Book: ii 'Health and Health Care Inequities'

In the introduction to Health and Health Care Inequities - A Critical Political Economy Perspective, Borras concludes:

'This book aims to spark thoughutful conversation and collaboration by moving away from capitalism to improve society and health. Health is not just about nursing and medicine; it is integrally connected to economic, political, cultural, and institutional systems. Moreover, it encompasses philosophy and ethics. Capitalism's focus on individualism and competition harms people and the environment,making it all but impossible to achieve health equity. We must work together to envision and create a new world that ensures fairer and better health for all.' p.3.

This sets the tone for a short 163 page book, with a page of acknowledgements, (said) introduction pp.1-3, reference listing pp.136-153; 10 page index, and eight chapters:

Chapter 1: Social Determinants of Health Inequities
Chapter 2: Neoliberalism and Canada’s Housing Policies
Chapter 3: Neoliberalism and Canada’s Health Care System
Chapter 4: Political Power and Policy Advocacy
Chapter 5: The Role of Evidence and Ideas
Chapter 6: A Critical Political Economy Approach
Chapter 7: Searching for Socialism
Chapter 8: Mobilizing for Health Equity

Chapter 1 on 'Social Determinants' provides the first of many political points to underscore the effort with Hodges' model here. If income and poverty come second the preceding paragraphs on wages reveal the socialist stance stand of the author, and the acknowledged networks. Throughout the book the relational nature of determinants, inequality, inequity, protected characteristics, socio-economics and political struggle is raised. In the discussion on wages the importance of education is described in cross-cultural and gender-based terms. The book possibly turns on the sentence:

'To effectively address poverty, we need to unite those who are in poverty with individuals who have more economic stability but are still ulnerable within our capitalist system. These individuals are at risk of falling into poverty if they lose their jobs due to workplace closures or privatization. It is essential to acknowledge that certain groups experience higher poverty rates, but we should see them not as victims but as protagonists and capable workers facing unique but connected challenges.' p.7.

For the people who follow the news, the majority of 'us' are (even if only roughly) aware of the distribution of wealth across national and the global population: the injustice. The erosion and lack of union representation within many workforces, especially 'Big-tech'. The way utility enterprises have provided dividends for shareholders at the expense of ongoing investment in infrastructure, the quality of service provided to the public and even public safety. COVID (p.7), crystalised 'difference' for us all. I came to now substitute collective for 'group' in Hodges' model. Suddenly all those individuals, many working in health, were collectively vulnerable:

Individual

|

      INTERPERSONAL    :     SCIENCES               

HUMANISTIC  --------------------------------------  MECHANISTIC      

 SOCIOLOGY  :    POLITICAL 

|

Group

PSYCHOLOGICALLY EXISTENTIALLY BELIEFS	SCIENCE PHYSICALLY data, information, knowledge
SOCIALLY CULTURALLY SOCIAL MEDIA	wisdom, leadership, truth LAW - POLICY FREEDOM - CHOICE

Throughout the text, I like the concise coherence Borras demonstrates in the steps from wages, income and poverty to investigate the state of health inequities. Once again (from i) the context is Canada, but the lessons are for all - as globalisation should/must demand?  There is public health history too. As expected Canada's First Nation, Indigenous, and Nunavut populations are frequently referenced regards exclusion and disparity in health services access and provision. Under health inequities, after infant mortality and life expectancy there is a convention(?) adopted of several axes being identified. The first (p.9) is the class-health axis, then class-gender-health and others. No surprise I found the relational and organisational aspects of these 'constructs' very helpful. As I try to think of Hodges' model as a mathematical object I realise (through oft impromtu conversations^) that we don't have two 'axes' in Hodges' model. Still musing on this; and more to follow ...

Arnel M. Borras. (2025) Health and Health Care Inequities - A Critical Political Economy Perspective. Fernwood Publishing.

^A pure maths lecturer, Gower St Waterstones, London.

See also: Post i : Post iii : Post iv : Post v (to follow)

Book: 'Health and Health Care Inequities' i

I didn't attend online the book launch for Health and Health Care Inequities. It appeared to be in the early hours for the UK. Making good progress on a week's break last month, upon return, a presentation and some writing proved a distraction. I've picked it up again, a task that was smooth and straightforward such is the style and writing. H&HCI is - as expected - academic. The statistics, politics and government publications come thick and fast. But they literally do count here.

