Search

The COVID-19 pandemic has disrupted societies globally. Public health institutions were tasked with responding to the pandemic in a dynamic and uncertain context. This paper sheds light on the experiences of COVID-19 response actors as they navigated multi-dimensional crises associated with the pandemic in general and vaccine hesitancy in particular. This research was conducted during the initial phase of the COVID-19 vaccine rollout in Flanders, Belgium. Participants included informants across all levels of the COVID-19 vaccination strategy including but not limited to those producing scientific knowledge, providing policy input, or implementing public health directives locally. 'Crisis' was identified as a recurring theme in interviews with informants. The paper highlights multi-dimensional crises experienced by informants such as the: (i) crisis of prioritization, (ii) crisis of communication, (iii) crisis of the changing image of science, (iv) crisis of epistemic agency and autonomy, and (v) crisis of trust. [ABSTRACT FROM AUTHOR]

In some countries, far-reaching 'lockdown' measures to contain the spread of coronavirus were implemented early in 2020. In Austria, these early measures were met with a high degree of compliance among the country's population. In this paper, we draw upon qualitative interviews, and ask how people made sense of the restrictions imposed during the first lockdown in April 2020 and what shaped their compliance. Empirical research has so far tried to explain compliance by means of people's disposition and motivations as well as demographic and social characteristics. Instead of focussing on who is compliant, we aim to understand how people practice compliance. We do this by approaching compliance through the concepts of values and practice. First, our findings indicate that people assess whether measures are suitable and legitimate in relation to the values of science, the law, and morality. Second, people assign additional personal value to compliance by stressing its positive implications on their own lives. By adopting a nuanced perspective on compliance as inextricably linked to peoples' values and practices, our paper critically contributes to the political and scholarly discussion of pandemic public health measures. Understanding compliance through the lens of values shows how people make sense of the measures in the context of their everyday lives, helping us to move away from a binary understanding of (non-)compliance that has become morally charged. [ABSTRACT FROM AUTHOR]

This paper examines the atmosphere of mistrust that permeated the response to the tenth Ebola epidemic in Eastern DRC (2018–2020). The concept of an 'atmosphere of mistrust' that we develop in this article directs attention to the elusive-yet-pervasive presence of mistrust in interactions between responders and communities during the Ebola epidemic. This analysis focuses on the popular notion that 'Ebola is a business'. Our interviewees frequently used this saying during our research on the Ebola response to explain why mistrust had emerged, how it materialized, and against whom it was directed. Based on these interviews, we examine 'Ebola is a business' as a slogan that enabled people to voice mistrust. This slogan, as we aim to show, resonated with a wider atmosphere of mistrust that governed the emergency situation in Eastern DRC. In using it, people responded to their perceptions of mistrust whilst simultaneously perpetuating and extending this atmosphere of mistrust. Our analysis of the atmosphere of mistrust highlights the power of atmospheres in governing situations, mobilizing people, and disrupting structures of discrimination. It aims to contribute to a better understanding of the barriers inhibiting the collaborations between affected communities and responders, which are required to deliver effective epidemic responses. Moreover, we argue that voice and the atmosphere are important analytics for exploring the histories of mistrust that Ebola epidemics ask for. [ABSTRACT FROM AUTHOR]

Research recruitment, eligibility, and who chooses to participate shape the resulting data and knowledge, which together inform interventions, treatment, and programming. Patterns of research participation are particularly salient at this moment given emerging biomedical prevention paradigms. This paper explores the perspectives of Black and Latino young men who have sex with men (BL-YMSM) regarding research recruitment and eligibility criteria, how their experiences influence willingness to enroll in a given study, and implications for the veracity and representativeness of resulting data. We examine inclusion and recruitment as a complex assemblage, which should not be reduced to its parts. From April to July 2018, we conducted in-depth interviews with 30 BL-YMSM, ages 18–29, in New York City. Interviews were recorded, transcribed, and analyzed using the constant comparative method. Black and Latino YMSM's responses unveiled tensions between researchers', recruiters', and participants' expectations, particularly regarding eligibility criteria (e.g. age, sex frequency), assumptions about 'risky behaviors,' and the 'target' community. Men preferred peer-to-peer recruitment, noting that most approaches miss key population segments. Findings highlight the need to critically examine the selected 'target' community, who sees themselves as participants, and implications for data comprehensiveness and veracity. Study eligibility criteria and recruitment approaches are methodological issues that shape knowledge production and the policies and programs deployed into communities. These findings can inform how future research studies frame recruitment and eligibility in order to better meet the needs of participants and ensure future research engagement. [ABSTRACT FROM AUTHOR]

The landscape of cancer is changing, with earlier detection and the emergence of new treatment options signalling the potential reconfiguration of cancer (for some) as a chronic condition. Cancer is increasingly experienced in terms of chronicity, incorporating both ongoing episodes of acute treatment alongside the long-term management of disease, symptoms, and side effects. This emphasis refocuses attention toward living-with, as well as beyond, cancer. Yet, how cancer chronicity is understood and experienced by both patients and healthcare professionals remains underexplored. While sociological scholarship has critically analysed how chronic illness has been positioned as a problem of/for the person and/or the healthcare system, less attention has been paid to instances like cancer, where chronicity might be viewed as reflective of forms of success (e.g. through the deferral of mortality even in the absence of 'cure'). In this paper we draw on qualitative interview data from a large study of cancer survivorship including patients, their family carers and health professionals, across two Australian hospitals. We critically analyse the dimensions of chronicity in the cancer sphere, understanding cancer-as-chronicity as producing a particular form of subjectivity, shaped by the everyday management and experience of treatment, impairment, symptoms, and side-effects. We posit that constructions of cancer as chronic, and associated imperatives linked to longevity, commitment, and resilience, are placing new demands on patients, family carers, and professionals alike. [ABSTRACT FROM AUTHOR]

Smoke-Free School Policies (SFSP) are primarily designed to ensure educational spaces remain free of second-hand smoke, whilst contributing to a reduction in adolescent smoking by challenging the practice per se. Evidence regarding the latter goal is inconclusive, however, with most studies suggesting SFSPs are ineffective in reducing smoking prevalence. A dearth of qualitative research limits our understanding of why this inefficacy persists and how it might be addressed. This paper addresses this lacuna through a critical discursive analysis of data from 56 focus groups, generated with adolescents across 17 schools in seven European cities. It reveals that, while smoking is banned on school premises in most European countries, young people experience wide variation in implementation. Despite this, participants framed SFSPs in remarkably similar ways. Among young people most likely to smoke, representations of SFSPs often undermined their efficacy, leading to the displacement of smoking (outside the school grounds) rather than a reduction in prevalence. We argue that, policy effectiveness could be improved if schools worked collaboratively with students to develop positive collective beliefs and understandings about SFSPs, but caution realism about the potentially limited power of schools to reduce adolescent smoking prevalence. [ABSTRACT FROM AUTHOR]

