A Sociology Clinic: A Sociology of the People, by the People, for the People?

Tor Anders Bye, Sociologist and Fellow, Sociology Clinic, Trondheim, Norway

The ‘sociology clinic’, established in the middle of the city of Trondheim in Norway by Aksel Tjora, Professor of Sociology at NTNU, was opened on 1st July 2014. It was a concept he had been nurturing for nearly a decade before a suitable and affordable location presented itself. The overriding aim was to take the practice, craft and trade of sociology out of its normal university setting and into the community. The rental agreement was concluded, the clinic formally registered as a business, and the venue adapted and decorated to – quite literally – present a shop window for sociology in Trondheim. Aksel set about recruiting a team of skilled and imaginative sociologists of all ranks to take up the challenge of introducing and integrating sociology into the local community.

The original vision for the sociology clinic was to take sociology from NTNU’s out-of-town, out-of-sight and therefore out-of-mind Dragvoll-campus, which is several miles from the city and as many thousand feet above it, and into the vigorous and challenging environment of the city centre.

As well as physically bridging the gap between ivory tower and the day-to-day life of citizens, the clinic team set about putting its expertise to use and out to tender. ‘We can cure anything but disease’, Aksel Tjora proclaimed! Nor was this a cry in the wilderness. The background research had been done and solid grounds existed for two complementary premises: first, that there was a need for community-based studies to inform and guide urban planners and commercial endeavours; and second, that it was possible and desirable to involve community bodies and citizens as participants in the research process. On a more ambitious scale, the clinic might prove a focus for professional sociological and policy-oriented investigations into the far-reaching effects of socio-cultural and institutional change on the city environment.

These themes find an echo in early projects based in the clinic. For example, a team of sociologists used qualitative methods to evaluate the deployment of Trondheim’s ‘culture fund’, and went on to appraise its effectiveness in relation to the fund’s long-term goals. At the same time, this study contributed to the broader understanding of the politics and economics of the cultural field. Another project involved collaborating with ‘Agraff’, a small architectural firm located not far from the clinic. One outcome was the genesis of the concept of ‘passiar social’, the sociability of passing by, of happenstance, which fed back into local planning. Localities are interrelated in complex and potentially dynamic ways:  how one area is revitalised can impact directly on another. In this case the significance leading people to walk by the docks of ‘Ravnkoa’ was maximised. These sociologies – of space, neighbourhood and community – have tangible ramifications for the health of citizens.  As we hoped, such projects yielded a twofold return: first, they informed municipal and commercial plans; and second, they refined C. Wright Mills’ ‘sociological imagination’ by requiring constant theoretical and conceptual innovation and improvisation away from the university campus.

A final, related aspiration long articulated by Aksel Tjora is relevant here. The sociology clinic has had a liberating effect for and on the discipline. Its physical separation has given it a degree of autonomy from the traditional or conservative constraints of the university bureaucracy. The clinic is an independent initiative, unattached and unaffiliated to NTNU. With this comes the opportunity to step outside a ‘McDonaldised’ academic culture that can value the mass production of peer-reviewed papers in high impact journals above originality, creativity, real-life problem solving and even education.

The concept of the sociology clinic is commended here. The work done within its confines in Trondheim has been very encouraging across all the fronts mentioned here. The sociologists who have shared coffees and conversations and studied and researched there have been able to do outside the conventions and canons found on the NTNU campus. Studies that could not have been conducted from the campus base have flourished from the clinic, most notably those involving close liaisons with local politicians, planners, commercial concerns and citizens. Engagement and participation have been constant motifs. The ever-evolving clinic team firmly believe in the concept. They believe too that work done within and from the clinic will in time feed its scholarship back into the mainstream discipline and enliven its orthodoxies.

Perhaps most of all, the clinic opens its door to the wider community. Sociologists come by, but so also do others, maybe just to ask questions or exchange an idea or two. The sociology clinic is proving an important step towards a sociology of the people, by the people, for the people.

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Easing of US Trade Embargo, the Cuban Paradox, and Lessons in Health Care: A Natural Experiment

Christopher J. Fries, University of Manitoba, Canada

Since 1960 Cuba has been a under trade embargo by the United States. The results of this embargo, imposed by one of the world’s wealthiest, industrialized nations on a country with a population of less than 12 million, have been grave for the nation’s economy and the formal health care system of Cuba, especially since the collapse of the Soviet Union. The loosening of trade restrictions announced by US President Obama in 2014 and now working their way through American Congress constitute an interesting natural experiment on the relationship between economic development and population health. It will be fascinating to watch how freer trade affects measures of population health status, such as life expectancy and infant mortality, in Cuba. However, the case of Cuba already holds lessons about the relationship of the health care system to population health.

