| 1. |
- Ahlberg, Beth Maina, 1949-, et al.
(författare)
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Invisibility of Racism in the Global Neoliberal Era : Implications for Researching Racism in Healthcare
- 2019
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Ingår i: Frontiers in Sociology. - : Frontiers Media SA. - 2297-7775. ; 4
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Forskningsöversikt (refereegranskat)abstract
- This paper describes the difficulties of researching racism in healthcare contexts as part of the wider issue of neoliberal reforms in welfare states in the age of global migration. In trying to understand the contradiction of a phenomenon that is historical and strongly felt by individuals and yet widely denied by both institutions and individuals, we consider the current political and socioeconomic context of healthcare provision. Despite decades of legislation against racism, its presence persists in healthcare settings, but data on these experiences is rarely gathered in Europe. National systems of healthcare provision have been subject to neoliberal reforms, where among others, cheaper forms of labor are sought to reduce the cost of producing healthcare, while the availability of services is rationed to contain demand. The restriction both on provision of and access to welfare, including healthcare, is unpopular among national populations. However, the explanations for restricted access to healthcare are assumed to be located outside the national context with immigrants being blamed. Even as migrants are used as a source of cheap labor in healthcare and other welfare sectors, the arrival of immigrants has been held responsible for restricted access to healthcare and welfare in general. One implication of (im)migration being blamed for healthcare restrictions, while racism is held to be a problem of the past, is the silencing of experiences of racism, which has dire consequences for ethnic minority populations. The implications of racism as a form of inequality within healthcare and the circumstances of researching racism in healthcare and its implication for the sociology of health in Sweden are described.
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| 2. |
- Bradby, Hannah, 1966-, et al.
(författare)
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Undoing the unspeakable : researching racism in Swedish healthcare using a participatory process to build dialogue
- 2019
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Ingår i: Health Research Policy and Systems. - : Springer Science and Business Media LLC. - 1478-4505 .- 1478-4505. ; 17
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Tidskriftsartikel (refereegranskat)abstract
- Background:Racism is difficult to discuss in the context of Swedish healthcare for various cultural and administrative reasons. Herein, we interpret the fragmentary nature of the evidence of racialising processes and the difficulty of reporting racist discrimination in terms of structural violence.Methods:In response to the unspeakable nature of racism in Swedish healthcare, we propose a phased participatory process to build a common vocabulary and grammar through a consultative framework involving healthcare providers and service users as well as policy-makers. These stakeholders will be involved in an educational intervention to facilitate discussion around and avoidance of racism in service provision.Discussion:Both the participatory process and outcomes of the process, e.g. educational interventions, will contribute to the social and political conversation about racism in healthcare settings. Creating new ways of discussing sensitive topics allows ameliorative actions to be taken, benefitting healthcare providers and users. The urgency of the project is underlined.
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| 3. |
- Dahal, Prabin, et al.
(författare)
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Competing risk events in antimalarial drug trials in uncomplicated Plasmodium falciparum malaria : a WorldWide Antimalarial Resistance Network individual participant data meta-analysis
- 2019
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Ingår i: Malaria Journal. - : BMC. - 1475-2875 .- 1475-2875. ; 18
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Tidskriftsartikel (refereegranskat)abstract
- Background: Therapeutic efficacy studies in uncomplicated Plasmodium falciparum malaria are confounded by new infections, which constitute competing risk events since they can potentially preclude/pre-empt the detection of subsequent recrudescence of persistent, sub-microscopic primary infections.Methods: Antimalarial studies typically report the risk of recrudescence derived using the Kaplan-Meier (K-M) method, which considers new infections acquired during the follow-up period as censored. Cumulative Incidence Function (CIF) provides an alternative approach for handling new infections, which accounts for them as a competing risk event. The complement of the estimate derived using the K-M method (1 minus K-M), and the CIF were used to derive the risk of recrudescence at the end of the follow-up period using data from studies collated in the WorldWide Antimalarial Resistance Network data repository. Absolute differences in the failure estimates derived using these two methods were quantified. In comparative studies, the equality of two K-M curves was assessed using the log-rank test, and the equality of CIFs using Gray's k-sample test (both at 5% level of significance). Two different regression modelling strategies for recrudescence were considered: cause-specific Cox model and Fine and Gray's sub-distributional hazard model.Results: Data were available from 92 studies (233 treatment arms, 31,379 patients) conducted between 1996 and 2014. At the end of follow-up, the median absolute overestimation in the estimated risk of cumulative recrudescence by using 1 minus K-M approach was 0.04% (interquartile range (IQR): 0.00-0.27%, Range: 0.00-3.60%). The overestimation was correlated positively with the proportion of patients with recrudescence [Pearson's correlation coefficient (rho): 0.38, 95% Confidence Interval (CI) 0.30-0.46] or new infection [rho: 0.43; 95% CI 0.35-0.54]. In three study arms, the point estimates of failure were greater than 10% (the WHO threshold for withdrawing antimalarials) when the K-M method was used, but remained below 10% when using the CIF approach, but the 95% confidence interval included this threshold.Conclusions: The 1 minus K-M method resulted in a marginal overestimation of recrudescence that became increasingly pronounced as antimalarial efficacy declined, particularly when the observed proportion of new infection was high. The CIF approach provides an alternative approach for derivation of failure estimates in antimalarial trials, particularly in high transmission settings.
