What Difference Does Difference Make? The Persistence of Inequalities in Healthcare Delivery

Scholars across many disciplines have amassed a mountain of research documenting how social differences along lines of race, class, gender, and sexuality shape how those who need medical attention are cared for in the US healthcare system. Here, we aim to succinctly review a selection of studies that have considered the many ways both patients' and healthcare providers' social identities can impact care delivery. After establishing how these differences influence patient–provider interactions and patient diagnosis, treatment, and outcomes, we argue that a critical sociological perspective can help us to better understand why these inequities persist despite decades of research calling attention to them. Specifically, we suggest that research guided by symbolic interactionist and intersectional frameworks can generate more comprehensive analyses of inequality in healthcare delivery and help researchers delve deeper into the complex interactional processes undergirding disparities in care provision. We conclude by highlighting recent work that illustrates the value of this approach.     

“He's Doing Fine”: Hope Work and Emotional Threat Management Among Families of Seriously Ill Children

In this study, I examine how people in emotionally fraught circumstances strategically structure social interactions in order to protect fragile emotional states. Data come from interviews and observations with 18 families of children being treated for life‐threatening conditions at an elite university research hospital. I show how families worked to ward off emotional threats to their ability to maintain hope that their children would recover by preempting and restructuring social interactions with friends and family members and pruning social networks. These efforts allowed families to minimize reciprocal obligations and avoid encountering pessimistic reflected appraisals that might trigger “emotional shortcuts” leading to states of fear and anxiety. Similar efforts to reconstruct social interactions and social networks may be common among those working to maintain fragile emotional states in a variety of challenging circumstances.     

‘I’m not really sure but I hope it’s better’: early thoughts of parents and carers in a regional trial site for the Australian National Disability Insurance Scheme

The National Disability Insurance Scheme (NDIS) is one of the most significant initiatives in Australian social policy history. Its complexity has been compounded by a fast-paced introduction and ongoing refinement throughout the initial trial phase. Parents and carers of very young disabled children face particular challenges accessing and navigating NDIS systems. This article presents findings from a mixed-method pilot study examining the perspectives of parents and carers of disabled children in one NDIS trial site – the Hunter Region of New South Wales. The research highlights a number of policy assumptions potentially impacting on NDIS take up for young disabled children and their families in regional contexts. Based on research findings a number of policy suggestions and improvements for disabled children and their families entering the NDIS and other individualised funding schemes are outlined.     

Constitutional Reform and Canadian Social Policy

It is generally accepted that Governments, with a neo-conservative or more properly a Victorian neo-liberal bent will, through various means and mechanisms, try to dismantle aspects of the Welfare State. While these mechanisms usually take the form of privatization, reductions in expenditures, de-indexing and the like, a much more subtle process currently is underway in Canada. Two broad initiatives — Constitutional Change and Free Trade — of the Mulroney government seriously threaten the future of the Canadian Welfare State. The Welfare State is not the direct target in either of these initiatives but the implications, in the view of the authors, are profound. This article examines the question of constitutional reform and the consequences for Canadian social policy.     

Neoliberalism,Inequality and Politics: The Changing Face of Australia

Since the early 1980s Australian public policy has undergone the most major transformation since Federation. This transformation has been underwritten by two key principles: liberalism – the view that citizens are autonomous individual actors whose interests are best served when they are free from coercive government interventions into individual action; and marketisation – the belief that free markets are arenas which best enable individual autonomy and produce efficient economic outcomes. These principles define ‘neoliberalism’ or ‘hard liberalism‘. After summarising the major policy changes identified with neoliberalism in Australia, the paper introduces a new research project that examines its impact on socioeconomic inequality, gender inequality and politics and culture. Inspection of relevant data indicates that there are important trends in inequality, public opinion and political behaviour that warrant this investigation.     

Survival Trees: An Alternative Non-Parametric Multivariate Technique for Life History Analysis

In this paper an extension of tree-structured methodology to cover censored survival analysis is discussed. Tree-based methods (also called recursive partitioning) provide a useful alternative to the classical survival data analysis techniques, such as the semi-parametric model of Cox, whenever the main purpose is defining groups of individuals, either with complete or censored life history, having different survival probability, based on the values of selected covariates. The essential feature of recursive partitioning is the construction of a decision rule in the form of a binary tree. Trees generally require fewer assumptions than classical methods and handle non standard and non linear data structures efficiently. Tree-growing methods make the processes of covariate selection and grouping of categories in event history models explicit. An example concerning the analysis of time to marriage of Italian women is presented.