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In their 2010 book, Lorna Weir and Eric Mykhalovskiy conceptualised the role of vigilance in unknown and emerging infectious disease threats. Theirs is a macro-level account which draws on empirical data to describe vigilance as a set of technical and political arrangements that govern collection, analysis, interpretation and communication of data as it pertains to unknown threats. In this paper we expand their work to detail a conceptual analysis of the role of vigilance at the micro-level during periods of high infectious disease threat. Our data are daily press conferences and associated non-discursive tools in New South Wales (NSW), Australia during times of heightened COVID-19 risk. This paper is a conceptual analysis that draws on theories of vigilance and related concepts to show how a key aspect of vigilance is making previously unseen threats visible or present. Communications formulated and encouraged three types of vigilance as a set of governing relations: institutional or authority-based; individual outward-facing; and individual inward-facing. We also describe the relationship between vigilance and related concepts that are used in response to anticipated public threats. Authority based vigilance involved contact tracing and policing of movement and behaviours. In individual outward facing vigilance people were asked to be alert to, analyse, and react to risk in their immediate environment. Inward facing vigilance required people to gather and react to information about their own behaviours and within their own bodies. There was a relationship between different types of vigilance; as risk increased and authority-based vigilance was less successful in containing the spread of infection, individual vigilance had a stronger role to play. This extension of vigilance at the micro-level sees some of the same unintended consequences as Weir and Mykhalovskiy describe at the global level, particularly in how burdens are inequitably distributed and experienced. • Citizens became an arm of vigilance apparatus during COVID-19 pandemic in Australia. • Vigilance was authority-based; individual outward facing; individual inward facing. • Disadvantaged populations carried higher vigilance burden. • Earlier conceptions of vigilance in infectious disease emergencies are extended. [ABSTRACT FROM AUTHOR]

Abstract While vaccine-critical activism has been widely documented and discussed, comparatively little has been said about the concerted response of pro-vaccine activists defending the majority view. This paper explores two case studies of pro-vaccine activism in Australia and the United States (US). It shows how pro-vaccine views and behaviours can take varying forms due to different aims and methods of engagement – oppositional counteractivities in favour of vaccination in Australia, and issue-based advocacy as part of a political alliance in the US. The focus in Australia comes from a pro-science stance and includes 'skeptics' against pseudoscience directly opposing vaccine-critical groups. In the US, the focus takes the form of an issue-specific campaign that has arisen from existing pro-vaccine parent blogs and discussion groups pushing for policy change rather than public confrontation. These case studies exemplify how pro-vaccine activism can take varying forms of either reinforcing the mainstream view or countering digression from it. Drawing on qualitative research, this paper aims to examine the types of practices and strategies employed by activists to voice their support of vaccination, and discusses the means, messages, and motivations of pro-vaccine activism. It ends with an argument for why a study – of public support for in addition to studying public opposition to vaccination – can help to better understand vaccination views and behaviours. These findings have wider implications for the study of counter-activism and the polarisation of civil society groups. Highlights • Pro-vaccine views and behaviours are understudied. • Case studies on pro-vaccine activist groups in Australia and the United States. • Pro-vaccine activism reinforces the mainstream or counters digression from it. [ABSTRACT FROM AUTHOR]

Abstract Many countries use financial incentive programs to attract physicians to work in rural areas. This paper examines the effectiveness of a policy reform in Australia that made some locations newly eligible for financial incentives and increased incentives for locations already eligible. The analysis uses panel data (2008–2014) on all Australian general practitioners (GPs) aggregated to small areas. We use a difference-in-differences approach to examine if the policy change affected GP entry or exit to the 755 newly eligible locations and the 787 always eligible locations relative to 2249 locations which were never eligible. The policy change increased the entry of newly-qualified GPs to newly eligible locations but had no effect on the entry and exit of other GPs. Our results suggest that location incentives should be targeted at newly qualified GPs. Highlights • Difference-in-differences design is used to study GP rural financial incentives. • Overall rural-urban distribution of GPs is unaffected by financial incentives. • New GPs are more likely to respond to financial incentives than existing GPs. • The findings suggest a targeted approach in incentive design. [ABSTRACT FROM AUTHOR]

Health systems have long been criticised for focussing on curing rather than preventing disease. This paper examines to what extent the Adelaide Thinkers in Residence (ATiR) scheme contributed to the change in norms whereby promoting well-being and a strategy to achieve this - Health in All Policies (HiAP) - was adopted by the South Australian (SA) State Government from 2007. The data presented in this paper are drawn from a five year (2012–2016) detailed mixed methods case study of the SA HiAP initiative which involved document analysis, interviews and workshops with public servants and political actors. We adapt the framework used by Finnemore and Sikkink (1998) which explains how norm changes can lead to political changes in international affairs. We also use Kingdon's concept of policy entrepreneurs to determine whether these ideas moved to an implementable initiative with the help of both a specific ATiR program on HiAP and the broader TiR scheme which promoted a series of innovations relevant to health. The process involved the ATiR reinforcing the work of local norm entrepreneurs with that of powerful external policy entrepreneurs, adapting the discourse about the value of prevention and promoting well-being so that it fitted with the dominant economic one. The powerful organisational platform of the ATiR, which was under the Department of the Premier and Cabinet and linked to the South Australian Strategic Plan (SASP) was used to advance these ideas. The case study offers important lessons for other jurisdictions on how to shift policy to encourage intersectoral approaches to health. [ABSTRACT FROM AUTHOR]

