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

博士论文研究：医疗紧缩和社交网络的动员

• 批准号: 1851328
• 负责人: Cristiana Giordano
• 金额: $ 2.52万
• 依托单位: University of California-Davis
• 依托单位国家: 美国
• 项目类别: Standard Grant
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-04-01 至 2021-09-30
• 项目状态: 已结题
• 来源: https://www.nsf.gov/awardsearch/showAward?AWD_ID=1851328&HistoricalAwards=false
• 关键词: Doctoral; Dissertation; Research; Healthcare; Austerity

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.

减少国家资助的医疗保健形式是应对经济危机的一种越来越普遍的反应。当公共项目和私人财政资源都减少时，需要稳定获得药物的慢性病患者为了生存而调动了什么样的社会资源？对与经济危机相关的未满足的医疗保健需求的社会科学解释主要集中在发展中国家。在美国或欧洲等背景下，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政策下的药品获取问题，背景是以前强大的全民医疗保健系统。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权利的人，他们必须在以频繁的危机驱动的重新制定为特征的治疗经济中寻求药物。这项研究的重点是培养研究生严格的科学数据收集和分析方法，旨在了解人们动员的社会资源，以解决未满足的药物需求，当公共医疗不再可靠，财政资源和药物分布不均时。除了为培训一名研究生提供资金外，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认识，因为这些组织调解紧缩对保健结果的不同影响。 泰勒·贝尔在加州大学戴维斯分校的克里斯蒂安娜·佐丹奴博士的监督下，将探索在医疗保健服务紧缩的情况下，什么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，雅典已经制定了针对欧洲公共医疗保健的最严格的紧缩措施。雅典是希腊国家资助的医疗资源最集中的地方，因此，当公共资源消失时，人们如何调整寻求药物的做法将得到最好的强调。为了了解药品是如何交换的，以及促进这些交换的关系，co-PI将在新兴的基层团结诊所和药店进行参与观察，这些诊所和药店是许多人在紧缩措施侵蚀全民医疗保健系统后转向的，削减了50%以上的预算。共同主要研究者还将通过一系列关于扩展社交网络的观察和存档方法，以及与具有代表性的药物寻求者样本的访谈（通过麦吉尔疾病叙述访谈和有针对性的半结构化随访），跟踪、绘制和分析药物网络和治疗经济。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保健负担的差异分配。这项研究为政策制定者提供了深入的见解，这些政策制定者关注被剥夺公民权的慢性病患者为了获得所需药物而建立的社会资源，因为国家资助的医疗保健撤回。该奖项反映了NSF的法定使命，并通过使用基金会的知识价值和更广泛的影响审查标准进行评估而被认为值得支持。