Egypt’s Popular Uprising and the Stakes of Medical Neutrality

Amidst the recent political uprisings in the Arab region, physicians and other healthcare workers have found themselves in the crossfire. This paper focuses on Egypt’s doctors, paying special attention to how many have both appealed to and practiced medical neutrality as its own potent and contested political stance, particularly since the period of military rule following Mubarak’s removal from power. Our paper draws on interviews with physicians who served as volunteers in the field hospitals in the days of unrest and violence, and with others who played a major role in documenting protesters’ injuries, police brutality, and other forms of state violence against unarmed citizens. Based on interviews with doctors who belong to organizations such as “Tahrir Doctors” and “Doctors Without Rights,” our paper reveals how these doctors’ commitment to professional ethics put them at odds with the orders of military personnel, rendering their appeal to “medical neutrality” a weighty political act in and of itself.     

Street Scenes: The Politics of Revolutionary Video in Egypt

Images of mass protests that arose from Egypt in early 2011 enraptured global audiences with unexpected scenes of street politics and unprecedented possibilities for political change. While the presence of thousands of cellphone cameras, perhaps hundreds of thousands, provided the technology for a multitude of witnessing, the hyper-visibility of the street in times of protest made image-making practices both threatening and powerful. The recursive rehabilitation of counter-revolutionary images happened on many fronts. Western journalists have long characterized the “Arab Street” as a “barbarous urban mob” and, despite enchantment with the “Arab Spring,” still perpetuated a simplistic analysis of street politics in the region. Meanwhile local television, advertising, and music videos endlessly recycled revolutionary images in superficial modes of patriotic sentimentality; while the urban poor, unable to realize the aims of “bread, freedom, and social justice,” have suspiciously remained the unclaimed image of the Egyptian revolution. But by attending to the social life of revolutionary street media, this article reviews the potential for emerging image practice to cultivate new kinds of political subjectivity and collectivity.     

Gendering ethno-nationalist conflict in Northern Ireland: A comparative analysis of nationalist women's political protests

This article examines and develops a comparison of the Holy Cross School conflict and the campaign by Robert McCartney's sisters and partner to bring those responsible for his murder to justice in Northern Ireland. Both events involved women who identify with the Irish nationalist community in public protest. The article employs a feminist theoretical framework to investigate the ethno-gender dynamics of these particular manifestations of women's political protest. By engaging in a comparative analysis of both protests, the article exposes how these specific expressions of women's political agency and the political discourses and images that they stimulated were influenced by, reflected and disturbed notions about the role of women in nationalist societies.     

Fundamental Interventions: How Clinicians Can Address the Fundamental Causes of Disease

In order to enhance the “structural competency” of medicine—the capability of clinicians to address social and institutional determinants of their patients’ health—physicians need a theoretical lens to see how social conditions influence health and how they might address them. We consider one such theoretical lens, fundamental cause theory, and propose how it might contribute to a more structurally competent medical profession. We first describe fundamental cause theory and how it makes the social causes of disease and health visible. We then outline the sorts of “fundamental interventions” that physicians might make in order to address the fundamental causes.     

How primary health care professionals and residents assess issues related to the oral health of older persons?

doi: 10.1111/j.1741‐2358.2009.00355.x
How primary health care professionals and residents assess issues related to the oral health of older persons? Background and objectives: It is known that older persons need integrated primary health care. However, oral health may not be a frequent concern of multi‐professional teams taking care of older persons. The aim of the present study was to evaluate knowledge and practices related to oral health care, as reported by professionals and residents in a primary health care service. Material and methods: One hundred and seventy‐three health professionals and residents were assessed in this cross‐sectional study by means of a structured questionnaire containing questions pertaining to oral health practices and beliefs. Participants were grouped based on their professions into “primary health care dentists” or “other primary health care professionals” and based on their working status into “permanent team” or “residents”. Results: Permanent team members (other professionals) assessed and recommended dental care more frequently than residents. Permanent team members (other professionals) also reported that they felt they were able to inform older patients in respect to oral health‐related issues more frequently than did residents (68.7% vs. 31.3%, respectively). Conclusion: Oral health‐related knowledge and beliefs were frequent among non‐dentists primary health care workers, suggesting that primary health care which integrates oral health represents an attainable goal.     

