Health Discourse Research Articles

Toxic Shock: A Social History by Sharra L. Vostral

Reviewed by: Toxic Shock: A Social History by Sharra L. Vostral Donna J. Drucker (bio) Toxic Shock: A Social History By Sharra L. Vostral. New York: New York University Press, 2018. Pp. 227. Sharra L. Vostral begins Toxic Shock: A Social History with a vivid description of her experience learning about this syndrome as an American teenager in 1982. The public health concerns about contracting a sudden illness from (and possibly dying from) tampon use were broadcast extensively on television, in newspapers and magazines, and on product labels. As a teenager in California in the early 1990s, this reviewer also remembers these widespread but vague warnings about sudden death due to toxic [End Page 1261] shock syndrome (TSS) from overlong tampon use. From so few documented cases nationwide, how did TSS rise to such prominence in the United States' public health and safety discourse? Vostral addresses that and many other questions in the first book-length history of the syndrome. Vostral's central argument is that "TSS was a paradigm shift in the way that illness manifests because the supposedly inert tampon interacted with a common bacterium (Staphylococcus aureus) to cause sickness in otherwise healthy women" (p. 2). She explores this argument from five perspectives that comprise the book's five roughly chronological central chapters: the material, technological history of tampons and S. aureus; medicine and epidemiology; communication and journalism; law and lawsuits; and policy and politics. The narrative begins with a history of tampons as material technologies. It focuses on how synthetic superabsorbent materials (like those in Rely, the Procter & Gamble tampon that became the focus of TSS investigations) provide an environment where they and the bacteria act together to produce conditions where TSS can occur. The next chapter describes how scientists, physicians, and policymakers identified, traced, and publicized TSS from the late 1970s onward (chapter 2). The book also traces media attention to TSS, Procter & Gamble's withdrawal of Rely tampons from the market, and U.S. Food & Drug Administration (FDA) efforts to require warning inserts in tampon boxes under a Ronald Reagan administration hostile to federal regulation. Chapter four centers on a lawsuit brought against Procter & Gamble by the family of a woman who died from TSS after using Rely tampons. Vostral then examines the efforts of an uneasily aligned task force made up of consumer advocates, feminist health activists from the Boston Women's Health Book Collective, Procter & Gamble representatives, and FDA Bureau of Medical Devices staff members. In early 1982, they were charged with developing standard guidelines for tampon absorbency, but they ultimately produced nothing. By 1990, the FDA Federal Register published standard absorbency ranges for different tampon sizes, though there is still no federal requirement to list tampon ingredients on the box or guidelines on how long tampons should be worn. The book's primary theoretical contribution is in the first chapter, where Vostral introduces the concept of biocatalytic technology. Biocatalytic technologies "are not primarily dangerous to humans but have the potential to catalyze microbial activity that may result in harm because of their use" (p. 38). Intriguing and potentially useful as this analytic is, it largely disappears from the rest of the book until the conclusion, when the narrative turns to the policy-oriented, legal, and activist elements of TSS's history. There is consequently a disconnect between the first chapter of the book, which develops this analytic and its potential for identifying bacteria as "a nonhuman unintended user . . . able to exploit the technology," and the remaining four chapters (p. 22). The tampon users, activists, lawyers, [End Page 1262] litigants, scientists, and policymakers in the final four chapters focus on the tampons themselves and pay little attention to S. aureus as an actor. Toxic Shock joins a wider literature of social and technological histories of menstruation and menstrual products. These include Vostral's own Under Wraps (Lexington Books, 2009); Lara Freidenfelds's The Modern Period (Johns Hopkins University Press, 2009); Janice Delaney, Mary Jane Lupton, and Emily Toth's The Curse (University of Illinois Press, 1976/ 1988); and Sara Read's Menstruation and the Female Body in Early Modern England (Palgrave Macmillan, 2013). Vostral proves the argument that TSS changed scientific understandings of...

