Kevin Neil White

Health Care Markets in Australia: Ownership of the Private Hospital Sector

Over the past decade, the Australian hospital sector has undergone a massive economic and administrative reorganization with ramifications for both the private and the public sectors. Changes such as privatization, deregulation, and the entry of foreign capital into the hospital sector are occurring in the hospital systems of many countries, including Australia, the United States, and the United Kingdom. These developments are radically transforming the hospital sector, altering established relationships between the state, the medical profession, the consumer, and the corporate investor, and raising important questions about the future of hospital services in regard to equity, accessibility, and quality.

The State, the Market, and General Practice: The Australian Case

This article examines the development of general practice in the latter half of the 20th century, documenting the issues of concern to both the profession and the state. General practice developed hand in hand with the welfare state in Australia. As the structural changes associated with restructuring of the welfare state have advanced, so have the fortunes of general practice declined, despite significant attempts in the 1970s and 1980s to “save” general practice by both the profession and the state. These structural changes have operated on two fronts, the economic and the cultural. On the economic, changes to the employment of general practitioners clearly indicate ongoing proletarianization, particularly in a changing environment of labor-capital relations. At the cultural level, development of the self-help and the womens movements and the elective affinity of these groups with the individualism of the new right are leading to deprofessionalization. The author advances this argument in a review of general practice over the last 40 years and in a case study of community health services. Theoretically he argues for a combination of the proletarianization and the deprofessionalization theses.

Positivism resurgent: the epistemological foundations of evidence-based medicine

Abstract The aim of evidence-based medicine (EBM) is to introduce scientific coherence into what clinical epidemiologists characterise as the unscientific practice of medicine and, in particular, variations in diagnoses, treatment and prescribing. This paper lays out the claims of EBM—its concept of scientific knowledge, its model of disease and its construction of the role of epidemiology in medicine—and analyses them in the framework of a sociology of medical knowledge. It argues that rather than a paradigmatic restructuring of medicine, EBM is an appeal to positivistic canons of scientificity which have been systematically challenged by both the philosophy and the sociology of medicine. The paper concludes by providing a brief account of sociological explanations of practice and diagnostic variation in modern medicine. Taking these sociological explanations into account would much improve the delivery of medicine.

Life insurance, the medical examination and cultural values.

This paper is concerned with the commodification of the risk of death which occurred with the development of life insurance and with the role of the medical examination in making life insurance a viable commodity. Using British and Australian data, it shows how the medical profession and the medical examination were crucial to nineteenth century life insurance institutions in the calculation of the value of human lives. Life insurance institutions combined a developing ideology of health with the knowledge of health statistics and applied both for a developing institutional finance market. The calculation and preservation of the value of individual human lives by the pooling of risks on selected lives is the service which life insurance sells and which underpins finance capital. The knowledge developed from health and morbidity statistics was a process both of social surveillance and of market-oriented monitoring for economic risk-reduction. At the level of the individual the necessity for life insurance was the dissolution of traditional community and familial support as industrial capitalism developed.

Framing disease: The avian influenza pandemic in Australia

Abstract Since 2003, avian influenza has recently spread around the world sparking fears of a potential pandemic. As a result of this, a range of explanations and expectations surrounding the phenomenon were generated. Such social representations of disease depict the issue under discussion and frame reactions to the event. This paper explores the social representations surrounding avian influenza in Australia. Methodologically, a textual analysis of media and government documents was conducted in order to uncover the social representations implicit in these accounts. This demonstrated a symbolic framing of avian influenza with reference to the Spanish Influenza pandemic (1918). Analytically, the study draws upon the concepts of social representations from Durkheim and of risk and symbolic risk in the work of Beck. Overall, it is argued that the framing of avian influenza as a risk, mediated through the collective memory of Spanish Influenza, characterised the nature of the social representations surrounding the phenomenon. This resulted in the production of symbolic solutions to the threat.

The avian influenza pandemic: Discourses of risk, contagion and preparation in Australia

This paper examines the construction of avian influenza in Australian media and federal government policy, with a focus placed on discourses of contagion, preparedness and risk. The threat of an infectious disease outbreak, such as avian influenza, on social life is surrounded by a range of collective narratives which attempt to make it explicable. These narratives socially define the disease and provide explanations for its existence. The paper demonstrates that central to these narratives are depictions of the source of the outbreak and suggestions of appropriate responses to the threat. Methodologically, a narrative analysis of print media and government documents was conducted. This showed that conceptually both government and media discourses could be understood in terms of risk, contagion and blame. Furthermore, it was found that narratives linking the risk of avian influenza with globalised interconnectedness and contagion by the developing world underpin discourses of causation and frame the reactions to and preparation for a potential outbreak.