Hybrid UCB banks in China – public storage as ethical biocapital

In China, under the heading of “private-for-public” banking, hybrid UCB banking has been politically supported by the government and is based on regulation developed since the 1990s. Although hybrid UCB banking was regarded as an “ethical” alternative to private UCB banking due to its accessibility to “the people”, this study, based on archival research and interviews with bankers, medical professionals, scientists and pregnant women contends that the practice of this ideal needs to be closely scrutinized. Analysing UCB bank networks in China in terms of “public biovalue” and “ethical biocapital”, we illustrate, first, how the synergy of public and private storage of UCB in hybrid models benefit private storage, and how transparency and oversight may increase donation and the uptake of UCB. Second, we describe the problems associated with this hybrid model. Finally, we show how the biovalue of public storage is used as ethical biocapital to buttress UCB networks.     

Physical strength predicts political violence

Research has revealed an association between individual physical strength and attitudinal support for modern war. Physical strength of one individual has an infinitesimal effect on the outcomes of state-level aggression involving large-scale armies and complex military technology. The fact that stronger individuals do support such aggression hints at an evolved psychology specialized for small-scale coalitional aggression, where strength of coalition members non-negligibly contribute to the net coalition strength. Here, I examined whether strength also accounts for participation in modern political aggression, as contrasted to mere support. Given that contemporary political aggression primarily occurs within—not between—states, I focused on intra-state forms of political violence, specifically violent antigovernment protests. To enhance external and ecological validity, I relied on large probability samples from both non-WEIRD and WEIRD countries experiencing political violence (N = 6283; interviewees were quota-sampled from YouGov online panels to generate representative samples of online adult populations). Multinational analyses revealed that self-perceived strength significantly predicts intentions to participate in political violence and self-reported participation, and that this association is stronger among young interviewees, but not among men (compared to women). The predictive power of strength was modest but comparable to that of gender, an established predictor of aggression. I discuss why the fact that strength—a physiological variable—relates to political violence—a complex modern phenomenon—is remarkable. Subsequently, I suggest a new research agenda that draws on insights from evolutionary research to study modern political violence.     

The Critical Periphery in the Growth of Social Protests

Social media have provided instrumental means of communication in many recent political protests. The efficiency of online networks in disseminating timely information has been praised by many commentators; at the same time, users are often derided as “slacktivists” because of the shallow commitment involved in clicking a forwarding button. Here we consider the role of these peripheral online participants, the immense majority of users who surround the small epicenter of protests, representing layers of diminishing online activity around the committed minority. We analyze three datasets tracking protest communication in different languages and political contexts through the social media platform Twitter and employ a network decomposition technique to examine their hierarchical structure. We provide consistent evidence that peripheral participants are critical in increasing the reach of protest messages and generating online content at levels that are comparable to core participants. Although committed minorities may constitute the heart of protest movements, our results suggest that their success in maximizing the number of online citizens exposed to protest messages depends, at least in part, on activating the critical periphery. Peripheral users are less active on a per capita basis, but their power lies in their numbers: their aggregate contribution to the spread of protest messages is comparable in magnitude to that of core participants. An analysis of two other datasets unrelated to mass protests strengthens our interpretation that core-periphery dynamics are characteristically important in the context of collective action events. Theoretical models of diffusion in social networks would benefit from increased attention to the role of peripheral nodes in the propagation of information and behavior.     

From Exceptional to Liminal Subjects: Reconciling Tensions in the Politics of Tuberculosis and Migration

Controlling the movement of potentially infectious bodies has been central to Australian immigration law. Nowhere is this more evident than in relation to tuberculosis (TB), which is named as a ground for refusal of a visa in the Australian context. In this paper, I critically examine the “will to knowledge” that this gives rise to. Drawing on a critical analysis of texts, including interviews with migrants diagnosed with TB and healthcare professionals engaged in their care (n=19), I argue that this focus on border policing, rather than resettlement and the broader social determinants of health that drive current rates of TB, paradoxically renders migrants diagnosed with TB as liminal subjects in the post-arrival phase. This raises ethical issues about who “matters,” as well as dilemmas about what constitutes adequate care for the “Other,” both of which go to the heart of the political economy of migration.     

Peace in the Clinic: Rethinking “Global Health Diplomacy” in the Somali Region of Ethiopia

Drawing on ethnographic research with Somalis, within aid organizations, and within health care facilities in the Somali Region of Ethiopia, this article argues that what is called “global health diplomacy,” despite its origins and articulations in interstate politics, is fundamentally local and interpersonal. As evidence, I outline two very different health programs in the Somali Region of Ethiopia, and how, in each, existing animosities and political grievances were either reinforced or undermined. I argue that the provision of health care in politically insecure and post-conflict settings like the Somali Region of Ethiopia is precarious but pivotal: medical encounters have the potential to either worsen the conditions in which conflicts and crises recur, or build new interpersonal and governmental relations of trust. Effective global health diplomacy, therefore, cannot be limited to building clinics and donating medicine, but must also explicitly include building positive relationships of trust between oppositional groups within clinical spaces.     