Developing a deep and contextualised understanding of risk is important for public health responses to young people's alcohol consumption, which is frequently positioned as an outcome of risky behaviour. This paper expands conceptualisations of risk to encompass its wider social and cultural context through a social practice exploration of young people's controlled and managed intoxicated alcohol consumption practice. We report data from a fourteen-month qualitative study of the alcohol consumption practices of 23 young people in England, drawing on group interviews and social media interactions. Our findings provide a nuanced understanding of risk-taking, demonstrating that risk is an important aspect of the ongoing participation and performance in alcohol consumption practice and that health information and advice can be and was frequently incorporated into drinking practice without contributing to fundamental change. This raises new questions about the effectiveness of health interventions that focus on the individual, discussed in the final section of the paper. [ABSTRACT FROM AUTHOR]

The paper explores how paid and unpaid labor history over the life course influence women's cardiovascular disease. U.S. women comprise about 50% of the paid workforce and perform the majority of unpaid labor. However, the influence of women's work on their health is under-researched. Our sample was drawn from the Women's Health Initiative Observational Study, a cohort of post-menopausal women in the U.S. aged 50–79 at recruitment. Women were categorized into five groups according to paid labor history: worked in paid jobs consistently throughout adult life; left the workforce early; entered the workforce later; discontinuous work history; never worked outside the home. Live birth history (none, at least one, missing) served as a proxy for unpaid labor in prime age. Cox proportional hazard models were used to estimate the hazard ratio of CVD associated with different paid work histories. We then assessed the effect of unpaid labor on the relation between paid labor and CVD. Paid labor participation was not associated with CVD risk among women without unpaid labor after adjusting for age, education, and birth cohort. Among those with unpaid demands, leaving the workforce early or having discontinuous work history was protective. In this U.S. sample, the association between paid work participation history and CVD risk depends on the presence of unpaid labor. Our results demonstrate the necessity of including work – paid and unpaid – in consideration of women's health. [ABSTRACT FROM AUTHOR]

This paper explores public health policy implementation through partnership working at the local level by examining how local actors from public health, and the wider workforce make sense of and work on social inequalities in health. An ethnographic case study was used to examine policy implementation in one local strategic partnership in north-west England during a period of significant resource constraint. Semi-structured interviews were the primary method of data generation. Sensitising concepts from figurational sociology were used to develop a theoretical account of how local policy implementation directed at narrowing social inequalities in health tended to give rise to relatively fragmented and short-term services, projects and practices, which focused on lifestyle factors and behaviour change. Theorising partnership work as figurations goes some way to explaining the apparent paradox among participants who expressed a relatively detached appreciation of wider social influences, alongside emotional involvement in their work. This process of individualisation explains how local professionals tended to conceptualise health inequality and the social determinants of health as personal troubles. Individualisation meant that the social reality of working in partnerships on difficult issues was simplified. Thus, any scope for working on the social determinants of health tended to be overlooked. The extent to which this was intentional or a matter of struggling to see opportunities, or a mixture of the two, was difficult to discern. Although the policy landscape has changed, the findings give some insight into understanding how local collaborative processes reproduce local public health work underpinned by lifestyle choices. [ABSTRACT FROM AUTHOR]

This paper examines determinants of ethnic disparities in workplace risks of COVID-19 among health and social care workers (HCWs) in the UK. This was undertaken to inform public health policy in the management of COVID-19 relating to health and social care provision. A cross-sectional survey was administered in July–August 2020 (n = 456) to elicit HCWs' experiences of COVID-19 management in the workplace and their perceptions of exposure, personal protection against infection, involvement in local clinical management, and other workplace hazards. Findings suggest minority ethnic HCWs were twice as likely as White HCWs to be in a patient-facing role (OR = 2.14, 95% CI:1.21; 3.78, P < 0.01) and twice as likely (63% vs 39%) to be caring for COVID-19 positive patients (OR = 2.68, 95% CI: 1.77; 4.06, P < 0.01). Those in nursing, were three times as likely to be redeployed to a COVID-19 care setting (OR = 3.33, 95%CI: 1.23; 9.02, P= 0.02). Minority ethnic HCWs within lower- and mid-level roles carried a higher burden of frontline clinical management of COVID-19 positive patients than their White counterparts. This study found evidence of ethnic disparities across several workplace hazards, with increased exposure to and less protection against infection, more responsibility for the clinical management of infection, and evidence of systemic racial bias in the disproportionate redeployment of minority ethnic nursing staff to COVID-19 areas. An NHS-wide review is required to assess procedural fairness, ensure safe practices now, and to avert future crises. [ABSTRACT FROM AUTHOR]

Scotland is faced with pernicious health inequalities, which stem from inequalities in living conditions and the societal structures that create them. While action is needed to address the wider structural causes of health inequalities, the role of general practitioners (GPs) merits attention due to health care's potential to mitigate or exacerbate health inequalities. Minimal research, however, has explored how GPs understand the fundamental causes of health inequalities nor how they conceptualise their role in mitigating these. This paper aims to fill this gap using in-depth qualitative interviews with 24 GPs working in some of Scotland's most socio-economically disadvantaged, urban areas. Using Raphael's SDH discourse framework, this paper found clear linkages between GPs' perceptions of their patients, how they defined the 'problem' of health inequalities, and what they thought could be done to tackle them in disadvantaged areas. In general, there was convergence on how interviewees viewed their role in mitigating health inequalities through their work with individual patients. However, greater variation was found when describing the boundaries of their role and how far these extended beyond individual encounters. Specifically, only those GPs fluent in discussing structural causes of health inequalities discussed obligations to change local systems via strengthening community linkages and to influence higher level policies related to the SDH. This suggests that while there is a degree of what Metzl and Hansen deem 'structural competency' amongst some GPs working in disadvantaged areas, the scope remains to deepen this competency more broadly. [ABSTRACT FROM AUTHOR]

