Michael Calnan

University of Kent | KENT · School of Social Policy, Sociology and Social Research

In this paper we discuss the consequences of commercialisation of medicine and the associated shift in professional values, identity, and practices for patients, doctors, and health care organisations in India. We do so within the broader frame of the widely reported fall in trust in the health system in India, and with a view to reflect on how tru...

Context The COVID-19 pandemic has reignited a commitment from the health policy and health services research communities to rebuilding trust in healthcare and created a renewed appetite for measures of trust for system monitoring and evaluation. The aim of the present paper was to develop a multidimensional measure of trust in healthcare that: (1)...

Privatisation in its many guises has occurred in the NHS over the last decade. These have had their costs not least fragmentation leading to waste; creation of a self-seeking for-profit service sector; a threat to patient trust in the healthcare system and inequities in access to care with a two-tier system becoming a possibility

Introduction There is a growing acknowledgement of the salience of hope for mental health service-users, in influencing care outcomes and recovery. Understandings of the processes through which hopes are co-constructed, alongside specific conceptualisations of experiences of hoping, remain limited however. Methods This qualitative study explored h...

Background Trust in government is associated with health behaviours and is an important consideration in population health interventions. While there is a reported decline in public trust in government across OECD countries, the tools used to measure trust are limited in their use for informing action to (re)build trust, and have limitations relate...

Background Vaccine hesitancy exists on a continuum ranging between complete adherence and complete refusal due to doubts or concerns within a heterogeneous group of individuals. Despite widespread acknowledgement of the contextual factors influencing attitudes and beliefs shaping COVID-19 vaccine hesitancy, qualitative research with equity-deservin...

It is acknowledged that health technology assessment (HTA) is an inherently value-based activity that makes use of normative reasoning alongside empirical evidence. But the language used to conceptualise and articulate HTA's normative aspects is demonstrably unnuanced, imprecise, and inconsistently employed, undermining transparency and preventing...

The ability of governments and nations to handle crises and protect the lives of citizens is heavily dependent on the public’s trust in their governments and related social institutions. The aim of the present research was to understand public trust in government during a time of crisis, drawing on interview data (N = 56) collected during the COVID...

The importance of measuring trust in health systems has been accentuated due to its correlation with important health outcomes aimed at reducing COVID‐19 transmission. A systematic review published almost a decade ago identified gaps in measures including the lack of focus on trust in systems, inconsistency regarding the dimensionality of trust and...

are systems with similar universal principles, they can show different political measure patterns in the pharmaceutical field. This paper aimed to provide a comparative analysis of pharmaceutical policies highlighting strategies to guarantee access and sustainability to High-Price Medicines (HPMs) in Brazil and England. We performed an integrative...

In this chapter, we examine the social forces shaping the design and delivery of the COVID-19 vaccination programme in England. Looking beyond direct inclusion or exclusion in policy decision-making, we view health and health care as an arena containing several powerful interest groups. Our approach considers the influences, interests, and strategi...

Risk, vulnerability and uncertainty In the Introduction, we outlined a number of features of late-modern societies – uncertainty, complexity and abstractness in particular – which may serve to heighten experiences of anxiety and vulnerability (Wilkinson, 2001) and, moreover, exacerbate challenges to individual considerations of action and decision-...

The study of trust presented in this book is predominantly theoretical in nature, though our analyses of the concept are nevertheless grounded in, and illustrated through, qualitative data collected in our research within community-based services that deliver healthcare for people experiencing serious mental health problems – especially those with...

This book explores issues central to contemporary theoretical debates around the nature of trust, linking abstract concerns to empirical analysis with interviews with service-users, practitioners and managers.

This chapter will develop a theoretical framework for understanding how trust in the context of psychosis services is possible – in spite of the emphasis upon more negative characteristics of mental heath institutions within a range of narratives in public sphere discussions and, moreover, within the experiences of many service users. As touched up...

This final chapter has two main aims. First, to summarise the major themes that emerged from the theoretical and empirical analysis and discuss their implications for furthering the understanding of the nature and salience of trust relations in the context of mental healthcare and beyond. This will involve a summary of the key conclusions that emer...

