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Within the vast majority of qualitative health research involving Indigenous populations, Indigenous people have been marginalised from research conceptualisation and conduct. This reflects a lack of regard for Indigenous ways of knowing, being, and doing, has served to perpetuate deficit narratives of Indigenous peoples' health and wellbeing, and contributes to failure in addressing inequities as a result of ongoing colonisation and institutionalised oppression and racism. There is a need to place Indigenous voices and ways of doing at the centre of research by working in intercultural partnership, bringing together Indigenous and Western knowledges. This paper explores how such an approach can be applied, demonstrating a reflective process of conceptualisation and conduct that brings together Indigenous ways of working with grounded theory with Aboriginal communities in Australia. Furthermore, it supported a non-Indigenous researcher to learn ways of working respectfully, guided by community protocols. A six-stage research process was developed, overseen by an Aboriginal Women's Advisory Group. Research conceptualisation and conduct centred on three principles: bringing together Aboriginal ways of working with Western research methodology; using women's own voices to develop a narrative of cardiovascular health and wellbeing; and ensuring that tangible outcomes were delivered to women and communities in the spirit of partnership and reciprocity. This approach, guided at all steps by Indigenous women, demonstrates a way of adapting qualitative Western methodology to ensure values and principles of ethical guidelines of conduct are upheld to unravel constructs of colonisation, redress past wrongdoing, and reverse deficit narratives. [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]

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]

Amendments to various state laws have made it easier for cisgendered lesbian, bisexual and queer (LBQ) women to access Australian fertility clinics. When women conceive through clinics, they generally use intrauterine insemination (IUI) or in vitro fertilisation (IVF). IUI is cheaper and requires less invasive medical intervention than IVF. A recent survey found that almost 60% of Australian cisgendered LBQ women who conceived with clinical assistance did so using IVF, despite most presenting to clinics without a diagnosis of infertility and seeking donor sperm only. In this paper, based on 20 interviews with Australian clinicians who treat LBQ patients seeking pregnancy, we explore potential explanations for why over half of LBQ women using Australian fertility clinics to conceive used IVF rather than IUI. A 'perfect storm' of factors appears to converge in this tendency. Although some LBQ women are purposefully choosing IVF to achieve biological relatedness for two mothers, other pressures toward high intervention conceptions include the distinction between 'social' and 'clinical' infertility by Medicare (the Australian national health insurance scheme), the relative profitability of IVF procedures and issues with the supply and quality of donor sperm. Accessing sperm from clinics appears to set some Australian women without male partners on a potentially unnecessary path to a high intervention and costly conception. [ABSTRACT FROM AUTHOR]

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

This paper examines the multiple tensions arising in an Australian university and public sector collaboration that aimed to investigate an obesity intervention. A key site of conflict with the external collaborators emerged when we, the researchers, focusing on the experiences of marginalized local people, presented research findings that were at odds with the dominant understanding of obesity that framed the public health intervention. From those with a range of roles in the public sector, we received claims of misrepresentation and requests to change or not publicly release certain research findings. Drawing on the 'policy learning framework' of Dunlop and Radaelli, we examine these epistemic conflicts and point to the Achilles' heels of the 'engagement and impact' agenda. From the perspective of government, the inherent weakness stems from the lack of control in a partnership, and from the perspective of academics, it is the danger of undermining trust in universities and the knowledge academics produce, through the process of engaging with government and being party to research that is designed to shore up a position that government has already decided upon. This case study has implications for academic and government collaborators who may benefit from explicit planning about how to negotiate discord around the processes of learning that occur in and across research, policy, and practice. [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]

It behoves the Australian Curriculum: Health and Physical Education (HPE) to provide an education for children and young people that accounts for future trends and new health challenges, but what such a curriculum should look like is a challenge in itself. As the Lead Writer of the curriculum’s background Shape Paper, supported by an Advisory Panel under the auspices of the Australian Curriculum, Assessment and Reporting Authority, I will outline and reflect upon where HPE may be heading in Australia with a focus on its relationship to public health. ‘Sacred ties and fresh eyes’ reminds us that some of those providing input, commentary and exerting influence over curriculum directions have an enduring sense of what the curriculum should address while others are looking for new ways of seeing health education. An ensuing dilemma is that new ways of seeing may not have the accumulated evidence of traditional practices nor the authority of programmatic, biophysical research. Rather they are informed by a constellation of factors, including research that provides a persuasive and credible solution in the eyes of many. Bernstein’s concepts of field, classification and frame are useful for making sense of the patterns of power and influence in the curriculum-making exercise. [ABSTRACT FROM PUBLISHER]

