Healthcare systems across the globe are characterized by power and hierarchy intrigues with various stakeholders holding varying viewpoints on what is supposed to be the most ideal situation. The same is significantly intrinsic in the current Australian health care system. The health care system is part and parcel of the societal setup and therefore it greatly subscribes to the sociological provisions of particular societies. Societies are composed of underlying hierarchal and power facets that act either in favor of the positive wellbeing of the entire society or to the detriment of the same. At the healthcare facility level, this situation is extended to impact the relationship between different healthcare practitioners significantly impacting the provision of health care services (Cockerham, & Scambler, 2010).
Hierarchical power intrigues in societies emanate from the existence of social inequalities that affect different individuals and sections of the community to access critical socioeconomic elements. This by extension impacts the ability of the members of the society to access quality healthcare services equally. To this end, hierarchical power relations are responsible for asymmetric associations that advantage some disadvantaging others. This paper will be keen to bring out how intrinsic hierarchy and power are to the existing Australian healthcare system and how such a system may influence me as a healthcare practitioner. The paper will employ feminism, conflict theory, and functionalism sociological theories and concepts to substantiate arguments.
To help explain how hierarchical power intrigues help shape and impact the society and healthcare facilities stakeholders, it is important to first define what sociology really is. According to Wills and Elmer, (2011) sociology can be defined as the study of social life and the complex relationships stakeholders in its exhibit. Sociology utilizes sociological theories, perspectives, and concepts to explain how the society stakeholders shape and impact different society constructs including hierarchy and power relations (Haralambos, & Holborn, 2008). Moreover, sociologists are in a position to explain the emergence and existence of social inequalities responsible for hierarchical power imbalances as well as proposing the most optimal strategies to curb the disadvantaging aspects of the same. Being part of the society, healthcare facilities hierarchy and power intrigues can as well be explained through sociological theories and perspectives (Cockerham, & Scambler, 2010).
The Organization for Economic Co-operation and Development (OECD) [OECD, 2016] indicated that the Australian health care system is amongst best healthcare systems worldwide. Even as such, the Australian healthcare system is extensively hierarchical with power and dominion coming at play at different levels of the system which by extension ominously impact healthcare delivery (Nugus, Greenfield, Travaglia, Westbrook, & Braithwaite, 2010). From a society perspective, like any other society set up, the Australian society is punctuated by wide socioeconomic inequalities that significantly affect the abilities of different individuals and sections of the society to access quality healthcare (Reiss, 2013).
One of the most instrumental and influential sociological theories in explaining the impacts and implications of hierarchy and power both at the healthcare facility level as well as at the society level is the conflict theory. Phelan, Link, and Tehranifar (2010) points out that conflict theory is of the view that justice and fairness are very critical in a society in which case there shouldn’t be any power inequalities baring members of the society from equally accessing quality and affordable healthcare. Conflict theory pioneer; Karl Marx envisaged for world societies in which there is fair and equitable access to critical socioeconomic elements. Moreover, Karl Marx observed that the societies’ hierarchical power intrigues emanating from the inequitable access of fundamental socioeconomic elements adversely impact the equitable access to healthcare (Shaw, 2008). In the healthcare context, these socioeconomic elements are called social determinants of health (Marmot, Friel, Bell, Houweling, Taylor, 2008) which may include factors such as employment distribution, gender, wealth distribution, races, tribes, access to clean water, access to food, housing and neighborhood conditions.
In sociology, sociological discourses are extrapolated through the “structure-agency” concept. The conflict theory under the “structure-agency” concept is not biased towards structure or agency in describing the manner in which the inequalities in social determinants of health impact healthcare delivery. This conflict theory proposition follows the assumption that the entire social framework; individuals and institutions, work to enhance either the denial of access to health care services or promote the easy access of the same to different individuals and society sections. This is made possible through the exploitation of underlying hierarchies and powers in the society. Indeed, the “structure-agency” concept in extrapolating sociological discourses has proven instrumental in giving a comprehensive and wholesome picture of the healthcare hierarchy and power relationships (Short & Mollborn, 2015).