This paper aims to increase understanding of how mothers diagnosed with breast cancer while in the paid workforce experience and manage their multiple demands of taking care of themselves, their children and their paid work. In-depth, semi-structured interviews were conducted with 32 women who were mothers of dependent children and in the paid workforce at the time of their breast cancer diagnosis. The sample includes women living in urban and rural Australia. The study found that after a breast cancer diagnosis, participants tended to prioritise their health and wellbeing over paid work. Yet dominance of gendered identity meant that they tended to place the needs of family, especially children, above their own health and wellbeing. The key factors that influenced mothers' decisions to continue in, return to, or leave paid work after a breast cancer diagnosis included: a change in perspective regarding what was important in their lives; level of support from the workplace and home; the extent to which participating in paid work was a financial necessity; the extent to which their identity was connected to paid work, and; ongoing level of pain or fatigue. The paper concludes that using the sociological concepts of the fateful moment, boundary maintenance and a feminist ethic of care produces a more nuanced understanding of women's participation in paid work after breast cancer than examining paid workforce participation, or unpaid responsibilities and mothering, separately. The nature of the permeability or malleability of boundaries between work, family and taking care of the self affects women's participation in paid work during and/or after breast cancer treatment. Increased boundary permeability or malleability brought about more by cooperation than conflict facilitated positive experiences of re-negotiating boundaries, whereas increased permeability or malleability brought about more by conflict than cooperation created difficulties for women in finding an acceptable balance between their family, paid work and taking care of their own health after breast cancer. [ABSTRACT FROM AUTHOR]

Sociological studies of the complementary and alternative medicine (CAM) occupations have documented the professionalisation strategies these groups use to establish boundaries between themselves and their competitors, including seeking educational accreditation and statutory regulation/licensure. Chiropractic has been particularly successful at professionalising and in Australia and the UK it is taught within public universities. Recent events have threatened chiropractic's university foothold, however, showing that professionalisation needs to be understood as an ongoing process of negotiation. Based on interviews with chiropractors in Australia and the UK, this paper examines the professionalisation strategies deployed by chiropractors within and outside of the university. Highly divergent strategies are identified across different sectors of the profession, relating to defining the chiropractic paradigm, directing education and constructing professional identity. In each domain, chiropractic academics tended to prioritise building the evidence base and becoming more aligned with medicine and other allied health professions. Although some practitioners supported this agenda, others strove to preserve chiropractic's vitalistic philosophy and professional distinction. Following Bourdieu, these intra-professional struggles are interpreted as occurring within a field in which chiropractors compete for different forms of capital, pulled by two opposing poles. The differing orientations and strategies pursued at the two poles of the field point to a number of possible futures for this CAM profession, including a potential split within the profession itself. [ABSTRACT FROM AUTHOR]

Systematic differences in the ways that people use and interpret response categories (differential item functioning, DIF ) can introduce bias when using self-assessments to compare health or quality of life across heterogeneous groups. This paper reports on an exploratory analysis involving the use of anchoring vignettes to identify DIF in a commonly used measure for assessing health-related quality of life - namely the EQ-5D. Using data from a bespoke (i.e. custom) survey that recruited a representative sample of 4300 respondents from the general Australian population in 2014 and 2015, we find that the assumptions of response consistency (RC) and vignette equivalence (VE) hold in a sub-sample of respondents aged 55–65 years (n = 914), which demonstrates that vignettes can appropriately identify DIF in EQ-5D reporting for this age group. We find that the EQ-5D is indeed subject to DIF, and that failure to account for DIF can lead to conclusions that are misleading when using the instrument to compare health or quality of life across heterogeneous groups. We also provide several important insights in terms of the identifying assumptions of RC and VE. We conclude that the implications of DIF could be of considerable importance, not only for outcomes research, but for funding decisions in healthcare more broadly given the strong reliance on patient-reported outcome measures in economic evaluations for health technology assessment. [ABSTRACT FROM AUTHOR]

Advance care planning is premised on concepts of individual autonomy and self-determination. The standardisation of this individualist approach to decision-making erases the diverse cultural sensibilities and vocabularies that shape trajectories of care. In attempting to redress this exclusion, this paper foregrounds previously overlooked vernaculars and practices for understanding how care for the aged and those approaching the end of life is understood and enacted in Australia's culturally diverse society. Drawing on ethnographic interviews and participant-observation with ageing Chinese migrants and their families in Adelaide, South Australia, it examines the multiple enactments of 'face' in end-of-life care. In so doing, the paper extends Goffman's theorisation of 'face', opening up the 'front' of the bounded individual to reveal how persons are mutually implicated in relational contexts. Attending to cultural contours of face and their intersections with filial piety, this paper unsettles the imperative of self-determination in advance care planning and reveals how intergenerational shifts from older to younger generations can reorient care at the end of life. • Face provides a critical context for understanding aged and end-of-life care in Chinese families. • Face and filial piety are enacted differently in different contexts. • Diverse cultural vocabularies and practices are needed in care settings. • Care at the end-of-life is always relational and nuanced. [ABSTRACT FROM AUTHOR]

This paper investigates the health effects of the introduction of a near universal paid parental leave (PPL) scheme in Australia, representing a natural social policy experiment. Along with gender equity and workforce engagement, a goal of the scheme (18 weeks leave at the minimum wage rate) was to enhance the health and wellbeing of mothers and babies. Although there is evidence that leave, especially paid leave, can benefit mothers' health post-partum, the potential health benefits of implementing a nationwide scheme have rarely been investigated. The data come from two cross-sectional surveys of mothers (matched on their eligibility for paid parental leave), 2347 mother's surveyed pre-PPL and 3268 post-PPL. We investigated the scheme's health benefits for mothers, and the extent this varied by pre-birth employment conditions and job characteristics. Overall, we observed better mental and physical health among mothers after the introduction of PPL, although the effects were small. Post-PPL mothers on casual (insecure) contracts before birth had significantly better mental health than their pre-PPL counterparts, suggesting that the scheme delivered health benefits to mothers who were relatively disadvantaged. However, mothers on permanent contracts and in managerial or professional occupations also had significantly better mental and physical health in the post-PPL group. These mothers were more likely to combine the Government sponsored leave with additional, paid, employer benefits, enabling a longer paid leave package post-partum. Overall, the study provides evidence that introducing paid maternity leave universally delivers health benefits to mothers. However the modest 18 week PPL provision did little to redress health inequalities. [ABSTRACT FROM AUTHOR]