Borras and the Fernwood are based in Canada. The focus of Borras's thesis is then Canadian politics, economics, society, social and cultural challenges, poverty, exclusion, global standing, statistics and reporting (and more) are all relevant globally. Especially as COVID, climate change, and the current state (or stasis?) of global health provision attests. The book is unashamably Marxist, but not heavy with it. If that makes sense. I was drawn to the publisher too. Well: critical books for critical thinkers; how could I resist!
The influence of Marx and Marxism on the 20th century is profound and full of contradictions. There's the history, and its lessons of Marxism as a political ideology and the geopolitical exemplars that have given Marxism a 'bad' name. To the extent that 'socialism' is also tainted. What other term can be applied that captures 'Marxism', Marxist thought and its relevance today? And that is, relevance in terms of health, health care and social care inequities? 'Struggle' seems utterly inadequate amid current news?

Amidst the history of various revolutions, some arguably on-going, fizzled out, on life support ...? it is, it seems, capitalism that goes marching on. To keep time, the metronome is the tick of central processing unit, and now the graphics 'pu' and tensor; for we live in the 'information age'. I've been keeping notes, but will begin with some reading today, which is an excellent point to 'healthcare professionals', obsessed as we are, with evidence.

'I often go back to Carol Weiss. Years ago, she said three things that go into the decision making ... information, ideology, and interest. And then she went on to say, don't for one moment think that information can trump either ideology or interest. So if you look at the whole climate debate right now, it's actually an ideological debate, The right-wing, the Republicans, some Conservatives here, their rejection of the evidence has nothing to do with the evidence. It's really an ideology ... our group thinks this way, and we are aligned with the fossil fuel industry because they're rich and powerful. Our whole system is based on cheap energy. And so we have to keep going kind of thing. And bugger the evidence.

And that second one, which is actually very closely related to that, is interest. By interest, she meant power and wealth and stakeholders. So, who gets the policy they want? The people who have the money and power to influence it. So, the fossil fuel industry is very powerful ... And so, no matter what the evidence is, they have a financial interest in not having any controls upon them having the minimum of controls. And so, that will triumph usually. So, you put together ideology and interest, and it will almost always overcome evidence or information.' p.78.

More to follow and a return here is essential.

Weiss, C.H. (1983). Ideology, Interests, and Information. In: Callahan, D., Jennings, B. (eds) Ethics, The Social Sciences, and Policy Analysis. The Hastings Center Series in Ethics. Springer, Boston, MA. https://doi.org/10.1007/978-1-4684-7015-4_9

Arnel M. Borras. (2025) Health and Health Care Inequities - A Critical Political Economy Perspective. Fernwood Publishing.

See also: Post ii : Post iii : Post iv : Post v (to follow)

(In-person) Seminar: Healthism, Neurodiversity, and Respectability Politics

Accustomed to posting news of many seminars and events that I cannot attend, this one does produce some frustration in that it is of marked interest but in-person. I am reaching out, seeking slides, and papers, and will follow-up, as for me, Professor Kukla's seminar really 'speaks' to Hodges' model. The relation conjoins the individual and collective, as it did originally for Brian Hodges in creating the eponymous model:

https://hodges-model.blogspot.com/2023/08/brian-e-hodges-r-i-p.html

Hodges' model is invariably potentiated, as are all conceptual (idealised) models to encompass self-care, individual health care through to family, public and population health. As posted previously, the family(!) of -isms can be represented too:

https://hodges-model.blogspot.com/search?q=ism

Seminar Series in Analytic Philosophy 2024-25: Session 15

Healthism, Neurodiversity, and Respectability Politics

Quill Kukla (Georgetown University)

28 February 2025, 16:00 (Lisbon Time – WET)

Faculdade de Letras de Lisboa, Sala Mattos Romão [C201.J] (Departamento de Filosofia)

 

Abstract: “Healthism” is the pervasive ideology according to which each of us is responsible for valuing and protecting our own health and prioritizing health over other values, while society has the right to enforce, surveil, and reward healthy living. Neurodiversity and other forms of cognitive difference are generally understood through the lens of health: they are taken as diagnosable pathological conditions that should be treated or mitigated via medical interventions. Putting these two ideas together, neurodivergent people are supposed to try to be “healthy,” through pharmaceuticals, behavioral therapy, and the like, and society has an investment in making them be “healthy.” But neurodivergence is not a morbidity in a typical sense, so it is unclear what “health” means in this context. In practice, our societal standards for health for neurodivergent people are defined in terms of what avoids disrupting neurotypical expectations and systems or making neurotypical people uncomfortable. “Health,” for neurodivergent people, is in effect respectability—it is not defined in terms of their own needs or flourishing but in relation to the norms and needs of others. This can be seen from a close reading of diagnostic definitions and official medical “treatment” methods and goals. Trying to “treat” neurodivergent people by making them respectable citizens who are palatable within neurotypical productivity culture is usually likely to backfire; typically bad for their own well-being, and a social loss.

