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The English National Child Measurement Programme (NCMP) is a nationally mandated public health programme. It provides data for child excess weight indicators in the Public Health Outcomes Framework, part of the government's approach to reducing childhood obesity. Drawing on a meta-ethnographic synthesis of household members' experiences of the programme, we conceptualise the NCMP as a 'technique of futuring' to generate new insights into how it (re)shapes and (re)imagines past, present, and future responsibilities and practices for overweight children, parents, and carers, in potentially harmful ways. For children categorised by the NCMP as overweight, the NCMP is an emotionally significant event, driving new bodily practices, new food practices and changed relationships with peers. This paper outlines how parents come to resist and reframe the programme and its results, to protect their children from a weight-focused future. They consider the potential risks of bullying, dysfunctional eating, and mental health consequences more important than future risks of overweight. We show how parents of children categorised as overweight preserve their claim to 'responsible' and 'good' parenting amongst peers, whilst shifting the blame for childhood obesity to other, 'irresponsible' parents, thus reproducing moralising and responsibilising discourses inherent within the 'behaviour change' messaging of the NCMP and associated research. Finally, we consider a central paradox of this programme and the use of NCMP population level monitoring data to (re)shape lives at the individual and social level – the children it sets out to help are the most likely to experience harm as a result of it. [ABSTRACT FROM AUTHOR]

By analysing debates between member states of the World Health Organisation (WHO) over health inequities experienced by sexual and gender minorities (SGMs) from 2013 through to 2015 and 2016, this paper interrogates a WHO decision to 'do nothing', and the relationship between this decision and the production of ignorance and non-knowledge. This paper problematises state representatives' discursive practices regarding the lack of evidence on SGM health inequalities, drawing on the sociology of ignorance. Informed by the sociology of nothing, two analytical categories – non-recognition (omissive) and mis-recognition (commissive) of SGM communities – are proposed to critically understand the production of 'no-bodies' and the tolerance of the lack of evidence. The lack of evidence, rather than prompting WHO action, was used as a rationale for intentionally neglecting the health concerns of particular social groups due to their invisibility in health research. Therefore, the paper argues that the lack of evidence in itself is symptomatic of the existence of SGM health inequities, which require the WHO to take action such as formally expressing concerns about and endorsing research on the topic. [ABSTRACT FROM AUTHOR]

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

Commercial actors play a key role in promoting public health agendas as they move into space previously occupied by the state-sponsored health sector and welfare state. This paper examines how marketing of digital self-monitoring devices promotes public health. Existing self-monitoring research often separates or compares positions of commercial actors and users, using a discourse lens to examine commercial actors' 'expectations' and 'promises', and user research focusing on 'practices'. The research on which this paper is based moves beyond this divide, examining commercial and user worlds through a practice lens. We draw on the research's first stage which examined self-monitoring device marketing, arguing that marketing can be understood as constituting self-monitoring practices. Much literature on self-monitoring focuses on novel networked devices, resulting in potential over-emphasis on change and innovation. Taking cases of well-established bodily monitoring (weighing and blood pressure), we set self-monitoring within a longer history. We draw on Shove's practice theory which attends to histories of practices and evolutions in practices required elements materials, meanings and competences. Commercial companies are shown to rework well-embedded practices as they constitute the practice elements of self-monitoring. They thus keep in play continuities and novelty, maintaining connections to health while moving away from clinical associations. We argue that, in constituting self-monitoring practices as 'aesthetic', 'enjoyable', and 'shared', commercial actors address implicit resistances to negative connotations of 'individualised', 'responsibilised' consumer citizens implied in neo-liberal health-promotion agendas, widening the self-monitoring market and promoting public health by creating more desirable 'lifestyle' practices. [ABSTRACT FROM AUTHOR]

Both environmental improvement and collective agency over local decisions are recognised strategies for promoting health and health equity. However, both strategies have been critiqued for their association with policies that emphasise local resources and decision-making while the state disinvests in social and environmental determinants of health. This paper explores the role of place-based community empowerment initiatives in building collective control and improving health. We examined the perspectives of participating communities using qualitative data from interviews and observational fieldwork embedded within an evaluation of a national community empowerment initiative: Big Local (funded by The National Lottery Community Fund and overseen by Local Trust). We selected five examples of community action to improve and maintain built environments. We found that while academics (including the authors) are interested in mechanisms to health impacts, participants focused on something more general: delivering benefits to their communities and maintaining services threatened by state disinvestment. Participants sometimes used 'health' as a pragmatic justification for action. We posit that systemic pathways to health impact are plausible even when communities themselves do not forefront health goals. For example, 'quick wins' and 'quick losses' resulting from early community action have potential to galvanise or undermine collective agency, and so affect communities' capability to deliver future improvements to social and environmental determinants of health. However, structural limitations and unequal access to resources limit the potential of communities to make health-promoting change, as some participants acknowledged. Collective agency may improve socio-environmental determinants of health but systemic barriers to empowerment and equity persist. [ABSTRACT FROM AUTHOR]