Labour casualization and the psychosocial health of workers in Australia

This article presents the results of a qualitative study of 72 workers in regional Victoria, Australia. Against the background of the growing casualization of the workforce it demonstrates the impact on the health and well-being of these workers, focusing on the intersection between psychosocial working conditions and health. In particular it focuses on the detrimental impact on workers’ sense of self-efficacy and self-esteem. It emphasizes how the job insecurity characteristic of non-standard work extends beyond the fear of job loss to involve uncertainty over the scheduling of work, with debilitating consequences for workers’ autonomy, self-efficacy and control over their lives. Additionally, it is argued that the exclusion of these workers from paid leave and other entitlements in the workplace confers a lower social status on these workers that is corrosive of their self-esteem. It is these key socio-psychological mechanisms that provide the link between insecure work and workers’ health.

Health, Freedom and Work in Rural Victoria: The Impact of Labour Market Casualisation on Health and Wellbeing

Abstract This paper presents the findings of a qualitative study of the impact of casualised and independent contractor work place arrangements on the psycho-social health of 72 workers in regional Victoria. It contributes to our understanding of the crisis in rural Australia in its use of qualitative methods focusing on the impact of work on health and well-being. There is some evidence in the literature that casualised work arrangement enhance the health and well-being of workers by giving them a sense of autonomy and freedom to negotiate their conditions of work. On the other hand, these arrangements may make an already vulnerable group even more vulnerable to uncertain work conditions, poor pay and uncertainty for their future with a significantly negative impact on their health and wellbeing. The results of these interviews support this latter perspective and show that these workers do not experience freedom and autonomy, but rather lowered social status, insecurity and serious limitations to their ability to manage their health, psychological wellbeing and social relations.

Ludwik Fleck: Thought Collectives and the Sociology of Medical Knowledge

One of the most important — indeed the only early — sociologist of medical knowledge went unacknowledged in his lifetime and was left in obscurity until a series of chance events in the 1970s led to his rediscovery. We are still sorting through the implications and applications of his work as this chapter shows. Ludwik Fleck spent most of his professional career in medicine, in particular on disorders of the blood. While he gained a solid professional recognition, the anti-Semitism of the pre-war years and the subsequent war cast a long shadow over many Jewish scholars.

Book Review: Consuming Health: The Commodification of Health Care

tures, housing conditions, and patterns of leisure, the geographical location and dispersal of populations, memberships in trade unions and clubs and voting patterns. Communities are held together less by traditions and increasingly by a general transformation of society that Beck has paradoxically referred to as ‘capitalism without class’ (p. 205). In the chapter ‘Freedom’s Children’, the authors claim that western Europeans are not living in an age defined by a decline of values, suggesting that ‘instead, we are threatened by something much “worse”’ (p. 157). They go on to characterize this as suffering from freedom, although strictly speaking it may be more correct to refer to ‘Liberty’s Children’. In the absence of any discussion of the importance of the public realm (and its tangible relation to freedom, despite evidence that the authors are familiar with the work of Arendt, pp. 175–6, 210), this raises an unacknowledged ambivalence that is not immediately apparent. In some sense the authors seem to be equating freedom and liberty, and it is clear that they are not the same things at all, regardless of how many sociologists and, more particularly, some political theorists, continue to use the terms as though they were the same thing. It is not just that society is losing its connections with past traditions; it would seem that some traditions, especially political traditions, have been totally eclipsed by rather rudimentary knowledge of political history, from the French Revolution to the present, that is thoroughly saturated by discourses of liberty. This is even more so today with the decline of the public realm (as opposed to the authors’ discussion of public welfare). Individuals go about their business in the private realm (which in political tradition originally meant deprived) with unprecedented liberty in the delusion that they are more ‘free’. Overall, the authors provide an overview of institutionalized individualism that provides a provocative and challenging glimpse of sociological practices that go beyond the confines of class as a central organizing principle for Anglo-Saxon sociology. However, there are few insights for political science (broadly defined) except for a sociological reinventing of politics and public life that distinguishes between politics and sub-politics (in other words a colonization of political science by sociology and sociological insights). The general analysis of the implications of individualization understood in a sociological sense goes some way towards their goal of reinvigorating the discipline of sociology into the future.