Power & Hierarchy Are Intrinsic To Healthcare

Power & Hierarchy Are Intrinsic To Healthcare

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Power & Hierarchy Are Intrinsic To Healthcare

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Power & Hierarchy Are Intrinsic To Healthcare

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Discuss about the Power And Hierarchy Are Intrinsic To A Healthcare System In Australia.

Governments all over the world are aiming to provide value for money health benefits for its citizens.  As the health costs across the world are spiraling out of control special focus is being paid on beliefs of illness, modalities of treatment and beliefs about health. Health professionals and the hospitals are under constant pressure to diagnose the illness accurately and to find its cure.  We are living in an age where people are obsessed with health. They are continuously being bombarded with images and messages from fitness gurus, health authorities and health professionals where ever they go (Berry & De Geest, 2012). In this essay, we will discuss how power and hierarchy are intrinsic to a healthcare system in Australia. We would discuss about theories and perspectives such as the biomedical approach, Pluralist theory and socialist dominance theory. We will also discuss how biomedical approach has failed to capture the impact of hierarchy and power on the healthcare system in Australia.  (Cockerham, 2013). Like many other countries, Australia has maintained a symbiotic and interdependent relationship between the community, government, and medicine. This relationship has been based on reciprocity and mutual resource dependency. But there are evidence that social trends such as proletarianization, corporatization, and managerialism are giving rise to challenges to the power of the medicine. (Cockerham, 2013).  Australian healthcare has been influenced by ideologies of the center right and center-left parties. (Rayner & Lang, 2012). Sociologists of science and medicine have always argued how modern health professionals are seeking opportunities to secure their legitimate position and gain their turf in the healthcare sector. These studies stress how labor division in the healthcare settings is maintained, challenged, constructed and negotiated by daily actions (Kieft, et al., 2014). In Australia, the Biomedical approach is the one that is predominant to illness and health. The health care system focuses on the biological and physical aspects of illness and disease. This model ideologically underpins the contemporary beliefs of nature as well as the remedies of disease and illness. Firstly, illness was an imbalance within the individual. But this model changed the perspective from “bedside medicine” to being “hospital medicine” shifting to an object orientated approach.
The health care professionals (doctors, nurses etc) experience a privileged position in the healthcare industry due to this biomedical approach (Wilson, 2012). Sociologists have argued that it is necessary that economic factors along with political factors are incorporated in this profession. Eliot Friedson in the year 1984 focused on the medical profession and explained how government needs to regulate the autonomy on the work of the health professionals (Kieft, et al., 2014) . He showed his concern that due to the nature of this profession and its knowledge and expertise healthcare professionals have an autonomy. Even when they have numerous ideological and political conflicts. He explains how once this profession has achieved autonomy they will easily secure government authority and will set educational requirements and standards for their profession. Willis has also identified how healthcare workforce in Australia have practiced medical dominance on different levels. Firstly, these professionals have autonomy on their work and do not have any evaluation by any other body or organization (Wilson, 2012). Secondly, they hold authority of direct supervision as well as limiting of other health professionals’ groups such as dentists, physiotherapists and homeopaths. Thirdly they practice absolute power on health occupations through referrals, paid leaves, pensions etc. Friedson explains how medical dominance is prevalent in four dimensions in healthcare sector. Firstly, it is in the form of medical research and knowledge which is approved by health professionals, secondly physicians treat and diagnose, thirdly physicians supervise other healthcare professionals and lastly healthcare professionals do not possess equal status in their profession (Cronin, et al., 2015). This gives the physicians the occupational power to easily influence the decisions for resource allocation and on organizational