Heather A. Howard

From collection to community to collections again: Urban Indigenous women, material culture and belonging:

First Story Toronto – a community organization dedicated to the Indigenous histories of Toronto, Canada – is steward to a collection of items mostly made and collected during the 20th century. With origins in the Anglican Church Women, the collection reflects a time when policies and actions of the state and churches internalized colonial processes within Canada. Yet the donation of the ACW material to a Native woman and housing advocate in 1976 hints at the shifting political and cultural contexts of this collection. Native crafts were used by Indigenous women in the city in displays of both Indigenous sovereignty and multiculturalism. Recently, the collection has been taken up by another group of Indigenous women in the Memory, Meaning-Making and Collections project. Handling sessions with artefacts and ‘talking circles’, initially designed to research the role of objects in collective memory and life-history processes, have been appropriated by the participating seniors toward their own goals. The collection has become a source of continuing education, sparking the women to teach and learn beadwork and quillwork; compare life experiences among urban Indigenous people; question history-making processes; and visit museum stores to handle collections and learn with curators. The histories intersecting with this collection thus push back against a range of tropes, provide more nuanced insights into the lives and values of urban Indigenous women in Canada, and the ways collections are used in articulations of belonging among Indigenous peoples.

Canadian Residential Schools and Urban Indigenous Knowledge Production about Diabetes

The construction of illness as an inscription on the body of colonization figures importantly among Indigenous community-based service and health care providers. While residential schools and diabetes have both been characterized as products of colonization, little work has been done to examine how they are connected to and informative for health provider practice. The research data presented in this article come from a collaborative urban Indigenous community-based study examining the legacy of negative relationships with food that was instilled in residential schools and used in diabetes intervention. I illustrate how residential school disciplined eating, providing a context for understanding the contemporary production of Indigenous health knowledge and practice in the urban setting, and the diet-related management of diabetes.

Electronic Health Records and the Disappearing Patient

With rapid consolidation of American medicine into large-scale corporations, corporate strategies are coming to the forefront in health care delivery, requiring a dramatic increase in the amount and detail of documentation, implemented through use of electronic health records (EHRs). EHRs are structured to prioritize the interests of a myriad of political and corporate stakeholders, resulting in a complex, multi-layered, and cumbersome health records system, largely not directly relevant to clinical care. Drawing on observations conducted in outpatient specialty clinics, we consider how EHRs prioritize institutional needs manifested as a long list of requisites that must be documented with each consultation. We argue that the EHR enforces the centrality of market principles in clinical medicine, redefining the clinicians role to be less of a medical expert and more of an administrative bureaucrat, and transforming the patient into a digital entity with standardized conditions, treatments, and goals, without a personal narrative.

Care Managers and Knowledge Shift in Primary Care Patient-Centered Medical Home Transformation

Primary care practices across the United States are implementing a new model of care, the patient-centered medical home (PCMH), in an effort to improve care to patients and, consequently, control health care costs. The addition of care managers is a key aspect of PCMH implementation with important implications for the production and reproduction of authoritative knowledge in primary care. Redistribution of patient interaction from the primary care provider to a range of other health care providers in this model of care is a significant means by which primary care approaches to the prevention and management of chronic diseases such as diabetes are being transformed. Based on a study of a health insurance company-sponsored primary care transformation project in Michigan, we explore the perceptions of care management from the perspective of providers and practice staff to examine these shifts in knowledge and their broader implications for primary care. This research demonstrates how the diffusion of clinica...

Racialized Risk in Clinical Care: Clinician Vigilance and Patient Responsibility

ABSTRACT Racial/ethnic identity is contingent and arbitrary, yet it is commonly used to evaluate disease risk and treatment response. Drawing on open-ended interviews with patients and clinicians in two US clinics, we explore how racialized risk is conceptualized and how it impacts patient care and experience. We found that racial/ethnic risk was a common but poorly defined construct for both patients and clinicians, who intermingled concepts of genetics, biology, behavior, and culture, while disregarding historical or structural context. We argue that racializing risk embodies social power in marked and unmarked bodies, reinforcing inequality along racial lines and undermining equitable health care. Video abstract Read the transcript Watch the video on Vimeo