In the Journals

In the Journals, January 2021, Part 1

Social Science & Medicine

Why public health framing matters: An experimental study of the effects of COVID-19 framing on prejudice and xenophobia in the United States

Lindsay Y. Dhanani, Berkeley Franz

The COVID-19 pandemic has triggered a notable increase in the expression of prejudicial and xenophobic attitudes that threaten the wellbeing of minority groups and contribute to the overall public health toll of the virus. However, while there is evidence documenting the growth in discrimination and xenophobia, little is known about how the COVID-19 outbreak is activating the expression of such negative attitudes. The goal of the current paper therefore was to investigate what aspects of the COVID-19 pandemic may be contributing to this rise in expressions of prejudice and xenophobia. More specifically, this study used an experimental design to assess the effects of using stigmatized language to describe the virus as well as the threat to physical health and economic wellbeing posed by the virus on COVID-19 prejudice. Data were collected from a national sample of 1451 adults residing within the United States. Results from 2 × 2 x 2 between-subjects analyses of covariance demonstrated that emphasizing the connection between China and COVID-19, rather than framing the virus neutrally, increased negative attitudes toward Asian Americans, beliefs that resources should be prioritized for Americans rather than immigrants, and general xenophobia. Emphasizing the severity of the economic impact of the virus also increased beliefs that Asian Americans are a threat to resources and general xenophobia. In contrast, messages which emphasized the serious health risks of COVID-19 did not increase bias toward Asian Americans or xenophobia. Our findings suggest that specific types of public health messaging related to infectious diseases, especially framing the virus in terms of its country of origin or its likely economic impact, may elicit prejudice and xenophobia. Public health campaigns that emphasize the severity of the virus, however, are not likely to trigger the same negative attitudes. Implications for public health responses to health crises are discussed.

Understanding professional stakeholders’ active resistance to guideline implementation: The case of Canadian breast screening guidelines

Zhicheng Wang, Lisa Bero, Quinn Grundy

Health guidelines aim to improve patient outcomes through the promotion of evidence-based practice. Yet, when a guideline’s recommendations significantly differ from, or threaten the interests, values and preferred practices of end-users, organised and often very public resistance to guideline implementation may result. To explore this phenomenon, we theorise a case study consisting of the public discourse following the update to a primary care breast screening guideline in Canada in 2018. Informed by sociological perspectives on the professions and evidence-based medicine, this paper aims to explore: [1] why professional stakeholders form active resistances to the implementation of some clinical guidelines; and, [2] how professional values, perspectives, interests and/or experiences influence the stakeholders’ stance. Current understandings have taken a reductive approach in conceptualising the exclusion of experts and their resistance as “conflict of interest.” Rather, we suggest that resistance is the product of multiple areas of contention, stemming from tensions related to clinical and professional autonomy, medical jurisdiction, and the role of medical elites. We highlight considerations for future guideline development and implementation process changes to mitigate and resolve issues related to active resistance. These considerations include understanding resistance as a political strategy, increasing transparency of public input and coalition building as a part of the public response to active resistance.

The future of research on work, safety, health and wellbeing: A guiding conceptual framework (Open Access)

Glorian Sorensen, Jack T. Dennerlein, Susan E. Peters, Erika L. Sabbath, Erin L. Kelly, Gregory R. Wagner

Work plays a central role in health. A conceptual model can help frame research priorities and questions to explore determinants of workers’ safety, health, and wellbeing. A previous conceptual model focused on the workplace setting to emphasize the role of conditions of work in shaping workers’ safety, health and wellbeing. These conditions of work include physical, organizational, and psychosocial factors. This manuscript presents and discusses an updated and expanded conceptual model, placing the workplace and the conditions of work within the broader context of socio-political-economic environments and consequent trends in employment and labor force patterns. Social, political and economic trends, such as growing reliance on technology, climate change, and globalization, have significant implications for workers’ day-to-day experiences. These structural forces in turn shape employment and labor patterns, with implications for the availability and quality of jobs; the nature of relationships between employers and workers; and the benefits and protections available to workers. Understanding these patterns will be critical for anticipating the consequences of future changes in the conditions of work, and ultimately help inform decision-making around policies and practices intended to protect and promote worker safety, health, and wellbeing. This model provides a structure for anticipating research needs in response to the changing nature of work, including the formation of research priorities, the need for expanded research methods and measures, and attention to diverse populations of enterprises and workers. This approach anticipates changes in the way work is structured, managed, and experienced by workers and can effectively inform policies and practices needed to protect and promote worker safety, health and wellbeing.