This paper examines the food provisioning practices of low-income single mothers affected by market-driven welfare reforms in Australia. We explore the tensions between women's care responsibilities and the government's welfare-to-work reform, and the effects of these tensions on the nutritional health and wellbeing of women and their children. Conducting a thematic analysis of 20 interviews with single mothers receiving either Parenting Payment Single, Newstart Allowance (NSA), or the Disability Support Pension, we found that when women's income and time were significantly compromised, especially when women were transferred onto the less generous unemployment benefit NSA, that food provisioning became more psychologically taxing and nutritional health decreased. The findings suggest that public health researchers must focus on challenging the structural antecedents of women's food work and hunger to alleviate the responsibilities of single mothers in countries facing similar circumstances. [ABSTRACT FROM AUTHOR]

Trade agreements influence the distribution of money, goods, services and daily living conditions – the social determinants of health and health equity, which ultimately impacts differentially on health within and between countries. In order to advance health equity as a trade policy goal, greater understanding is needed of how different actors frame their interests in order to shape government priorities, thus helping to identify competing agendas across policy communities. This paper reports on a study of how policy actors framed their interests for the Trans Pacific Partnership agreement. We analysed 88 submissions made by industry actors, not for profit organisations, unions, researchers and individual citizens to the Australian government during treaty negotiations. We show that policy actors' ideas of the purpose of trade agreements are shaped by competing underlying assumptions of the role of the state, market and society. We identify three primary framings: a dominant neoliberal market frame, and counter frames for the public interest and state sovereignty. Our analysis highlights the potential enabling and constraining impact of policy frames for health equity. In particular, the current dominant market framing largely excludes the social determinants of health and health equity. We argue that advocacy needs to tackle head on the underlying assumptions of market framings in order to open up space for the social. We identify successful examples of health framing for equity as well as opportunities for engagement with 'non-traditional' allies on shared issues of concern. [ABSTRACT FROM AUTHOR]

Workplace health promotion (WHP) is advocated to progress the health and well-being of employees. However, research findings on its uptake and impacts are equivocal, particularly in smaller workplaces. This paper describes managers' and workers' responses to a WHP programme in the Australian Capital Territory. Informed by a cultural economy framework, in-depth interviews were conducted with 44 workers and managers from 10 small to medium sized enterprises (SMEs). Examining their availability and acceptability to workers and managers, we found a limited array of health promotion activities were adopted; a caring environment, provision of healthy foods, occasional health checks and health advice. Physical activity programmes during work hours were unlikely to be accepted by managers due to time costs, and workers were reluctant to spend their non-paid time on them. Casual workers were often excluded from WHP activities because their work times did not synchronize with other employees' hours. This study illuminates how WHP is shaped by a complex of employment regulations that stress individual performance, associated limits on employer and worker time and resources, and organizational, cultural norms and practices regarding healthy work environments. We conclude that SMEs are implementing a limited array of behaviour change initiatives reflecting a particular view of health promotion. While organizational change may expand adoption of health practices during the workday, there are impediments to workers adopting wholesale changes in their health practices given a national culture of long hours, and intense job demands embedded in Australia's neoliberal employment system. [ABSTRACT FROM AUTHOR]

In this paper, we examine a situated example of the media’s (re)production of shared understandings around smoking, pregnancy and health. Through a discursive lens, we address the way in which Australian media personality Chrissie Swan accounted, on radio, for her continued smoking while pregnant after photographic evidence of her tobacco use entered the public domain. We argue that Swan’s account of her smoking privileges a version of ‘the good mother’ as solely responsible for the health of her foetus, and right to feel ashamed when putting this at risk. A construction of smoking as a (medicalised, irrational) addiction enables her to manage a positive identity in the face of this construction: she presents as being ‘thwarted’ in her quitting efforts by a force beyond her control. Ultimately, we argue that the version of ‘good motherhood’ constructed in Swan’s account is paradoxical, and may serve both to support, and constrain, pregnant smokers’ capacity to sustain quitting behaviours over the long term. In turn, we argue that ‘moralising’ anti-smoking interventions aimed at pregnant women may be less useful than an approach that interrogates the range of socio-cultural expectations of ‘good motherhood’ by which pregnant women are simultaneously positioned. [ABSTRACT FROM AUTHOR]

