Situating Solidarities: social challenges for science and technology studies
Health innovation and the grand challenge of ageing: Governing the personal health systems revolution
Location Economy 46
Date and Start Time 17 September, 2014 at 10:30
Demographic ageing is widely seen as a "grand challenge", and policy makers, industry, academic researchers, health care providers, and lobby groups have identified research and innovation as a promising response. Such perspectives often view science and technology as a potential solution to otherwise independent problems of aging, and neglect two important recent developments in personalized health technology: (i) that demographic aging is associated with shifting attention from curing acute diseases to managing and preventing chronic diseases and (ii) that current generations of older persons use ensembles of health and non-health technologies to negotiate health, illness, fun and well-being. This track brings together contributions that investigate these newly arising socio-technical ensembles of health and non-health technologies, practices of negotiating later life, health care regimes, and user driven innovation of personal health systems. The relevant variety of health and non-health technologies is very broad and may include medical and assistive devices, domestic utensils, online and ICT-mediated technologies, transport technologies, and social and family care regimes.
This session invites contributions including the following themes:
- Multiple stakeholder involvement and multiple values in health technology and personal health systems innovations;
- New ways of organizing citizen or patient-centred health innovations and related workforce issues; changing practices of healthcare / care in the policy context;
- Governance of personal health systems and changing medical health care regimes;
- Studies on practices of user-producer interactions in various contexts of older persons and providers of personal health technologies;
- User innovations by older persons in health technology.
The papers will be presented in the order shown and grouped 3-3 between sessions
This track is closed to new paper proposals.
Negotiating goodness in AAL research and development
The aging population is seen as one of the greatest challenges European societies will face in the upcoming decades and Ambient Assisted Living (AAL) is framed as one promising solution. I assume AAL systems/products/services, their users and society to be co-produced (Jasanoff, 2004) in RTD practices, which are simultaneously shaped by and productive of broader visions of the collective good. A required part of RTD practice in projects funded under the European Commission's AAL Joint Programme or the Austrian benefit programme is user involvement, which I understand as an array of practices of enacting and negotiating sociomaterial values. Multiple stakeholders are hereby included in the RTD process, who might come with their specific vision of what a well-aging society is and what needs to be done to get there. In this paper I will inquire which practices of user involvement are deemed valuable by differently situated actors in order to work towards a well-aging society, appropriate user representations and, accordingly, a successful system/product/service. Drawing on preliminary empirical results from my PhD-project (document analysis and qualitative interviews with project workers) I will focus on practices of good RTD in the AAL context and explore what work is needed for a multiplicity of values to be given space in RTD practice and how tensions between differing versions of goodness and clashing visions of attainable futures are balanced.
Have you done the homework? From a problem-solving perspective to a participatory approach
This proposal arises from an ongoing three-year (2013-2016) research project named SUITCASE (SUstainable, Integrated and Territorial CAre SErvices) carried out in partnership with a consortium of companies, aimed at developing innovative services for the welfare of citizens in their own home, with a focus on older adults (> 65 years). The approach of Suitcase is centred on the integration of events coming from heterogeneous sources. Non-intrusive, off-the-shelf sensors are being installed in the homes of the users. Other data are collected by human operators, clinical sources, social services, and from public and private institutions and organizations delivering services to the citizens.
Research activities are informed by the concept of active ageing (well-being) (World Health Organization 2002) which is the assumption for the construction of a sociotechnical infrastructure (Bowker, Star 1999; Orlikowski 2007; Suchman et al. 1999). The project applies a User Centered Design approach for the co-design of services to properly answer to users' needs.
However, within the consortium there was not convergence (Bowker, Star 1999) about how to identify the elderly's needs, despite a shared interpretative perspective. Our contribute is inspired by this disalignment (Star, Griesemer 1989) and it is aimed to discuss - starting from a qualitative set of data (diaries and interviews) - the difference between a rational, problem-solving perspective and a participatory design approach for which asking powerful questions is crucial. We will discuss the role of diaries and the "message" that the users send when they don't write diaries as requested.
Two ways of co-constructing the user in assistive robotics
Several EU funded projects focus on assistive robots as Ambient Assisted Living (AAL) technologies. This field of applied robotics is defined as robots performing physical or "social" tasks for the well-being of persons with disability whether in domestic or care facility contexts. The submission presents two cases of assistive robotic projects out of an ongoing, comparative dissertation project. In both projects researchers deployed assistive robots to elderly, a market-ready solution for the treatment of dementia and a prototype platform for physical assistance at home.
