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In Australia, like many high-income countries, food insecurity is associated with increased risks of chronic diseases, sub-optimal development outcomes in children, and mental health conditions including depression and anxiety. Food insecure households employ a range of strategies, including the use of food charity, to help alleviate hunger and meet cost of living pressures. The aim of this paper is to investigate the lived experience of food insecurity for welfare-dependent households, and to examine these experiences within a structural violence framework. Structural violence investigations seek to understand the distal causal factors that can help explain poor health patterns and inequities. Semi-structured interviews were conducted with customers (n = 78) of food pantries, soup kitchens, and community development programs (June 2018 to January 2019) in the state of Victoria, Australia. Thematic analysis established evidence of controlling, demeaning and depriving practices in the interactions between the participants and the services and staff at national welfare providers and food charities. The same providers and charities nominally set up to address the exact situations in which participants found themselves. The findings of this study suggest that food and social services are an on-the-ground setting through which structural violence is enacted and experienced. [ABSTRACT FROM AUTHOR]

Prevention of chronic diseases happens within systems of action across whole communities. In local communities, organisations play important roles that influence health, but many are in non-health sectors where health or 'prevention' is not their main remit. In this paper, we explore how organisations in communities perceive their role as part of a local system of chronic disease prevention. We use interview data from 'Prevention Tracker', an investigation undertaken with Australian communities that aimed to describe how local prevention systems are organised. Four communities participated – one regional, one remote, and two urban. In each, local advisory groups identified key informants for semi-structured interviews (n = 80). We applied the Ottawa Charter for Health Promotion as a sensitising framework to categorise responses; and undertook inductive thematic analysis to generate deeper insights into organisations' orientation to prevention. While some respondents clearly recognised and articulated linkages between their organisation's activities and prevention, sometimes drawing from health promotion principles to do so, many did not and were prompted by the interview to consider their contributions. A proportion explicitly distanced themselves from prevention despite their work directly addressing the social determinants that underscore health. For some, this distancing reflects a tactical decision to reduce competition and promote partnership between organisations, and to engage clients. This study demonstrates that diverse organisations make contributions to prevention – often outside of 'core business' – whether or not the organisations themselves realise, relate to and/or self-identify as playing this role. [ABSTRACT FROM AUTHOR]

Drawing on findings from a study of two social generations of gender and sexuality diverse Australians, this paper offers a critical analysis of expectations and experiences of inclusive health care for LGBTQ+ youth. Data were collected by means of individual and focus group interviews with people from two different social generations who grew up in regional or urban Australia: those born in the 1970s (n = 50) and those born in the 1990s (n = 71). Data were analysed inductively to develop insights into what inclusive health care meant, and what this revealed about the potential for fostering belonging in healthcare settings. Findings raise critical questions about how inclusiveness of care might best be understood in encounters between gender and sexual minorities and health professionals. In particular, forms of 'inclusivity labour' were observed across the social generations, both in terms of the work involved in seeking to locate supportive services, and in assessing the performance of clinicians in healthcare settings, with implications for the continued engagement of LGBTQ+ young people with essential forms of care. Mobilising contemporary forms of inclusivity labour, including attention to the affective dimensions of healthcare engagement, has the potential to promote both better health and more meaningful experiences of belonging for gender and sexual minorities. [ABSTRACT FROM AUTHOR]

There is growing global consensus for researchers to look beyond patient culture to gain a more nuanced understanding of the ways in which wider socio-structural forces influence health outcomes. In line with these critiques, this paper examines culturally diverse patients’ views about the symptoms, aetiology, and experiences of their depression, and considers how socio-structural forces are implicated in the illness experience. Analysing the transcripts of interviews with 28 Indian-Australians and 30 Anglo-Australians with depression, our results reveal cultural differences between Indian- and Anglo-Australians regarding the chronicity, perceived severity, and aetiology of their depression. Our results also show how these cultural differences are related to socio-structural forces such as time, money, and migration. We conclude by arguing that the current medicalised approach to treating depression needs to shift to a more empathetic problem-solving one; such a change would prompt greater critical consideration of the socio-structural forces that impact people’s mental health and not just focus on individuals’ culture and pathologies. [ABSTRACT FROM PUBLISHER]

Children have been made a priority in Australian government obesity interventions, with programmes tending to focus on promoting behaviour change in food and exercise practices. This paper reports findings from ethnographic research with a group of Australian children aged 10–14 years living in a low socio-economic suburban setting. We propose that central to these children’s experiences of food and eating is the negotiation and management of hunger. Historically, disadvantage has been embodied and inscribed on children’s bodies in very visible ways, and the coexistence of hunger and obesity is part of this continuum. Despite considerable evidence of food insecurity in our research site, issues of hunger were absent in an obesity intervention underway at the time. We examine how hunger was felt in children’s lives, how it was managed and the ways in which messages about eating less, while eating more ‘healthy foods’, were at odds with the children’s experiences of hunger. Moreover, we argue that hunger and obesity in this context were doubly stigmatised, as children were very aware of how their hunger and their bodies marked them as different and disadvantaged. Attention to both the embodied and social impacts of hunger on children and their everyday relationships is key in formulating more sensitive, contextualised public health interventions. [ABSTRACT FROM PUBLISHER]

