Medicalization of Old Age: Experiencing Healthism and Overdiagnosis in a Nordic Welfare State.

In Denmark, people are expected to take responsibility for their health, not least as their bodies age and they experience signs of physical or mental decline. Drawing on fieldwork among older Danes, I illustrate that an excessive focus on health gives rise to social and structural controversies and disparities, linking ideas of healthy behavior at the individual level with the societal framing of disease and aging. I argue that this emphasis contributes to the unwarranted diagnosis of bodily variations that naturally occur in the aging process, a phenomenon referred to as overdiagnosis, adding to a broader medicalization of old age.

Reproductive gerrymandering, bureaucratic violence, and the erosion of abortion access in the United States.

In the contemporary American political landscape, gerrymandering and the passage of anti-abortion legislation are intimately connected in what I call reproductive gerrymandering. I develop this concept as an analytic tool to understand the disjuncture between the passage of laws restricting reproductive healthcare access and the will of the majority of voters. In this ethnographic project, Ohio serves as an important case study where efforts to elect a supermajority of extremist anti-abortion Republican officials has allowed for the passage of unpopular legislation restricting abortion. I argue that the mundane bureaucratic processes involved in electoral redistricting and state budget procedures are forms of bureaucratic violence that result in structural harm experienced by pregnant people, especially those who are most marginalized. Reproductive gerrymandering provides a means for theorizing the connections across domains involving partisan redistricting, reproductive governance in the form of anti-abortion legislation, and the structural violence experienced by pregnant people seeking abortion.

Patient patients: middle-aged British Pakistani women and the intuition of limits to care.

This paper examines the affective inequalities underpinning the extensive responsibilities of care that are shouldered by chronically ill -middle-aged British Pakistani women. In the context of ethnic health inequalities, chronic illness and premature ageing are ubiquitous. Further, mid-life generates gendered pinchpoints in the dynamics of care. The paper draws on extended conversations with women over seven/eight years and tracks their unsettled perspectives on sabar (patient endurance). Middle-aged women described how, over the long haul of living alongside chronic illness, they intuited that they must place some limits on caring for others, and that care required self-care - not in a biomedical sense, but in the sense of attention to their own bodily and relational needs. The paper extends anthropological critiques of Levinas's philosophy of infinite responsibilities to care, tracking how changes at several temporal scales - the life course, intergenerational re-negotiations - affect care. While social transformations of gender, and the proliferation of neoliberal discourses on self-care do affect the traction of normative notions of selfless care for others, the paper locates women's changing perspectives on sabar primarily in the provocations of everyday life.

Mistrustful Dependency: Mistrust as Risk Management in an Italian Emergency Department.

Mistrust is increasingly a daily reality of healthcare delivery worldwide. Yet it remains understudied as a form of relationship and a force in its own right. I address this gap through the ethnography of an Italian Emergency Department (ED), where conflicts have increased since the 2008 financial crisis. I show how mistrust does not result in a breakdown of healthcare interactions. Rather, mistrust is used in ambivalent care relationships to negotiate the roles, the risks, and the power that patients and staff are willing to entrust to others. Mistrust manifests in risk management strategies within relationships of "mistrustful dependency."

'A factory of therapy': accountability and the monitoring of psychological therapy in IAPT.

Since the introduction of the Improving Access to Psychological Therapies (IAPT) programme in NHS England, psychological therapy has gained traction as 'evidence-based' and 'effective' in both clinical and economic terms. In the process, psychotherapeutic care has been reconstituted as highly manualised, standardised, and quantifiable. Drawing on anthropological fieldwork with mental health practitioners, this paper examines some common tensions that practitioners experience in their daily work where psychotherapy is sought within the framework of evidence-based medicine (EBM). For therapists working within IAPT, extensive monitoring and practices of accountability have come to undermine psychotherapeutic efforts to care for patients as 'people'. As a result, many practitioners now feel that they are working in a 'factory of therapy' whereby psychological treatment is recast in the service of outcome measures, and by which critique of the IAPT service, as well as caring relations within it, have been precluded.

'I do not feel well here as such. But it has become my home': abandonment and care in healing shrines.