Straight outta the tropics: pathological features of techno-scientific promises in neglected tropical disease research

ABSTRACT To gain support, scientific and technological promises need to be credible and address legitimate issues. This article explores this production of legitimacy and credibility that sustains techno-scientific promises in neglected tropical disease research, a group of infectious diseases that affect one billion individuals globally but remain largely excluded from the scope of the pharmaceutical industry. Specifically, I examine the dynamics of techno-scientific promises and expectations by focusing on Chagas disease research in Argentina, where neglected tropical diseases have been deemed legitimate objects of research efforts but, at the same time, they depend on international connections with high-profile stakeholders to become credible. However, in a context marked by the rise of global health organizations and the recent engagement of the pharmaceutical industry, these kinds of commitments to research and development to fight against neglected tropical diseases have resulted in three distinct “pathological features” or mismatches in their structures of expectations: the asymmetry between beneficiaries and scientific and technological decision-makers; the affected populations’ inability to invest in the hopes and expectations embodied in potential healthcare technologies; and the performative effects of techno-scientific promises, whereby leading solutions for neglected tropical diseases align with the rule of mainstream technoscience but hold only rhetorical continuity with formulations of the problem that originate in public health policies and discourse.

Cultivating Colonial Subjects: The Planner as Gardener in the Work of Patrick Geddes

This article examines the work of urban planner Patrick Geddes in the context of the interwar British empire, arguing that his writing evinces the ideological assumptions of colonialism in the early twentieth century. Geddes considered the planner less as a visionary architect of urban space and more as a gardener, not only in creating literal green spaces but in cultivating people and places. Assuming that such cultivation would naturally subordinate political conflict to an essential harmony, he advocated for sustainable, locally-oriented planning in his work in India and mandate Palestine. As such, in his writing, cultivation emerges as a central figure, one that aims to grow citizen-subjects invested in the structures of British empire. Cultivation conjoins a verdant imaginary of the city and its attendant discourses of health, sanitation, and urban improvement with the power structures of the liberal, imperial state. Geddes's theories indicate how polyvalent figures of cultivation were central to the practice of colonial urban planning. Importantly, this article reads Geddes's writing as a mode of speculative fiction intended to create an imaginative framework for the (colonial) urban planner.

Son preference, security concerns and crime against women: Expanding the public health discourse in India.

The phenomenon of son preference in India and the declining number of girls due to such a mindset has been an area of concern. While the Preconception and Prenatal Diagnostic Techniques Act and the Beti Bachao and Beti Padhao scheme have been the mainstay of the government's initiative to counter this reproductive injustice, recognizing son preference and crime against women as public health concern opens up a new vista to counter this injustice. This study has identified that the public health system needs to engage with the following aspects to counter the problem: counseling services to women and men around fertility choices; access/availability to contraceptive choices; engaging men and boys in developing a response against violence; gender-sensitive training and capacity building; access to sexual and reproductive rights awareness amongst girls, women, boys, and men; and health insurance for senior citizens.

Zombic Forms: Ebola's Postmortem Virality.

This article examines US-based popular media coverage and public health discourse surrounding the 2014-2016 Ebola epidemic in West Africa. It demonstrates how the construction of the Ebola virus and its victims as "zombies"-not properly live nor properly dead, spectacularly supernatural yet materially impactful has worked to displace culpability, suppress theories of iatrogenic contagion, and ultimately, justify modes of disease surveillance that seek to cordon off non-Western bodies. In order to do so, Section 1 traces representations of the disease in popular fictional and nonfictional accounts; Section 2 analyzes the visual representation of the disease by photojournalists; and Section 3 examines the oftentimes paradoxical rhetoric that emerged from disease surveillance projects regarding local populations' complicity in their own infection rates.

Reconciling civil liberties and public health in the response to COVID-19

The COVID-19 pandemic has highlighted the challenges governments face in balancing civil liberties against the exigencies of public health amid the chaos of a public health emergency. Current and emerging pandemic response strategies may engage diverse rights grounded in civil liberties, including mobility rights, freedom of assembly, freedom of religion, and the right to liberty and security of the person. As traditionally conceived, the discourses of civil rights and public health rest on opposite assumptions about the burden of proof. In the discourse of civil and political rights of the sort guaranteed under the Canadian Charter of Rights and Freedoms, the onus rests on government to show that any limitation on rights is justified. By contrast, public health discourse centers on the precautionary principle, which holds that intrusive measures may be taken—lockdowns, for example—even in the absence of complete evidence of the benefits of the intervention or of the nature of the risk. In this article, we argue that the two principles are not so oppositional in practice. In testing for proportionality, courts recognize the need to defer to governments on complex policy matters, especially where the interests of vulnerable populations are at stake. For their part, public health experts have incorporated ideas of proportionality in their evolving understanding of the precautionary principle. Synthesizing these perspectives, we emphasize the importance of policy agility in the COVID-19 response, ensuring that measures taken are continually supported by the best evidence and continually recalibrated to avoid unnecessary interference with civil liberties.