Unhealthy food environments are known to be major drivers of diet-related non-communicable diseases globally, and there is an imperative for major food companies to be publicly accountable for their actions to improve the healthiness of food environments. This paper examines the prevalence of publicly available policies and commitments of major packaged food and soft drink manufacturers, and fast-food restaurants in Australia, New Zealand and Fiji with respect to reducing food marketing to children and product (re)formulation. In each country, the most prominent companies in each sector were selected. Company policies, commitments and relevant industry initiatives were gleaned from company and industry association websites. In Australia and New Zealand, there are a higher proportion of companies with publicly available marketing and formulation policies than in Fiji. However, even in Australia, a large proportion of the most prominent food companies do not have publicly available policies. Where they exist, policies on food marketing to children generally focus on those aged less than 12, do not apply to all types of media, marketing channels and techniques, and do not provide transparency with respect to the products to which the policies apply. Product formulation policies, where they exist, focus mostly on salt reduction and changes to the make-up of overall product portfolios, and do not generally address saturated fat, added sugar and energy reduction. In the absence of strong policies and corresponding actions by the private sector, it is likely that government action (e.g. through co-regulation or legislation) will be needed to drive improved company performance. [ABSTRACT FROM AUTHOR]

Bushfires, and resulting bushfire smoke, were major environmental, social and health crises in Australia in the summer of 2019–20. In Australia's national capital the smoke pollution index topped global charts, and public health communications were rapidly developed that advised people to stay indoors to avoid smoke exposure. Drawing on interviews with a diverse range of housed residents, we explore people's experiences of navigating public health advice and managing the bushfire smoke in relation to the materiality of their homes. Given the increasing likelihood of living with such crises in the Anthropocene, we highlight the need for future bushfire public health advice to recognise local housing geographies, residents' embodied vulnerabilities and the relational ways people live with their everyday built environment, and suggest possible policy responses. [ABSTRACT FROM AUTHOR]

Assumptions about time, value, labour, and health coalesce in the policy decision to extend the pension eligibility age in Australia from 65 to 67 years. Acknowledging the multiple, often incompatible ways in which time is conceptualised and experienced, we question the expectation of extending Australians' working lives. Drawing on semi-structured interviews with 19 male and female bus drivers over the age of 55 in Australia, we illustrate that older blue collar workers may accumulate chronic health conditions that not only limit their ability to maintain the strict time-discipline required to remain in the workforce, but also introduce demands on their time beyond paid employment (including those required for the management of chronic health conditions). Poor health, and the multiple ways in which it constrains labour participation and time, fosters diverse, unequal, and uneven experiences of the final years of work for these blue collar workers, which may not allow them to meet the policy expectation to work until the age of 67. We argue that by failing to acknowledge the long-term health effects of blue collar work and its work-limiting bodily effects, raising the pension age devalues industrial work histories and manual labour. Finally, acknowledging the social milestone of retirement, we question the moral dimensions of extending the pension eligibility age. [ABSTRACT FROM AUTHOR]

The recent advent of new, highly effective, direct-acting antivirals (DAAs) is dramatically reshaping the hepatitis C virus (HCV) treatment landscape and prisons are set to play an important role. While there is a substantial literature addressing the centrality of stigma to experiences of living with HCV in the community, including as a barrier to treatment, scant attention has been paid to documenting how HCV-stigma figures within the distinct sociality of prison life. This article focuses on initial, pretreatment interviews with prisoner participants (n = 32) from the first, real-world trial of HCV 'treatment-as-prevention' in prison: Australia's Surveillance and Treatment of Prisoners with Hepatitis C (SToP-C) study. Drawing on recent developments in stigma theory alongside Goffman's original insights, we posit HCV-stigma as a relational, contingent and political process, materialised across the network of power relations in prison. Participant accounts describe a complex picture, with reports ranging from those suggesting the 'normalisation' of HCV to those detailing the potential effects of HCV-stigma, including additional disciplinary attention from officers and/or the rejection from peer networks by fellow prisoners. While acknowledging the limiting effects HCV-stigma may yet have on treatment-as-prevention efforts, we speculate that with committed political leadership, operational investment, sufficient prisoner engagement, interventions such as SToP-C may also afford opportunities for such effects to be challenged, disrupted, and even left behind. [ABSTRACT FROM AUTHOR]

Findings from recent deaf education intervention programmes with health care professionals emphasise the importance of sociocultural dimensions of medicine, pointing to the need to further investigate health professionals’ current understandings of deafness. Situated within a social constructionist and critical realist framework, we investigated health professionals’ understandings of deafness and experiences of providing health services in Australia to d/Deaf people. Through an inductive thematic analysis of 18 individual interviews with medical or allied health professionals, we identified an overarching theme we labelled hearingness as privileged, whereby professionals accounted for the quality of the health services available to d/Deaf people in Australia. The professionals recognised the services as not good enough and, through relating their efforts to do the best they can, and describing how the situation could always be better, it was evident that the professionals were negotiating a larger health system that disadvantages the needs of d/Deaf people for the needs of people with hearingness. We discuss the implications of working within a system that privileges hearingness. [ABSTRACT FROM PUBLISHER]