The concept of vulnerability is frequently used in public health policies to develop tailored interventions or dedicate proportionately more resources to certain sub-populations. However, once segments of the population are identified as vulnerable, they are rarely consulted regarding whether this label is acceptable before instituting interventions. Instead, it is implicitly assumed that the targeted individuals identify themselves as vulnerable and experience an unambiguous and consistent need for public health assistance. In this paper, using public health interventions during heat waves as a case study, we question such assumptions. A qualitative study was conducted in Montreal, Canada involving two focus groups among populations specifically targeted by the heat action plan as vulnerable: one composed of individuals diagnosed with schizophrenia, and one composed of individuals who have alcohol or drug addictions. Findings revealed significant heterogeneity in the definition and experience of vulnerability as it is used in the context of a heat action plan in Montreal. We found differences between the two focus groups in several areas including sources of information they had access to within the heat action plan measures and their perspectives regarding the appropriateness of specific measures in the heat action plan. We then observed differences within each of the focus groups in several areas including their social networks relationships. The concept of vulnerability is often used in public health policies. Yet, while this concept may be convenient for shaping policies to reduce inequalities in health, the heterogeneity of populations defined as vulnerable should not be underestimated. [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]

This article explores the ways in which patients and their families (hereafter referred as ‘users’) share and evaluate disease-specific evidence via online communities. The aim is to understand what this user engagement in healthcare and knowledge production reveals about society’s shifting perceptions of trust in the institutions of ‘evidence-based medicine’ (EBM) such as regulators, bioethicists and scientists and the implications for EBM. To do this, I use the case of experimental stem cell therapies (eSCTs). ESCTs are commonly labelled in academic literature as ‘unproven’, a label that frames their lack of conclusive clinical evidence as unsafe, inefficacious and thus unethical when clinically used. Despite this framing, users engage with other users to share and evaluate all available evidence for themselves, including on-going clinical trial and experiential evidence to build trust for and undertake eSCTs. Increasingly, this user engagement with evidence takes place in online communities that range from user-created and user-run Facebook pages to user-to-user discussion forums on healthcare provider sites or blogs with little if any provider-input in conversations. In this paper, I draw on a sample of these user conversations to show the complex and unpredictable ways in which what counts as evidence and how trust is built for it are shifting. In so doing, I reflect on the shifting relations between the institutions of EBM and society for greater control over evidence that lies at the heart of the evidentiary basis of public health policies. [ABSTRACT FROM AUTHOR]

This paper uses bibliometric analysis and critical discourse analysis to explore the rise in research involving nonhumans in public health, and the potential contribution of posthumanist social theory to this growing body of public health scholarship. There has been a sudden and rather marked increase in research and writing on animals, zoonoses and/or the ‘One-health’ paradigm within public health journals since 2006. Indeed ‘One-health’ rather than ‘posthumanism’ holds together research involving nonhumans of various kinds – from viruses to animals – within the discipline. Advocates of the ‘One-health’ paradigm argue that human and animal health must be integrated through joining the research, training and care practices of human and animal medicine. By mapping the terrain of public health research involving non-human species, we consider how and where posthumanist theory could be productively drawn upon to contribute to both critical and applied research involving nonhumans within public health. We specifically ask how the posthumanist insight to ‘follow the nonhumans’ would raise new questions and analytics for this research area. [ABSTRACT FROM PUBLISHER]

Despite improvements in access to transition-related medical care, many transgender people still face numerous barriers to paying for gender-affirming procedures. Crowdfunding websites have gained immense popularity as a strategy for trans people to raise money for transition-related healthcare expenses. Using descriptive statistics and thematic content analysis, this paper illustrates how fundraising campaigns for medical gender transition both reveal and reinforce health and social inequalities. Although trans people crowdfund for a variety of transition-related needs, the majority of online campaigns are used to fund chest surgeries among young, white, binary-identified trans men in the United States. Most campaigns fall dramatically short of their fundraising goals. In addition, campaigns use medicalized, normatively gendered transition narratives that privatize inequality in marginalized communities. The article concludes with a consideration of how to incorporate a 'revolutionary etiquette' in crowdfunding for transition healthcare. [ABSTRACT FROM AUTHOR]

This paper uses practice theory to explore a poorly understood phenomenon with important health implications: How and why an increasing number of young Americans regularly use multiple tobacco products. Practice theory is a promising alternative to traditional public health frameworks for understanding everyday activities related to health. It broadens the analytic focus from characteristics of individuals to viewing practices as having lives of their own in competing for, winning, and losing practitioners. We drew from in-depth interviews with 21 young adults (ages 18–29; California) who regularly use cigarettes, electronic nicotine delivery systems (ENDS), and/or smokeless tobacco. Participants described their everyday routines. We examined the characterizing elements of each tobacco product use practice and the roles of each within participants' routines. We found that each product comprises a distinct substance use practice with different roles to play in different situations and contexts. Notably, many participants rotated between or modulated use of different products as a strategy for reducing perceived tobacco-related harms. Cigarettes are uniquely capable of aiding in the space-time organization of everyday activities and coping with crisis, while ENDS and smokeless tobacco open up times and spaces for nicotine consumption. This kind of approach aids our understanding and anticipation of the evolution of tobacco use practices as new products and regulations are introduced. [ABSTRACT FROM AUTHOR]

Ideas about intersectoral action and policy-making for health (ISA) are prominent among public health professionals. They are often presented as effective ways to address root causes of poor health and health inequality, and as such the best way to promote population health. The implementation of such ideas has proven difficult though. In this paper we argue that neo-institutional theory can help us conceptualize implementation challenges by pointing to implicit expectations and contradictions associated with the ISA idea itself. With Denmark as empirical case, we conducted a document analysis of recommendations for municipal ISA. The analysis shows how the recommendations provide a very abstract conceptualization of ISA that does not give much practical guidance for action. We show how ISA is discursively constructed with buzzword qualities as the natural way to organize health promotion, by being presented as a means to produce better quality services, more cost-effective operations and ensure the future of the welfare state, while at the same time hardly changing much at all. By applying the lens of institutional logics we show how ISA, although being vaguely defined, offer ambiguous normative and symbolic repertoires for action. We discuss the implementation challenges associated with this advocacy rhetoric and suggest that the domination of the corporation logic may appear to reduce the political character of ISA and potentially conflict with the ideals of health as a matter of social justice and human rights. [ABSTRACT FROM AUTHOR]

It is now widely accepted that context matters in evaluations of the health inequalities impact of community-based social initiatives. Systems thinking offers a lens for uncovering the dynamic relationship between such initiatives and their social contexts. However, there are very few examples that show how a systems approach can be applied in practice and what kinds of evidence are produced when this happens. In this paper, we use data from ethnographic fieldwork embedded within a multi-site mixed method evaluation to demonstrate how a systems approach can be applied in practice to evaluate the early stages of an area-based empowerment initiative – Big Local (funded by the Big Lottery Fund and delivered by Local Trust). Taking place in 150 different local areas in England and underpinned by an ethos of resident-led collective action, Big Local offers an illustration of the applicability of a systems approach to better understand the change processes that emerge as social initiatives embed and co-evolve within a series of local contexts. Findings reveal which parts of the social system are likely to be changed, by what mechanisms, and with what implications. They also raise some salient considerations for knowledge generation and methods development in public health evaluation, particularly for the evaluation of social initiatives where change does not necessarily happen in linear or predictable ways. We suggest future evaluations of such initiatives require the use of more flexible designs, encompassing qualitative approaches capable of capturing the complexity of relational systems processes, alongside more traditional quantitative methods. [ABSTRACT FROM PUBLISHER]