Effective obesity prevention requires a synergistic mix of population-level interventions including a strong role for government and the regulation of the marketing, labelling, content and pricing of energy-dense foods and beverages. In this paper we adopt the agenda of the Australian Federal Government (AFG) as a case study to understand the factors generating or hindering political priority for such ‘regulatory interventions’ between 1990 and 2011. Using a theoretically-guided process tracing method we undertook documentary analysis and conducted 27 interviews with a diversity of actors involved in obesity politics. The analysis was structured by a theoretical framework comprising four dimensions: the power of actors involved; the ideas the actors deploy to interpret and portray the issue; the institutional and political context; and issue characteristics. Despite two periods of sustained political attention, political priority for regulatory interventions did not emerge and was hindered by factors from all four dimensions. Within the public health community, limited cohesion among experts and advocacy groups hampered technical responses and collective action efforts. An initial focus on children (child obesity), framing the determinants of obesity as ‘obesogenic environments’, and the deployment of ‘protecting kids’, ‘industry demonization’ and ‘economic costs’ frames generated political attention. Institutional norms within government effectively selected out regulatory interventions from consideration. The ‘productive power’ and activities of the food and advertising industries presented formidable barriers, buttressed by a libertarian/neolibertarian rhetoric emphasizing individual responsibility, a negative view of freedom (as free from ‘nanny-state’ intervention) and the idea that regulation imposes an unacceptable cost on business. Issue complexity, the absence of a supportive evidence base and a strict ‘evidence-based’ policy-making approach were used as rationales to defer political priority. Overcoming these challenges may be important to future collective action efforts attempting to generate and sustain political priority for regulatory interventions targeting obesity. [ABSTRACT FROM AUTHOR]

For over twenty years there have been calls for greater ‘consumer’ participation in health decision-making. While it is recognised by governments and other stakeholders that ‘consumer’ participation is desirable, barriers to meaningful involvement nonetheless remain. It has been suggested that the reifying of ‘evidence-based policy’ may be limiting opportunities for participation, through the way this discourse legitimates particular voices to the exclusion of others. Others have suggested that assumptions underpinning the very notion of the ‘affected community’ or ‘consumers’ as fixed and bounded ‘policy publics’ need to be problematised. In this paper, drawing on interviews (n = 41) with individuals closely involved in Australian drug policy discussions, we critically interrogate the productive techniques and constitutive effects of ‘evidence-based policy’ and ‘consumer participation’ discourses in the context of drug policy processes. To inform our analysis, we draw on and combine a number of critical perspectives including Foucault's concept of subjugated knowledges, the work of feminist theorists, as well as recent work regarding conceptualisations of emergent policy publics. First, we explore how the subject position of ‘consumer’ might be seen as enacted in the material-discursive practices of ‘evidence-based policy’ and ‘consumer participation’ in drug policy processes. Secondly, we consider the centralising power-effects of the dominant ‘evidence-based policy’ paradigm, and how resistance may be thought about in this context. We suggest that such interrogation has potential to recast the call for ‘consumer’ participation in health policy decision-making and drug policy processes. [ABSTRACT FROM AUTHOR]

Aboriginal health policy in Australia represents a unique policy subsystem comprising a diverse network of Aboriginal-specific and “mainstream” organisations, often with competing interests. This paper describes the network structure of organisations attempting to influence national Aboriginal health policy and examines how the different subgroups within the network approached the policy discourse. Public submissions made as part of a policy development process for the National Aboriginal and Torres Strait Islander Health Plan were analysed using a novel combination of network analysis and qualitative framing analysis. Other organisational actors in the network in each submission were identified, and relationships between them determined; these were used to generate a network map depicting the ties between actors. A qualitative framing analysis was undertaken, using inductive coding of the policy discourses in the submissions. The frames were overlaid with the network map to identify the relationship between the structure of the network and the way in which organisations framed Aboriginal health problems. Aboriginal organisations were central to the network and strongly connected with each other. The network consisted of several densely connected subgroups, whose central nodes were closely connected to one another. Each subgroup deployed a particular policy frame, with a frame of “system dysfunction” also adopted by all but one subgroup. Analysis of submissions revealed that many of the stakeholders in Aboriginal health policy actors are connected to one another. These connections help to drive the policy discourse. The combination of network and framing analysis illuminates competing interests within a network, and can assist advocacy organisations to identify which network members are most influential. [ABSTRACT FROM AUTHOR]

This paper applies a critical analysis of the impact of neo-liberal driven management reform to examine changes in Australian primary health care (PHC) services over five years. The implementation of comprehensive approaches to primary health care (PHC) in seven services: five state-managed and two non-government organisations (NGOs) was tracked from 2009 to 2014. Two questions are addressed: 1) How did the ability of Australian PHC services to implement comprehensive PHC change over the period 2009–2014? 2) To what extent is the ability of the PHC services to implement comprehensive PHC shaped by neo-liberal health sector reform processes? The study reports on detailed tracking and observations of the changes and in-depth interviews with 63 health service managers and practitioners, and regional and central health executives. The documented changes were: in the state-managed services (although not the NGOs) less comprehensive service coverage and more focus on clinical services and integration with hospitals and much less development activity including community development, advocacy, intersectoral collaboration and attention to the social determinants. These changes were found to be associated with practices typical of neo-liberal health sector reform: considerable uncertainty, more directive managerial control, budget reductions and competitive tendering and an emphasis on outputs rather than health outcomes. We conclude that a focus on clinical service provision, while highly compatible with neo-liberal reforms, will not on its own produce the shifts in population disease patterns that would be required to reduce demand for health services and promote health. Comprehensive PHC is much better suited to that task. [ABSTRACT FROM AUTHOR]

