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In this paper, we view health strategies in the field of personalised medicine as performative actions which articulate the development desired for a given society and demonstrate and affirm values and visions for that society. Based on a qualitative study in Denmark, we show how political actors and policy documents articulate visions for personalised medicine through a distinct sociotechnical imaginary. This sociotechnical imaginary mobilises the distinction between non-profit public and for-profit private organisations, placing personalised medicine in the public domain as the self-evidently desirable future for Danish health care In the Danish case, the issue of implementing personalised medicine becomes an opportunity to revisit the vision for the welfare state and verify public institutions as a shared space for state and citizens. While Danish political actors see personalised medicine as transformative, they articulate this transformation as being steered by public actors, at the same time downplaying the role of private companies. Where public health studies have focused on how political investments into personalised medicine may marginalise specific groups and populations, the Danish case shows that also powerful transnational players may be excluded from political discourse. It teaches us not to treat personalised medicine as one phenomenon, but to pay direct attention to the local contexts in which it operates and shapes what 'public' and 'health' become. [ABSTRACT FROM AUTHOR]

There is renewed optimism about the development of policy and practices related to promoting health in prison settings, driven by the epidemiological data which suggests that the health of people in prison remains very poor. In England and Wales, the focus of this paper, independent prison inspections, conducted by Her Majesty's Inspectorate of Prisons for England and Wales (HMIP), form a critical element in how prisons are assessed. This includes efforts within prisons to promote health and well-being. This paper, using content and thematic analysis, analyses one year (2018) of inspection reports in 38 male prisons. Analysis demonstrates that a 'whole-prison approach' to promoting health and well-being is poorly understood, with only 41% of prisons showing characteristics of this approach. Of the male prisons inspected in 2018, there was good availability of disease prevention activities and screening programmes (88%) and smoking cessation support (94%). The provision of peer support mechanisms, access to condoms and access to health information was highly variable across prisons. The paper makes several conclusions about the state of health promotion in prison and moreover the current criteria adopted by HMIP to assess health and well-being which seems to offer a very narrow biomedical perspective. [ABSTRACT FROM AUTHOR]

The news media has consistently promoted weight loss as a solution to the "obesity epidemic", despite research refuting the connection between fatness and health. In this paper, I examine the framing of weight loss in news articles during lockdown months of 2020, addressing whether healthist ideologies about weight loss persisted or declined during the pandemic. Most articles reflected a healthism lens, encouraging weight loss to achieve good health and to prevent COVID-19. However, some articles rejected weight loss or utilized a Health at Every Size perspective. This study has implications for research on body surveillance, neoliberalism, public health, and media reporting about weight loss and COVID-19. [ABSTRACT FROM AUTHOR]

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]

Recent interdisciplinary scholarship has drawn increased critical attention to issues related to race, gender, class, and culture within public physical activity (PA) spaces, foregrounding the importance of rethinking dominant narratives of PA and promoting diverse and more inclusive practices within these contexts to address PA disparities. This paper addresses issues related to diversity and inclusion within community fitness spaces by examining the experiences of stakeholders and members involved in 'The Collective' Free Fitness Group (CFFG), a free, open-to-the-public fitness community based in Oakland, Ca (the original name has been changed for purposes of anonymity). This organization has made intentional efforts towards addressing diversity and inclusion across its membership and is located in one of the most ethnoracially diverse regions of the country. Drawing on McGee's (1980) concept of ideographs, we explore the potential limitations and consequences of how the CFFG Oakland community members communicated discourses and lived experiences of and to one another and the broader Oakland community. Specifically, we argue that by emphasizing certain expressions of and while deemphasizing alternative forms, participant responses reflected a 'paradox' of diversity, despite their shared in-group identification around as an important individual moral virtue and their open and community. This study contributes new knowledge to the 'paradox' literature and may inform future physical activity interventions and theoretical directions of study. [ABSTRACT FROM AUTHOR]