In relation to clinical trials, it is far more usual to speak of the community (singular, static) than of publics (multiple, emergent). Rarely defined, the community is commonly taken to be the existing people in a given area, which the trial will engage, mobilise or sensitise to facilitate successful recruitment and retention. Communities are assumed to pre-exist the research, to be timeless, and to be a whole (sometimes consisting of different parts, referred to as stakeholder groups). In this paper, we suggest a conceptual shift from ‘trial community’ to ‘experimental publics’. Using an empirical case study of an HIV prevention trial in Zambia, we draw out the following key points: firstly, publics do not pre-exist research activities but are enacted in concert with them. Secondly, publics are dynamic and transient. And thirdly, experimental publics are situated at the intersection of various forms of inclusion and exclusion, both locally and globally. Our findings emphasise the need to create long-term forms of participation in science, which transcend both the instrumental goals and the individual timelines of specific trials. [ABSTRACT FROM PUBLISHER]

Young bisexual women experience worse mental and sexual health outcomes in comparison to their heterosexual and lesbian peers. These disparities are associated with stigma and devaluation of bisexual identities. The current paper addresses a community-based focus group project in which participants discussed bisexual stigma in regard to bisexual erasure and other stereotypes. Specifically, participants detailed experiences of feeling pressured to provide evidence of their bisexual identity, modifying their relationship or sexual behavior to conform to these expectations, as well as feeling excluded from queer community. Further, participants discussed how these experiences were related to decreased mental and sexual health. Future research should further investigate the relationship between bisexual stigma, pressure to provide evidence of bisexual identity, and negative mental and sexual health outcomes. [ABSTRACT FROM PUBLISHER]

In 1998, the Supreme Court of Canada ruled that prosecuting people for HIV-status nondisclosure would neither affect people’s willingness to undergo HIV testing, specifically, nor undermine HIV prevention, more generally. Since that time, limited research has explored this topic. This paper reports a survey of a convenience sample of 721 gay, bisexual, and other men who have sex with men. The aim was to examine participants’ sexually transmitted infection (STI) and HIV testing practices, sexual activities, and perceptions about nondisclosure prosecutions. Results suggest that nondisclosure prosecutions appear to have affected the STI testing practices of the participants in this research who were: (a) the most likely to have reported a sexual history involving unprotected receptive anal sex, and (b) least likely to have undergone testing for STIs. [ABSTRACT FROM PUBLISHER]

Dietary health is a key theme of health policy and public debates on health and inequality. The social gradient in dietary health is evident, but less is known about the processes in everyday life through which less healthy diets are shaped among people with low socio-economic status. In this mixed methods study we recruited 30 men and women living in low income households in Denmark and combined qualitative interviews about household practices with quantitative estimates of the quality of participants' diets. The qualitative findings show that in general, the participants' food practices were conditioned by budget restrictions and bundled with other non-food practices in their everyday life, which in most, but not all, cases conflicted with engagement in healthy eating. Only few participants reported feeling able to provide 'proper foods' according to their own preferences. We identified five distinct pathways through which food practices were performed. All were structured by distinct life situations which created different ways in which food practices were bundled with other practices. The quantitative estimates of participants' diets show that none of the participants' diets categorized as healthy. The combined analysis showed that estimated dietary quality varied between the five pathways, and that the degree of budget restraint and the practice of handling a disease in the household were notably important for the performance of food practices. [ABSTRACT FROM AUTHOR]

The concept of an Ecological Approach to health and including Health in All Policies warrants inter-sectoral and transdisciplinary collaboration to improve health determinants and reduce health inequities. Agriculture policies, which greatly influence food production and its environmental impacts as well as food availability and dietary consumption, are therefore of interest to public health. Increasing rates of non-communicable diseases linked to diets containing high levels of processed foods, increasing numbers of households unable to access nutritious food and the environmental consequences of the food system are amongst the major health challenges of today, both globally and in Ireland. In 2010, Ireland’s Department of Agriculture, Food and Fisheries published Food Harvest 2020 a roadmap for Irish agriculture for the subsequent decade prepared against a backdrop of rising diet-related ill-health and increasing environmental concerns. This article critically analyses the process of consultation and stakeholder involvement in the development of Food Harvest 2020 from a public health perspective. Publically available documents including submissions to the Food Harvest 2020 consultation process were the primary source of data. This study highlights a distinct absence of public health representation in the process, an avoidance of some key public health challenges and the dominance of a ‘business as usual’ approach. [ABSTRACT FROM AUTHOR]

Antibiotics are a routine part of everyday life in many contexts, contributing to the development of antimicrobial resistance (AMR). Our ethnographic research documents the ways that antibiotics have become a key part of everyday life for precariously employed urban day-wage workers living in a large informal settlement in Kampala, Uganda. We found that for many people, their daily work and ongoing health was entangled with antibiotic use; that is, people showed us how their antibiotic use cannot be separated from the realities of living in a politically, economically and environmentally degraded 'informal' landscape. Thinking through entanglement as itself a politics, we show how limited political power, inability to demand change, and inequitable access to good health care, are associated with high rates of infection and disease, precarious work, and polluted environments. Antibiotics, we argue, have become a way to negotiate the inequalities written into these informal urban landscapes; their use entangled with ongoing relations with labour, environment and bodily suffering. Through this approach, we show how antimicrobials are used in society, with an attention to how vulnerabilities, risks, and forms of abandonment and exclusion shape their everyday use. Antibiotic use is entangled with everyday life in informal settlements, and the politics that produce 'informality'. In Kampala today, the entanglement of antibiotics with life in informal settlements reveals how forms of urban segregation, life in 'slums' and their everyday acceptance, shape the pathways and uses of antimicrobials. [ABSTRACT FROM AUTHOR]