Drawing on testimonies from oral history interviews with HIV/AIDS community activists and PrEP users, this paper analyses new forms of collective action in relation to the efforts to implement PrEP in England. The analysis of this PrEP response, delivered by an assemblage of independent actors and public health-related agents exposes three important aspects in relation to the lived experiences of first-wave PrEP users and HIV activists: (i) the negotiation of PrEP as a medical commodity, (ii) the use of gay dating apps as enabling technologies in regard to peer support, and (iii) the fact that access to PrEP was not equally distributed and differed between gay communities. This paper concludes that although this response was effective in decreasing HIV infection, it was only partially transformative in terms of social/health justice. However, the response featured forms of collective action that contrasted with the individualistic paradigm of the biomedicalisation of HIV prevention, pointing to a shift in future HIV prevention interventions. [ABSTRACT FROM AUTHOR]

Neoliberalism has profoundly shaped health discourse and promotion in Western countries, and scholars have also begun applying the hegemonic global ideology and framework of governance to study the non-Western world. This paper examines Traditional Chinese Medicine (TCM) discourse on China's mainstream television through the theoretical lens of neoliberalism. A critical discourse analysis finds that the 'actively responsible individual', the central notion of neoliberal health promotion, is deeply embedded in the rhetoric of traditional medicine and interwoven with the entrenched cultural values and beliefs. Media exploit the ancient healing philosophy to cultivate consumerist desires and exhort people to engage in self-care and self-medicine. By imposing expert authority, emphasizing conventional expectations, and exerting traditional moralities, media imperceptibly installed the neoliberal value of self-regulation and shaped individual conduct without challenging, and even reinforcing, the predominant political ideology and mainstream culture. The findings contribute to the understanding of health promotion in contemporary China and provide some evidence for the academic debate on the validity of applying neoliberalism to study China. [ABSTRACT FROM AUTHOR]

The field of health promotion has developed at the interface of science and policy, resulting in programmatic tensions between the values of evidence-based and participatory approaches. This paper aims to go beyond debates between these positions, to develop an understanding of how health promotion practices are – unintendedly – performed and constructed by epistemic and political technologies of accountability. Drawing from Science and Technology Studies, the paper provides an in-depth qualitative analysis of two Dutch health promotion practices. The first presented itself primarily in epistemic terms, as an evidence-based project, while the other presented itself primarily in political terms, as a citizens' initiative. The analysis shows that while, in the first case, the specific epistemic design of health promotion as a randomized controlled trial performs robust international scientific credibility but a lack of local political credibility, the participatory approach of the second case performs robust local political credibility but meagre scientific credibility. The analysis makes clear that health promotion practices are – unintendedly – performed by situated entanglements of diverse technologies of accountability that operate on local, national and global scales, which can be aligned in diverse ways. More insights into these webs of accountability are required to improve health promotion through improving the cultures of accountability. [ABSTRACT FROM AUTHOR]

The past two decades have seen an increasing role for the UK community and voluntary sector (CVS) in health promotion in disadvantaged areas, largely based on assumptions on the part of funders that CVS providers are better able to engage ‘hard-to-reach’ population groups in services than statutory providers. However, there is limited empirical research exploring CVS provider practices in this field. Using ethnographic data, this paper examines the experiences of a network of CVS providers seeking to engage residents in health-promoting community services in a disadvantaged region in the North of England. The paper shows how CVS providers engaged in apparently contradictory practices, fluctuating between an empathically informed response to complex resident circumstances and (in the context of meeting externally set targets) behavioural lifestyle approaches to health promotion. Drawing on concepts from figurational sociology, the paper explains how lifestyle drift occurs in health promotion as a result of the complex web of relations (with funders, commissioners and residents) in which CVS providers are embedded. Despite the fact that research has revealed the impact of targets on the work of the CVS before, this paper demonstrates more specifically the way in which monitoring processes within CVS contracts can draw providers into the neoliberal lifestyle discourse so prevalent in health promotion. [ABSTRACT FROM PUBLISHER]

Since the shift to legalizing recreational cannabis use in Canada in 2018, there has been increased attention on the consequences of cannabis use on women's reproductive and maternal health, with particular attention to the impact of cannabis in utero and through breastfeeding. This has resulted in an intense focus on the behaviors of individuals who consume cannabis during the perinatal period, which raises questions about the impact this has on women and mothers who have historically been under the surveillance of the Canadian public health, health and social care, and legal systems. Grounded in an intersectional feminist framework that acknowledges how race, ability, class, and other social positions impact and differentiate women's experience, this paper presents findings emerging from a participatory arts-based research approach called Photovoice with 23 mothers living throughout Canada. All participants consumed cannabis during pregnancy and breastfeeding and illustrated through photographs and individual and group discussion how their experiences of intersectional stigma and surveillance by health and social care providers resulted in barriers to accessing cannabis-related information and support. Implications arising from our inquiry suggest there is a dire need for public health, perinatal care, and social care responses that run counter to the current context where stigma and fear prevent parents from accessing cannabis information and support. [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]