This paper examines how, in the midst of changing political times, some characteristics of HIV activism are changing, and suggests the relevance of these shifts for other fields of health activism. Despite the UK achieving UNAIDS's '90–90-90ʹ testing and treatment goals, many in the UK lack up-to-date HIV knowledge and retain stigmatising attitudes, and some areas of testing failure remain. In response, people with HIV and HIV organisations are generating imaginative, collaborative projects that indicate effective contemporary forms of health activism may, as other critical health research suggests, be decentred, participatory, multimodal, affective, and implicit. The paper describes a 2016 HIV NGO-run comedy event directed at HIV awareness which was researched via qualitative pre- and post-measures, and two-month follow-up interviews. Findings pointed to strong effects of comedy, as enjoyment and 'break' in HIV thinking, feeling, and action; of a one-off event's emotionality and particularity; and of performance in generating collectivity and HIV citizenship. The paper discusses the potential transferability of these findings to other health activisms, particularly around stigmatised conditions. It argues that such strategies of emotionality, multi-modality, and solidarity in a performance event can work as implicit activism for changing times, generating social change via a doubled politics of resistance and alterity. [ABSTRACT FROM AUTHOR]

This paper explores how the rationing of medical care for older people by frailty score was justified and operationalised in the UK during the COVID-19 pandemic. COVID-19 was expected to overwhelm the National Health Service (NHS) in the UK. In March 2020, the National Institute for Health and Care Excellence (NICE) published the 'COVID-19 rapid guideline: critical care in adults', which advised that clinicians use the Clinical Frailty Score (CFS) to inform decisions about which patients over the age of 65 should be offered ventilatory support. We present a Foucauldian Critical Discourse Analysis of this guidance and the supporting online resources. Analysis shows how the guidance merchandises the CFS as a quick and easy-to-use technology that reduces social and physical complexity into a clinical score. This stratifies older people by frailty score and permits the allocation of resources along these lines. We show how this is justified through epidemiological discourses of risk, which are merged with the language of individual mortality prediction. We discuss the proceduralisation of the CFS alongside a growing body of research that problematises its application in resource allocation. We argue that the pandemic has increased the use of the concept of frailty and that this effectively obfuscates the concept's limitations and ambiguities; the ageism implicit in the response to COVID-19 in the UK; and the relative resource scarcity facing the UK's NHS. [ABSTRACT FROM AUTHOR]

Since the 1990s, researchers have used community-based participatory approaches to achieve outcomes relevant to local communities, to build collaborative and sustainable research infrastructures, and to address disparities in knowledge production. Notwithstanding these strengths, communities and researchers have questioned its success in addressing power imbalances inherent in collaborative research encounters. In this methodological paper, we describe a novel community-based program science approach to guide an interdisciplinary research project on HIV self-testing among men who have sex with men in three Kenyan counties. Drawing on ethnographic field notes, we detail how community researchers and their academic and programmatic partners collaborated through all phases of the research process, including research design and data collection. Importantly, community researchers also played an integral role in data analysis and dissemination, going well beyond the conventional role of 'community engagement' in global health research. We also present findings from qualitative interviews conducted by community researchers with their peers to inform the rollout of HIV self-testing kits in their respective county-contexts. Our approach highlights that engaging community directly in evidence production allows research findings – owned and generated by communities on their own behalf – to be fed more swiftly and effectively into community-led program delivery. [ABSTRACT FROM AUTHOR]

This paper focuses on the recent interest in patient engagement (PE) in drug development, expressed in the growing number of calls for engagement, novel organizations dedicated to changing the culture of drug development, and guidelines for directing and evaluating PE. By reviewing materials produced by actors in the field and analyzing publications reporting on PE initiatives, I map sites of action where PE is being conceived and practiced, delineate how PE is being shaped, and analyze relationships emerging within and around the collectives involved. Pharmaceutical industry players actively mold the landscape of PE in drug development through creating tools and frameworks for PE. These instruments for guiding the implementation of PE are disseminated via training and dedicated events, concurrently disseminating a particular configuration of PE. PE emerges as an attempt to open new avenues for increasing productivity amidst concerns about the future of drug innovation, while PE practices fit smoothly into the arrangements for producing and distributing pharmaceutical knowledge largely shaped by the industry. The ongoing participatory turn in drug development is taking place without shifting the established concentration of epistemic power among commercial entities. [ABSTRACT FROM AUTHOR]

This paper draws upon the notion of slow emergency as a framework to interpret ethnographic and qualitative findings on the challenges faced by Puerto Ricans with chronic conditions and health-sector representatives throughout the island during and after Hurricane María. We conducted participant observation and qualitative interviews with chronic disease patients (n = 20) health care providers and administrators (n = 42), and policy makers (n = 5) from across the island of Puerto Rico in 2018 and 2019. Many Puerto Ricans coping with chronic diseases during and after María experienced bureaucratic red tape as a manifestation of the colonial legacies of disaster management and health care. They describe a precarious existence in perpetual 'application pending' status, waiting for services that were not forthcoming. Drawing on ethnographically informed case examples, we discuss the effects of these bureaucratic barriers on persons with three chronic conditions: renal disease, opioid dependency, and HIV/AIDS. We argue that while emergency management approaches often presume a citizen-subject with autonomous capacity to prepare for presumably transient disasters and envision a 'post-disaster future' beyond the immediate crisis, Puerto Rican voices draw attention to the longer, sustained, slow emergency of colonial governance. [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]