Dependence, choice and trust A number of questions have appeared, more or less explicitly, within the preceding chapters pertaining to a tension between processes of trust formation and the extent of choice involved within these. One example of this was in Chapter Three where we followed Barbalet in noting a ‘forced option’ (Barbalet, 2009: 372) as...

Chapter Two analysed various ways in which service users developed trust in spite of general public perceptions, not to mention significant personal experiences, which might have warded against such positive expectations. Many of the social contexts and professional relations described by participants suggested positive grounds for trust, yet histo...

Thus far, much attention has been paid to the contexts of vulnerability and uncertainty that make trust relevant and salient for service users. We have briefly noted in earlier chapters that mental health professionals deal with manifold uncertainties, though the ways in which these uncertainties are intertwined with high levels of vulnerability ha...

This book explores issues central to contemporary theoretical debates around the nature of trust, linking abstract concerns to empirical analysis with interviews with service-users, practitioners and managers.

In this editorial, we identify the key questions requiring further exploration in the sociology of vaccines. In doing so, we discuss the socio-structural forces shaping views towards knowledge about and access to vaccination, trust in vaccines and regulators/decision makers, the associated problem of financial interests in vaccine development and r...

Although the National Health Service (NHS) and the Unified Health System (SUS) are systems with similar universal principles, they can show different political measure patterns in the pharmaceutical field. This paper aimed to provide a comparative analysis of pharmaceutical policies highlighting strategies to guarantee access and sustainability to...

This chapter begins with a brief overview of sociological perspectives on the body and why they have become topical of late. This provided the background context for understanding sociological perspectives about the aging body and the implications of changes in bodily appearance, bodily functioning, and bodily control. The decline in the aging body...

This entry focuses on the sociology of the body in the context of older age. It begins with a brief overview of sociological perspectives on the body and why it has become topical of late. This provides the context for understanding some sociological insights about the aging body and the implications of changes in bodily appearance, bodily function...

Providing a sociological analysis of the policy response to the COVID-19 pandemic in England, this study places particular analytical emphasis on the interplay between powerful structural interests and the influence on the development of COVID-19 policy. Considering a range of actors, (including the government, scientific experts and the medical pr...

Decisions need to be made about which services or technologies should be prioritized for provision in the NHS in England .The analysis focuses specifically on the National Institute for Health and Care Excellence (NICE), and on how they appraise expensive medicines. This analysis takes a sociological perspective on decision-making in relation to un...

In the context of current clinical practice guidance, this paper will analyse the role of GPs in decision-making about the primary prevention of cardiovascular disease (CVD) using theconcept of pharmaceuticalisation. Drawing on thematic analysis of semi-structuredinterviews with 20 GPs, the paper argues that the way GPs approach CVD pharmaceuticali...

Recent policy conversations about vaccination programmes primarily target the problem of vaccine hesitancy and the lack of public participation at the level required for community immunity, or herd immunity. In this editorial, we will first explore the nature of public vaccine hesitancy, review what is known and demonstrate the significance of unde...

The global Covid-19 pandemic is posing considerable challenges for governments throughout the world and has and will have a significant influence on the shape of peoples social and economic life and wellbeing in the short and longer term. This opinion paper discusses the current health policy response adopted in England to control or manage the epi...

The global Covid-19 pandemic is posing considerable challenges for governments throughout the world and has and will have a significant influence on the shape of peoples social and economic life and wellbeing in the short and longer term. This opinion paper discusses the current health policy response adopted in England to control or manage the epi...

The global Covid-19 pandemic is posing considerable challenges for governments throughout the world and has and will have a significant influence on the shape of peoples social and economic life and wellbeing in the short and longer term. This opinion paper discusses the current health policy response adopted in England to control or manage the epi...

This chapter focuses on the introduction and implementation of the Health and Social Care Act (2012) in England which reignited the debate about the extent to which the government funded National Health Service (NHS) in England is being privatised and/or marketised. It analyses past health service policy developments as they relate to the role of t...

This chapter focuses on the introduction and implementation of the Health and Social Care Act (UK Legislation 2012) in England which reignited the debate about the extent to which the government-funded National Health Service (NHS) is being privatised and/or marketised. It analyses past health service policy developments as they relate to the role...