Public health efforts to lift childhood vaccination rates can be supported or undermined by media representations of parents. Polarising representations neglect the large range of ‘middle-ground’ positions people occupy, potentially alienating parents. In recent years, Australian public health actors have tried to better engage journalists to avoid this. As these efforts have unfolded, the main national immunisation policy lever has become more punitive. This paper examines whether Australian newspaper representations of parents have changed, by comparing 153 newspaper articles from two periods: 1997-1998 (prior to the development of a public health lobby targeting the media; when the first national childhood immunisation policy was introduced) and; 2015-2016 (5 years after advocacy groups began working with the media; and when the national policy took a punitive turn). We analyse patterns and shifts (between 1997-1998 and 2015-2016) in the portrayal of parents as complacent, alternative, hesitant and as choosing. Australian newspaper portrayals of parents are broadly aligned with the policy targets of the day. In 2015-2016, there was less negative representation of parents who occupy the ‘middle-ground’ between vaccine acceptance and rejection. However, coverage of alternative parents (vaccine objectors) intensified in quantity and negativity. Concurrently, there were new (minority) portrayals of vaccine objectors as invisible, and as victims being denied choice. This signals that reporting may simultaneously align with national policy targets and destabilise public health efforts to avoid polarising misrepresentations of parents, characterisations likely to undermine trust in public health. Rather than ‘blame the media’, this analysis illuminates conflicts within public health. [ABSTRACT FROM AUTHOR]

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

A roundtable discussion was held with 29 experienced Public Health researchers and policy makers from 9 countries at an international conference in Australia. Their experiences were discussed about establishing and maintaining research projects and health programs in developing countries. This paper aims to (1) Highlight methodological issues relevant to the conduct of research and development in low income settings as discussed at the roundtable; (2) List the main barriers in implementing research and project initiatives in low-income settings; and (3) present recommendations for meeting researchers' needs across cultures without jeopardising methodological rigour. Lessons learnt on barriers for the conduct of methodologically sound research were classified in four domains: investigator factors, community factors, strategic factors and methodological factors. Proposed solutions emerged in the areas of strategic guidelines, attitudinal changes and methodological approaches. Practical solutions to individual and systematic barriers were also suggested. It is hoped that these recommendations will influence current practice and assist other researchers in preparing and undertaking appropriate research methods and health program delivery strategies in low-income settings. [ABSTRACT FROM AUTHOR]

Sexual identities lie at the heart of social and public health writings about sexual health risk and, as such, are often subject to uncritical assumption and imposition. In this paper, a critique is offered of such discourses along with the equation that sexual identity can predict the nature of practice within and outside the bedroom. In doing so, the authors draw on the findings of two recent independent yet conterminous Australian qualitative studies of sexual identities and practices to examine how young women's and men's identities resist occupying stable, predictable and causal relationships to sexual practices. Finally, the implications of such empirical findings for HIV/AIDS and STI prevention activities are explored. [ABSTRACT FROM AUTHOR]

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

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

As a school subject, health education functions as a contemporary apparatus of governmentality by attempting to shape the health[y] conduct of young people. Currently, health education, along with many other institutions and programmes, is heavily shaped by neoliberal logics of risk. This paper is interested in exploring how these tenets shape versions of curriculum and classroom practices. The article draws on ethnographic data and the analytical device of governmental assemblages to consider how governmentalities are brought to life at their point of application; via teacher interviews and classroom practices. Analysis reveals that health education pedagogical assemblages are made up of the usual ‘neoliberal suspects’: risk discourses and strategies that attempt to individualise and responsibilise. However, accompanying these ‘usual suspects’ are a raft of melodramatic and affective intensities, including disgust and shame. These affective pedagogical assemblages are significant for scholars interested in understanding the governmental machinery of health education, and public health and health promotion more broadly, and its potential effects. [ABSTRACT FROM PUBLISHER]

