Midwifery in Colorado: A case study in the politics of professionalization

This paper uses documentary evidence, interviews, and participant observation to examine the professionalizing activities of lay midwives in Colorado. It shows that professionalization for midwives is primarily a political process. In order to gain state recognition and professional autonomy, lay midwives were forced into the political arena, where they encountered resistance from economic competitors. I argue that medical dominance over childbirth practices and professional segmentation between lay midwives and certified nurse midwives were the primary reasons Colorado lay midwives failed to achieve professional status.I would thank the Colorado midwives for their cooperation in this study. My thanks also to the reviewers for their comments on earlier drafts.     

Self-Care—New Challenge to Individual Health

Abstract

We are beginning to recognize that further improvements in health care are best achieved through the development of the lay resource in health in contrast to the professional resource. Recent research has shown that the vast proportion of health care still remains in the hands of lay people, and that efforts aimed at improving this resource can have a powerful effect on health and the health care industry. It is important now that health professionals recognize a new public interest in demystifying medicine and deprofessionalizing health care.

With this increased recognition we can begin the road back to establishing a health competent society, less dependent on unnecessary professional intrusion. We can also look forward to a broader-based perspective on health and health care, which may very well involve new concepts of health that are at variance with present professional views and practices. We can also expect to achieve a new level of equity in responsibility for the production of health care as well as its consumption.     

Lay and professional knowledge in social work: reflections from ethnographic research on child protection

This paper is concerned with the discursive interaction of lay and professional knowledge in the practice of social workers. The contention is that identifying discrete sources of knowledge—such as evidence-informed materials—may be less important for explaining how social workers guide their practice than recognising the effect of the discursive interaction of lay and professional knowledge within organisational culture. The example used for this discussion is child protection work, with a particular emphasis on how practice can be seen to be gendered. In the course of making this overall argument, the paper draws on academic debates about the nature of knowledge in professional work and discusses lay and professional knowledge as revealed through ethnographic research carried out in a social work team in the UK.     

A paradigm shift: from disease to health orientation

The history of science has been described as ‘paradigm shifts’ of sequential overthrow, each new paradigm replacing the previous one. A paradigm is an overarching view-point which guides the articulation of theories and other activities in a particular field. In the exploration of health, two different types of approach can be identified. The pathogenic view, which has dominated the orientation of medicine over the last hundred years, focuses on disease states and underlying factors that modify the chances of entering into one of those states. The competing salutogenic view appears to be undergoing a renaissance in the new strategies of public health and health promotion, and producing theories of health based on more holistic approaches and diverse methods. The two paradigms exist side by side, and both are in a constant state of flux. The advocates of the health-oriented paradigm say it is difficult to reach a true, in-depth understanding of human health on the basis of a disease-oriented approach or from the traditional vantage-point of risk-factor epidemiology, whereas opponents point out that health does not lend itself to exact measurements or experimentation in keeping with the Galilean natural science ideal. The importance and utility of health orientation need to be explored and ascertained in further research. The approach seems, however, to have a number of crucial assets that might help avoid the limitations of the established disease and risk-factor epidemiology approaches and promote new directions of pursuit, including a better understanding of the complex relationships between aging and health, and other current challenges in creating healthy public policy.

This paper was presented at the Second International Workshop on the Aging Male, Weimar, Germany, November 1999     

Contemporary Epidemiology: A Review of Critical Discussions Within the Discipline and A Call for Further Dialogue with Social Theory

The discipline of epidemiology, which holds major influence on public health policy as well as on clinical medical practice, has in recent decades to a large extent been concerned with the identification of factors and markers of risk for disease. Much health information and intervention is thus informed by a wealth of studies on a variety of risk factors, of which the individual is encouraged to keep informed and to be responsible about. Meanwhile, risk factor epidemiology has been subject to intense debate, both within and outside the discipline. The following review offers an overview of critical intradisciplinary debates. It then opens discussion on three partially overlapping areas where social theory has been called upon to contribute to epidemiological inquiry, namely analysis of macro‐social determinants of health and disease, of categories of human difference and of embodiment. The review ends with, and is motivated by, a plea for further integration of and dialogue between epidemiology and social theory.     

