Not Breathing Easy: “Disarticulated Homework” in Asthma Management

– Julie Spray, Chelsey Carter, Erika Waters & Jean Hunleth

What happens to the “chronic homework” of asthma management when racism, socio-economic disadvantage, and medical systems gaps in the U.S. “disarticulate” families from professional care?

“Sometimes, us, we—we is a doctor. We have to tell the doctors what’s goin’ on.”

Stephanie, caregiver of Scott (13) and Unicorn (6), St. Louis

Recent health policy in the United States encourages an outsourcing of labor from professional practice into domestic spaces, where in theory, medical professionals supply the training, technologies, and guidance needed to discharge responsibility for care to patients or caregivers. Mattingly et al. (2011) term this labor “chronic homework,” describing the relationship between the assigning and undertaking of medical care at the borders of professional and domestic domains. This is a system predicated on relationships between professional and caregiver. However, in our research with families and providers in two U.S. sites, we observed a “disarticulation” of asthma care from professional medicine. Caregivers may undertake routine asthma management with little physician oversight, transforming chronic homework into what we term “disarticulated homework.” We argue that expanding the concept of chronic homework to theorize disarticulation processes can help elucidate how health disparities are reproduced in the gap between medical systems and domestic life.

[asthma, self‐management, caregiving pharmaceuticalization, health disparities]

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