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Similar to Martin French: How Do Surveillance Systems Organize HIV Service Delivery?
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Martin French: How Do Surveillance Systems Organize HIV Service Delivery?
- 1. HHooww DDoo SSuurrvveeiillllaannccee SSyysstteemmss OOrrggaanniizzee SSeerrvviiccee DDeelliivveerryy?? The Case of HIV Surveillance in Ontario Martin French Sociology & Anthropology
- 2. OOuuttlliinnee II.. SScchhoollaarrsshhiipp oonn SSuurrvveeiillllaannccee aanndd WWoorrkk PPrraaccttiiccee IIII.. HHIIVV SSuurrvveeiillllaannccee iinn OOnnttaarriioo——HHooww DDooeess IItt WWoorrkk?? TTwwoo mmuuttuuaallllyy--rreeiinnffoorrcciinngg cciirrccuuiittss ooff ssuurrvveeiillllaannccee EEppiiddeemmiioollooggiiccaall ssuurrvveeiillllaannccee SSuurrvveeiillllaannccee aatt tthhee ppooiinntt--ooff--ccaarree oorr sseerrvviiccee ddeelliivveerryy II.. SSeerrvviiccee PPrroovviiddeerrss aass SSuurrvveeiillllaannccee AAggeennttss?? IIII.. CCoonncclluuddiinngg RReemmaarrkkss
- 3. SScchhoollaarrsshhiipp oonn SSuurrvveeiillllaannccee aanndd WWoorrkk PPrraaccttiiccee CCllaassssiicc ssoocciioollooggiieess (ee..gg.. KKaarrll MMaarrxx, MMaaxx WWeebbeerr)) iilllluussttrraatteedd hhooww ssuuppeerrvviissiioonn aanndd oovveerrssiigghhtt ccoouulldd ccoonnssttrraaiinn iinnddiivviidduuaall ddiissccrreettiioonn iinn tthhee ccoonntteexxtt ooff oorrggaanniizzaattiioonnaall wwoorrkk Part I
- 4. SScchhoollaarrsshhiipp oonn SSuurrvveeiillllaannccee aanndd WWoorrkk PPrraaccttiiccee MMoorree ccoonntteemmppoorraarriillyy,, ssoocciiaall sscciieennttiissttss ((ee..gg.. GGeeooffff BBoowwkkeerr aanndd SSuussaann LLeeiigghh SSttaarr)) hhaavvee iilllluussttrraatteedd tthhee rroollee ooff ccllaassssiiffiiccaattiioonn aanndd ssuurrvveeiillllaannccee ssyysstteemmss iinn tthhee rreegguullaattiioonn nnoott jjuusstt ooff sseerrvviiccee pprroovviissiioonn,, bbuutt aallssoo pprrooffeessssiioonnaall pprraaccttiiccee.. Part I
- 5. HHIIVV SSuurrvveeiillllaannccee iinn OOnnttaarriioo—— HHooww DDooeess IItt WWoorrkk?? HHIIVV TTeessttiinngg NNoommiinnaall NNoonn-nnoommiinnaall AAnnoonnyymmoouuss Part II
- 6. HHIIVV SSuurrvveeiillllaannccee iinn OOnnttaarriioo—— HHooww DDooeess IItt WWoorrkk?? HHIIVV TTeessttiinngg aanndd eeppiiddeemmiioollooggiiccaall ssuurrvveeiillllaannccee PPoolliittiiccss ooff ccllaassssiiffiiccaattiioonn Part II
- 7. HHIIVV SSuurrvveeiillllaannccee iinn OOnnttaarriioo—— HHooww DDooeess IItt WWoorrkk?? HHIIVV TTeessttiinngg aanndd SSuurrvveeiillllaannccee aatt tthhee ppooiinntt--ooff--ccaarree IIddeeaallllyy uusseedd ttoo gguuiiddee ssuubbsseeqquueenntt cclliinniiccaall iinntteerraaccttiioonnss Part II
- 8. SSeerrvviiccee PPrroovviiddeerrss aass SSuurrvveeiillllaannccee AAggeennttss?? HHIIVV TTeessttiinngg aanndd SSuurrvveeiillllaannccee aatt tthhee ppooiinntt--ooff--ccaarree CCaarree——CCoonnttrrooll Part III