Extensive evidence has shown that working nonstandard hours, such as evening or night shifts, impacts negatively on workers' own health, and a growing literature suggests such impacts extend to the health of workers’ children. Using matched parent and child data from a large Australian panel survey this paper explores the effects of parental work schedules on the mental and physical health of adolescents aged 15–20 in sole-parent families. Random-effects models indicate adolescents have marginally worse emotional and physical health when their parent works nonstandard hours, based on SF-36 component summary scores, associated primarily with emotional or physical role limitations. Parental weekend schedules are particularly detrimental to adolescent physical health. Evidence is found that the effects of nonstandard work schedules on adolescent wellbeing are transmitted through increased work-family conflict and exacerbated where parents have low job control. [ABSTRACT FROM AUTHOR]

Understanding the health consequences of retirement is important, as many developed countries have already started raising state pension eligibility age, with the intention to induce postponed retirement. This paper estimates the causal effect of retirement on the health outcomes of older women in Australia, utilising the exogenous variation in retirement induced by the change in age eligibility for the Australian Age Pension. Using a sample of 19,185 observations for 3771 women from waves 2001–2011 of the Household, Income and Labour Dynamics in Australia (HILDA) Survey, we show that retirement status has positive and significant effects on women's self-reported health, physical and mental health outcomes. We also find that longer time spent in retirement confers clear additional health benefits. We show that retirement affects physical and mental health in diverse ways and that the estimated positive health effects of retirement are coincidental with increased post-retirement physical activity and reduced smoking. Our finding that retirement can improve health suggests that the welfare losses from working life prolongation policies will be larger than currently though when we include the cost of the foregone health improvements. [ABSTRACT FROM AUTHOR]

This article explores expositions of subjectivity in accounts of postnatal depression (PND). It examines the public narratives of 19 Australian women contributing to a health information website ( healthtalkaustralia.org ), collected across two Australian qualitative research studies conducted between 2011 and 2014. For the first part of the paper we analysed narrative data using a combination of phenomenological and psychoanalytic techniques. We found that postnatal distress was described in embodied, relational terms and that women depicted their distress as a pre-verbal intrusion into ‘known’ selves. We interpreted this intrusion as a doubly relational phenomenon - informed at once by a woman’s encounter with her infant and her ‘body memory’ of earlier relational experiences. For the second part we examined how and why women classified this relational distress as PND. We drew on illness narrative literature and recent work on narrative identity to explore why women would want to ‘narrate PND’ – an apparently antithetical act in an environment where there is a duty to be a good (healthy) mother. We highlight the dual purpose of the public PND narration – as a means of re-establishing a socially sanctioned known self and as a relational act prompted by the heightened relationality of early maternity. Our focus on the salutary aspects of narrating PND, and its links to relational maternal subjectivities, offers a novel contribution to the current literature and a timely analysis of a largely uninterrogated sociocultural phenomenon. [ABSTRACT FROM AUTHOR]

This paper examines key processes from the social identity model of traumatic identity change in the context of the aftermath of a natural disaster. It focuses on the roles of (i) group membership gain, (ii) group membership continuity, (iii) social identity revitalisation, and (iv) the severity of natural disaster exposure on post-traumatic growth (PTG) and post-traumatic stress (PTS). (N = 410, M age = 53.24 years) comprised adult survivors of the Australian 2019-20 Black Summer bushfires, recruited to complete an online survey via geo-targeted Facebook advertisements. showed that group membership gain was positively correlated with PTG, whilst group membership continuity negatively correlated with PTS, highlighting the different roles played by group gain and continuity in post-trauma recovery. Preliminary evidence for the validity of a new author-developed social identity revitalisation measure was found, which mediated some relationships between group gain and continuity and PTG and PTS. Lastly, the extent that participants were affected by the fires moderated the relationship between group gain and PTS. Specifically, for those most affected, group gain was correlated with lower reported PTS, whilst for those less affected, group gain was correlated with higher reported PTS. We discuss implications for theory and draw attention to the concept of revitalisation, which shows promise as a potentially critical contributor to post-trauma recovery. • Group membership gain and continuity play different roles in post-trauma recovery. • Social identity revitalisation is a critical ingredient that promotes growth. • Disaster damage moderates the relationship between group gain and PTS. [ABSTRACT FROM AUTHOR]

This paper studies the association between homelessness and mental health episodes focusing on episodes of depression, anxiety and other conditions (bipolar affective disorder, schizophrenia, and post-traumatic stress disorder). Using panel data from the Australian Journeys Home survey, we investigate the extent to which this association is due to common determinants of homelessness and mental health episodes, or whether there is a causal link between them. The results indicate that episodes of depression increase the probability that a person becomes homeless. This is not the case for other mental health conditions. We find no evidence that becoming homeless causes a person to have a mental health episode. Instead, respondents are less likely to be diagnosed with depression in the 6 months after being precariously housed. Overall, our results indicate that, except for depression, the links between mental health episodes and homelessness are complex and are mostly unlikely to be causal. Using information on service usage, we find suggestive evidence that people use mental health services when they need to but that more coordination with housing services is required to protect them from becoming precariously housed. • This paper uses panel data from the Australian Journeys Home survey. • Episodes of depression increase the probability to become precariously housed. • But they do not increase the probability of literal homelessness. • Episodes of homelessness are not causally linked to other mental health conditions. • More coordination needed between services to protect the depressed from homelessness. [ABSTRACT FROM AUTHOR]

This paper investigates whether the Australian government's Coronavirus Supplement, a temporary income support payment for unemployed jobseekers during the height of the COVID-19 pandemic, protected mental health (frequency of feeling anxious or depressed during the past week) by lowering financial stress (how comfortable people are in paying for essential services). We use unique nationally representative repeated cross-sectional data on 3843 unemployed Australian adults over the period April 6, 2020 to May 10, 2021. We find that the Coronavirus Supplement payment significantly reduced reported financial stress, and lower financial stress was associated with lower mental distress. Though the Coronavirus Supplement was designed to reduce financial stress, we find the Supplement was also successful in protecting community mental health indirectly via its ability to reduce financial stress. The findings provide support for income support packages to protect mental health during economic shocks. However, transitory support measures also tend have short-lived positive effects on mental health, suggesting that more permanent income support reform may have longer-term mental health benefits. • Did the Australian Coronavirus Supplement (CVS) protect mental health? • The CVS directly lowered financial stress. • The CVS indirectly reduced mental distress via lower financial stress. • Permanent support measures may be more beneficial than transitory ones. [ABSTRACT FROM AUTHOR]

