|I’m delighted to present my book: Health and the Network Society published by Ariel now available at the book stores. I perfectly know that it would not become a best-seller but I hope it could contribute just a little to foster new debates and further research on ICT and Health.Health systems are embedded within technological, economic, social and cultural changes of our current social structure: the network society. This book is based on empirical research about the transition of the Catalan health system towards the network society. The results show how the interaction between the technological, economic, organizational, social and cultural dimensions are facilitating the emergence of new profiles of citizens, patients and healthcare professionals. The determinants that shape these new profiles allow us to identify the inhibitors and drivers of Industrial healthcare systems towards the Network healthcare systems.|
I’m glad to share my slides presented on World Internet Project 2009 – Macau entitled Health and the Internet: Autonomy of the User. The presentation is based on a paper written by Rita Espanha and myself for the book “World Wide Internet. Changing Societies, Economies and Cultures” edited by Gustavo Cardoso, Angus Cheong and Jeffrey Cole.
I’m delighted with the great atmosphere of the conference due to the different research perspectives that have been presented by researchers around the world. Twitter #wip200. Finally, thanks Rita for the opportunity to work together. This presentation and the book chapter are just the begining.
Notes from the conference: Internet Research 9.0: Rethinking Community, Rethinking Space. Copenhagen October 15 – 18, 2008. Mimi Ito: Hanging Out, Messing Around and Geeking Out: Youth Participation in Networked Publics.
Mimi Ito is a cultural anthropologist studying new media use, particularly among young people in Japan and the US. Her research right now focuses on digital media use in the US and portable technologies in Japan. Her last works published are: Networked Publics and Beyond Barbie® and Mortal Kombat: New Perspectives on Gender and Gaming. I strongly recommend the reading of her blog.
Her presentation was based on Digital Youth Research project:
Since the early 1980s, digital media have held out the promise of more engaged, child-centered learning opportunities. The advent of Internet-enabled personal computers and mobile devices has added a new layer of communication and social networking to the interactive digital mix. While this evolving palette of technologies has demonstrated the ability to capture the attention of young people, the innovative learning outcomes that educators had hoped for are more elusive. Although computers are now fixtures in most schools and many homes, there is a growing recognition that kids’ passion for digital media has been ignited more by peer group sociability and play than academic learning. This gap between in-school and out-of-school experience represents a gap in children’s engagement in learning, a gap in our research and understandings, and a missed opportunity to reenergize public education. This project works to address this gap with a targeted set of ethnographic investigations into three emergent modes of informal learning that young people are practicing using new media technologies: communication, learning, and play +info.
Mimi Ito stars with the team members of the project and with the objectives:
The first objective is to describe kids as active innovators using digital media rather than as passive consumers of popular culture or academic knowledge.
The second objective is to think about the implications of kids’ innovative cultures for schools and higher education and to engage in a dialogue with educational planners.
The third objective is to advise software designers about how to use kids’ innovative approaches to knowledge and learning in building better software.
Then she explains the methodology based on ethnographic research in both local neighborhoods in Northern and Southern California, and in virtual places and networks such as online games, blogs, messaging, and online interest groups. Mimi Ito also remarks the amount of data collected: 594 semi structure interviews; 79 informal interviews; 67 groups; 28 diary studies; 4146 questionnaires and also more than 5000 hours of observation of 10468 profiles; 15 on-line forums; 389 videos; 50 events and classroom observation.
After that she introduces to the audience the term networked publics as “an alternative to terms such as audience or consumer. Rather than assume that everyday media engagement is passive or consumptive, the term publics foregrounds a more engaged stance. Networked publics takes this further; now publics are communicating more and more through complex networks that are bottom-up, top-down, as well as side-to-side. Publics can be reactors, (re)makers and (re)distributors, engaging in shared culture and knowledge through discourse and social exchange as well as through acts of media reception”.
Mimi Ito remarks that Youth Networked Publics like traditional youth publics are based on: local scale of interaction, many to many and peer to peer forms of participating, sharing and learning. But unlike traditional youth publics are also based on: accesibility 24/7, persistence, networked peer space, access to more specialized and niche publics, broader contexts for publication and privacy.
Networked publics are sources of diversity about identity, culture and practice. Further beyond access issues, Mimi Ito identifies two main drivers:
1. Friendship-driven learning and participation: peer to peer sharing and reputation.
Kids prefer to hang out, participate, socialize off-line but time, space and structural restrictions encourage them to go on-line. Research results reveals that most of the kids prefer to meet people first off-line and after that face to face meeting go on-line. Otherwise, you can be consider as a freak or a geek by your own friends “Meeting people first on-line is not cool”.
Mimi Ito uses the term peer pressure to identify some practice among kids “If I put someone in my top ten friend on Facebook or MySpace, that someone is supposed to do the same with me”. On-line reputation has consequences on off-line reputation. Another way of peer pressure was the consequences of private data available on SNS as amplifiers of “drama” thinking about the changes on engaged or falling in love in the personal profile.
Finally, Mimi Ito states that kids share social practice… they help each other to create, produce and distribute content through social technology.