- 10. AAcckknnoowwlleeddggeemmeennttss TThhaannkkss ttoo AAlleexx MMccCClleellllaanndd ffoorr oorrggaanniizziinngg tthhiiss iimmppoorrttaanntt wwoorrkksshhoopp aanndd ffoorr iinnvviittiinngg mmee ttoo ppaarrttiicciippaattee TThhaannkkss ttoo LLiiaamm MMiicchhaauudd ffoorr aaccttiinngg aass oouurr ddiissccuussssaanntt TThhaannkkss,, eevveerryyoonnee,, ffoorr ppaarrttiicciippaattiinngg iinn tthhiiss ddiissccuussssiioonn TThhaannkkss ttoo SSSSHHRRCC,, CCIIHHRR aanndd tthhee UUSS HHHHSS ffoorr ffuunnddiinngg wwhhiillee ccoonndduuccttiinngg tthhee rreesseeaarrcchh iinnffoorrmmiinngg tthhiiss pprreesseennttaattiioonn Part IV
- 11. RReeffeerreenncceess BBoowwkkeerr aanndd SSttaarr BBeerrgg DDooddddss,, CC..,, WWeeaaiitt,, MM..,, BBoouurrnnee,, AA..,, EEggeeddee,, SS..,, JJeessssuupp,, KK..,, aanndd WWeeaatthheerrbbuurrnn,, PP.. ((22001133)).. KKeeeeppiinngg CCoonnffiiddeennccee:: HHIIVV aanndd tthhee CCrriimmiinnaall LLaaww ffrroomm SSeerrvviiccee PPrroovviiddeerr PPeerrssppeeccttiivveess.. LLoonnddoonn:: SSiiggmmaa RReesseeaarrcchh,, LLoonnddoonn SScchhooooll ooff HHyyggiieennee aanndd TTrrooppiiccaall MMeeddiicciinnee MMooll MMyykkhhaalloovvsskkiiyy,, EE.. 22001111.. ““TThhee PPrroobblleemm ooff ‘‘SSiiggnniiffiiccaanntt RRiisskk’’:: EExxpplloorriinngg tthhee PPuubblliicc HHeeaalltthh IImmppaacctt ooff CCrriimmiinnaalliizziinngg HHIIVV NNoonn--ddiisscclloossuurree,,”” SSoocciiaall SScciieennccee && MMeeddiicciinnee 7733((55)):: 666688--667755.. MMyykkhhaalloovvsskkiiyy,, EE..,, BBeetttteerriiddggee,, GG..,, aanndd MMccLLaayy,, DD.. 22001100.. HHIIVV NNoonn--DDiisscclloossuurree aanndd tthhee CCrriimmiinnaall LLaaww:: EEssttaabblliisshhiinngg PPoolliiccyy OOppttiioonnss ffoorr OOnnttaarriioo.. TToorroonnttoo:: aa rreeppoorrtt ffuunnddeedd bbyy aa ggrraanntt ffrroomm tthhee OOnnttaarriioo HHIIVV TTrreeaattmmeenntt NNeettwwoorrkk.. OO’’BByyrrnnee,, PP.. aanndd GGaaggnnoonn,, MM.. ((22001122)).. ‘‘HHIIVV CCrriimmiinnaalliizzaattiioonn && NNuurrssiinngg PPrraaccttiiccee’’.. AAppoorriiaa:: TThhee NNuurrssiinngg JJoouurrnnaall,, 44((22)),, 55--3344.. SSaannddeerrss Part IV
Editor's Notes
- Although they didn’t use the concept of surveillance per se, Classic sociologies illustrated how supervision and oversight could constrain individual discretion in the context of organizational work For instance, we might think of Karl Marx’s analyses of labour in factory settings as illustrating the regulation of collective labour power through an assemblage of autonomous machines and managerial oversight. Similarly, we can think of Max Weber’s analyses of bureaucratic administration as illustrating the implication of bureaucratic knowledge-management in the exercise of domination.
