Power Hierarchies Research Articles

A participatory process in all aspects? Negotiating agreements within Swedish healthcare (*)

ABSTRACT This article deals with agreements within healthcare in Sweden, a unitary state where responsibility for healthcare is decentralized to 21 regions with self-rule. The agreements are concluded by the central government and the Swedish Association of Local Authorities and Regions (SALAR). The literature categorizes agreements as a ‘soft’ policy instrument with participation as a crucial aspect. We investigate the process behind the agreements and focus on the participation of SALAR. Our material consists of interviews with respondents of SALAR and the Ministry of Health and Social Affairs. The findings suggest that the process is participatory, but not in all aspects. Differences are noticed during various phases. A conclusion is that the power relationship between the central government and SALAR is unequal. The results contribute to a more nuanced understanding of central–local relations in the era of multi-level governance, highlighting a power hierarchy.

Navigating the intersection of international politics and international education

International education and the process of internationalization have evolved through distinct historical phases, each characterized by shifting global political outlooks and increasing complexity. International politics and the global power hierarchy have always played a significant role in shaping the development of international education and directions of academic mobility. Since the era of ancient Greece, various periods have witnessed diverse patterns of student mobility concentrated in specific geographic regions, paralleling prevailing power structures. Currently, international education is undergoing a distinct phase in which its significance in public diplomacy and foreign policy is widely recognized. However, its use for further national interests has also been criticized for potential manipulation. This article provides a historical background and conceptual framework for understanding the intersection of international politics and international education.

Getting the numbers right: Power, creativity and 'good' routine maternal and neonatal health data in Southern Tanzania.

What makes routine maternal and neonatal health data to be 'good quality'? That depends on whom you ask - the people collecting and reporting these data across health system levels have different priorities and face varying constraints. Data are constructed by people, about people, and they both reflect and impact human interactions. This study analyses the power dynamics shaping how routine health data are collected and reported in labour wards of two hospitals in Southern Tanzania. We draw from focused ethnographic observation at these two labour wards and 29 in-depth qualitative interviews with health care workers (HCWs), hospital leaders, and relevant district- and regional-level managers. We distinguish between two different types of power that shape how people engage with routine maternal and neonatal health data: authoritative and discretionary power. Authoritative power, or top-down power 'over', is reflected in how maternal and neonatal health targets and measurement demands are imposed on individuals lower in the power hierarchy. We show how this results in an environment where data are seen as 'political things' and where HCWs feel pressured and fear being blamed for poor health outcomes. Yet, data can also be a means for HCWs to exercise discretionary power - a type of bottom-up power to act creatively to deflect scrutiny and protect themselves and others. Strategically handling and manipulating data, HCWs 'get the numbers right' by balancing their own needs, top-down expectations, and structural challenges. HCWs may hereby compromise their own definitions of 'good' data, and as as consequence, limit the usefulness of routine data to inform clinical decision making and health system planning. We underline the importance of supportive supervision, feasibility and perceived relevance of routine health data for those tasked to collect and report it, in order to better navigate the blurry line between constructive accountability and counter-productive pressure.

Accountability and objectivity: Humanitarian narratives at the intersection of evidence and localisation

In the last decade, there has been a push for greater evidence-based practice within the humanitarian sector, alongside an increasing turn towards localising humanitarian assistance. Humanitarian actors and organisations have been increasing their production and use of evidence, while also being encouraged to reflect more critically on power hierarchies and decolonise humanitarian aid. This paper explores the intersection of these two narratives, examining how the use of evidence in humanitarian decision-making fits within a localisation agenda. Based on interviews with humanitarian health practitioners located globally, we examine how evidence is defined, and how it is used, including to inform both hierarchical and bottom-up approaches to decision-making. We find clear hierarchies about what counts as good evidence, with a weighting towards randomised-controlled trials, and that the perspectives of populations most affected by crises and the expertise of local actors were not routinely seen as central forms of evidence. Narratives about needing to build the capacity of local actors persist, alongside the notion of evidence as objective. We suggest that a disconnect exists between humanitarian discourses about evidence and localisation, arguing for the need to view evidence as political and influenced by researcher positionality This suggests that more consideration of locally-driven knowledge is needed and will strengthen humanitarian decision-making. We argue that a distinction between evidence and localisation does a disservice to both agendas and that finding synergies between these concepts would strengthen both.

Elevating Student Voice and Levelling Traditional Power Hierarchies Through Open Textbook Co-Creation: What Do Students Say?

