Living in Cange, among the “water refugees” whose lives had beenupended by decisions made elsewhere, provided as good a setting asany to learn that regnant models of health care financing and deliv-ery would not lead to good outcomes among the landless poor.

middle-class Haitianwoman who worked for the U.S. embassy. Acéphie’s looks and man-ners kept her out of the backyard, the traditional milieu of Haitian ser-vants. In addition to cleaning, she answered the door and the phone.Although Acéphie was not paid well— she received thirty dollars eachmonth— she recalled the gnawing hunger in her home village and man-aged to save a bit of money for her parents and siblings, especially herbrother, who had never been able to find a paying job.

a French naval delega-tion demanded an indemnity of 150 million francs from Haiti for the“losses”—land, capital, and the bodies of slaves themselves— enduredby the French plantation owners during the revolution. Haiti continuedto pay off this odious debt ($21 billion in today’s dollars) until 1922

alling into question whether the NHS was ‘sustainable’ or ‘affordable’ Thepublic was repeatedly told that the public sector is bad at management; onlythe private sector is efficient and could manage services well

His English background did not help put him in good stead with either of the city’s dominant ethnic groups.

The Milwaukee Anti-Vaccination Society launched in 1891

t did not help relations that the majority of Poles originally hailed from regions in Europe long under German control.

There was even an impeachment.

With nat

biomedicine conceptualizes disease as a discrete entity;each disease, be it cholera or paranoia,is assumed to be an objective, clinicallyidentifiable,andhence boundableentity.Normalpracticein biomedicine,whetherin its diagnostic,research,or treatmentcapacities,is guided by the conceptualiza-tion of diseases as distinct, discrete, and disjunctiveentities that exist (in theory)separatefrom other diseases and from the social groups and social contexts inwhich they arefound

"exhaustive-to include all conditions-and to ensure thatnoparticular event of sickness will be classified undermore than one code numbe

nosological systems that encompass them are trans-formed over time in response to changing social conditions and events

However, these laudableefforts have placed little emphasis on thelarger economic and political processes inwhich stigma is grounded.

Stigma and discrimination are partof complex systems of beliefs about illnessand disease that are often grounded in socialinequalities

Egypt, infertilewomen "live" patriarchy each and every day in their interactions with husbands,in-laws, and community members. Husbands may threaten to leave infertile wives(although most do not), and mothers-in-law may torment infertile daughters-in-law(and most do

y effectively and compassionatelylistening to them narrate their own subjective experiences of sickness and health,pain and suffering, oppression and resistance, good health and occasional joy thatare part and parcel of women's health experiences around the globe.

Thus,Gruenbaum demonstrates how Western universalizing campaigns to eradicate fe-male circumcision around the globe are often based on simplistic and culturallyinsensitive understandings of African women's lives and their local moral worlds(including local versions of Islam). Such insensitivity leads to programs that aremorally offensive and bound to produce a cultural backlash

, multiple forms of oppression may intersect in women's lives,and these forms of oppression are not merely ad

as birthing women became convinced thatbiomedicine had something useful to offer the

. To take but one example, epidural anesthesia in childbirth would notexist were it not for women demanding more effective forms of analgesia that wouldalso allow them to remain awake (or, alternatively, take a comfortable, pain-free nap)during the birthing proce

n which authoritative knowledge of childbirth is seen to beheld by obstetricians rather than birthing wome

he "problem" ofteen pregnancy-which has received a great deal of biomedical and public healthattention in the United States in recent years-would not be considered a problem inmany parts of the world

"gender blindness"; to wit, Foucault himself didnot distinguish between or account for the ways in which male and female bodiesare treated differently through societies' disciplinary mechanisms

whom grew up during the difficult yearssurrounding World War II

problems (Inhorn 2002, 2003,2004a, 2006), as well as their positive contributions to reproductive health and par-enting (Dudgeon and Inhorn 2003, 2004), are largely ignored in the ethnographies,as well as in the global public health initiatives, which have failed to take men andtheir reproductive health problems and concerns seriously