Due to diverging research interest and method set, the projects followed two contrasting ways of integrating the elderly and their needs into the research: A "top down" approach on the organizational level of elderly care and a participatory design approach on the other hand. The submission reconstructs those two tactics from participant observation and expert interviews and focuses on the question, how these different procedures co-construct the user and it's needs. The analysis of the methods and rhetorics observed shows for example how different stake holders of elderly care have to be integrated while the actual users are systematically blanked out. The use of the participatory design approach on the other hand led to an interesting entanglement of community work amongst recruited "expert lay users" and the researchers.
In comparing these tactics the submission seeks to contribute to the question, how research projects on assistive robots as personal health technologies shape elderly and disabled as users in order to make them fit into the needs of there research.
Future of aging in Wallonia, Belgium: Lessons learnt from a cross-European stakeholder involvement project
In this paper we build on the achievements of a cross-European stakeholder involvement experience which aimed at providing both the national and the EU level with input for meeting the societal and technological challenges and opportunities of an aging population by 2025. Six European countries/regions were engaged in three scenarios dealing differently with two main concerns: (1) Is it the public or private health care providers who are providing future elderly care? (2) How do the senior citizens and other groups in the society organise themselves in order to meet the needs for care? In our presentation, specific attention will be given to the data collected in Wallonia, Belgium, although data collected in other countries will be produced when relevant. Our methodology is threefold, combining input from a wide range of experts who made a technology overview describing available care technology and home-based telemedicine; an overview of policy measures related to telecare and home-based telemedicine; and a scenario workshop that engaged stakeholders (from the care and health sectors, the industry and public authorities) and allowed us to elaborate visions on the use of telecare in the ageing society along classical cornerstones of welfare systems. Such visions will be analyzed taking into account the current transformations of the Belgian federal State and the implications for the survival Belgian healthcare system will be drawn. Lastly, we will discuss important differences and similarities between European nation-states and offer concluding observation with regard to the relevance of methodological nationalism to address global challenges such as aging societies.
Managing therapy in the wild: A study about elderly patients with complex therapy
In recent years Western societies have undergone remarkable demographic changes. Life expectancy and average age of the populations have increased and several studies have focused on the ways in which elderly people try to manage their conditions outside healthcare institutions. In this paper we will focus on a particular category of elderly people, patients with complex medication schemes, analyzing care practices and formal-informal relations through which complex therapies are managed. The materials presented originate from AETAS, a two-years research project conducted in the Province of Trento (North-East Italy). Taking the cue from 45 in depth interviews addressed to elderly people with multiple health problems (and with their caregivers), we will focus on:
• home as the space of "therapy in the wild", where expert knowledge and practices of health care organizations melts into and cope with mundane knowledge and practices;
• the role played by medications and health technologies in the configuration of care practices enacted by patients and their caregivers outside institutional boundaries. For example, we will show how General Practitioners try to configure patients and their caregivers as users able to manage the therapy autonomously, advising them on how to arrange the domestic setting and the therapy tools within it (i.e. blisters in the cupboard and scale in the bathroom, etc.).
The core contribution will be to highlight the ways in which medicines, medical practice and mundane arrangements connect everyday life routines with therapy management practices.
Eating muscle: Protein and the governing of aging bodies
The prospect of ageing societies in the Western world has brought issues to do with the health and welfare of older adults to the fore of political governance. With ageing often comes a certain amount of frailty and natural loss of muscle tissue, which for some lead to a need for public health care, perhaps on an everyday basis, as everyday activities become harder to manage alone. Concerns about the quality of life of older adults is therefore often articulated in pair with matters to do with food and diet, as one major aspect of age-related loss of muscle mass, as defined by nutrition science, has to do with not giving the body the nutrients it requires. Drawing from ethnographic fieldwork in a health intervention-program in Denmark, where older adults are eating (potential) muscle mass by way of a daily protein supplement, the paper discusses how public issues are tied together with personal bodies through food and eating. What are the political trajectories of nutrients that are aimed at specific bodies? And what becomes of the personal space of an eating body, when what is being eaten is also a public matter of concern?
This track is closed to new paper proposals.