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Write the Impact of Hierarchy and Power to me as a Healthcare Professional.

Social Determinants of Health in Australian Healthcare

Sociology is a concept that entails the study of social life. Many sociologists fashion and work with theories, which explain the way identities and people shape the society. Sociology presumes that a working society depends on healthy people and on managing diseases towards a healthy society. Over a century ago, Rudolf Virhow acknowledged that medicine is in essence a social science, as well as politics nothing more than medicine on a huge scale. Sociology of medicine emphasizes on testing sociological hypotheses, employing medicine as a field for studying fundamental issues in social stratification, power and authority, social structure, socialization and the wider concept of social values (Brown & Barnett, 2004). While traditionally medicine has sustained and sustained a status of dominance plus power in the healthcare care, there are many suggestions that modern social trends of the healthcare system are leading to problems to medicine’s conventional power. Thus, in Australia, these emerging social trends in the healthcare systems are having some influence on the prevailing spot of the health practitioner (Collyer, 2012).

 The paper will investigate hierarchy and power in Australian healthcare based on sociological theories. The paper will further discuss the biomedical model and social health determinants in healthcare in Australia.

Originally, the paper will describe vital concepts, like social determinants of health (SDH), biomedical model, and structure. Consequently, the SDH from the feminist perspective will be investigated where commonalities between SDH, the biomedical model and the feminist theory will be examined. Finally, comparison and examination of the Marxist perspective against SDH and it connection to the biomedical framework will be explored (Khan, 2015).

Sociology entails the study of social behaviour or society, which comprises its origins, growth, structure, networks, as well as institutions. Accordingly, sociology makes a vital contribution to multidisciplinary research into social issues of interest to clinicians, as well as other health expert, the expansion of health policy in addition to epidemiological studies. Sociology is a very important perspective for healthcare professionals, which is an understanding of the social context of health along with healthcare that will result in a more comprehensive understanding of the health sectors, novel insights, and a change of the way the society perceive the healthcare sector and promote client-health professional relationship (Henslin, Possamai, Possamai-Inesedy, Marjoribanks & Elder, 2013).

The allocation of power along with socio-political characteristics of health is the structural or hierarchical elements of wellbeing of society, as well as arbitrates access to healthcare. These elements emanates from the state and structural features of society. The social determinants of health (SDH) include income, social class, gender, employment, education, ethnicity, as well as social support (Willis & Parry, 2016).

SDH as a form of social stratification where stratification is evident in the manner the society is based on divisions between various groups founded on income, or socioeconomic position is regularly determined through race, ethnicity, gender, education, religion, as well as occupation (Wilkinson & Pickett, 2005). These social factors may fashion social divisions in the society. Studies show that although groups studied can be in paid job and were not even deprived, there exist remarkable variations in disease levels along with the death. For example, those groups in subordinate ranks in the service hierarchy were more probable to be sick as compared to those in higher ranks in service. This trend is predominant in South Australia where around 68 per cent rise in social disparity in general majorly occur in most underprivileged income quintile between 2005 and 2006, as well as 61.8 per cent rise in social inequality for unskilled along with expert employers for the similar time (Glover, Hetzel, Glover, Tennant & Page, 2006). Hence, variations in health will not be only described by income, although too is considered to be a product of social rank along with social inequity. The social stratification puts a person in a social power structure or hierarchy, which is shaped by many factors. Thus, earnings are but single factors, others comprise position in the organization, status, gender, or control over job.

Hierarchy and Power in Australian Healthcare

In addition, the SDH do not happen in a space; however, are characterized by the manner power functions in a specific society. Thus, the social determinants of health are an invention of factors that include public along with social policies, types of governance, as well as society plus cultural values. How power is utilizes affects the social determinant of health in either constructive or unconstructive means for the populace. Power distribution in the society ascertains social organization, stratification along with hierarchies that, in turn, impacts wellbeing. Therefore, power is vital in the expansion of health inequalities. Neo Marxist perspectives of power are founded on division of labour amid those individuals that have the abilities of production (elites) and those who have finances, as well as material goods plus those individuals that have only the job skills to trade or the lower-class.

The Marxist believes that the greater degree of unemployment too undermine the bargaining influence of the working-class that will expose them to augmented ill health. When the government makes the decision to follow the neo-liberal marketplace ideology in place of welfare state, then the low paid people will be at peril of poorer wellbeing via social plus political agenda in place. For instance, the Australian healthcare system is universal in addition to funded through tax levied founded on income, the Medicare Levy. Thus, the Australian healthcare systems safeguards it people from excessive health costs that can be disastrous for the family. This effect of these policies on the SDH is apparent in Australian life expectancy of 86.1 years plus 82.5 years for females and males correspondingly. In addition, the Australian healthcare system is influenced by the key political teams in the society; their degree of confidence supremacy is dictated by their class, standing, as well as political associations (Chernichovsky, 2006). For instance, Australian Medical Association (AMA) that embodies physicians along with their concerns. Accordingly, any confront to the power of doctors in the Australian healthcare sector is destabilized by Australian Medical Association. Thus, this makes sure that power plus earnings bottom-line of the physicians is safeguarded. For instance, endeavours by nurses to enlarge their responsibility into healthcare professionals such as nurses, which include admission to Medicare supplier member along with medicine rights to offer healthcare to persons in remote, as well as rural areas are systematically blocked by the AMA (Bartley, Ferrie & Montgomery, 2006).

