Recent years have witnessed the rise of populism and populist leaders, movements and policies in many pluralist liberal democracies, with Brexit and the election of Trump the two most recent high ...profile examples of this backlash against established political elites and the institutions that support them. This new populism is underpinned by a post-truth politics which is using social media as a mouthpiece for 'fake news' and 'alternative facts' with the intention of inciting fear and hatred of 'the other' and thereby helping to justify discriminatory health policies for marginalised groups. In this article, we explore what is meant by populism and highlight some of the challenges for health and health policy posed by the new wave of post-truth populism.
Quality-of-life measurement in depression is advocated as a patient-centred indicator of recovery, but may instead enhance the mimetic authority of randomised controlled trials (RCTs) which have been ...roundly critiqued in mental health. In this paper we draw on the social life of methods approach to extend the well-developed critique of RCTs into the field of quality-of-life measurement. We accomplish this through consideration and critique of the conceptual and epistemological development of quality-of-life measurement in depression, including the role of psychometrics in its development. Examining conceptual developments from the 1970s onwards, we consider how the scientific literature on quality-of-life in depression aligns with behavioural economics and consumerism but falls short of engaging with genuinely patient-centred approaches to recovery. We argue that quality-of-life measures in depression were developed within a consumerist model of healthcare in which the medical model was a central pillar and ‘choice’ a rhetorical device only. While quality-of-life instrument development was largely funded by industry, psychometrics provided no coherent solution to the ‘affective fallacy’ (high correlations between quality-of-life and depressive symptoms). Industry has largely abandoned the measures, while psychotherapy research has increasingly endorsed them. We argue that in their design and implementation, quality-of-life measures for depression remain based on a commercial model of healthcare, are conceptually flawed and do not support concepts of patient-centred healthcare.
In the English NHS, integrated care is seen as an opportunity to deliver joined-up care for children and families. This paper examines the lessons learnt by professional stakeholders in the process ...of developing different examples of integrated models of care/frameworks for children's services.
Initial desk research was undertaken to identify different examples of integrated care models and systems/frameworks for children's services. This identified forty-three examples in England. Of these, twelve examples were shortlisted after consultation with the senior managers within the Health and Care Partnership that had commissioned the research, and a more detailed online search for published documents was undertaken. Semi-structured qualitative interviews were then conducted with sixteen professional stakeholders in eight of these examples, ranging from one to four interviewees per example. Interviews focused on the lessons learnt from integrating and transforming services. Data were analysed using framework analysis.
The eight examples vary in their design but have several broad commonalities. A number of common themes and learning have emerged, of which two were identified within all eight examples: the first is about focusing on children and young people; the second is about focusing on partner engagement and collaboration and the importance of building trust and relationships between partners. A number of other important themes also emerged together with several challenges.
A number of common factors were identified that are essential to success in integrating health and care systems. Common across all localities were being child-centric and focusing on child outcomes plus the importance of building trust, engagement and relationships with partners. The findings can help health and care system leaders transform services to ensure efficiency, improvement in services and integration.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
The 2012 English Health and Social Care Act marked a fundamental reform of statutory healthcare in England in ways which elevated the interests of the government over the interests of patients or the ...professions, and which undermined traditional alliances between professions and patients. Drawing on a countervailing powers framework we present a thematic analysis of parliamentary papers, press releases and other publicly available materials produced across the reform process by four key actors in the healthcare field—the government, medical profession, patients and ‘for profit’ providers. This analysis explores how the pursuit of sectional interests by these actors may have acted to constrain potential alliances and ultimately contributed to the enactment of the legislation by default. This conclusion has relevance for other Beveridge model healthcare systems undergoing health and social care reform under the auspices of austerity.
Discourses of recovery and resilience have risen to positions of dominance in the mental health field. Models of recovery and resilience enjoy purchase, in both policy and practice, across a range of ...settings from self-described psychiatric survivors through to mental health charities through to statutory mental health service providers. Despite this ubiquity, there is confusion about what recovery means. In this article we problematize notions of recovery and resilience, and consider what, if anything, should be recovered from these concepts. We focus on three key issues, i) individualization, ii) the persistence of a deficit model, and iii) collective approaches to recovery. Through documentary analysis we consider these issues across third sector organizations, and public and mental health policy. Firstly, definitional debates about recovery reflect wider ideological debates about the nature of mental health. The vagueness of these concepts and implicit assumptions inherent in dominant recovery and resilience discourses render them problematic because they individualize what are social problems. Secondly, these discourses, despite being seen as inherently liberatory are conceptually dependent on a notion of deficit in that talk of “positives” and “strengths” requires the existence of “negatives” and “weaknesses” for these concepts to make sense. We argue that this does little to substantially transform dominant understandings of psychological distress. Thirdly, these issues combine to impact upon the progressive potential of recovery. It comes to be seen as an individualistic experiential narrative accompaniment to medical understandings where the structural causes of distress are obscured. This in turn impacts upon the potential for recovery to be used to explore more collective, political aspects of emotional distress. Drawing on the work of Fraser, we use this critique to characterize “recovery” as a “struggle for recognition,” founded on a model of identity politics which displaces and marginalizes the need for social, political and economic redistribution to address many of the underlying causes of emotional distress. We conclude by stating that it is only when the collective, structural experiences of inequality and injustice are explicitly linked to processes of emotional distress that recovery will be possible.