2. Interest-driven learning and participation. Still a minority of youth is driven by interest. Two case studies based on FANSUBBING and ANIME MUSIC VIDEOS.
After the explanation of these two case studies Mimi Ito finishes her talk with some considerations about the diversity in genres of youth participation on-line; peer based learning, participation and reputation; the scale of networked communities and the youth access to broader audiences; new forms of litarecy and media social practice used by youth to produce knowledge without the constrictions of the adul world.
I really enjoy Mimi Ito speech and her work but I wonder why her research project does not take into account the traditional categories like education level, parents’ wages, family structure,… Do they matter? Am I old fashion?
Update – Video Mimi Ito Keynote @ IR9.0
The entire infrastructure and culture of medicine is being transformed by digital technology, the Internet and mobile devices. Cyberspace is now regularly used to provide medical advice and medication, with great numbers of sufferers immersing themselves within virtual communities. What are the implications of this medicalisation of cyberspace for how people make sense of health and identity?
The Medicalisation of Cyberspace is the first book to explore the relationship between digital culture and medical sociology. It examines how technology is redefining expectations of and relationships with medical culture, addressing the following questions:
- How will the rise of digital communities affect traditional notions of medical expertise?
- What will the medicalisation of cyberspace mean in a new era of posthuman enhancements?
- How should we regard hype and exaggeration about science in the media and how can this encourage public engagement with bioethics?
This book looks at the complex interactions between health, medicalisation, cyberculture, the body and identity. It addresses topical issues, such as medical governance, reproductive rights, eating disorders, Web 2.0, and perspectives on posthumanism. It is essential reading for healthcare professionals and social, philosophical and cultural theorists of health.
I have started to read the book but I haven’t finished it yet so I can not comment many things. As you can see above I have reproduced the back page of the book and linked the table of contents. It looks very interesting.
I am positively amazed by the digital identity of the authors. Andy Miah and Emma Rich have their own web sites and they have developed a blog with the same title of the book The Medicalization of Cyberspace. It looks like the “new generation” of researchers are taking care of the Internet to spread their work and build their networks.
I’m working on the introduction of my thesis tentatively titled “Health and the Internet in the Network Society” and I have started to read Ways of Knowing: a New History of Science, Technology and Medicine by John V. Pickstone.
About the book:
In Ways of Knowing, John V. Pickstone provides a new and accessible framework for understanding science, technology, and medicine (STM) in the West from the Renaissance to the present. Pickstone’s approach has four key features. First, he synthesizes the long-term histories and philosophies of disciplines that are normally studied separately. Second, he dissects STM into specific ways of knowing—natural history, analysis, and experimentalism—with separate but interlinked elements. Third, he explores these ways of knowing as forms of work related to our various technologies for making, mending, and destroying. And finally, he relates scientific and technical knowledges to popular understandings and to politics.
Covering an incredibly wide range of subjects, from minerals and machines to patients and pharmaceuticals, and from experimental physics to genetic engineering, Pickstone’s Ways of Knowing challenges the reader to reexamine traditional conceptualizations of the history, philosophy, and social studies of science, technology, and medicine.
About the author:
John V. Pickstone is director of the Centre for the History of Science, Technology and Medicine and the Wellcome Unit for the History of Medicine at the University of Manchester. He has edited or coedited a number of books, most recently Medicine in the Twentieth Century (with Roger Cooter), and has written widely on the history of biomedical sciences, medicine, and science in Britain, and on medical innovations and policy.
My notes will be reproduced at the wiki.
I have been reading and taking some wiki notes about ‘Pathways to the Doctor’ in the Information Age: the Role of ICTs in Contemporary Lay Referral Systems written by Nettleton and Hanlon. The article stars explaining the ‘clinical iceberg’ concept identified by social scientists (Last, 1963; Wadsworth et al., 1971) during the post-war years. This concept refers to how and why individuals do, or do not seek medical help. In 1973, Zola’s study of the reasons given by outpatients revealed that it was not symptoms per se that prompted people to seek help but rather it was their social circumstances. He identified five ‘distinct no-physiological’ triggers to the decision to seek medical aid’:
- the occurrence of an interpersonal crisis;
- the perceived interference of an illness with social relationship;
- ‘sanctioning’ by another person that a visit is warranted;
- perceived interference whith physical activities;
- and temporalizing symptoms -’if its no better by Monday’ (p.58).
In other words medical and health advice was proffered and sought within what came know as the ‘lay referral system’ (Freidson, 1970). Sociologists therefore cast light on the informal health care work undertaken by lay people and demonstrated that in seeking formal health care professionals saw only the tip of the iceberg of illness (p.58).
Echoing Pickstone’s periodisations of medicine, Smith (2002) conceptualises a move from what he calls ‘industrial age medicine’ to ‘information age healthcare’:
Going over my notes, I have found points in common between the ‘clinical iceberg’ and ‘the long tail’ concept. But even in this ‘Information age health care’ Nettleton and Hanlon concluded that people’s pathways to care are rooted in their wider social circumstances, their particular health care needs and, in terms of gender at least, are structurally constrained. But somewhat paradoxically there seem to be two processes at work here. On the one hand there is a growing diversity of health care provision and use, and yet on the other hand the norms and values that underpin notions of health care use are concurrently contributing to reinforcement of the caution and conventionality. It appears that the Internet use is actually more contextually specific and so the circumstances of use tend to be both embedded and embodied.