The biomedical model of health (BMM) emphasizes more on the management of a specific physical disease whilst only considering the biological elements other than averting it at the original stage by considering the social and mental elements of wellbeing. The framework views the body as a machine that may be renovated through management when faulty. The biomedical model plays a leading function when diagnosing in addition to treating the illness. Nevertheless, the framework approaches the disease of an individual in a very slender manner because it does not reflect on the emotional, cultural, social, as well as religious elements of illness. The model treats the patient taken as machinery not a distinctive person with specific wants because it stresses more on treatment other than prevention. In Australia, the biomedical model is quite reflected in health spending (Borrell-Carrió, Suchman, & Epstein, 2004).

Sociology's Contribution to Healthcare

One instance is the gathering of information on preventable deaths in Australia. Preventable death is described by Piers, Carson, Brown, and Ansari (2007) as: the illness is an exclusive one; the efficient innovations are understood to healthcare experts plus healthcare services; right of entry to healthcare services is available, as well as available to persons with the disease. Paradoxically, the information on preventable death rates in Australia discloses that elements rather than bacteria impact the incidence of disease or avoid the illness.

 Thus, these factors that comprise place of dwelling or socioeconomic position result in other frameworks being expanded. The BMM has many limitations that render it useful in the current healthcare in Australia. First, the model fails to handle the psychological and social causes of illness. The model, for instance, the focus on substance interventions to treat social inequalities does not clarify the behavioural, lifetime, power, along with social elements of healthcare states. Second, the high cost of healthcare tech along with biomedical solutions to healthcare challenges. It crucial to comprehend the use and the drawbacks of the BMM provided the place as fundamental, both socially, as well as politically to majority of the global healthcare systems. Thus, the dominance of the BMM; nonetheless, implies that the government of Australia will carry to view it as a legitimate strategy and continue channelling finances in that direction. Third, the cost effectiveness of lifestyle changes has defied the role of BMM. The model deals with diseases with cures of diabetes in addition to cardiovascular disease through costly healthcare interventions, like heart transplants, but these diseases can be managed through addressing lifestyle factors, such as diet, and exercise. Finally, the model fails because some practitioners fail to subject their work to investigation. This is basically the case in Australia in which efforts to evaluate healthcare facilities, service delivery along with healthcare practitioners have been frustrated by the AMA (AIHW, 2008). Therefore, this is apparent in the gap in the nationwide compilation of healthcare information in the wellbeing of Australians.

Feminists consider that knowledge in a given society is influenced by power, apparent through what familiarity is honoured. For example, the way disease is defined is influenced by the knowledge that influences the financing of the healthcare (Luttrell, Quiroz & Scrutton, 2007). The assumption is that, for instance, in wellbeing that “masculinity” is usual is certainly apparent in modern practice of only taking men in treatment trials plus fundamental medications in which drugs doses are founded on men bodies. In Australia, there has been limited financing into challenges that men face. The BMM was based on the supposition of “masculinity” being ordinary, as well as the “femininity” being anomalous, as well as funding has adopted this thinking. Thus, the monetary support embraces biomedical plus masculinity social constructs, as well as because the financing of healthcare is determines by the power of different interest groups to develop agenda, the capability to pressure along with transform the current hierarchies either promotes or restrains the power of specific interest groups, as well as their healthcare outcomes. In addition, the power, knowhow along with supremacy of the BMM ascertains where finances is channelled to where healthcare interventions. Hence, this can stop alternate perspectives of healthcare, as well as health provision being explored and implemented and constrain the health of specific groups (Marmo, Siegrist & Theorell, 2006).

Biomedical Model and Social Health Determinants in Australian Healthcare

In my profession as a nurse practitioner, I have been influenced by power and hierarchy in my organization. In many instances, I have not been privileged to enjoy the power that doctors in the organization that I work as a nurse. The Australian healthcare system is characterized by hierarchies and power relations that have continued to determine who has an influence in this kind of healthcare system (Kuhn, 2005). The present power and hierarchical structures in the Australian healthcare system have created many challenges when it comes to opportunities to my practice. These structures can be better explained through the sociological perspectives mainly Marxism and feminist. These perspectives offer a better understanding regarding the current inequalities in the healthcare in my practice and its influence because of the hierarchical and power elements that exist. The biomedical model has some weaknesses because it does not consider the issue psychological concerns of causes of such health inequalities, but rather focuses on the needed treatment. This model is limited to the application in the power and hierarchical issues in the healthcare system in Australia (Collyer, 2012).

