Project

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Austerity Medicine. Precarious Healthcare in Contemporary Spain

Applicant Kehr Janina
Number 167984
Funding scheme Ambizione
Research institution Institut für Sozialanthropologie Universität Bern
Institution of higher education University of Berne - BE
Main discipline Ethnology
Start/End 01.08.2017 - 31.07.2020
Approved amount 476'334.00
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All Disciplines (3)

Discipline
Ethnology
General history (without pre-and early history)
Public Health and Health Services

Keywords (10)

neoliberalism; public health; care; precarity; statehood; Spain; Southern Europe; infrastructure; austerity; anthropology

Lay Summary (German)

Lead
Überall in Europa wird heute gespart, auch bei der medizinischen Versorgung. Sparmassnahmen im Gesundheitssektor betreffen Menschen unmittelbar, da sie Einfluss darauf nehmen, wie Krankheit erlebt wird, und wer wie medizinisch behandelt wird. Austerität geht also sprichwörtlich unter die Haut. In Spanien ist die Austeritätspolitik im Gesundheitsbereich besonders brisant und politisch umkämpft.
Lay summary

Inhalt und Ziel des Projektes

 Das Forschungsprojekt beschäftigt sich mit den alltäglichen Konsequenzen der staatlichen Sparmassnahmen auf die medizinische Versorgung in Spanien, insbesondere in Madrid. Im Rahmen einer Feldforschung vor Ort in Krankenhäusern, Gesundheitszentren und Haushalten untersucht die Studie, wie PatientInnen, deren Familien sowie Angehörige der Gesundheitsberufe „Medizin“ in Zeiten der Austerität erleben und verstehen. Drei Forschungsfragen stehen dabei im Mittelpunkt: Seit wann und inwiefern spielen Sparmassnahmen im spanischen Gesundheitswesen eine Rolle? Wie schlagen sich Sparmassnahmen in der alltäglichen Gesundheitsversorgung der Bevölkerung nieder, und welche medizinischen, politischen und ökonomischen Werte werden im Versorgungsalltag gegeneinander abgewogen und verhandelt? Welche Widerstände entwickelt die Bevölkerung gegen Austeritätsmassnahmen und welche neuen Versorgungsstrukturen entstehen als Antwort darauf? Ziel des Projektes ist es, ein Bild von „Medizin“ in Zeiten der Austerität aus der Sicht von in Spanien lebenden Menschen nachzuzeichnen, und dabei Vorstellungen von Staatlichkeit und Fürsorge in einer immer stärker ökonomisierten Gesundheitsversorgung zu analysieren.

Wissenschaftlicher und gesellschaftlicher Kontext

 Einem Ansatz der moralischen Ökonomie folgend geht das Projekt davon aus, dass Austeritätsmedizin verschiedenen Rationierungsprozessen unterworfen ist und mit Ungleichheiten einhergeht, die moralisch, politisch und sozial bedingt sind. Das Projekt untersucht die Wechselwirkungen zwischen solchen Wertigkeiten und alltäglichen medizinischen Praktiken, so wie sie von PatientInnen und Angehörigen der Gesundheitsberufe erlebt und mitgestaltet werden. Damit leistet es einen Beitrag zum Verständnis der sich wandelnden Beziehungen zwischen Staat, Ökonomie und Gesellschaft am Beispiel eines Lebensbereiches, der Menschen heute an ihrer verletzlichsten Seite betrifft: Krankheit, Gesundheit, und medizinische Versorgung. 

 

Direct link to Lay Summary Last update: 02.05.2017

Responsible applicant and co-applicants

Employees

Publications

Publication
L'hôpital
Kehr Janina, Chabrol Fanny (2018), L'hôpital, in Anthropologie et Santé, 16/2018, 1-13.
Transfigurations of Health and the Moral Economy of Medicine: Subjectivities, Materialities, Values
Kehr Janina, Dilger Hansjörg, Eeuwijk von Peter, Transfigurations of Health and the Moral Economy of Medicine: Subjectivities, Materialities, Values, in Zeitschrift für Ethnologie.