Two decades since the WHO Regional Office for Europe outlined and published a report on health promotion in prison, which stimulated further debate on the concept of the ‘health promoting prison’, this paper discusses the extent to which the concept has translated into practice and the extent to which success has been achieved. This paper primarily focuses on why there has been a gap between the strategic philosophy of health promotion in prison and practical implementation, suggesting that factors such as ‘lifestyle drift’ and public and political opinion have played a part. A further argument is made in relation to the overall commitment of European countries and more broadly WHO in their support of settings-based health promotion in this context. It is proposed that there has been a weakening of commitment over time with a worrying ‘negative trajectory’ of support for health promoting prisons. The paper argues that despite these challenges, the opportunities and potential to address the needs of those who are often most vulnerable and excluded is colossal and acting to tackle this should be a greater priority. [ABSTRACT FROM PUBLISHER]

Reducing health inequalities by focusing health promotion efforts on specific areas rather than individuals is based on the premise that changing something about a place may improve health outcomes for people living in that place. This paper examines the evidence base regarding the efficacy of area-based interventions by reviewing evaluations of interventions aimed at reducing inequities between groups and which are based on changing a specific place. Only 24 papers met our review criteria. The overall success of area-based interventions was difficult to gauge due to the use of multiple strategies, inadequate evaluation reports, variation in the size or type of area, insufficient funding for implementation, policy changes over the course of the program and lack of long-term evaluations. However, the value of changing a place, area or location in some way was demonstrated in several studies which were adequately funded and evaluated. Thus, there is some evidence that area-based interventions reduce inequities, but more well-designed and well-timed evaluations of outcomes are necessary to draw any firmer conclusions. Explicit attention must also be given to geographical concepts associated with an area-based approach, such as area, scale, location and locality, neighbourhood, community and place. [ABSTRACT FROM AUTHOR]

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

The aim of this paper is to examine the role of health promotion in locality commissioning teams—as pre-cursors of Primary Care Groups—drawing on the experiences of a project in the West Midlands. Wider implications for the workings of the new Primary Care Groups will be drawn. The paper will consider some fundamental differences between health promotion and other public health approaches. Using a model of health promotion practice, it will show how the practice of different stakeholders in locality commissioning can be made sense of by these different and in some cases incommensurable paradigms. Our argument is that being able to model practice so as to make these paradigmatic differences explicit and to acknowledge diversity and inconsistency is a prerequisite for healthy collaboration. [ABSTRACT FROM AUTHOR]

At a time of increasing diversity in family forms and family practices the evening family meal is promoted as an imperative; a straightforward solution to complex social problems such as childhood obesity, family breakdown and depression. In this paper we discuss the challenges faced by families in achieving this imperative on an everyday basis drawing on visual data generated by children from a qualitative research project with 50 diverse families in Victoria, Australia. We demonstrate the complex and messy realities of everyday family food consumption which is shaped by social structures such as gender, work and care interacting with micro level elements such as food preferences and child agency. We argue the family meals imperative is a biopedagogy that should be decentred. We suggest that recognising and supporting diverse modes of family interaction and belonging beyond the shared table may be a more fruitful strategy for promoting public health. [ABSTRACT FROM AUTHOR]

This paper extends the terms of engagement between social science, posthumanist debates and One Health by questioning whether ‘the public’ may include non-human animals. The One Health concept refers to interdependence between human beings and non-human species in socio-ecological systems. One Health interventions and critiques have tended to emphasize the prevention of zoonotic infections, whereas this paper reflects on more than a decade of engaged research in One Health promotion. Repeatedly, this particular approach to One Health promotion has highlighted the imprint of multi-species entanglements in public life, especially the problematization and politicization of people’s pets. Serious consideration for multi-species entanglements cautions against conflating ‘the public’ with human beings and human interests, to the exclusion of all others. Human beings have never lived separate and apart from non-human species, and we all depend on shared environments. To do justice to multi-species entanglements, socio-ecological theory should undergo expansion in health promotion. [ABSTRACT FROM PUBLISHER]

This paper examines the current weight-centric approach to the promotion and practice of physical activity for health. We argue that examining the assumptions and belief systems that drive physical activity promotion may provide a foundation for considering and pursuing appropriate forms of social change in the policy, prescription and practice fields. Counter perspectives and critical voices offering alternative health paradigms are systematically marginalised or silenced in this discourse. We outline the significance of a public pedagogy approach in developing alternative ways of promoting, representing and experiencing physical activity beyond weight focused perspectives. We advocate that physical activity policy makers and practitioners, including those promoting a non weight-centric approach to health need to undertake ‘border crossing’ and work across ‘artificial’ institutional barriers. The paper discusses the principles of a non-weight based, cross-disciplinary Health at Every Size (HAES) approach. It presents a critical examination of the potentials of harnessing a HAES paradigm as an alternative to a weight-loss focused physical activity intervention. At the same time, it argues that even this approach needs to better address the complexities of weight rather than search for singular, universal responses to the problems of healthism. [ABSTRACT FROM PUBLISHER]