From the 1980s onwards, discourses of risk have continued to grow, almost in ubiquity. Ideas and practices of risk and risk aversion have extended to UK mental health care where services are expected ...to assess and manage risks, and high-quality clinical assessment has been revised to incorporate risk assessment. This article problematises practices of risk assessment in mental health provision, focussing on the base-rate problem. It presents an analysis of audio recordings of risk assessments completed within a primary care mental health service. The analysis is informed by a critical logics approach which, using ideas from discourse theory as well as Lacanian psychoanalysis, involves developing a set of logics to describe, analyse and explain social phenomena. We characterise the assessments as functioning according to social logics of well-oiled administration and preservation, whereby bureaucratic processes are prioritised, contingency ironed out or ignored, and a need to manage potential risks to the service are the dominant operational frames. These logics are considered in terms of their beatific and horrific fantasmatic dimensions, whereby risk assessment is enacted as infallible (beatific) until clients become threats (horrific), creating a range of potential false negatives, false positives and so forth. These processes function to obscure or background problems with risk assessment, by generating practices that favour and offer protection to assessors, at the expense of those being assessed, thus presenting a challenge to the stated aim of risk assessment practice.
Walking and cycling have been transformed by digital technologies, which range from mapping apps for wayfinding, through ‘wearables’ which monitor activity, to social media apps for comparing ...activity within social groups. Some technologies are explicitly orientated to health projects, others are not, yet all have potentially profound effects on bodies, health‐orientated identities, and understandings of health.
This paper uses the concept of biomedicalisation to explore emerging literature on the intersection of digital technologies with everyday mobility, focusing on walking and cycling. Beyond simply ‘medicalising’ mobility (by bringing it into the realm of public health), digital technologies contribute to various transformations of health: encouraging some health practices, inhibiting others; creating or excluding individual and collective health‐related identities; and reconfiguring health and well‐being. There is research evidence on the contingent and multiple relationships between digital technologies and social practices, with specific themes including quantification; the role of apps in framing walking as extraordinary, cycling as competitive; enabling users to perform as healthy, neoliberal citizens; and digital careers. There has been less attention on how social divisions are reproduced or disrupted by the mediation of mobility through digital technologies. Further research should consider the impact of digital technologies on political economies of health.
COVID-19 has had a significant and measurable impact on individuals and families in economically deprived areas both in the United Kingdom and internationally. This article examines issues of ...community resilience and service adaptability and focuses on the period during the first lockdown in the United Kingdom (May to July 2020). Data were collected from members of the local community in Southend, with specific reference to the ‘A Better Start Southend’ programme of support. The evidence presented in this article uncovers the impact of the ‘first lockdown’ on families with young children, and local children’s and community services.
Over the past decade, some of the world's most stable parliamentary democracies have witnessed a revival in right‐wing populist political parties, movements and leaders. Although there is a growing ...body of theoretical and empirical literature documenting the rise of populism, there has been very little exploration of the implications for health policy of this important political development. In this article, we draw from three illustrative international cases, originating from the USA, the UK and Italy, to explore the ways in which right‐wing populism influences health policy: the election of President Trump in the United States (and subsequent healthcare reforms), the United Kingdom's vote to withdraw from the European Union (Brexit), and how this has played out in the context of the UK National Health Service, and the rise of a politically aligned anti‐vaccination movement in Italy. Drawing on the work of the influential socio‐political theorist Ernesto Laclau, we interpret populism as a performative political act, predicated on drawing logics of equivalence (and difference) between different actors. We use this theoretical framing to explore the ways in which the recent upsurge in right‐wing populism creates a specific set of barriers and challenges for access to healthcare and the health of populations.
Building on Rinaldi and Bekker's scoping review of articles on the impact of populist radical right (PRR) politics on welfare and population health, this short article formulates three pointers ...towards a framework that might help structure future research into PRR, populist politics more generally, and coronavirus disease 2019 (COVID-19) and other health issues. First, we discuss the centrality of welfare chauvinism to the PRR's impact on health, taking this as a cue for a broader reflection on the importance on distinguishing between the nativist and populist dimensions of PRR politics. Secondly, we turn our attention to the potential moderating effect of the PRR's welfare chauvinism on the welfare cuts proposed by their right-wing coalition partners, comments we see as pointing to the need to focus on nativist, populist, neoliberal and other threats to welfare policy more generally, rather than on the PRR only. Thirdly, we reflect on the paradoxical nature of welfare chauvinism - its negative consequences for the health of the 'own people' it proclaims to defend - as a starting point for a brief discussion of the need to consider carefully the not-so-straightforward relation between the PRR's political rhetoric, its (impact on) policy and institutions, and the outcomes of such policy.
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