In contrast to the recent proliferation of studies incorporating ordinal methods to generate health state values from adults, to date relatively few studies have utilised ordinal methods to generate health state values from adolescents. This paper reports upon a study to apply profile case best worst scaling methods to derive a new adolescent specific scoring algorithm for the Child Health Utility 9D (CHU9D), a generic preference based instrument that has been specifically designed for the estimation of quality adjusted life years for the economic evaluation of health care treatment and preventive programs targeted at young people. A survey was developed for administration in an on-line format in which consenting community based Australian adolescents aged 11–17 years (N = 1982) indicated the best and worst features of a series of 10 health states derived from the CHU9D descriptive system. The data were analyzed using latent class conditional logit models to estimate values (part worth utilities) for each level of the nine attributes relating to the CHU9D. A marginal utility matrix was then estimated to generate an adolescent-specific scoring algorithm on the full health = 1 and dead = 0 scale required for the calculation of QALYs. It was evident that different decision processes were being used in the best and worst choices. Whilst respondents appeared readily able to choose ‘best’ attribute levels for the CHU9D health states, a large amount of random variability and indeed different decision rules were evident for the choice of ‘worst’ attribute levels, to the extent that the best and worst data should not be pooled from the statistical perspective. The optimal adolescent-specific scoring algorithm was therefore derived using data obtained from the best choices only. The study provides important insights into the use of profile case best worst scaling methods to generate health state values with adolescent populations. [ABSTRACT FROM AUTHOR]

The potential for regulatory measures to address escalating rates of obesity is widely acknowledged in public health circles. Many advocates support regulations for their potential to reduce health inequalities, in light of the well-documented social gradient in obesity. This paper examines how different social groups understand the role of regulations and other public health interventions in addressing obesity. Drawing upon focus group data from a metropolitan city in southern Australia, we argue that implementing obesity regulations without attention to the ways in which disadvantaged communities problematise obesity may lead to further stigmatisation of this key target population. Tuana's work on the politics of ignorance, and broader literature on classed asymmetries of power, provides a theoretical framework to demonstrate how middle class understandings of obesity align with dominant ‘obesity epidemic’ discourses. These position obese people as lacking knowledge; underpinning support for food labelling and mandatory nutrition education for welfare recipients as well as food taxes. In contrast, disadvantaged groups emphasised the potential for a different set of interventions to improve material circumstances that constrain their ability to act upon existing health promotion messages, while also describing priorities of everyday living that are not oriented to improving health status. Findings demonstrate how ignorance is produced as an explanation for obesity, widely replicated in political settings and mainstream public health agendas. This politics of ignorance and its logical reparation serve to reproduce power relations in which particular groups are constructed as lacking capacity to act on knowledge, whilst maintaining others in privileged positions of knowing. [ABSTRACT FROM AUTHOR]

In physiotherapy, the therapeutic relationship - in which a therapist and patient work together to achieve treatment goals – is increasingly seen as the foundation of patient care. How the therapeutic relationship is established and enacted, however, is not well understood. One way to better understand the nature of the relationship is to examine how therapists and patients evaluate and inform each other about the patient's physical capacity, sensation, and emotions. As the patient and therapist's talk is the primary means to realise and exchange such evaluations, our focus is on evaluative language used by the therapist and patient in their interactions. The aim of this paper is to examine the language and function of evaluation in physiotherapy consultations. The study is a discourse analytic one using Appraisal Theory. In Appraisal Theory, language resources that speakers use to construe evaluations such as emotions, judgments of behaviour and aesthetics are expressed as a system. The sub-systems are Affect ( expressing emotion), Judgment ( assessing behaviour) and Appreciation ( evaluating processes and objects). The data are a convenience sample of 18 consultations from two cultural and therapeutic settings: primary healthcare (Sweden, Australia); and hospital rehabilitation (Australia). The findings show that both patient and therapist utilise all sub-systems of Appraisal; however, use of the sub-systems by the therapist and patient differs functionally. Judgment and Appreciation play a central role in therapists' co-construction of patients' physical history and presenting problem. In contrast, patient Affect evaluations, mainly to do with emotions about loss of capacity and pain, are generally not followed up by the therapist. The findings suggest that while patients engage with the therapeutic relationship from a clinical and interpersonal perspective, therapists are more narrowly focused on their own clinical tasks. The study findings have implications for understandings of the therapeutic relationship in physiotherapy and can inform teaching. [ABSTRACT FROM AUTHOR]

The unbalanced distribution of general practitioners (GPs) across geographic areas has been acknowledged as a problem in many countries around the world. Quantitative information regarding GPs' location decision over their lifecycle is essential in developing effective initiatives to address the unbalanced distribution and retention of GPs. This paper describes the age profile of GPs' location decision and relates it to individual characteristics. I use the Medicine in Australia: Balancing Employment and Life (MABEL) survey of doctors (2008–2012) with a sample size of 5810 male and 5797 female GPs. I employ a mixed logit model to estimate GPs' location decision. The results suggest that younger GPs are more prepared to go to rural and remote areas but they tend to migrate back to urban areas as they age. Coming from a rural background increases the likelihood of choosing rural areas, but with heterogeneity: While male GPs from a rural background tend to stay in rural and remote areas regardless of age, female GPs from a rural background are willing to migrate to urban areas as they age. GPs who obtain basic medical degrees overseas are likely to move back to urban areas in the later stage of their careers. Completing a basic medical degree at an older age increases the likelihood of working outside major cities. I also examine factors influencing GPs' location transition patterns and the results further confirm the association of individual characteristics and GPs' location–age profile. The findings can help target GPs who are most likely to practise and remain in rural and remote areas, and tailor policy initiatives to address the undesirable distribution and movement of GPs according to the identified heterogeneous age profile of their location decisions. [ABSTRACT FROM AUTHOR]