See also: 'recovery'

Jones P. (2014) Using a conceptual framework to explore the dimensions of recovery and their relationship to service user choice and self-determination. International Journal of Person Centered Medicine. Vol 3, No 4, (2013) pp.305-311.

Call for Abstracts (for Publication): "Visual Narratives, Aesthetics, and Decoloniality: Imagery and the Construction of the Other"

Mappæmundi is pleased to announce a call for papers for a collective publication on 

"Visual Narratives, Aesthetics, and Decoloniality: Imagery and the Construction of the Other"

Please find all the details below.

We invite contribution proposals for the edited volume Visual Narratives, Aesthetics, and Decoloniality: Imagery and the Construction of the Other. The book aims to critically examine the persistent influence of colonialism in shaping modern subjectivities, tracing its historical roots in the formation of Western modernity and interrogating its continued implications in contemporary contexts. It positions media and visual narratives as central discursive spaces where colonial legacies are both perpetuated and, potentially, contested. This volume conceptualizes and critically interrogates aesthetics as a foundational condition that establishes a visual lexicon integral to Western modernity. The aesthetic framework not only shapes the development of visual narratives but also plays a crucial role in the construction and perpetuation of varied subjectivities.

In particular, we focus on the critical analysis of the role of visual narratives within the framework of epistemological colonialism. Visual narratives have been central in defining, reinforcing, and legitimizing colonial ideologies by shaping perceptions and controlling representations of colonized peoples and cultures. These visual narratives have played a fundamental role in constructing colonial time and space, which were systematically controlled by Western epistemologies. This volume positions itself as a counterpoint to this colonial legacy, offering critical perspectives that challenge and re/deconstruct the visual lexicon of Western modernity. Through this lens, the book seeks to uncover pathways for alternative visual expressions that resist colonial frameworks and promote inclusive, decolonized understandings of identity and, more broadly, cultural production.

The arts, the media, and communication are powerful forces that can either perpetuate or challenge colonial legacies. Addressing and dismantling these legacies is essential for the creation of just, inclusive, and equitable societies - i.e., societies that value, embrace and benefit from the diversity of reason. From a decolonial lens, the book seeks not only to question the validity of established forms of knowledge but also to question the very criteria by which knowledge is defined. The objective is to contribute to critical discourses on potential pathways forward by amplifying cultural voices marginalized within the colonial matrix of power.  To this aim, we invite contributions that engage with scholarship in diaspora studies, subaltern and postcolonial studies, critical race studies, decolonial aesthetics, visual culture, and visual practices, with a particular emphasis on non-hegemonic epistemologies.

When bringing together these critical issues and perspectives, the book shall offer a comprehensive and interconnected framework for understanding postcolonial experiences in the 21st century. It will explore the role of aesthetics in shaping modern subjectivities, tracing the roots of domination in multiple paths toward modernity. This book intends to serve as an essential resource for scholars, researchers, activists, and the general public, encouraging deeper engagement with colonial histories that continue to shape contemporary life.

We especially encourage contributions from scholars, artists, and practitioners from the Global South that:

• Engage in theoretical discussions on aesthetics and visual narratives from a decolonial perspective.
• Combine theoretical frameworks with analyses that directly engage with visual arts, such as photography and other forms of artistic expression.
• Discuss case studies that examine individual works of art, archives, photojournalistic projects, or other forms of visual narratives.
• Explore media as a space for resisting and challenging colonial legacies.
• Offer comprehensive analyses of how media and art contribute to the perpetuation or disruption of colonial ideologies.
• Provide practical strategies and share lived experiences that contest colonial-rooted narratives.
• Critique prevailing ideologies within the discursive spaces of media and art production and consumption.

Submission Details

The volume Visual Narratives, Aesthetics, and Decoloniality: Imagery and the Construction of the Other will be part of the Mappæmundi series published by Ventura Edizioni. It will be edited by Dr. Tomás Cajueiro (Universitat Autònoma de Barcelona) and Dr. Estevão Bosco (American College of the Mediterranean and the Latin American Social Science Faculty). The final publication will be exclusively in English. However, abstracts may be submitted in Portuguese, English, Spanish, or Italian. Once a proposal is accepted, authors will be responsible for translating their final chapters into English. Chapters should range from 20,000 to 40,000 characters, including spaces, and must incorporate visual materials to support the analysis of visual works. 