It is easy to speculate on why this might be

unwittingly participated in this reproductive essential-ization of women by significantly overfocusing on the realm of reproduction

where, although for many women around the world, rehealth services are the only point of contact for he

ns. Although one could argue that the overwhelming focus ontheir reproduction is empowering-given the centrality of reproductionlives and its function as a fundamental source of women's power in maaround the globe-essentializing characterizations of women that contithem to the realm of reproduction are both unfortunate and po

overemphasis on the microbiological-in this case, BV-has obscuredthe underlying determinants of reproductive risk, which are macrostructural innature

n concerned with prematurity and low birth weight among pregnantAfrican American women and their offspring.

women themselves rarely define their health problems in the same ways that thebiomedical community defines them

t was noted that females across the lifespan and from traditionally un-derrepresented populations should be included as research subjects, and that researchshould be multidisciplinary, including basic, translational, behavioral, and clinicalresearch, especially on conditions that may be chronic or multisystemic in nature.However, the research agenda was clearly not a reflection of what U.S. women them-selves perceive to be their major health problems. Although various women's healthlobbying groups on specific diseases (e.g., breast cancer) may have influenced theresearch agenda, the list of research priorities was clearly a "top down" conception-the creation of a group of powerful biomedical and public health "experts" wholaid out a research agenda designed for each other to follow.This content downloaded from 147.134.0.128 on Sat, 04 Jan 2020 12:24:15 UTCAll use subject to https://about.jstor.org/terms

n examining Table 2, it becomes apparent that the NIH has defined women'shealth research priorities in strictly medical and public health terms. For example, thelist focuses heavily on discrete physiological processes, organ systems, pathologies,and therapeutic interventions. As such, it reflects a fragmented view of women'shealth and women's bodies. Furthermore, it almost entirely neglects the socioculturalmatrix in which women's ills develop, including in the context of poverty, patriarchy,and other life stresses. Although "healthy living," "care giving," and "quality of life"are highlighted in two of the priority areas, these are the only real concessions tobehavioral research, of the kind undertaken in schools of public health. The rest ofthe research agenda is highly biomedical in detail and in scope

Sex differences in health and disease at the genetic, molecular, cellular, and functionalleve

Women are rarely the ones to set the boundaries of the discussions surroundingthe identification and definition of their health problems.

It is my hope that biomed-ical researchers and practitioners who might read this article will be able to reflectdispassionately on anthropologists' critiques of their field

women's health problems often cannot be separated from the larger social, cultural,economic, and political forces that shape and sometimes constrain women's lives.Examining macrostructur

Western world

Western and non-Western setting

Indeed, listening to whatwomen themselves have to say about their health and well-being would seem to beof vital importance to policy making

in internationalfamily-planning campaig

at constitutes "women's health" has been largely for-warded by the Western biomedical and public health establishm

as hypertension and cardiac disease related tosmoking and obesity, has become a cause for al

global HIV/AIDS pandemic has high-lighted women's vulnerability to the HIV virus, often in areas of the world wherewomen continue to suffer significantly from reproductively related morbidity andmortalit

ccepted as‘standard’ in the United States are appropriate biologically, culturally, and socially for diverse groupsboth within the country and globally

Yet although more than half of new cancercases and about two-thirds of cancer deaths occur in low- and middle-income countries, only aboutfive percent of global cancer resources are spent there

multifaceted, complex reality of cancer globally

The exclusion felt more broadly by Bedouin citizens is not adownstream component of health policy but is the backdropagainst which health policy was formed. However, this as-pect of health policy’s history was not one that policymakersactively engaged

I set appointments only on days when the husbands aregoing [into town]. I am aware of the problem and I try to adaptmy treatment. [For example], someone from far away I tryto give a treatment that is long term. I give them my phonenumber. It’s a shame for someone to come 70-80km [to aclinic]. Instead, I tell them to call me, present the picture. Wewill talk for five minutes on the phone it will cost you 1.5NIS[$0.40].... I try to find alternatives.

Quality—in the numeri-cal sense of the word—becomes one way of knowing, yetit may not overlap with patients’ lived experience of healthand quality health care.

policy may guarantee access, providers are unable to deliverthem.