Trouble in the Gap: A Bioethical and Sociological Analysis of Informed Consent for High-Risk Medical Procedures

Concerns are frequently raised about the extent to which formal consent procedures actually lead to “informed” consent. As part of a study of consent to high-risk medical procedures, we analyzed in-depth interviews with 16 health care professionals working in bone-marrow transplantation in Sydney, Australia. We find that these professionals recognize and act on their responsibility to inform and educate patients and that they expect patients to reciprocate these efforts by demonstrably engaging in the education process. This expectation is largely implicit, however, and when it is not met, this can give rise to trouble that can have adverse consequences for patients, physicians, and relationships within the clinic. We revisit the concept of the sick role to formalize this new role expectation, and we argue that “informed” consent is a process that is usually incomplete, despite trappings and assumptions that help to create the illusion of completeness.     

On violence,intersectionality and transversal politics

The persistence of violence over the past several decades coupled with the explosive growth of intersectionality as a form of critical inquiry and praxis suggest that the connections between violence, intersecting power relations and political resistance remain highly salient. In this commentary, I ask, in what ways might continuing to focus on violence illuminate the connections between intersecting systems of power and on the contours of political resistance? To address this question, I revisit two themes in “The Tie That Binds: Race, Gender and US Violence”, namely, (1) how conceptualizing violence as a saturated site of intersecting power relations contributes to analyses of political domination and (2) how attending to the analyses and actions of African American women and similarly subordinated groups deepens understandings of flexible solidarity as a core feature of transversal politics.     

Reforming the NHS reforms.

Rather than improving efficiency, the reforms imposed on the NHS have increased bureaucracy, reduced patient choice, limited the range of core services, and led to inequity of treatment. In this paper I examine how the medical profession might help to solve these problems. Priorities must be set for health care since no government can afford all the possibilities offered by medical science. It is essential to forge a consensus of patients, carers, professionals, the public, and government if a system of priorities is to be equitable and just. We also need to be able to measure quality of outcome in health care. This requires consensus on what is the desired outcome and the development of appropriate guidelines, audit, and performance review. This is primarily a task for the health professions supported by management and by adequate investment. Basically, the government must reinstate the three traditional values of the NHS--equity, consensus, and regard for representative professional advice.     

Quantification Methodology of “Health Human Resources” Related to “Health Technologies” Based on Indicators “RhSan”, “TechSan” and “RhTech”: Application to Senegal

ObjectivesAfter a century of spectacular advances, healthcare systems are facing unprecedented crisis, linked to shortage of health human resources and health technologies. In fact, availability of care depends on both technological and human resources of health. The objective of this study is to develop indicators that can measure qualitatively human resources and technologies of health in healthcare facilities, in order to assess availability of care in sub-Saharan African countries.Materials and MethodsRegarding “health technology” related to “medical devices”, an indicator called “TechSan” for “Technologies de Santé” was previously developed and published (Ndione FB et al. (2019) [6]). To address the deficiencies in usual indicators related to health human resources, a second indicator called “RhSan” for “Ressources humaines de santé” in French is proposed. This indicator assigns a weight to each health worker taking into account his specific “level of medical knowledge” and “experience”. In order to correlate “RhSan” with “TechSan”, a third indicator called “RhTech” is also developed to assess matches between “health technologies” and “health human resources” and establish realistic availability of care. These indicators have the advantage to be consolidated by specialty such as laboratory, imaging, surgery, and “mother and child care”.ResultsThe application of TechSan, RhSan and RhTech to data collected in Senegal in 2016, enabled to assess the distribution of “health technology” and “health human resources” in this country. They also permit the mapping of care availability per specialty in Senegal. The results show a strong oversupply of Dakar in terms of both human resources and technologies of health compared to other Senegalese regions. Oppositely, Sedhiou, Kaffrine, Matam and Kédougou are poorly endowed showing limits of the Senegalese health pyramid system.ConclusionTechSan, RhSan and RhTech can provide reliable decision-making tools in order to elaborate health policies in sub-Saharan African countries on more rigorous basis.     