Schools and schooling have long provided a tempting site for the delivery of public health strategies that address and promote young people’s current and future health. However, an emerging concern regarding the mobilisation of public health interventions within school settings has been the failure of school teachers to deliver such programs with fidelity. For educators, these notions of fidelity stand in stark contrast to the tenets of student-centred teaching. In seeking to explore these tensions further, this paper draws upon a collaborative health education project conducted with schools and teachers from Queensland, Australia. Findings from this project reveal the complexity associated with curriculum implementation in school settings, where diverse resources including timetable allocations and teacher expertise mitigate the achievement of program fidelity. In our efforts to explain the findings emerging from this project, we have drawn on the conceptual reference points of Basil Bernstein’s theory of the pedagogic device to reveal the predictable misalignment of the health and education sectors’ expected outcomes of school-based health initiatives. In conclusion, we argue that our exploration of issues pertaining to fidelity demonstrates the need for health and education sectors alike to conduct their work according to a clear articulation of the realistic, educative role that schools can play in promoting healthy living. [ABSTRACT FROM PUBLISHER]

Surveillance has always been intricately connected to both the theory and practice of public health. The salience of epidemiologic method, particularly the enumeration of ‘risk factors’ and the interpolation of different population ‘groups’, underscores this reality. However, in the post 9/11 era, there has been a conflation between public health and ‘national security’ concerns. Consequently, border control, imagined as a frontier where the two most readily connect, now co-opts public health concerns, for instance ‘threats’ to legitimate specific forms of securitisation, including the case of infectious diseases such as tuberculosis. In this paper, we highlight the manner in which the Australian border control regime functions as a technology of surveillance in relation to the ‘threat’ of TB and the effects it both produces for individuals and affected communities. Specifically, we highlight how spectacles enacted in the name of border control need to be carefully attended to, lest they ultimately serve to undermine the goals of public health itself. [ABSTRACT FROM PUBLISHER]

This paper provides a thematic review of the literature on cancer in Aboriginal people in Australia, focusing on experiences in diagnosis, treatment and care as well as addressing sociocultural factors to guide the public health response to poorer treatment outcomes. A search of both medical and social scientific databases for journal articles published between 1995 and 2006 show that cancer incidence and possibly survival and mortality data are likely to be underestimated in Aboriginal people. Aboriginal people are more likely to die from cancer than non-Aboriginal Australians. There are significant differences between the cancer experiences of those living in the city and in rural or remote areas. There is also a relative absence of literature on cancer in Aboriginal men, who are likely to have particular needs during diagnosis, treatment and care. In drawing conclusions from these data, it can be seen that Aboriginal people with cancer have poorer outcomes than non-Aboriginal Australians, and there is a need for further research in the patterns of care and predictors of outcomes in Aboriginal men and women with cancer. Particular attention should be given to the different needs and experiences of Aboriginal people in urban or rural/remote areas. These findings indicate an urgent need to allocate additional resources to the treatment and care of Aboriginal people with cancer, in addition to screening interventions. There is also a continuing need to acknowledge cultural differences in the health beliefs of Aboriginal people and to work in partnership with Aboriginal community controlled health organisations. [ABSTRACT FROM AUTHOR]

The new genetics ‘industry’ has emerged at a time of public ambivalence towards science, an ambivalence that could move to outright distrust when the commercial imperatives of increasingly market-oriented science gradually replace the more traditional imperative of ‘public good’. Genetics research and development is at the vanguard of the movement of science into the market economy and, as such, has come under intense public scrutiny. The political and social environment now demands public participation in the development of regulatory structures. Commercialization aims for rapid advances in research, leading to new genetic therapies and other public health benefits. However, this rapid progress has resulted in human tissue banks and genetic databases un(der)regulated in many countries, and challenges to accepted notions of privacy, ownership and consent. This paper presents an outline of the way Australia has embraced public participation in the development of a regulatory framework governing human genetic databanks. It argues that after a two-year, two-stage national inquiry into the protection of genetic information, the country now stands at a crossroads: it either addresses the recommendations of the inquiry—providing a model for the development of public trust in the human genetics industry, and in the state to regulate it, or continues to ignore the recommendations, fostering cynicism regarding the consultation process and an even greater level of distrust in the ability/willingness of the state to regulate the industry. [ABSTRACT FROM AUTHOR]