Social movements and the contested institutional identity of the hospital (open access)

Gro Kvåle, Dag Olaf Torjesen

Taking popular protest as a common reaction to changes in hospital services as its point of departure, this paper explores how a social movement has taken on the issue of the hospital as an institution. In the wake of the transformation of Norwegian public hospitals into health enterprises (trusts), this paper explores community resistance to the proposals and plans of decision-makers to restructure hospitals. The study is based on a qualitative and quantitative analysis of the website/blog for the local hospital movement’s activities from 2007 until 2017 and of its involvement and resistance in respect of three instances of proposed change to the hospital structure during this period. The study reveals that the health enterprises and the managerialism they represent pose a threat to individual safety and sense of belonging, and to the preservation and identity of the local community. Moreover, the framing of the cause of the local hospital movement illuminates how the institutional identity of the hospital is highly contested between the institutional categories of ‘public administration’ on the one hand, and ‘the company’ on the other. The impact of the local hospital movement has proven modest in terms of influencing and reversing decisions to restructure hospitals, but it has been considerable in terms of cultural support for its concepts and values, not just concerning hospitals and health care services, but also with regard to democratic governance.

Ethics of care and selective organisational caregiving by private employers for employees with chronic illness in a middle-income country

Lavanya Vijayasingham, Uma Jogulu, Pascale Allotey

For people with chronic illnesses in low-and-middle-income countries, access to enabling resources that contribute to health, economic and social resilience such as continued employment, often fall outside the health sector’s remit or delivery of national structural protection. In the absence of sufficient laws and policies that mitigate discrimination and enhance reasonable work modifications, private employers have a high degree of agency and discretion in how they hire, manage, or terminate employees with chronic illnesses (ECI). There is a scarcity of research on how employers make decisions under these conditions. Using a constructivist grounded theory approach, we interviewed and analysed data from 30 human resource (HR) professionals and decision-makers within private organisations in Klang Valley, Malaysia (June 2015–September 2016). In this paper, we use ‘ethics of care’ as an analytic, and moral lens to present HR’s decision-making rationales in caring for and managing ECI. Respondents described the positive influence of international practices, including through parent company policies, as a reference for best practice. While overt bias and discriminatory perceptions were predictably described, participants also discussed care as relational organisational culture, and strategy, albeit selectively. Apart from illness factors such as duration and severity, descriptions of ‘selective caregiving’ included considerations of an employee’s duration in organisations, the perceived value of the employee to employers, organisation size, ethos, resources and capabilities, and how organisations managed the uncertainty of illness futures as a potential risk to organisation outcomes. Selective caregiving can contribute to social, economic and health inequalities in populations with chronic illness. Nevertheless, global health actors can use the problems identified by participants, as entry points to engage more closely with employers and the broader private and commercial sectors in LMICs, to facilitate more inclusive care, and care-based intersectoral work to address the social and economic determinants of health.

