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Papers by Rebecca Hester
The Edinburgh Companion to the Critical Medical Humanities, 2016
Rutgers University Press eBooks, Dec 31, 2019
Cultural Competence has been a long-standing approach to dealing with diversity in health and med... more Cultural Competence has been a long-standing approach to dealing with diversity in health and medicine. This paper will challenge us to re-think that framework in light of diversity issues in Appalachia. Rather than aspiring to more competence about Appalachian culture , the paper asks us to foreground relations of power in the study and practice of health and medicine in Appalachia
Feminist Politics of Translation in the Latin/a Américas, 2014
International Journal of Environmental Research and Public Health
The health sector response to dealing with the impacts of climate change on human health, whether... more The health sector response to dealing with the impacts of climate change on human health, whether mitigative or adaptive, is influenced by multiple factors and necessitates creative approaches drawing on resources across multiple sectors. This short communication presents the context in which adaptation to protect human health has been addressed to date and argues for a holistic, transdisciplinary, multisectoral and systems approach going forward. Such a novel health-climate approach requires broad thinking regarding geographies, ecologies and socio-economic policies, and demands that one prioritises services for vulnerable populations at higher risk. Actions to engage more sectors and systems in comprehensive health-climate governance are identified. Much like the World Health Organization’s ‘Health in All Policies’ approach, one should think health governance and climate change together in a transnational framework as a matter not only of health promotion and disease prevention, b...
<p>For the last few decades cultural competence has been celebrated as the curricular respo... more <p>For the last few decades cultural competence has been celebrated as the curricular response to a variety of political and social challenges in healthcare. These challenges include the persistence of race- and ethnicity-based health disparities, breakdowns in communication between the patient and provider, and issues of cultural difference around delivery and acceptance of healthcare. Commonly defined as 'a set of congruent behaviors, attitudes, and policies that come together in a system, agency or among professionals and enable that system, agency or those professions to work effectively in cross-cultural situations', cultural competence is meant to engender increased sensitivity, humility and awareness with regard to cultural diversity in the clinical context.</p>
Health Humanities Reader, 2014
Over the past forty years, the health humanities, previously called the medical humanities, has e... more Over the past forty years, the health humanities, previously called the medical humanities, has emerged as one of the most exciting fields for interdisciplinary scholarship, advancing humanistic inquiry into bioethics, human rights, health care, and the uses of technology. It has also helped inspire medical practitioners to engage in deeper reflection about the human elements of their practice. In Health Humanities Reader , editors Tess Jones, Delese Wear, and Lester D. Friedman have assembled fifty-four leading scholars, educators, artists, and clinicians to survey the rich body of work that has already emerged from the field--and to imagine fresh approaches to the health humanities in these original essays. The collection's contributors reflect the extraordinary diversity of the field, including scholars from the disciplines of disability studies, history, literature, nursing, religion, narrative medicine, philosophy, bioethics, medicine, and the social sciences. With warmth and humour, critical acumen and ethical insight, Health Humanities Reader truly humanizes the field of medicine. Its accessible language and broad scope offers something for everyone from the experienced medical professional to a reader interested in health and illness.
Health & Justice, 2020
Background Correctional systems in several U.S. states have entered into partnerships with Academ... more Background Correctional systems in several U.S. states have entered into partnerships with Academic Medical Centers (AMCs) to provide healthcare for people who are incarcerated. This project was initiated to better understand medical trainee perspectives on training and providing healthcare services to prison populations at one AMC specializing in the care of incarcerated patients: The University of Texas Medical Branch at Galveston (UTMB). We set out to characterize the attitudes and perceptions of medical trainees from the start of their training until the final year of Internal Medicine residency. Our goal was to analyze medical trainee perspectives on caring for incarcerated patients and to determine what specialized education and training is needed, if any, for the provision of ethical and appropriate healthcare to incarcerated patients. Results We found that medical trainees grapple with being beneficiaries of a state and institutional power structure that exploits the neglect...
