Module 4, Power, Politics and Privilege in Healthcare Flashcards
Weberianism
acknowledges the way in which people both shape and are shaped by the social structure. introduces the concept of prestige
- is in the middle of structure and agency - the role of individual actors but actors within these structures and the ability to change the structures as well as influence structures have on individuals
Weberianism (where it comes from?)
- key theorist was Max Weber (influenced my Marx)
- like Marx, Weber perceived society to be characterized by conflict and social stratification
- diverged from Marx regarding the nature and source of social stratification
- combines focus on agency with structuralist tendencies
- there are elements of it that are close to marxism and extend it or build upon it
- marxism: our societies look stable but because they are in constant struggle - balance powers between different groups (proleteriat - labour produces the capital and bourgeoisie - class the has a lot of capital)
- there are different groups in society and different groups control different resources but it differs in nature and source in these resources
- people have agency but works within these structures and expands the definition of social stratification to look at different types of groups within societies
Weberianism: Assumptions (3)
a. weber argued that social stratification arose from three interrelated factors:
- property (economic and material resources) - things we can hold (land, money, inventory, supply - objects that are easily translated into money and land)
- power (political resources) - if you have political power you can also have control over property but there are different and you do not need one to have the other
- prestige (social status and social resources) - this is where it differs from marxism - social status as a resource was not considered by marxism but he did say status is associated with having economic control but he did not consider prestige itself was a resource - this becomes an extension of marxis
Prestige
respect, privilege, and honours given to members of particular ‘status group’
- could have economic capital but they do not need to however there is something else that gives them position within society
examples:
- military - there are distinct in someway - comes with honour (sense that we should respect people who have served the country) but does not come with that much money
- doctors - a certain prestige that comes with the position (we take value of their opinions)
- ivy league universities - currency that comes with saying you attended
- pastors or religious figures - authority person that communities go to for help and have a high status in communities and typically is not associated with wealth (one that Weber was considering as it is a group that exists independent on economic capital)
- it recognizes that there is power associated with material objects but there is also power with being recognized as an authority
Weberianism - What are the 4 Key Concepts
- status groups
- social closure
- medical dominance
- rationalization
Weberianism: key concept (status groups)
- status groups reflect cultural and sometimes legally conferred privileges, social respect and honour
- based on membership in specific professional, ethnic or religious groups and have common interests and lifestyles (for example all doctors do the same thing)
- can be based on ‘class’ but not always – this is difference from Marxism (exists independent to class but usually correlates - ivy school admission can depend on if your family attended but people are also there on scholarship)
- celebrities are culturally recognized and there is no license to be a celebrity as it is conferred on you by the recognition of others - some are legally conferred (doctor) whereas others are not
- people can move within groups and groups are not always associated with certain factors (acquire a status of prestige that is not associated with their class)
Weberianism: key concept (social closure)
“the way power is exercised to exclude outsiders from the privileges of social membership”
- to maintain prestige, membership in status group is limited
- also involves status groups wielding power over other groups
- groups are only valuable if it excludes certain people to maintain exclusive or elite status - if everyone can part of the group it loses its prestige
- the membership must be limited in someway (ex. medical school)
- exercise their influence over other groups in society (religious figures that set out guidelines and to be apart of the religion you have to follow the mandates to be apart of it)
- university professors comes with a certain status
Weberianism: key concept (medical dominance)
“refers to the fact that medicine was, and to some extent still is, the most powerful profession in the system. it points to the power the medical profession has, despite its limited numbers, to control its own work, and that of other health care workers, and to have influence over health policy and the organization of hospitals.”
- group that maintains a limited membership but control a disproportionate amount of how the medical care system operates
- most of the staff at the hospital is to be followed by the doctors (controlling a large part of the work)
- would need a doctor to refer you to another doctor but not to refer you to a physiotherapist however you will see the doctor if you want it to be covered by health insurance by a note written by doctor
- physicians control a large amount of our health care system and hold high prestige within it (control how we operate, who others can access etc.)
- doctors are apart of a system and approach to western nation that dominates (one medical system that is dominant)
What are some trends that are challenging medical dominance?
- nurses are getting more autonomy (changing understanding of role of nurses) - some nurses that are able to practice without the direct supervision of physicians (have slightly more things they can do)
- pharmacists are able to prescribe for certain medicines, do not always need a doctors note
- we have much more access to healthcare now (googling beforehand) for better and for worse (advocating for yourself at the doctors - helpful or bad)
- overtime there has become a changing dynamic and patients have quite a different power within the system
Weberianism: key concept (rationalization)
- weber’s work also focused on the process of rationalizations
- described as overarching trend towards more bureaucracy, rules, regulations, policies and protocols
- “the standardization of social life through rules and regulations”
- societies trend towards increased policy and bureaucracy - that every year and every generation we become more buraeatic
- when confronted with a challenge or disruption our society responds by trying to put into place rules and regulations
Weberianism: key concept (rationalization 2)
- emphasis on reason, logic and intellect
- devaluation of emotion and nurturing
- acceptance of rules and regulations in name of efficiency
- associated with concept of McDonalization (gives you the same thing each time - our society moves towards rationalization and when taken to the extreme it results in the McDonalization of social life as it is an attempt to deliver the same thing every time with great consistency)
- results in the depersonzailation of our healthcare system as it starts rely on scientific evidence forgetting emotion and nurturing
- how we organize our work in the health care system and a process to how things are carried out
◦ example: how frequently is the nurse going to check in, what type of paperwork needs to be filled out, how many patients you can have on a ward - standarization of processes as there is very little opportunity for individualized heth care and there is not many deviations - there is both agency and structure to what extent can a nurse act in a way that is counter to what the role expects
Sample questions for using Weberianism to understand health
- how are prestige and social closure demonstrated in the Canadian health care system?
- how has the process of rationalization and McDonaldization changed the working conditions of various groups of health care professionals?
- how does the trend towards bureaucracy and policy impact the care provided?
Chiropractors
challenging medical dominance since 1885…
- example of some of the power and politics of our health care system
- how chiropractors have challenged medical dominance and what the response of the medical community has been to that challenge
Daniel David Palmer
- born in Ontario in 1845 and moved to Iowa where he took up magnetic healing (also was a teacher, beekeeper, and shop owner) - healing practice using magnets
- spiritualist - said the idea for chiropractic came to him from the ‘other world’ where we communicated with a doctor who had died 50 years earlier (communicate with people beyond our material world)
- opened the Palmer School of Chiropractic in Iowa in 1897 - early days of regulation of medical practices so you could get away with something like this)
- at this point a lot of people were practicing different forms of healing practices coming from many different traditions and there was not of regulations as medical dominance was not fully established
Daniel David Palmer (what did chiropractic mean)
- taught that 95 percent of all diseases can be attributed to ‘subluxations’ of the spine that impede the flow of nerve impulses and energy - elements from other healing practices (it is a very specific way of thinking - the spine conducts the way of energy and flow of energy through the body)
- health is the result of unimpeded flow of energy (sometimes referred to as vitalism), illness is the obstruction (to the flow of energy) - origins of chiropractic
- treat the spine and realignment of the spine to fix issues