Proposals must be submitted to tomaskju AT gmail.com by April 4, 2025.

Theoretical and Textual Articles

Chapters may integrate theoretical insights with practical interventions or focus solely on theoretical exploration. Contributions can draw on real experiences from individuals, communities, and organizations. Potential research methods include literature reviews, case studies, comparative analyses, discourse analyses, and analyses of photographs and visual works. Abstracts should have a maximum of 5,000 characters, including references. Chapters should fall between 35,000 and 40,000 characters.

Visual narratives

For contributions focusing on the analysis of visual content, the textual component must range from 10,000 to 15,000 characters. The abstract, while limited to a maximum of 5.000 words, should also include an overview of the visual material being analyzed.

Important Dates 

Abstract Submission Deadline: April 4, 2025
Notification of Proposal Acceptance: May 11, 2025
Full Chapter Submission Deadline: September 11, 2025 
For more info: tomaskju AT gmail.com
--
Departamento de Filosofia, Comunicação e Informação
Faculdade de Letras da Universidade de Coimbra
3004-530 Coimbra, Portugal ... (and my source).

Break in a hand or leg ...

individual - PERSON - patient
|

INTERPERSONAL : SCIENCES

humanistic ------------------------------------- mechanistic  

SOCIOLOGY : POLITICAL

|

family - group - population

	"When one breaks a hand or leg, the bones, the tendons, the muscles, the arteries, the nerves, and the skin do not break and tear in one line, nor afterwards do they grow together and heal at the same time."
	"... So, in a revolutionary break in the life of society, there is no simultaneousness and no symmetry of processes either in the ideology of society, or in its economic structure. The ideological premises which are needed for the revolution are formed before the revolution, and most important ideologic deductions from the revolution appear only much later" (1960:159).

Trotsky, L. (1960). Literature and Revolution. Translated by Rose Strunsky. Ann Arbor: University of Michigan Press.

Blau, H. (1991). The Surpassing Body. TDR (1988-), 35(2), 74-98. doi:10.2307/1146090

HelpForce the Domains for Change in Social Care

There are many lessons to be found - and as governments continue to learn - trip over, in the ongoing COVID-19 pandemic.

The government made a call for volunteers:

https://www.england.nhs.uk/2020/03/your-nhs-needs-you-nhs-call-for-volunteer-army/

 and the public has responded with 750,000 respondents:

https://www.goodsamapp.org/NHS

While of little consequence in the larger world, for me this crisis continues to reveal how the axes of Hodges' model encompass far more than their respective labels might indicate.

Taking the vertical axis:  INDIVIDUAL to GROUP (population) nations have had to resort to law to direct, instruct, force their citizens to stay at home.

Health policy, public health and economics specialists have long sought a means to influence people's behaviour. Nudge theory has joined the basic motivators of carrot and stick.

In the UK the call for volunteers has a long history.

Tom Hughes-Hallet, Your NHS Needs You, The Sunday Times, 26 August 2018, p.22.

HelpForce

individual

|

INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group - population

An individual's behaviour ...

... and the impact of the same.

THE BIG SOCIETY

"The Big Society was a political ideology developed in the early 21st century. The idea proposed "integrating the free market with a theory of social solidarity based on hierarchy and voluntarism". Conceptually it "draws on a mix of conservative communitarianism and libertarian paternalism". Its roots "can be traced back to the 1990s, and to early attempts to develop a non-Thatcherite, or post-Thatcherite, brand of UK conservatism" such as David Willetts' Civic Conservatism and the revival of Red Toryism. Some commentators have seen the Big Society as invoking Edmund Burke's idea of civil society, putting it into the sphere of one-nation conservatism.   The term Big Society was originated by Steve Hilton, director of strategy for the Conservative Party, and the idea became particularly associated with the party's leader David Cameron who was a strong advocate for it. The idea formed the flagship policy of the 2010 UK Conservative Party general election manifesto and was part of the subsequent legislative programme of the Conservative–Liberal Democrat coalition agreement. The stated aim was to create a climate that empowered local people and communities, building a "big society" that would take power away from politicians and give it to people." WikiPedia

Clearly, there is a macro form of nudge and hopefully this will result in social care being given the attention (funding) it desperately needs, recognising the value and values inherent in the sector.

Also in the Sunday Times article 'The NHS in numbers':
9m - Increase in UK population of pensioners in next 40 years

1942 - When William Beveridge's blueprint for postwar welfare state was published

10,000 - Volunteers supporting 4,000 staff at Marie Curie cancer care charity.