There are calls for the democratisation of higher education in line with the principles of social justice. Collaboration with students offers the potential for creating a more inclusive higher education environment, and open textbook development initiatives can be a vehicle for change. This paper focuses on the experiences of students as co-creators in open textbook initiatives at the University of Cape Town, South Africa. Drawing on interviews with 11 open textbook collaborators, this paper utilises Nancy Fraser’s social justice framework to explore students’ perspectives on injustices, challenges of collaboration and co-creation, and power dynamics in student–staff partnerships. The study shows that students experience and navigate various injustices in their classroom contexts related to economic maldistribution, cultural misrecognition and political misrepresentation. It reveals a complex interrelationship between student voice, power dynamics in the classroom, and the power of student–staff partnerships to build confidence and flatten hierarchies in open textbook co-creation. The student views presented here provide powerful evidence of a range of benefits they experience when the traditional hierarchies between student and lecturer are levelled through collaborative open textbook development processes. Results indicate that co-creation activities enabled them to have a voice through the power of publication and own their academic journeys.

Power Dynamics and Research Ethics in Sensitive Research

Drawing on ethnographic fieldwork among people experiencing homelessness in Croatia, this article explores power dynamics between researchers and participants in sensitive research. This study shows that these power dynamics are continually shifting depending on researcher positionalities and field sites (shelter facility vs public spaces). In addition, this becomes more complex in interdisciplinary teams where members within an internal team power hierarchy have different positionalities and aspirations. This article also challenges the adequacy of procedural ethics and recommends ethics in practice or relational ethics, which is essential in qualitative research characterized by a discourse of immersion, reflexivity, and rapport.

Specialists’ learning from facilitating group peer telementoring: a qualitative study

BackgroundGroup peer telementoring supports interprofessional learning through multi-directional and synchronous engagement where experienced and knowledgeable individuals exchange guidance and support with differently experienced and knowledgeable individuals. A leading example of group peer telementoring among medical specialists and medical generalists is Project Extension for Community Healthcare Outcomes (Project ECHO), a rapidly spreading program with demonstrated learning outcomes among community-based medical generalists. Yet the multi-directional exchanges that characterize group peer telementoring interactions suggest that specialists facilitating sessions may also learn from the group experiences. We explored what medical specialists learn from community-based medical generalists and from other specialists as a result of facilitating and participating in group peer telementoring.MethodsPairs of ECHO administrative staff and researchers interviewed medical specialists who facilitated Project ECHO work. Using interview transcripts, we identified 129 learning episodes in which 53 specialists discussed what they learned from their Project ECHO experiences. An inductive multi-phase thematic analysis was used to identify what medical specialists were learning and from whom.ResultsThree primary themes emerged from the data. Specialists learned about community-based health care, including learning about unique and novel community-based treatments and patient needs. Specialists broadened and deepened their knowledge of patient care, including taking an interprofessional view and learning more about their own specialty area. Specialists also learned about learning, including revelations about power hierarchies, the importance of opening space for learning, and practicing humility.ConclusionsProject ECHO’s emphasis on group peer telementoring brought the realities of community-centric care to the attention of medical specialists, deepening their knowledge about patient care and about learning. Specialists learned from community-based medical generalists, other medical specialists within their discipline, and from medical specialists with other expertise. The "all teach, all learn" space that medical specialists endeavored to create in Project ECHO for community-based medical generalists created a safe space for specialists to admit what they did not know. Continued facilitation and participation in group peer telementoring may provide medical specialists with feedback about diagnoses, treatments, and community-based resources for low-income rural and inner-city patients that contributes to their continued development and medical education.

Navigating Workplace Stigma: Examining the Relationship between Power, Authenticity and Religious Coping among employees in Industrial Sectors

Power dynamics, authenticity, religious coping, and workplace stigma within a socio-economic context in Punjab, Pakistan are explored. The research uses a mix methods design of quantitative surveys and qualitative interviews to gather comprehensive data from 350 professionals, from across different professions. Using quantitative analysis, we found there is a significant negative correlation between power dynamics and authenticity (r = -0.57, p < 0.01), meaning that the more power imbalance individuals experience, the less likely they are to display their true selves in their work environment. In addition, religious coping was shown to mediate the relationship between power dynamics and authenticity (? = 0.42, p < 0.01) suggesting that the use of religious practices can help those to maintain authenticity in the workplace. Second, religious coping was positively correlated with psychological well-being (r = 0.60, p <. 01), even among professionals who reported experiencing workplace stigma. Finally, qualitative findings further explained the protective nature of religious coping, showing how it allows individuals to cope with power hierarchies and to reduce stigma related stress. The need to create authentic workplaces and the impact of religious coping strategies on employee wellbeing are emphasized in this study. Organizations can thus create supportive atmospheres where professionals feel comfortable expressing themselves authentically while accessing psychological resilience by addressing power dynamics and stigma in the workplace.