Homicide and cultural evolution

Homicide rates are suitable materials for the study of “cultural evolution,” because they vary dramatically between societies (hence, are “cultural”) and change gradually rather than saccadically (hence, “evolve”).Sociological models of the sources of variation in homicide rates (“subcultures of violence”; demographic change; “legitimation of violence”; mass media effects) are criticized for inattention to the social context of violence and to the individual motives of the protagonists. Models of culture change that emphasize “transmission” are criticized for treating the culture-bearing person as a passive vessel rather than an active strategist. A satisfactory theory of the “cultural evolution” of violence awaits satisfactory theories of how people apprehend their interests and how they pursue them.     

Are ME/CFS Patient Organizations “Militant”?

Myalgic encephalomyelitis or chronic fatigue syndrome (ME/CFS) is a contested illness category. This paper investigates the common claim that patients with ME/CFS—and by extension, ME/CFS patient organizations (POs)—exhibit “militant” social and political tendencies. The paper opens with a history of the protracted scientific disagreement over ME/CFS. We observe that ME/CFS POs, medical doctors, and medical researchers exhibit clear differences in opinion over how to conceptualize this illness. However, we identify a common trope in the discourse over ME/CFS: the claim of “militant” patient activism. Scrutinizing this charge, we find no compelling evidence that the vast majority of patients with ME/CFS, or the POs representing them, have adopted any such militant political policies or behaviours. Instead, we observe key strategic similarities between ME/CFS POs in the United Kingdom and the AIDs activist organizations of the mid-1980s in the United States which sought to engage scientists using the platform of public activism and via scientific publications. Finally, we explore the contours of disagreement between POs and the medical community by drawing on the concept of epistemic injustice. We find that widespread negative stereotyping of patients and the marginalization and exclusion of patient voices by medical authorities provides a better explanation for expressions of frustration among patients with ME/CFS.     

No water for the poor: the Roma ethnic minority and local governance in Slovakia

This article contributes to the emerging critiques of inequalities in the access to water by focusing on three inter-related aspects: affordability, accessibility and quality of water. Based on extensive fieldwork, the paper explores the situation in segregated Roma settlements in Slovakia and highlights the critical role of power asymmetries at a local level. It builds a conceptual framework using Bourdieu’s notions of “social field”, “habitus”, “doxa”, and “capital”, highlighting the central role of power asymmetries at a local level. Insights are drawn on how dominantly positioned social actors command decision-making regarding water supply, and how social hierarchies, inequalities and the “positionality” of Roma as a marginalized group are functional to the lack of political will to address insufficient water access for Roma in any efficient manner.     

Ecosystem Approaches to Human Health and Well-being: Reflections from Use in a Mining Context

This article briefly discusses the evolution of ecosystem approaches, and illustrates the use of ecosystem approaches to assess human health and well-being in a mining context. It discusses the various elements that help distinguish such approaches from other approaches. Well-being here is understood broadly in terms of its “constituents” and “determinants,” of which health is an important constituent. Ecological, health, and social assessments highlighted a number of impacts from mining activity in Goa, India. These generated a list of issues of concern that were validated by stakeholders—community, industry, and government—which served as a basis for the development of tools to track mining-induced changes in health and well-being. The article concludes by reflecting on some of the challenges posed by the use of ecosystem approaches to assessing human health and well-being.     

Society as Cause and Cure: The Norms of Transgender Social Medicine

This article analyzes how trans health was negotiated on the margins of psychiatry from the late 1970s and early 1980s. In this period, a new model of medical transition was established for trans people in Norway. Psychiatrists and other medical doctors as well as psychologists and social workers with a special interest and training in social medicine created a new diagnostic and therapeutic regime in which the social aspects of transitioning took center stage. The article situates this regime in a long Norwegian tradition of social medicine, including the important political role of social medicine in the creation of the postwar welfare state and its scope of addressing and changing the societal structures involved in disease. By using archival material, medical records and oral history interviews with former patients and health professionals, I demonstrate how social aspects not only underpinned diagnostic evaluations but were an integral component of the entire therapeutic regime. Sex reassignment became an integrative way of imagining and practicing psychiatry as social medicine. The article specifically unpacks the social element of these diagnostic and therapeutic approaches in trans medicine. Because the locus of intervention and treatment remained the individual, an approach with subversive potential ended up reproducing the norms that caused illness in the first place: “the social” became a conformist tool to help the patient integrate, adjust to and transform the pathology-producing forces of society.