As a result, even when theyhave access, parents may still be reluctant to bring childreninto the health care system given concerns for deportationor penalization

itizens no longer argue for health care morebroadly as a right (which is guaranteed under national healthreform laws), but rather they petition the courts for specificpills and treatments

Because care is absent despite the promises of reform—pay-ments are not provided, medicines are not delivered, servicesare unavailable—individuals turn to the courts to seek theirhealth rights

n other words, policies aredynamic entities that are continuously created and changed

which both societal change and the main-tenance of the status quo occur

makes these objectsseem obvious or bounded

Hence the bulk of qualitative work in, say,health services research, seeks to discover (throughsemistructured interviews and/or focus group discus-sions) people’s views of a biomedically definedphenomenon— for example, a disease or a health serv-ice

How-ever, such study also links with a trend in medicalanthropology that argues for the need to focus beyondclinical encounters between individuals to the powerrelations that produce and shape sickness

Rather, itregards the knowledge and practice of “experts” aslocally variable— as are the knowledge and practice oflay people— and it includes both within the boundariesof empirical inquiry.

incorporate its theoretical basis (sociology has a betterestablished history of application to health issues

reduced to a limited setof methods that requires little theoretical expertise, nodiscipline based qualifications, and little training

The individuals responding to the illness stories may shapethe context for future disclosure; if people feel their stories are validated and ac-knowledged by a family member or close friend, they may be willing to sharemore in the future. In contrast, a negative experience in sharing an illness storymay hinder future disclosure

Second, this study seeks to understand how illness survivors and their familymembers use narratives as a method of communicating their changing identities

First, this study advocates the need for learningabout the composition of survivor identities over the course of a life-threatening ill-ness

The main goal of the present study is to examine, from the perspectives of adolescents, whetherand how Chinese parents communicate with their adolescent children about sexuality, and howChinese adolescents think of such communication

sociocultural aspects of sex, such as standards of sexual conduct

exual socialization agent for Chinese adolescents

ge from lo-cal media outlets and can, therefore, shapepublic perceptions about the nature of crimeand the nature of race relations within thecommuni

e analyze the total number of hate crimeincidents reported in the Uniform Crime Re-port data for the ye

t state actors are most likelyto grant concessions to movements whenthey are generally sympathetic to the goalsof the movement and when support from amovement's adherents could potentially af-fect their chances of winning electoral con-tests

ombinesthese two approaches and proposes that it isthe interaction between organizationalstrength and political context that affects thelikelihood of movement succ

The central insight of the framingperspective in social movement research isthat, regardless of objective circumstances,individuals are unlikely to participate in col-lective action unless they first come to viewtheir circumstances in terms of a collectiveproblem that could be solved through collec-tive action

use each reported inci-dent represents a deliberate choice made bylocal authorities to take positive action onlegislation that endorses the validity ofclaims and demands asserted by various civilrights organizations

es. In fact, rec-ognition can be used as a tactic to avoidmaking real concessions to a move

While re-searchers disagree on whether such an in-crease has actually taken plac

applying direct pressure on legislators,but also by framing discussion about the is-s

It is clear that differences in the numberhate crimes reported in various regionsnot simply reflect differences in the numof criminal acts motivated by bias. They minstead reflect different incentives to callacts of bias to the attention of local authori-ties, as well as different incentives that in-fluence law enforcement agents to respondto, and to report, hate crim

Yet in other circumstances, fail-ure to report hate crime incidents can be po-litically perilou

) notes, there is astrong disincentive for police to identifycrimes as bias-motivated because a highnumber of reported incidents can tarnish theimage of the communit

dependent on the way in which lawenforcement agents interpret the event, andmany law enforcement agents are less thanenthusiastic about hate crime legislation

unit that has more expertise on hate crimes,then evaluates the case to determine whetherit qualifies as a hate cri

t, "Bias crimes require po-lice officers to examine not only what hap-pened, but also why it happened. Further-more, the search for what happened is com-plicated by contested stories and by victimswho are sometimes afraid to acknowledgethe bias nature of the crime for fear ofrevictimization" (p. 1

s. And, the HCSA does not specify themechanism for collecting hate crime d

art of the problem stems from the factthat the HCSA requires the federal govern-ment to collect data on hate crimes, but itdoes not require local law enforcementagencies to partici

tet 2001). Yet even with afederal mandate for collecting hate crimedata, comparisons across geographicboundaries remain problematic. For in-stance, a total of 1,943 hate crimes were re-ported to the federal government for thestate of California in the year 2000, whilenot a single hate crime was reported for thestate of Alabama, despite the fact that advo-cacy organizations identified several crimi-nal acts of bias that occurred within thatstat