Science as Culture, 2019
ABSTRACT In 2011, a number of controversial experiments were conducted on the H5N1 flu virus. Whi... more ABSTRACT In 2011, a number of controversial experiments were conducted on the H5N1 flu virus. While the experiments illuminated growing biosecurity concerns regarding gain-of-function research, the controversy also signaled an evolving biosecurity threat landscape in which biological information, understood to be a latent and potential form of biological life, and the digital infrastructures that circulate this information, have also come to be seen as dangerous. This new threat landscape is informed by the technological framing of biological life as code. What kinds of biosecurity practices are called for when biological life is understood as code and what are the implications for life itself of developing such security practices? The United States has developed a techno-security infrastructure, which this article calls ‘bioveillance,’ in response to the dangers of mobile and mutable biological information. Collapsing biosecurity and cybersecurity into the emerging field of cyberbiosecurity and mirroring the networked life forms that it intends to prevent from proliferating, bioveillance is a vital component in a burgeoning global techno-security culture. The fact that biological life is not a code or information in any strict sense means that bioveillance will face significant challenges in its implementation not least because by using digital technologies to manage the communicability of informationalised biology, bioveillance also produces and proliferates that which it aims to forestall. This means that the more U.S. institutions do to generate biological information for biosecurity purposes, the more bioinsecurities they risk producing. Bioveillance and biological danger become one in the same.
Review of International Political Economy, 2019
Abstract In this article, we seek to intervene on the global health security debate and attendant... more Abstract In this article, we seek to intervene on the global health security debate and attendant literatures to argue that the primary focus of global health security – that infectious disease is an existential security threat to both humans and vital infrastructures – only tells one part of the story about the meaning and significance of biological danger in the contemporary context. While important, this perspective fails to grapple with the ways that our conception of what biology is and what it can do have been altered through advances in science and technology, particularly through the intermingling of computer science and molecular biology. Starting from the premise that biology has been informationalized, we argue that biological exchange is not only a threat to humans and the institutional structures they create, it is also, importantly, a political and economic opportunity for firms and core states involved in global health security, and one of the key bases for an emergent global political economy of health security. We forward the idea of a somatic-security industrial complex to capture this dynamic.
Clinical Otolaryngology, 2017
To demonstrate the feasibility and efficacy of the Google Glass as a tool to improve patient sati... more To demonstrate the feasibility and efficacy of the Google Glass as a tool to improve patient satisfaction and patient-physician communication for otolaryngology residents in the outpatient clinic setting. The primary outcome of the study was to improve patient satisfaction scores based on physician communication related questions from Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys.
Emerging Technologies
As cybersurveillance, datamining, and social networking for security, transparency, and commercia... more As cybersurveillance, datamining, and social networking for security, transparency, and commercial purposes become more ubiquitous, individuals who use and rely on various forms of electronic communications are being absorbed into a new type of cellular society. The eventual end of this project might be a world in which each individual, each cell in the electronic “body politic,” can be monitored, managed, and, if dangerous to the social organism, eliminated. This chapter examines the objectives, desires, and designs associated with such a cellular biopolitics. Are individuals being incorporated into a Borg-like cyber-organism in which they no longer “own” their substance, preferences, desires, and thoughts and in which they are told what they should be doing next?
HEC forum : an interdisciplinary journal on hospitals' ethical and legal issues, 2012
Cultural competence has become a ubiquitous and unquestioned aspect of professional formation in ... more Cultural competence has become a ubiquitous and unquestioned aspect of professional formation in medicine. It has been linked to efforts to eliminate race-based health disparities and to train more compassionate and sensitive providers. In this article, I question whether the field of cultural competence lives up to its promise. I argue that it does not because it fails to grapple with the ways that race and racism work in U.S. society today. Unless we change our theoretical apparatus for dealing with diversity to one that more critically engages with the complexities of race, I suggest that unequal treatment and entrenched health disparities will remain. If the field of cultural competence incorporates the lessons of critical race scholarship, however, it would not only need to transform its theoretical foundation, it would also need to change its name.
