Kaiser Permanente's Manifesto 2005 Demonstration

Summary

In 1996, the eight-million member Kaiser Permanente HMO adopted a vision statement that said by 2005 it would expand its services to include home- and community-based services for its members with disabilities. It funded a 3-year, 32-site demonstration that showed that it was feasible to link HMO services with existing home-and community-based (HCB) services and that members appreciated the improved coordination and access. This private-sector project showed that devolution can produce innovative and feasible models of care, but it also showed that without federal financial and regulatory support, such models are unlikely to take hold if they are focused on “unprofitable” populations, for example, those who are chronically ill, poor, and/or disabled.     

Dialogic communication in the health care context: A case study of Kaiser Permanente's social media practices

This case study examines how one of the largest not-for-profit health care organizations in the US, Kaiser Permanente, uses social media to communicate with its stakeholders. Through content analysis and interviews, this study identifies the communication models reflected in a sample of social media posts and examines the organization's approach to using social media. The study finds evidence of both one-way and two-way communication models, as well as principles of dialogic communication. The implications of these findings are discussed.     

Decentralisation and devolution to the English regions: Assessing the implications for rural policy and delivery

The White Paper Your Region, Your Choice: Revitalising the English Regions opened the way for reforms to regional government in England which, it asserted, will improve decision-making and deliver better quality services. In the field of rural policy, too, there are demands for decentralisation to improve service delivery and reflect the diversity of rural areas. Drawing upon a case study of rural policy making and implementation in the English West Midlands, this paper explores current institutional structures for rural policy making and how further administrative decentralisation or political devolution might enhance them. It reveals a complex set of fragmented structures and blurred accountabilities in which policy implementation is an outstanding concern. The Government's administrative reforms, together with proposals to decentralise responsibility for rural service delivery, may assist in promoting greater differentiation and co-ordination at the regional tier. Nonetheless, in the absence of the transfer of significant resources and influence to an elected regional body, efforts to establish a more distinct and coherent approach to rural policy-making and delivery will continue to be hampered.     

Children as domestic employees: Problems and promises

While children's domestic work is widely seen as acceptable in a child's own home, there has been growing attention to the vulnerability of children employed in domestic service; some people have argued that this work should be banned outside children's homes. This article considers both the potential harm as well as the benefits accruing to children in such environments, and has inquired into the opinions of children who themselves are involved in this kind of situation. This exploration has encountered obstacles: for example, institutions for fostering children and extended-family scenarios frequently blur the boundaries between work within the home and for outside employment. While support for child domestic workers should be a matter of urgency, stopping children from working outside their homes is not necessarily an effective way of protecting them, and, further, this approach removes possible material resources from some disadvantaged children. It is, instead, better to focus on positive ways of improving children's opportunities.     

Naturally Occurring Retirement Community-Supportive Service Program: an example of devolution

Devolution is defined as the transfer of power or authority from a central government to a local government. This article addresses federal policies on housing for the elderly and the devolution of funding for federal senior housing and describes two aspects of devolution of federal housing policy for the elderly. One, it points out the decreasing interest in senior housing by federal authorities as indicated by the decreased amount of funds allocated for this purpose. Two, it emphasizes the need for supportive, assistive services for residents of senior housing and how federal funds have not addressed this need adequately or sufficiently. As a consequence, there have emerged Naturally Occurring Retirement Communities (NORCs) in New York State, a housing arrangement that provides supportive and health services to all eligible residents. The article concludes with a discussion of policy implications and the need for additional research before replicating this model.     