How power and knowledge hierarchies affect communication in intrapartum care: findings from public health facilities in two southern Indian districts

BackgroundEffective communication is a key element of medical care; it can foster a warm interpersonal relationship, facilitate the exchange of information, and enable shared decision-making. In the context of obstetric care, it is associated with a range of positive clinical and social outcomes for mother and baby. Extant communication frameworks and respectful maternity care (RMC) guidelines emphasize the importance of effective communication during intrapartum care. Yet, studies conducted in Indian public health settings suggest that there are gaps in the implementation of RMC guidelines.MethodsAs part of a larger study on disrespect and abuse in Indian public hospitals, we studied the nature of communication in the intrapartum context and the extent to which it is respectful. The study is based on interviews with 29 providers across different levels of public health facilities. Interviews were translated, transcribed, and thematically coded. We examined codes related to communication to understand what kinds of communication occur during intrapartum care and the role played by knowledge and power hierarchies. We then considered their implications for RMC.ResultsWe identified four types of communication that occurred in the context of intrapartum care: (a) compassionate, to comfort and support the laboring woman, (b) factual, to obtain or provide information or updates, (c) prescriptive, to obtain consent and cooperation from the woman and her family members, and (d) defensive, to protect against accusations of poor care. Knowledge and power hierarchies operated differently in each type of communication, with prescriptive and defensive communication more likely to be disrespectful than others.ConclusionsOur findings suggest that successful implementation of RMC guidelines requires greater attention to knowledge and power hierarchies, and an understanding of the ways in which they operate in a clinical setting. Integrating this understanding into guidelines, medical education, training programmes, and interventions will facilitate effective and respectful communication during maternity care.

Decentring the West in the International Baccalaureate Diploma Programme: towards a framework for critical reflection on curriculum and teaching

ABSTRACT The International Baccalaureate (IB) has attracted criticism for its Eurocentricity and Western-centricity (Bunnell et al., 2017; Walker, 2010). This article explores international mindedness, questioning whether the IB perpetuates culturally hegemonic, colonial, and Westernised ideas. The paper draws on research data collected in two International Baccalaureate Diploma Programme (IBDP) international schools in the Hong Kong SAR. We observed IBDP lessons and interviewed teachers about their uses of local and global culture and content in their teaching, considering whether the adaptation of curriculum based on cultural significance and perspectives functions to shift the Western-centric discourses for which the IB is commonly criticised. Our analysis suggests that attempts to decentre the West in the curriculum are challenging, resulting from factors including a lack of critical understanding among teachers, demands and expectations regarding assessment, the aspirations of students and their parents, and a lack of time and space within the timetable and curriculum. Drawing on literature and teacher practices, we propose considerations to move beyond recognitive politics to a more critical set of practices unsettling hierarchies of knowledge and power. The task of de-centering the IBDP’s “Western” epistemology requires further consideration and research. In this paper, we contribute to this ongoing inquiry through providing an analysis of a particular set of circumstances in Hong Kong and providing a framework to enable critical reflection of curriculum and teaching practices that could be considered across IB programmes.

Power Dynamics of Cross-Border Conflict in Lebanon and Syria

This paper identifies the main conflict actors in cross-border conflict across Lebanon and Syria as being Hezbollah and the Syrian Arab Armed Forces, and highlights the power hierarchies between those actors as well as between them and ordinary people in those border regions. The paper shows that in those two countries, both state and non-state actors (de factor authorities) are the main conflict actors who are invested in the conflict status quo that they profiteer from—the state is therefore also part of the problem. The paper additionally argues that there is a need to understand hierarchies of power among conflict actors and how they position local communities at the bottom of the conflict economy pyramid. The paper shows that local communities end up entangled in the conflict economy for the sake of economic coping and survival. Often, both conflict actors and local communities act pragmatically rather than ideologically for the sake of economic survival or gain, but conflict actors trap local communities in the coping economy by removing alternatives, cultivating relationships of dependency by coping communities on major conflict actors. The paper uses these conclusions to present recommendations for conflict response policies. The paper is published as part of the Cross-Border Conflict, Policy and Trends (XCEPT) research programme funded by UK International Development.