During the Cold War period (1946 – 1989), the Soviet Block provided financial support and trade to Cuba that helped shield the island nation from the economic effects of the embargo. The embargo prohibits US companies and their subsidiaries from trading with Cuba. As part of the embargo, medicine and health care supplies cannot be traded to Cuba. After the collapse of the Soviet Union and with it, foreign aid, first the economy and then the health of Cuba suffered. For instance, Stanford University, School of Medicine, researchers Paul Drain and Michele Barry show that owing to food shortages, average adult caloric intake decreased 40 per cent, the percentage of underweight newborns increased 23 per cent, the number of surgeries performed declined by 30 per cent, the number of pharmaceutical medicines available declined from 1300 to less than 900, and Cuba’s total mortality rate increased 13 per cent.

However, and surprisingly, despite the embargo, Cuba has the highest average life expectancy and the lowest infant and child mortality rates among 33 Latin American and Caribbean countries. In fact, on several key measures of the health of a population, Cuba is doing about as well as, or even slightly better in comparison with the far richer countries of Canada and the United States! For instance, according to the latest data from the World Health Organization, at 78 years, average Cuban life expectancy is only four less than Canada’s 82 years and about the same as the US’s 79 years. The WHO reports that Cuba’s infant mortality rate (5/1000 live births) approximates Canada’s (4.6/1000 live births) and betters the US rate of 5.9/1000 live births.

Cuba is a poor country that spends about $405 per capita total spending on health care. This compares with the $4,610 spent in Canada and $8,845spent by the US. In other words, Canada spends more than ten times what Cuba does on health care and the US spends more than twenty times as much! Despite this and the challenges to the Cuban health care system stemming from the embargo, on many measures Cubans are as healthy as Canadians and Americans.

Though countries like the US and Canada spend much more on our formal health care systems than does Cuba, we do not receive matching returns in terms of population health. This is sometimes referred to in the health research literature as ‘the Cuban health paradox’. Cuba is achieving world-class population health outcomes on its developing-world budget. How is this possible? The Cuban experience clearly illustrates that there is more to health care than expensive, high-tech medical products and services. It is possible to spend less and get more! This is because, as the Cuban Paradox demonstrates, medicine does not equate with health.

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A Manifesto for Action Nursing

Benny Goodman, Lecturer in Nursing & Sociology, School of Nursing & Midwifery, Plymouth University

This manifesto calls for a social movement for political activism by nurses and other health professionals, to address inequalities in health and the social inequalities that highly structure, but do not determine, health outcomes. This action can operate at individual, clinical, organisational, national and international level.

Our aim is to respond to threats to health and socialised health service delivery from corporate, financial and political interests.

Our vision is for decreasing social and health inequalities in which the social gradient is greatly diminished.

Our goal is to create a networked social movement involving political and civic activism to bring critical understanding and action into the public sphere.

As millions of people in the UK, and billions across the globe, experience a daily struggle to both give and receive care, nurses must ally themselves with the progressive forces which seek to redress the balance of power of the ‘Greedy Bastards’ whose actions have the unintended consequences of social inequalities and inequalities in health. Action Nursing, alongside an ‘Action Sociology’, wishes to remove the ‘flowers from the chains’ so that we more clearly see what holds us back from understanding care as vital, as central, to our ‘species being’ and is not mere adjunct, to be ignored within the private (female) domain.

As many governments embrace austerity policies within a neoliberal political economy, capital accumulation takes on various anti-democratic forms unaccountable to the people engaged in what Marcuse (1964) called ‘the pacification of the struggle for existence’.  The provision of nursing may be seen as a cost and not a benefit to those who decide where the investments should be made. Capital accumulation practices in health care delivery, especially in the care of older people and those with mental health issues, often results in absent or stretched services, or hiring under educated and poorly trained staff who too often lack supervision and development and who work in high patient to staff ratios. It also seeks private insurance based schemes and prefers services which can return profits. Care givers also work in the private domain, the informal sector, providing vital support to the wider business of capital accumulation but with very little or no recognition or return for such efforts. This ideology is maintained by appeals to the moral character of such work, often locating it firmly within kin networks as a ‘reciprocal gift’ that would be sullied by any suggestions of a cash nexus.

Nurse educators, clinicians and students do not work in a socio-political vacuum. However, one would think that they do if the content of curricula and the learning experiences planned are anything to go by. Indeed any discussion around political economy, patriarchy and capitalism is liable to be met with surprise, apathy, or disdain apart from those engaged in teaching the social sciences in nursing. Nursing cannot shy away from addressing these questions. Nurses as women, who experience the requirements to care in both their domestic and public lives, bear the brunt of the demands of a society which needs that care to be done but is unwilling to fully fund it. We need to argue for the social value of care and against privatised individualised provision which falls unfairly on the shoulders of those who often do not have the resources to provide it.

