Doctoral Dissertation Research: An Ethnographic Analysis of Healthcare Services Delivery in Socially Marginal Communities

Nicholas Iacobelli在宾夕法尼亚大学Phillipe Bourgois博士的监督下，将探索医疗保障是如何在社会边缘社区之间谈判的。这项研究的重点是监狱囚犯，这是一个基本上没有保险的人群，外面的医疗保健服务不稳定，但矛盾的是，他们是目前唯一受到宪法保障的美国人口群体。这项研究试图通过对监狱医疗保健的法律、政治和经济决定因素进行人种学评估，并将其与最高安全级别监狱中惩教医疗保健管理的日常操作进行比较，来评估这一悖论。这个项目将解决1)如何依赖监狱来产生医疗保障，以及2)什么社会因素影响当地的寻求和提供护理。这个项目通过考察监狱中每天的监禁动态，并在国家服务和公民身份的更大背景下对其进行分析，回应了监狱环境中缺乏详细的人种学研究。这项研究的人种学方法将提供对决定护理的人际、行政和法律过程的洞察，并将重点放在“实地”的利害关系上。因此，它处于独特的位置，能够产生关于当代国家服务、社会边缘化和卫生的政治角色的知识。它还将能够帮助当地惩教保健提供者构建其政策和做法，以应对研究结果，并引发关于护理提供和监禁成本的更广泛辩论。

Nicholas Iacobelli, under the supervision of Dr. Phillipe Bourgois of the University of Pennsylvania, will explore how healthcare security is negotiated among socially marginal communities. The research focuses on prison inmates, a population largely uninsured and with inconsistent healthcare access on the outside, but who are paradoxically the only U.S. population group currently guaranteed a constitutional right to healthcare. The study seeks to evaluate this paradox through an ethnographic evaluation of the legal, political, and economic determinants of prison healthcare juxtaposed with the everyday operations of correctional healthcare administration in a maximum-security prison. This project will address 1) How prisons are relied upon to generate healthcare security, and 2) What social factors shape local care seeking and provision.This project responds to the dearth of detailed ethnographic research in prison settings by examining the everyday dynamics of incarceration and analyzing them in the larger context of state services and citizenship. The study's ethnographic approach will provide insight on the interpersonal, administrative, and legal processes that dictate care with a focus on what is at stake "on the ground."It is thus uniquely situated to generate knowledge about contemporary state services, social marginalization, and the political role of health. It will also be able to help local correctional healthcare providers structure their policies and practices to address the study's findings and generate broader debate about care provision and the costs of incarceration.