Toni Schofield

Social isolation in old age: a qualitative exploration of service providers' perceptions

This paper presents findings from a qualitative study of social isolation in the context of service provision to older people. It draws on in-depth interviews with 18 Australian aged care practitioners about their perceptions of social isolation among their clients. The findings show that service providers experience significant levels of concern and frustration and a sense of powerlessness in meeting the needs of such clients. In analysing these accounts, the identification and management of isolation is conceptualised as a social practice which occurs in specific relational settings. The provision of care to lonely, isolated old people is structurally constrained in two ways. First, because of inadequate public resource allocation, the relationship between practitioners and older clients is dominated by time pressure and instrumentality. Secondly, the organisational and professional rules which service providers are required to follow shape the interpersonal relations between practitioner and client in ways which negatively impact on the outcomes of care for both.

Gendered organizational dynamics The elephant in the room for Australian allied health workforce policy and planning

Australian governments have reported an impending ‘crisis’ with workforce shortages in the health sector expected to deepen over the next decade. The allied health professions, however, have barely rated a mention despite the fact their retention rates are low and they are expected to play an expanded and more preventive role in the future. This article examines current Australian public policy approaches to the allied health professions in relation to workforce shortages. It identifies the dominance of technocratic representations of the problem, noting that these have become more pervasive and robust with the New Public Management (NPM). Recent Australian sociological discussion suggests that technocratic ‘framing’ of allied health workforce shortages is limited by its failure to address the role of organizational and institutional dynamics. Such an analysis advances prevailing policy-based problematizations of allied health workforce shortages, but is itself constrained by the lack of acknowledgement of the gendered character of Australian health services organization and the role this may play in allied health workforce shortages.

Health inequity and its social determinants: a sociological commentary

Abstract In 2005, the World Health Organisation (WHO) established the Commission on the Social Determinants of Health. It is to produce its final report in May 2008, identifying actions to address the vast health disparities that have accompanied global economic expansion and widespread political turmoil. The Commission and its anticipated report are a major part of a new research and policy approach committed to the advancement of global health equity. This paper explores the fundamental goals, principles and concepts of the health equity ‘movement’, and its relationship to the ‘social determinants of health’ approach. It argues that such an approach is an instrument for rendering the problem of health inequity real and actionable by institutional authorities and policy practitioners. However, its prevailing frameworks and methods impose significant constraints on its capacity to identify effectively the mechanisms by which health inequities are produced. Accordingly, the actions suggested by the prevailing approach to the problem of health inequity are likely to be less than efficacious. The paper suggests that a more dynamic understanding of the social, as provided by critical sociology, has much to offer in advancing efficacious policy interventions in the field of health and equity.

Injured workers’ experiences of the workers’ compensation claims process: institutional disrespect and the neoliberal state

Abstract This paper reports on the results of a recent qualitative study of injured workers’ experiences of the claims process in NSW. It provides an analysis that suggests that recent legislative amendments to improve the process have been of limited value. The paper argues that the obstacles to reform derive from the institutional practices associated with the day-to-day management and administration of the claims process. While these practices are informed by a corporate-rationalist administrative logic, they are enacted through intersubjective relations that involve systematic disrespect and humiliation of work-injured claimants by insurance company officials. Such practices embody the principles and techniques of an intensified neoliberal governance in the Australian state.

‘Just choose the easy option’: students talk about alcohol use and social influence

Previous research into young people’s drinking behaviour has studied how social practices influence their actions and how they negotiate drinking-related identities. Here, adopting the perspective of discursive psychology we examine how, for young people, social influences are bound up with issues of drinking and of identity. We conducted 19 focus groups with undergraduate students in Australia aged between 18 and 24 years. Thematic analysis of participants’ accounts for why they drink or do not drink was used to identify passages of talk that referred to social influence, paying particular attention to terms such as ‘pressure’ and ‘choice’. These passages were then analysed in fine-grained detail, using discourse analysis, to study how participants accounted for social influence. Participants treated their behaviour as accountable and produced three forms of account that: (1) minimised the choice available to them, (2) explained drinking as culture and (3) described resisting peer pressure. They also negotiated gendered social dynamics related to drinking. These forms of account allowed the participants to avoid individual responsibility for drinking or not drinking. These findings demonstrate that the effects of social influence on young people’s drinking behaviour cannot be assumed, as social influence itself becomes negotiable within local contexts of talk about drinking.

“Social stuff” and institutional micro-processes: alcohol use by students in Australian university residential colleges

The literature on alcohol consumption among university and residential college students in Australia and comparable countries shows a high incidence of heavy and/or frequent drinking. In this article, we report the findings from a study on alcohol consumption among undergraduate university students living in residential colleges in Australia. The aim of the study was to examine residents’ alcohol use as part of a broader set of institutional practices in higher education that are constructed as central to the student experience. The data were collected through in-depth semistructured interviews with 29 students from seven residential colleges. We found that inclusion of alcohol in many students’ social and extracurricular activities while residing in college is associated with heavy and/or frequent drinking. We suggest that the use of alcohol among students is shaped by the colleges’ institutional micro-processes, leading to a tension between college managements’ aim to foster alcohol citizenship and students’ liberty to engage in frequent and/or heavy drinking.

