Hannah Bradby

Pathways to care: how superdiversity shapes the need for navigational assistance

The recently developed sociological concept of superdiversity provides a potentially interesting and useful way of developing an understanding of life in contemporary Europe. Here we report on research based on individual narratives about access to health care, as described by a range of people from very different sociocultural backgrounds in four European countries. This article notes the frequent appearance in first-person narratives of the need for navigational assistance in the form of knowledge, cultural competence and orientation that facilitate the identification and use of pathways to health care. Our dataset of 24 semi-structured interviews suggests that, in the context of needing health care, the feeling of being a stranger in a strange land is common in people from a wide range of backgrounds. In social settings characterised by transnationalism and cultural heterogeneity, it is important to understand the need for navigational assistance, particularly at times of uncertainty, in the design and delivery of health services. The relationship between the inhabitants of contemporary Europe and the healthcare systems available in the places where they live is dominated by both complexity and contingency - and this is the cultural field in which navigation operates.

Understanding healthcare practices in superdiverse neighbourhoods and developing the concept of welfare bricolage: Protocol of a cross-national mixed-methods study

BackgroundDiversity in Europe has both increased and become more complex posing challenges to both national and local welfare state regimes. Evidence indicates specific barriers for migrant, faith and minority ethnic groups when accessing healthcare. However, previous studies of health in diverse cities in European countries have mainly adopted an ethno-national focus. Taking into account the new complexity of diversity within cities, a deeper and multi-faceted understanding of everyday health practices in superdiverse contexts is needed to support appropriate healthcare provision.Methods/DesignThis protocol describes a mixed method study investigating how residents in superdiverse neighbourhoods access healthcare. The study will include participant observation and qualitative interviewing as well as a standardised health survey and will be carried out in eight superdiverse neighbourhoods – with varying deprivations levels and trajectories of change – in four European countries (Germany, Portugal, Sweden and UK). In each neighbourhood, trained polylingual community researchers together with university researchers will map formal and informal provision and infrastructures supportive to health and healthcare. In-depth interviews with residents and healthcare providers in each country will investigate local health-supportive practices. Thematic analysis will be used to identify different types of help-seeking behaviours and support structures across neighbourhoods and countries. Using categories identified from analyses of interview material, a health survey will be set up investigating determinants of access to healthcare. Complex models, such as structural equation modelling, will be applied to analyse commonalities and differences between population groups, neighbourhoods and countries.DiscussionThis study offers the potential to contribute to a deeper understanding of how residents in superdiverse neighbourhoods deal with health and healthcare in everyday practices. The findings will inform governmental authorities, formal and informal healthcare providers how to further refine health services and how to achieve equitable access in diverse population groups.

International medical migration: A critical conceptual review of the global movements of doctors and nurses

This paper critically appraises the discourse around international medical migration at the turn of the 21st century. A critical narrative review of a range of English-language sources, including grey literature, books and research reports, traces the development and spread of specific causative models. The attribution of causative relations between the movement of skilled medical workers, the provision of health care and population health outcomes illustrates how the global reach of biomedicine has to be understood in the context of local conditions. The need to understand migration as an aspect of uneven global development, rather than a delimited issue of manpower services management, is illustrated with reference to debates about ‘brain drain’ of Africa’s health-care professionals, task-shifting and the crisis in health-care human resources. The widespread presumed cause of shortages of skilled health-care staff in sub-Saharan Africa was overdetermined by a compelling narrative of rich countries stealing poor countries’ trained health-care professionals. This narrative promotes medical professional interests and ignores historical patterns of underinvestment in health-care systems and structures. Sociological theories of medicalization suggest that the international marketization of medical recruitment is a key site where the uneven global development of capital is at work. A radical reconfiguration of medical staffing along the lines of ‘task-shifting’ in rich and poor countries’ health-care systems alike offers one means of thinking about global equity in access to quality care.

Research Agenda in Medical Sociology

Sociology queries taken for granted understandings of the world and especially those that claim universal applicability, but that in fact support particular interests. In showing up the hidden work ...

Migration and danger: ethnicity and health

Ethnicity and health are contested terms that are difficult to define, arising from a moment in the development of public health where difference – both constructed and embodied – was recognised to intersect with inequalities in health. The complex, contingent nature of both ethnicity and of health mean that proxies are used as means of trying to capture key dimensions of these complex concepts (Bradby 2003). Any research involves sampling: even the richest of ethnographic accounts selects material and excludes other, while variable construction is always a sampling of all possible indicators. In setting the context for this special issue, we consider recent migration to Europe, and how the current political and economic concerns have delimited understandings of the wider links between health and ethnicity. Throughout 2015 and 2016, migrants seeking entry to Europe have been in the news with the scale of the displacement through the summer of 2015 and the continuous arrival of people across national borders widely reported. Movements have continued over land and sea, despite winter weather, in unprecedented numbers with over a million people registered for asylum in Europe in 2015. According to Eurostat figures for 2015, more than 450,000 asylum applications have been lodged in Germany (35% of all applications within the EU), more than 150,000 in Hungary (14% of all applications within the EU) and Sweden (12% of all applications within the EU), more than 50,000 in Austria (7% of all applications within the EU), Italy (7% of all applications within the EU) and France (6% of all applications within the EU), with around 40,000 in the Netherlands, Belgium and the UK. Behind the figures lie stories of migrant journeys that have involved significant dangers in order to achieve mobility for a range of compelling reasons. In addition to registered asylum seekers, large numbers of refugees entered Europe by land and sea throughout 2015 and 2016. A boat overloaded with 800 passengers capsized off the Libyan coast in April 2015, resulting in hundreds of deaths. Images of Aylan Kurdi’s (2012–2015) drowned body, washed up on a beach in Turkey, spread rapidly via social media in September 2015. Greek island beaches, marketed as ideal holiday locations, featured in news feeds strewn with boat wreckage, discarded life-jackets and wet clothing. Images of columns of people walking through the Balkans and Hungary to seek protection and shelter from war, civil war and persecution, and to attain the status of a ‘recognised refugee’ in European countries, demonstrated the desperation and determination that underpinned the movement. Images of families carrying children and supporting elderly and disabled relatives through long journeys, despite the new