This chapter explores key sociological questions about what work looks like in the twenty-first century in Britain and argues that while changes in the form, experience, and understanding of work might in some ways be significant, they are in the main, partial and piecemeal. We begin with a brief review of the consequences of industrialization and...

From childhood to millennials and beyond, we need to take a life-course approach to occupation and work when in pain. In ‘Foundations’, we provide a critical account of the nature of work, and of pain. In ‘Investigations’, we analyse bi-directional relationships between children living with chronic pain and parents; between being a child in pain an...

• This chapter explores the use of survey methods in research into health and health care which are widely used in this and other fields of research • It begins by defining and explaining what quantitative survey methodology is; the techniques and resources required for carrying out a survey • It outlines and the role of theory and the process of...

Consumer trust in the modern food system is essential given its complexity. Contexts vary across countries with regard to food incidents, regulation and systems. It is therefore of interest to compare how key actors in different countries might approach (re)building consumer trust in the food system; and particularly relevant to understanding how f...

Purpose The purpose of this paper is to compare the perspectives of actors who contribute to trust in the food system in four high income countries which have diverse food incident histories: Australia, New Zealand (NZ), the United Kingdom (UK) and the Island of Ireland (IOI), focussing on their communication with the public, and their approach to...

This commentary expands on two of the key themes briefly raised in the paper involving analysis of the evidence about key contextual influences on decisions of value. The first theme focuses on the need to explore in more detail what is called backstage decision-making looking at how actual decisions are made drawing on evidence from ethnographies...

It has been argued that the health system in India appears to be systematically falling short in achieving equitable improvements in health status, quality of care, and social and financial risk protection. The poor performance of the health system is to a large extent due to the failure of the state regulators and of the professional associations...

Introduction The perspectives of older people on dignity in care have been largely overlooked in British policies, and the tendency has been to look at ways in which care providers should ‘deliver dignity’ by reference to agreed standards. For example, the Dignity Challenge developed in 2006 identified 10 dignity tests against which services could...

Older people’s perspectives on their experiences of ageing and dependency shed light on the complex nature of dignity as a personal and social concept. In this study, participants revealed how, as they became dependent on others for support and care, their lives felt increasingly precarious and their sense of dignity was challenged. Influenced by t...

This paper is a chapter in the first book in the Sociology of Health Professions series. Book Link: https://policy.bristoluniversitypress.co.uk/professional-health-regulation-in-the-public-interest. Chapter Abstract: The general intention of systems of regulation is to control the practices of actors to achieve a variety of economic and social obj...

Introduction At the heart of the regulatory enterprise is the intention to control the behaviour of actors to achieve a variety of economic objectives and social objectives in the public interest. This chapter examines the current regulatory regimes and practices in the health system in India, using the trust/control duality as an analytical frame....

This article reports on a discourse analysis of the representation of healthcare in the print news media, and the way this representation shapes perspectives of healthcare. We analysed news items from six major Australian newspapers over a three-year time period. We show how various framing devices promote ideas about a crisis in the current public...

Background: The 2013-2016 Ebola virus disease (EVD) epidemic in West Africa was the largest in history and resulted in a huge public health burden and significant social and economic impact in those countries most affected. Its size, duration and geographical spread presents important opportunities for research than might help national and global h...

Context: The National Institute for Health and Care Excellence (NICE) has an explicit mandate to include patient and public involvement in the appraisal of medicines to be available for funding on the NHS. NICE involves an appraisal committee who are required to take on board experiential evidence from patient experts alongside population-based ev...

Is having a trusting doctor-patient relationship better for patients’ health?

Background Food regulatory bodies play an important role in public health, and in reducing the costs of food borne illness that are absorbed by both industry and government. Regulation in the food industry involves a relationship between regulators and members of the industry, and it is imperative that these relationships are built on trust. Resear...

This article examines the "technological appraisals" carried out by the National Institute for Health and Care Excellence as it regulates the provision of expensive new drugs within the English National Health Service on cost-effectiveness grounds. Ostensibly this is a highly rational process by which the regulatory mechanisms absorb uncertainty, b...

This article discusses findings from a qualitative longitudinal study of dignity in later life, which focused on the perspectives of older people at a time when their need for help and support was increasing as a result of long-term illness. It reflects critically on the methodology for its ability to generate knowledge about this eventful and unst...