A feminist cybersecurity: addressing the crisis of cyber(in)security

Abstract This article draws on feminist security studies (FSS) to construct a more inclusive cybersecurity. We ask: What can a gendered lens do for cybersecurity? Methodologically, this exploratory piece brings FSS insights to bear on studies in cybersecurity (both traditional and critical) to better conceptualize the risks and benefits embedded in the cybersphere, as well as the role of gender in cyberspace. We propose incorporating a gendered lens (an intersectional approach) to shed light on violence and insecurity online. Without recognizing gendering in the cyber realm, including how gender intersects with other systems of oppression, cybersecurity scholars and policy-makers cannot fully understand what we term the crisis of cyber(in)security. Additionally, we challenge simplistic solutions that rely solely on human rights protections in cyberspace. Such approaches often reinforce existing gender and power hierarchies through protectionist discourse. Our FSS-based understanding of cybersecurity has important policy implications. It calls for increased access and diverse participation in cybersecurity policy-making and diplomacy, and promotes a more thoughtful approach to human rights protection to address a broader range of cyber-based insecurities and forms of violence.

Integrating systems of power and privilege in the study of resilience.

Although current approaches to the study of resilience acknowledge the role of context, rarely do those conceptualizations attend to societal systems and structures that include hierarchies of power and privilege-namely systems of racism, colonialism, patriarchy, and capitalism-nor do they articulate how these structural realities are embedded within individual experiences. We offer critiques of the current literature from this structural lens, using the concept of master narratives to articulate the incomplete and, at times, damaging story that the discipline of psychology has told about resilience. We then provide three models that center history, systems, and structures of society that can be employed in the study of resilience. We close with lessons learned from listening to those voices who have been marginalized by mainstream society, lessons that require us to redefine, broaden, and deepen our conceptualization of resilience. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

A different perspective and an overlooked source on migratory routes from Italy to South America: microcosms of men and women and economic macrocosms (1885-1915)

The article analyzes aspects of social history during the migratory flows between Italy and South America between the late nineteenth and the early twentieth century, drawing in particular on newly disclosed archival records. Contrary to research about the transatlantic mass exodus from other countries at the turn of the twentieth century, the travel experience has rarely and only recently received scholarly attention in studies about Italian migration. The aim of this new study perspective is to understand the complexities of individuals, interests and cultures, which, with different roles and a clear power hierarchy, determined the characteristics and management of the routes. The analysis of the logbooks contributes to shedding light on the role of industrial capitalism in the ship-owning industry and to gathering information about the conditions of the journey, the routes and level of professionalism of the crews, including everyday aspects such as life on board, how stowaways were handled and the health and hygiene conditions of passengers and crew members.

Bringing the community into the classroom: professional identity and practice of social workers who studied alongside at-risk adolescent girls

ABSTRACT This study explores the professional identity development of social workers who participated in an academic elective course alongside at-risk adolescent girls aged 16–18. The course, influenced by critical pedagogy, and community and feminist social work, emphasized three core principles: flattening power hierarchies, challenging socio-structural oppression, and mutual learning. In-depth interviews were conducted with course graduates, social workers with 1 to 4 years of experience. Phenomenological analysis uncovered that the course acted as a ‘transitional space’ between student and professional life. Three subthemes emerged: recognizing the vulnerability and strengths of adolescent girls, reflecting on personal life experiences, and learning about forming partnerships with clients. Forming partnerships with clients was enabled by three vehicles: daring to be equal, daring to be authentic, and learning from clients’ knowledge. This study highlights the creation of a ‘community of practice’ through innovative teaching methods and community involvement. It underscores the importance of hands-on experiences and engagement with real-life contexts to bridge the gap between theory and practice, enhancing understanding of concepts like partnership and nonhierarchical approaches in both community and general social work.

Centralization or decentralization? Power allocation in team innovation management.

Power disparity, as an important form of internal team hierarchy, presents a "double-edged sword effect". To reconcile the inconsistent effects and systematically explore the different mechanisms of power disparity, this study constructs a comprehensive theoretical model based on power functionalism and power conflict theory, with team coordination and team conflict as dual mediators, and power legitimacy as moderator. By collecting valid questionnaires from 76 teams across 27 different types of companies in various regions, statistical analysis and hypothesis testing were conducted on the data. The results conclude that power disparity positively influences team innovation performance through the team coordination path and negatively affects it through the team conflict path. However, under the moderating effect of power legitimacy, the negative effect of the team conflict path is suppressed, and the positive effect of the team coordination path is strengthened, thus ensuring that power disparity has a positive effect on team innovation performance. This study provides a useful reference for designing the power hierarchy within enterprises, and offers profound insights into effective organizational structure and decision-making processes.

