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Bergen S. "The kind of doctor who doesn't believe doctor knows best": Doctors for Choice and the medical voice in Irish abortion politics, 2002-2018. Soc Sci Med 2022; 297:114817. [PMID: 35247770 PMCID: PMC8939907 DOI: 10.1016/j.socscimed.2022.114817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/08/2022] [Accepted: 02/11/2022] [Indexed: 11/19/2022]
Abstract
This article examines how the physician advocacy organization Doctors for Choice articulated a collective pro-choice "medical voice" over the course of sixteen years. This voice was central to the successful 2018 campaign to repeal Ireland's Eighth Amendment, which had imposed a virtual ban on abortion in the Republic of Ireland since 1983. I examine how DfC set itself in opposition to the powerful cadre of anti-abortion Catholic physicians who had dominated Irish public discourse on abortion for decades. DfC not only had to provide a strong alternative argument, but also had to distance itself from a legacy of physicians as gatekeepers to abortion. Based on oral histories and documentary sources, I argue that DfC developed a collective pro-choice "medical voice" and a politics of physician advocacy by leveraging the cultural authority of physicians and using discourses of medical expertise and patient autonomy. Doctors have been called upon to use their social position to fight health-related social inequality. By providing a detailed case study based on individual experiences of and perspectives on physician advocacy, this article examines the framework of "physician advocacy" in practice. It identifies affective and structural barriers to physician engagement in abortion politics across medical specialties. Finally, it considers how, in the face of these barriers, a small group of physicians helped to set the terms of a movement for accessible and equitable abortion care in Ireland.
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Affiliation(s)
- Sadie Bergen
- Columbia University Mailman School of Public Health, Department of Sociomedical Sciences, USA.
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Tichenor M, Winters J, Storeng KT, Bump J, Gaudillière JP, Gorsky M, Hellowell M, Kadama P, Kenny K, Shawar YR, Songane F, Walker A, Whitacre R, Asthana S, Fernandes G, Stein F, Sridhar D. Interrogating the World Bank's role in global health knowledge production, governance, and finance. Global Health 2021; 17:110. [PMID: 34538254 PMCID: PMC8449994 DOI: 10.1186/s12992-021-00761-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 08/31/2021] [Indexed: 12/03/2022] Open
Abstract
Background In the nearly half century since it began lending for population projects, the World Bank has become one of the largest financiers of global health projects and programs, a powerful voice in shaping health agendas in global governance spaces, and a mass producer of evidentiary knowledge for its preferred global health interventions. How can social scientists interrogate the role of the World Bank in shaping ‘global health’ in the current era? Main body As a group of historians, social scientists, and public health officials with experience studying the effects of the institution’s investment in health, we identify three challenges to this research. First, a future research agenda requires recognizing that the Bank is not a monolith, but rather has distinct inter-organizational groups that have shaped investment and discourse in complicated, and sometimes contradictory, ways. Second, we must consider how its influence on health policy and investment has changed significantly over time. Third, we must analyze its modes of engagement with other institutions within the global health landscape, and with the private sector. The unique relationships between Bank entities and countries that shape health policy, and the Bank’s position as a center of research, permit it to have a formative influence on health economics as applied to international development. Addressing these challenges, we propose a future research agenda for the Bank’s influence on global health through three overlapping objects of and domains for study: knowledge-based (shaping health policy knowledge), governance-based (shaping health governance), and finance-based (shaping health financing). We provide a review of case studies in each of these categories to inform this research agenda. Conclusions As the COVID-19 pandemic continues to rage, and as state and non-state actors work to build more inclusive and robust health systems around the world, it is more important than ever to consider how to best document and analyze the impacts of Bank’s financial and technical investments in the Global South. Supplementary Information The online version contains supplementary material available at 10.1186/s12992-021-00761-w.