The World Health Organization (WHO) has for a long time been in the forefront to advocate for the minimization of negative social determinants of health for purposes of advancing world societies that are healthy since everyone can be able to access healthcare without being bared by the societies’ hierarchical power structures. 2008 WHO report titled
“Closing the gap in a generation: Health equity through action on the social determinants of health”, envisaged the need for world countries to strive to fuse the inequalities posed by social determinants of health so that positive health outcomes for all can be realized. To this end, the Australian healthcare system needs to heed to this call by striving to minimize the same for purposes of elevating fairness in healthcare access for its diverse society.
Navarro, (2009) assert that the higher likelihood is for people living in poverty in Australia to undergo detrimental social determinants of health than their much economically endowed counterparts. As such, the poor are more likely to access poor health services than the rich (Lee, 2015). Using the example of social class, culture and ethnic background, the Aboriginal and Torres Strait Islander peoples and people of other cultures are likely to undergo discrimination and intimidation in their quest for quality and affordable health services. Conflict theory views discrimination as a social ill that needs to be eradicated to allow equality in the access of critical yet fundamental social services such as health care.
In contrasting viewpoint to the conflict theory’s perspective to equitable access of social determinants of health and how the same contribute to hierarchical power intrigues in the society the biomedical theory to healthcare sociology is of the perspective that healthcare ought to be approached from an objective and physical viewpoint. Timmermans and Haas (2008) assert that the biomedical theory to healthcare sociology draws from the Cartesian philosophy, in which case there is a detachment of the soul, mind, and spirit from the body. The body is seen as an object that deserves repair in terms of treatment whenever its dysfunctions. This makes the biomedical model not to be inclined to either the structural or agency side of the “structure-agency” sociological discourse.
Feo and Kitson (2016) assert that the biomedical theory simply aims to distance social aspects from patients’ illness. The biomedical theory has however been instrumental in contributing significantly to clinical research and patient treatment and management. This withstanding the theory’s main criticism remains its assumption that the mind and the body can be separated and by extension asserting that no social aspects can be incorporated in healthcare delivery discourse. To this end, the biomedical theory assumes that there are no hierarchical and power concerns in healthcare.
This notwithstanding, the feminist theory reinforces the tenets of conflict theory from a gender perspective. The feminist theory is of the opinion that healthcare hierarchical power intrigues perpetrated by patriarchal and capitalist societies ought to be completely eradicated. The theory views men and women as equally endowed with the requisite mental and physical capabilities of being their own thinkers and doers of things. To this end, the feminist theory partakes and exposes both the both the structural and agency perspectives of sociological “structure-agency” discourse. Burton (2016) asserts that discrimination against women has rocked the globe throughout history and has been viewed as their men’s weaker counterparts.
This is the case even at the healthcare practitioner’s level. The society perceives women as inadequate and incompetent to assume medical courses while at the health facility level, they are seen as incapable of tackling complicated healthcare concerns and therefore they are pushed to perform less demanding healthcare activities. Pedwell and Whitehead (2012) have labeled out discriminatory employment trends, unequal resource distribution, cultural and religious stipulations, financial capacities, sexual psychological orientations as yardsticks and platform of grounding power hierarchies meant to humiliate and discriminate women.
A critical implication of hierarchical power inequalities in healthcare facilities is the commission of medical mistakes and errors. Hierarchical power relations between different healthcare practitioners hinder the smooth therapeutic and professional interrelationships between these practitioners such that some practitioners shy away from advancing corrective advice to more educated or experienced practitioners during patient care. Throughout the medical history, power, control, and dominion tussles have rocked the healthcare industry with particular healthcare practitioners perceiving themselves as the custodians of power and authority (Fewster-Thuente, & Velsor-Friedrich, 2008).
Gender and professional levels have remained one of the platforms to exert inequitable hierarchical power relations in the healthcare industry with women being forced to always contend from the receiving side. Women have for a long time been made to endure exploitative power hierarchies that are keen to escalate social ills such as bullying, discrimination, intimidation, and segregation (Liberatore, & Nydick, 2008). By adopting the social determinants of health perspective, Burton (2015) the feminist theory’s aim is to advance a society setup that enhances the development of women in communities as well as in healthcare settings.