AYUSH for COVID-19: Science or Superstition?

There is a lot of discussion on COVID-19 control strategies from the mainstream approaches, but it is also necessary to examine the contributions of the Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa Riga and Homeopathy (AYUSH) sector, which is now being brought into public health interventions nationally. Although the AYUSH sector had previously joined the management of dengue and chikungunya outbreaks in some Indian states, its participation has remained contentious and there is reluctance in mainstream public health discourses to seriously examine their interventions. This is a commentary on the efforts made by the Ministry of AYUSH, state AYUSH directorates, AYUSH research institutions, and public hospitals, based on official documents as well as official statements reported in the media, with the aim of bringing out concerns in the process of adapting traditional textual knowledge and practices to public health requirements of the current age.

Editorial Introduction: The Erotics of Asexualities and Nonsexualities: Intersectional Approaches

Editorial Introduction:The Erotics of Asexualities and Nonsexualities: Intersectional Approaches Ela Przybylo (bio) and Kristina Gupta (bio) This special issue is fueled by the growth, involvement, and excitement stemming out of asexual community organizing, scholarship, and friendships. Since David Jay created the Asexual Visibility and Education Network (AVEN) in 2001, asexuality groups have blossomed both online and offline across the world. One would be hard-pressed to find a part of the world where people do not identify as asexual and seek out asexual knowledge and community, including in nations as far-reaching as China, Poland, the United States, Canada, Iran, and Brazil. AVEN's early definition of asexuality as "experiencing little or no sexual attraction to others" has been affirmed, challenged, expanded, and complexified over the past two decades of asexual community organizing, with many identifying as not only asexual but also gray asexual, demisexual, aroace, reciprosexual, aceflux, and beyond. Asexuals are now represented in television shows (such as BoJack Horseman, Shadowhunters, and Sirens) and in young adult literature (such as Claire Kann's Let's Talk About Love and Kathryn Ormsbee's Tash Hearts Tolstoy), and greater visibility has increased general literacy around asexuality. Asexuality is also becoming more and more integrated into LGBTQ2IA+ organizations and spaces, with pressure for the A of the acronym to stand for asexual and aromantic and to be included under the queer umbrella. Recent years have also seen aromanticism burgeoning as an identity that challenges commitments to romantic modes of relating and attraction, one that is distinct from asexuality. As with asexuality, multiple aromantic forms—including grayromantic, demiromantic, aroflux, and of course aroace—have developed. Asexuality studies, which we understand broadly as the interdisciplinary field of asexuality-affirming scholarship, has likewise played a role in building knowledge and community. Across disciplines, asexuality studies affirms that asexuality is valid and prolific in the face of the undermining and disbelieving of its legitimate claim to being a sexual orientation and identity. Although visibility of and literacy around asexuality have increased, asexuality is too often still regarded as a form of repression, drawing on pseudo-psychoanalysis, [End Page vii] or it is pathologized as a medical problem in need of redress (Chasin 2015; Kim 2014; MacInnis and Hodson 2012). Such asexphobia (Kim 2014) draws attention to the ways in which asexuality is stigmatized and sexual relationships are elevated above other forms of relating and considered integral to happiness and well-being. Asexuality studies thus offers critiques of the interconnected systems that encourage sex and romance as relational modes prized over other forms of intimacies—an encouragement termed sexusociety, sex normativity or sexualnormativity, and/or compulsory sexuality by asexuality studies scholars (Carrigan 2011; Cerankowski and Milks 2010; Chasin 2011; Chasin 2013; Emens 2014; Gupta 2015; Hinderliter 2009; Przybylo 2011; Rich 1980). In this sense, asexuality studies asks not only for queer communities and society more broadly to accept asexuality but also demands that everyone take the concerns of asexuality seriously in how they think about their own modes of attraction and relationships. Thus, the contributions of asexuality studies matter to everyone, as they help us all question the compulsory nature of sex and romance as well as its uneven application across lines of ability, racialization, gender, age, and geographical context. As the coeditors of this special issue, we are invested in and energized by this ever-developing scholarship and the challenges it poses to the compulsoriness of sex, sexuality, and romance. We both became interested in researching and writing about asexuality early in our academic careers: Ela Przybylo published her first piece on asexuality and sex-centralized society, or sexusociety, in 2011, and Kristina Gupta published her first piece on the constraining effect of the sex for health discourse, also in 2011. Nearly a decade later, academic work on asexuality is robust and has been published across academic fields as well in popular formats (i.e., Chen 2020; Decker 2016; Hills 2015). To briefly summarize some of the main themes in this scholarship: Researchers in psychology have examined asexuality as a sexual orientation, assessing its prevalence and its correlation with other psychological, biological, and behavioral variables (e.g., Antonsen et al. 2020; Bogaert 2004; Brotto et...