In thinking about care, much research has focused on kin relations, family-related care, and formal (medical) or informal care providers. Yet, how do we understand care responsibilities in contexts where kin care is absent despite being a desired social norm, and people turn to other community sources or practices? This paper draws on ethnographic research in a Sufi religious shrine in western India well-known for providing succor to those in distress, including those with mental illness. Interviews were conducted with pilgrims who had left homes due to strained relationships with kin members. For many of them, the shrine emerged as a sanctuary, even while not entirely a safe one, allowing women to live alone. While both academic research on mental health institutions and state responses have delved into the abandoned or 'dumped woman' in long-stay institutions or care homes, this paper argues that 'abandonment' is not a straightforward condition, but rather a dynamic discourse that works in different ways. For women bereft of kinship ties, narratives of being abandoned by kin became ways of justifying long (and sometimes permanent) residence in religious shrines, which were able to absorb such 'abandoned' pilgrims who had nowhere else to go, even if half-heartedly so. Importantly, these alternative forms of living made possible by shrines reflect women's agency, enabling women to live alone even while belonging to a community. In a context with limited social security options for women in precarious family situations, these care arrangements become significant, even if they are informal and ambivalent forms of care. Keywords: kinship; abandonment; agency; care; religious healing.

Pricing the Priceless Surgery: Professional Expertise and the Marketing of High-Risk Surgery in South Korea.

Through ethnographic fieldwork in cosmetic surgery clinics in Seoul, South Korea in 2018, in this article I investigate how professional clinicians persuade consumers to purchase surgery during consultations. Enamored by the ascendancy of the Korean cultural industry, many non-Koreans are drawn to Korea for the storied, domestic brand of surgery believed to be inextricable from the aesthetic appeal of their idols. Clinical professionals capitalize on this Korean ascendancy by transforming the meanings of surgical success (as symbolic attainment of moral-existential satisfaction) and failure (as deficiency of its symbolic rewards) to trust in their moral authority and expertise.

Narratives on Reproductive Justice Among Black Adolescent Girls in Clinical Research in the US.

Narratives reflecting on a longitudinal study of sexual and reproductive health during the adolescent years of young, low-income, Black women in the US show that participants felt cared for, supported, and recognized during the study in ways counter to dominant modes of structural, medical, and obstetric racism and stratified reproduction. Black women's narratives illuminate how research tools offered access to alternative, unanticipated, and improvised sources of Black feminist care and social networks that have much to teach us about how to transform adolescent care in the face of reproductive injustices in the US.

"Blood Has No Colour": Racialized Donor In/Ex-clusion in the South African National Blood Service.

Accounting for challenges with HIV transmission and testing, the South African National Blood Service (SANBS) transitioned toward eliminating race as a risk categorization in 2005 and actively recruiting black donors. I trace the racialization and nationalization of blood through an analysis of this transition, outreach efforts, and data from fieldwork with blood donors and SANBS staff. I examine indexicality as a semiotic means of in/ex-clusion in blood donation. Due to the sociocultural and medical significance of blood, an ethnographic account of blood services provides insights into biological citizenship and the dynamics of justice and reconciliation in post-apartheid South Africa.

A "Rich People's Disease": Migrant Workers and Structural Disability in China.

Drawing on fieldwork in southwest China, I examine how structural marginalization shapes therapeutic choices and healing experiences of chronic illness. I explore why Chinese rural migrant workers avoid chronic care in biomedicine to grapple with their chronic kidney disease. I show that migrant workers, who live precarious labor lives, experience chronic kidney disease as both a chronic, disabling experience and an acute crisis. I call for broader awareness of structural disability and argue that chronic disease care necessitates not only treating the disease but also the provision of equitable social security.

Weeping wombs: Leucorrhea and the chronicity of distress in Gilgit-Baltistan.

In Gilgit, capital of the Gilgit-Baltistan region in northern Pakistan, leucorrhea - vaginal discharge known in the vernacular as safaid pani, or 'white water' - serves as both a medical diagnosis and signifier of the chronicity of the reproductive, social, and emotional burdens endured by women. While ethnomedical providers explained safaid pani as resulting from relatively benign forms of 'weakness', which required minimal dietary or ethno-botanical recourse, allopathic physicians approached discharge as evidence of numerous pathologies that necessitated protracted and sometimes also expensive treatments. Physicians' clinical assessments were not solely biomedical, but also integrated informal folk and formal ethnomedical theories of causation. Clinical diagnoses that affirmed leucorrhea as a pathophysiology substantiated women's belief that it was proof of the destructive effects of sustained social inequity, peril, and distress on the body, and the uterus in particular. Women and their treating providers recognized the power of the (dys)functional uterus to not only threaten women's reproductive wellness but also their social, marital, and familial status, which hinged on their ability to become pregnant and give birth, to sons especially. Because of the ailing uterus's expansive importance, weeping wombs served as a potent source for women's claims making and calls for attention and care.