Collaboration

Group / person Country
Types of collaboration
Centro de Ciencias Humanas y Sociales Madrid (Dr. Francisco Ferrandiz Martin) Spain (Europe)
- in-depth/constructive exchanges on approaches, methods or results
Technische Universität München, Professur für partizipative Technikgestaltung (Dr. Sanchez Criado) Germany (Europe)
- in-depth/constructive exchanges on approaches, methods or results
Universitat de Barcelona, ERC Project "Grassroots Economics" (Prof. Susana Narotzky) Spain (Europe)
- in-depth/constructive exchanges on approaches, methods or results
Université de Strasbourg, SAGE - Sociétés, Acteurs, Gouvernement en Europe (Prof. Christian Bonah) France (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
King's College London, Department of Social Sciences, Health and Medicine (Dr. Carlo Caduff) Great Britain and Northern Ireland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
University of Chicago, Department of Anthropology (Prof. Kaushik Sunder Rajan) United States of America (North America)
- in-depth/constructive exchanges on approaches, methods or results
Universität Basel, Departement für Geschichte (Dr. Peter-Paul Bänziger) Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
Université Paris Descartes, CERMES 3, ERC Advanced Grant "Globhealth" (Dr. Fanny Chabrol) France (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Publication
ETH/Universität Zürich, Centre for the History of Knowledge (ZGW) Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results
- Research Infrastructure
Universität Bremen, Institut für Ethnologie und Kulturwissenschaft Germany (Europe)
- in-depth/constructive exchanges on approaches, methods or results
Universität Bern, SNF Project "Intimate Uncertainties" (Prof. Sabine Strasser) Switzerland (Europe)
- in-depth/constructive exchanges on approaches, methods or results

Scientific events

Active participation

Title Type of contribution Title of article or contribution Date Place Persons involved
Valuing Health Talk given at a conference A city of care? Community Healthcare in Austerity Spain 04.09.2018 Edinburgh, Great Britain and Northern Ireland Kehr Janina;
EASA Conference 2018 Talk given at a conference Survival after the Crisis. The Slow Violence of Austerity in Contemporary Spain 14.08.2018 Stockholm, Sweden Kehr Janina;
Reconfiguring Care Infrastructures: austerity and innovation in Europe's welfare services Talk given at a conference States of incomplete care in Spain 15.11.2017 Brighton, Great Britain and Northern Ireland Kehr Janina;


Communication with the public

Communication Title Media Place Year
Print (books, brochures, leaflets) “Esto no es vida” Crisis crónica y luchas para cuidarse International 2017

Associated projects

Number Title Start Funding scheme
154512 Biopolitical Nostalgia in Times of Austerity. UK Protest Movements to Save the NHS 01.04.2014 International short research visits

Abstract

In this Ambizione project, I investigate austerity and its everyday effects and inequalities in contemporary Spanish healthcare. To date, only quantitative studies in public health have explored the consequences of austerity in the healthcare sector. How do doctors, nurses and patients practice and experience healthcare in conditions of austerity, inside and outside of medical settings? How are the conflicting economic, political and moral values of health negotiated on the ground in austere times? My research will be one of the first anthropological studies to explicitely investigate the street-level effects of austerity policies in the domain of medicine in Spain from peoples' perspectives, and the ubiquitous political mobilisations for public healthcare it engenders.Spain is a particularly interesting case: it is one of the European countries hardest hit by austerity; and yet it has a very strong public health infrastructure that is publicly funded, and matters much to its citizens, politically and affectively. As a consequence, important resistances against the politics of austerity in the domain of medicine have emerged in Spain, which can be examined side by side with austerity’s everyday consequences as well as its cultural meanings in medical settings.In my research, I will firstly ask how austerity came to matter in the Spanish healthcare system, by analysing official public health documents and economic policies, grey literature and by conducting interviews with civil servants. Secondly, I will investigate through ethnographic fieldwork in medical and home settings in Madrid how political concerns with austerity translate in everyday medical practice and care relations and how medical, political and economic values are negotiated and experienced by health professionals and patients. Thirdly, resistance to the politics of austerity will be examined by doing ethnographic work with activist groups that “defend” the public health system against increasing precarization and advocate for public health otherwise. I will realize one year of in-depth research in Madrid to respond to my three research concerns. Taken together, my project contributes to understand austerity medicine itself as well as peoples’ attachments to “their” health system in Spain, and the shifting meanings and moral visions of the state, the public and citizenship they entail. It thereby fills an important research gap on changing welfare states in Southern Europe in times of austerity in a domain which greatly matters to people: health and medicine. The proposed project builds on my post-doctoral research and publications in the field of global public health as senior lecturer at the Centre for Medical Humanities at the University of Zurich. It will constitute the main part of my habilitation project in anthropology. Academically, the Ambizione project will be an important contribution to international debates in the flourishing field of medical anthropology on the unequal politics of life as well as contemporary precariousness in the domain of health and welfare. My thorough empirical study on austerity medicine based on ethnographic methods will help to understand the shifting role of the state in today’s economized public health, intimate experiences of care under increasingly precarious conditions, the production of new social and economic inequalities and the emergence of citizen insurgencies against the unequal distribution of health care. Such an anthropological perspective, because it is attentive to peoples’ everyday experience in their link to larger economic and political forces, is crucial to understanding the street-level consequences of austerity: it is grounded in providers’ and patients’ points of view, while placing them in a wider context of the global healthcare economy and the unequal worth of lives.
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