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

Engaging public audiences with population health science necessarily requires a society level perspective; however, many existing communication strategies and programs tend to focus at the individual level. This paper describes a novel approach to engaging community members with the social determinants of health outcomes using an interactive exhibit within a science centre. The exhibit was capable of supporting understanding about social determinants of health in adults and children under the age of 15 within an average three-minute interaction. The presence of a facilitator who guided and supported discussions about the exhibit and its concepts with the visitors was also key to sustaining visitor engagement. These exploratory findings suggest the use of informal learning settings, such as science centres and museums, may provide a means to communicate population health and improve discourse about public health policy. [ABSTRACT FROM AUTHOR]

Health Promotion in sub-Saharan Africa (SSA) is currently facing many difficult challenges. Health status is worse than in any other region, with the midpoint data indicating that that SSA is not on track to achieve any of the Millenium Development Goals. This paper explores the history of health promotion in Africa, from before Alma Ata, through the 1970s, 1980s and 1990s, and up to the present. Using examples from Mozambique, Zimbabwe and South Africa during their transitional periods, and health promotion approaches adopted to tackle HIV/AIDS, diarrhoea and non-communicable diseases, the paper shows how the focus has shifted away from the ideals of the Ottawa Charter to an individualistic behaviour change approach. The reasons for the shift reflect political choices of governments that have favoured technocratic approaches over harnessing the popular mobilisations that have accompanied national struggles. The experiences of global movements, such as the Global Equity Gauge Alliance are considered as a way of enhancing local health promotion initiatives which, as presently conceived, are limited in their ability to address equity and the broader determinants of ill health. [ABSTRACT FROM AUTHOR]

This paper describes the details of a strategy developed to evaluate intervention outcomes of a number of community-based programmes. The rationale for the development of the strategy and its reception into practice is also described. This paper contributes to the debate about qualities and characteristics of appropriate evidence for health promotion by detailing the package of tools developed. These drew on health impact assessment, theories of change and participatory appraisal. In particular, the impact of context on evaluation is highlighted. Although this work is focused on community health promotion officers in the UK, the issues are relevant to a wide range of workers such as public health nurses and community development workers internationally. Alongside the description of the evaluation process is an exploration of power and empowerment of stakeholders in public health services' planning and evaluation. Power, in terms of that afforded by tools and language, held by the different stakeholders is one of the key determinants shaping a service. This makes for a rather ambitious and complex paper; however, the authors consider it is a timely and worthy challenge to address. [ABSTRACT FROM AUTHOR]

Core HIA documents, researchers and practitioners assert the significance of community participation in health impact assessment. Despite the rhetoric, there has been little critical examination of the role of community participation in HIA. Knowledge and debate regarding what constitutes community participation and how it may best be achieved is often confused and opinion is divided as to its usefulness and appropriateness for HIA. This paper does not seek to argue the merits or drawbacks of community participation; rather, the authors explore the origins and character of the current discord around public participation in HIA and provide a lexicon for moving practice and discussion forward. The authors argue that the origins of the participation problem stem from: (1) unexplored tensions within the Gothenburg consensus paper and other formative documents in the development of HIA; (2) inherent tensions arising from the dual origins of HIA, specifically Environmental Impact Assessment (EIA) and Healthy Public Policy (HPP); and (3) a lack of rigour and clarity relating to the terminology of community participation where community participation is used as a 'catch all' phrase for every situation without critical examination. In order to move debate forward, the authors advance a model, the Typology of Public Involvement in HIA, for guiding discussion of community participation. This model comprises a set of context-specific HIA approaches with varying degrees of public involvement. The model also presents a suite of defined terms for understanding and discussing participation. [ABSTRACT FROM AUTHOR]

Diagnosis constitutes a major categorisation tool in medicine. This paper adds to the paucity of knowledge about part of the work such a tool performs. It examines the ways in which diabetes epidemiology translates into attempts to prevent diabetes from occurring through screening and diagnosing, and then managing those categorised as ‘at high risk’. Using a qualitative design in the context of a small-scale Danish intervention study, the findings suggest that health professionals overinterpreted relative risk reductions and exaggerated treatment effects; simultaneously, prediabetics called into question the scientifically set thresholds. Nonetheless, arguments concerning changed behaviour’s benefits were sought to be incorporated into self-care routines. The data highlight how, by identifying a normatively set threshold, a diagnosis can determine health promotion messages’ impact in ‘high-risk’ prevention strategies. [ABSTRACT FROM PUBLISHER]