This paper examines how contemporary understandings of ‘health’ and ‘care’ are engaged with and practiced by women with disordered eating. Based on findings from an Australian study investigating why people with disordered eating are reluctant to engage with treatment services (March 2012 to March 2015), we demonstrate how young women use elements of a ‘health habitus ’ and ‘care’ to rationalise and justify their practices. Moving beyond Foucauldian theories of self-discipline and individual responsibility we argue that Bourdieu's concept of habitus and ethnographic concepts of care provide a deeper understanding of the ways in which people with disordered eating embody health practices as a form of care and distinction. We demonstrate how eating and bodily practices that entail ‘natural’, medical and ethical concerns (in particular, the new food regime known as orthorexia) are successfully incorporated into participants' eating disorder repertoires and embodied as a logic of care. Understanding how categories of health and care are tinkered with and practiced by people with disordered eating has important implications for health professionals, family members and peers engaging with and identifying people at all stages of help-seeking. [ABSTRACT FROM AUTHOR]

Recent social science scholarship has sought to understand the visible and invisible impacts of how antibiotics are entrenched as infrastructures and put to work as a proxy for higher levels of care (clinical or otherwise) within modern healthcare. Using a qualitative research design, in this paper our aim is to draw attention to less visible aspects of antimicrobial stewardship (AMS) in residential aged care and their implications for nurse-led optimization of antibiotic use in these settings. By developing an account of the perceptions, experiences and practices of staff regarding the 'on the ground' work associated with implementing and upholding AMS objectives our study extends research on attempts to dismantle antibiotic infrastructures in Australian residential aged care facilities (RACF). Drawing on a review of relevant policies, empirical data is presented from fifty-six in-depth interviews conducted in 2021 with staff at 8 different RACFs. Interview participants included managers, nurses, and senior and junior personal care assistants. Our results suggest that registered nurses in residential aged care have been tasked with promoting antibiotic optimization and assigned with AMS responsibilities without sufficient authority and resourcing. A host of hidden care work associated with AMS strategies was evident, reinforcing some staff support for empirical antibiotic prescribing as a 'safety net' in uncertain clinical cases. We argue that this hidden work occurs where AMS strategies displace the infrastructural role previously performed by antibiotics, exposing structural gaps and pressures. The inability of organisational accounting systems and the broader AMS policy agenda to capture hidden AMS workflows in RACFs has consequences for future resourcing and organisational learning in ways that mean AMS gaps may remain unaddressed. These results support findings that AMS interventions might not be easily accepted by aged care staff in view of associated burdens which are under recognised and under supported in this domain. • AMS accreditation is a requirement for Australian aged care facilities (RACFs). • RACFs are unique care contexts with resource constraints and high clinical uncertainty. • Interviews with RACF staff highlight how AMS tensions are managed though hidden work. • Further reform requires understanding how AMS in RACF can be made feasible. • Tailored resourcing to replace antibiotic infrastructures will be critical for AMS effectiveness. [ABSTRACT FROM AUTHOR]

The increasing prominence of the private sector in health care provision has generated considerable interest in understanding its implications on quality and cost. This paper investigates the phenomenon of cream skimming in a mixed public-private hospital setting using the novel approach of analysing hospital transfers. We analyse hospital administrative data of patients with ischemic heart disease from the state of Victoria, Australia. The data set contains approximately 1.77 million admission episodes in 309 hospitals, of which 132 are public hospitals, and 177 private hospitals. We ask if patients transferred between public and private hospitals differ systematically in the severity and complexity of their medical conditions; and if so, whether utilisation also differs. We find that patients with higher disease severity are more likely to be transferred from private to public hospitals whereas the opposite is true for patients transferred to private hospitals. We also find that patients transferred from private to public hospitals stayed longer and cost more than private-to-private transfer patients, after controlling for patients' observed health conditions and personal characteristics. Overall, the evidence is suggestive of the presence of cream skimming in the Victorian hospital system, although we cannot conclusively rule out other mechanisms that might influence hospital transfers. [ABSTRACT FROM AUTHOR]

This paper examines the spatio-temporal disjuncture between ‘the future’ in public health obesity initiatives and the embodied reality of eating. Drawing upon ethnographic fieldwork in a disadvantaged community in South Australia (August 2012–July 2014), we argue that the future oriented discourses of managing risk employed in obesity prevention programs have limited relevance to the immediacy of poverty, contingencies and survival that mark people's day to day lives. Extending Bourdieu's position that temporality is a central feature of practice, we develop the concept of short horizons to offer a theoretical framework to articulate the tensions between public health imperatives of healthy eating, and local ‘tastes of necessity’. Research undertaken at the time of Australia's largest obesity prevention program (OPAL) demonstrates that pre-emptive and risk-based approaches to health can fail to resonate when the future is not within easy reach. Considering the lack of evidence for success of obesity prevention programs, over-reliance on appeals to ‘the future’ may be a major challenge to the design, operationalisation and success of interventions. Attention to local rather than future horizons reveals a range of innovative strategies around everyday food and eating practices, and these capabilities need to be understood and supported in the delivery of obesity interventions. We argue, therefore, that public health initiatives should be located in the dynamics of a living present, tailored to the particular, localised spatio-temporal perspectives and material circumstances in which people live. [ABSTRACT FROM AUTHOR]