Individualization and Prevention

SUMMARY

In 1905, Massachusetts General Hospital initiated the first medical social work program in the United States. Based on the writings of its leaders, this paper presents the early history of medical social work in the United States. Inspired by developments in European health care that emphasized the community context of disease, medical social work pioneers saw a need to individualize the patient while also promoting public health measures in the community, improving the patient's environment to eliminate the causes of disease. In addition, since they served patients because of their diseases rather than their poverty, medical social workers were among the first to provide social work services to the non-poor. In spite of their emphasis on environmental change, many of early medical social work leaders had an anti-institutional bias; they were suspicious of large-scale solutions for what they saw as fundamentally individual problems. Consequently, methods for promoting individual adaptation developed more rapidly than methods for promoting environmental change. Ironically, the medicalization of social problems in contemporary times has resulted in a focus on individual pathology rather than social and lifestyle causation in health, even as the rising cost and complexity of the system challenges health care consumers in the United States. Reaffirming the environmental emphasis of medical social work pioneers provides a way for today's health care social workers to incorporate environmental modification into their practice and promote the health of all citizens.     

The hospital accident and emergency department: what is its role?

The problem over the use of accident and emergency departments is portrayed in terms of a typical conflict between professional and lay needs. However, in contrast with the more common image of the professional hospital doctor successfully developing both structural and interactional strategies for maintaining professional dominance over the patient, it is argued that the structural characteristics of the accident and emergency department pose control problems for the profession. These control problems have been exacerbated by developments in other areas of the health service and have led to the development of policies which emphasize both clinical and social elements of patient need. Although there is apparent recognition by providers of the importance of taking into account patient need, the proposed policies are based on professional images of how patients 'ought' to use the service. What is clearly lacking is comprehensive data on how the public and the community wishes to use the service and how they actually use the service. Data from national and local studies on patient felt needs and patient demand for the hospital accident and emergency departments are presented and the implications for policy are discussed.     

Rethinking Activism and Expertise within Environmental Health Conflicts

This review presents the contributions of research on the intersection of science and social movements, its theoretical and methodological limitations, and potential solutions for its further development. Three different types of relationships between activism and knowledge have been identified within environmental health conflicts: (i) lay – activists requesting help from sympathetic scientists in order to conduct independent studies; (ii) expert – activists promoting new research agendas and sub‐fields within established scientific disciplines; and (iii) expert – activists acting beyond the limits of the academic community and partnering with social movements. In this review, I argue that much of the existing literature considers expertise as “something” possessed by individuals, and heavily emphasizes the difference between “lay” and “expert” activists. This entails two main theoretical reductionisms: (i) reification of knowledge; and (ii) overlooking the contribution of activism to expertise and vice versa. I propose considering expertise as the property of a network and focusing future research within environmental health conflicts on the co‐emergence and construction of a network of expertise (Eyal 2013) or ethno‐epistemic assemblage (Irwin & Michael 2003) and social movements. Through this symmetrical network approach, we will be able to develop a more consistent theory of the co‐production of activism and expertise, as well as its political implication to fight environmental health injustice.     

Reflexive Research Ethics for Environmental Health and Justice: Academics and Movement-Building

Community-engaged research on environmental problems has reshaped researcher-participant relationships, academic-community interaction, and the role of community partners in human subjects protection and ethical oversight. We draw on our own and others' research collaborations with environmental health and justice social movement organizations to discuss the ethical concerns that emerge in community-engaged research. In this paper we introduce the concept of reflexive research ethics: ethical guidelines and decision-making principles that depend on continual reflexivity concerning the relationships between researchers and participants. Seeing ethics in this way can help scientists conduct research that simultaneously achieves a high level of professional conduct and protects the rights, well-being, and autonomy of both researchers and the multiple publics affected by research. We highlight our research with community-based organizations in Massachusetts, California, and Alaska, and discuss the potential impacts of the community or social movement on the research process and the potential impacts of research on community or social movement goals. We conclude by discussing ways in which the ethical concerns that surface in community-engaged research have led to advances in ethical research practices. This type of work raises ethical questions whose answers are broadly relevant for social movement, environmental, and public health scholars.     