). In 1994, theHCSA was amended to include crimes mo-tivated by bias against individuals withphysical or mental disabiliti

We are particularly interestedin the role that activist organizations play inpromoting, or impeding, compliance withpublic policie

First, what determines compli-ance with a public policy once it is put intoplace? Second, what factors explain varia-tion in compliance with public policy acrosslocal settings?

hose who possessample material resources or who hold insti-tutionally based power have a distinct ad-vantage in this competition because these re-sources can be used to formulate a persua-sive causal argument and to ensure that theargument captures the attention of lawmak-ers and the general public

). Stone (1989) argues that "prob-lem definition is a process of image making,where the images have to do fundamentallywith attributing cause, blame, and responsi-bility"

. Addition-ally, some conditions that cause pain andsuffering for large numbers of people maynever be defined as public proble

hich public policy forma-tion is influenced by socially constructeddefinitions of public problems

utcomes. The presence of resourceful civil rights organizations in a county can lead to higher numbers of re

Intuitive decision making is perhaps never more important than during a crisis. A crisissituation is a change—whether sudden or evolving—that results in an urgent problem that mustbe addressed immediately

Intu-ition can be described as emotionally charged judgments that arise through quick, nonconscious,and holistic associations.34

Programmeddecisions are decisions that become somewhat automatic because people’s knowledge allowsthem to recognize and identify a situation and the course of action that needs to be taken.

performance-avoid orientation focus on demon-strating their competence so that others will not think poorly of them

erformance-prove orientation focus on demonstrating their competenceso that others think favorably of them.

learning orientation,where building competence isdeemed more important thandemonstrating competence

behavioral modeling

social learning theory argues thatpeople in organizations have the ability to learn through the observation of others.20

Variable ratio schedules reward people after a varying number of exhibited behaviors

Fixed ratio schedules rein-force behaviors after a certain number of them have been exhibited

Variable interval schedules are designed to reinforce behavior at more random points in time

fixed interval schedule is probably the single most common form of reinforce-ment schedule. With this schedule, workers are rewarded after a certain amount of time, and thelength of time between reinforcement periods stays the same

Continuous reinforcement is the sim-plest schedule and happens when a specific consequence follows each and every occurrence of adesired behavior

Extinction occurs when there is the removal of a consequence following anunwanted behavior.

Pun-ishment occurs when an unwantedoutcome follows an unwanted behav-ior.

Negative reinforcement occurs when an unwantedoutcome is removed following a desired behavior

Positive reinforcementoccurs when a positive outcome follows a desired behavior

contingencies of reinforcemen

antecedents

REINFORCEMENT

Tacit knowledge, in contrast, is what employees can typically learn only through experience

Explicit knowledge is the kind of information you’re likely to think about whenyou picture someone sitting down at a desk to learn.

Expertiserefers to the knowledge and skills that distinguish experts from novices and less experienced peo-ple.4

decision making, which refers to the process of generating and choos-ing from a set of alternatives to solve a problem.

Learning reflects relatively permanent changesin an employee’s knowledge or skill that result from experience.1

Effects of Motivation on Performance and Commitment

psychological empowerment, which reflects an energyrooted in the belief that work tasks contribute to some larger purpose.7

internal comparisons, meaningthat they refer to someone in the same company.69 Others are external comparisons, meaning thatthey refer to someone in a different company.

ccording to equity theory, any imbalance in ratios triggers equity distress—an inter-nal tension that can only be alleviated by restoring balance to the ratios.65

Equity theoryargues that you compare your ratio of outcomes and inputs to the ratio of some comparisonother—some person who seems to provide an intuitive frame of reference for judging equity.64

quity theory acknowledges that motivation doesn’t just dependon your own beliefs and circumstances but also on what happens to other people.6

Rather than directly affecting other variables in the diagram, moderators affectthe strength of the relationships between variables. One moderator is feedback, which consistsof updates on employee progress toward goal attainment.52

askstrategies, defined as learning plans and problem-solving approaches used to achieve successfulperformance.51

Goal setting theory views goals as the primary drivers of the intensity and persistence of effort.44

Motivational Force = E P × Ʃ[(P O) × V ]

intrinsic motivation—motivation that is felt whentask performance serves as its own reward.30

xtrinsic motivation—motivation that is controlledby some contingency that depends on task performance

Needs can be defined as cognitivegroupings or clusters of outcomes that are viewed as having critical psychological or physiologi-cal consequences.26

alence reflects the anticipated value of the outcomes associated with performance(abbreviated V).24 Valences can be positive (“I would prefer having outcome X to not having it”),negative (“I would prefer not having outcome X to having it”), or zero (“I’m bored . . . are we stilltalking about outcome X?”)