Researchers of community health worker (CHW) models in many countries are looking for ways to scale without losing one of their main advantages, their context-sensitivity. This paper looks at one research strategy to make CHW projects scalable, namely by developing a generic notion of culture-sensitivity. Based on in-depth qualitative analysis, we reconstruct how 'culture' has been enshrined in a US-based CHW project and specifically in the artefact of a binder with teaching materials for vulnerable mothers. The inscription of generalized, culture-sensitive spaces into the binder did allow the Project to comply with standards of evidence-based medicine while respecting community self-determination and made space for creative and competent CHW practices. Yet at the same time, it took away from more substantive conceptions of community engagement and from community empowerment through CHWs. Our analysis highlights how the focus on culture can invisibilise and displace the importance of competent CHW practice and processes of community engagement. [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]

A wide range of evidence shows systematic differences in health status among social groups, which are associated with unequal exposure to and distribution of the social determinants of health (SDH). However, the role of these SDH has not been studied extensively in low-income countries, where most studies focus on access to medical care. In this paper, we undertake a retrospective cross-sectional analysis of the SDH in Mozambique for the period 2002–2014 based on a set of household budget surveys, covering 152,259 observations. We run logistic regression models, comparing various sets of determinants of health status proxied by two measures: self-assessed overall health and number of days ill. The results, which include models stratified by sex, age and year, consistently show that neither better access to healthcare nor material conditions are related to better health. Rather, macro factors, proxied by place of residence, are the dominant predictor of health inequalities. In the stratified models, women and elders appear more vulnerable to poor health. The policy implication is that a narrow focus of health policy on selected services ignores the underlying economic and social context and their role in producing well-being or poor health. More integrated approaches are required to address the health equity gap in low-income countries. [ABSTRACT FROM AUTHOR]

Many public health interventions encourage healthy behaviours by strengthening health norms within schools or workplaces. Such health norms and health-normative contexts can also produce social hierarchies and forms of othering, including unhealthy 'deviant' behaviours. This article aims to better articulate how deviance is produced in a health normative school context. We approach the interplay between a health-oriented environment and deviance from a practice theoretical perspective, emphasising four different facets of this perspective. This paper is based on a case study in a school that has a strong orientation towards healthy eating, drawing on observations, focus group discussions with children, interviews and a survey (forty students, aged 10–11). We analyse how strong norms on healthy behaviour depend on the meticulous guarding of boundaries with deviant behaviours as well as, in some cases, associated 'others'. The article thereby promotes a practice theoretical approach on deviance emphasising the mundane character of healthy eating in school. We contribute to the debate on deviance and norms as to better understand healthy eating practices by distinguishing four different facets of a practice theoretical approach: 1) practice as distinct entity 2) the performance of practice 3) practices in a nexus of multiple practices and 4) individuals as nodal points of practices. The results assist in critically reflecting on assumptions upon which many public health interventions are built as well as contributing to an understanding of normativity and deviance in mundane practices such as snacking in school. [ABSTRACT FROM AUTHOR]

The health and ecological harms created and spread by firms active in many unhealthy commodity industries (UCIs) have received considerable attention from the public health community. However, less focus has been paid to analysing the distribution of wealth and income – important social and economic determinants of health – by these industries. This study aimed to examine long-term trends in wealth and income distribution by publicly listed corporations active in four UCIs: fossil fuels; tobacco; ultra-processed foods; and alcohol. Quantitative analysis of a range of data was conducted for firms listed on stock exchanges in the United States (US). Wealth and income distribution metrics were analysed at the industry level, including effective corporate tax rates and shareholder value ratios. The equity ownership structures and investor location of 20 of the largest firms were also explored. Since the 1980s, US-listed firms in the examined UCIs have distributed much less of their wealth and income to governments and much more to shareholders and investors mostly based in high-income countries. The study provides evidence that firms active in UCIs create a 'double burden of maldistribution': their externalised social and ecological harms disproportionately affect disadvantaged population groups and governments in low- and middle-income countries; whilst, simultaneously, they are increasingly transferring wealth and income to a group over-represented by a small and privileged elite. The identified distributive injustice warrants increased policy attention. [ABSTRACT FROM AUTHOR]

