Allison Kirkman

Dementia in the news: the media coverage of Alzheimer's disease

Objective:  To identify and analyse the contexts in which Alzheimers disease is portrayed in the New Zealand print media.

Gender and Ethnicity in Health

There are persistent disparities in health outcomes by ethnicity and gender. This chapter addresses a range of explanations for these disparities including systemic discrimination, the legacies of colonization and patriarchy, and the influence of medical practitioners’ attitudes on their interactions with patients. A case study of discrimination in the United States, including a discussion of the Tuskegee Syphilis Experiment, illustrates its ongoing impact. The chapter concludes that the complex interactions between ethnicity and gender within a wider system of social stratification, contribute to discrimination and oppression which manifest in various forms in health and illness.

Medicalization and Contested Illnesses

Medicalization is the process by which conditions, experiences, and situations, which were at one time not seen as medical in nature, come under medical jurisdiction for treatment. This chapter explores the concept of medicalization historically, the different levels of medicalization, and the contemporary forces driving medicalization. It draws on a range of examples of contested illnesses including attention deficit hyperactivity syndrome, fibromyalgia, and pre-menstrual dysphoric disorder, with a detailed case study of Gulf War related illnesses. Finally the chapter addresses the recent phenomenon of biomedicalization, which is reorganizing health care in a number of ways including a widening of the ambit of medicine to incorporate enhancement processes applied to seemingly healthy bodies.

Disability and Chronic Illness

This chapter focuses on disability and chronic illness. It draws on literature from medical sociology and disability studies to explore the meanings that individuals and families make of illness, incapacity, and bodily uncertainty, as well as broader questions around the social oppression which turns bodily impairments into handicaps and disability. The chapter works through a range of theoretical perspectives including arguments about the biographies of chronic illness, the social production of chronic illness, stigma and the social model of disability. A case study is discussed of disability in India. The chapter concludes that because the stigmatization faced by people living with long-term conditions is socially, culturally and environmentally shaped, we can be hopeful that their experiences may change.

Technology and Health

This chapter begins from the starting point that technology and the social world are co-constituted. It addresses several lively areas of technological development in medicine. The chapter begins by examining the complicated and highly mediated way Magnetic Resonance Imaging (MRI) images are produced. It then discusses the dramatic increase in genetic testing and genetic screening. It considers the concept of ‘somatic individuality’ and recent developments in genomics. A case study is discussed of the growing transnational reproductive market and the rapid growth of gestational surrogacy in India. Finally, the chapter turns to the new health and well-being apps created for mobile phones that apparently ‘empower’ health consumers. The chapter concludes that new health technologies have and will be co-constituted along with new forms of contemporary sociality.

Material Conditions and Health Inequalities

There is a clear social gradient, where the poor, the less educated and those living in more deprived neighbourhoods have a lower life expectancy and are more likely to be sicker than their more fortunate neighbours. This chapter explores various explanations for the causal pathways that explain this gradient, drawing on a case study of AIDs in Zambia. The chapter argues that there is not one singular explanation for disparities in health outcomes, but that political and economic systems, psychosocial effects of particular forms of work, the accumulation (or lack) of social capital, and an individual’s life course, including their experiences as a child, all play a role in perpetuating the inequalities that arise due to the relationship between material conditions and health.

Health Consumers and the Clinical Encounter

The relationship between the health professional and the patient, or health consumer, and the clinical encounter where this relationship develops, are central to the experience of health care for most people. This chapter explores the history of these roles and the clinical encounter itself, from notions of the sick role and the paternalistic medical encounter, through to twenty-first century models of the active health consumer, and new models of the clinical encounter. A case study of the treatment of complementary medicine in the clinical encounter through conversation analysis is developed. The chapter concludes that although transformation has occurred to the roles of health consumers, who are now expected to co-produce their own good health, and health professionals, whose social status has declined in the contemporary context, nevertheless the entrenched culture of the clinical encounter may continue to act as a hindrance to substantive change.

Institutions of Health Care

The organization of health care institutions is not one of stability, but of constant change. It varies over time and from country to country. This chapter explores the development of the hospital and primary care in the community through a range of examples. A case study of how care for the elderly is provided in China is developed. The chapter addresses debates around the price and cost of health services, evidence-based medicine, rationing debates and accountability, and concludes that the international trend of rationalizing our institutions of health care may lead to greater efficiency or a more equitable distribution of services; however, it may also give rise to debates around humanitarian ethics and our sense of moral justice.

Sexuality, Sexual Behavior and Gender

Sexuality, sexual behavior and gender can only be explained by examining the social and historical context in which certain forms of sexuality and gender are seen as ‘normal’ and others as deviant. This chapter examines the way in which homosexual identity has been explained in different historical time periods and cultures. It considers biological and psychological explanations, interactionist and social constructionist approaches, and queer theories. A case study of the diagnosis and treatment of HIV/AIDS is discussed to illustrate the relationship between health, the law and sexuality. The chapter then considers attempts to control female reproductive health, and discourses linking aging, health and sexuality for women and men. The chapter concludes that sexuality remains a moral concern in contemporary society, therefore it continues to impinge on the provision of health care, as well as equality in health care provision.

Promoting Public Health

Public health touches everyone’s lives. This chapter discusses important social and political dimensions of public health. It begins by exploring the founding myths of public health, identifying the underlying values and tensions of these myths, in particular regarding the relationship between public health and the state. The relationship between the state, international bodies and citizens is expanded upon through an examination of how public health relates to different cultures. The role of citizens is analyzed through the concepts of popular epidemiology and empowerment. A case study of tobacco control is outlined to illustrate public health processes and activities. The chapter concludes by reflecting on the uses of public health, in tempering commercial companies and the state itself, while also highlighting the need for citizens to remain alert to the potentially disempowering tendencies of public health.