Instrumentality represents the belief that successful performance willresult in some outcome(s).19

pastaccomplishments—the degree to which they have succeeded or failed in similar sorts of tasksin the past.15 They also consider vicarious experiences by taking into account their observa-tions and discussions with others who have performed such tasks.16 Self-efficacy is also dictatedby verbal persuasion because friends, coworkers, and leaders can persuade employees that theycan “get the job done.” Finally, efficacy is dictated by emotional cues

self-efficacy, defined as the belief that a person has the capabilities needed to execute the behav-iors required for task success.13

Expectancy represents the belief that exerting a high level of effort will result in the success-ful performance of some task.

Expectancy theory describes the cognitive pro-cess that employees go through to make choices among different voluntary responses.

engagement. You can think of engagement as a contemporary synonym, moreor less, for high levels of intensity and persistence in work effort. Employees who are “engaged”completely invest themselves and their energies into their jobs

motivationis defined as a set of energetic forces that originates both within and outside an employee, initiateswork-related effort, and determines its direction, intensity, and persistence.

Another reason is that job satisfaction is strongly correlated with normativecommitment. Satisfied employees are more likely to feel an obligation to remain with their firm74and a need to “repay” the organization for whatever it is that makes them so satisfied, whethergood pay, interesting job tasks, or effective supervision.

Effects of Job Satisfaction on Performance and Commitment

motionalcontagion shows that one person can “catch” or “be infected by” the emotions of another per-son.59

Such jobs are high in what’s called emotional labor, or the need to manage emotions tocomplete job duties successfully.58 Flight attendants are trained to “put on a happy face” in frontof passengers, retail salespeople are train

These events can trigger emotions, which are states of feel-ing that are often intense, last for only a few minutes, and are clearly directed at (and caused by)someone or some circumstance.

affective events theory, workplace events can generate affective reactions—reactions thatthen can go on to influence work attitudes and behaviors.54

First, the activityin question has to be challenging. Second, the employee must possess the unique skills neededto meet that challenge.

Moods are states of feeling that are often mild in intensity, last for an extended periodof time, and are not explicitly directed at or caused by anything.47

job crafting, where they shape,mold, and redefine their jobs in a proactive way.46

ob enrichment,such that the duties and responsibilities associated with a job are expanded to provide morevariety, identity, autonomy, and so forth.

feedback, is the degree to which carrying out theactivities required by the job provides employees with clear information about how well they’reperforming.40

Autonomy is the degree to which the job provides freedom, independence, and discretion to theindividual performing the work.37

Significance is the degree to which the job has a substantial impact on the lives of other people,particularly people in the world at large.

variety, is the degree to which the job requiresa number of different activities that involve a number of different skills and talents.

What kinds of tasks create these psychological states?” Job characteristics theory,which describes the central characteristics of intrinsically satisfying jobs, attempts to answer thisquestion.

mean-ingfulness of work, which reflects the degree to which work tasks are viewed as something that“counts” in the employee’s system of philosophies and belief

Put simply: Boring jobs may be easier, but they’renot necessarily better.Final PDF to printer

Value-percept theory argues that job satisfac-tion depends on whether you perceive that your job supplies the things that you value

alues are those things that peopleconsciously or subconsciously want to seek or attain.3

Shaping Public OpinionBecause policymakers are influenced by the electorate’s opinions, many interestgroups seek to influence the policymaking process by shaping public opinion

Such a situation is idiotic, of course. Yet elements of it already exist. And unless we beginto turn this around, there will be worse to come

They went one stepfurther and asked for a patent on the basic biological relationship between homocysteineand vitamin deficiency. A patent was granted that covered both the test and the scientificfact. Eventually, a company called Metabolite took over the license for the patent

He is not alone: nearly half of all Americans believe in thevaccine-autism link or are unsure about it

Now, if we agree that disability is not inherently a bad difference, thenwe can insist that disability should not be used to justify infanticide,lesser medical treatment, or any other treatment based on the assump-tion that a disabled person’s life must have diminished well-being

Doulia begins withthe fact of inevitable dependency and depends on an acknowledgmentof our inextricable interdependency.

