Chris L. Peterson

Revitalizing primary health care and family medicine/primary care in India - disruptive innovation?

CONTEXT India has rudimentary and fragmented primary health care (PHC) and family medicine systems, yet it also has the policy expectation that PHC should meet the needs of extremely large populations with slums and difficult to reach groups, rapid social and epidemiological transition from developing to developed nation profiles. Historically, the system has lacked impetus to achieve PHC. OBJECTIVE To provide an overview of PHC approaches and the current state of PHC and family medicine in India in order to assess the opportunities for their revitalization. METHODS A narrative review of the published and grey literature on PHC, family medicine, Web2.0 and health informatics key papers and policy documents, pertinent to India. OUTCOMES A conceptual framework and recommendations for policy makers and practitioner audiences. FINDINGS PHC is constructed through systems of local providers who address individual, family and local community basic health needs with strong community participation. Successful PHC is a pre-eminent strategy for India to address the determinants of health and the almost chaotic of massive social transition in its institutions and health care sector. There is a lack of an articulated comprehensive framework for the publicly stated goals of improving health and implementing PHC. Also, there exists a very limited education and organization of a medical and PHC workforce who are trained and resourced to address individual, family and local community health and who have become increasingly specialized. However, emerging technology, Health2.0 and user generated health care informatics, which are largely conducted through mobile phones, are co-evolving patient-driven health systems, and potentially enhance PHC and family medicine workforce development. CONCLUSIONS In order to improve health outcomes in an equitable manner in India, there is a pressing need for a framework for implementing PHC. The co-emergence of information technologies accessible to the mass population and user-driven health care provide a potential catalyst or innovation for this transition.

Stress And The Workplace: The Medical Scientists' Experience

Abstract Health care in Victoria has undergone considerable change throughout the last decade. The need for productivity gains because of downsizing and budget cuts alongside Casemix funding, privatisation and the introduction of Enterprise Bargaining Agreements (EBAs) has placed considerable strain on workers who are finding they are working more hours with considerably less control over their jobs and their working lives. This paper analyses the effects of the most recent changes on a group of Medical Scientists working in the health care sector using a similar questionnaire to the Australian Council of Trade Unions (ACTU) Employment Security and Working Hours Survey 1999. It finds that Medical Scientists are experiencing more work intensification, less control over their work and are more stressed than is suggested for other workers by the ACTU survey.

A sociological analysis of chronic fatigue syndrome and the impact on family support structures

Discusses chronic fatigue syndrome (CFS), which is a “contested disease”, that is, it is not recognized by the medical profession as a legitimate illness and, consequently, people suffering from the illness are not eligible for support/aid. Explores what this non‐recognition means and the impact it has on both the sufferers and their families. Refers to repetitive strain injury and Alzheimer’s disease – neither of which were recognized by medical professionals until recent times – as examples of illnesses that have gained medical legitimacy. Reports that sufferers of CFS, who did not receive an adequate medical diagnosis, were under pressure to become active again, whereas sufferers who received a diagnosis of persistent fatigue gained a lot more support from family and friends. Investigates also the strains involved in coping with a family member with an illness such as Alzheimer’s disease or CFS – as ever economic resources figure prominently. Raises the issue of management of illness in modern society. Recommends that, as health care is pushed ever more onto families and the community, so they should be the recipients of financial support.

A sociological approach to resilience in health and illness

Work on resilience in health and illness has been approached from a number of perspectives. These are the biological and psychosocial with a focus on the individuals responses to cope and adapt to changing circumstances wrought by changing physical health states. This we argue has a place but is far too narrow emphasizing the neoliberal view that the sick or imperfect individual is ultimately responsible for their own health outcomes. In this perspective, the individuals failure to cope or adapt may be seen as a personal failure to interact with the health system on offer. A broader sociological approach focuses on the overarching sociopolitical system within which health and illness occur and looks at the role of concepts such as growing social and economic inequity and the process by which neoliberalism establishes the framework of unequal opportunity and life chances. At this broader level, resilience relates to interplay between the sociopolitical and health systems and the individual. It is the role of the health system to provide opportunities, and supports and to reduce inequities to promote healthy lifestyle and beneficial coping approaches. We aim to understand and describe the mechanisms and opportunities afforded to individuals by their place in the social structure and to argue for health reform that makes a health system that assists all individuals be resilient. Longitudinal data from the Australian Epilepsy Longitudinal Survey are used to understand how income, inequity, and social isolation affect resilience over time.