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]

Healthy eating campaigns that promote unprocessed foods to children using character licensing and fun appeals hope to offset the aggressive marketing of highly processed, unhealthy foods to children. Such campaigns are equally premised on the assumption that fruits, vegetables, and other whole foods are not desirable enough in the current food environment and must be marketed as child friendly to be appealing. This paper examines how children in Canada classify foods and whether they think of whole, unprocessed foods as ‘for them.’ Children aged 7–12 (n = 183) completed a survey asking them to classify various foods (fruit, vegetables, milk, eggs, beef, whole grains) as for ‘kids’, ‘adults’ or ‘both’. Most children classified these foods as for both adults and kids, suggesting that promotional initiatives to convince children that whole foods are uniquely children’s fare may not be necessary. Given the questionable efficacy of marketing whole foods as fun and ‘for kids,’ alongside the ethical stakes of commercializing childhood, we recommend that public health initiatives reject attempts to market whole foods as kids’ foods. Instead a key opportunity exists to emphasize the message that good food is for everyone – which is the most conducive to a building a healthy food environment and positive food habits across a lifetime. [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]

Neoliberal ideology champions privatization, personal responsibility, and entrepreneurship, and public health practice under neoliberalism channels this individualized focus. Though this ‘new public health’ may be seen as a liberalizing practice of governance, in which individuals are free to maximize health and autonomy, this privatization also embeds responsibility within the individual without regard to existing or resulting inequalities. This paper examines the presence of neoliberal ideology in the narratives and subjectivities as it relates to HIV prevention in the lives of young gay and bisexual men living in New York City. We also seek to further the critique of neoliberalism in HIV prevention. The men often saw themselves or others as rational, autonomous agents, yet there were also clear instances where social and structural factors were at play. These factors influenced a subjectivity existing outside the narrow, atomistic framework of neoliberalism. Implicit moral hierarchies arose from notions of personal responsibility and recklessness, pitting men against each other and potentially inhibiting social and community prevention efforts. Further, neoliberal ideology obscured the social and structural mechanisms at play, such as racial inequality, economic inequality, homophobia, and sexual shaming. In contrast to the ideology of neoliberal public health, we must explicitly consider the resources, opportunities, and social conditions that shape autonomy and subjectivity among young gay and bisexual men. [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]

Since the development of the welfare state, the Swedish school subject Health and Physical Education (HPE) has been regarded as an important site for public health work, and still assumes a central role in promoting the health of the coming generation. A specific type of health intervention, promoted by researchers in recent years, is the use of so-called exergames. In some countries, these fitness games are used as teaching aids in physical education classes and can be seen as examples of how public health issues and popular culture are shaping HPE in schools. The aim of the study reported in this paper is to examine which messages about health and body are offered, and how these are expressed in some of the fitness games used as teaching aids in school. The results of the study highlight the dangers of using exergames in the teaching of HPE in schools. The messages communicated by the games have a number of potentially harmful consequences, particularly with regard to the creation of specific health and bodily norms based on a measurable ideal. The use of this tool in education is thus far from value free, and the problems that might be solved when using the games are not necessarily the ones that education should privilege. [ABSTRACT FROM AUTHOR]

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]

This article explores how professionals within Swedish addiction treatment (n = 18) describe and make sense of relapse prevention (RP). RP is known as a self-control programme for maintaining behavioural change, helping people deal with high-risk situations. However, since self-control techniques have been incorporated widely in the addiction treatment field, the specificities of RP have become vague. To grasp what RP 'is', we draw on John Law's and Annemarie Mol's thoughts on how logics enact objects and realities. We thus follow critical scholarship in Science and Technology Studies and view treatment as a local knowledge-making practice that may depart from how it was originally designed. A key question is how RP is potentially transformed and made-to-matter when moved from the controlled settings of theorising and experimental studies to practice. The professionals used a logic of fixity to make RP stable, structured and evidence-based, easily distinguishable from other interventions. They also used a logic of fluidity to explain how and why they tinkered with it and adapted it to the preferences of both staff and attendees. The two logics enacted two different realities of addiction treatment: one in which RP is standardised, temporally demarcated and can solve most addiction problems, and another where interventions must be individualised, continuous and adapted to local settings and needs. It did not appear contradictory to 'make up' RP as both fixed and fluid; the two realities exist side by side, but with different material effects. [ABSTRACT FROM AUTHOR]