Researching health in diverse neighbourhoods: critical reflection on the use of a community research model in Uppsala, Sweden

ObjectiveA community research model developed in the United Kingdom was adopted in a multi-country study of health in diverse neighbourhoods in European cities, including Sweden. This paper describes the challenges and opportunities of using this model in Sweden.ResultsIn Sweden, five community researchers were recruited and trained to facilitate access to diverse groups in the two study neighbourhoods, including ethnic, religious, and linguistic minorities. Community researchers recruited participants from the neighbourhoods, and assisted during semi-structured interviews. Their local networks, and knowledge were invaluable for contextualising the study and finding participants. Various factors made it difficult to fully apply the model in Sweden. The study took place when an unprecedented number of asylum-seekers were arriving in Sweden, and potential collaborators’ time was taken up in meeting their needs. Employment on short-term, temporary contracts is difficult since Swedish Universities are public authorities. Strong expectations of stable full-time employment, make flexible part-time work undesirable. The community research model was only partly successful in embedding the research project as a collaboration between community members and the University. While there was interest and some involvement from neighbourhood residents, the research remained University-led with a limited sense of community ownership.

Visibility, resilience, vulnerability in young migrants

Young unaccompanied asylum seekers have been portrayed as vulnerable, resilient or both. Those granted residency in Europe are offered support by health and social care systems, but once they leave the care system to make independent lives, what part can these services play? Our review of research with migrants who have been in care in Sweden and the United Kingdom found evidence of unmet need, but little research describing their own views of services. The limited published evidence, supplemented by interviews with care leavers in a UK inner city, suggests that in defining health needs, young people emphasise housing, education, employment and friendship over clinical or preventative services. Some felt well supported while others described feeling vulnerable, anxious, angry or sad. These experiences, if linked with the insensitivity of even one professional, could lower young people’s expectations of healthcare to the extent that they avoided contact with service providers. In supporting young migrants’ resilience to meet everyday challenges, friendly support from peers, carers and professionals was important. They needed determined advocacy at key moments. The different challenges for the Swedish and UK health and welfare systems along with the resilience/vulnerability trajectory are described.

Is Superdiversity a Useful Concept in European Medical Sociology

Medical sociology has a poor track record of researching diversity in theoretically innovative ways. This paper notes usage of the term superdiversity in migration and urban studies, to ask about its utility in general and more specifically for researching the social production of health and illness. Referring to a multi-country interview study about healthcare seeking strategies, the need to understand the diversification of diversity and the challenges for multi-method health research are described. Six interviews each were conducted in Germany, Spain, Sweden and the UK, to give a diversity sample of 24 adults who described their strategies and practice when seeking healthcare. In discussing how far superdiversity can help to model socio-economic and cultural changes already identified as challenging health policy and service provision, the paper draws on case study material. The complex intersecting dimensions of population diversity to which superdiversity draws attention are undoubtedly relevant for commissioning and improving healthcare and research as well as policy. Whether models that reflect the complexity indicated by qualitative research can be envisaged in a timely fashion for quantitative research and questions of policy, commissioning and research re key questions for the superdiversity’s ongoing usefulness as a concept.

Universalism, diversity and norms: gratitude, healthcare and welfare chauvinism

ABSTRACT Access to universal healthcare is a normative expectation of citizens in European welfare states. As part of a comparative study of healthcare in diverse European neighbourhoods, we met women who described failures of the public healthcare system, together with gratitude for that system. Challenges to European welfare states of ageing populations, the retraction of resources available for healthcare, and globalised migration streams have been linked to xenophobic ‘welfarist’ attempts to restrict access to services for new arrivals and those seen as failing to contribute sufficiently. Stories of healthcare systems’ failure to treat symptoms, pain, and suffering in a timely and caring fashion came from eight women of non-European migrant backgrounds as part of a wider interview study in four European cities (Birmingham, Uppsala, Lisbon, Bremen). These accounts suggest that a normative aspect of welfare provision has been reproduced – that is, the expression of gratitude – despite inadequate services. Where welfarist attitudes to migration meet normative aspects of healthcare, suffering may be compounded by an expectation of gratitude. The regrettable unmet healthcare need of the eight women whose cases are presented suggests that other marginalised healthcare users may also be under-served in apparently universal healthcare systems.

Margaret Stacey: The Sociology of Health and Healing

Margaret (Meg) Stacey (1922–2004) played key roles in establishing sociology as a university-based discipline in Britain and in developing a sociology of medicine, health and illness as a distinct specialism. This chapter outlines her biography and career, during which she helped to consolidate a sociology of health and illness that attends to inequality of various forms, offers critical perspectives on orthodox medicine through a comparative approach and that is committed to theoretical and empirical development. Her interests in the gendered division of labour, her feminist commitment, and a concern to address suffering, are considered in assessing her influence on the discipline.