In contemporary societies healthcare is a key social institute that addresses the issues of maintenance and improvement of citizens’ health. While population health is largely produced outside of healthcare settings themselves, the functioning of healthcare, including diagnosis, treatment, and prevention of illness, injury, and other impairments, is essential for people’s wellbeing. Yet, healthcare can be and often is insufficiently accessible, responsive, and efficient for different members of society. How can healthcare provision and society be bridged?

Through the exploration of a combination of theoretical and practical perspectives, this online course highlights the necessity of a dialogue and collaboration between healthcare professionals, patients, and the public at large. Course participants will critically explore challenges posed by disjunctures between healthcare and society, analyze both benefits and unintended consequences of bridging the two, and propose ways to accomplish the bridging in practice of healthcare provision.
After completion of this course you will be able to:

Recognize disjunctures between healthcare provision and society
Be aware of consequences of disjunctures between healthcare provision and society
Identify opportunities for bridging healthcare provision and society, using a biosocial approach to health
Analyze cases of disjunctures between healthcare provision and society, and propose opportunities for bridging
Recognize the historical trends of scientification, professionalization, and medicalization, in the relations between medicine, health care, and society.

This course was developed by a consortium of five universities: Maastricht University, National Research Tomsk State University, National University of "Kyiv-Mohyla Academy", National Pirogov Memorial Medical University, Vinnytsya, and Siberian State Medical University within the framework of BIHSENA project. BIHSENA stands for “Bridging Innovations, Health and Societies: Educational capacity building in the Eastern European Neighbouring Areas”. BIHSENA project has been funded with support from the European Commission. This course reflects the views only of the authors, and the Commission cannot be held responsible for any use which may be made of the information contained therein.

Syllabus

WEEK 1
Why bridging?
During the last two centuries modern medicine has gained the role of being a key social institution. Advances in science have enriched medical practice with evidence of the causes and consequences of different diseases and have provided algorithms for effective forms of treatment. Health care has evolved and made impressive gains in protecting the wellbeing of individuals and society. However, there is a number of problems that contemporary healthcare faces. Divergent priorities, understandings, and preferences between patients and healthcare practitioners can result in ineffective treatment, or worse, in health impairments. Lack of responsiveness by healthcare systems to everyday life and the needs of individuals they serve can result in an unequal access to health services by some population groups. These problems are the results of disjunctions between healthcare and patients, and in a broader scope, between medicine and society. This module highlights the importance of understanding such disjunctions and analyzing their roots and consequences. Learners will take a journey through the history of modern medicine and healthcare to explore how they have acquired their prominent characteristics of scientification and professionalization, expressed in a tendency of reducing a disease to a biological phenomenon while often not recognizing the personalities of patients and their cultures, beliefs and environments. During this module, we will focus on the reasons why these characteristics of patients and population groups are important for health provision and public health practices.

WEEK 2
Bridging healthcare professionals and patients
Social roles of doctor and patient, as well as relations between them, are dramatically changing in contemporary societies in the context of rapid technological shifts and scientific advancements, the commercialization of medicine, and the introduction of the idea of wider public engagement in healthcare provision. During the second module of the course we will delve into these complexities in order to understand the perspectives of medical professionals and their patients, discrepancies between their mutual expectations, and ways through which trustful cooperation can be built. We will consider the key social science approaches to understanding doctors’ professional role and construction of authority. We will also investigate challenges to this authority that emerge in the context of contemporary transformations of medical institution. Particular attention will be paid to issues of patient choice and control in healthcare, and strategies through which patients approach medical services and establish trust in relations with healthcare professionals. Module 2 aims to delineate disjunctures between healthcare professionals and patients, and to offer possible ways to bridge perspectives of these two groups.

WEEK 3
Bridging healthcare services and population groups
Healthcare systems are established in many countries to ensure that individuals are able to obtain health services when illness strikes and that they have access to effective interventions to prevent or reduce risk of disease and disability. Yet, often we observe a disjuncture between healthcare and the population groups it is meant to serve, which results in problems with access to health care even where the necessary services are seemingly in place. Module 3 examines various kinds of barriers between population groups, their health, and healthcare and suggests ways to bridge the divide through linking social analysis with healthcare services provision for development of services adapted to the people’s needs, lifestyles, and circumstances.

WEEK 4
Bridging public health and public
The notion of public health appears to be intrinsically connected to the public domain. Yet, it appears that with increasing scientification and professionalization of public health over the course of past decades a gap between public health and public has been widening, rather than the other way around. During the last module of this course we will explore the reasons for these developments. Over the course of these last decades, public health has, firstly, expanded considerably, now covering ‘everything from eating, drinking and exercise to sleep, sex and work and addressing lifestyle from before conception right into extreme old age’, in the words of Klasien Horstman. Secondly, public health is increasingly invested in scientifically-based prevention, assuming that evidence-based interventions will turn risk behavior into healthy behavior and framing public health problems, largely, as technical problems which have to be solved through scientific expertise. This module traces the evolution of public health approaches and the rise of contemporary disjunctures between these approaches and the public they target. We see that in daily life people have their own ideas of risk and safety, have to deal with multiple other issues (such as supporting their families and adhering to their notions of the leading a good life), and operate within their unique contexts at specific rhythms. Consequently, the public often does not respond to public health interventions as expected. This module explores ways to bring the public back into public health and bridge the disjunctures demonstrated.