The paradox of Durkheim's manifesto: Reconsidering The Rules of Sociological Method

Conclusion In summary, my three formulations of Durkheim's The Rules of Sociological Method as a manifesto have progressively found it to be epistemologically and pedagogically embedded in its object of scientific interest. In the first and most limited formulation, Durkheim's text was a violent and strategic preparation for his vision of sociology, that laid its grounds, but was ultimately inessential to sociological practice itself. It marked what he hoped was a historical rupture in western thought, after which true sociological reason could get underway. In my second formulation his text was the creation of a precise sociological object and moral reality. And while constituting sociology's first action, the manifesto could then be superseded as this morality began to sustain itself. Nevertheless, more than in the first formulation, it actively produced a new social fact in European culture. Finally, in the third formulation, Durkheim's manifesto is an ongoing moment of sociology itself (in the sense of a Hegelian moment, which is fully visible only in its first conflict-ridden appearance, but subsequently constitutes an essential part of the phenomenon's makeup). This manifesto is sociology's first clear attempt to understand representation as the fundamental element of social life. As such, sociological images and language are more than new social facts, they are also collective representations themselves, that reveal how the collective both imagines itself and interprets its own images. In this last formulation, sociology is deeply intertwined with the phenomena it seeks to explain, and becomes increasingly so as it proceeds historically.The implications of understanding sociology as a collective representation are manifold. But among the most important is that sociology develops by way of a dialectical relation to its object. Not surprisingly, a century after the appearance of Durkheim's manifesto, popular mass culture is permeated with reified sociological language, while cultural and mass-media studies have become a central interest of contemporary social theory. One could even speculate what Durkheim might say about late twentieth-century North American or European culture, and the place of sociological images therein. Would he, like one might imagine Freud, despair at the popular tropes and metaphors that he helped produce? Would he see only a monster of his own creation? Unlike Freud, who might be able to condemn popular psychoanalytic language as itself an indication of an immature culture looking for therapeutic fathers, Durkheim formulated the inevitability of the reification and deification of sociological language. For example, he explains that his own time was dominated by the language of the French Revolution: ...society also consecrates things, especially ideas. If a belief is unanimously shared by a people, then ... it is forbidden to touch it, that is to say, to deny it or to contest it. Now the prohibition of criticism is an interdiction like the others and proves the presence of something sacred. Even today, howsoever great may be the liberty which we accord to others, a man who should totally deny progress or ridicule the human ideal to which modern societies are attached, would produce the effect of a sacrilege. He gives Fatherland, Liberty, and Reason as examples of the sacred language inherited from the Revolution. And although he understands that these ideas are historically contingent, he nevertheless defends their value, especially the value of Reason. Evidently, Durkheim is not troubled by the knowledge that thoughts are shaped by the sacred ideas of their time.Noting the popularity of his own texts in the undergraduate classroom, Durkheim might ask how they function now. He might ask how The Rules of Sociological Method is an academic collective representation. He might also ask more generally how the word society has come to be used as a moral reality, or a social fact. How do speakers gain a moral stronghold on conversation by invoking society as the overarching totem (signifying everything from tradition and order to constraint and oppression)? Durkheim would probably conclude that in its current usage society means many things, and perhaps is even reducible to a dada utterance. Society is the punishing god and the forgiving god; it is used to authorize the judge and justify the deviant. It is, most generally, the way our culture signals its attempt to formulate itself by way of its sacred images.And yet, to avoid concluding that sociology, as it proceeds, ultimately becomes another instance of the object it studies, one must see Durkheim as providing the opportunity within his images and tropes to make them more than religion or ideology. In other words, although social reality has traditionally been represented as the Judaeo-Christian god in western cultures, that does not mean that Society will in turn become the new god of the organically solidary collective. As Durkheim provided sociology with a basic manifesto orientation (in all three of my formulations of sociology as strategic, moral, and interpretive), he also provided the opportunity for sociology continually to change its object by studying it. While normally for scientists their influence on their object constitutes a disastrous error, because the data have been contaminated by the act of observation, Durkheim makes clear that sociology inevitably has this effect (indeed it has this moral obligation and responsibility). Sociology encourages a culture where the openness of human identities and practices is generally known, and where this openness does not lead to anomic despair. This was Durkheim's promise to his time - i.e., that looking at ourselves as agents of our collective condition provides an opportunity to produce sacred objects that are sacred by the very fact that they are patently produced collectively. While all collectives produce representations of themselves, what is peculiar to the sociological culture is that it is supposed to be able to identify these as such - it is supposed to see its own totem building. This requires a certain ironic orientation grounded in an insight that the collective could be drastically otherwise, without provoking a crisis of meaning. In this way, sociology is a system of beliefs without being an ideology or religion.And, of course, within a sociological culture change does occur. Once these sociological tropes are established, they undergo interpretation and reinterpretation as they are disseminated, circulated, and used in popular discourse. As the dialogue between academic language and popular language continues through time, sociologists are required to imagine sociological interventions that keep these images dynamic rather than ideological. Hence, as sociology contributes to the sacred language used by opinion (or doxa), it is neither reducible to opinion, nor fully distinguishable from it. Sociology seeks to influence the way opinion recollects its basis (i.e., social life), and in so doing must change its own language to continue to induce para-doxa.It is possible therefore that the tropes and images introduced by Durkheim have served many rhetorical purposes and need to be reinterpreted by each new generation of sociologists as they consider the particular sociological rules of method of their own time. But what is inexhaustible about the Durkheimian legacy is his insight that sociology must look for its effects at a general discursive level, remaining cognizant that it is a part of modernity's particular collective representations. Thus formulated, the grounds of sociological thought are necessarily present even in the most specialized of contemporary research, as each topic covertly speaks about collective representational desire. Sociology also meets its own limits (even the possibility of its own death) at the very point where it becomes self-conscious as a cultural practice - i.e., its various inevitable crises as to its relevance point to its entanglement in the representational anxieties characteristic of modernity in general. It seems to me crucial that sociological practitioners acknowledge and orient to this condition so that sociology remains vital to itself and to the collective life it studies. Or in stronger, more polemical words: sociology is a significant cultural force to the extent that it understands itself already to be one.