The aim of this paper is to discuss the ways in which the setting approach to health promotion in schools, as part of knowledge-based international policies and guidelines, is embedded in the Danish policy landscape and enacted at the local governance level. The study draws on the sociology of translation and treats policy implementation as a non-linear process of (re)interpretation involving different actors in plural, mutually interwoven, non-hierarchical networks. Data were generated and analysed using a three-tiered process: the first tier focused on key international guidelines, the second on national policies, and the third on policies in selected municipalities. Through these tiers, we discuss actors and actor networks involved in the translation processes, their interactions and the dynamics of problematisation at the national and local levels. The results point to two different, but entangled, processes of translation. At the national level, despite resistance by a number of actors with differing priorities, the translation resulted in the integration of selected key principles of the setting approach to health promotion in the national curriculum for health education. At the municipal level, however, the principles seem to be 'lost in translation', as the treatment of schools as settings for promoting health and well-being remains largely subordinate to the discourses of disease prevention and individual behaviour regulation, dominated by the agenda of actors in the health sector. [ABSTRACT FROM AUTHOR]

Policy contexts for health promotion (HP) are often reported to be unsupportive. However, in South Australia, there is a long history of support. This paper reports on the research question: To what extent were key South Australian (SA) policies and strategic documents supportive of HP and health system building blocks for HP from 2003 to 2013? Twenty SA government documents were examined through an analysis of HP (goal, actions and strategies) and World Health Organization health system building blocks. The policy and practice context changed from strong support for HP in 2003 to its near abandonment in 2013. Key findings include: a wavering commitment to reducing health inequities as well as indeterminate support for community participation. In terms of leadership and governance for HP, there was an abdication of 'health governance' for reorienting health services toward HP, although there was a strong focus on 'governance for health' through intersectoral collaboration. Other system building blocks were supported to varying levels; however, in 2013, financing, workforce and HP practice were found to have disappeared from the policy agenda. Information as a system building block was also a key theme. On one hand, the importance of monitoring population health was commonly discussed, and on the other, the lack of evidence of HP effectiveness was significant in decisions that led to the decline in the HP policy and practice. This review of key SA government documents over a 10-year period offered a striking picture of how the HP policy context changed in one Australian state. [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]

Over the past decade, public health approaches to end-of-life care have received increased literature, policy and practice focus. These developments recognise the significance of community engagement activities and their contribution to end-of-life care. In the United Kingdom, community engagement is a priority for the majority of hospices. Nevertheless, there exists some ambiguity about the range of different practice that exists under this heading, the principles underpinning it and the outcomes for the work. Conceptual clarity is an essential next step in the development of this emergent field. The aim of this paper is to present a definition and a conceptual model of community engagement for end-of-life care services and the communities they serve. A spectrum of community engagement in end of life care is presented, derived from models in the general community engagement literature. Types of engagement extend on a continuum from informing through consulting, co-producing, collaborating to empowerment, with the later levels capable of achieving more penetrating health and social change. The factors that affect the type and nature of engagement are represented in boxes at either end, demonstrating that it is not the influence of a single factor, but the overall balance of factors that determines the quality and outcomes of the engagement work. This spectrum is designed to aid professional services and the communities they serve to embark on community engagement projects with an open awareness of the requirements and key components underpinning their success and a shared understanding and language. [ABSTRACT FROM AUTHOR]

Rates of non-communicable diseases (NCDs) are increasing globally, particularly amongst low- and middle-income countries. Critical public health scholars have argued that while political and socio-economic factors shape health outcomes within particular environments, neoliberal public health efforts tend to emphasise individual responsibility to avoid behavioural risks and ‘choose’ health. Yet there is little analysis of how these discourses about personal responsibility for NCDs are internalised, resisted or adapted by target populations in the Global South. This paper does so by examining local understandings of causal attribution for NCDs in Fiji. Data are drawn from qualitative research with outpatients, villagers and health care staff on the island of Ovalau (n = 68). Residents deem individual choices to be the principal cause of poor health outcomes. While they mention some social, historical and spiritual determinants of NCDs, community members have internalised a neoliberal governmentality, in which individuals are held morally accountable for preventing disease. Moreover, these messages about NCDs intersect with other discourses that promote personal responsibility in Fijian society - such as colonial legacies, traditional gender roles and Christianity. This local adaptation of neoliberalism reproduces historically entrenched stereotypes about Indigenous Fijians as irresponsible citizens, and obscures community recognition and response regarding the structural determinants of the NCD problem. [ABSTRACT FROM AUTHOR]

