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Editorial
Fran Collyer
Department of Sociology & Social Policy, University of Sydney, NSW
Toni Schofield
Behavioural and Community Health Sciences, University of Sydney, NSW
Article Text
Welcome to the fifteenth volume of Health Sociology Review. In this issue we have papers analysing the health experiences, health policies, and health care systems of various countries, including Australia, China and North America. The first tranche of papers examine some of the basic conceptual building blocks of health care and health policy research: agency and structure, social class, race, consumers and community participation, and the notion of a life-pathway. A second set investigates issues of topical interest within the health care system, specifically the accreditation of doctors, and nursing care for obese patients.
A third group turns the focus toward reproductive health, investigating the practice of paternity testing, fatherhood, and women's post-partum health care needs. William Cockerham starts the issue with a timely reminder of the role of both structure and agency in the determination and prevalence of disease, and argues for caution in applying theoretical models - developed to explain illhealth in the West - to the Asian context. Given the research evidence from the West of the relationship between health, individual choice, behaviour, social norms, lifestyle, life-chances, and social class; Cockerham surveys existing, though somewhat sparse evidence of the impact of social class on health lifestyle practices in the Asian context, and proposes a model which may assist in future research.
Also concerned with the Asian region is a paper by Jingqing Yang on the privatisation of professional knowledge in the Chinese health care system. Yang argues that despite prohibitions against charging patients for services in the predominantly public health care system, the practice of 'red packets' is widely prevalent, and constitutes a form of unofficial sanction for medical professionals to increase their income.
Moreover, the sale of professional skills and expertise - forms of intellectual property and practice traditionally owned by the state - are increasingly considered by the public and medical professionals to be private property. Yang suggests that the complicity of the public in the practice of 'red packets' has placed pressure on the state to soften its regulation of medical professionals. The tentative, and as yet unofficial privatisation of medical, professional knowledge in China, indicates the first steps have been taken in the emergence of a private health care market.
David McCallum takes us from the Asian region to Australia, with his historical paper on the removal of Aboriginal children during the 19th century from their families and taken into state care. McCallum's focus is on the construction of 'race' as a category which enabled the state to act differently toward various populations. The author shows that neglected white children were considered in need of state care, as were healthy 'half-caste' Aboriginal children; yet weak or deprived Aboriginal children were returned to the missions and their family context without further state intervention. McCallum's analysis provides an illustration of how the filtering lens of race has led to differing state responses to the bodily health of groups within the population.
The subsequent paper takes us from a focus on race to the consumer of health care services. Judy Taylor, David Wilkinson and Brian Cheers tease out the differences between consumer and community participation in health care planning and programs. They indicate the conflation of these terms is not accidental, for encouraging consumers rather than communities to be involved with government agencies is consistent with the rise of managerialism and the increasing privatisation of services during the late 20th and early 21st centuries. Health policies directed at individuals, rather than communities, enables the state to take the 'less political' route, for this means it can transfer the responsibility for problems which stem from the structural location of an individual, to the individual themselves and their poor life-style choices or bodily incapacities.
The authors utilise the case of rural health management boards in Australia to illustrate how the inclusion of communities can lead to improved health outcomes. Mike Lloyd challenges the alleged superiority of longitudinal health research as a means to ascertain the factors leading to health and wellbeing. He argues that longitudinal research assumes 'life pathways' can be tracked in linear sequence; disputes the notion of behaviour as largely goal oriented; and rejects the idea of 'causes' as readily located in past events (such as childhood trauma). Employing the work of philosopher Alphonso Lingis, Lloyd proposes the need for life pathways to be considered in terms of 'lived experience', in which chance, emotion and portentous events such as meeting and falling in love, constitute, motivate, and produce the human experience, and as such 'pathways' are not pre-determined but 'unfold' in the immediacy of a moment. This author calls for a re-evaluation of longitudinal research and warns against the uncritical use of variables in the determination of the causes of healthy or unhealthy life pathways.
The subsequent two papers investigate issues arising from the health care system. The first of these, by Dimitria Groutsis, considers the implications of geography on the medical labour market. Groutsis examines the complex process of accreditation of overseas-trained doctors, demonstrating how stratification within the Australian medical labour market is shaped by key members of the medical fraternity. Carol Jeffrey and Simon Kitto take a very different theoretical approach in their work on the nursing of obese patients. Here the authors focus on how nurses care for patients and make sense of their work in the midst of three competing discourses: of medicine, nursing and neo-liberalism. This study of nursing in a bariatric ward challenges the idea of nursing work as wholly determined by the discourses of biomedicine, and shows how prevailing ideas about obesity, individual responsibility, and holistic care are incorporated into the way nurses 'make sense' of their role as carers.
The final group of papers examine the issue of reproductive health. Michael Gilding's work gives an insight into the market for DNA paternity testing, comparing the industry context in the USA and Australia. Gilding explains why such tests are five times more prevalent in the USA: not the least of which are differences of government policy and the funding arrangements of the two health care systems. Christine Everingham and Tarquin Bowers report on the results of a small, qualitative, empirical study of new parents which investigated the impact of new discourses of fatherhood. The authors found these new discourses have re-shaped, and unrealistically raised expectations, adding to the already difficult task of parenting. Moreover, promulgated within a conservative political context, new discourses of fatherhood have been created and used by various groups in Australia to re-instate patriarchal control over women and children. The final paper for this volume, by JaneMaree Maher and Kay Souter, also draws on an empirical, qualitative research study. Here the focus is on the health of new mothers, and findings indicate that maternal health is generally overlooked amidst the focus on the new baby. The more positive outcome of the study however, indicates the support provided by other women, and the central and effective role of maternal and child health nurses in the health care system.
We trust our readers will find much of interest in this issue of our journal, and as always, we wish to express our appreciation for the assistance of the authors, reviewers, editorial board, Book Review Editor, the publisher, and our subscribers: without whom this issue would not, and could not have been produced.
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