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The Health System Dynamics Framework: The introduction of an analytical model for health system analysis and its application to two case-studies
Get PDFFrameworks can clarify concepts and improve understanding of underlying mechanisms in the domain of health systems research and strengthening. Many existing frameworks have a limited capacity to analyze interactions and equilibriums within a health system overlooking values as an underlying steering mechanism. This paper introduces the health system dynamics framework and demonstrates its application as a tool for analysis and modelling. The added value of this framework is: 1) consideration of different levels of a health system and tracing how interventions or events at one level influence other elements and other levels; 2) emphasizes the importance of values; 3) a central axis linking governance, human resources, service delivery and population, and 4) taking into account the key elements of complexity in analysis and strategy development. We urge the analysis of individual health systems and meta-analysis, for a better understanding of their functioning and strengthening.
On Not to be Gay: Aversion therapy and transformation of the self in Postsocialist China
Get PDFIn this article, through a critical reading of the published diaries written by gay ‘patients’ who received aversion therapy in south China in the 1990s, I examine how the transformation of subjectivities from gay to straight was made possible by such ‘self-technologizing’ practices as writing and communication. I also consider the centrality of the body and affect in the process of subject (trans)formation, and ask how a new, coherent and authentic ‘self’ was fabricated through bodily and affective experiences. This discussion not only reveals the social construction of the self as central to China’s postsocialist governmentality, but also the central role that gender and sexuality play in processes of self-formation
I Did it For Me: Negotiating identity and agency
Get PDFScholars have debated the feminist critique of female beauty practices for years with the fundamental disagreement revolving around the notion of “agency.” This study used textual analysis to explore how the concept of “agency” has been employed in cosmetic surgery ads placed in large city magazines. Three themes emerged: realize your potential, pleasing yourself, and control your destiny. This research expands our understanding of how physicians are repositioning cosmetic surgery to women through discourses that empower, appeal to their sense of self, and play upon feminist sensibilities that privilege individual choice. This research also contributes to the literature surrounding the ongoing debate of agency by examining how it plays out in another form of text previously unexamined (physician advertising) and how it touches upon a new player in the health beauty system (physicians) rather than prior studies, which focus on idealized images in the media
Engaging with the discourse on lifestyle modifications: Evidence from India
Get PDFLifestyle modifications through a range of health care practices are considered central to the management, control and prevention of chronic non-communicable diseases. While there is a critical perspective on the epistemologies of such global health discourses in existing literature, empirical evidence on how people engage with such prescriptive lifestyle modifications in different cultural contexts is very limited. The paper in this context draws on illness narratives of heart patients to discuss about the anxiety and uncertainty expressed by patients and others about notions of what constitutes ‘healthy’ and ‘risky’. It specifically unpacks the global-local dynamics in the construction of risk and healthy lifestyle and examines the contexts in which such global discourses are embodied, resisted or negotiated in different cultural contexts. The paper also examines how global health discourses travel to local sites through popular press. The paper draws on evidence collected through analyzing two Indian national English dailies and in-depth interviews with heart patients and their family members in Delhi, India in 2007-2008.
Tracing the Evolution of American Health Care through Medicare
Get PDFWith President Obama’s health care reform currently under intense partisan scrutiny in the United States, this article is an objective resource for understanding the ways in which Medicare has historically served as a weather vane for charting the changes to the American health care system. During its nearly fifty-year tenure as the standard for the provision of medical care in the U.S., Medicare has evolved in fits and spurts, with its core structure shifting over time as the result of each decade’s economic and political climate. It is only by understanding these past revisions, both independently and in the context of the concurrent changes in other nations around the world, that we can fully comprehend the state of America’s health care system today, and make the necessary allowances to ensure that the nation’s health care will survive to provide for its constituents in the years to come
Challenging Patriarchy: Trade, outward migration and the internationalization of Commercial sex among Bayang and Ejagham women in Southwest Cameroon
Get PDFThis paper documents the specific local and global socio-economic forces that led to the outward migration of Bayang and Ejagham women to work as commercial sex workers on the Cameroon-Nigeria border regions in the 1980s and 1990s. It demonstrates that these women’s personal accumulation strategies are adaptative- drawing on time and space specific modes of capitalist accumulation and kinship systems of power. The intertwined nature of these forms of accumulation demonstrate that patriarchal forms of power and capitalist forms of accumulation in this region were not competitive, but rather complementary systems. This conjuncture also gave women the latitude to claim some form of sexual and economic agency, suggesting that at least in Africa, patriarchy as a power field is dynamic and relational, simultaneously opening up spaces for both resistance and agency.The impact of sex work is disproportionate since most women of our study were involved in subsistence sex, with the risk of exposure to violence and HIV/AIDS. These women nevertheless sought to reconfigure gender relations