This paper explores how advice to mothers about raising healthy children differs in two distinct disease regimes as portrayed in articles in the pre-eminent Canadian women’s magazineChatelaineabout 50 years apart, 1928–1944 and 1990–2012. The paper compares intensive mothering, medicalization and the perception of risk. It suggests that both intensive mothering and medicalization are continuous from time period to time period (although the content of both mothering and medicalization differ in the two periods). Medicalization focused on the physical well-being and emphasized the importance of the routinized behaviours designed for conformity in the early period. In the latter period, there is a greater focus on individuality of children and their emotional well-being. This is linked to the rise of the discourses of the psy professions. With respect to risk, however, the paper documents an important change in the expansion of the degree to which life is considered risky. The substantive, theoretical and practical consequences of the findings are discussed. [ABSTRACT FROM PUBLISHER]

Much research has examined the social constructions of overweightness and obesity in the broader society. This paper aims to contribute to this literature by examining the popular constructions of lifestyle behavior in direct-to-consumer advertising (DTCA) geared toward overweight and obese individuals. We are centrally interested in how pharmaceutical advertisements frame healthy behaviors as a solution to the experience of overweightness and in distinguishing how this framing differs from dominant discourses of health and obesity. We employ ethnographic content analysis to examine the healthy lifestyle discourses of 120 consumer-directed television ads for weight-related conditions. We identify two types of healthy lifestyle ads: (1) drug compliance ads, where behavioral changes around health management are largely restricted to the use of drugs, and (2) complementary drug use ads, where drug use and other types of healthy behaviors, such as diet and exercise, are regarded as essential components to a treatment regimen plan. In all ads, DTCA regards prescription drug adoption as a type of behavior change that, like diet and exercise, is necessary to minimize health risks. We find that to promote drugs, the pharmaceutical industry encourages lifestyle changes, and they do so by simultaneously drawing on and expanding upon the dominant public health discourse around healthy behavior. In finding that pharmaceutical companies frame drug use as a necessary component for overweight and obese individuals’ health management, this research contributes to the vast literature that problematizes normative views of the nature, causes, and treatment of obesity and weight-related conditions. [ABSTRACT FROM AUTHOR]

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

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

This article follows the Norwegian policy-making process on social inequalities in health applying models for policy development with focus on linear and non-linear movements. The focus is process-oriented following the introduction of a comprehensive, cross-sectoral strategy to tackle socioeconomic health inequalities in Norway. A case study design was selected and two theoretical frameworks have guided the research. Whitehead's model for health inequality intervention (2007) follows a linear theory-based logic, underpinning the idea that implicit or explicit theories or formulation of a distinct problem causally predicts design and outcome of policy programmes. The second approach is based on Kingdon's (2003) perception that policy-making often occurs unpredictably within independent streams of the policy formulation process. The model focuses on the non-linearity of the flow and timing of policy action. The present case suggests that both linear and non-linear models are necessary for understanding of the Norwegian policy-making process on social inequalities in health. Whitehead's model is a conceptual model focussing on the linear structure of the policy process, useful for identifying the different entry points for choice of direction in policy-making. Kingdon's multiple streams model is useful for gaining insight into the agenda-setting process that may be predictable, but may also be unpredictable and steer non-linear movements. The model identifies components necessary for a problem to rise on the political agenda with a particular focus on the role of policy entrepreneurs. [ABSTRACT FROM AUTHOR]

This paper examines the conceptualization of health as a resource and the implications that such a definition has for public health programs and policies. First introduced in the Ottawa Charter for Health Promotion, health is commonly defined by practitioners, policy makers, and scholars as a resource for everyday life. However, despite frequent references to health as a resource, little attention has been paid to the meaning of this one-line phrase. Thus, we draw on a multidisciplinary body of literature to examine key features of health that characterize it as a resource, as well as its similarities, differences, and associations with other resources. We argue that, as a resource, health is appropriately conceptualized as a type of capital that can be invested in by individuals and societal institutions to achieve positive health returns. Similar to human capital, health is embodied in individuals, and, as such, it is not a tradable resource like money. Health cannot be exchanged or sold for goods and services and it cannot be obtained directly in exchange for goods and services. Instead, as a type of capital, health is a stock of biopsychosocial resources that people can draw on to participate in society. Although health shares some characteristics with human capital, we contend that health is not a component of human capital, as some scholars indicate. Lastly, we maintain that there are important program and policy implications, both positive and negative, of adopting an economic definition of health. [ABSTRACT FROM AUTHOR]

This paper critically examines the public policy environment that underpins the politics of health promotion in England. English health policy from the late 1970s to the mid 1990s was not receptive to health promotion. The new Labour government elected in 1997 claimed to embrace a 'Third Way' between the free market and socialism that would appear to embrace a community-centred approach to health promotion that would through partnership-building promote equity; perversely, however, the election of this government rhetorically committed to healthy public policy was accompanied by a crisis in health promotion delivery. Despite apparent commonalities between the Third Way and health promotion, the Third Way was in many respects a neoliberal ideology and so has contributed to the marginalisation of health promotion. Although some might argue that health promotion has been mainstreamed, it is argued here that in terms of the crucial National Health Service infrastructure underpinning the health promotion movement, that the organisational capacity for health promotion has been significantly weakened. Thus the question is how you revive a movement that has lost its way? The answer must include taking a historically informed approach to analysing the problem and identifying solutions. Wider systems issues in England include the emergence of multidisciplinary public health, the sequence of changes to national health promotion organisations and the wider marginalisation of the public health movement. It is only by critically analysing and addressing these systemic issues that the prospects for health promotion in England can be revived. [ABSTRACT FROM AUTHOR]