Judicial bypass attorneys’ experiences with abortion stigma in Texas courts

Kate Coleman-Minahan, Amanda Jean Stevenson, Emily Obron, Susan Hays

Texas requires pregnant young people under 18 (i.e., minors) seeking abortion without parental consent to go to court with an attorney to petition a judge for permission to obtain abortion. There is a lack of empirical data on the process through which abortion laws stigmatize abortion and on the actors involved. We use data from in-depth qualitative interviews with 19 attorneys who participated in a collective 800 judicial bypass cases to explore what’s at stake for multiple actors within a shared social space and how interactions between those actors reproduce stigma. We extend stigma theory to explain how structural abortion restrictions produce stigma at the individual level. We find that to protect their interests in “keeping pregnant minors in,” the Texas court system constrains attorneys’ ability to represent minors through politicization and stigmatization; attorneys face logistical and emotional challenges, including navigating hostile or ill-informed courts, witnessing court actors humiliate their clients without means of recourse, and experiencing stigma themselves. Although what’s most at stake for their clients becomes most at stake for attorneys— helping young people obtain a judicial bypass so they can access abortion and protecting them from humiliation and trauma— they must reconcile their own violation of norms stigmatizing abortion with their consciences’ motivation to represent bypass clients and protect their professional identity and career advancement from being “tainted” by taking judicial bypass cases. In order to protect what is at stake for their clients in the context of the highly stigmatized Texas courts, attorneys rationally make trade-offs that protect some stakes while undermining others. Moreover, attorneys’ management of experienced stigma and their violation of norms stigmatizing abortion leads some to reproduce abortion stigma in their interactions with minors.

Towards a collaborative structure of interpreter-mediated medical consultations: Complementing functions between healthcare interpreters and providers

Cristina Álvaro Aranda, Raquel Lázaro Gutiérrez, Shuangyu Li

In today’s multilingual and multicultural societies, healthcare interpreters are increasingly needed to mitigate communication barriers in language-discordant, intercultural medical consultations. To orient these interactions, existing guidelines, best practices and recommendations shed light on the behaviour and responsibilities of interpreters and healthcare providers involved. These documents, however, mainly treat both professionals as individuals that take care of separate, unrelated dimensions of consultations, thus failing to address how they can work collaboratively. This seems to be particularly relevant if we consider that prescriptive documents advocate for an invisible interpreter rather than an active participant, consequently ignoring the positive functions interpreters are playing when they step out of their prescribed roles. In this context, this paper sets out to explore potential collaboration between both professional groups to improve communication as a whole. Drawing on Goffman’s production format (1981), we examined excerpts from real interpreter-mediated medical consultations that took place at a public hospital in Madrid (Spain) over a period of five months (February–June 2017). Data analysis reveals that interpreters enact an author role as main participants of consultations and serve several functions in medical encounters, consequently sharing some of the responsibilities which are conventionally seen as doctors’. This may reveal potential areas of interest for interprofessional collaboration. In addition to interpreting, participants performed other clinical functions, thus accounting for complementary functions of that performed by healthcare providers. Interpreters act as clinical and therapeutic allies, patient empowerers and metalinguistic negotiators. In light of our findings, the next step is to design a new model for the interpreter-mediated medical consultations that integrates both perspectives in a collaborative, non-excluding proposal.

How do state policies shape experiences of household income shocks and mental health during the COVID-19 pandemic?

Rachel Donnelly, Mateo P. Farina

The tremendous job loss and wage cuts during the COVID-19 pandemic raises concerns about the mental health of the population. The impacts of income shocks on mental health may differ across U.S. states during the pandemic, as states have different policy contexts that likely influence mental health. The present study uses survey data from the Census Bureau’s Household Pulse Survey (April–July 2020) to examine whether mental health outcomes vary across U.S. states and to what extent specific state-level contexts moderate the associations between household income shocks and depression (n = 582,440) and anxiety (n = 582,796). We find that the prevalence of depression and anxiety differs across states by household income shock status. For individuals, living in a state with supportive social policies – primarily those related to Medicaid, unemployment insurance, and suspended utility shut offs during the pandemic – weakens the association between household income shocks and mental health. Findings suggest that the lack of a strong federal response to the pandemic alongside the devolution of federal power to states over the past 40 years contributes to inequalities in mental health across states. We provide insight about how specific existing and emergency-related policies can reduce adverse mental health consequences of household income shocks.