‘#YouCanTalk’: A multimodal discourse analysis of suicide prevention and peer support in the AustralianBeyondBlueplatform

Research has shown that suicide rate in Australia is on the rise and that most people who die by suicide are not in contact with mental health services. They most likely communicate their suicidal thoughts to family members or close friends, whose responses may sound unhelpful and/or dismissive, thus reinforcing suicidal ideation. This national emergency has been tackled via a social media campaign, #YouCan Talk, launched by a government-supported digital platform, BeyondBlue. This article adopts a multimodal discourse analysis approach to investigate how peer support is encouraged and articulated in the context of mental health discourse for suicide prevention. The two case studies selected for analysis from the BeyondBlue platform are (1) the #YouCanTalk social media campaign, designed to teach carers to identify severe depression and effectively respond to suicide warning signs and (2) a sample of posts from a thread for peer support in a monitored online forum devoted to help carers who seek peer advice. Unlike previous research, the article focuses on how pronouns and verbs index interpersonal relations in a systemic-functional perspective as well as other multimodal resources, such as visuals, layout and hyperlinking, to understand how identities are entextualised by both professional health providers and peer carers in digital platforms that address mental health issues.

Interrogating traditionalism: gender and Swazi Culture in HIV/AIDS policy

ABSTRACT Since the late twentieth century, HIV/AIDS-related global public health discourses in Eswatini (formerly Swaziland) have been driving cultural change there. Cultural change refers to local critical consciousness about the value of the royalist state’s traditionalist policies and projects that get branded as a ‘Swazi Culture’. Using feminist discourse analysis of health policy documents, supplemented by ethnographic insights, this article shows how global health discourses addressing the epidemic are critical of traditionalism predominately on grounds that it creates harms and transmission risk in gender- and sexual-based violence and inequalities for women. This criticism echoes a longer history of external interrogations of local sociocultural practices, today including kingship, as a gendered problem for health, a move that simultaneously interrogates state traditionalism but, in turn, solidifies the state’s own cultural reifications. More broadly, this case shows how gender and sexuality reshape relationships between nation-states, health systems, and culture in postcolonial Africa.

An international review of arts inclusion policies: lessons for Hong Kong

Purpose The purpose of this paper is to review and compare the implementation of “arts inclusion” policies (AIPs) by 14 different public administrative systems around the world. It aims to provide a consolidated source which informs further studies in this field, and to develop a framework to compare AIPs at a global level. Design/methodology/approach Using “arts inclusion policy” as the search term, academic journals from a wide spectrum of fields were reviewed. A data set was extracted from the Compendium of Cultural Policies and Trends’ online database which provided real-time information of national cultural policies. Another data set is from the United Nations’ Inequality-adjusted Human Development Index, as the geographic scope of the review – largely focussing on UK, US, Australian, Scandinavian and Asian contexts. Using existing policy-making literature as benchmark, the authors designed and applied a comparative framework dedicated to AIPs which focussed on “policy-making structures” as the main ground of comparison. Findings An important finding is that the policy development and implementation of AIPs often underscore inter-sectoral involvement in many public administrations in this study. With policy leadership and financial incentives pivotal to effective AIPs, central governments should take a more concerted leadership role to include AIPs in national inter-sectoral policies, encourage evidence-based research, expand funding and advocate the recognition of the impacts of arts inclusion. It is concluded that AIPs in western countries remain more developed in targeted scopes and programme diversity compared to those of Asian countries and regions. Continued studies in this field are encouraged. Originality/value This review is the first of its kind to include a number of Asian and western countries within its research scope, allowing it to offer a more holistic outlook on the development and implementation of AIPs in different countries and regions. A common critique with all relevant existing literature was usually their lack of concrete comparative grounds, and the present study’s all-encompassing review of literature from across different levels and sectors of respective public administrative systems contribute to a unique and comprehensive perspective in the arts and health discourse.