'Having the card makes us feel worthless': the negative value of government-funded health insurance in India.

Since the 2000s, hundreds of government-funded health insurance (GFHI) schemes were introduced in India. These schemes are meant to prevent poorer households from incurring catastrophic health expenditures. Through GFHIs, policy-makers want to mobilize the decision-making powers of private consumers in a liberalized healthcare market. Patients are called upon to act as 'co-creators' of healthcare value by optimizing supply through demand. Based on long-term ethnographic fieldwork with insurance users in South India, we argue that GFHIs fail because people experience the value of insurance in drastically different ways that only partly overlap with how the policy assumes they value insurance. In addition, the hollow promises of health coverage can be experienced as so frustrating that signing up for health insurance actually makes people feel devalued.

Latinx immigrant experiences with chronic illness management in Central Texas: reframing agency and liminality through nepantla.

Immigrant rights have become increasingly contentious and partisan issues in the United States, and especially within the U.S. healthcare system. It is particularly essential to pay attention to Latinx immigrants-the largest immigrant and uninsured population in the United States. Latinx immigrants face many structural and legal challenges that may impact their biomedical healthcare access and treatment, creating a state of liminality or in-betweenness, especially when managing a chronic illness such as diabetes, hypertension, or arthritis. Using qualitative methods at a free healthcare clinic in Central Texas, the study reveals how the chronic illness narrative becomes inextricable from the immigrant narrative for this particular group, and how a unique 'dual-liminality' emerges from living with both an immigrant status and chronic condition. This study also introduces how Gloria Anzaldúa's theory of nepantla can be used to push existing understandings of migrant liminality in medical anthropology by reframing the experiences of U.S. Latinx immigrants with chronic illness as ones of opportunity. Nepantla functions as a novel theoretical lens to better understand how Latinx immigrants may regain agency in their chronic illness management and promote social change by helping others in similar situations.

Biological embedding vs. embodiment of social experiences: How these two concepts form distinct thought styles around the social production of health inequalities.

OBJECTIVES: This article compares research on biological embedding and the embodiment of social experiences, two concepts proposed in the 1990s to introduce a new perspective on the social production of health inequalities. We draw on Ludwig Fleck's concept of 'thought style' (1935/2008) to question the possible emergence of a common research program around the processes by which the social becomes biological. METHODS: We compiled a corpus of 322 articles referring to either biological embedding or to the embodiment of social experiences, identified in the Web of Science core collection and published from 1990 to 2021. We analyzed the articles' use of these concepts using scientometric indicators and qualitative content analysis. RESULTS: Initial differences between the research agendas associated with biological embedding and embodiment are strengthened as both concepts circulate around scientific communities studying the social production of health inequalities. Thought styles formed around embedding and embodiment differ significantly in terms of shared references, sets of methods and research questions, and policy recommendations. Research on biological embedding forms a thought style shared by researchers in the biomedical and public health sciences. Conversely, the concept of embodiment of social experiences connects perspectives from biomedical, public health, human and social sciences, and gathers three thought styles, one identical to that of biological embedding and two formed in social epidemiology and in medical anthropology. CONCLUSIONS: Acknowledging the differences between the concepts and divergences in their evolution provides an opportunity for identification of topics where thought styles are either complementary or in tension.

Economic Rationalities and Notions of 'Good Cure and Care'.

The development of the health care system in Switzerland has recently been driven by different processes such as economic rationalization, bureaucratization, or digitalization, while maintaining professional notions of 'good cure and care.' Drawing on qualitative data from a Swiss acute hospital, we analyze how potentially market driven modes of governance manifest themselves in the everyday activities of nurses and physicians. We show how professional understandings of 'good cure and care' remain persistent and intermingle with logics that we call economic rationalities, manifesting in the four interrelated issues of financial pressure, bureaucratization, time pressure, and staff shortage.