This paper focuses on newspaper coverage of the Marlene Sharp legal case in Australia, concerning a non-smoking bar worker who was awarded damages for laryngeal cancer caused by passive smoking. All Australian metropolitan and Victorian regional newspaper coverage of the case was obtained from a commercial media monitoring agency for the month of May 2001, yielding 100 articles for analysis. A qualitative text analysis was conducted on newspaper articles, coding for content, tone and frame. Coverage of the outcome of the Marlene Sharp case was predominantly positive for tobacco control, with positive coverage (45% of articles) outweighing negative coverage (13% of articles) by a factor of 3 to 1. The most commonly occurring frame (27% of articles) advanced the view that legislation to protect workers from secondhand smoke is appropriate, even overdue, and encouraged the government to create smoke-free policies to protect workers. Other common frames positive for tobacco control included ‘smoking as socially unacceptable’ (9%) and ‘smoking as a societal problem’ (9%). Of articles framed negatively for tobacco control, ‘individual rights’ (5%) and ‘system cynicism’ (5%) were most common. Legal cases present special opportunities for public health media advocates to bring a human face to the need to progress passage of smoke-free policies. [ABSTRACT FROM AUTHOR]

Drawing on extensive behavioural data from Sydney, this paper examines some of the strategies that gay men have devised to manage (as distinct from eliminate) risk of HIV transmission. Apart from negotiated safety and positive-positive sex, which have been practised for some time, the evidence presented here confirms the role of a number of other harm-reduction strategies, some safer than others. The challenge now for educators, both locally and elsewhere, is how to sustain safe sex and where appropriate build harm reduction into gay men's health education in the face of diverse and ever-changing gay communities. Recent rises in HIV infections have increased uncertainty and serve as a timely reminder that there are no easy solutions to what remain complex and difficult-to-grasp phenomena. [ABSTRACT FROM AUTHOR]

International efforts to control female genital surgery (also referred to as female genital mutilation) have mainly targeted countries where the practice is culturally sanctioned. Women in these countries belong to a mainstream culture and are supported by their communities through the process of debate and change. In displaced communities, particularly among migrants and refugees living in Western countries, women from these communities are the visible minority, and the focus and implementation of legislation and health policy addressing female genital surgery risks creating or increasing inequities in access to reproductive health. This paper reviews health policy on female genital surgery in Australia. We relate the frequency of genital cosmetic surgery in the wider population to procedures such as re-infibulation following childbirth, requested by African women; this latter procedure is illegal and currently unavailable in most public hospitals. Data are presented to highlight the effects of these and other political and legal inconsistencies on the reproductive health of women from displaced communities. [ABSTRACT FROM AUTHOR]

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

Consuming alcohol in night-time entertainment (NTE) precincts is a common practice for young adults in urban environments. Public health research often emphasises the 'harms' associated with drinking in NTE precincts and views these as being a product of the widespread availability of alcohol. However, this obscures more complex accounts of the various elements at play in young adults' drinking on a night out. Employing assemblage thinking and a meta-ethnography of published qualitative research in Australia, we analyse and assemble the socio-cultural and material elements that may coalesce in young adults drinking on a night out. We identify a broad range of elements in assemblages of young adults drinking, including norms, settings and places, social elements, and desirable effects. We suggest that public health researchers pay closer attention to the diverse range of socio-cultural and material elements in which young adults' drinking is entangled. We argue that assemblage thinking opens up new possibilities for maximising the social connection and pleasure that engaging in NTE precincts affords young adults while also minimising undesirable experiences. [ABSTRACT FROM AUTHOR]

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

Full-body computed tomography (CT) screening came to Australia in 2002. Within a year, public access to self-referred full-body CT screening was withdrawn as a consequence of sustained professional and political pressure and legislative changes. We examine how self-referred full-body CT scans were made available to Australian consumers, and evaluate the social, cultural and system factors that contributed to their de-implementation. Using historical methodologies, insider accounts and an ethnographic content analysis of policy documents, statutory reports, grey and scholarly literatures, we show how the rapid de-implementation of full-body CT scans in Australia arose from interconnected social, cultural and system factors, and an unusual harm profile for the technology. In the Australian context, this case suggests that neither single actors nor robust health technology assessments are likely to be sufficient to protect people from the unwanted consequences of too much medicine. The coordinated interaction of multiple stakeholders achieved this unusual example of successful, early de-implementation. Each stakeholder exercised their authority within their respective remits to shape public perceptions of and access to the new CT screening service: it is possible that without the actions of each, the final de-implementation outcome may not have been achieved. These findings are timely, given growing concerns about overdiagnosis and the emergence of new forms of testing technologies. Against a background of technological optimism and commercial opportunism, a commitment to vigilance and cross-sectoral coordination across a range of decision-making roles and institutions will be key to efforts to prevent the harms of overdiagnosis. [ABSTRACT FROM AUTHOR]