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Affiliation(s)
- Marlee Tichenor
- Department of Anthropology, Durham University, Dawson Building South Road, Durham, DH1 3LE, UK.
| | - Janelle Winters
- Global Health Studies, Department of History, University of Iowa, 280 Schaeffer Hall, Iowa, 52242, USA
| | - Katerini T Storeng
- Center for Development and Environment, University of Oslo, Norway, Postboks 1116, Blindern, 0317, Oslo, Norway
| | - Jesse Bump
- Department of Global Health and Population, Harvard University T H Chan School of Public Health, 665 Huntington Avenue, Building 1, Room 1205, Boston, MA, 02115, USA
| | - Jean-Paul Gaudillière
- Centre de recherche médecine, science, santé et société (CERMES3), Ecole des Hautes Etudes en Sciences Sociales, 7, rue Guy Môquet, 8 - 94801, Villejuif Cedex, BP, France
| | - Martin Gorsky
- Centre for History in Public Health, London School of Hygiene and Tropical Medicine, UK, Room S12, LSHTM, 15-17 Tavistock Place, London, WC1H 9SH, UK
| | - Mark Hellowell
- Global Health Policy Unit, Social Policy, University of Edinburgh, Chrystal Macmillan Building, 15A George Square, Edinburgh, EH8 9LD, UK
| | - Patrick Kadama
- African Center for Global Health and Social Formation, Plot 13 B Acacia Avenue, Kololo, P.O. Box 9974, Kampala, Uganda
| | - Katherine Kenny
- Department of Sociology and Social Policy, University of Sydney, Australia, A02 - Social Sciences Building, Camperdown, NSW, 2006, Australia
| | - Yusra Ribhi Shawar
- Bloomberg School of Public Health and Paul H. Nitze School of Advanced International Studies, Johns Hopkins University, 615 N. Wolfe Street Room E8132, Baltimore, MD, 21205, USA
| | - Francisco Songane
- Africa Public Health Foundation, 5th Floor, The Atrium Kilimani, Nairobi, Kenya
| | - Alexis Walker
- Columbia University Irving Medical Center, 630 W. 168th St., New York, NY, 10032, USA
| | - Ryan Whitacre
- Global Health Centre, Graduate Institute of International and Development Studies, Case postale 1672, 1211, Genève 1, Switzerland
| | - Sumegha Asthana
- Center of Social Medicine and Community Health, Jawaharlal Nehru University, New Mehrauli Road, New Delhi, 110067, India
| | - Genevie Fernandes
- Usher Institute, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Felix Stein
- Centre for Development and the Environment, University of Oslo, Postboks 1116 Blindern, 0317, Oslo, Norway
| | - Devi Sridhar
- Usher Institute, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, UK
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Uddin S, Mori Y, Shahadat K. Private management and governance styles in a Japanese public hospital: A story of west meets east. Soc Sci Med 2019; 245:112719. [PMID: 31838335 DOI: 10.1016/j.socscimed.2019.112719] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Revised: 11/16/2019] [Accepted: 12/02/2019] [Indexed: 10/25/2022]
Abstract
This paper examines a case of healthcare governance reform in a Japanese hospital to demonstrate how and why physicians may resist NPM ideals in healthcare. We find that the governance reform departed significantly from its idealized form. The intended structure of decentralized governance was ruptured by the CEO, with unanticipated consequences. The power of the medical school, arising out of the ikyoku system in the context of chronic shortages of physicians and the respect afforded to physicians by wider society, was played out in the hospital, with cost management taking a back seat. We find that the general patterns of interaction between and among key stakeholders in relation to accountability and the governance process are shaped by some form of verticality, monologues rather than dialogues, indirectness and silence rooted in Japanese cultural context. Cultural political economy approach guided us to examine both semiotic and extra semiotic features and their dialectical moments with key actors in assessing the limits of NPMs in non-Western contexts.
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Affiliation(s)
- Shahzad Uddin
- Essex Business School, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, UK.
| | - Yuji Mori
- School of Management and Information, University of Shizouka, 52-1 Yada, Suruga-ku, Shizuoka 422-8526 Japan.
| | - Khandakar Shahadat
- Hull University Business School, University of Hull, Cottingham Road, Hull, HU6 7RX, UK.
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