Coming Out of Employers' Homes: Migration, Domestic Work and Health Claims.

Migrant domestic workers in Kuwait live amid structural inequalities, including health disparities, yet little is known about how they manage wellness alongside imperatives to work and earn. In this article, I examine Sri Lankan women's coming out of employers' homes through authorized and unauthorized channels and how they use illness and exhaustion to justify their need for more autonomous conditions. Exploring the physical, emotional, and political dimensions of these processes, I highlight the Sri Lankan vernacular notion of "heart-being" within women's actions to safeguard health and seek existential grounding, as they assert biolegitimate claims to return home or live unauthorized.

Colonial Geographies: Indigenous Access to Primary Care in British Columbia.

This article considers the demonstrated lack of access to primary health services in remote Indigenous communities in British Columbia as a form of structural exclusion shaped by the history of settler colonialism. Drawing on collaborative research conducted with an Indigenous nursing organization, I link ethnographic case studies with historical research demonstrating how racially segregated health care developed within an assimilatory political mandate. I argue that access to and quality of care must be understood as two inter-related dimensions of health equity, which must be regarded by decision-makers as a key site for addressing the health disparities faced by Indigenous populations.

'COVID containers' in pandemic mediascapes: discursive economies of health, bodies, and race in North America.

Bringing an ethnographic sensibility to pandemic mediascapes, this article critically examines three media artifacts that assembled around COVID-19 - as an entity that is viral, social, and political - in the early months of the pandemic in North America. Focusing on the household, the cruise ship, and the body-with-underlying-conditions as 'COVID containers', the author argues that material and discursive responses to the pandemic, articulated through imaginaries of containers and containment, uphold notions of risk, order, and health that garner meaning through implied racial intertexts. The article analyzes COVID-19-related data, graphics, talk, and news stories to show how logics of inside/outside, safety/risk, and comfort/fear that animate efforts to contain a viral threat intensify the pathologization, harm, surveillance, and risk of groups long imagined as 'threats' to social order. Throughout, The author demonstrates how idioms of containers and containment make 'the body' a key locus of health, diverting attention from systems and histories complicit in producing ill-health. A coda reflects on Scheper-Hughes and Lock's influential essay ' The mindful body', re-reading their articulation of the 'Western body' through lenses drawn from scholarship in Black studies, queer studies, and disability studies that are central to understanding COVID-19 as relation(s) - borne from racial capitalism - that differentially distribute risk, health, and care.

"But It's Not That They Don't Love Their Girls": Gender Equality, Reproductive Rights and Sex-Selective Abortion in Britain.

Recent demographic analysis of sex ratios at birth in the UK has signaled the issue of "missing girls" in British Asian minority populations. This paper juxtaposes the processes of reproductive regulation set in motion by this new demographic knowledge of son preference, with lived experiences of gender equality and family-making practices. Ethnographic research conducted with British Pakistani, Indian, and Bangladeshi families reveal diverse mechanisms of family decision-making that add to and nuance the prevailing statistics. We use the lens of "gender equality" and vernacular framings of sex-selective abortion to advance conceptual understandings of son preference as increasingly disconnected from selective reproduction, at the same time as selective reproduction is connected with the governance of ethnic minority identity and reproduction.

Datafied Pregnancies: Health Information Technologies and Reproductive Governance in Turkey.

Since the early 2000s, Turkey has been going through a dynamic period of health reforms where the global push toward health statistics has converged with the state's pronatalist concerns over declining birth rates. Reproductive behaviors are now monitored via health information technologies such as centralized databases. The World Health Organization and the Turkish Ministry of Health celebrate these technologies as essential steps toward evidence-based health care delivery. The everyday realities of these technologies, however, are more complicated, especially for nurses and their patients. Drawing on ethnographic fieldwork in state-run health clinics in Istanbul, this article demonstrates how these data-driven health technologies build on nurses' gendered care labor and increase surveillance on urban poor and/or ethnoracially minoritized communities. In doing so, I argue that the datafication of reproduction operates as a particular mode of "reproductive governance" (Morgan and Roberts 2012) that reflects and reproduces existing social hierarchies and inequalities.