authority. This present status of medical practitioners is due to the social, technological, economic and political factors. But many developments are challenging this medical sovereignty (Rayner, & Lang, 2012) . Some of these developments are other health professions such as physiotherapy, nursing, and psychology seeking their own independence and power. Physiotherapists have majorly achieved this independence as they have got the status of being an allied health profession. But other professionals such as nurses still are subordinate to the physicians . This has led to many incidences of struggle between health personnel’s. Medical dominance is not limited to patient-doctor relationship but could present it in forms like subordination where higher healthcare providers direct their subordinates (Kieft, et al.,2014). social forces such as deskilling, technology, cost-cutting policies by the government and deprofessionalism are also undermining the power of medicine (Wilson, 2012). To understand it lets take an example of a patient’s family that wants to be involved in the treatment and decision making regarding the care of their family member. This changes the authority that the physician had to a more team orientated partnership. She explains how this arrangement will include open communication, cross-referrals, reviews etc. this team orientated approach in restructuring the Australian healthcare system can be great as it will give equal power to all its members. Another factor that can curb the autonomy of the physicians or their medical dominance is through cost containment measures and malpractice suits as followed by other countries like United States of America. Despite these points the public legitimacy and prestige related to this profession is very high. The power of this profession is increasing with the advances that are made in technology, surgery and diagnostic techniques. Gender and class factors also play a vital role in medical dominance as it is observed that allied professionals are usually females and of a low social class. These allied professionals are continuously making demands through their unions for better working hours and pay. (Wilson, 2012).
Many studies have supported the view that independent status of allied professions such as dentists, physiotherapists etc will affect the medical dominance (Wilson, 2012) . While many other studies have shown that this has not caused any difference in the medical dominance but has increased the dominance of medicine through the division of labor. There is a shortage of empirical data that can prove how the independence of allied professions has affected medical dominance. There was a study conducted by  Brian S. Turner in the year 1986 who studied the “complaints” made by nurses in their daily work. These complaints were about the constraints that are imposed with by their superiors in a hospital setting. The data showed that the nurses were made clear that they are subordinate by their profession and cannot make any autonomous decisions for the patient’s care. (Kieft, et al.,2014).
The Biomedical model does not discuss the impact of power and hierarchy in the health care setting. (Neilson, 2017).  Numerous studies have shown that there is a link between social domination and boundary demarcation. Let’s first understand what is a hierarchy? Hierarchy is a layered system that has members of a society or organization that are ranked according to the relative authority or status (Cronin, et al.,2015),( Knight, & Mehta, 2016). Whereas power is the capacity or ability to act and do something in a specific way (Neilson, 2017). This capacity influences the course of events and influences others. In Australia healthcare system, should give universal access to its citizens in the form of services that are funded by taxes. Medicare is the health program that covers this universal access to treatments in hospitals and other medical services (Sav, et al.,2015). But does this philosophy of universal access is underpinning Medicare as Medicare has always been based on equity? This equity should ensure equal access to all services. This is just an ideal form of definition for equal access which in the case of Medicare is not getting justified (Neilson, 2017).. The dilemma that health educators and administrators feel is that the medical profession that is dominant in the country is maintaining its status in the healthcare system but other allied professions are also striving for their power and autonomy. This is affecting the patients as professional autonomy and medical shortages are strengthening their medical dominance over the sector but the people are getting affected due to lack of quality healthcare. (Greenfield, et al.,2014).