Public health agencies tasked with improving the health of communities are poorly supported by many 'business-as-usual' funding practices. It is commonplace to call for more funding for health promotion, but additional funding could do more harm than good if, at the same time, we do not critically examine the micro-processes that lead to health enablement – micro-processes that are instigated or amplified by funding. We are currently engaged in a university-and-policy research partnership to identify how funding mechanisms may better serve the practice of community-based health promotion. We propose three primary considerations to inform the way funds are used to enable community-based health promotion. The first is a broader understanding and legitimising of the 'soft infrastructure' or resources required to enhance a community's capacity for change. The second is recognition of social relationships as key to increasing the availability and management of resources within communities. The third consideration understands communities to be complex systems and argues that funding models are needed to support the dynamic evolution of these systems. By neglecting these considerations, current funding practices may inadvertently privilege communities with pre-existing capacity for change, potentially perpetuating inequalities in health. To begin to address these issues, aspects of funding processes (e.g., stability, guidance, evaluation, and feedback requirements) could be designed to better support the flourishing of community practice. Above all, funders must recognise that they are actors in the health system and they, like other actors, should be reflexive and accountable for their actions. [ABSTRACT FROM AUTHOR]

For patient communities, digital media have dramatically transformed the options for action. This includes working collectively to change policies in ways that would have been difficult, if at all possible, before the internet. Yet, to date, the impacts of patients' growing use of digital media on their sense of collective agency have been little explored. Drawing on the findings from an Australian study on patients' use of digital media to access treatments (involving 50 interviews with participants from HIV/AIDS, breast cancer and neurodegenerative communities) and using a governmentality lens, this article sheds light on the changing character of patients' sense of agency in an age of digital media. We identify a shift in patients' conceptions of their agentic selves associated with the growing use of these media – from 'activists' to 'advocates' – and consider the implications for critical public health. As we argue, this 'digital self-advocacy' is manifest in patients' accounts of how they use digital media to achieve their goals and reflects the responsibilisation that is a hallmark of neoliberal governance. We suggest that digital self-advocacy offers a restricted vision of patient agency that limits rather than facilitates actions needed to respond to crises and to advance health justice. In our conclusion we consider whether the context and the nature of a condition or disease may also have a bearing on patients' sense of agency in an age of digital media, making reference to patient responses to a new illness phenomenon dubbed 'long COVID-19ʹ. [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]

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]

The issue of women’s consumption of alcohol during pregnancy has gained increasing public attention in Australia in recent years. This article examines the framing of the issue in news media and pregnancy and parenting websites during 2013-2014, with particular attention to the two most prominent frames of ‘contested evidence and advice’ and ‘women’s rights’. Public health guidelines in Australia, as elsewhere, advise women that not drinking during pregnancy is the safest option, but debate continues to surround the evidence to support this advice and its impact. This article considers these guidelines in the context of critical public health scholarship highlighting the intensification of discourses of health, risk, and responsibility in relation to pregnancy and maternal practices. Newly published scientific research provided a key source of news about the risks associated with alcohol consumption during pregnancy, with stories reporting on studies that variously identified evidence of harm, or no harm, to the fetus. In the context of the ‘women’s rights’ frame, consuming alcohol during pregnancy was not constructed primarily as a matter of scientific research or expert opinion but as one of many social practices women negotiate during pregnancy. It foregrounded the rights of women to make their own decisions about alcohol consumption. The deployment of these two frames in mediated public discussion of the issue reflects the inconclusiveness of evidence about the risks of low to moderate consumption and shows women critically engaging with public health advice in the context of the numerous directives they are inundated with during pregnancy. [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]

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]

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 article discusses various reports published within the issue which includes Scandinavian public health policies and practices, recommendations for intersectoral action for health in Danish municipalities and collective identity of public health.

