notes the increase in punitive responses to crime in the community at large, but also illustrates the way in which the Commission shifted the cultural ground in positive ways.
Taken together, these four papers should indeed challenge sociologists about to embark on studies in the field of Indigenous health and illness. They span the sociological spectrum of theory and method and consider the merits of using classical structural analysis with or without approaches such as demography; critical ethnography; social constructionism; analysis of formal and informal medical texts; case studies of health policy, health intervention and health promotion programmes; and sociologically informed history, especially of Aboriginal political movements and their profound effects at national and local levels. We hope this symposium inspires sociologists to take the challenge further.
Symposium on Stigma and Health
Readers may well find the boundaries between sociology, history and politics also blurred in the next symposium. Four papers on 'stigma and health' present constructive ways to use theory and method with two kinds of people: those resisting the stigma and oppression of chronic illness; and those recognising the stigma associated with their work in and around the field of health care. The papers explore the aspirations and dilemmas of people many of whom must ask themselves every day how to engage fully and fruitfully with the social world and how to sustain the psychic-some say spiritual-and physical energy needed to do so. Neville Millen and Christine Walker have found that many people with chronic illness in Australia today aspire to be public advocates for improved care, resources and facilities. In sociological terms it seems much benefit is derived from exchanging the stigma of illness for the communally respected status: 'political activist'. The next paper presents an interesting contrast with the Millen and Walker approach. Catherine Garrett celebrates the ethic of 'living for others' in a spiritual sense as she sensitively explores links between chronic illness, hope and healing-with theological as much as sociological imagination.
Analysing the stigmas attached to certain kinds of work in and around the health field calls for an understanding of the subtleties of social change. For example the stigma attached to funeral work is supposedly lessening; but Pam Carden experienced it as a difficult problem for herself and other workers in the industry in Adelaide; and whereas in recent decades the stigma attached to women seeking abortion has waned, Margie Ripper argues that the last five years has seen a marked re-stigmatising of the health professionals who provide abortions. These four papers demonstrate how sociological analysis can offer invaluable insight into the 'everyday' of health and illness.
Matters administrative
The journal continues largely with the support of you the subscriber and with the generous assistance of The Australian Sociological Association. For the layout and design of this issue we have had the capable assistance of Kate Wiseman, secretary to the Bachelor of Health Science Programme here at Flinders University. The previous issue was submitted to the National Library of Australia for registration on the Australian Public Affairs Information Service (APAIS) and Australasian Medical Index (AMI) data- bases. We will continue this for subsequent issues. The journal is also now listed with the Department of Education, Science and Technology as a refereed journal. Health Sociology Review and the previous Annual Review of Health Social Sciences have always been peer reviewed journals, as has been clearly stated in the journal. We have now altered the wording to more closely conform to DEST guidelines.
We are now able to offer subscribers credit card facilities. Please see the subscription form at the back of this issue.
Preparations for Vol 11 (1 & 2) are already underway. The next issue will be published in the Spring. Toni Schofield from Sydney University will co-edit this volume with a series of papers on women's health from the Health Sociology Day of The Australian Sociological Association's national conference held in Sydney in December 2001. A further symposium will include papers on the links between sociology and spirituality. This will be edited and introduced by Charles Waddell. Other papers will return to the ever-present structural issues confronting the Australian health care sector.
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