Cultural competence has been celebrated as the curricular response to a variety of political and ... more Cultural competence has been celebrated as the curricular response to a variety of political and social challenges in healthcare. Despite its wide adoption, it has been roundly critiqued for the ways that it conceptualizes culture. While extensive, these critiques have largely left the concept of " competence " unanalyzed. Taking a critical approach, this chapter describes the trouble with aspirations to competence when it comes to culture in medicine. Beyond offering a " Disneyfied " version of culture, the chapter argues that cultural competence legitimates and reinforces the epistemological and social power of biomedicine under the guise of redressing cultural ignorance and attending to the cultural diversity of the patient. In so doing, cultural competence contributes to epistemic injustice, which is linked to racial and ethnic injustice. Arguing against competence, the chapter concludes that more emphasis needs to be paid to the " culture of power "...
The Body as Border Rebecca Hester In this paper, I argue that the modern medical paradigm, biomed... more The Body as Border Rebecca Hester In this paper, I argue that the modern medical paradigm, biomedicine, has produced a relationship between race, gender, and disease that legitimates violence against gendered and racialized bodies through the creation of a health norm based on a “universal” subject that is white, male and heterosexual. This relationship has been upheld through a biopolitical state that perpetuates and sustains the life and health of “normative” subjects at the expense and death of “non-normative” subjects. Central to biopower is the cultural production of difference as pathology in which appearance and essence are collapsed under the medical gaze thereby ontologizing non-normative subjects as pathological, deviant and abnormal and justifying violent and harmful medical interventions on their bodies. In the second half of the paper I explore the possibility of embodiment as a collective technique to resist biopower and the pathologizing of difference.
This essay illuminates the challenges of using cultural competency training as an ethnicity-based... more This essay illuminates the challenges of using cultural competency training as an ethnicity-based political strategy for indigenous Mexicans struggling to gain rights and recognition in a transnational context. Through an analysis of the political and philosophical stakes in a cultural competence training delivered to social service providers by Mexican migrants, the essay interrogates the claim that these trainings, even when provided by linguistically and culturally competent facilitators, intervene in social and health inequities. The analysis is based on two and a half years of ethnographic research with a well-known indigenous Mexican migrant-led non-profit organization in California, Centro Binacional para el Desarrollo Indígena Oaxaqueño. Latino Studies (2015) 13, 316–338. doi:10.1057/lst.2015.30
The Edinburgh Companion to the Critical Medical Humanities, 2016
Rutgers University Press eBooks, Dec 31, 2019
Cultural Competence has been a long-standing approach to dealing with diversity in health and med... more Cultural Competence has been a long-standing approach to dealing with diversity in health and medicine. This paper will challenge us to re-think that framework in light of diversity issues in Appalachia. Rather than aspiring to more competence about Appalachian culture , the paper asks us to foreground relations of power in the study and practice of health and medicine in Appalachia
Feminist Politics of Translation in the Latin/a Américas, 2014
International Journal of Environmental Research and Public Health
The health sector response to dealing with the impacts of climate change on human health, whether... more The health sector response to dealing with the impacts of climate change on human health, whether mitigative or adaptive, is influenced by multiple factors and necessitates creative approaches drawing on resources across multiple sectors. This short communication presents the context in which adaptation to protect human health has been addressed to date and argues for a holistic, transdisciplinary, multisectoral and systems approach going forward. Such a novel health-climate approach requires broad thinking regarding geographies, ecologies and socio-economic policies, and demands that one prioritises services for vulnerable populations at higher risk. Actions to engage more sectors and systems in comprehensive health-climate governance are identified. Much like the World Health Organization’s ‘Health in All Policies’ approach, one should think health governance and climate change together in a transnational framework as a matter not only of health promotion and disease prevention, b...
