Community participation (Health Sciences)

User participation in mental healthcare has increased considerably in many countries around the world in the past decades. However, users' voices are still incipient in other countries. This was the case of Suriname where user participation emerged just recently with the creation of a client council at the national mental healthcare service (PCS). The PCS client council was implemented as a result of a project involving a transnational partnership between stakeholders in Suriname and the Netherlands. Employing a qualitative research approach, this paper examines the client council implementation process and analyses stakeholders' expectations for its future performance, benefits and disadvantages. The paper concludes that the client council offers a space from which traditionally excluded users can renegotiate their identities, develop new skills, influence care provision and exercise their citizenship. For genuine participation to emerge, however, it will be necessary to invest in effecting cultural and organisational change in mental healthcare, tackling power differentials between care providers and users, resourcing the council and reducing the stigma attached to mental illness. Transparency, consultation, negotiation and full collaboration are also identified as key elements to foster productive transnational partnerships, especially when they involve stakeholders belonging to countries with a colonial history.

Embora a Constituição Federal de 1988 assegure
aos povos indígenas o direito às políticas sociais,
a saúde permanece um campo de tensão no trato
desses povos com o Estado. Muito se tem defendido a
necessidade de garantir a diretriz de participação no
Sistema Único de Saúde e a inserção dos indígenas
nos mecanismos de controle social. Dessa forma,
este trabalho busca contribuir com o debate sobre
os sentidos da participação e refletir sobre os
desafios da sua configuração como controle social
no âmbito da saúde indígena. A análise foi feita
com base nos relatórios das conferências de saúde,
na bibliografia afeita ao tema e em entrevistas
realizadas com atores-chave. A pesquisa buscou
lançar luz sobre a diversidade dos contextos, dos
atores e das pautas das cinco conferências de saúde
indígena realizadas. Concluímos que houve um
deslocamento na participação nas conferências para
uma atuação mais burocrática dentro dos estritos
limites estabelecidos pela gestão. Ainda assim, é
fundamental valorizarmos a potência contida nos
mecanismos do controle social, que não à toa são
objetos de combate dos grupos mais conservadores
da sociedade. Neste sentido, há que se valorizar tais
espaços, ocupá-los e transformá-los.

The slippery patient’s position into the physician’s office. Groundwork for a pragmatic approach of health inquietude exposition

In this article, I offer to shed some new light on the sociological analysis of the patient-doctor encounter. To that end, I orient my approach on the examination of health-related inquietude exposition. I draw on ethnographic data, observations of patient-doctor encounters and interviews with patients. From the office threshold through the exit, the patient seems weaving. Even though, patient’s conditions are little problematic from the diagnostic point of view, the person, and her/his subject position, seem constantly tangent, tacking between different states. The scale of the patient’s difficulty is somehow surprising. S/he has to navigate both for communicating the medical trouble which simultaneously exposes him/her to several risks (e.g. not being taken seriously, not being examined with attention, suffering might not be alleviated, solicitude request might not be met) and for elucidating what is going on with this troubling biological body. I show how an analysis can be carried out on the subject’s arrangements with one’s inquietude and its exposition to the doctor. While focusing on the patient dynamics of exposition/being exposed, I provide insight for a little discussed space of reflection and inquiry.

Sur la base de l’observation d’échanges entre médecins (généralistes et spécialistes) et patient.e.s et du retour rétrospectif (lors d’entretiens) de ces dernier.e.s sur leur conduite, nous examinons des consultations médicales à partir d’une lecture pragmatique de l’exposition de l’inquiétude. Du seuil à la sortie du cabinet, les patient.e.s semblent louvoyer. Alors même que les situations rencontrées sont relativement peu problématiques du point de vue du diagnostic, la personne – et sa position de sujet – semblent constamment glisser entre différents états. L’ampleur de la difficulté du patient a quelque chose de surprenant. Il doit louvoyer tant pour communiquer un trouble qui l’expose simultanément à différents risques – ne pas être pris au sérieux, ne pas être examiné avec attention, sa souffrance ne soit pas soulagée, sa demande de sollicitude ne soit pas entendue – que pour élucider ce qu’il se passe avec ce corps biologique. En examinant les dynamiques par lesquelles il s’expose en inquiétude et s’en trouve exposé, nous ouvrons un espace de questionnements. Ce site d’enquête classique qu’est la rencontre médecin-patient permet de poser quelques jalons d’une réflexion socio-anthropologique plus large qui interroge les reconfigurations des conditions d'exposition et de traitement de l’inquiétude qui accompagnent l’essor de nouvelles médiations donnant accès à des informations relatives au corps en général (extensions d'Internet, cartes génomiques individuelles, applications de self-tracking).

The research field of health inequalities is unavoidably politicized: through the ideological context in which such research is conducted, through the explanatory frameworks advanced, and through the linked discourses that propose or imply particular solutions to the problem.
After years of official neglect, reducing inequalities in health is now an established part of UK Government policy. However, the research evidence has become increasingly complex in past decades and a number of different explanatory discourses have developed. This discussion paper presents a brief overview of three identiŽ able but contested explanations (poverty/deprivation; psychosocial stress; individual deŽ cit) and adopts an existing discourse model (Levitas’s RED, MUD and SID) to conceptualize the links between such explanations and potential policy solutions. A ‘political’ model of the research–policy relationship is used to suggest that the uncertainty surrounding competing explanations and solutions to the problem of health inequalities enables flexibility of interpretation and political manoeuvring at the policy-making level. The capacity for shifts in discourse enables the UK Government to claim leadership in tackling the issue whilst simultaneously assigning responsibility for action to the community and individual level.