The Ottawa Charter has been a phenomenal influence guiding the development of the concept of health promotion, and in shaping public health practice in the past 20 years. The world has changed somewhat since 1986 in many ways that could not have been anticipated by those drafting the Charter. Substantial social and economic changes have occurred, and continue to occur. These include the globalization of trade, the invention and development of the internet and mobile communications, as well as the emergence of new threats to health such as HIV/AIDS. Such profound changes require adaptations to established health promotion strategies and the development of new strategies. This paper considers the origins, describes changes and suggests adaptations to the five strategies of the Ottawa Charter - build healthy public policy; create supportive environments for health; strengthen community actions; develop personal skills; and reorient health services - that now routinely provide the framework for consideration of any major public health challenge. [ABSTRACT FROM AUTHOR]

The emergence of health promotion in the 1980s was a direct response to critiques of health education which centred on its victim-blaming orientation and a growing appreciation of the need to address the wider determinants of health and health-related behaviour. This paper argues a priori that such critiques centre on a preventive model of health education and overlook its broader potential. It reviews a number of alternative models of health education and locates these within the core values of equity and empowerment which underpin the Ottawa Charter and subsequent WHO documents. It suggests that, despite the rhetoric of health promotion, practice frequently remained focused on individual behaviour change and the use of persuasive health education. The move to health promotion effectively stifled further debate about the broader role of health education in achieving individual empowerment and social change. This paper calls for a broader conceptualisation of health education--the New Health Education--and concludes that this should be the driving force behind health promotion. [ABSTRACT FROM AUTHOR]

Over the past 30 years, the important role of primary care in public health has been widely recognised, and in the UK a range of measures to support public health in general practice have been introduced since the late 1980s. In 2004 a new general medical services contract was introduced changing the way general practitioners are reimbursed in the NHS. The new contract shifted the emphasis from the individual practitioner to the practice and introduced a new performance incentive framework, the Quality Outcomes Framework, which rewards performance through targeted financial payments. The performance framework identifies specific areas of clinical and organisational performance and patient experience activities-including a number of health promotion activities-and practices attract points for attaining performance targets. This paper examines the experience and impact of the new GMS contract on public health activities in general practice. While the contract has only been operating for three full years, there is emerging evidence to suggest that it may have a negative impact on public health activities in general practice. The use of financial incentives appears to be skewing practice towards areas that are rewarded, which may not be those that maximise health outcomes, and there is some emerging evidence suggesting that there is a negative effect on health inequalities. This paper reviews current evidence on public health incentives in general practice within a wider context of the impact of incentives for public health. [ABSTRACT FROM AUTHOR]

Over the last 30 years, there has been a growing recognition of the potential for community-based efforts to improve public health. However, the costs and 'added value' of community engagement approaches remain unclear. This paper reports findings from a systematic review of the economic evidence relating to planning, design, delivery or governance of health promotion interventions. Key databases were searched, review bibliographies were checked and experts in the field of economics of public health were consulted. To be eligible for inclusion, studies needed to report community engagement or community development approaches for primary health promotion; to include a control or suitable comparator group; and to assess both health outcomes and costs. Data were extracted and studies were quality assessed. Of the 4405 references screened, 152 records (3%) were potentially relevant and eight studies met the inclusion criteria for the review. Seven studies reported positive findings, but no study was designed to evaluate the impact or cost-effectiveness of a specifically 'community-engagement' component. The review found tentative evidence that community engagement as part of a multifaceted approach to health promotion may have positive effects and could be cost-effective. To improve the evidence base for community engagement, future studies need to involve communities more closely at all stages of the research in order to fully capture the community's priorities and perspectives, and appropriately assess the value added and opportunity cost of engagement. [ABSTRACT FROM AUTHOR]

Over the past decade, a number of health promotion programs have been developed in western countries to address body image dissatisfaction and associated eating disorders among women and girls. There has, however, been little critical examination of the application of health promotion theory and practice in this area. This paper reports on an interview study with health promotion workers responsible for managing and implementing the most extensive, long-running body image health promotion program in Australia. The study explores the ways in which health promotion workers envision body image as a site for preventive intervention, and specifically attends to the power dynamics of subject constructions and the opportunities for community empowerment and involvement. The study reveals a dominant discourse of individualised self-care as a solution to body image dissatisfaction, and a simultaneous reliance on marketing frameworks and practices. The paper explores the dilemmas associated with the application of these approaches in this area, particularly the way they reproduce contradictions in the social body which are implicated in producing the pursuit of thinness itself, and the tendency of marketing discourse to dissipate the possibilities for resistance. The paper also considers other approaches to health promotion for their potential to overcome some of the dilemmas associated with the marketing of self-care. [ABSTRACT FROM AUTHOR]