<p>For the last few decades cultural competence has been celebrated as the curricular respo... more <p>For the last few decades cultural competence has been celebrated as the curricular response to a variety of political and social challenges in healthcare. These challenges include the persistence of race- and ethnicity-based health disparities, breakdowns in communication between the patient and provider, and issues of cultural difference around delivery and acceptance of healthcare. Commonly defined as 'a set of congruent behaviors, attitudes, and policies that come together in a system, agency or among professionals and enable that system, agency or those professions to work effectively in cross-cultural situations', cultural competence is meant to engender increased sensitivity, humility and awareness with regard to cultural diversity in the clinical context.</p>
Health Humanities Reader, 2014
Over the past forty years, the health humanities, previously called the medical humanities, has e... more Over the past forty years, the health humanities, previously called the medical humanities, has emerged as one of the most exciting fields for interdisciplinary scholarship, advancing humanistic inquiry into bioethics, human rights, health care, and the uses of technology. It has also helped inspire medical practitioners to engage in deeper reflection about the human elements of their practice. In Health Humanities Reader , editors Tess Jones, Delese Wear, and Lester D. Friedman have assembled fifty-four leading scholars, educators, artists, and clinicians to survey the rich body of work that has already emerged from the field--and to imagine fresh approaches to the health humanities in these original essays. The collection's contributors reflect the extraordinary diversity of the field, including scholars from the disciplines of disability studies, history, literature, nursing, religion, narrative medicine, philosophy, bioethics, medicine, and the social sciences. With warmth and humour, critical acumen and ethical insight, Health Humanities Reader truly humanizes the field of medicine. Its accessible language and broad scope offers something for everyone from the experienced medical professional to a reader interested in health and illness.
Health & Justice, 2020
Background Correctional systems in several U.S. states have entered into partnerships with Academ... more Background Correctional systems in several U.S. states have entered into partnerships with Academic Medical Centers (AMCs) to provide healthcare for people who are incarcerated. This project was initiated to better understand medical trainee perspectives on training and providing healthcare services to prison populations at one AMC specializing in the care of incarcerated patients: The University of Texas Medical Branch at Galveston (UTMB). We set out to characterize the attitudes and perceptions of medical trainees from the start of their training until the final year of Internal Medicine residency. Our goal was to analyze medical trainee perspectives on caring for incarcerated patients and to determine what specialized education and training is needed, if any, for the provision of ethical and appropriate healthcare to incarcerated patients. Results We found that medical trainees grapple with being beneficiaries of a state and institutional power structure that exploits the neglect...
Science as Culture, 2019
ABSTRACT In 2011, a number of controversial experiments were conducted on the H5N1 flu virus. Whi... more ABSTRACT In 2011, a number of controversial experiments were conducted on the H5N1 flu virus. While the experiments illuminated growing biosecurity concerns regarding gain-of-function research, the controversy also signaled an evolving biosecurity threat landscape in which biological information, understood to be a latent and potential form of biological life, and the digital infrastructures that circulate this information, have also come to be seen as dangerous. This new threat landscape is informed by the technological framing of biological life as code. What kinds of biosecurity practices are called for when biological life is understood as code and what are the implications for life itself of developing such security practices? The United States has developed a techno-security infrastructure, which this article calls ‘bioveillance,’ in response to the dangers of mobile and mutable biological information. Collapsing biosecurity and cybersecurity into the emerging field of cyberbiosecurity and mirroring the networked life forms that it intends to prevent from proliferating, bioveillance is a vital component in a burgeoning global techno-security culture. The fact that biological life is not a code or information in any strict sense means that bioveillance will face significant challenges in its implementation not least because by using digital technologies to manage the communicability of informationalised biology, bioveillance also produces and proliferates that which it aims to forestall. This means that the more U.S. institutions do to generate biological information for biosecurity purposes, the more bioinsecurities they risk producing. Bioveillance and biological danger become one in the same.