In May 2017, the Saskatchewan Transportation Company (STC), a 70-year-old bus company in Saskatchewan, Canada, was shut down through an austerity budget that saw several cuts. The government justified its decision on budgetary grounds although opponents cited possible negative impacts of the decision. A Foucauldian Discourse Analysis (FDA) was employed to examine discourses used by different actors to explain the closure and the implications of these discourses for health and health equity. Data from 47 days of parliamentary debates, 751 newspaper articles, and 2 focus group discussions were imported into NVivo software for analysis. Discourses and counter-discourses surrounding the closure were explored and interpreted in the broader context of austerity and the politics of health. The evidence suggests that the closure of STC was facilitated by several contextual factors anchored around discourses of economic rationalization, minimization, government discretion, and the representation of the bus as a relic of a socialist past. Opponents of the closure defended the bus on the grounds of its utility and the possibility of marginalization/victimization of former bus users. A democratic and an evidence deficit as well as secondary discourses of human rights and environmental/climate impacts were used to argue against the STC closure. The research reveals the critical role of power in the creation of health inequities through austerity measures, particularly through discourses that negate the existence and associated rights of vulnerable users of public services such as public transportation. [ABSTRACT FROM AUTHOR]

The use of policing to enforce public health guidelines has historically produced harmful consequences, and early evidence from the police enforcement of COVID-19 mandates suggested Black New Yorkers were disproportionately represented in arrests. The over-policing of Black and low-income neighborhoods during a pandemic risks increased transmission, potentially exacerbating existing health inequities. To assess racialized and class-based inequities in the enforcement of COVID-19 mandates at the ZIP-code-level, we conducted a retrospective spatial analysis of demographic factors and public health policing in New York City from 12 March–24 May 2020. Policing outcomes (COVID-19 criminal court summonses and public health and nuisance arrests) were measured using publicly available police administrative data. After controlling for two measures of social distancing compliance, a standard deviation increase in percentage of Black residents was associated with a 73% increase (95% CI: 35%, 123%) in the COVID-19-specific summons rate and a 34% increase (95% CI: 17%, 53%) in the public health and nuisance arrest rate. Percentage of Black residents and historical stop-and-frisk rates had stronger associations with COVID-19 summons rates than multiple measures of social distancing compliance. Findings demonstrate pronounced spatial and racialized inequities in pandemic policing of public health that mimic historical policing practices deemed racially discriminatory. If the field of public health supports criminalization and punishment as public health strategies, it risks reinscribing racialized health inequities. [ABSTRACT FROM AUTHOR]

Legal protections for people living with HIV (PLHIV) are important for protecting human rights, yet little research has examined how laws translate into awareness and understanding for key populations. The Philippines has recently revised their legal protections for PLHIV in response to its growing HIV epidemic, where HIV-positive gay, bisexual and other men who have sex with men bear the majority of cases. We present findings from interviews with 21 HIV-positive gay, bisexual and other men who have sex with men in Manila, Philippines regarding awareness, understanding, and needs regarding HIV-specific legal protections at the time just before new revisions to the omnibus HIV law were passed. Overall, there was no standardized way participants became aware of legal protections; few became aware through healthcare providers, while most learned through online resources, social media, and advocacy organizations. However, even after learning about HIV-specific legal protections, many found the law too complex to understand or did not understand how to use such protections. This led participants to preemptively take action to avoid HIV-related discrimination, even if they were protected by law. Participants demonstrated a strong desire for interventions and policies to improve legal awareness and understanding for PLHIV, government officials, and private businesses. This research demonstrates the value of increasing awareness and understanding in policy-specific interventions designed to improve quality of life for PLHIV. Interventions centered around legal protections are currently underdeveloped, providing a strong opportunity to integrate such interventions in existing practice or as stand-alone tools to decrease perceived stigmatization. [ABSTRACT FROM AUTHOR]

Though work and paid employment are generally beneficial, and unemployment is frequently harmful, precarious employment relations are also health damaging. This study compared the health status of workers in highly precarious employment with unemployed individuals in 35 European countries. We used data from the 6th European Working Conditions Survey (2015) (n = 33,938). The prevalence of precariousness was 58.99%. We fitted a multi-level generalized linear model (GLMM) to calculate the adjusted prevalence ratios (aPR) of health-related outcomes according to quartiles of precariousness and unemployment. We calculated the aPR of health-related outcomes in the highly precariously employed (quartile 4 of precariousness), with reference to unemployed individuals. We found significant associations of higher prevalence of bad health status, headache, skin and hearing problems, anxiety, fatigue, backache, upper and lower muscular pain and injuries among quartiles 3 and 4 of precariousness compared with those with no precarious employment. The confidence intervals of the aPR for most of health-related outcomes overlapped between the highest quartiles of precariousness and recent unemployment, indicating no significant differences among these groups. We conclude that unemployment and higher degrees of precariousness can be similarly health damaging. Therefore, we propose that employment conditions should be better monitored. This is an essential first step in order to document, and identify interventions to prevent, the health-damaging consequences of growing levels of precarious employment. This will be essential for achieving the 8th sustainable development goal of decent work and economic growth by 2030. [ABSTRACT FROM AUTHOR]

Despite significant engagement with new and emerging issues in public health practice, the public health literature has few theoretical explanations for how new practices emerge, take root, and become institutionalized. In this contribution, we utilize Pierre Bourdieu's sociological concepts of field, habitus and capital, and in-depth interviews with public health practitioners to document and describe the emerging field of public health adaptation to climate change Ontario, Canada. In doing so, we identify and explain three types of climate change action and associated practices – 'wait and see', repackaging existing actions and championing new actions – that practitioners relate to climate change adaptation in Ontario (i.e. business as usual, repackaging existing actions and championing climate new actions). We discuss the typology in relation to the dominant and emerging logics that practitioners ascribe to promoting practical action on this sub-field of environmental health practice to promote a discussion of how social change occurs within a well-established field of professional practice. Findings suggest, that change and innovation can result from exogenous shocks that force practitioners to adopt new practices (e.g. the increasing frequency and intensity of climate-related impacts on health), how the 'rules' of a given field are interpreted by practitioners and made actionable, and through the negotiation of new rules by practitioners with a 'radical habitus' who champion particular issues, albeit resulting in significant professional risk. We discuss these findings in relation to Bourdieu's theory, concluding there is significant room for practitioner agency to cultivate normative dispositions and influence the adoption of policy and practice-change. [ABSTRACT FROM AUTHOR]

