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Governing How We Care

Governing How We Care: Contesting Community and Defining Difference in U.S. Public Health Programs

Susan J. Shaw
Copyright Date: 2012
Published by: Temple University Press
Pages: 214
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  • Book Info
    Governing How We Care
    Book Description:

    As local governments and organizations assume more responsibility for ensuring the public health, identity politics play an increasing yet largely unexamined role in public and policy attitudes toward local problems. InGoverning How We Care, medical anthropologist Susan Shaw examines the relationship between government and citizens using case studies of needle exchange and Welfare-to-Work programs to illustrate the meanings of cultural difference, ethnicity, and inequality in health care.Drawing on ethnographic research conducted over six years in a small New England city, Shaw presents critical perspectives on public health intervention efforts. She looks at online developments in health care and makes important correlations between poverty and health care in the urban United States. Shaw also highlights the new concepts of community and forms of identity that emerge in our efforts to provide effective health care.Governing How We Careshows how government-sponsored community health and health care programs operate in an age of neoliberalism.

    eISBN: 978-1-4399-0684-2
    Subjects: Sociology, Anthropology, Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. Acknowledgments
    (pp. ix-x)
  4. Introduction
    (pp. 1-17)

    When I was an ethnographer for a federally funded study on HIV risk and needle use, I met Dave Wood, a middle-aged, slightly built African American heroin user who spent many of his days circulating through a neighborhood shopping plaza where people would arrive to get their morning coffee at McDonald’s, pick up a loaf of bread at Sav-A-Lot, or buy and sell drugs in the parking lot. Dwayne Rogers, the outreach worker who was my partner on the study, introduced me to Wood. They had known each other for many years, starting from Rogers’s own drug-using days when he...

  5. 1 The Governmentality of Community Health
    (pp. 18-36)

    Governmentality, as defined first by Michel Foucault (1991) and elaborated by subsequent social theorists and anthropologists (e.g., Inda 2005; Ong and Collier 2005), explores the knowledge formations and sets of practices that together work to construct and govern populations and subjects. Drawing on the case studies that follow, I contend that community health practices represent a privileged site for examining the “conduct of conduct”—the norms, etiquette, and behavior of individuals and populations—because the populations targeted by community health interventions are constituted, in part, by their difference. As health care and prevention are increasingly imbricated in a wide range...

  6. PART I Technologies of Citizenship and Difference

    • [I Introduction]
      (pp. 37-42)

      Long concerned with urban, low-income, and marginalized populations, community health workers and scholars use a range of strategies to highlight ethnic and racial health disparities and engage diverse groups in programs to improve health. These strategies and programs respond to the social construction of difference as expressed in statements about unequal health outcomes among ethnic groups. Community health researchers collaborate with those seeking to reform medical education and health care to eliminate disparities in care; both groups draw on constructions of difference and meanings of recognition as they construct their target populations. In both cases that make up this section,...

    • 2 Community Health Advocates: The Professionalization of “Like Helping Like”
      (pp. 43-71)

      “Sometimes you just have to look the other way,” insisted Ron Washington to the room full of people attending a six-week training for new Community Health Advocates (CHAs). Numbering about twenty, the future outreach workers would go door-to-door in underserved neighborhoods to enroll residents as patients and clients at community agencies such as Thornton Community Health Center (TCHC), a primary care clinic that was one of three community-based organizations sponsoring the CHA program. Washington, an African American man in his fifties who had previously worked with recovering drug users, worried that people would associate the CHAs with the police if...

    • 3 Neoliberalism at Work: Contemporary Scenarios of Governmental Reforms in Public Health and Social Work
      (pp. 72-102)

      Seven months into my fieldwork in 1998, the CHA program began to receive federal welfare reform monies for operating support. As the health center began to take part in the nationwide reallocation of resources aimed at moving welfare recipients into the “world of work,” this new phase brought many changes to the CHA program, which had been in operation less than a year before it received this new grant. The Access Enterprise, as the county’s Welfare-to-Work (WtW) project was called, made CHA coordinators subject to new regimes of accountability. Funding requirements specified many features of the CHA program that had...

    • 4 Technologies of Culturally Appropriate Health Care
      (pp. 103-128)

      In the mid-1990s in Thornton, Massachusetts, activists and community health leaders worked to establish what would become Thornton Community Health Center (TCHC) as part of a struggle to bring quality, culturally appropriate health care to low-income and minority patients. According to organizers, economically and ethnically marginalized Thornton residents were unable to obtain quality care from existing health care resources (Shaw 2005). When I began my fieldwork there in 1998, TCHC had been caring for patients for two years but still struggled with the best way to reach so-called hard-to-serve residents of its surrounding neighborhoods. Building on established models of lay...

  7. Part II Technologies of Prevention and Boundaries of Citizenship:: Drug Use, Research, and Public Health

    • [II Introduction]
      (pp. 129-134)

      Terms such ascommunity,culture, anddifferencebecome disaggregated into collections of practices and beliefs as we examine their multiple meanings in community health. Subject positions for health care workers are shaped by diverse forces, including the political economy of health care, visions of community mobilization, and concepts of community and difference. The CHA program designers described in Part I imagned their community in ethnic terms; community was a relational vision in which people bound together by a shared ethnic identity choose a common course of action. However, as explored further in Part II, the issue of identity is almost...

    • 5 “I Always Use Bleach”: The Production and Circulation of Risk and Norms in Drug Research
      (pp. 135-155)

      “I always use bleach—I never share my needles.” An injection drug user (IDU) speaking to a researcher knows this is the appropriate thing to say when she is asked, “Do you [how often do you, why do you] share your needles?” In ethnographic research I conducted on HIV risk among people who inject drugs in Thornton, participants repeated variations on these themes while I observed them getting high and interviewed them about their “risk practices.” They sometimes would repeat these mantras as they failed to use bleach or even used their partner’s needle before my eyes. This disjunction between...

    • 6 Syringe Exchange as a Practice of Governing
      (pp. 156-183)

      Despite widespread evidence of their effectiveness in reducing the spread of HIV among injection drug users (IDUs), syringe exchange programs (SEPs), which provide sterile syringes to IDUs in return for used ones, remain controversial. As perhaps the most widely practiced innovation of the harm reduction movement, SEPs act on users’ actions by providing them the means to use a sterile syringe for every injection. To accomplish this, SEPs across the United States use techniques ranging from strictly enforced one-for-one exchange to encouraging secondary exchange, in which individual members collect syringes from their contacts and exchange them at the SEP in...

  8. Conclusion
    (pp. 184-190)

    After college, I spent some time as an activist with the AIDS and women’s health movements in New York City. I remember attending endless strategy sessions in advance of protest actions, trying to come up with our demands. (Never do an action without presenting demands!) In these conversations someone would often share this bit of social movement wisdom: when negotiating with the people in charge, ask for everything, because it increases the chances of getting what is most crucial. As I now observe diverse groups engaged in community health advocacy, it occurs to me that they may be practicing some...

  9. References
    (pp. 191-210)
  10. Index
    (pp. 211-214)
  11. Back Matter
    (pp. 215-215)