The doctors hold the power to make most of the health decisions that limit my input as nurse because of financial and political power.  In my practice as a female nurse can be explained through feminist theory where my role has been restricted to nurse and rising to an executive position has been a great challenge for many years I have been in the profession. Thus, feminist theory better provides the implications of power and hierarchy in the health sector in Australia for my case. As a nurse, I am the most affected individual by power and hierarchy in Australia. This is attributed to the fact the doctors maintain the highest medical dominance via subordination along with sexual division of labour (Urban, 2014). Despite playing an important role in the healthcare sector in working with the majority of the patients, AMA has been instrumental in restricting my position in the healthcare sector for many years. Despite the feminist movements, nurse’s position in the healthcare sector has been undermined in many occasions, which is evident for my case (Esmail & MacKinnon, 2013).

Conclusions

The healthcare system in Australian has been greatly influenced by capitalist interests where the strategy that has the most characterized relationship between medicines along with allied healthcare practitioners within the healthcare facility is subordination. Doctors have greater authority, which comprise financial control as compared to nurses or allied healthcare practitioners. This power is created by the hierarchy in the healthcare setting where nurses and allied practitioners are restricted in their scope of practice in spite their capacity to undertake roles that are the same as that of doctors. Similar to Marxist view, the doctors create division of power between two groups. This division of power considers nurses and allied health practitioners as less for the job, disempowering them and gives power to the other group. Finally, the Marxist view in the case of Australian healthcare systems emphasizes the pervasiveness of hierarchy and power

References 

Australian Institute of Health & Welfare (AIHW). (2008). Australia’s Health 2008. Australian Institute of Health & Welfare: Canberra. [Accessed 06.10.2018].

Bartley M, Ferrie J, & Montgomery SM. (2006). Health and labour market disadvantage: unemployment, non-employment and job insecurity”, in Social Determinants of Health  edited by Marmot M & Wilkinson R 2006, Oxford University Press.

Borrell-Carrió, F., Suchman, A. L. & Epstein, R. M. (2004). The Biopsychosocial Model 25 Years Later: Principles, Practice, and Scientific Inquiry. Annals of Family Medicine, 2(6); 576-582.

Brown, L. & Barnett, J. R. (2004). Is the corporate transformation of hospitals creating a new hybrid health care space? A case study of the impact of Markets, Rights and Power in Australian Social Policy co-location of public and private hospitals in AustraliA.  Social Science & Medicine. 58(2); M427–444.

Chernichovsky D. (2006). The High Performance Health System presentation from the Pluralism, Choice and the State in Emerging Paradigms in Health Systems.  The Millbank Quarterly. 80(1); 5-40.

Chung H & Muntaner C, (2008). Political and welfare state determinants of infant and child health indicators: An analysis of wealthy countries.  Social Science & Medicine. 63(2); 829-842.

Collyer, F. M. (2012). Mapping the sociology of health and medicine: America, Britain and Australia compared. Palgrave Macmillan, Basingstoke.

Esmail N, & MacKinnon J. (2013). Health care lessons from Australia. Vancouver, BC, Canada: Fraser Institute.

Glover J, Hetzel D, Glover L, Tennant S & Page A. (2006). A Social Health Atlas of South Australia (Third edition). Adelaide: The University of Adelaide.

Henslin, J., Possamai, A., Possamai-Inesedy, A., Marjoribanks, T., & Elder, K. (2013). Sociology. Melbourne: P.Ed Australia.

Khan H.A. (2015). The idea of good governance and the politics of the global south: an analysis of its effects. Abingdon: Routledge.

Kuhn, R. (2005). Class and struggle. Frenchs Forest, N.S.W: Pearson Education.

Luttrell C, Quiroz S & Scrutton C, (2007). Empowerment: an overview. Viewed at www.poverty-wellbeing.net. [Accessed 06.10.2018].  Marmot M, Siegrist J & Theorell T. (2006). Health and the psychosocial environment at work. In Marmot M & Wilkinson R 2006, editors Social Determinants of Health. Oxford University Press: Oxford.

Piers L, Carson N, Brown K & Ansari Z. (2007). Avoidable mortality in Victoria between 1979 and 2001”, Australian and New Zealand Journal of Public Health. 31(2); 5-12.

Urban, A. (2014). Taken for granted: normalising nurses’ work in hospitals. Nursing Inquiry. 21(1); 69-78.

Wilkinson R & Pickett K. (2009). The Spirit Level: Why more equal societies always do better. Penguin Books: New York.

Willis E. & Parry Y. (2016).  The Australian health care system. In: Willis E, Reynolds L, Keleher H, editors. (eds) Understanding the Australian Health Care System. Chatswood, NSW, Australia: Elsevier. pp. 232-277.

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