The links between social capital and mental wellbeing are established but the direction of the social capital-wellbeing relationship is rarely systematically examined. This omission undermines the validity of social capital as a basis for health interventions. The aim of this paper was to explore the short-term (one-year) reciprocal relationship between community participation – an important component of social capital – and mental wellbeing. We used nationally representative Household, Income and Labour Dynamics in Australia (HILDA) Survey data, 2005–11. The HILDA Survey is an annual cohort study from which was extracted a sub-sample of panel data (the same people participating across multiple waves) enabling us to use fixed effects regression methods to model the longitudinal association of mental health and participation controlling for individual heterogeneity. The results showed that better mental wellbeing in one year was generally related to more community participation the next year, while greater past community participation was linked to better mental wellbeing the next year independent of (i) initial mental wellbeing, (ii) multiple potentially confounding factors and (iii) unobserved and time-constant heterogeneity. Political participation was marginally related to worse mental health in both directions. The results also showed that the association between community participation and mental wellbeing the next year is weaker for those with poor initial wellbeing than for initially healthier respondents. Our findings may inform the trial and scientific evaluation of programs aimed at increasing informal social connectedness and civic engagement to promote mental wellbeing. [ABSTRACT FROM AUTHOR]

It has been suggested that complementary medicines are currently ‘under-regulated’ in some countries due to their potential for harm as a direct result from side-effects or interactions; from delaying more effective care; or from the economic cost of purchasing an ineffective or inappropriate treatment. The requirement of additional labelling on complementary medicine products has been suggested in Australia and may provide additional information to consumers at the point of purchase. This paper details a unique way of testing the potential effects on consumer behaviour of including either a traffic light logo or regulatory statement on labels. Using a discrete choice experiment, data were collected in 2012 in a sample of 521 Australians with either type 2 diabetes or cardiovascular disease. We find that additional labelling can affect consumer behaviour, but in unpredictable ways. The results of this experiment are informative to further the dialogue concerning possible regulatory mechanisms. [ABSTRACT FROM AUTHOR]

Chronic pain is associated with significant costs to individuals directly affected by this condition, their families, the healthcare system, and the society as a whole. This paper investigates the relationship between chronic pain and life satisfaction using a sample of around 90,000 observations from the first ten waves of the Household, Income and Labour Dynamics of Australia Survey (HILDA), which is a representative survey of the Australian population that started in 2000. We estimate the negative impact on life satisfaction and examine the persistence of the effect over multiple years. Chronic pain is associated with poor health conditions, disability, decreased participation in the labour market and lower quality of life. We calculate the compensating income variation of chronic pain, based on the measurement of chronic pain, the life satisfaction of individuals and the income of households. Panel data models with random and fixed effects are used to control for characteristics of individuals that do not vary over time. Further, we investigate whether individuals who experience chronic pain exhibit adaptation and recovery in life satisfaction after 3 years. Overall, we find that chronic pain has a large negative association with life satisfaction, and that the compensating income variation is substantial (around 640 US$ per day). [ABSTRACT FROM AUTHOR]

In this paper, we introduce the idea of the bio-socio-material body to think through the body politics that emerge within the nexus of health, well-being and domestic energy consumption as people age. Our work draws upon an ethnographic study with older Australians in regional New South Wales, Australia. We enrich social practice theory conceptualisations by foregrounding the body as a dynamic bio-socio-material entity that shapes and is shaped by practices. In doing so, we draw attention to the body politics of managing health, well-being and energy consumption while trying to age successfully. We identify that the bio-socio-material dimensions of the body play an important role in how health, well-being and energy practices are performed. Energy practices are bound up in understandings of health and well-being as an ongoing and contingent process. Here, the use of energy and appliances becomes integral to how people negotiate and work towards successful ageing. We found that embodied practices of health, well-being and energy consumption are linked to biological, emotional, affective, social and material concerns that create body politics. These include tensions and challenges relating to health and vitality, caring for the sick and the dying, maintaining good mental health, the affordances of buildings and appliances, energy affordability and billing anxiety, social connectedness, and pleasures and pains. We raise questions emerging from our research on the implications for successful ageing. We call for attention to how health, well-being and energy are imbricated and for policy and programmes that better support older people to navigate the nexus of health, well-being and energy consumption as they age. • Energy consumption helps support health and well-being as people age. • Bodily capacities mediate older people's energy, health and well-being practices. • Participants navigate challenges managing health, well-being and energy consumption. • Biological, emotional, affective, social and material concerns create a body politics. • Policy should support health, well-being and energy practices for successful ageing. [ABSTRACT FROM AUTHOR]

Abstract: Cigarette smoking is a risk factor in a range of serious diseases, including cardiovascular disease, cancer, stroke and type II diabetes. Theory suggests that working long hours will increase smoking propensities among workers. Consequently there is a significant body of evidence on the relationship between working time and smoking. Results, however, are inconsistent and therefore inconclusive. This paper provides new evidence on how working time affects smoking behaviour using nationally representative panel data from Australia (from 2002 to 2011) and the United Kingdom (from 1992 to 2011). We exploit the panel design of the surveys to look at within-person changes in smoking behaviour over time as working time changes. In contrast to most previous studies, this means we control for time invariant aspects of personality and genetic inheritance that may affect both smoking propensities and choice of working hours. We find that working long hours tends to increase the chances that former smokers will relapse, reduce the chances that smokers will quit and increase cigarette consumption among regular smokers, and that these effects tend to become more pronounced for workers who usually work very long hours (50 or more hours a week) compared to those who work moderately long hours (40–49 h a week). [Copyright &y& Elsevier]