Tom Hughes-Hallet, Your NHS Needs You, The Sunday Times, 26 August 2018, p.22.


https://en.wikipedia.org/wiki/Big_Society

Books: Technology, Capital and Ideology - captured in h2cm...

individual

|

INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

|

group - population

	The Technology Trap
	Capital and Ideology

My sources:
The Times and FT Weekend.

||||| Still |||| Too |||||| Many |||| Walls |||||||||||

c/o and Photographs © John Davies
http://www.johndavies.uk.com/

"Working in West Berlin in 1984, the British photographer John Davies became fascinated by the Wall as a symbol of the cruelty of the cold war. When he returned this year to shoot the same locations, he found a city healed and changed beyond recognition." p. 25.

INDIVIDUAL

|

INTER-PERSONAL : SCIENCES

HUMANISTIC -------------------------------------------------- MECHANISTIC

SOCIOLOGY : POLITICAL

|

GROUP

Niederkirchnerstrasse & Wilhelmstrasse, 2019 © John Davies	Niederkirchnerstrasse & Wilhelmstrasse, 1984 © John Davies

"There was a horror about 

the Wall. It was shocking for 

me at the time - an affront." p.27.

See also:

John Davies
http://www.johndavies.uk.com/

Callahan, William A.(2018) The politics of walls: barriers, flows, and the sublime. Review of International Studies. pp. 1-26. ISSN 0260-2105 DOI:10.1017/S0260210517000638

My source:
Guy Chazan, The Freedom of Berlin, FT Magazine, November 2-3, 2019, pp.24-29.

With thanks to John Davies, Guy Chazan and FT.

Healthcare USA* - Finance and the need for peripheral vision!

I came across this item on twitter c/o Gregg Masters - many thanks Gregg.

2011 Benchmarks in Accountable Care Organizations: Metrics from Early ACO Adopter

A key part of this is the chart below - which is copied below:

New Chart: Top 5 Challenges of ACO Creation

SUMMARY: Accountable care organizations (ACOs) create integrated delivery systems that encourage teams of physicians, hospitals and other providers to collaboratively coordinate care for ACO members. We wanted to see the biggest challenges organizations face in creating an ACO.

I keep coming up against and apologising for the fact of geography that puts me on the UK side of the Atlantic (it's the place I call 'home'), the NHS 'market' and the different ways health care is debated and framed with respect to finance. Basically 'P'rivate medicine and 'S'ocial medicine.

My perspective is limited, but the same applies to many people whether East, West, Private or Social and of course in reality things are never that cut and dried.

The reason I've picked this up though is three-fold:

Firstly, this post was found in the summary above and is wrapped up in the three words - integrated, collaboratively and coordinated - icc. Looks like we've got an ACO alright.

It is A Complex Organization.

The clue to the publication and survey is clearly vested in 'accountable', but in terms if icc where and with whom does accountability rest? No doubt accountability can - and must - be defined financially. What about the 'C'? When we think about 'care' - integration, collaboration and coordination there is a need to acknowledge and for me - reach out across the [h2cm's] humanistic axis.

Secondly, the graph 'speaks' volumes, but I wonder what I'm missing in not having the full copy? I wonder where the real human *care* factors are in this? If my colour vision is correct it would be worth checking the exact make-up of the 18% 'Other'.

Thirdly, I have a problem I admit. Residing in the UK working in the cocoon (and not so cosy at the moment) that is social medicine I see the US health care sector as a Matrix-like green ;-) haze of falling and tripping dollar signs - $$$ $$$. I know that's unfair as the N & S American continents are of course also fueled by those positives that charge and motivate health care workers the world over. In the chart though even when 'staff' are mentioned it's in terms of 'buy-in'. Yes it may be a cheap shot, but I'm versed in some dialects of consultancy speak...

There could be an account of the individual, nursing care, the therapeutic relationship, the quality of outcomes ... in the evidence-based care contribution 8%, but these days the search for evidence is fiscal too.

I just wonder here what might be lost in achieving integrated, collaborative and coordinated care if the people - the extended team - are lost amid the finance? Sometimes to see we need to rely on peripheral vision too. In fact it's a bit like looking down a telescope to 'see' you have to look off-center. If financial accountability is what colours your health care world, don't forget to avert your vision and take in the black and the white.

With no prospect of a 'study tour' (a scratch of the surface) there is much I need to learn of the organizational systems, commissioning and finance of health - not just in the USA, but here in the UK.

*These issues apply globally.