高职学生职业素养培养的途径和方法探索

提高高职学生的职业素养,促进高职学生成长成才及职业生涯的发展,为学生参与社会竞争奠定良好的基础。文章以长沙电力职业技术学院为实践主体,针对目前高职学生职业素养缺失表现及高职学生职业素养培养的重要性,探索高职学生职业素养培养的有效途径和方法。     

Moments of Uncertainty: Ethical Considerations and Emerging Contaminants

Science on emerging environmental health threats involves numerous ethical concerns related to scientific uncertainty about conducting, interpreting, communicating, and acting upon research findings, but the connections between ethical decision making and scientific uncertainty are under‐studied in sociology. Under conditions of scientific uncertainty, researcher conduct is not fully prescribed by formal ethical codes of conduct, increasing the importance of ethical reflection by researchers, conflicts over research conduct, and reliance on informal ethical standards. This article draws on in‐depth interviews with scientists, regulators, activists, industry representatives, and fire safety experts to explore ethical considerations of moments of uncertainty using a case study of flame retardants, chemicals widely used in consumer products with potential negative health and environmental impacts. We focus on the uncertainty that arises in measuring people's exposure to these chemicals through testing of their personal environments or bodies. We identify four sources of ethical concerns relevant to scientific uncertainty: 1) choosing research questions or methods, 2) interpreting scientific results, 3) communicating results to multiple publics, and 4) applying results for policy making. This research offers lessons about professional conduct under conditions of uncertainty, ethical research practice, democratization of scientific knowledge, and science's impact on policy.     

Die Netzwerkperspektive in der Gesundheitsförderung als Ansatz für professionelles Handeln

Network perspective and health promotion have in common, the orientation on resources and changing from the pathogenic, deficit oriented viewpoint towards a salutogenic one, a perspective based on protective and supporting factors. On principle this means an expanded and integrating orientation which goes beyond the individual by considering the personal circumstances and environmental conditions. The integration of network perspective in counseling processes needs a professional attitude, grounded in a basic understanding of networks as functional and health-promoting in the sense of social support but also as a systemic view considering transactional relations between individual and environment. Here processes of empowerment play a central part. The expansion of opportunities for professional action in the sense of a salutogenic basic attitude refers to foundation and action guiding principles of health promotion.     

HIV/AIDS and constructs of gay community: Researching educational practice within community-based health promotion for gay men

This paper reports on the methodology of a comparative study of three gay communities in Australia as they struggle with HIV/AIDS. The study focused on the pedagogy and practice of HIV/AIDS education for disease prevention and for health maintenance for people living with HIV/AIDS, through the investigation of three problematics: (1) constructs of 'community'; (2) the centrality of gay community-based health educators; and (3) the relations of gay men within and to their communities. The study was conceived of as a critical ethnography involving a three-part sample in the three sites and using three related research methods: (1) individual and group interviews; (2) textual analysis; and (3) participant observation. The theoretical bases for the study and its design lay in notions of 'performativity', community and adult education, organizational and institutional processes, and the idea of a 'post-AIDS' sociality. The methodology is explained in detail, as are various consultative processes embedded in the design to facilitate and enable a productive relationship with the communities researched.     

My home, your workplace: people with physical disability negotiate their sexual health without crossing professional boundaries

This paper aims to describe research that examined the views of people with physical disability, living in Australia, of their sexual well-being needs from their own perspective. We explored the impact their sexual well-being needs had on their relationships with professional carers. A social model of disability was used to understand how sexual well-being is facilitated or denied in community care. We also explored whether clients' sexual well-being needs could be met without carers or clients 'crossing the line'. Our findings indicate the multiple ways that 'professional boundaries' were negotiated between clients and professional carers. The data show that the location of the 'line' changed, depending on a range of personal, social, economic and environmental factors. The data also show a gap between the sexual well-being needs of people living with a physical disability and the level of support provided at the social and organisational levels. Suggestions are made for research and practice directions.     

