Health and medicine sociology

Social Justice in Times of Uncertainty: perspectives from health and medical sociology (Session 1 of 2)

June 29, 2021 10:45
June 29, 2021 12:15

Chair: Stéphane Cullati and Raphaël Hammer, for the RN-SHM


Ursula Meidert, Selina Egger & Verena Klammroth-Marganska; Zurich University of Applied Sciences, School of Health Professions, Institute of Occupational Therapy

Cyril Pervilhac, Dr. PH., MPH, Retired (ex-WHO Geneva, HIV/AIDS Department)

Michael Gemperle, Susanne Grylka-Baeschlin, Jessica Pehlke-Milde, Verena Klamroth, Thomas Ballmer, Brigitte Gantschnig, alle Departement Gesundheit, Zürcher Hochschule für Angewandte Wissenschaften

In contemporary societies, uncertainty is part of the lives of individuals, regardless of where and when they live. Societies, communities, and other social institutions are meant to reduce the uncertainty of lives by offering protection, education, work, and especially health and access to healthcare. Uncertainty can be a driver for the life course, a motivation to surpass oneself, a source of change or an obstacle to initiative but, also, a factor of ill health. Growing up in unstable families (divorce, property taken away, violence, poverty, etc.) can direct children on socially disadvantaged life course pathways, and ultimately to poorer health. Uncertainty at work cause psychosocial stress to employees and workers. Uncertainty about future pensions received at retirement can increase anxiety and worries. And, recently, the onset of the COVID-19 pandemic has plunged our societies into great uncertainties, both in the short term at the sanitarian level and in the medium and long term at the social and economic levels.

Just and egalitarian societies can mitigate the negative impact of uncertainties on the lives and health of individuals. Recent trends in contemporary societies showed both increase of living standards and security, but also increase of social and health inequalities, which have been accentuated by the COVID-19 pandemic in 2020.  Is the impact temporary or structural? Are inequalities at the micro, meso and macro level cumulating? The health care system itself and the medical and health personnel have also been under pressure, pointing to vulnerability of hospitals. 

Moreover, suddenly arrived, the COVID-19 pandemic has been concurrently studied by the scientific community and managed by public health authorities while in the media spotlights. The convergence of this viral epidemic with an “infodemic”, or “digital epidemic”, is not trivial. Media and social media are saturated with information, potentially reassuring, but also contradictory and generating uncertainty. Controversies that have aroused in the public debate about wearing a mask and potential treatments for example have also emphasised scientific uncertainty and the importance of lay population trust in expert authorities. 

SESSION 1: COVID-19: perspectives from health and medical sociology

“If you stay inside the stress thing, you of don't stand a chance”: Stress perception of older employees during corona times 

Ursula Meidert, Selina Egger & Verena Klammroth-Marganska; Zurich University of Applied Sciences, School of Health Professions, Institute of Occupational Therapy 

Background: Employees often face job-related stress. Persistent stress can be harmful for both physical and mental health. Furthermore, stress affects job performance and may lead to absence from work, thus imposing not only a disruption on a personal and institutional level but also financial burden on society. During corona-times ordinary work life has for many employees been disrupted. This empirical study focus on stress perception of older employees, and their coping strategies. Furthermore, it explores how stress changes during their working career and how they perceived stress during their life course and during the corona crisis. 

Method: A moderated online-focus group of 90 minutes was conducted with 5 participants. All participants were 50 years of age or older and were mature in their career. Participants were recruited through notices on websites, direct mailings to companies and mailing lists as well as personal contacts. The interview was conducted in December 2020 during the second corona wave in Switzerland. The interview was recorded and transcribed, its content analyzed with content analysis. 

Results: Participants stated that external control of work-tasks and the responsibility for others as well as unplanned tasks/incidents on top of already high work-load created stress. Not all participants were affected the same through the corona crisis. While some had an increase in tasks and demands, others felt no change. Moreover, already stressful situations got worse through additional work, various communication channels due to home-office situation and disruption of the usual workflow. 

Own attitude towards work, such as need for recognition, to achieve something in life and perfectionism were powerful motives for participants that lead them in the past frequently into stressful situations or prolonged times under pressure and stress. On the other hand, they felt that prolonged stress was a sign of time, as they felt a faster pace and increased demands, tight deadlines and a general shortage of time at work than it used to. On the other hand, others felt more relaxed now than when they started their career as they felt they already achieved something in life and could better let things be. However, participants stated to need more rest and longer recovery time than they used to. 

Participants value the possibility to reflect on stress and share personal experiences especially during times when many employees are bound to work at home. 

Conclusion: While for some the corona crisis lead to additional stress, most factors related to stress were either in the personal mind set and/or preceded the corona situation. 

Keywords: Stress perception, older employees, life course perspective, corona times

Social sciences and social justice in the complex equation of measures against COVID-19 - the case study of France in 2020

Cyril Pervilhac, Dr. PH., MPH, Retired (ex-WHO Geneva, HIV/AIDS Department)

As observed across the world in recent months, the COVID-19 pandemic continues to underscore the inadequacies of our health systems and global inequities, particularly among more vulnerable populations. Only a few publications point to the importance of social sciences to address these issues despite vast experience in overcoming epidemics and pandemics on the African continent over the past four decades proving their vital contribution, perhaps most notably in fighting HIV/AIDS and Ebola. Hard sciences with bio-medical sciences still largely dominate the equation of the response. 

This case-study of France gives some answers as to how social sciences such as anthropology, sociology and psychology can play a more prominent role in the response to the COVID-19 pandemic to balance the equation towards more social justice. Social science researchers need to go beyond carrying out research and publishing their findings; they need to seize better and more pro-actively the opportunities they are offered and incorporate social science insights into problem-solving.