Evidence suggests that despite the popularity and influence of key health equity concepts, they often fail to shift the thinking and actions of health workforces towards the social and structural determinants of health inequalities. These findings tend to be attributed to institutional constraints, along with the role of influential discourses which promote a focus on individuals and behaviours. However, questions have also been raised about the clarity and utility of the concepts themselves, and the extent to which the language they use works (or indeed fails to work) in reorienting thinking and action. The purpose of this study was to explore how partners in an applied health research collaboration in England interpreted the popular 'upstream-downstream' story, and what it means to work 'upstream' to reduce health inequalities. Where participants were not familiar with its academic or technical usage, the story was taken to be a metaphor for prevention generally, or it prompted a root cause analysis of the more discrete ways in which inequalities were encountered in participants' research or work. Even in instances where participants did hold more socio-political perspectives, these were often not evoked by the metaphor itself. Two of the 18 participants were unable to equate the metaphor with particular actions or ways of working, while others found it to be a poor fit with how they understood inequalities. The study findings illustrate and explain the challenges that arise when technical metaphors from the health equity literature are opened-up to interpretation by wider audiences. [ABSTRACT FROM AUTHOR]

We assess the extent and quality of High-Income Countries' (HIC) practices in monitoring Socioeconomic Inequalities in Health (SIH) through routine data collection/collation and analysis systems. Official websites of government authorities of eligible countries were examined for any reports containing data on SIH, which were assessed for quality from an epidemiological perspective, using published guidelines for monitoring of socioeconomic inequalities in health status.Despite the global commitment to Sustainable Development Goal 10, and recommendations of the WHO 2008 Commission of Social Determinants of Health, most of the thirty-six HIC whose websites were searched appear not to be routinely monitoring SIHs. Only seven HIC websites were found to have SIH monitoring reports that were readily discoverable on their official websites. Only two countries (England and Scotland) have been publishing such trends in detail for more than a half-decade. Although an SIH monitoring system is not itself a sufficient condition for reducing SIH, it is likely a necessary one. For countries that are planning to establish a system, lessons from others who have established such systems include the value of routinely and automatically post-coding of major health outcomes, with robust assignment of average socio-economic status to each local area. [ABSTRACT FROM AUTHOR]

Within a neoliberal environment that prioritizes the individual over the community, understanding challenges associated with advancing population-level or universal interventions is important if public health is to remain a relevant collective institution. As a case example, we considered a controversial public health intervention – community water fluoridation – and undertook focus groups with dental hygienists in Calgary, Alberta, Canada, to explore ways that fluoridation (a population-level intervention) is understood and discussed in their day-to-day clinical interactions as frontline cavity prevention experts. The overarching theme in our data centered around a key public health conundrum – that is, the difficulties reconciling individual and community- or population-level responsibility for health. Dental hygienists wrestled with the transdisciplinary nature of population-level public health interventions; acknowledged changing roles and relationships between themselves and their patients; and revealed dissonance in their own beliefs about individualism and collectivism in health. Our findings shed light on communication challenges where public health information delivery intersects with clinical encounters, in the context of empowered and knowledgeable health consumers. A challenge for the public health community is to reflect on how to better address a contemporary public's reasonable information requests and negotiate the clash between individualism and collectivism more effectively. [ABSTRACT FROM AUTHOR]

High rates of obesity in Newfoundland and Labrador, Canada’s eastern-most province, have helped to position Newfoundlanders as a ‘problem population’ within discourses of the Canadian obesity ‘epidemic.’ As such, biopedagogies of obesity have been deployed by public health offices in the province, through which Newfoundlanders are imagined as unhealthy eaters who are unknowledgeable about healthy eating, a narrative which aligns with older classist stereotypes about Newfoundland as ubiquitously poor, its population uneducated, backward, and naïve. A qualitative study with 28 participants (and a total of 54 interviews) from St. John’s, the urban center of Newfoundland and Labrador, however, not only revealed a group of people quite knowledgeable about and invested in biopedagogies of healthy eating and healthy weights as propagated by public health discourse, but who also resisted them through alternative understanding of healthy foodways. Results of this study therefore contribute to critical obesity scholarship, as they interrupt assumptions that position populations with high obesity rates as unknowing and uncaring about healthy eating and body weight, demonstrate the ways in which a population might resist biopedagogies of obesity, and highlight the need for research disrupting universalist stereotypes about ‘problem populations’ and their health behaviors. [ABSTRACT FROM PUBLISHER]