Social epidemiologists and scientists have shown how time and place as dimensions are involved in influencing the health of an individual. Different theories like social dominance theory explain how inequality is based on age, sex and the arbitrary set. Where age explains how adults have more power and status than children in the society, sex discrimination shows how men are more powerful in the society than women and arbitrary set is about discrimination based on ethnicity example whites used to hold power over blacks (Willis, 2011). Pluralist theory: A functionalist perspective is about power distributed in veto groups where the government is just an impartial participant (Muntaner, et al.,2015).. This theory could be understood by taking an example of parents being impartial arbiters while their kids are fighting. So, the government acts a referee to ensure that competition is fair among all the groups. Another theory called the “elite theories: conflict perspectives” explain how power in the democratic society is in the hands of few wealthy organizations and individuals. This power in the hands of few influences even the government and shape the decisions in the interest of these wealthy people (Muntaner, et al., 2015). A government where in any country should be neutral, but with the impact of this theory government officials and politicians cater to the interests and needs of the few. In Australia, power and hierarchy are affecting the health and care giving in numerous ways. One such setback is the inability of the poor to quit smoking. The Australian government has recently increased the tax on tobacco to which now a pack of cigarette will cost almost 40$ (Tropman, & Nicklett, 2012). But it will only affect the poor in more adverse ways, as now they will spend their income on tobacco and forego the expenses on essentials as food and shelter. New Zealand faced the same problem when the poor income families faced more difficulties when the government increased the tax on tobacco (Tropman, & Nicklett, 2012). A study titled ” Socio-economic disparities in tobacco exposure and use: are the gaps widening? and another study “Impact of tobacco control interventions on socioeconomic inequalities in smoking: a review of the evidence” concentrate on the fact that how power relations are influencing the social geography of tobacco use and smoking. Power is defined as the capacity to act in the interest of an organization or individual (Cronin, et al.,2015). It was in the year 1997 Grabb identified how government can control the production by controlling the materials used for production, they can also control the production by controlling labor power, and by controlling ideology and cultural dominance. This study stresses on the fact that there may be an intentional class profiling and intentional racial profiling while advertising for tobacco.  Greenhalgh, EM, Scollo, MM, & Pearce, M. in their article “Smoking, ill-health, financial stress and smoking-related poverty among highly disadvantaged groups” explained how citizens who were living in remote and regional areas of the country which comprised of over 30% of the Australian population have higher rates of smoking than people who were living in the major cities and regions (Hill, et al.,2013). Prevalence of smoking in areas around the cities have reduced over time but the percentage of people smoking in these remote regions have remained the same. These people have also reported having more tobacco-related diseases such as diabetes, cardiovascular diseases, arthritis, and asthma. (Bonevski, B., Bryant, J. & Paul, C., 2010), (Hitsman, 2016), (Jiang, et al.,2017), ( Millett, et al., 2011), (Wang, et al.,2015).
In this essay we learned how healthcare cannot be relied on only the use of the healthcare models. These models have various implications for the society, patient, and for the credibility of the healthcare sector. As a health professional, we need to focus that we should not take advantage of the power that we are given by the healthcare model. We should not engage in self-regulation and should point out any irregularity in our profession. Medical errors and fatalities need to be reported even when they are done by a superior (Rayner & Lang,2012). We should not treat patients as “through put” and should not treat them based on quantified averages. Example how long should a mother take to give birth etc. We need to learn that absolute control of the profession is neither helping the public nor it is helping the health professionals as decreased waiting list numbers are a proof (Wilson, 2012). Clinical governance and managerialism are needed to control the autonomy of physicians which in turn will help us to gain the trust of the public in the healthcare sector. While the structural dominance intrinsic to the healthcare sector but the medical dominance is not needed in this profession. This struggle to gain control and turf on the healthcare sector is only reducing the trust that the public has in this profession. Further empirical research is needed to learn about the struggle and the perspectives that the patients, medical professionals, and health professionals have on this issue. As a health professional, we need to monitor our self-perception of competence as this is influencing our perception about authority and in turn medical dominance. We need to perceive our own position in the health care industry and build our attitude for a team orientated patient-centered care. Where we have a realistic relationship with our allied counterparts and our patients.
Berry, E. & De Geest, S. (2012). Tell Me What You Eat and I Will Tell You Your Sociotype: Coping with Diabesity. Rambam Maimonides Medical Journal, 3(2), p.e0010.  doi:  10.5041/RMMJ.10077
Bonevski, B., Bryant, J. & Paul, C. (2010). Encouraging smoking cessation among disadvantaged groups: A qualitative study of the financial aspects of cessation. Drug and Alcohol Review, 30(4), pp.411-418. doi: 10.1111/j.1465-3362.2010.00248.x.