Using an empirical approach, we reviewed for France two national evaluation reports and their data: a mid-term report of an independent scientific team led by the Hôpitaux Universitaires de Genève (HUG), and a policy-oriented report at Senate level, released, respectively, in October and in December 2020. We also benefitted from additional secondary sources, and hands-on experiences of epidemics and pandemics in Africa.

Our detailed findings provide evidence of a lack of use and weight of social sciences in the formulation of national policies, in the national evaluation to overcome injustice, and, as per additional quantitative data, in the tailoring and improvements of key preventive measures (i.e. basic hygiene measures and mental health). To advance social justice, we also address cross sectoral issues such as vulnerable populations, communities and civil society, and communications. We suggest how to overcome these shortcomings for the present and future pandemics in France, applicable worldwide, and we offer practical conclusions for each domain analyzed. 

In conclusion, the culture of preparedness for a pandemic ought to be revisited. We need a new approach that expands to include more than the traditional focus on epidemiological surveillance and early detection of outbreaks, establishment of rapid responses, and dissemination of data, knowledge and technology. We need to reframe prevention and global health issues as a fundamentally social process where understanding the communities’ needs and acceptance to the measures using social sciences is central to the solution. Pursuing these early findings, further research should exploit detailed data from secondary sources of information beyond those used for evaluation here, including plans, committee reports, detailed strategies and measures implemented. In addition, there is a need for collection of primary information, with interviews of those responsible in various domains. Some avenues for research for doctoral candidates in social sciences are paved here.

Our hope is that our findings will contribute to a new paradigm of global health that benefits from the full spectrum of social sciences and makes social scientists more effective partners in bringing greater social justice to the populations in need.

Gesundheitsfachpersonen und die digitale Technik

Michael Gemperle, Susanne Grylka-Baeschlin, Jessica Pehlke-Milde, Verena Klamroth, Thomas Ballmer, Brigitte Gantschnig, alle Departement Gesundheit, Zürcher Hochschule für Angewandte Wissenschaften

Auf bisher unvergleichliche Weise erfuhren telemedizinische digitale Hilfsmittel (Videokonferenz etc.) während der Corona-Pandemie einen Boom. Ganz besonders betroffen sind davon personenbezogenen Dienstleistungen und der Gesundheitsbereich. Im Gesundheitsbereich avancierten digitale Medien innert Kürze zu möglichen Hilfsmitteln für die ansteckungssichere Erbringung von Leistungen, und bereits heute herrscht die Meinung vor, dass dies erst der Anfang einer eigentlichen Digitalisierungswelle im Gesundheitswesen sei. In welchem Verhältnis die digitalen Hilfsmittel zur Arbeit von Gesundheitsfachpersonen und deren psychosozialen Bestandteilen (Betreuung, Beratung etc.) stehen, ist jedoch noch wenig bekannt. 

Der vorgeschlagene Beitrag interessiert sich am Beispiel der Berufsgruppe der Hebammen für die Erfahrungen, die Berufsfachleute des Gesundheitssektors mit der Behandlung auf Distanz gesammelt haben, und wie sie den Einsatz digitaler Medien bewerten. Die Berufsgruppe der Hebammen ist deswegen interessant, da sie dem persönlichen Kontakt und der Beziehungspflege im beruflichen Handeln ein hohes Gewicht zukommen lässt. Die empirische Grundlage stellt eine online-Umfrage unter Mitgliedern des Schweizerischen Hebammenverbandes während des Lockdowns im Frühling 2020 dar (N = 630). 

Erste Ergebnisse der Auswertung der Antworten auf die offenen Fragen nach den wahrgenommenen Vor- und Nachteilen der Behandlung auf Distanz zeigen, dass Hebammen sich gegenüber digitalen Medien trotz der aussergewöhnlichen Lage insgesamt wenig euphorisch zeigen. Zwar erkennen viele in der Behandlung auf Distanz durchaus Vorteile. Diese Vorteile beziehen sich neben der Möglichkeit, die Klientenbeziehungen aufrechtzuerhalten und Beratungen dennoch durchzuführen, jedoch besonders auf die Arbeitnehmerdimension (vgl. Schumann et al. 1982): Verringerung der unbezahlten Arbeitsbelastung durch die einfachere Klärung von niederschwelligen Fragen und Wegfall der grösstenteils unbezahlten Reisezeit. Im Gegenzug dazu verweisen die genannten Nachteile vor allem auf die Produzentendimension (vgl. Schumann et al. 1982): Viele Hebammen sehen sich in ihren Möglichkeiten, erforderliche Untersuchungen, Interventionen und Therapien durchzuführen eingeschränkt und sogar in ihrer Fähigkeit beschnitten, die Situation in ihrer Komplexität überhaupt zu erkennen und einzuschätzen. Weitere statistische Analysen zeigen, dass das Behandeln auf Distanz während der Corona-Pandemie mit abnehmendem Alter und mit zunehmenden Möglichkeiten, die Leistungen abzurechnen, eher positiv erlebt werden. Hier zeigen sich diskussionswürdige Unterschiede innerhalb der Berufsgruppe, die nicht nur auf die starke Situationsgebundenheit der Bewertungen digitaler Medien und auf «gegensätzliche Ideologien der Berufsarbeit» (Hunter 2004), sondern möglichweise auch auf unterschiedliche berufliche Dispositionen verweisen. 

Erwähnte Literatur:

Hunter, Billie (2004): Conflicting ideologies as a source of emotion work in midwifery. Midwifery, 20(3), 261–272.

Michael Schumann et al. (1982): Rationalisierung, Krise, Arbeiter: eine empirische Untersuchung der Industrialisierung auf der Werft. Frankfurt am Main: Europäische Verlagsanstalt.