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]

This paper, based on qualitative research among a group of women in South Wales, looks at the meanings they give to the menopause, its effects on their working and family lives and the support currently offered by medicine and health promotion. This study is set against a wider discussion of the medicalization of the menopause, and the organization of work within which the current generation of women are situated. It also argues for a new public health approach including the adoption of more qualitative research techniques that would address the concerns and beliefs of people rather than following the traditional 'objective' epidemiological model. The paper concludes that the present generation of women do not share a negative view of the menopause but are struggling against mixed messages from their own cultural background, from promotion of medicalized 'solutions' and from contemporary pressures of work. [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]

This qualitative study explores the structural barriers to preventive interventions targeting childhood obesity in the Danish health care system. Based on interviews with relevant health care professionals, the paper reports on the problems which are experienced by general practitioners and health visitors and which complicate implementation of the policies of the Danish health authorities. Findings show that the current system is not well equipped to treat early overweight. A gap in primary preventive health care for children at age 3–5, indistinct lines of responsibility, inadequate cooperation, and lack of resources together make it difficult for health care professionals to initiate interventions and reach the children in need of support. By analyzing the policy implementation process in a theoretical framework that discloses the discursive allocation of responsibilities, the study is able to provide a deeper description and analysis of the problem. The study makes it clear how preventive health care for overweight children rests on the negotiation of formal and performed responsibilities among health practitioners within a framework of scarce resources and communication deficit. [ABSTRACT FROM PUBLISHER]

This paper examines the epidemic of orthodoxy affecting the evaluation of current health promotion work. This has resulted in the privileging of certain methods, in particular, experimental method and the randomized control trial. Problems identified by public health researchers are discussed but the major focus of our critique concerns the ways in which the experimental method and, especially, the randomized control thai, assume that the audience of any health promotion message comprises a number of asocial individuals who occupy nondiscursive space in ahistorical time. An alternative approach is advocated which focuses attention on the programme of health promotion and education rather than on any one individual health promotion initiative or intervention. Attention is also given to educational and health promotion practices; it is here, we argue, that some of the answers to 'what works' are to be sought. We illustrate our argument with reference to a number of recent Australian health promotion campaigns, including 'Condoms Every Time' and 'Negotiated Safety'. [ABSTRACT FROM AUTHOR]

This paper explores the implications of workplace health promotion, particularly in relation to the needs of people in low-paid employment. The paper draws on research carried out during 1995 involving a telephone survey of 101 employing organizations in the Avon area of England. The influence of organizational factors such as size and business sector on health activity in the workplace were examined, together with perceptions about the take up of workplace health promotion by people in low-paid employment. The survey also explored the extent of professional and worker involvement in planning workplace health activity. Case study research explored the links between occupational health provision and health promotion activity in three different workplaces. Implications of the research for policy and practice are discussed. [ABSTRACT FROM AUTHOR]

In this paper we consider what impact a biopolitics that creates a compliant self-governing weight-focused population has had on Māori health in Aotearoa/New Zealand. We frame this discussion with three vignettes that in different ways demonstrate the deleterious effects of the individualisation of health on Māori. We argue that the current biopolitics is best explained as 'the health of Maoris' not 'Māori Health'. To counter this current biopolitics we put forward an alternative epistemology, the 'Atua Matua' framework. This epistemology pays respect to a Māori view of health that is holistic, encompassing physical, emotional, spiritual, cultural and familial well-being and does not give ground to the requirement for individualism so prevalent in neoliberalism. Finally, we consider what this new epistemology might offer to the public health agendas in Aotearoa and other countries where indigenous populations suffer ill health disproportionately. Thus, our implications have potential not only for Māori health but human health in general. [ABSTRACT FROM AUTHOR]

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

In this paper, I demonstrate how autoethnography can be utilized as a methodology to conduct public health research. My argument is structured around an application of Jacques Lacan’s psychoanalytic theory which I see as supporting and extending a critical understanding of the so-called obesity epidemic and related issues. I argue that the body mass index (BMI) measure has achieved an unconscious position as a ‘Sovereign Good’ and, as such, provides the moral and ethical mechanism through which state-sanctioned science, via the wider weight-loss industry, prescribes people into a state of weight anxiety. I conclude that public health practitioners who find themselves promoting weight loss towards the ‘healthy’ range of the BMI are in an unethical position, one that should be entirely rejected. Instead I point to the ethics of desire as an alternative position that might help public health practitioners who are interested in actually improving public health. [ABSTRACT FROM PUBLISHER]