Doctoral Dissertation Research: Healthcare Austerity and the Mobilization of Social Networks

减少政府资助的医疗保健形式，是应对经济危机的一种越来越常见的应对措施。当公共项目和私人财政资源双双后退时，需要稳定获得药品的慢性病患者为了生存，动员了什么样的社会资源？社会科学对与经济危机相关的未得到满足的医疗保健需求的描述主要集中在发展中国家。在美国或欧洲等地，人们对紧缩与医疗资源之间的关系知之甚少。这项研究解决了紧缩下的药品获取问题，背景是以前强大的全民医疗体系。与经济危机相关的日益加深的金融和医疗不平等已经让位于新被剥夺公民权的人，他们必须在一个以频繁的危机驱动的重新配方为特征的治疗性经济中寻求药物。这项研究的核心是培训研究生进行严格的科学数据收集和分析方法，试图了解在公共医疗不再可靠、财政资源和药品分配不均的情况下，人们为解决未得到满足的药品需求而动员的社会资源类型。除了为研究生的培训提供资金外，该项目还将通过向负责改善公共卫生服务的政府和非政府组织广泛传播其研究结果来提高科学理解，因为它们调解了紧缩对医疗保健结果的不同影响。泰勒·贝尔将在加州大学戴维斯分校的Cristiana Giordano博士的指导下，探索在医疗保健获取方面的紧缩条件下，哪些形式的社交网络将取代公共基础设施。这项研究在希腊雅典进行，希腊针对整个欧洲的公共医疗制定了最严格的紧缩措施。雅典拥有希腊最集中的国家资助的医疗资源，因此，它将最好地突显出，当公共资源消失时，人们如何调整寻求药物的做法。为了了解药品是如何交换的，以及促进这些交流的关系，联合PI将在紧急的基层团结诊所和药店进行参与者观察，在紧缩措施侵蚀了全民医疗体系，削减了50%以上的预算后，许多人转向这些诊所和药店。联合PI还将通过扩展的社交网络上的一系列观察和档案方法，以及对具有代表性的药物寻求者样本的访谈(通过麦吉尔疾病叙事访谈和有针对性的半结构化后续行动)，跟踪、绘制和分析制药网络和治疗经济。这些发现将有助于医学、政治和经济人类学关于不平等的辩论，特别是在经济紧缩条件下医疗负担的不同分配方面。这项研究为政策制定者提供了洞察力，这些政策制定者关注被剥夺公民权的慢性病患者为建立获得所需药物的机会而建立的社会资源类型，作为国家资助的医疗保健撤回。这一奖项反映了NSF的法定使命，并通过使用基金会的智力优势和更广泛的影响审查标准进行评估，被认为值得支持。

Reductions in state-sponsored forms of healthcare are an increasingly common response to economic crisis. When public programs and private financial resources both recede, what kinds of social resources do chronically ill people, who need stable access to pharmaceuticals, mobilize in order to survive? Social scientific accounts of unmet healthcare needs associated with economic crises have largely focused on the developing world. Less is known about the relationship between austerity and healthcare resources in contexts such as the U.S. or Europe. This research addresses pharmaceutical access under austerity in a context with a previously robust universal healthcare system. Deepening financial and healthcare inequalities associated with economic crisis have given way to newly disenfranchised people that must seek pharmaceuticals in a therapeutic economy characterized by frequent crisis-driven reformulations. This research, which is centered on training a graduate student in rigorous methods of scientific data collection and analysis, seeks to understand the kinds of social resources people mobilize in order to address unmet pharmaceutical needs, when public healthcare is no longer dependable and financial resources and pharmaceuticals are unevenly distributed. In addition to providing funding for the training of a graduate student, the project would improve scientific understanding through broadly disseminating its findings to governmental and non-governmental organizations charged with improving public health access, as they mediate the differential impacts of austerity on healthcare outcomes. Taylor Bell, under the supervision of Dr. Cristiana Giordano of the University of California at Davis, will explore what forms of social networks replace public infrastructures under conditions of austerity in healthcare access. This research takes place in Athens, Greece, which has instituted the most stringent austerity measures targeting public healthcare across Europe. Athens has the highest concentration of state-sponsored healthcare resources in Greece, and so, will best highlight how people adjust pharmaceutical-seeking practices when public resources disappear. In order to learn how pharmaceuticals are exchanged and the relationships that facilitate these exchanges, the co-PI will conduct participant observation in emergent grassroots solidarity clinics and pharmacies, which many people turned to after austerity measures eroded the universal healthcare system, cutting its budget by more than 50%. The co-PI will also track, map, and analyze pharmaceutical networks and therapeutic economies through a range of observational and archival methods on extended social networks, as well as interviews (through both the McGill Illness Narrative Interview, and well as targeted semi-structured follow-ups) with a representative sample of pharmaceutical seekers. The findings will contribute to debates in medical, political, and economic anthropology about inequality, specifically in the differential distribution of healthcare burdens under conditions of economic austerity. This research offers insight to policymakers concerned with the kinds of social resources that disenfranchised, chronically ill people build in order to establish access to needed pharmaceuticals, as state-funded healthcare retracts.This award reflects NSF's statutory mission and has been deemed worthy of support through evaluation using the Foundation's intellectual merit and broader impacts review criteria.