While much has been made of the governmentality evinced in drug policy, its effects on people who use drugs have received less attention. Scholars who have investigated these effects commonly focus on the views and experiences of individuals receiving treatment for their drug use, often reporting an explicit desire among individuals in treatment for a return to a normal, healthy life. Many authors trace this desire to the normalisation inherent in drug policy, and the governmentality involved in the delivery of drug treatment more directly. This article adds to these discussions by shifting focus from the experience of individuals in treatment to those out of treatment settings. In so doing, we aim to develop a more nuanced understanding of how heavy drug users negotiate power, governmentality and the modulations of health and illness in the course of everyday life. We ground our discussion in qualitative research conducted in Melbourne, Australia, with 31 current methamphetamine consumers. We argue that regular methamphetamine consumption involves a complex and ambivalent relationship with the ideas of health and normal life, imposing as well as reflecting a form of estrangement between its consumers and mainstream (or normal) society. This ambivalence has important implications for the delivery of health and social services among methamphetamine consumers, insofar as the restoration of normal health and the reintegration of former drug users into mainstream society are typical health service goals. We address some of these policy implications by way of conclusion. [ABSTRACT FROM PUBLISHER]

The response to HIV in many countries is informed by routine behavioural surveillance of affected populations, yet the impact of this surveillance is rarely considered. In Australia, the Gay Community Periodic Surveys (GCPS) recruit 8000 men each year, surveying sexual practices, drug use and health service utilisation, in line with international guidelines. Using actor–network theory and Ian Hacking’s concept of ‘looping effects’, this article considers how knowledge of gay men is produced by behavioural surveillance, the interdependencies between the surveillance network and its subjects, and the potential for unintended consequences as a result of the mass participation of gay men in the surveillance network. The case of the GCPS is used to show how behavioural surveillance relies on a large, complex assemblage of human and non-human actors, with an emphasis on standardisation and repetition to make its practices durable. The distance of surveillance from gay men’s practices means that the network relies on an imaginary of gay men to create survey tools and to interpret data. This imaginary may be communicated to gay men during their participation in the surveillance, particularly when they are engaging with the surveillance questionnaire. This has the potential to affect their subjectivity and the practices the surveys seek to monitor. Considering the implications of this analysis, it is argued that HIV prevention could be improved if we consider how behavioural surveillance produces knowledge of gay men and the ways in which gay men affect and are affected by surveillance. [ABSTRACT FROM PUBLISHER]

The article pays tribute to public health practitioners Gavin Mooney and Del Weston.

A substantial minority of Western women smoke during pregnancy. Understanding smoking from these women’s point of view may provide a richer understanding of experiences that are very often silenced, and provide some explanation for why pregnant women smoke despite widely disseminated public health campaigns urging them to stop. Strong social pressures directed at women to stop, justified mainly by arguments of protecting the foetus, are reinforced through the policing of women’s bodies, which is particularly powerful during pregnancy. This emerges in the form of criticism, confrontation and judgement, irrespective of individual women’s contexts and social backgrounds. Interviews with 11 Australian women who had smoked during recent pregnancies were conducted to explore their smoking-related experience of stigma. Thematic analysis examined their perceptions of stigma and surveillance, in the strong anti-smoking climate of Australia. Women’s talk constructed medical and social pressures as two separate dimensions of stigma, which they accepted or resisted, or – at times – did both. They also used discursive strategies to negotiate their position as ‘good mothers’ despite stigma, and spoke about the need to manage the contexts in which they smoked. The women’s talk suggests that directive, critical public health campaigns, and the associated social stigma, may actually make it harder for some to stop smoking. More supportive approaches that move away from a focus on individual responsibility, and from the assumption that pregnant women need to be coerced into healthy decision-making, might better assist some pregnant smokers to seek cessation support. [ABSTRACT FROM PUBLISHER]

In 2006, 2010, and 2011 attempts were made by health policy advocates to ignite policy debate about the introduction of supervised injecting facilities (SIFs) in Melbourne, Australia. Although there have been a number of attempts to introduce SIFs in Australia, only one facility has been introduced in Sydney, and it has only recently achieved full operating status beyond an extended nine-year trial period. This article retraces the policy narratives in documentary materials (parliamentary debates, policy documents, public advocacy and empirical research) to reflect on the causes for policy impermeability in this contested arena. Interest in supervised injecting rooms, whilst always an exemplar of harm reduction, actually emerged in New South Wales in the mid-1990s from government concern over endemic police corruption. Subsequent policy narratives in Victorian SIF advocacy tended to focus heavily on the health and welfare of drug users, with a notable absence of concern about SIFs as a response to police corruption. It is suggested that future policy initiatives in this arena be mindful of the role and influence of policy narratives that focus on policing, if future SIF advocacy is to be successful. [ABSTRACT FROM PUBLISHER]

