title: Critical interactionism: an upstream-downstream approach to health care reform.
abstract: Currently, per capita health care expenditures in the United States are more than 20% higher than any other country in the world and more than twice the average expenditure for European countries, yet the United States ranks 37th in life expectancy. Clearly, the health care system is not succeeding in improving the health of the US population with its focus on illness care for individuals. A new theoretical approach, critical interactionism, combines symbolic interactionism and critical social theory to provide a guide for addressing health care problems from both an upstream and downstream approach. Concepts of meaning from symbolic interactionism and emancipation from critical perspective move across system levels to inform and reform health care for individuals, organizations, and societies. This provides a powerful approach for health care reform, moving back and forth between the micro and macro levels. Areas of application to nursing practice with several examples (patients with obesity; patients who are lesbian, gay, bisexual, and transgender; workplace bullying and errors), nursing education, and research are also discussed.
authors: College of Nursing, University of Rhode Island, Kingston, USA. jjmartins@cox.net
authors: Diane Cocozza
authors: DC
authors: Martins
authors: Patricia M
authors: PM
authors: Burbank
mesh_terms: D004506:Education, Nursing / Q000592:standards; D005060:Europe; D018166:Health Care Reform / Q000191:economics / Q000379:methods* / Q000592:standards; D006801:Humans; D009732:Nursing Care / Q000379:methods* / Q000592:standards; D009742:Nursing Theory; D010687:Philosophy, Nursing; D014481:United States