A propagação de memes sobre a legalização ou não do aborto: novos discursos, velhas questões

O presente artigo tem como objetivo analisar os discursos contra e a favor da legalização do aborto através dos memes e observar como a memória discursiva é retomada para a construção de “novos” discursos. Trata-se de uma pesquisa qualitativa de cunho descritivo-interpretativista fundamentada nos postulados teóricos da Análise do discurso de linha francesa, sobretudo em Pêcheux (1997), Foucault (2009a, 2009b), Maingueneau (2008) e Paveau (2013), com ênfase nas concepções de discurso, formação discursiva, memória e interdiscurso. Selecionamos como corpus quatro memes, sendo dois que se colocam a favor da legalização do aborto e dois contra, publicados em páginas de quatro diferentes blogs da web. A análise nos permite afirmar que, ao propagar determinados discursos sobre a legalização do aborto, há uma retomada de discursos já existentes para reafirmar ou negar determinadas posições, tratando a causa como uma questão política alicerçada nos discursos da saúde e da religião.

Predictors of contraceptive use among adolescent girls and young women (AGYW) aged 15 to 24\u2009years in South Africa: results from the 2012 national population-based household survey

BackgroundDespite a variety of contraceptives being available for women in South Africa, a considerable number of adolescent girls and young women still face challenges in using them. This paper examines socio-demographic and behavioral predictors of using contraceptives among adolescent girls and young women (AGYW) aged 15 to 24 years.MethodsA secondary data analysis was conducted based on the 2012 population-based nationally representative multi-stage stratified cluster randomised household survey. Multivariate backward stepwise logistic regression model was used to examine socio-demographic and behavioural factors independently associated with contraceptive use amongst AGYW aged 15 to 24 years in South Africa.ResultsOut of 1460 AGYW, 78% (CI: 73.9–81.7) reported using some form of contraceptives. In the model, contraceptive use was significantly associated with secondary education [OR = 1.8 (1.2–2.7), p = 0.005], having a sexual partner within 5 years of their age [OR = 1.8 (1.2–2.5), p = 0.002], and sexual debut at age 15 years and older [OR = 2.5 (1.3–4.6), p = 0.006]. The likelihood of association decreased with other race groups-White, Coloured, and Indians/Asians [OR = 0.5 (0.3–0.7), p = 0.001], being married [OR = 0.4 (0.2–0.7), p = 0.001], never given birth [OR = 0.7 (0.5–0.9), p = 0.045], coming from rural informal [OR = 0.5 (0.3–0.9), p = 0.010] and rural formal settlements [OR = 0.5 (0.3–0.9), p = 0.020].ConclusionsEvidence suggest that interventions should be tailor-made to meet the needs of AGYW in order to, promote use and access to contraceptives. The results also suggest that family planning interventions should target those who had not given birth in order to reduce unplanned and or unintended pregnancies and associated risk factors. These findings contribute to public health discourse and reproductive health planning for these age groups in the country.