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Car dependence in rural Scotland: transport policy,devolution and the impact of the fuel duty escalator

This paper examines dependence on the car in rural Scotland, assesses the impact of the fuel duty escalator on rural communities and discusses the role of the new Scottish Executive in shaping future rural transport policy. Questionnaires, interviews and travel diaries were used in five areas and revealed that households in rural Scotland enjoy high levels of car ownership, and that the car is used for over three-quarters of all journeys. Isolation and income levels are the most significant predictors of car use. Those living in ‘removed’ areas — i.e. locations distant from main roads and/or bus routes — are more likely to own vehicles and make a higher proportion of their journeys by car. Affluent households enjoy higher levels of car ownership, and make more journeys over greater distances by this mode than those on low-incomes. Less affluent households are also more likely to have disposed of a vehicle without replacing it, suggesting a more fluctuating dependence on the car. Although those living in rural Scotland appear to count on the car, a distinction is made between those who have no alternative (structurally dependent) and those who have alternatives but rely on their vehicles. It is difficult to predict the exact impact of the fuel duty escalator, but it is argued that the majority of households will cope with increases in the cost of motoring, while a significant minority of low income households in isolated areas will struggle to absorb the extra cost. The study highlights the need for the Scottish legislature to secure additional funding in order to sustain rural communities in the face of the rising fuel costs and suggests that an appropriate policy response might be to support isolated shops and services, i.e. subsidising alternatives to the journey as well as alternatives to the car.     

Community and its 'virtual' promises: a critique of cyberlibertarian rhetoric

The paper examines and critiques some of the libertarian rhetoric surrounding the 'virtual community'. In so doing, it argues that cyberlibertarians have misunderstood what community is by placing too much emphasis on a disembodied individual. Although it remains influential, cyberlibertarian rhetoric is a far cry from the everyday practices that are being constructed and reproduced via the Internet. By drawing attention to such practices, the paper attempts to bring to the fore the sociality of cyberspace interactions and redefine the virtual community in line with Maffesoli's concept of 'neo-tribe'. The Internet is thus thought to open up a new space where human 'will to live' is expressed in a social and embodied fashion (Maffesoli 1996).     