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]

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]

An integral part of colonisation is the suppression and marginalisation of indigenous knowledges. The indigenous health system within Aotearoa (New Zealand) was supplanted with a colonial infrastructure and praxis which has proven ineffective in addressing systemic health inequities created by the processes of colonisation. This novel study interrogates discursive representations of Māori (Indigenous peoples of Aotearoa) within colonial public health policy between 2006 and 2016. Colonial policy refers to generic or mainstream policy that are designed for 'all' New Zealanders. We utilised thematic analysis to examine 106 policies and, after excluding 13 ethnic specific policies, identified 68 policies containing no mention of Māori. The analysis highlights five themes relating to discursive representations of Māori. These were: i) silence about Māori health; ii) Māori as especially at risk; iii) Crown (lack of) responsiveness to te Tiriti o Waitangi obligations; iv) recognition of Māori philosophical approaches to service provision; and v) utilising mātauranga Māori (Māori knowledge). These findings suggest colonial policy presents a barrier to the pursuit of health equity and is poorly aligned to global Indigenous human rights declarations. Within the context of Aotearoa it echoes the sentiments of the key Waitangi Tribunal [WAI 2575] finding that health policy is contributing to health inequities and failing Māori. Health policy must be decolonised to better engage with human rights declarations and te Tiriti o Waitangi obligations in order to achieve health equity. [ABSTRACT FROM AUTHOR]

Health educators are increasingly publicizing the noxious health effects of sugar-sweetened beverages (SSB). American counties are implementing SSB taxes, as modeled after the 'success' of tobacco policies, to address the 'obesity crisis'. Under-explored is how the linking of SSB to a stigmatized condition, 'obesity', has affected attitudes toward the purchasing and consumption of SSB and those individuals who purchase and consume SSB. This study sought to explore individuals' attitudes and experiences with SSB in rural Michigan. Three themes emerged: Negativity, Egregious beverages and Implicated imbibers. These attitudes were situated within a context of increased exposure to SSB health discourses, particularly among younger participants. Additional themes arose regarding which SSB were labelled especially problematic, who should or should not be drinking SSB, as well as the consequences of drinking SSB. Pop/soda, energy drinks, and diet pop/soda were identified as particularly harmful, albeit for different reasons – sugar, caffeine, and unnatural additives. Many participants reported reacting negatively when they saw children of higher weights drinking SSB, though judgement was reserved for parents. Ultimately, SSB and their consumers appear increasingly stigmatized in ways that carry important equity implications for already marginalized groups. [ABSTRACT FROM AUTHOR]

Public health professionals may be confronted with unique ethical challenges in outbreak response situations. We conducted interviews with twenty-two public health professionals involved in responses to the 2014–2015 Ebola epidemic in Sierra Leone and Liberia to explore how they understood and experienced the ethical challenges involved in this work. The concerns covered in these interviews ranged dramatically, but three themes emerged as unique contributions from a subset of individuals integrally involved with the frontline response, who framed concerns about representation as key ethical issues. These included concerns regarding misrepresentations of West Africans as 'resistant' to the epidemic response, failures in material and information resources provided in the response, and representations of 'rationality' between responders and publics. Such concerns suggest that perspectives advanced in the critical public health literature in recent decades are circulating amongst public health professionals involved in outbreak response, although discord amongst respondents suggests the need for more deliberate efforts to reframe thinking about resistance, resources, and rationality in future public health outbreak responses. [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 2008, the World Health Organization's Commission on Social Determinants of Health (CSDH) presented an influential compilation of evidence establishing the relationship between health inequities and the unfair distribution of power, wealth, and resources. A decade later, individual and bio-behavioural responses to health inequities persist. The purpose of this scoping review was to explore the extent to which this evidence guided research, practice, and policy in global and public health. To do this, we assessed different ways the CSDH evidence and calls for action were integrated in scholarly publications (citation, portrayal of health inequities, alignment with calls for action, and orientation toward root causes). A systematic search of peer-reviewed articles (2000–2016) using search terms related to 'knowledge-to-action' and 'health equity' led to 330 included articles. Results suggest integration of CSDH evidence and calls for action in scholarly work is modest: 59% (n = 163) of authors (2009–2016) cited the report. A large portion of authors did not reference causes of health inequities (52% before and 51% after the CSDH) and few referred to issues of power. Among 110 post-CSDH empirical articles, half did not align with CSDH principles for action. This review illustrates that much scholarly work that purported to contribute to health equity did so in ways that conflicted with the CSDH's characterization of the remediable nature and distribution of health inequities. These results provide a practical platform for assessing how global and public health efforts can move towards better alignment with the best available evidence about advancing health equity. [ABSTRACT FROM AUTHOR]