Prescriptive Power: Biologism, Biopsychiatry and Drug-centred Psychopharmacology

This paper looks to make a contribution to the critical project of psychiatrist Joanna Moncrieff, by elucidating her account of ‘drug-centred’ psychiatry, and its relation to critical and cultural theory. Moncrieff's ‘drug-centred’ approach to psychiatry challenges the dominant view of mental illness, and psychopharmacology, as necessitating a strictly biological ontology. Against the mainstream view that mental illnesses have biological causes, and that medications like ‘anti-depressants’ target specific biological abnormalities, Moncrieff looks to connect pharmacotherapy for mental illness to human experience, and to issues of social justice and emancipation. However, Moncrieff's project is complicated by her framing of psychopharmacological politics in classical Marxist notions of ideology and false consciousness. Accordingly, she articulates a political project that would open up psychiatry to the subjugated knowledge of mental health sufferers, whilst also characterising those sufferers as beholden to ideology, and as being effectively without knowledge. Accordingly, in order to contribute to Moncrieff's project, and to help introduce her work to a broader humanities readership, this paper elucidates her account of ‘drug-centred psychiatry’, whilst also connecting her critique of biopsychiatry to notions of biologism, biopolitics, and bio-citizenship. This is done in order to re-describe the subject of mental health discourse, so as to better reveal their capacities and agency. As a result, this paper contends that, once reframed, Moncrieff's work helps us to see value in attending to human experience when considering pharmacotherapy for mental illness.

Re-imagining risky health behaviour as salutogenic practice

Abstract Background Much has been written about the problematic risky health practices that some young women in western cultures engage in defined as, for example, drinking alcohol to excess, smoking and taking drugs. Conversely the literature is more limited with regards to the meaning that young women attribute to such ’unhealthy’ practices. Exploring and understanding meaning is important in order to design more effective health promotion interventions. Methods This paper will present findings from 22 in-depth interviews with young women aged 18 - 14 years in post-compulsory education who were invited to talk about health and risk. Discourse analysis was used to explore the data drawing on feminist and governmentality perspectives. Results The data presented complex constructions of risk taking in health drawing on intertwined discourses of moralism, healthy citizenship, idealised femininity and health as a gendered pursuit. However, the young women also constructed their ’unhealthy’ practices in alternative, more agentic, resistant and philosophical ways. Conclusions Based on these latter findings it is proposed that some risky health behaviours should be interpreted as salutogenic rather than pathogenic in nature. Subjective constructions of risky health practices as salutogenic should be taken into account in risk communication strategies and interventions in public health. Key messages Exploring and understanding meaning is important in order to design more effective health promotion interventions. Subjective constructions of risky health practices as salutogenic should be taken into account in risk communication strategies and interventions in public health.

Rethinking illness through performance: The gaze and the aesthetics of health in Charles Burns' Black Hole

Abstract Focusing on the relation Charles Burns' Black Hole weaves between identity, illness, performance and desire, this article reads in Black Hole a celebration of perversion as its own epistemic structure as it simultaneously exposes the possibilities opened up by performance for a re-articulation of abnormality as a positive identity whose own idiosyncratic value can, in turn, become a site of investment for new individual and cultural forms of desire. Narrating the story of a group of American teenagers whose community is prey to a sexually transmitted disease, which visibly transforms the body of its host through the addition of extraordinary appendages, Black Hole opens up the experience of sickness to the notion of performance. Multiplying the set of responses available to the subject, it promotes an idiosyncratic understanding of illness as an identity while cultivating an understanding of the latter as the solidification of a specific mode of performance. Exploring the ways in which the two contrary practices of dissimulation and voluntary spectacularization embodied by Burns' protagonists signal new possible spaces of resistance to the visual dominance of the medical apparatus and its identificatory discourse, this article exposes how the willful appropriation of the sick identity and its correlative self-objectification force the re-articulation of the unidirectional relation set up by the gaze as a bidirectional mode of address in which both actors participate in the constitution of desire. Reading in Burns' portrayal of Eliza a positive and active embrace of monstrosity as its own form of identity and a disruption of the traditional relationship posited by the dominant discourse between active observer and passive patient, this article explores the potential implicit in performance to challenge the traditional hegemonic discourse of medicine and public health and to articulate a new approach to desire and sexuality for and around the contagious monster.

Developing a student mental health policy for a South African university: Consultation, contestation and compromise

Given high rates of student mental health difficulties globally, the need for universities to have a student mental health policy has been increasingly recognised. In the South African context, such policies must not only balance the mental health needs of students with the realistic constraints of university resources in a time of austerity, but also engage with complexities posed by the Global North foundations of the fields of psychology and psychiatry and the systemic determinants of mental health. This article describes the development of a student mental health policy at a South African university, with a focus on points of contestation that emerged out of a broad-based institutional consultation process. Areas of contestation included the scope of university support for student mental health, defining mental health difficulties, the use of a disability framework for mental health, and processes of verification. All of these were embedded within a broader tension between health and social justice discourses. The compromises that were designed to balance these complexities within the student mental health policy are discussed, and reflections are offered that may inform the development of student mental health policies at other South African universities.