Attitudes and Behaviors of Social Work Students Toward Lesbian and Gay Male Clients

Abstract

Since the requirement of the Council on Social Work Education (CSWE) to integrate theoretical and practice content about the oppression of gay and lesbian persons into the curriculum, few studies have assessed the effectiveness of various methods of incorporating the content. This paper reports the results of a study examining the effects of a panel presentation on social work students' attitudes, their anticipated professional practice, and the relationship between their attitudes and anticipated professional behavior. It also compares the results from the panel presentation with the results from other intervention methods. Results indicated that the panel presentation had little influence on the attitudes or anticipated professional behavior of students. Intervention methods integrated into the classroom setting influenced the attitudes and anticipated professional behavior of students significantly more than the panel presentation.     

浅谈职业生涯规划教育在中职学校的开展

市场经济条件下,中职生面临激烈的就业竞争,如何帮助和引导他们做出科学、合理的职业生涯规划,成为中职学校教学的重点。学生在老师的引导下通过自身评估和对环境因素的分析,结合职业理想,规划在校学习生活,可以提高综合素质和就业竞争力,为顺利就业和个人实现终身可持续发展奠定基础。     

Dialogue and Challenge: Involving Service Users and Carers in Small Group Learning with Social Work and Nursing Students

This paper examines the rationale for service user and carer involvement in professional education and reflects on an initiative in which social work and nursing students undertook a sequence of joint learning in relation to mental health theory and practice. Central to this initiative was the promotion of opportunities for dialogue, both between students from different professional disciplines and between students, service users and carers. To enable this, much of the learning took place in small groups facilitated by either a service user or a carer.

Evaluation of this initiative indicated that, for the majority of social work and nursing students, learning from this shared experience had a major impact on their professional development. However, a small but significant minority found it hard to enter into a dialogue with others on a basis of equality and a sharing of their human as well as their professional experience. Some students indicated that they would have preferred a focus on acquiring more specialist professional knowledge and skills. This raises important issues in relation to the changing expectations of professionalism and professional education—and what really makes someone ‘fit for practice’.     

Lay discourses of the rural: Developments and implications for rural studies

Considerations of lay discourses of the rural - people's everyday interpretations of rural places and ideas of the rural - have become increasingly evident in some key articles addressing the theory and practice of academic rural studies. A major element of the retheorization of rural studies, which itself is set within the broader contexts of recent developments in social theory, considerations of lay discourses have concerned themselves with the nature and implications of everyday interpretations and constructions of the rural, and, in some cases, how academic discourses are complexly bound up with such processes. This paper sets out to review some of the key examples of how and why lay discourses are being used in academic approaches to the rural, and how some of these are also addressing the key question of the problematic relationship between lay and academic discourses. It then aims to develop these initiatives, firstly, by suggesting some clarification of what lay discourse is; how other discourses, particularly popular and professional, should be identified; and why close attention should be paid to how they link up. Secondly, drawing on qualitative case study material gathered from an academic incursion into lay discourses of a small village in south west England, it is suggested that the very different nature of lay discourses has not been fully appreciated, and this has led to only partial success in some academic attempts to assimilate them into new approaches to rural studies, particularly in the ongoing debate about definitions of the rural. It is shown that lay discourses of the rural, such as they are, can be expected to be both spatially and conceptually complex and incoherent to an extent that will make it difficult for them to be incorporated into established (modern) academic rural approaches and thus leads to conclusions that in part support Murdoch and Pratt's (1993) concept of the ‘post-rural’.     

[Mis]Placing Race in Biomedical Clinical Context: Racial Categories,Medical Research,and the Reproduction of Health Disparities

Notions of racial categories as biologically significant remain persistently salient to oppressive hegemonic ideas about race, despite scientific evidence to the contrary. Biomedical and epidemiological researchers are both professionally socialized and institutionally mandated to utilize racial categories in their research design, implementation, and interpretation processes, under the premise that doing so can facilitate the development of measures to combat racial disparities in health outcomes and care. However, when aggregate data intended to illustrate racial disparities are inappropriately extrapolated to the individualized context of biomedical clinical practice, essentialist notions of racial difference are reified. This paper integrates interdisciplinary perspectives from the fields of sociology, medicine, public health, epidemiology, evolutionary biology, and biological anthropology to explore the ideological, historical, and structural contexts through which the conflation of racial categories as indicators of group‐level inequities in health outcomes and care experiences with essentialized notions of biological differences between racial groups may inform disparate care at the level of individual patient encounter in biomedical clinical practice.