Review of International Political Economy, 2019
Abstract In this article, we seek to intervene on the global health security debate and attendant... more Abstract In this article, we seek to intervene on the global health security debate and attendant literatures to argue that the primary focus of global health security – that infectious disease is an existential security threat to both humans and vital infrastructures – only tells one part of the story about the meaning and significance of biological danger in the contemporary context. While important, this perspective fails to grapple with the ways that our conception of what biology is and what it can do have been altered through advances in science and technology, particularly through the intermingling of computer science and molecular biology. Starting from the premise that biology has been informationalized, we argue that biological exchange is not only a threat to humans and the institutional structures they create, it is also, importantly, a political and economic opportunity for firms and core states involved in global health security, and one of the key bases for an emergent global political economy of health security. We forward the idea of a somatic-security industrial complex to capture this dynamic.
Clinical Otolaryngology, 2017
To demonstrate the feasibility and efficacy of the Google Glass as a tool to improve patient sati... more To demonstrate the feasibility and efficacy of the Google Glass as a tool to improve patient satisfaction and patient-physician communication for otolaryngology residents in the outpatient clinic setting. The primary outcome of the study was to improve patient satisfaction scores based on physician communication related questions from Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys.
Emerging Technologies
As cybersurveillance, datamining, and social networking for security, transparency, and commercia... more As cybersurveillance, datamining, and social networking for security, transparency, and commercial purposes become more ubiquitous, individuals who use and rely on various forms of electronic communications are being absorbed into a new type of cellular society. The eventual end of this project might be a world in which each individual, each cell in the electronic “body politic,” can be monitored, managed, and, if dangerous to the social organism, eliminated. This chapter examines the objectives, desires, and designs associated with such a cellular biopolitics. Are individuals being incorporated into a Borg-like cyber-organism in which they no longer “own” their substance, preferences, desires, and thoughts and in which they are told what they should be doing next?
HEC forum : an interdisciplinary journal on hospitals' ethical and legal issues, 2012
Cultural competence has become a ubiquitous and unquestioned aspect of professional formation in ... more Cultural competence has become a ubiquitous and unquestioned aspect of professional formation in medicine. It has been linked to efforts to eliminate race-based health disparities and to train more compassionate and sensitive providers. In this article, I question whether the field of cultural competence lives up to its promise. I argue that it does not because it fails to grapple with the ways that race and racism work in U.S. society today. Unless we change our theoretical apparatus for dealing with diversity to one that more critically engages with the complexities of race, I suggest that unequal treatment and entrenched health disparities will remain. If the field of cultural competence incorporates the lessons of critical race scholarship, however, it would not only need to transform its theoretical foundation, it would also need to change its name.
Cultural competence has been celebrated as the curricular response to a variety of political and ... more Cultural competence has been celebrated as the curricular response to a variety of political and social challenges in healthcare. Despite its wide adoption, it has been roundly critiqued for the ways that it conceptualizes culture. While extensive, these critiques have largely left the concept of " competence " unanalyzed. Taking a critical approach, this chapter describes the trouble with aspirations to competence when it comes to culture in medicine. Beyond offering a " Disneyfied " version of culture, the chapter argues that cultural competence legitimates and reinforces the epistemological and social power of biomedicine under the guise of redressing cultural ignorance and attending to the cultural diversity of the patient. In so doing, cultural competence contributes to epistemic injustice, which is linked to racial and ethnic injustice. Arguing against competence, the chapter concludes that more emphasis needs to be paid to the " culture of power "...
The Body as Border Rebecca Hester In this paper, I argue that the modern medical paradigm, biomed... more The Body as Border Rebecca Hester In this paper, I argue that the modern medical paradigm, biomedicine, has produced a relationship between race, gender, and disease that legitimates violence against gendered and racialized bodies through the creation of a health norm based on a “universal” subject that is white, male and heterosexual. This relationship has been upheld through a biopolitical state that perpetuates and sustains the life and health of “normative” subjects at the expense and death of “non-normative” subjects. Central to biopower is the cultural production of difference as pathology in which appearance and essence are collapsed under the medical gaze thereby ontologizing non-normative subjects as pathological, deviant and abnormal and justifying violent and harmful medical interventions on their bodies. In the second half of the paper I explore the possibility of embodiment as a collective technique to resist biopower and the pathologizing of difference.