The study aimed to investigate the association between caregiver experiences of racial discrimination and physical and emotional health outcomes for their children and to explore potential pathway variables in this relation. We analysed data from two instances of the New Zealand Health Survey that provide nationally representative data for children and adults, with high response rates for each of the major ethnic groupings (Indigenous Māori, Pacific, Asian, and European/Other). Questionnaires from the primary caregiver and their child (5 to 14 years) were linked to create n = 2,958 child-primary caregiver dyads in the 2006/07 Survey and n = 2,632 dyads in the 2011/12 Survey. Children whose caregivers reported any experience of racial discrimination had poorer mental health, self-esteem, and behaviour scores on the CHQ PF-28 scale, even after adjustment for caregiver sociodemographic variables. Multivariable models identified a worsening in child emotional health as the number of reported racism experiences increased. Caregiver experiences of racism were not associated with medicated asthma in their children. Multivariable models suggest that caregiver psychological distress may be a pathway linking vicarious racism to poorer child emotional health. [ABSTRACT FROM AUTHOR]

In this cross-sectional study, we evaluated the associations between precarious employment and health-related outcomes in salaried workers from 28 countries in Europe (2014). We used data from the Flash Eurobarometer 398 among salaried workers (n = 7,702). We fitted multi-level generalized linear models (GLMM) using the Poisson family and country as the random effect, to calculate the crude (cPR) and adjusted (aPR) prevalence ratios with their 95%CI of health-related outcomes (health problems, sick leave, health and safety risks in the workplace) according to precarious employment. We found significant associations between having a precarious employment and health problems caused or worsened by the work (stress/depression/anxiety, musculoskeletal problems, infectious diseases, respiratory problems, accidents/injuries and allergies), sick leave of more than 15 days [aPR: 1.43, (CI95%: 1.09;1.87)] and exposure to violence or harassment [aPR: 1.82, (CI95%: 1.42;2.34)]. Our study shows an association of precarious employment, understood as a multidimensional construct, and negative health-related outcomes and sick leave of more than 15 days. Therefore, we recommend prioritizing legislative measures for reducing non-standard arrangements and for improving the conditions of workers in non-standard arrangements. [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]

Despite the Internet's global importance as a sex-seeking venue for men who have sex with men (MSM) and other sexual and gender minorities, little is known about this topic in sub-Saharan Africa. Furthermore, existing public health research offers limited insight into the sociocultural aspects of sexuality and how they articulate with patterns in online sex-seeking behavior. In 2015, we conducted survey and ethnographic research with 105 sexual and gender minorities in Abidjan, Côte d'Ivoire. Nearly half of survey respondents reported finding partners primarily online. Three quarters reported having found at least one partner online. Interviews with 24 of the survey participants revealed that a primary motivation for using online venues was that they allowed for the preservation and management of discretion and anonymity, permitting users to avoid discrimination and violence. While secondary to their strategies for managing such social risk, participants also reported using the profile features of online venues to filter out partners they perceived as presenting a risk to their sexual health. Though interview participants perceived online venues as providing a degree of protection against potential stigma and violence in offline contexts, survey data showed that over one quarter of participants had experienced extortion and/or blackmail by sexual partners they met online. By taking into account the sociocultural context of sexuality and sexual activity in Abidjan, these findings highlight the disjuncture between essentialist notions of MSM who use the Internet to find sex partners as a universal, at-risk group, and the complexity of sexual and gender minorities' experiences. [ABSTRACT FROM AUTHOR]

Like many rural and suburban counties in the Midwestern United States, George County, Indiana is facing increased rates of heroin use, drug-related overdose, and hepatitis C. Following an outbreak of HIV in 2015 in a nearby county, the George County department of health launched an effort to open a needle exchange despite considerable opposition from the community, including ambivalent stances among current and former users of opiates. This article examines these conflicted perspectives noting their grounding in a moral approach to addiction and seeks to explain opposition to the needle exchange program by examining locals' depictions of the religious and moral landscape of the county. This analysis is based on 29 qualitative interviews conducted with 20 people who have experience using heroin or prescription opioid painkillers and 13 other community members involved in local efforts to address addiction. Ethnographic observation of public events was undertaken. Examining the contours of the local moral economy and its links to religious spirituality and practice reveals that the moral model of addiction both mitigates and produces social exclusion and begets conflicted stances towards the presence of an initiative to open a modest needle exchange program. Interviewees expressed a variety of stances towards the initiative feeling that it might decrease the spread of disease, but may not be used effectively. Though it is situated on morally contested terrain, it may be a step towards social inclusion and empowerment for addicted individuals who stake their right to health and a place in the community. [ABSTRACT FROM AUTHOR]

As a group, middle-aged same-sex attracted women (SSAW) appear to consume more alcohol than exclusively heterosexual women in the same age range; however, few studies document their collective drinking practices or identify opportunities to reduce associated harms. Online surveys which included open-ended questions were completed by a self-selected sample of SSAW (N = 134) aged 36–51, recruited in Victoria, Australia. We identify 12 sub-elements of SSAW's collective drinking practice using a schema grounded in social practice theory (SPT). Responses are compared for SSAW who consumed alcohol with others at moderate and at heavier levels, based on screening. Heavier drinking respondents were more likely to observe that: alcohol use is normalised for SSAW; they are not pressured to drink; drinking produces pleasurable effects; drinking facilitates management of uncomfortable moods and that venues welcoming SSAW are saturated with alcohol. In line with SPT, links between sub-elements described by heavier drinkers are explored to identify potential interventions. For example, we recommend an expansion of social opportunities without alcohol that engender affirming affective states for SSAW. Further, many SSAW's commitment to the importance of moderation and rejecting coercion to drink could be used to combat the conviction that drinking is an inevitable response to discrimination experienced by sexual minorities. It was apparent that although they drank with other SSAW, our survey respondents did not share a consistent or altogether unique drinking culture. We suggest that an SPT approach entailing data coding to multiple sub-elements supports the identification of diverse configurations of drinking practice within heterogeneous subpopulations. [ABSTRACT FROM AUTHOR]

Cambodia has experienced an impressive economic growth in the last two decades that has not been matched by equal investments in public health care. In combination with other historical and sociocultural factors, this has led to a set of private and public health care practices that divert from standards of clinical good practice. Based on qualitative data collected in malaria and (para)typhoid fever projects, we will describe falsified laboratory test results, dubious diagnostic practices of both unlicensed and licensed doctors, the sales of substandard preparations and combinations of medicines, and even surgeries for commercial interest instead of patient well-being. Patients navigate this complex medical landscape by circumventing costly clinical care – by self-diagnosing and self-medicating, using medicines bought from drug sellers – and by actively seeking out clinical interventions when the required financial investment is perceived to match the illness severity. We will explore what practices constitute healthcare in urban and rural Cambodian settings; what differentiates these practices from clinical 'good practice' guidelines in conventional medicine; and which mechanisms patients, drug sellers and medical doctors have developed to navigate a health care system that at the same time enables, encourages, and sanctions such unregulated practices. [ABSTRACT FROM AUTHOR]