This article discusses a study of flu vaccine uptake and hesitancy in a rural community during the 2009–2010 H1N1 pandemic flu season. In it, we explore study participants' understanding of the relationship between vaccines, illness, and immunity, as well as parent intentionality in accepting or forgoing flu vaccines for their children. Our research offers novel conclusions about how people respond to the development and implementation of vaccines for newly emerging flu strains and establishes a warrant for qualitative research on vaccination practices that attends to participants' views about vaccines in the context of their overall ideas about health. Our findings suggest that more accurate understandings of people's beliefs and experiences of vaccination can be developed through qualitative research that values vernacular discourse. Our findings also suggest that influenza vaccination provides a fruitful context in which to study vaccine hesitancy and refusal. Finally, our study demonstrates that vaccine concerns are more demographically widespread than is presumed by current research. [ABSTRACT FROM AUTHOR]

While enormous strides have been made in the representation of women in clinical trials, the percentage of women enrolling in Phase I trials still remains low, which both raises public health concerns about the safety of new drugs and social justice concerns regarding their inclusion in research. As part of a longitudinal study of healthy volunteers in the United States, our inquiry aimed to examine impediments to women enrolling in Phase I trials as well as their experiences participating in these studies at residential research clinics. We analyzed 111 semi-structured interviews conducted with 47 women who had enrolled in at least one Phase I trial. Our study indicates that women face discrimination during all stages of their participation in Phase I trials from their ability to qualify for studies, the treatment they receive in the clinic facilities, and a lack of social support. Specifically, we found that (1) study designs disadvantage participants of childbearing potential, (2) women feel vulnerable in the clinic space when outnumbered by men, and (3) heterosexual women are often discouraged from participation by their husbands or significant others. Placing these findings within the scholarly literature on barriers to women's clinical trial participation, we argue that diverse strategies attending both to physiological and social factors are needed to combat inequalities in U.S. Phase I trial participation. [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]

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]

Critics of government intervention for the prevention of lifestyle-related chronic disease often conceptualise such efforts as 'nanny state', reflecting a neoliberal perspective and derailing wider debate. However, it is unknown how the community perceives such interventions. Given the importance of public opinion to government willingness to implement population-level system change, we aimed to better understand Australian community attitudes towards government-led prevention, in particular whether nanny state conceptualisations reflect community attitudes. We used an iterative mixed methods approach to data collection and analysis based on focus groups (n = 49) and a national survey (n = 2052). Despite strong endorsement (91%) of personal responsibility for health, 46% of survey respondents thought government plays a large role in prevention. The nanny state conceptualisation was not dominant in either the survey or focus group data. Qualitative data analysis highlighted alternative conceptualisations, namely government as a: canny investor; leader on positive health behaviour; partner or facilitator for health. Respondents' level of support for specific interventions overlaid these general conceptualisations with considerations of the target population and risk factor, intervention mechanism and government motives. Community perceptions regarding prevention therefore reflect more thoughtful and complex interpretations of preventive actions and policies than suggested by nanny state conceptualisations. We argue that advocates and legislators should not allow debate around preventive measures to be restricted to the nanny state-libertarian continuum, but engage the community in more collectivist considerations of future health costs, beneficiaries, equity and likely outcomes of both action and inaction in order to garner community support and identify information gaps. [ABSTRACT FROM AUTHOR]