Cronin, K., Acheson, D., Hernández, P. and Sánchez, A. (2015). Hierarchy is Detrimental for Human Cooperation. Scientific Reports, 5(1), 89-93.  doi:10.1038/srep18634
Cockerham, W. (2013). Social causes of health and disease. 2nd ed. Cambridge: Polity Press, p.34.
Greenfield, G., Ignatowicz, A., Belsi, A., Pappas, Y., Car, J., Majeed, A. and Harris, M. (2014). Wake up, wake up! It’s me! It’s my life! patient narratives on person-centeredness in the integrated care context: a qualitative study. BMC Health Services Research, 14(1),34-37. doi: 10.1186/s12913-014-0619-9.
Hill, S., Amos, A., Clifford, D. & Platt, S. (2013). Impact of tobacco control interventions on socioeconomic inequalities in smoking: review of the evidence. Tobacco Control, 23(e2), pp.e89-e97. doi: 10.1136/tobaccocontrol-2013-051110.
Hitsman, B. (2016). A New Blueprint for Addressing Tobacco Use Disparities to Reduce Health Disparities: The Sociopharmacology Theory of Tobacco Addiction. Nicotine & Tobacco Research, 18(2), pp.109-109.
Jiang, W., Leung, B., Tam, N., Xu, H., Gleeson, S. & Wen, L. (2017). Smoking status and associated factors among male Chinese restaurant workers in metropolitan Sydney. Health Promotion Journal of Australia, 28(1), p.72. doi: 10.1007/s00268-009-9938-0.
Kieft, R., de Brouwer, B., Francke, A. and Delnoij, D. (2014). How nurses and their work environment affect patient experiences of the quality of care: a qualitative study. BMC Health Services Research, 14(1), 23-32. doi: 10.1186/1472-6963-14-249.
Knight, E. & Mehta, P. (2016). Hierarchy stability moderates the effect of status on stress and performance in humans. Proceedings of the National Academy of Sciences, 114(1), pp.78-83. doi:  10.1073/pnas.1609811114
Millett, C., Lee, J., Gibbons, D. and Glantz, S. (2011). Increasing the age for the legal purchase of tobacco in England: impacts on socio-economic disparities in youth smoking. Thorax, 66(10), pp.862-865. doi: 10.1136/thx.2010.154963.
Muntaner, C., Ng, E., Chung, H. and Prins, S. (2015). Two decades of Neo-Marxist class analysis and health inequalities: A critical reconstruction. Social Theory & Health, 13(3-4), pp.267-287. doi:  10.1057/sth.2015.17
Neilson, D. (2017). In-itself for-itself: Towards second-generation neo-Marxist class theory. Capital & Class, 1(1), p.30-34. https://doi.org/10.1177/0309816817723299
Rayner, G. & Lang, T. (2012), Ecological Public Health: Reshaping the Conditions for Good Health , Routledge, Oxford.
Sav, A., McMillan, S., Kelly, F., King, M., Whitty, J., Kendall, E. & Wheeler, A. (2015). The ideal healthcare: priorities of people with chronic conditions and their carers. BMC Health Services Research, 15(1). doi:  10.1186/s12913-015-1215-3
Tropman, J. & Nicklett, E. (2012). Balancing the Budget through Social Exploitation: Why Hard Times Are Even Harder for Some. Advances in Applied Sociology, 02(02), pp.111-119. DOI:10.4236/aasoci.2012.22015
Wang, X., Abughosh, S., Peters, R. & Essien, E. (2015). Racial and Ethnic Disparity in Smoking Cessation Medication Use among Adult Smokers in the United States. Journal of Behavioral Health, 4(3), p.63. doi: 10.5455/jbh.173063
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Wilson, N. (2012). Chaos in Western Medicine: How Issues of Social-Professional Status are Undermining Our Health. Global Journal of Health Science, 4(6),56-67.

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