This study explores whether population-level measures of income inequality and poverty rates are associated with mass shootings in the United States. We test these potential connections by examining the incidence rate of mass shootings using random effects negative binomial regressions for a panel data-set that included 3144 counties for the years 1990-2015. According to the adjusted models, income inequality is significantly associated with the three or more victim-related injuries (incidence rate ratio [IRR] = 1.39; 95% confidence interval [CI] = 1.11, 1.67; P < .001) and four or more victim-related deaths definition of mass shootings (IRR = 1.36; 95% CI = 1.08, 1.64; P < .01). However, poverty rates lack a reliable association with the three or more injuries (IRR = 1.07; 95% CI = .75, 1.39) and four or more deaths definition (IRR = .95; 95% CI = .71, 1.19). When considered in conjunction with the literature on inequality and crime, these results indicate that counties with high inequality may foster an environment of anger and resentment that ultimately leads to mass shootings. [ABSTRACT FROM AUTHOR]

Since late 2009, Greece has been dealing with the effects of a debt crisis. The neoliberal principles embedded in the three structural adjustment programmes that the country accepted have required radical cuts in health care funding, which in turn have led to widening inequalities in health. This article focuses on access to health care for people with disabilities in Greece in the context of these structural adjustments. We investigate possible differences in unmet health care needs between people with and without disabilities, using de-identified cross-sectional data from the European Health Interview Survey. The sample included 5400 community-dwelling men and women aged 15 years and over. The results of the logistic regressions showed that people with disabilities report higher unmet health care needs, with cost, transportation, and long waiting lists being significant barriers; experience of all barriers was positively associated with low socio-economic status. These findings suggest that a section of the population who may have higher health care needs face greater barriers in accessing services. Austerity policies impact on access to health care in both direct and indirect ways, producing long-term disadvantage for disabled people. Social policies and comprehensive anti-discrimination legislation might help to address some of the barriers this population faces. [ABSTRACT FROM AUTHOR]

Syndemics (socially produced intertwined epidemics) of psychosocial issues have been shown empirically to increase the risk of HIV infection among gay, bisexual and other men who have sex with men (GBM). However, to intervene effectively identifying those who are most vulnerable is critically important. Using an intersectionality framework, this study analyzed data drawn from 8490 Canadian GBM respondents to an online survey to evaluate demographic factors associated with experiencing a syndemic. A multivariable regression model was used to identify demographic characteristics among those experiencing a syndemic of two or more issues. Then, applying an intersectionality framework, the sample was stratified by gay and bisexual men, and by men partnered with woman (whether they were gay, bisexual or other), and the multivariate analyses for demographic variables were repeated for each strata. Multivariate regression models found that men were more at risk of syndemics if they identified as gay, were single, young (< 30-years-old), did not have a university degree and were low-income earners (< $60,000 per year). On stratified analysis, variations were found between gay, bisexual and female-partnered men where gay men were at greater odds of reporting a syndemic. These results provide further evidence that syndemics of psychosocial issues increase the risk of HIV infection among GBM. More so, the occurrence of syndemics was dependent on every single variable investigated including ethnicity and income. As such, interventions to reduce the effects of syndemics should be targeted to those most at risk and address social and structural inequities. [ABSTRACT FROM AUTHOR]

Little work has been conducted to understand how alcohol marketers engage users with their brands’ Facebook pages in India and Australia. We aimed to evaluate and compare (i) the types of marketing techniques alcohol marketers utilize to facilitate user engagement on their brands’ Facebook pages and (ii) the extent to which users engage with these techniques in two diverse national contexts. We identified the ten most popular alcohol brands on Facebook in India and Australia based on the number of ‘likes’ for each official brand site. Brand websites and data analytic sources were accessed to collect metrics relating to number of likes, frequency of posts made by alcohol marketers on their brand websites and the resulting comments from fans, and messages relating to responsible drinking. The identified brands accrued substantial user engagement (e.g. Budweiser beer attracted 12.8 million likes in Australia and Foster’s beer 802,807 likes in India). The strategies employed were a mix of country-specific (e.g. India: inspirational talks and livelihood skills vs. Australia: posts related to the brand’s tradition or heritage) and generic approaches (e.g. alcohol sponsorship of sport, music, and fashion, offering consumption suggestions, organizing competitions, giveaways, and use of memes). This cross-national comparison illustrates that alcohol marketing on Facebook is user-focused and flexible, works with specific national contexts, and capitalizes on the cultural meanings users invoke in their interactions with sites. The study results also demonstrate the potential for brands to engage those under the legal drinking age by delivering alcohol content on Facebook. [ABSTRACT FROM AUTHOR]

In offering loans to low-income countries in exchange for policy reforms, the International Monetary Fund (IMF) typically sets the fiscal parameters within which health systems develop. In a recent report released by the organisation, the IMF claims that their programmes have promoted social protection, including access to health care. We revisit the findings presented in the IMF’s assessment. Drawing on material collected from the IMF and empirical analyses, we show that the report is methodologically flawed, unduly optimistic and potentially misleading. We conclude by reflecting on the IMF’s steadfast endorsement of targeted social assistance, despite a global tide turn towards universal social provision. [ABSTRACT FROM PUBLISHER]

Intersectionality theory calls for the understanding of race/ethnicity, sex/gender and class as interlinked. Intersectional analysis can contribute to public health both through furthering understanding of power dynamics causing health disparities, and by pointing to heterogeneities within, and overlap between, social groups. The latter places the usefulness of social categories in public health under scrutiny. Drawing on McCall we relate the first approach to categorical and the second to anti-categorical intersectionality. Here, we juxtapose the categorical approach with traditional between-group risk calculations (e.g. odds ratios) and the anti-categorical approach with the statistical concept of discriminatory accuracy (DA), which is routinely used to evaluate disease markers in epidemiology. To demonstrate the salience of this distinction, we use the example of racial/ethnic identification and its value for predicting influenza vaccine uptake compared to other conceivable ways of organizing attention to social differentiation. We analyzed data on 56,434 adults who responded to the NHFS. We performed logistic regressions to estimate odds ratios and computed the area under the receiver operating characteristic curve (AU-ROC) to measure DA. Above age, the most informative variables were education and household poverty status, with race/ethnicity providing minor additional information. Our results show that the practical value of standard racial/ethnic categories for making inferences about vaccination status is questionable, because of the high degree of outcome variability within, and overlap between, categories. We argue that, reminiscent of potential tension between categorical and anti-categorical perspectives, between-group risk should be placed and understood in relationship to measures of DA, to avoid the lure of misguided individual-level interventions. [ABSTRACT FROM AUTHOR]