Social position, education, gender and increasing age are all identified as important risk factors for disability pension. This study takes an intersectionality approach and examines their co-constitution, in relation to inequity in disability pension. The population included 22,203 middle-aged men and women participating in the community-based Hordaland Health Study, Western Norway (1997-1999). The participants were categorised in four exposure groups: higher educated men, higher educated women, lower educated men and lower educated women. The outcome was disability pension from 1992 to end of 2007, from a national registry. Using recommendations for intersectionality-informed quantitative research, we estimated the main effects of gender and educational attainment on disability pension, and potential statistical multiplicative interactions between gender and education in relation to cause-specific and all-cause disability pension. For all-cause disability pension, men with higher education had the lowest risk for disability pension (rate per 1000 person-years: 2.01) during the course of working life (from age 35 to 57), followed by higher educated women (rate 3.56), and lower educated men (rate 4.59). Finally, women with lower education had a substantially increased risk already in early middle age (rate 8.39). We found a statistical multiplicative effect of lower education and female gender on all-cause disability pension and disability pension with musculoskeletal disorders compared with men with higher education. The discussion highlights that inequity in disability pension is not only about defining vulnerable groups, but also about understanding how privileges and disadvantages are unequally distributed. [ABSTRACT FROM AUTHOR]

In 1993, Law 100 introduced major reforms to Colombia's health system and regulated the health care industry. We analyzed the structure of the social space of Colombia's health system and the transformations that took place between 1993 and 2013. We conducted a socio-historical study using a theoretical framework based on concepts developed by Pierre Bourdieu. In addition to documentary analysis, interviews were conducted with 26 key agents. We found that private health insurance companies situated at the 'dominant' pole accumulated capital and power during the period under study, while public and private providers situated at the 'dominated' pole face serious economic challenges due to the loss of capital and power. Measures taken by the state, a major funder of the system, to regulate the market have proved to be ineffective, forcing intervention from the legal field. More than two decades after Law 100 was introduced, health remains on the political agenda and the subject of dispute. A permanent crisis in the sector prevails partly due to the contradiction that exists between protecting the right to health, and strengthening of a profit-orientated market, thus hindering the fulfillment of the principles of quality and equity. [ABSTRACT FROM AUTHOR]

Policies that promote the social unacceptability of smoking may also result in smoking-related stigma. The aim of this study is to evaluate how norms against smoking and socioeconomic status (SES) are associated with stigma among smokers. We used data from a panel of adult smokers who participated in the 2008-2012 administrations of the International Tobacco Control Policy Evaluation Survey in Mexico (n = 6670 observations) and Uruguay (n = 3296 observations). Generalized estimating equations were used to account for correlations in the outcomes over time within individuals. We evaluated if injunctive smoking norms (i.e. significant other norms and societal norms), descriptive smoking norms (i.e. number of smoking friends), and two markers of SES (i.e. education and income) were associated with different aspects of smoking-related stigma (i.e. feeling uncomfortable, negative stereotype of smokers, and perceived marginalization). We found that stronger anti-smoking injunctive norms were associated with higher levels of all indicators of perceived stigma in Mexico and Uruguay. Having fewer smoking friends was associated with feeling uncomfortable and perceived marginalization in Mexico. Higher income and education were associated with a stronger negative stereotype of smokers in Mexico. Lower income and education were associated with a stronger negative stereotype of smokers in Uruguay. Study results suggest that factors that drive the social unacceptability of tobacco may stigmatize smokers, although further research is needed to determine whether policy-promoted stigmatization produces undesirable outcomes (e.g. lower cessation rates). [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]

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]

In the past decade, enthusiasm for intrauterine devices (IUDs) has rapidly grown in the United States. Messages from health care providers, pharmaceutical advertisements, and public health campaigns extol the freedom that women can experience using a long-term, internal, highly effective contraceptive method. Little research has investigated how young women conceptualize IUDs in terms of freedom and control. We conducted a thematic analysis of in-depth, individual interviews with 37 young Black and Latina women and explored their perspectives on IUDs as promoting and constraining freedom. Participants with favorable views of the IUD (n = 13) appreciated that it would allow them to live their day-to-day lives ‘normally’ without thinking about contraception and with minimal side effects. Four current IUD users found the method empowering because they could pursue their goals without fear of unintended pregnancy. In contrast, nearly two-thirds of participants (n = 24) had predominantly negative views and focused on temporal and physical features of IUD use. They expressed concern that IUDs would impinge on their personal agency by restricting their bodily autonomy since they would not be able to discontinue use without a health care provider; found the idea of a contraceptive method inside their body for years unsettling; and/or desired flexibility over their pregnancy plans. These results highlight a contradiction between IUD promotion discourses and some women’s views about the method and their approaches to pregnancy. Discursive and clinical practices that encourage the use of long-acting contraceptive methods like IUDs over other methods may unintentionally infringe upon reproductive autonomy. [ABSTRACT FROM PUBLISHER]