In India, over the last decade, a series of stewardship failures in the health system, particularly in the medical profession, have led to a massive erosion of trust in these institutions. In many low- and middle-income countries (LMICs), the situation is similar and has reached crisis proportions; this crisis requires urgent attention. This paper...

Background During the last two decades, differential consumption patterns in health-related behaviours have increasingly been highlighted as playing an important role in explaining persistent and widening health inequalities. This period has also seen government public health policies in England place a greater emphasis on changing ‘lifestyle’ beha...

This chapter explores very specific features of organisational culture, that of interwoven relations of (dis)trust across organisations, which bear fundamentally on the communicative and learning functioning of local healthcare services. Theoretical understandings of the interlinking of different trust relationships across healthcare settings remai...

In many contemporary healthcare systems, individuals are expected to be rational actors – weighing up available knowledge and making choices about their healthcare needs. In the policy context, this has been most explicitly applied to the financing of healthcare where there is encouragement for the purchase of private health insurance. However, per...

Background In response to long waiting lists and problems with access to primary care physiotherapy, several Primary Care Trusts (PCTs) (now Clinical Commissioning Groups CCGs) developed physiotherapy-led telephone assessment and treatment services. The Medical Research Council (MRC) funded PhysioDirect trial was a randomised control trial (RCT) in...

Quality and safety in healthcare settings are underpinned by organisational cultures, which facilitate or impede the refinement, sharing and application of knowledge. Avoiding the use of the term culture as a residual category, we focus specifically on describing chains of (dis)trust, analysing their development across relatively low-trust service...

This article presents an ethnographic study of regulatory decision-making regarding the cost-effectiveness of expensive medicines at the National Institute for Health and Care Excellence (NICE) in England. We explored trust as one important mechanism by which problems of complexity and uncertainty were resolved. Existing studies note the salience o...

Policy discourse shaped by neoliberal ideology, with its emphasis on marketisation and competition, has highlighted the importance of choice in the context of healthcare and health systems globally. Yet, evidence about how so-called consumers perceive and experience healthcare choice is in short supply and limited to specific healthcare systems, pr...

This paper explores the nature and reasoning for (dis)trust in Australian public and private hospitals. Patient trust increases uptake of, engagement with and optimal outcomes from healthcare services and is therefore central to health practice, policy and planning. A qualitative study in South Australia, including 36 in-depth interviews (18 from p...

Commentators suggest there is erosion of trust in the relations between different actors in the health system in India. This paper presents the results of an exploratory study of the situation of the providers in an urban setting in western India, the nature of their relations in terms of trust and what influences these trust relations. The data on...

The moral component of living with illness has been neglected in analyses of long-term illness experiences. This article attempts to fill this gap by exploring the role of the moral experience of illness in mediating the ability of those living with a long-term condition (LTC) to normalise. This is explored through an empirical study of women of Pu...

Theoretical analyses in sociological specialist areas such as health and illness are believed to be led by theorising from mainstream sociological thinking. However, in some cases the reverse is evident, such as in the sociology of professionalism, where considerable debate has focused on the changing position of medicine and doctors, which has bee...

Background Previous research has shown that the media can play a role in shaping consumer perceptions during a public health crisis. In order for public health professionals to communicate well-informed health information to the media, it is important that they understand how media view their role in transmitting public health information to consu...

In this article we examine how and why the media construct food risks, from the perspective of ‘media actors’ (people involved in different types of media) using data from 30 interviews conducted in 2013 with media actors from Australia and the United Kingdom. In modern society, many risks are invisible and are brought to the attention of the publi...

In modern society, many risks are invisible and are brought to the attention of the public through the mass media. This is particularly relevant for food, where the widening gap between producers and consumers in the developed world has increased the need for consumer trust. Therefore the media play a crucial role in how risk is constructed and pre...

This paper examines the ‘technological appraisals’ carried out by NICE (National Institute for Health and Care Excellence) as it regulates the provision of new drugs within the English NHS on cost effectiveness grounds. Regulators must assess and manage risk in order to ensure the effective functioning of the transactions which occur under their ju...