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| 4. |
- Hamed, Sarah, et al.
(författare)
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Understanding racism in Swedish healthcare
- 2019
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Ingår i: European Journal of Public Health. - Oxford : Oxford University Press (OUP). - 1101-1262 .- 1464-360X.
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Konferensbidrag (refereegranskat)abstract
- BackgroundDespite the removal of the term ’race’ from statutory documents in Sweden, after the Second World War, racism continues to exist in various institutions including healthcare. Racism can persist in the absence of a biological notion of ’race’ but becomes harder to explain when there is no official recognition. There is evidence of discrimination by patients and healthcare professionals, although fragmented and under-researched. As healthcare should be built on equity and solidarity, accounts of racism constitute a serious breach. Our research focuses on conceptualising racism in healthcare in Sweden to develop means of improving equity in care for populations characterised by migration-driven diversity.MethodsData from 28 qualitative interviews with both patients and healthcare professionals in Sweden was collected.ResultsPreliminary results indicate that patients from minority ethnic groups report that healthcare providers deem their symptoms as insignificant, due to their ethnicity. Consequently, they experience a loss of integrity and trust in healthcare, often leading them to avoid seeking healthcare. Healthcare professionals conceptualise racism in varied ways, ranging from denying racism, normalising and individualising racism to viewing racism as a structural problem. Patients did not report their experiences of racism, as racism was often subtle. Likewise, healthcare professionals mostly chose not to report their experiences for fear of being constructed as difficult colleagues.ConclusionsThe lack of space for discussing racism within healthcare constitutes a problem for healthcare professionals and patients and contributes to rendering experiences of racism invisible. This may be detrimental for achieving responsive healthcare and creates an unhealthy working environment for some healthcare professionals.
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| 5. |
- Rodgers, Paul, et al.
(författare)
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The Lancaster Care Charter
- 2019
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Ingår i: Design Issues. - : MIT Press - Journals. - 0747-9360 .- 1531-4790. ; 35:1, s. 73-77
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- In the fall of 1991 the Munich Design Charter was published in Design Issues. This charter was written as a design-led “call to arms” on the future nations and boundaries of Europe. The signatories of the Munich Design Charter saw the problem of Europe, at that time, as fundamentally a problem of form that should draw on the creativity and expertise of design. Likewise, the Does Design Care…? workshop held at Imagination, Lancaster University in the autumn of 2017 brought together a multidisciplinary group of people from 16 nations across 5 continents, who, at a critical moment in design discourse saw a problem with the future of Care. The Lancaster Care Charter has been written in response to the vital question “Does Design Care…?” and via a series of conversations, stimulated by a range of presentations that explored a range of provocations, insights and more questions, provides answers for the contemporary context of Care. With nation and boundary now erased by the flow of Capital the Charter aims to address the complex and urgent challenges for Care as both the future possible and the responsibility of design. The Lancaster Care Charter presents a collective vision and sets out new pragmatic encounters for the design of Care and the care of Design.
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