Conceptualizing Pain and Personhood in the Periviable Period: Perspectives from Reproductive Health and Neonatal Intensive Care Unit Clinicians

Elise Andaya, Lisa Campo-Engelstein

In 2020, the Pain Capable Unborn Child Protection Act was brought to an unsuccessful Senate vote for the third time in five years. The Act seeks to prohibit abortions after 20 weeks post-conception based on the scientifically contested claim that fetuses are at that point capable of feeling pain. It thus seeks to undermine Roe v. Wade’s viability standard by asserting that the capacity for pain perception is sufficient for “compelling governmental interest” in fetal life. The ability of many NICUs to offer life-sustaining interventions for periviable neonates means that, in many states, neonatologists and physicians who provide second-trimester abortion care may manage cases of the same gestational age. Given this overlap, this qualitative study examines how clinicians think about the capacity of periviable entities to feel pain and how these ideas shape clinical practice and understandings of compassionate care. Drawing on twenty semi-structured interviews conducted between June 2019 and April 2020 with clinicians providing second-trimester abortion care and NICU care in the Northeast United States, it examines how pain is “known” in the periviable period and how clinicians think about pain in relationship to personhood. A key finding is that the meaning of pain and implications for clinical care is shaped by the anticipated futures and personhood status of periviable entities as determined by pregnant people and families of neonates. Clinicians also stated that concerns around the alleviation of suffering, defined as long-term or chronic distress for pregnant people and/or neonates and their families, were more pressing than the potential experience of short-term physical pain. Legislative attempts to make contested ideas of “fetal pain” the basis for “governmental interest” ignores other forms of suffering that might result from denial of options, and potentially places clinicians at odds with their own conceptions of competent and compassionate care.

Emotions over five years after denial of abortion in the United States: Contextualizing the effects of abortion denial on women’s health and lives

Corinne H. Rocca, Heidi Moseson, Heather Gould, Diana G. Foster, Katrina Kimport

Background

The Turnaway Study was the first to follow women denied abortions because of state law or facility policy over five years. The study has found negative effects on women’s socioeconomic status, physical health, and on their children’s wellbeing. However, women did not suffer lasting mental health consequences, prompting questions about the effects of denial on women’s emotions.

Methods

In this mixed methods study, we used quantitative and qualitative interview data from the Turnaway Study to offer insight into these findings. We surveyed 161 women who were denied abortions at 30 facilities across the United States between 2008 and 2010 one week after the abortion denial and semiannually over five years. Mixed-effects regression analyses examined emotions about having been denied the abortion over time. To contextualize the quantitative findings, we draw on in-depth qualitative interviews with 15 participants, conducted in 2014-2015, for their accounts of their emotions and feelings over time.

Results

Survey participants reported both negative and positive emotions about the abortion denial one week after. Emotions became significantly less negative and more positive over their pregnancy and after childbirth. In multivariable models, lower social support, more difficulty deciding to seek abortion, and placing the baby for adoption were associated with reporting more negative emotions. Interviews revealed how, for some, belief in antiabortion narratives contributed to initial positive emotions. Subsequent positive life events and bonding with the child also led to positive retrospective evaluations of the denial.

Conclusions

Findings of emergent positive emotions about having been denied an abortion suggest that individuals are able to cope emotionally with an abortion denial, although evidence that policies leading to abortion denial cause significant health and socioeconomic harms remains.

Theory, Culture and Society

Towards a Decolonial Media Archaeology: The Absent Archive of Screenwriting History and the Obsolete Munshi (open access)

Rakesh Sengupta

Much has been written about how Foucault’s archaeology of the modern episteme, emerging from early 19th-century Europe, was curiously divorced from its context of colonialism. Media archaeology, as Foucault’s legacy, has also remained rather geopolitically insular and race agnostic in its epistemological reverse engineering of media modernity. Using screenwriting history as a case study, this article demonstrates how bringing decolonial thinking and media archaeology together can challenge linear narratives of modernity/coloniality in media history. The article connects two seemingly disparate histories of archival absence and human obsolescence to reveal the construction of an elusive screenwriting modernity that has historically obscured parallel scripting practices and pre-existing scribal traditions.

