Year: 2014
Type: dissertation
Abstract: The early writings of Dorothy Smith (1990) and the tools of institutional ethnography were used to explicate the social organization of stroke prevention care in Ontario, Canada. This study was undertaken to understand how social determinants of health that set the context for patients' lives and health are rendered invisible by the lens of health care professionals. This is despite the fact that there is substantial evidence that lower socioeconomic status is associated with higher incidence of stroke, stroke risk factors, and mortality after stroke. Data collection included observations of direct clinical care in a secondary stroke prevention clinic, interviews with patients, health care professionals, and extra-local informants, as well as the analysis of texts that were encountered in the setting. The entry point for data collection was through observations and interviews with patients who attended a secondary stroke prevention clinic. This local setting was connected through texts to the larger administrative and governing organizations, including the Ministry of Health and the Heart and Stroke Foundation. Data analysis made visible a new interventionist paradigm in stroke care. This paradigm relies on a pharmaceutical innovation, provincial data circulation, as well as on visual imagery of vascular disease through brain scans. Secondary stroke prevention was found to be based on statistical risk formulas which act as a proxy for certainty. Rather than prevention, secondary stroke prevention constitutes last minute `damage minimization' in patients with serious vascular disease. A significant finding was that patients did not know what secondary prevention was, yet actively participated in the related work, seemingly driven by the fear of disability. Biomedical risk ideology locates disability and `risk factors' in the body, thus social determinants of health are invisible. The complexity of health warrants the application of social as well as biomedical knowledge.
Source: TSpace (University of Toronto)
Author: Sarah Flogen
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2661778524