Health system resilience – a conceptual and empirical review of health system literature

Abstract Background The concept of health system resilience has gained popularity in the global health discourse, featuring in UN policies, academic articles and conferences. The term is commonly used to refer to the ability of health systems to respond to challenges. However, there has been no comprehensive overview of how the concept is understood and assessed in health systems research (HSR). Methods We conducted a conceptual and empirical review in 3 databases using systematic methods. Quantitative and narrative synthesis was used to trace the introduction of the concept to HSR, identify relevant definitions and examine its use in research. Results From 4063 references, we identified 96 articles concerned with health system resilience from 2007 - 2017, with a recent increase in literature (45% of studies published since 2016). Many articles take a general perspective; others focus on specific HSR building blocks (e.g. 28% on service delivery) or a particular type of crisis, such as climate change (12.5%) or natural disasters (10.4%). While the concept was developed from the ecological sciences, its meaning has been adapted in HSR, with a shift towards people-centred and process-oriented definitions. We identify three frameworks operationalising resilience: the “attributes” framework by Kruk et al. (2017), the “everyday resilience” framework by Barasa et al. (2017) and the “complex adaptive systems” framework by Blanchet et al. (2017). However, we find a mismatch between these frameworks and how the concept is assessed in 13 quantitative and 8 qualitative empirical studies. Conclusions The HSR literature has converged around a definition of resilience focusing on the system’s ability to mitigate ongoing challenges. Differences in emphasis remain, resulting in a variety of operational frameworks. The frameworks require further adaptation and testing in empirical studies to demonstrate the usefulness of “resilience” as an analytical category in HSR. Key messages There is a mismatch between conceptualisation and operationalisation of resilience in the HSR literature. Existing operational frameworks of resilience require further adaptation and testing in empirical studies to demonstrate the usefulness of “resilience” as an analytical category in HSR.

Promoção da saúde no processo de democratização brasileiro: biopolíticas e constituição de sujeitos da saúde

Em um estudo sobre promoção da saúde como uma biopolítica, objetivou-se analisar como práticas biopolíticas, no processo de democratização brasileira nos anos de 1980 e 1990, constituem sujeitos, por meio da objetivação pelos discursos e normas. A pesquisa teve como fonte documentos que instalam a promoção da saúde, considerando-os como monumentos, intencionais, com efeitos na objetivação de sujeitos. A promoção da saúde é considerada como prática histórica, datada e como dispositivo estratégico de governamentalidade. Organizando-se os documentos em subarquivos, a análise foi conduzida pela problematização – arqueológica e genealógica – de Michel Foucault. A promoção da saúde é articulada estrategicamente com o discurso da saúde ampliada e relações econômicas desenvolvimentistas. Em meio ao governo médico da vida ocorre a objetivação de sujeitos na relação com práticas de promoção da saúde, sobretudo na atenção básica, o que possibilita aportes para se problematizar a subjetividade nesses espaços.

Lived Experiences of Unwed Single Mothers: Exploring the Relationship between Structural Violence and Agency in the Context of Chinese Reproductive Health Discourse

ABSTRACT China’s family planning policy prioritizes the state and has historically silenced the voices of women in their own reproductive discourse. Unwed single Chinese mothers are in particular penalized and remain invisible in the national reproductive health discourse that promotes childbirth only within the institution of marriage. Drawing on Giddens’ theoretical framework of structure-agency, thirty in-depth interviews were conducted to understand the lived experiences of Chinese unwed single mothers. Specifically, this study explored the ways in which structural violence is communicatively enacted in the interactions within institutions such as police station, family planning office and health care system; and interpersonal relationships such as family and neighbors that silence the voices of the unwed single mothers. Further the study also explored the ways in which the women enact their agency to navigate these macro and micro level constrains and limitations. The findings revealed that the women’s experience of structural violence is often a manifestation of the state-controlled sexuality discourse in the social institutions and interpersonal relationships, and highlighted the women’s agency enactment through employing various communicative behaviors to manage these day-to-day struggles.