Intrinsic to the nursing project is a concern for the health of individuals, communities and populations but in any point in history nurses will find themselves confronting ideologies; these are erroneous worldviews or theories that justify, sanction or provide cover for financial, business or political interests. Nursing’s ethics of care should include opposing forces that suppress truths about the societies we inhabit.

Nursing care in an often uncaring society should necessarily be oriented to justice and solidarity. It should be active not passive and should exist as a form of intervention against ‘distorted communication’ that interpellates nursing and nurses into subservient subject positions.  This has never been developed fully in Nursing theory because the discipline has been focused on other laudable aims. The result is a large number of workers in health services have no analytical tools or critical thought in which to contextualise and critique their experiences with vulnerable people. Critical theoretical concepts, such as ‘governmentality’ or ‘praxis’ or ‘frontiers of control’ ‘or ‘critical reflexivity’, would be sadly be alien to most nurses.

Action Nursing therefore contests the (often biomedical) ‘taming’ of nursing especially in the post-1970s neo-liberal era, including the shying away from arguing about contentious or ‘risky’ issues. Witness the uncritical passivity with which nurses in the UK have accepted ‘values based recruitment’, the ‘6Cs’ and ‘revalidation’ as panaceas to the issues of the quality of care; witness as well the lack of action regarding the structural conditions of the NHS following the Health and Social Care Act.

An Action Nursing cannot stand on the sidelines as a passive recipient of the decisions made by other powerful actors. It has to dwell on exploitation and oppression that result in inequalities in health for the population and stress, burnout and compassion fatigue for nursing staff and other care givers in their homes. Action Nursing should engage in the Marcusian ‘Great Refusal; it stands against the actions of the wealthy and powerful and actions whose consequences include the social gradient seen in the mass of data on health inequalities and evidenced in people’s lives in such works as ‘The Life Project’ (Pearson 2016).

This manifesto also allies itself with the manifesto ‘from Public to Planetary Health’. This is the voice of health professionals who together with empowered communities could confront entrenched interests and forces that endanger our future. This could be a powerful ‘social movement from below’ based on collective action at all levels to create better health outcomes, protect our futures and support sustainable human development.

Marcuse H (1964) One Dimensional Man. Routledge. London.

Pearson H (2016) The Life Project. Penguin. Allen Lane.

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An Introduction to Social Theory and Health

Graham Scambler, University College London, UK
Editor, Social Theory & Health

When we made the case for introducing a new journal in a fairly crowded field we stressed that its mission would be to bring closer together – to bridge – two hitherto discrete literatures, social theory on the one hand and empirical research on health and health care on the other. Hence our title: Social Theory and Health. The inaugural issue was published in the autumn of 2003, since when the journal has grown from strength to strength. We have found our niche.

Even since 2003 social media and their reach and influence have grown exponentially. Moreover they encompass audiences well beyond academia. Given the current onus on public engagement on the part of universities and allied institutions it is perhaps surprising that communities of scholarship have on the whole been tardy in adopting and adapting to social media. Or perhaps it is not that surprising since most forms of popular communication have in the past been frowned upon, unrecognized and unrewarded!

Times are changing however, and innovative technologies and media are becoming mainstream and can no longer be entirely ignored or sidelined either by hard-line theorists or researchers or by their line managers. Facebook and Twitter (see @SocThHlth) are in common use, but it is perhaps blogging that has proved optimally attractive in academic circles. Social theorists and health researchers committed to blogging are numerous and transnational. The blogs of some are read by thousands as opposed to the normal run of peer review papers published in the more esoteric and arcane journals. So blogs have the potential to reach large and diverse publics as well as disciplinary or area specialists.

Blogs have several appealing characteristics, or so it seems to me. First and most obviously, they can make one’s work accessible to new and non-expert audiences. This requires, second, translations into more readily comprehensible formats and vocabularies, which is intrinsically worthwhile! And third, and excitingly, they afford an opportunity to think aloud. There are of course restraints: for those aspiring to or anxious about career advancement, for example, it is still the case that publishing in high impact journals is paramount, so it can be imprudent to prematurely leak ideas or data. There may be thieves about.

We hope to recruit as well as attract bloggers to parade their intellectual wares via our journal website. The invitation is a broad one. We are open to a multiplicity of different contributions. We specifically encourage submissions from ‘Southern’, post-colonial, feminist, disability theorists and health care workers and activists worldwide. The single constraint is that issues of theory and health are raised, preferably innovatively but possibly only in passing. As one of us has demonstrated, it is possible to blog too much (see http://www.grahamscambler.com), but the future is displacing the present even as I write.  Drafts should be submitted to Graham Scambler at: grahamscambler@hotmail.com.

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