I have been reading Health, Technology & Society. A Sociological Critique written by Andrew Webster, who has also written other articles and books about this issue. I would like to share my notes about the first chapter titled Understanding Innovative Health Technologies, partially based on other author’s paper Innovative Health Technologies and the Social: Redefining Health, Medicine and the Body.
The book explores fundamental changes in the way we understand and manage our health and our bodies, and how this understanding has been shaped by, and given expression through, developments in medical and related technologies (p.1) from a sociological perspective. This perspective argues that these technologies and the techniques, models and assumptions on which they are based, are given meaning through the way they are tied into other technologies ans social practices… The meaning of health technologies will also vary in different settings (from clinic, to the home, to the Internet), and vary in the way shape diverses notions of ‘health’ found within and between cultures. In this sense, technologies (not only the health but all fields) are best understood as an expression of, and thereby always expressed through, social relationship (p.1) .
The author states that medical technologies are two-sided: they provide new, more detailed, sources of information about our illness but at the same time new forms of uncertainty and risk. These relate not only to our understanding of the illness but also the expectations that inform and guide the social relationship through which we define and manage it. If technologies are congealed social relationship, those that disrupt existing relationship can be specially problematic.
Therefore, new health technologies not only disrupt relationship we have with other people, they can also redefine our relationship towards our own body and our sense of being well or ill, our sense of control over our body and its parts (p.2). A sociological perspective is also interested in the processes through which new health technologies are introduced in the first place, and what factors have shaped their introduction. Health and its definition depend not merely on a person’s sense of well being, but on powerful professional, commercial and institutional interests that captures health in order to define, control and exploit or deliver ‘it’ (p.3) .
New technologies, new health?
Webster identifies three innovative health technology based on those areas that are receiving disproportionately large levels of public and private funding upstream or those appearing in documents of health policy world that spends all its time scanning for the ‘horizon’ for ‘disruptive’ technologies…(p.6):
- Genetics-related developments
- Informatics-based systems and eHealth
- Tissue-related biomedicine
Even these three broad areas are strongly related with the development of the Information and Communication Technologies I wil just focus on Informatics-based systems and eHealth. The author refers to E-Health as a mix of digital technologies whose function is to diagnose, monitor, store and relay information about health, the patient, and the huge volumen of management data-flows that characterize national health systems today. They reflect a time of audit, standardization, technocracy and ambitions towards more efficient systems for managing health resources (p.11) . Based on the studies of other author, Webster describes some consequences of these technologies, talking about ’citizen-terminals’, ‘virtual human’, ‘smart homes’, ‘health Internet seeker’ and ‘e-scaped medicine’.
Developing the sociological critique
The author remarks there had been a much longer tradition in social theory that located health squarely within the wider structural and cultural dynamics of society (p.15) and wonders How, we might ask are these structural patterns of health mediated by the new technologies sketched mentioned above: will, for example, the introduction of e-health exacerbate or ameliorate access to health care and advice? (p.16)
What then can we say provides the core issues that would inform a sociological critique of the relations between health, technology and society? Such a critique, he suggests, would explore and challenges the implications of medical technoscience with respect to:
- the socio-economic factors shaping innovation and how these affect the structuring of health care delivery;
- the patterns of inequality in morbidity and mortality;
- the public and the private institutions that are investing huge amounts of political and economic capital in existing and novel areas such as genetics, informatics and tissue engineering fields;
- the regulation and control of new medical technologies;
- embodied knowledge about experience of health and disease. (p.17)
These are the main issues, they need to be understood as part of a wider range of structural and institutional changes characterizing contemporary societies that are not restricted to the field of medicine and health (p.18)
- The growing individualisation of our lives;
- The changing relationships between lay and expert knowledge;
- The increasingly globalised contest over (health) rights and resources;
- The tension between the political regulation and economic promotion of innovation by the state. (p.18)
We can see developments in technoscience in terms of three broad but related changes that have opened up clinical medicine to new influences and actors:
- Socialisation of medical innovation refers to the ways in which lay people are enrolled as active participants in the development of new technologies from the very early stage of develpment.
- Socialisation of clinical diagnosis refers to the fracturing of the medical monopoly over the meaning of health and disease, specially through the arrival of what has been called a ‘new medical pluralism’.
- Socialisation of clinical implementation refers to the ways in which lay people are required, but also perhaps actively embrace a turn towards taking greater responsability for making new health technologies ‘work’.
These three processes have then redefined the spatial, experimental and epistemic boundaries of convetional medicine and clinic. The critique must be the attentive context of use of technologies to reflect any notion of technological determinism across different contexts. It must explore the ways in which users (patients, carers, clinicians, etc.) make sense of technologies and how re-order the meaning of health. It must examine the expectations and hopes that surround them, and the subtle and not so subtle forms of inequity and insecurity they create.