Doctoral Dissertation Research: Impacts of Healthcare Reform on Healthcare Service Delivery for Vulnerable Populations

该奖项全部或部分根据2021年美国救援计划法案（公法117-2）资助。公共卫生系统总是植根于特定的社会背景。研究表明，公民如何与公共卫生运动互动和作出反应往往取决于公民与国家关系的质量。然而，边缘化社区如何与公共卫生系统互动的问题仍然没有得到充分研究。该奖项支持的研究采用观察、访谈和媒体分析的方法，调查在雄心勃勃的医疗改革背景下，弱势群体如何获得公共医疗服务。该项目除了为培训一名人类学研究生提供资金，使其掌握经验性科学数据收集和分析方法外，还将提高对公共卫生战略如何在不同的地方环境中转化、调整和修改的科学认识。这项研究将在一项先前中断的公共医疗服务已经恢复的情况下进行12个月。首先，研究询问了告知公共卫生工作者向弱势群体提供艾滋病毒服务的文化观念。其次，研究探讨了与改革后的公共卫生系统的互动如何影响弱势群体的归属感。研究人员将在两个不同的环境中工作：一个是当地的公共卫生中心，另一个是它所服务的更大的弱势社区。将通过详细观察、与卫生工作者和当地人口中的弱势成员面谈来收集数据。这项研究有助于国家关怀和国家与公民关系的理论。在政治人类学和医学人类学领域，该项目推进了对边缘化人群中政治主体性形成的理论理解，以及日常官僚互动如何塑造公民对国家的看法。最后，这项研究的结果将产生多角度的数据，帮助政策制定者、教育工作者和公共卫生工作者制定更好的政策和计划，预测当地文化因素对医疗服务提供的影响。该奖项反映了NSF的法定使命，并通过使用基金会的智力价值和更广泛的影响审查标准进行评估，被认为值得支持。

This award is funded in whole or in part under the American Rescue Plan Act of 2021 (Public Law 117-2). Public health systems are always embedded in a particular social context. Studies have demonstrated that how citizens interact with and respond to public health campaigns often depends on the quality of citizens’ relationship to the state. However, the question of how marginalized communities interact with the public health systems remains understudied. The research supported by this award uses observations, interviews, and media analysis to investigate how vulnerable populations receive public healthcare services in the context of an ambitious healthcare reform. In addition to providing funding for the training of a graduate student in anthropology in the methods of empirical, scientific data collection and analysis, the project will enhance scientific understandings of how public health strategies translate and are adjusted and modified in different local contexts. The research will take place over 12 months in a context where a previously discontinued public healthcare service has been resumed. Firstly, the research asks about the cultural ideas that inform public health workers’ delivery of HIV services to vulnerable groups. Secondly, the research explores how interactions with a reformed public health system impact the vulnerable community’s feeling of belonging. The researcher will work across two different settings: a local public health center and among the larger vulnerable community that it services. Data will be collected through detailed observation, and interviews with health workers and vulnerable members of the local population. This research contributes to theories of state care and state-citizens relations. In the fields of political anthropology and medical anthropology, the project advances theoretical understanding of the formation of political subjectivity among marginalized populations and how everyday bureaucratic interactions shape citizens’ ideas of the state. Finally, findings from this research will produce multi-perspective data that will aid policymakers, educators, and public health workers to develop better policies and programs that anticipate the effects of local cultural factors on the delivery of healthcare services.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.