Social exclusion and social inclusion have been popular policy themes in the UK and Europe, and made more modest appearances in countries such as Canada and New Zealand, for over a decade. In 2007, the Australian Government became the latest country in this trend of structuring social policy around issues of exclusion, launching its ‘Social Inclusion Agenda’ (SIA). The SIA aims to increase social and economic participation through a reorientation of social services and increased attention to issues of equity. At the same time, there has been international consensus on the importance of the social determinants of health (such as education, income and gender) for individuals and populations. The SIA has the potential to make a substantive contribution to the social determinants of health and hence the health and wellbeing of the population. However, much will depend on the extent to which international discourses of inclusion, exclusion, structural inequality and third way politics are taken up, adapted or discarded in the Australian context. At this formative stage of the SIA's development, the public health community is in a unique position to contribute to the development and direction of the SIA to secure the potential health gains it offers. This article outlines the formulation of social inclusion policy in Australia, and discusses the potential promises and pitfalls of a social inclusion approach. Our examination of the Australian experience of social inclusion policy provides an opportunity to reflect on the relationship between social inclusion and health internationally. [ABSTRACT FROM PUBLISHER]

Tobacco control advocates expend considerable effort in generating news stories on tobacco issues to assist progress in tobacco control, and the news coverage itself may have important policy and behavioral influences. Yet, studies of trends in such news coverage are uncommon. Between 2001 and 2006, we conducted a content analysis of tobacco-related newspaper articles in the 12 major daily Australian newspapers and coded them for type of article, topic, and tone. Overall, 6483 tobacco-focused articles were published, representing an average of one article every 4 days for each newspaper. There was variability in volume between years but no decline over time. Overall, 67% of articles reported on events that represented progress for tobacco control, 21% on setbacks, and 7% on events that were of mixed impact. Newspaper coverage of tobacco issues was dominated by articles on smoke-free issues (32% of articles), health effects of smoking (12%), education, prevention and cessation programs and services (12%), and the tobacco industry (9%). During the 6-year period, on average, Australian adults were potentially exposed to around one article on tobacco issues every week, or using a more stringent prominence-adjusted measure, one article every 2 to 3 weeks, a level comparable to paid media campaigns in some jurisdictions. Temporal variation in population exposure to news coverage about tobacco issues may reflect variability in newsworthiness of tobacco control issues, media advocacy resources and success, and/or preparedness of editors and journalists to entertain news stories on tobacco. [ABSTRACT FROM AUTHOR]

The women's and men's health movements in developed societies have had distinct but related histories, including periods of suspicion and occasionally explicit opposition. Nevertheless, they have a number of interests in common, suggesting the potential for strategic alliances. This article uses international literature, and Australia as a case study, to review the potential for gender collaboration, and to identify possible obstacles that must be dealt with if joint action is to be effective. It suggests that strategic alliances around common interests can contribute to population health. [ABSTRACT FROM AUTHOR]

This article contrasts two understandings of intoxication. The first, found in public health discourse, constructs intoxication as a harm produced by risky alcohol consumption and highlights its many negative consequences for individual and social well-being. The model of intoxication as a harm dominates the new Australian National Alcohol Strategy, which includes the reduction of intoxication as one of four priority areas. The second understanding, based on the everyday experiences of drinkers as well as popular discourse, approaches intoxication as a positive and enhanced state: a form of bodily pleasure. The article argues that while the understanding of intoxication as a harm is epidemiologically incontrovertible, the gap between the public health and everyday understandings of intoxication is a problem for campaigns that aim to alter drinking practices. This is particularly the case when, as recent research suggests, young people's drinking is part of a wide-ranging culture of hedonistic consumption. A clearer picture of the varied uses of alcohol and cultures of drinking, including controlled intoxication among young people, would enhance public health understandings of alcohol consumption and its risks and pleasures. [ABSTRACT FROM AUTHOR]

Over the last three decades Australia has very successfully adopted and applied the values, methods, and practice of health promotion to improve the average life expectancy and health of the population. Australia has, also, been part of and contributed to the global evolution of the field of health promotion. There is, now, substantial organisational capacity (including a specialist workforce) within the health sector (including the non-government and community sectors), although total financial investment as a proportion of total recurrent health expenditure remains consistently below 2%. However, despite its significant successes, health promotion in Australia has had little impact on improving the health of Indigenous Australians. Closing the 17-year gap in life expectancy is one of the greatest challenges facing health promotion in the future-necessitating a much more substantial investment in working across sectors to redistribute the social determinants of health, including political power. [ABSTRACT FROM AUTHOR]