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

在宾夕法尼亚大学的philippe Bourgois博士的指导下，Nicholas Iacobelli将探讨如何在社会边缘社区之间协商医疗保障。这项研究的重点是监狱囚犯，这一群体在很大程度上没有保险，而且在外面的医疗保健服务也不稳定，但矛盾的是，他们是目前美国唯一一个享有宪法保障的医疗保健权利的人口群体。本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的人种学评估，并将其与最高安全级别监狱的惩教保健管理的日常运作相比较，来评估这一悖论。该项目将解决1)如何依靠监狱来产生医疗保障，以及2)哪些社会因素影响了当地的医疗寻求和提供。该项目通过检查监禁的日常动态并在国家服务和公民身份的更大背景下分析它们，回应了监狱环境中详细的民族志研究的缺乏。该研究的人种学方法将提供对人际关系、行政和法律程序的见解，这些程序决定了对“实地”的关注。因此，它处于独特的位置，可以产生有关当代国家服务、社会边缘化和卫生的政治作用的知识。它还可以帮助当地的惩教保健提供者构建他们的政策和实践，以解决研究结果，并引发有关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.