White Extinction: Metaphysical Elements of Contemporary Western Fascism (open access)

Chetan Bhatt

The Euro-American far-right represents a highly diverse political movement comprising numerous ideological tendencies. It includes the European New Right, the US ‘alt-right’ and ‘alt-lite’, far-right accelerationism, traditionalism, and new forms of political misogyny. Despite the diversity in ideas and activities, this article argues that an overarching theme of the ‘fear of white extinction’ travels across and animates each major contemporary far-right tendency. The article explores a variety of older and contemporary metaphysical themes that are deployed in contemporary fascism. These include new configurations of racism, occultist ideas of nature and vitalism, the rendering of culture and civilization in ‘biocultural’ and ‘anthropological’ terms, and ideas about cosmic destiny. The article considers how older ideas from Nietzsche, Schopenhauer, Hans Günther, Ludwig Klages, Arnold Gehlen and others are mobilized in contemporary fascism to generate a critique of liberal modernity, one which leads remorselessly to a logic of white supremacy and apocalyptic violence.

Documenting Dictatorship: Writing and Resistance in Chile’s Vicaría de la Solidaridad (open access)

Vikki Bell

In Documentality (2013), Maurizio Ferraris argues that documents are at the heart of social institutions. Taking this notion as a cue, this piece considers a key organisation in the resistance to state violence and Pinochet’s dictatorship in Chile, the Vicaría de la Solidaridad, and focuses on the remarkable document where the desperate stories of people detained, disappeared and murdered following the coup in 1973 were recorded. This process of registration adopted an overtly rational, administrative response akin to the ‘bio-political’ modes of governing life that Foucault described. As such, it was also built upon a refusal to allow the lives of a section of the population to be cast as without value. Moreover, it ‘deferred’ to a future, in which such documentation would be an invaluable record of injustice. Its legacy is not confined to legal forums, however; academic work and Nicolás Franco’s artwork La Sábana (The Sheet, 2017) have also emerged.

Gramsci in the Postcolony: Hegemony and Anticolonialism in Nasserist Egypt

Sara Salem

This article traces Gramsci’s concept of hegemony as it travels from Southern Italy to Egypt, arguing that the concept ‘stretches’, following Fanon, through an encounter with the nexus of capitalism and (post-)colonialism. I explore a reading of Gramsci’s concepts in a postcolonial context, paying special attention to colonialism and anticolonialism as constitutive of the absence or presence of hegemony. Through an exploration of the Nasserist project in Egypt – the only instance of hegemony in modern Egyptian history – I show how colonialism and anticolonialism were central to the formation of Nasserist hegemony. Drawing on Edward Said, I look at two particular aspects of hegemony as a traveling theory to bring to light some theoretical entanglements that arise when Gramsci travels, in turn highlighting the continuing theoretical potential thinking through such entanglements, as well as of thinking with Gramsci in Egypt and the broader postcolonial world.

Paradoxes of Rationalisation: Openness and Control in Critical Theory and Luhmann’s Systems Theory (open access)

Jan Overwijk

For the Critical Theory tradition of the Frankfurt School, rationalisation is a central concept that refers to the socio-cultural closure of capitalist modernity due to the proliferation of technical, ‘instrumental’ rationality at the expense of some form of political reason. This picture of rationalisation, however, hinges on a separation of technology and politics that is both empirically and philosophically problematic. This article aims to re-conceptualise the rationalisation thesis through a survey of research from science and technology studies and the conceptual framework of Niklas Luhmann’s systems theory. It argues that rationalisation indeed exhibits a logic of closure, namely the ‘operational closure’ of sociotechnical systems of measurement, but that this closure in fact produces the historical logics of technical reason and, paradoxically, also generates spaces of critical-political openness. This opens up the theoretical and practical opportunity of connecting the politically just to the technically efficient.


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