This essay illuminates the challenges of using cultural competency training as an ethnicity-based... more This essay illuminates the challenges of using cultural competency training as an ethnicity-based political strategy for indigenous Mexicans struggling to gain rights and recognition in a transnational context. Through an analysis of the political and philosophical stakes in a cultural competence training delivered to social service providers by Mexican migrants, the essay interrogates the claim that these trainings, even when provided by linguistically and culturally competent facilitators, intervene in social and health inequities. The analysis is based on two and a half years of ethnographic research with a well-known indigenous Mexican migrant-led non-profit organization in California, Centro Binacional para el Desarrollo Indígena Oaxaqueño. Latino Studies (2015) 13, 316–338. doi:10.1057/lst.2015.30
Monsters, zombies, and cyborgs are everywhere! From film, literature, and college courses (like t... more Monsters, zombies, and cyborgs are everywhere! From film, literature, and college courses (like this one) to bumper stickers, video games, cereal boxes, and Halloween costumes, these creatures surround us in our everyday lives. This course will explore the promises and perils of monsters, zombies and cyborgs with a specific focus on their relationships to biomedical sciences and technologies, and, importantly, us. Drawing broadly from readings, film, and interactive activities informed by the social and humanistic studies of science and technology, the course will explore how biomedical science and technologies are reshaping our understandings of what it means to be human, what it means to be alive or (un)dead, and what we call human nature. Through course material and current events we will explore societal aspirations for exceeding the limits of the body and the mind and ask whether and in what ways we have become "posthuman."
How have " the politics of domination " shifted across time and how have these changes altered th... more How have " the politics of domination " shifted across time and how have these changes altered the ways that domination is exercised, understood, and imagined? What kinds of ideas, forces, and assumptions have remained consistent? What trends, changes, and movements have gained strength in reaction? This seminar asks these questions in the context of social, economic, scientific, technological, and environmental change in the contemporary world.
The seminar considers how theorists have historically thought about the politics of domination in terms of sociological categories (class, race, gender, elites, states, etc.) reflecting a shared disciplinary and conceptual foundation between sociology and political science, as well as how the politics of domination influences the " nature of nature. " The course draws from three exemplary frameworks to show how methodologically, disciplinarily, and conceptually these frameworks have been useful for thinking about, discussing, and operationalizing a politics of domination. These include institutions and organizations, nature/environment/society, and the body and life itself.
The first section will consist in the discussion of the effects of neoliberalism on institutional change in advanced and developing capitalist political economies and societies. Discussion will focus on the sources and nature of neoliberalism and its status as an " episteme " of social, political, and economic knowledge, that is, neoliberalism as an " idea, " and its relationship with contemporary states and capitalism. We will explore neoliberalism as a variant of Polanyi's " utopia of the market " and Polanyi's analysis of the market as a form of political authority. We then turn to the institutional context of the rise of neoliberalism in the advanced capitalist states: the making of postwar Fordism and its crisis, the changing nature of political domination under post-Fordist " flexible accumulation, " and the rise of financialization and the debt state. We will review the politics, ideologies, and practices of neoliberalism and their critiques.
The second section will consider the histories of nature that have been written into the social and natural realm via the study of ecological networks, the intersectional effects (and sources) of ecological domination, and ecological emancipation as a political and intellectual project. Each of these practices has been justified as a means of reining in nature's unpredictability, making it subservient to human knowledge and productivity on the one hand, or, limiting human domination over the planet (and ourselves) on the other. In the former, alternate forms of knowledge, livelihood, and governance have been marginalized to make way for more modernizing models of social control. In the latter, allegedly new spaces and modes of being are left open for exploration. This section therefore considers how contemporary forms of political domination write away subaltern ways of knowing and living, hence presenting a limited scope of available alternatives for social, political, and technological progress.
The final section examines the ways that the politics of domination work at the molecular level and through biomedical and health categories. As bodies are being reconfigured through biotechnology and bioengineering so, too, are governance strategies and political technologies of domination. This section explores the changing nature of politics alongside the changing “nature of nature”. It looks specifically at the relationships between geography, empire, technology, and the body.