Carole E. Hill - Community Health Systems In The Rural American South: Linking People And Policy

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Community Health Systems in the Rural American South

First published in 1988 by Westview Press

Published in 2021 by Routledge

605 Third Avenue, New York, NY 10017

2 Park Square, Milton Park, Abingdon, Oxon OX14 4RN

Routledge is an imprint of the Taylor & Francis Group, an informa business

Copyright 1988 by Taylor & Francis

All rights reserved. No part of this book may be reprinted or reproduced or utilised in any form or by any electronic, mechanical, or other means, now known or hereafter invented, including photocopying and recording, or in any information storage or retrieval system, without permission in writing from the publishers.

Notice:

Product or corporate names may be trademarks or registered trademarks, and are used only for identification and explanation without intent to infringe.

Library of Congress Cataloging-in-Publication Data

Hill, Carole E.

Community health systems in the rural American South.

Bibliography: p.

Includes index.

1. Rural health servicesSouthern States. 2. Public

healthSouthern States. 3. Medical policySouthern

States. 4. Community health servicesSouthern States.

I. Title.

RA771.6.S63H551988362.12097588-214

ISBN 0-8133-7541-X

ISBN 13: 978-0-3670-1439-1 (hbk)

ISBN 13: 978-0-3671-6426-3 (pbk)

DOI: 10.4324/9780429044250

Contents

2 A Rural Community Within the Regional Context

Southern Uniqueness

The Social Models of Southern Culture

Cober County: Levels of Organization and Resources

Health in Cober County

The People of Coberly

Summary

3 Alternative Illness Behavior and Decision Making

Research Strategies and Population Characteristics

Illness Episodes for Chronic and Acute Illnesses

Illness Response

Symptom Perception and Illness Behavior

Preventive Health Behavior

Utilization of and Access to Medical Facilities

Comparative Linkages and Alternatives

4 Family, Community, and Mental Health

Family and Community Linkages Throughout Life: Health-Seeking Behavior

Management and Perceptions of Mental Health Problems

Summary

5 Popular Medicine, Health Beliefs, and Cultural Models

Popular Medicines in the South

Popular Medicines in Coberly

Use of Traditional Healers in Coberly

Causal Explanations for Illness and Healing

Cultural Models of the Medical System

The Financing of Medical Care

Summary

6 Linking Community to the Health Policy System: Expanding Health Care Options

Mobilization for Change: The Establishment of a Clinic

Problems of Implementation

Community Issues and Problems

Policy Issues and Problems

The Failure of Primary Health Care in Coberly

7 Health Policy as a Cultural System

Culture and Policy

The Process of Policy Construction

Health Policy Metaphors

Rural Health Frames in the U.S.: Rural Versus Urban

The Assumptions of Federal Evaluation Measures

Metaphor and Reality

Linking Policy Metaphors to the State Level

8 The Convergence and Divergence of People and Policy

Convergent Processes

Divergent Processes

Linking People and Policy

Linkage Problems

Changing Policies and People

Summary

1. 2 A Rural Community Within the Regional Context
   1. Southern Uniqueness
   2. The Social Models of Southern Culture
   3. Cober County: Levels of Organization and Resources
   4. Health in Cober County
   5. The People of Coberly
   6. Summary
2. 3 Alternative Illness Behavior and Decision Making
   1. Research Strategies and Population Characteristics
   2. Illness Episodes for Chronic and Acute Illnesses
   3. Illness Response
   4. Symptom Perception and Illness Behavior
   5. Preventive Health Behavior
   6. Utilization of and Access to Medical Facilities
   7. Comparative Linkages and Alternatives
3. 4 Family, Community, and Mental Health
   1. Family and Community Linkages Throughout Life: Health-Seeking Behavior
   2. Management and Perceptions of Mental Health Problems
   3. Summary
4. 5 Popular Medicine, Health Beliefs, and Cultural Models
   1. Popular Medicines in the South
   2. Popular Medicines in Coberly
   3. Use of Traditional Healers in Coberly
   4. Causal Explanations for Illness and Healing
   5. Cultural Models of the Medical System
   6. The Financing of Medical Care
   7. Summary
5. 6 Linking Community to the Health Policy System: Expanding Health Care Options
   1. Mobilization for Change: The Establishment of a Clinic
   2. Problems of Implementation
   3. Community Issues and Problems
   4. Policy Issues and Problems
   5. The Failure of Primary Health Care in Coberly
6. 7 Health Policy as a Cultural System
   1. Culture and Policy
   2. The Process of Policy Construction
   3. Health Policy Metaphors
   4. Rural Health Frames in the U.S.: Rural Versus Urban
   5. The Assumptions of Federal Evaluation Measures
   6. Metaphor and Reality
   7. Linking Policy Metaphors to the State Level
7. 8 The Convergence and Divergence of People and Policy
   1. Convergent Processes
   2. Divergent Processes
   3. Linking People and Policy
   4. Linkage Problems
   5. Changing Policies and People
   6. Summary

Guide

Tables

10 Cober County Employment

11 Cober County Public Health Department services and number of individuals served

12 Mortality rates in Cober County

13 Selected population characteristics by race

14 Popular medicine

15 Composition of Board of Directors of Cober County PHCC

Figures

6 Health-seeking behavior

7 Organization of Cober County Primary Health Care Center, Inc.

8 Measures of manpower shortage areas

Maps

2 The subdivisions of the South

3 Courthouse square of Coberly

A cultural perspective of health care systems can provide health care providers and policymakers with a broader understanding of the issues they face when planning and implementing new health programs in communities. Health care takes place in a community setting while health care policy is developed at an entirely different level in the larger socioeconomic system. While some may think that this is common knowledge, there are few studies that attempt to link the community level systems of health with those of the policy level system and that allow for a comparison of the convergence and divergence of peoples health beliefs and behavior with those of policymakers.

In order to help fill the lacunae, I undertook the study of Coberly. My initial interest in medical anthropology in the late 1960s and early 1970s was in folk medicine. After a rather idealistic attempt to apply my findings to health service delivery by writing and talking about them to health professionals, I decided that if we as anthropologists were to have an impact on health care delivery, we should also analyze the power structure of health and, when possible, create and obtain power positions ourselves in order to effect health policies. The first step was to study up and understand the culture of policy and planning. Although this was not a new idea in the discipline, I set out to accomplish this goal by combining a systems approach with a health behavior and beliefs model.

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