- More contemporarily, social scientists have illustrated the role of classification and surveillance systems in the regulation not just of service provision, but also professional practice. For example, in their seminal study entitled Sorting Things Out: Classification and its Consequences, Geoff Bowker and Susan Leigh Star discuss the commonly hidden politics of classification. They emphasize that classifications have a material force (bring in Gary’s work here?), and that we need to attend to the politics that accompany the embedding of classifications into the information infrastructures that mediate and enable distributed forms of work In a fascinating case-study of a nursing-information system, they also show how the introduction of new information technologies do much more than support work already being done. New information technologies, Bowker and Star argue, change the very nature of the work they are meant to support; they codify what kinds of work will count as legitimate, and by extension, what sorts of work practices are illegitimate. I think the key take-away message from this scholarship, for our discussion today, is that we have to understand new information tools, like OCHART for instance, as much more than mere tools that support ongoing work. They are also, in effect, surveillance and classification systems, and they codify some kinds of work as more legitimate than other kinds of work. As a corollary, they may increase the discretionary latitude of some, while constraining the discretionary latitude of others. I think it’s important to emphasize that this isn’t necessarily a bad thing. Such systems can be amazing tools for propagating best-practices, for example. Even still, one wants to ask about the costs as well as the benefits of these systems.
- I want to talk about another circuit of surveillance, which is not wholly unrelated to epidemiological surveillance, but which is nonetheless distinct in some important ways. Whereas in epidemiological surveillance the emphasis is commonly placed discerning patterns in aggregate data, surveillance at the point-of-care or point-of-service delivery has mainly to do with capturing personal details. Of course, some of these details are fed up the chain, so to speak, and can become a part of aggregate data-sets. But, for the most-part, this circuit of surveillance is about rendering an individual longitudinally. There’s some fascinating scholarship on the role of the medical record in structuring clinical work and clinical interactions, as well as our knowledge of health and our ontologies of the body (e.g. Berg, Mol). And, we also have some related research that is looking at the role of documentation in the context of HIV testing and counseling. I’m thinking of work done by Eric Mykhalovskiy, Glenn Betteridge, Chris Sanders, Catherine Dodds, Patrick O’Byrne and Marilou Gagnon – I would include my work in this vein as well. Taking all of this work together, we can learn some interesting things about how surveillance at the point-of-care or at the point-of-service delivery works? For example, we can learn about what kinds of data are important, for whom, and for what purposes. And, we can think about what we’ve learned in relation to the roles played by public health and community-based organizations in the broader social response to infectious disease.
- So, thinking about what we’ve learned about surveillance at the point of care, how can this help us to theorize the role of public health and community-based organizations in the response to infectious disease? One of the things this work helps us to think about are the contemporary dynamics of a longstanding tension between care and control in public health responses to infectious disease. So, for example, we might ask, is HIV testing and counseling today about care provision, or is it about the control of individual behaviour? Of course, this question posits a binary difference between what are really two sides of the same coin. In posing it as a question for us to theorize, my intent is less to come up with a definitive answer, and more to come up with a way of thinking through how surveillance practices could be implicated in both care and control. In this vein, we can speculate about what will happen to the case files that a community-based organization keeps. And, we can think about what documentation strategies are appropriate. We know, for instance, that some peoples’ files have been taken up by courts in HIV non-disclosure cases (maybe add a previous slide which gives this as an example?). Given this potential use, what documentation strategies should community-based organizations be developing, and what are the ethics of these strategies?
- How do surveillance systems organize service delivery—a key question for reflection…