The US health system remains fraught with racial, gender, and class biases that lead to health care inequities. Although Black middle-class women are rarely studied in the context of health care disparities, they continue to face stereotyping and differential treatment. I argue that Black middle-class women are aware of pervasive stereotyping which leads them to emphasize specific class and cultural resources, i.e. cultural health capital, to mitigate discrimination. Based on in-depth interviews of 19 middle-class African-American women and two focus groups, the study explores stereotyping, bias and the use of cultural health capital as a strategy to mitigate them. Respondents overwhelmingly endorsed the importance of implementing these strategies, noting they were necessary to avoid differential treatment. The findings highlight pervasive stereotypes Black women face in health care settings and in general. Finally, the findings refocus our attention to the durability of race and gender discrimination across socioeconomic status and point to fundamental social inequities as determinants of health care disparities. [ABSTRACT FROM AUTHOR]

Social media platforms are important actors in the development of alcohol marketing techniques. While public health research has documented the activities of brands and consumers related to alcohol promotion and consumption on social media, there remains the need to develop an account of the native, participatory and data-driven advertising model of these platforms. This article examines the relationship between alcohol brands, media platforms and their users by analysing the activity of the 20 most popular alcohol brands’ Australian Facebook pages in 2012 and 2014. We report that the number of fans of alcohol brands increased by 52% from 2012 to 2014. While the number of posts dropped 12% from 2012 and 2014, total interactions with posts by users increased by 9%. Overall, brand activity and engagement became more consistent between 2012 and 2014. We argue that the changing character of user engagement with alcohol brands on Facebook can be related to changes in the platform architecture. Facebook is orchestrating a shift from exposure to engagement as its key advertising metric, and thus departing substantially from established mass media advertising paradigms. Effective policy responses to alcohol marketing in the digital era depend on a more rigorous examination of the marketing infrastructure of social media platforms. [ABSTRACT FROM AUTHOR]

We examined the association between racial/ethnic minority segregation and low birth weight (LBW) in Chicago and Toronto communities. While previous work has documented the importance of contextual effects on LBW, these studies have usually been conducted within a single city. We used Pearson correlation coefficients and OLS regression models to examine potential variability in the association between racial/ethnic minority segregation and LBW in Chicago (N = 77 communities) and Toronto (N = 140 communities). Results indicate that racial/ethnic minority segregation, unemployment, and low educational attainment are not associated with LBW in Toronto, while these indicators have strong and significant associations with LBW in Chicago. In a combined model with data from both cities, a 10% increase in minority composition is associated with a 0.5% increase in LBW, controlling for the effects of unemployment and low educational attainment. Stratified models show that this effect is only significant in Chicago, and subsequent models revealed opposite effects for percentage non-Hispanic Black and percentage Hispanic. Future research should consider additional cities for comparative analysis. Such work could test the notion that Chicago and Toronto represent opposite sides of a spectrum, reflecting variability in how social determinants map on to public health outcomes. Future research should also examine the significant heterogeneity observed in highly segregated communities, particularly in Chicago. [ABSTRACT FROM PUBLISHER]

We analysed cross-sectional data collected as part of the National Socioeconomic Characterisation Survey (2013) in Chile, in order to explore if there are differences in access to health care between adult Chileans with and without disability. The study included 7459 Chilean adults with disability and 68,695 people without disability. Logistic regressions were performed in order to determine the adjusted odds ratios for the associated variables. We found that despite universal health coverage, Chileans with disabilities are more likely to report worse access to health care, even when controlling for socio-economic and demographic variables, including age, gender and income. Specifically, they are more likely to face greater difficulty arriving at a health facility, obtaining a doctor’s appointment, being attended to in a health facility, paying for treatment due to cost, and obtaining necessary medicine. Both people with and without disability are more likely to face difficulties in accessing health services if they are affiliated with the public health provider, an indication of the economic factors at play in accessing health care. This study shows that universal health coverage does not always lead to accessibility of health services and underlines the disadvantaged position of disabled people in Chile in accessing health services. While efforts have been made recently to improve equity in health care access, disability in Chile poses an additional burden on people’s access to health care, emphasising the necessity for policy to address this perpetual cycle of disadvantage for disabled people. [ABSTRACT FROM PUBLISHER]

Comprehensive agri-food policy includes food waste reduction as an important policy goal. Food bank donor indemnification is codified in law in several countries to support the charitable food sector. Other policy instruments to address waste reduction have emerged recently, among them tax measures to incentivize private sector action. These have been increasingly linked to the discourse on hunger in many jurisdictions. We asked 17 Canadian food insecurity policy entrepreneurs to comment on a vignette scenario featuring a hypothetical proposal for food waste diversion as a policy response to household food insecurity; the polarization in responses – ‘Not human garburators,’ vs. ‘everyone wins’ – was remarkable. This case of an unexpected divergence in the response to a policy idea in the food insecurity realm provides an opportunity to understand fundamental differences in societal perspectives that might be relevant to public health more generally. In particular we address the parallel humanist and ecological imperatives at work in contemporary public health practice. It appears that objections to food waste diversion for human consumption could be crystallized in terms of Mary Douglas’s theory of morality within particular worldviews. From a humanist viewpoint, the proposal was an indignity; for those with an ecological worldview, it was sensible and pragmatic. Public health has embraced ecosystem thinking and takes for granted that its ecological approach is sensitive to humanist perspectives but the two worldviews may differ and humanist ideals of dignity may raise moral rancor when considered in the context of ecological good. [ABSTRACT FROM PUBLISHER]

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]

The ‘assets-based approach’ to health and well-being has, on the one hand, been presented as a potentially empowering means to address the social determinants of health while, on the other, been criticised for obscuring structural drivers of inequality and encouraging individualisation and marketisation; in essence, for being a tool of neoliberalism. This study looks at how this apparent contestation plays out in practice through a critical realist-inspired examination of practitioner discourses, specifically of those working within communities to address social vulnerabilities that we know impact upon health. The study finds that practitioners interact with the assets-based policy discourse in interesting ways. Rather than unwitting tools of neoliberalism, they considered their work to be about mitigating the worst effects of poverty and social vulnerability in ways that enhance collectivism and solidarity, concepts that neoliberalism arguably seeks to disrupt. Furthermore, rather than a different, innovative, way of working, they consider the assets-based approach to simply be a re-labelling of what they have been doing anyway, for as long as they can remember. So, for practitioners, rather than a ‘new’ approach to public health, the assets-based public health movement seems to be a return to recognising and appreciating the role of community within public health policy and practice; ideals that predate neoliberalism by quite some considerable time. [ABSTRACT FROM PUBLISHER]