Disability and the promises of technology: Technology, subjectivity and embodiment within an order of the normal

The topic of this article is the promises of technology for disabled people. The starting point is that disabled is not something one is but something one becomes, and, further, that disability is enacted and ordered in situated and quite specific ways. The question, then, is how people become, and are made, disabled - and, in particular, what role technologies and other material arrangements play in enabling and or disabling interactions. Drawing on a study of the uses of new technologies in the lives of disabled people in Norway, and recent work in disability studies as well as social studies of science and technology, this article explores precisely what positions and capacities are enabled; how these are made possible in practice; the specific configuration of subjectivity, embodiment and disability that emerges; and the limits to this mode of ordering disability and its technologies. The argument is that in this context the mobilization of new technologies works to build an order of the normal and turn disabled people into competent normal subjects. However, this strategy based on compensation achieves its goals only at a very high price: by continuing to reproduce boundaries between abled and disabled, and normal and deviant, which constitute some people as disabled in the first place. There are thus limits to normalization. And so, notwithstanding their generative and transformative power, technologies working within an order of the normal are implicated in the (re)production of the asymmetries that they and it seek to undo.     

Birth,blood and belonging: identity claims in post‐devolution Scotland1

Scotland is often seen as a good example of a civic/territorial rather than an ethnic/cultural form of nationalism. From the 1970s the campaign for a Scottish parliament stressed an inclusive, residence based, civic sense of being Scottish, and more recently, Scotland's political elites have seen the new parliament as an endorsement of territorial belonging. How valid are these assumptions? To what extent is political ideology at odds with people's sense of their national identity? Using a qualitative approach, we explore different identity claims currently being made in post‐devolution Scotland – those based on blood, birth and belonging. We argue that these are better conceptual tools for the purpose of unravelling the complexities of identity politics in this context than the contrast between civic and ethnic. Our data come from the Scottish part of a study in England and Scotland, and focus on three sets of respondents: English migrants to Scotland making blood or birth claims to Englishness and/or Britishness; English migrants making belonging claims to Scottishness; and Scottish nationals making claims for themselves as well as assessing migrants’ claims. We also explore the significance of constitutional change in the context of respondents’ identity negotiations, and examine whether it has affected their understandings of Scottishness.     

On Desmond: the limits of spontaneous sociology

Matthew Desmond’s “Relational ethnography,” is a manifesto for a relational turn in ethnography, liberating it from the “substantialism” of bounded places, processed people and group culture. Substantialism, however, proves to be a largely mythical category that obscures two types of relational ethnography: Desmond’s empiricist transactional ethnography and an alternative, theoretically driven structural ethnography. Drawing on Desmond’s own ethnographies, On the Fireline and Evicted, I explore the limitations of his transactional ethnography—a “spontaneous sociology” that rejects the theoretical engagement and comparative logic. I elaborate and illustrate structural ethnography, drawing out the implications for public and policy sociology.     

The situations of culture: humor and the limits of measurability

This article develops a theory of humor and uses it to assess the attempt to measure meaning-structures in cultural sociology. To understand how humor operates, researchers need to attend to two layers of cultural competencies: general typifications and situation-specific know-how. These cultural competencies are then invoked in ways that define humor as a specific form of experiential frame—the bi-sociation of meaning, its condensation, and resonance with experienced tensions in the social world. I show the usefulness of this theorization through the empirical case of AIDS humor in Malawi, a small country in South-East Africa. Using conversational diaries, everyday interactions, and newspaper cartoons, I argue both that such humor is widespread and that it reveals important facets of life in a country ravaged by the pandemic—what it means for the shadow of AIDS to be ever-present. Through this case, I then turn back to the question of measurement, arguing that although measuring tools may be able to identify large-scale semantic shifts, they necessarily miss forms of interaction such as humor, that are based on allusion, condensation, and what is left unsaid.