Still, at the healthcare facility level, the Australian healthcare system emphasizes the importance of involving patients in their own care through patient-centered care approaches. Patient-centered approaches to healthcare have been proven by empirical research to have abilities to shun power hierarchies exhibited by earlier traditional provider-patient care approaches (Jordan, Briggs, Brand, & Osborne, 2008). Pulvirenti, McMillan, and Lawn, (2014) contend that patient-centered approaches not only break power and authority impacts and implications at the provider-patient perspective but also power relations governing healthcare practitioners. The breakage of these power relations between different healthcare stakeholders by patient-centered approaches acts to enhance the tenets of conflict and the feminist theory when negative social determinants of health are also shunned through patient involvement in their own healthcare.
Adding to this healthcare sociological discourse regarding power hierarchies is the structural functionalism theory devised with tenets that remotely back the social determinants viewpoint from the structure side of the structure-agency continuum. The structural functionalism perspective of healthcare sociology brings together several facets of the social structure including institutions, and social groups to gain synergy which by extension help to maintain stability and social order. The theory is largely a macro- analytical viewpoint with little reference to individual social inequalities as outlined by the conflict theory (Smith, 2010). Healthy conditions and health care are fundamental to a functioning society (Parsons, 1951). Parsons (1951) further asserts that unhealthy conditions are responsible for hinder individuals from doing their duties and responsibilities in the society.
Parsons (1951) viewed that a big number of the people in the society fall ill, the society’s stability and functionality are significantly compromised. As such in support of the conflict theory and its equality in social determinants of health tenet, this theory perceives the factor “accessing support networks in access of positive social determinants” as very fundamental (McMurray & Clendon, 2015). To this end, Parson perceives society hierarchical powers as instrumental in developing healthy communities. The idea that the structural functionalism perspective is overly macro-minded reduces its feasibility in solving the society’s healthcare concerns evoked by society power hierarchies since the theory fails to recognize the fact that the people’s healthcare concerns emanate from these people’s different backgrounds as well as their abilities to access the same (McLaughlin, & Dietz, 2008). Parson’ ideology that the relationship between healthcare providers and patients can only be hierarchical is also criticized in the wake of more inclusive patient-centered approaches in the Australian healthcare system (Burnham, 2014).
The Australian healthcare system is overly hierarchical and power, control, and authority will always come at play between the society members, patients, healthcare practitioners, and the healthcare system regulators. With the wide differences in the social determinants of health, these inequalities are bound to continue escalating in the unforeseeable future. The Australian government is best suited to eliminate all social determinants inequalities as well as shunning all negative power hierarchies surrounding the Australian healthcare system for purposes of producing positive patient outcomes.
I am bound to be adversely impacted by the current healthcare system power hierarchies in Australia as I engage in my day to day healthcare duties. From the conflict theory viewpoint, and despite Australia’s deep-rooted social determinants’ of health inequalities, I will fashion my healthcare delivery to reflect what a just and fair society ought to be like by equitably serving my patients and families irrespective of their backgrounds and socioeconomic status. The biomedical theory, though biased against the sociological facet of health care, I will utilize the tenets of this theory to advance holistic evidence-based healthcare. I will also endeavor to be more gender sensitive as advocated for by the feminist theory in the execution of my healthcare duties.
The structural-functionalist theory impacts in me the ideology that making efforts to forge functional and stable communities through the provision of holistic healthcare services means developing coherent societies that are more accommodative and inclusive especially in accessing positive social determinants of health. To this end, one of my goals will be to strive to offer quality healthcare services congruent to social goals. Hierarchical power intrigues at the healthcare facility level and the inefficiencies they cause healthcare delivery enlightens me of the significance of shunning the same for optimal healthcare outcomes. Kuhlmann and Saks (2008) assert that effective interpersonal relationship and communication are critical regardless of healthcare providers’ professionalism, legislation backing, and educational levels.
In conclusion, hierarchical power intrigues in the Australian healthcare systems ought to be monitored by regulating authorities to ensure that rather than being a source of adverse healthcare delivery, they be a source of reinforcement of the same. Even as such, most power hierarchies are detrimental to healthcare delivery and therefore they must be eliminated or be orchestrated to advance holistic, quality and affordable healthcare (Liberatore, & Nydick, 2008). Healthcare sociological theories and perspectives and the sociological discourse; “structure-agency” are instrumental in expediting the same.
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