National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5a, DK-1353 Copenhagen K, Denmark.
Danish Institute for Local and Regional Government Research, Købmagergade 22, DK-1150 Copenhagen K, Denmark.
Soc Sci Med. 2017 Jul;185:1-8. doi: 10.1016/j.socscimed.2017.05.025. Epub 2017 May 10.
This paper examines the organisational dynamics that arise in health promotion aimed at reducing health inequalities. The paper draws on ethnographic fieldwork among public health officers in Danish municipalities and qualitative interviews from an evaluation of health promotion programmes targeting homeless and other marginalised citizens. Analytically, we focus on 'boundary work', i.e. the ways in which social and symbolic boundaries are established, maintained, transgressed and negotiated, both at the administrative level and among frontline professionals. The paper discusses three types of boundary work: (i) demarcating professional domains; (ii) setting the boundaries of the task itself; and (iii) managing administrative boundaries. The main argument is that the production, maintenance and transgression of these three types of boundaries constitute central and time-consuming aspects of the practices of public health professionals, and that boundary work constitutes an important element in professional practices seeking to 'tame a wicked problem', such as social inequalities in health. A cross-cutting feature of the three types of boundary work is the management of the divide between health and social issues, which the professionals seemingly seek to uphold and transgress at the same time. The paper thus contributes to ongoing discussions of intersectoral action to address health inequalities. Furthermore, it extends the scope and application of the concept of boundary work in the sociology of public health by suggesting that the focus in previous research on professional demarcation be broadened in order to capture other types of boundaries that shape, and are shaped by, professional practices.
本文考察了旨在减少健康不平等的健康促进中出现的组织动态。本文借鉴了丹麦市公共卫生官员的民族志实地调查和针对无家可归者和其他边缘化公民的健康促进计划的定性访谈。在分析上，我们专注于“边界工作”，即社会和符号边界的建立、维护、跨越和协商的方式，无论是在行政层面还是在一线专业人员中。本文讨论了三种类型的边界工作：（i）划定专业领域；（ii）确定任务本身的边界；以及（iii）管理行政边界。主要论点是，这三种类型的边界的产生、维护和跨越构成了公共卫生专业人员实践的核心和耗时方面，并且边界工作是试图“驯服一个棘手问题”的专业实践的重要组成部分，例如健康方面的社会不平等。三种类型的边界工作的一个交叉特征是管理健康和社会问题之间的鸿沟，专业人员似乎试图同时维护和跨越这一鸿沟。因此，本文为解决健康不平等问题的部门间行动的持续讨论做出了贡献。此外，它通过建议扩大先前研究中对专业划分的关注范围，以捕捉塑造和被专业实践塑造的其他类型的边界，从而扩展了公共卫生社会学中边界工作概念的范围和应用。