Decoding urban power: Architecture, symbolism and territorial control in Caracas

This study examines the conflictual dynamics surrounding the utilisation of state-architecture and symbolic imagery as instruments for power consolidation, profoundly shaping national identity and perceptions within the built environment. Drawing on Bourdieu's concepts of symbolic power and cultural capital, this research illuminates the complex interplay between architecture, territory and power. It offers insights into the endurance of societal values and the ongoing renegotiation and reconfiguration of urban space. The research also analyses how urban planning and territorial practices can ignite resistance and challenge existing power structures. The city of Caracas serves as a case study, where two key strategies employed by the current government are analysed: the “Great Housing Mission Venezuela” and the proliferation of Chávez symbolism across the urban realm. By exploring these territorialisation practices in Las Adjuntas, Macarao, the study further unveils the dynamics of power and socio-spatial hierarchies encoded in the urban landscape. These architectural and symbolic interventions are interpreted as attempts to shape perceived realities, consolidate hegemonic control, and regulate the city's socio-spatial order. The findings assert that these practices not only reflect power distribution, but also grant the potential for dominating, producing and controlling territories in nuanced ways. This multidisciplinary study provides a novel framework for decoding power structures embedded in the built environment.

Eco-Tech Odyssey: The Political Craftsmanship of a Green Technostate in the United Arab Emirates (UAE)

The United Nations’s annual climate conference in Dubai in late 2023 provided the United Arab Emirates (UAE) with an opportunity to market their interpretation of a technology- and innovation-focused approach to addressing the climate crisis. Simultaneously, this perspective also helps ensure the future and prosperity of the oil state. This article illustrates that the behavior of the technostate is problematic because it has the potential to expedite environmental damage and endorse a carbon-intensive business as usual. A significant concern lies in the fact that the techno-utopian mode with a green makeover reinforces the autocratic nature of the state, as well as its promotion to the outside world. By using ethnographic methods, this article depicts the UAE’s ecological (super-)modernization model as an inherently political process, as it discloses facets of authority, dominance, legitimacy, and power hierarchy. Ultimately, this article emphasizes the importance of practices and techniques in the conceptual debate, challenging the prevailing focus on a simplified regime-type dichotomy in the discourse on sustainability transformation.

I'm not giving up on you: Exploring the roles of politicized trust and critical agency in the Scratch coding trajectory of two Black boys

AbstractThis article looks at how a Black informal STEM educator supported two Black boys' learning opportunities in coding, specifically investigating how the establishment of politicized trust between the informal STEM educator and youth supported their development of critical agency. Using the dual lenses of socio‐spatial relationality and politicized trust, we explore how the socio‐spatial relationality of place, materials, and educator–youth interactions allowed for the shifting of power dynamics that were foundational to supporting youth in navigating a coding process that centered who they were and their interests, in the moment. We employ participatory design research aimed at reducing power dynamics by remediating who has power within a setting, grounded in dismantling and disrupting traditional power hierarchies through actively involving the community in the design process. We present two case studies that map the learning trajectories of Donovan and Jabria, two middle‐school aged Black boys. Their learning trajectories include the following phases: tensions related to coding with Scratch, pivotal interaction with the educator, and development of critical agency. We unpack how the socially produced space supported Donovan, Jabria, and Worsley to critically read the world of coding, rewrite coding through political action, and establish politicized trust. Throughout this process, we see through Donovan and Jabria's interactions they were constantly editing and producing their interactions with coding which led to newly created learning opportunities by developing their critical agency in coding. Four main points were identified: continuous access to materials, sustained engagement to reimagine possibilities, understanding that all disengagement is not equal, and being explicit in communicating expectations followed by concrete action. Across these points, the salience of relational politicized trust between educator and youth was a cross cutting thread.

Geographic Tunnel Vision and the Past and Future of Democracy

Abstract In the twenty-first century, the democracy bequeathed by the past confronts major, diverse challenges. In thinking about how it might be reimagined, it is important to look beyond conceptions of democracy that are associated with a distinctive Western tradition, indicated at an early point by Athens two and a half millennia ago. Recent scholarship has questioned some clear connection of that specific ancient experience with the democracy that has developed since the late eighteenth century, challenging in several ways what might be called “epistemic exclusion.” One challenge concerns a long debate about Athenian uniqueness. A second concerns how the founding generation of modern democracy thought about, or did not think about, Athenian practices. A third concerns whether a broader geography of influence has infused the entire modern history of democracy in which much innovation has happened in peripheral places in hierarchies of wealth and power. These reflections have implications for where to look for good ideas to construct a better democratic future.