Most dependency work, however, is done by family members, usu-ally women, but not exclusively

The decision becomes, ‘Wow, I think I’m goingto just stay put where I am.’ Which is the equivalent of a life sentenceof poverty” (quoted in Fessler 2015). Still worse, because the ADA is inplace, many will think that there is no longer a problem—legally, ob-stacles have been removed. It appears, then, that those who are disabledwho cannot find a way out of the precariat are themselves failures inthe modern economy. The fault redounds to them.

The portrait of Emeka Nnaka, a former semipro football player fromTulsa, Oklahoma, who broke his neck making a tackle, illustrates howeasily employment opportunities are frustrated and how the only op-tions available are low paid, part-time, and insecure. Nnaka recentlywas able to get an accessible van to transport him to work. Prior to that,Nnaka said, “I’d spend about three hours in transportation daily whenI was riding the lift. So, think about three hours out of your day inwhich you’re not doing anything” (Fessler 2015).

Precarity is perhaps most closely associated with labor and economicinsecurity

Furthermore, our well-being is dependent on others:

hat disability, as opposed tothe impairment in the body, is a social factor often caused by builtphysical environment that can, if the political will is there, be builtdifferentl

Let us ac-cept that disability is a constructed concept: the construction differsrelative to the time, place, and purpose for which it is employed.

Rather than effectively support-ing the aspiration of those disabled people who are able to be integratedinto productive labor, the withdrawal of care support undermines thoseaspirations, and it makes life still more precarious for those for whomthe ideal is meaningles

The first, I claim, has to do withthe inadequate conceptualization of dependence.

With the rise of neoliberalism and the advent of the disability move-ment, disabled people, who were one class of adults who were previouslyexempted from the ideal of self-sufficiency, are now expected to be“independent and productive.”

iberal ideal of the citi-zen and worker as independent and self-sufficient

Not only were there no guards, there were no rules.

“Misbehavior is as important in the study of nature as in people.

“It did not look like a museum,” recalled Alan Friedman, aphysicist and now the director of the New York Hall of Science.“The look of the exhibits was right off the lab bench. Roughwood. Things nailed into the table. This looked just like my low-temperature physics lab when I was a graduate student. It lookedreally friendly. It looked like home.

This“accelerator,” I later learned, was built by Robert Wilson, a physi-cist and Frank’s close friend from Los Alamos; it was, in essence, aminiature version of the four-mile- circumference particle accelera-tor Wilson had built at Fermi National Laboratory in Illinois

resulting in a final sample of 1,475 rural stakeholders in the United States

When Sloane left Jamaica, he filled his ship with species both dead and alive.

He used enslaved people as guides to the trees and animals of Jamaica.

but that they are different specimens, though going under one general name.”

adding and adding and never taking away.

influential man in the context of his time, describing his non-aristocratic birth, his rifts with other Royal Society members, and the deep complicity he and his collection enjoyed with slavery and imperialism.

General practitioners (GPs), who run private practices, are paid based on the number of patients they see

"socialized medicine" because the government both provides and pays for health care.

8.3

a permission slip to name the grief we experience vicariously and the helplessness we feel when medicine has reached its limits.

I asked the students if the poem related at all to their experience in the ICU. One of them, an aspiring surgeon, drew our attention to a particular image: “Day after day, on the same narrow coast, / we stood guard, waiting / for some speck to reappear …” The poem made him think of one of our patients, a man who had become paralyzed and could only blink. Each morning the student went into this patient’s room and spoke with his son, who was standing alert at his father’s side.

As I read “The Rabbit,” I saw my patients: bleeding, moaning, gasping. I pictured what once was, and what was lost.

I had enjoyed puzzles like that in the classroom, but I couldn’t reconcile this academic discussion with the existence of the man in the bed

I had so many questions: Who was he? Who had he been? What had happened to him? I hadn’t been to church since I left for college when I was 17 and yet, in that moment, my agnostic mind grasped for a higher being.