The production of critical theories in Health Systems Research and Education. An epistemological approach to emancipating public research and education from private interests
Get PDFThis paper aims at offering alternative methodological perspectives in health systems research, to produce critical, theoretical knowledge in domains such as health policy and management of health care, organization of disease control, political economy of health and medical practice.We first examined the reasons to believe that worldwide economic agents have driven publicly funded schools of public health to adopt their preferred policies and to orient their priority research topics. We then studied whether this hidden leadership has also contributed to shape research methodologies, which we contrasted with the epistemological consequences of a quest for intellectual independence, that is, the researcher’s quest to critically understand the state of health systems and generalize results of related action-research. To do so, we applied concepts of what could be named the ‘French School of Critical Sociology’ to qualitative research methodologies in descriptive health systems research. To do so, we applied concepts of what could be named the ‘French School of Critical Sociology’ to qualitative research methodologies in descriptive health systems research
Space, Identity and Health Risks: a study of domestic waste in Ibadan, Nigeria
Get PDFPoor waste management has characterized Ibadan’s modern and historical identity. As a consequence, residents of Ibadan (indigenes) hold diverse views about the city\u27s image, while non-indigenes label it "filthy" and "dirty". These perceptions, spatial and cultural, are deep rooted, intertwining with the political and cultural plane of Nigerian society. A distinction between “self” and “others” is seen to mark a discourse and counter discourse in the perception of health risks associated with domestic waste in the Ibadan. Through survey and descriptive ethnography, our paper examines the nature and extent of domestic waste in Ibadan, as a physical, community and psychological reality, where we seek to explain how generation and poor waste management impacts on these spaces and the very mechanics of identity. Different perceptions of health risks are observed as well the vulnerability to diseases associated with domestic waste and poor hygiene, bringing into play the socioeconomic variables and residential patterns which constitute the daily reality of this city. Our study establishes that the increase in urban population, the low economic status, the indiscriminate setting up of artisans’ shops or outlets and the overall inability of government agencies to monitor the menace of domestic waste and its attendant health risks, are central factors to the problem generically deemed one of “waste”.
Kanosa- Lending an Ear to the Body and Mind Secrets of Rural Women:Thoughts on Health and Modernity
No full textThis review article discusses the text Kanosa - Grameen Streechya Sharir ani Manatil Gupitancha, translated as ‘Lending an Ear to the Secrets of Body and Mind of the Rural Woman’ by Dr. Rani Bang. The original text provides detailed information on various life-cycle health experiences of women; illness categories (nosography); health practices; sexualities; diets and local life-worlds of health and bodily experiences based on the in depth discussions with local women. In the context of current trends and prevailing ideologies in the community health sector of India, our critical review highlights the significance of the approach adopted by Dr. Rani Bang in locating health as an integral part of culture.We seek to introduce important discussions in Bang’s text on ethnophysiology, local categories of diseases and their implications on modern community health interventions, as ell as the definitions of the normal, abnormal and pathological as provided by the local community. In light of these discussions, we examine certain characteristics of the modern Indian community health sector such as its inability to work with local epistemologies of health and illness and its philosophical reliance on Cartesian dualism and western notions of personhood. Certain features of community health such as complete separation of fertility and sexuality as well as the exclusively nutritional approach to dietary phenomena are also reviewed with reference to Kanosa and other significant literature.
The Initiative to extend Medicare into Mexico: a case study in changing U.S. Health Care Policy
Get PDFThis study examines the geo-political activities of interest groups, governments and multinational corporations involved in an initiative to extend Medicare to U.S. retirees residing in Mexico. If the initiative to change the current Medicare policy succeeds, the relocation of Medicare-eligible populations from the U.S. to Mexico is likely to increase; the U.S. is expected to gain cost-savings for taxpayers on Medicare; Mexico can develop senior-housing and options for long-term care it currently lacks; and foreign-led multinational corporations will increase their profits and dominance, fostering even more privatization in Mexico’s health care sector. By exploring new issues about retirement migration and health this study seeks to gain knowledge about the phenomena in a number of areas. First, the retirement migration of North Americans to Latin America is an under-studied phenomenon in the fields of social gerontology, migration research, and health policy studies. Second, the Medicare in Mexico initiative is even less well-known among health policy scholars than the retirement migration phenomenon into Mexico. Yet this initiative is inherently international in scope and involves a number of US-based institutions and interest groups actively promoting the project from within Mexico. Thus, the initiative has important geo-political and socio-economic implications for reforming health care systems in the U.S. and Mexico