Across the globe, people are not equitably included or respected by health services. This results in some people being 'hardly reached' and having less access to safe and appropriate care. While some health services have adopted specific agendas to increase inclusion, these services can struggle to implement such strategies because the underlying reasons for exclusion have not been addressed. This calls for preparation prior to implementation of inclusion approaches that deconstructs discourses and practices of exclusion. This paper presents a pre-inclusion framework that seeks to deconstruct exclusion in health services. Authors developed this framework from action research in four 'mainstream' regional health services in southeast Australia over five years. Research identified dominant discourses of exclusion among staff in these services. The study also identified common experiences of residents hardly reached by these services. Following, a range of change activities were undertaken within these services to deconstruct exclusion. Researchers also kept journals, reflected on their impact, and identified lessons learned from trying to deconstruct exclusion. Triangulating these analyses, researchers developed an interdisciplinary framework that weaves together Foucauldian theory on power/discourse with continuous quality improvement processes to embed cultural humility and voices of the hardly reached in health care. The framework outlines five foundational concepts (power as productive, deconstruction, use of continuous quality improvement processes, cultural humility and voices of service users), followed by six principles (a journey, expect resistance, whole of service approach, make visible the reasons for change, we are all cultural beings and people centred care) and six actions undertaken within health services (commitment, assessment of exclusion, action plans, structural change, reflective discussions and engagement). Until such approaches to deconstruct exclusion are implemented, inclusive agendas are likely to be ineffective. • Before inclusion can be achieved, reasons for exclusion must be challenged. • Pre-inclusion readies a health service for engagement with those hardly reached. • This framework weaves Foucault, cultural humility, those hardly reached and CQI. • The framework aims to rupture power relations to privilege discourses of service users. • Health practitioners learn about their privilege and actions of exclusion. [ABSTRACT FROM AUTHOR]

This paper examines the interrelationship between suicide, health, socioeconomic, and psychosocial factors in contributing to suicide in older adults in rural Australia. Drawing on a coronial dataset of suicide cases and a mixed methods sociological autopsy approach, our study integrated a quantitative analysis of 792 suicide cases with a qualitative analysis of medico-legal reports from 30 cases. The sociological autopsy provided novel insights into the entanglement of policy and service provision at the state-level with individual end-of-life decisions. Particular attention is drawn to age and gendered dimensions of suicide, especially in relation to health and social issues. The study showed a continuity between suicide and the patterning of an individual's life course, including experiences and consequences of inequality and marginality; a desire to meet culturally–normative ideals of autonomy; and a fragmented, under-funded, and intimidating social care system that offered limited options. • Sociological autopsy applied to unique coronial dataset of older adult suicide. • Combines quantitative and qualitative analyses of data from medico-legal reports. • Age and gendered differences in health and social issues related to suicide. • State-level policies and practices intersect with individual end-of-life decisions. • Imperative of prevention creates harmful environments and consequences. [ABSTRACT FROM AUTHOR]

Physician adoption of new technologies is a key issue for population health and the sustainability of the healthcare system. This paper explores gender differences in general practitioners' (GPs) adoption of new oral anticoagulants. We combine detailed individual data on physician and practice style characteristics from the Medicine in Australia: Balancing Employment and Life (MABEL) panel survey of Australian physicians with administrative prescribing data from the Australian Pharmaceutical Benefits Scheme (PBS) and the Medicare Benefits Schedule (MBS) for the period January 1, 2012 and December 31, 2015. After adjusting for various factors proposed in the literature as drivers of this gender gap, in addition to risk preferences and personality traits, we find a large statistical gender difference in the speed of adoption with men being faster than women in uptake. However, conditional on having prescribed for the first time, female and male GPs differ only slightly in the intensity of use of these new drugs. We show that the gender gap depends on the measure of uptake and discuss possible channels that could be driving the relatively large gender difference that remains in the speed of adoption. • We explore gender differences in general practitioners' (GPs) adoption of new oral anticoagulants (NOACs). • We control for various factors suggested in the literature and in addition include risk preferences and personality traits. • We use doctors' survey data linked to administrative records from GPs in Australia. • We find a large gender difference in the speed of adoption with men being faster than women. • But we do not find a significant gender difference in the intensity of adoption. [ABSTRACT FROM AUTHOR]

News media can be an important source of information about emerging health threats. They are also significant sites for the production of narrative on threats to life that help to condition and reflect the responses of governments and publics. Antimicrobial resistance (AMR) is one such health threat with particular significance because it represents the failure to manage the risks to antibiotics and other antimicrobials, health technologies that have provided the basis for modern medicine. Knowledge of how news media address this situation is an important element for an effective public health response to AMR and helps to extend the social analysis of health and media. Based on an analysis of television, printed and digital news for 2017 in Australia, this paper examines the patterns and meanings of AMR news. It shows that AMR is a fragmented story mainly framed by scientific discovery. These stories reassure audiences that science is seeking out the means of arresting AMR and, therefore, also constructs lay publics as passive witnesses to the AMR story. This pattern of AMR story-telling furthers the social standing of science and scientists, but it also neglects deliberation on collective action, important lacunae in the social response to AMR. • Digital news sources fragment narratives on antimicrobial resistance (AMR). • TV, printed and digital news mainly draw on discovery narratives to explain AMR. • Discovery narratives further scientific authority but foreclose audience agency. • Alternative narratives are needed to promote public engagement with AMR. [ABSTRACT FROM AUTHOR]

This paper argues that blood-borne viruses are relationally embodied, providing an alternative ontology to the individualising tendencies in medical science, and a more inclusive analysis of serodiscordance (mixed infection status) than the literature's focus on transmission risk in couples. We know little about the wider world of significant relationships in the lives of those with blood-borne viruses. People with HIV and hepatitis C are in a mixed-status relationship not just with intimate partners, but with other family members too. Drawing on qualitative interviews and phenomenological theory, we make the case that families (broadly defined) matter in the context of stigmatised, transmissible infections in ways that extend beyond individual bodies and beyond the usual preoccupation with risk. Despite recent advances in the treatment of blood-borne viruses, our study shows that these infections continue to be experienced and negotiated through embodied connections to significant others, made meaningful through culturally situated understandings and expectations regarding kinship, affinity, love, shared history and obligations. Our findings encourage broader recognition of these viral infections as intercorporeal phenomena, with families intimately entangled in co-creating the meanings and experiences of disease. • Unique study of families affected by stigmatised, transmissible infections. • Provides an innovative ontology of blood-borne viruses as relationally embodied. • Advances an inclusive analysis of "serodiscordance" (mixed infection status). • Original insights into how family matters in the context of HIV and hepatitis C. [ABSTRACT FROM AUTHOR]