Australian workplace health and safety regulatory approaches to prosecution: Hegemonising compliance

Enforcement of workplace health and safety regulations remains a contentious matter, especially in the context of Australia’s project to harmonise commonwealth, state and territory workplace health and safety legislation. This article presents the findings of a qualitative study investigating policies and practices associated with prosecution and enforcement in two Australian regulatory agencies, prior to harmonisation. The article finds that by 2008, both regulators had taken significant steps to render their enforcement policy and practice, particularly in relation to prosecution, more transparent and accountable to employers and the wider community. They produced detailed and publicly available enforcement policies and prosecution guidelines, reconfigured the work of the general inspectorate (confining it to routine workplace health and safety surveillance and the provision of education and advice to employers) and established a separate administrative unit responsible for investigation and prosecution. Both regulators structured prosecution processes to achieve explicitly technocratic outcomes, namely, enhanced efficiency, objectivity, timeliness, consistency and quality improvement in investigations. These processes went hand in hand with a dramatic decline in the use of prosecution in New South Wales from 2002 to 2010, and an uneven but marginal increase in Victoria for the same period. The article concludes by discussing what these findings might imply for workplace health and safety regulators’ approaches to prosecution and for deterrence under Australia’s new harmonised regime.

“Drinking Cultures” in University Residential Colleges: An Australian Case Study of the Role of Alcohol Policy, Management, and Organizational Processes

Young people’s heavy alcohol use has been widely linked to their “drinking cultures.” Recent scholarly commentary, however, suggests that prevailing conceptualizations of drinking culture, including those in “public health-oriented” research, tend to oversimplify the complexities involved. This article contributes to the conceptual clarification and development of young people’s “drinking cultures.” We provide a case study of a highly publicized example—that of Australian university residential college students. The case study focuses on the role of residential college policy and management in students’ alcohol use, examining how they represent, understand, and address it. Adopting a qualitative approach, we identify and analyze key themes from college policy documents and minimally structured interviews with college management related to students’ alcohol use. Our analysis is informed by two key existing works on the subject. The first is a sociological framework theorizing young people’s heavy drinking as a “culture of intoxication,” which is embedded in and shaped by broader social forces, especially those linked to a “neoliberal social order.” The second draws on findings from a previously published study on student drinking in university residential colleges that identified the significant role of institutional “micro-processes” for shaping alcohol use in university residential colleges. In understanding the specific character of students’ drinking in Australian university residential colleges, however, we also draw on sociological—specifically neo-institutionalist—approaches to organizations, proposing that Australian college policy and management related to students’ drinking do not operate simply as regulatory influences. Rather, they are organizational processes integral to residential college students’ drinking cultures and their making. Accordingly, college alcohol policy and management of students’ drinking, as they have prevailed in this Australian context, offer limited opportunities for minimizing harmful drinking.

The Reluctance of Liver Transplant Participants with Alcoholic Liver Disease to Participate in Treatment for Their Alcohol Use Disorder: An Issue of Treatment Matching?

ABSTRACT Liver transplantation (LT) has increased the survival for participants with end-stage alcoholic liver disease (ALD), however more than 50% of ALD transplant patients return to alcohol use after LT. Despite medical referral and a number of clinical trials of standard alcohol interventions, participants who are ALD transplant patients are reluctant to use specialist alcohol programs to support their required abstinence. The aim of this study was to identify those factors contributing to treatment reluctance by participants who are ALD transplant patients. The authors conducted a prospective case-control study comparing 40 ALD transplant patients matched for age and sex with 40 alcohol treatment seekers on a number of demographic and clinical predictors associated with treatment seeking. The authors found that lengthy abstinence and a progressive stage of change profile by participants who are ALD transplant patients contributed toward alcohol treatment being perceived as unwarranted or not needed. Furthermore, the ALD group differed significantly to those who would typically utilize alcohol treatment on a number of other clinical variables suggesting that standard alcohol interventions are not well tailored to the ALD transplant population. Two major barriers to help seeking among ALD transplant patients included the potential for stigma and limited access to alcohol services. Based on these findings, an individualized stepped-care alcohol treatment approach taking into account the clinical characteristics and needs of ALD transplant participants is required. Alcohol treatment needs to be integrated with the medical transplant program and is recommended for responsiveness to the ongoing psychological and social needs of those at risk of relapsing.

Men’s Health and Well-being

Men’s health and well-being is a recent arrival on the international public policy and health scene, following in the wake of the women’s health movement and the emergence of policy-making related to gender equity. To date, policy and research into men’s health have proceeded on the basis that the object of their discussions and inquiries is self-evident: populations comprise males and females. Corresponding with this division are two differentiated arenas of health and health service experience that are specific to each sex: women’s health and men’s health. This chapter proposes, however, that this common-sense understanding is limited as a foundation for understanding the health and well-being of men. It oversimplifies and misrepresents the issues involved.