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The controversy over vaccines, which has recently intensified following the COVID-19 pandemic, provokes heated debates, with both advocates and opponents raising allegations of bias and fraud in research. Researchers whose work raises doubts about the safety of certain vaccines claim to be victims of discriminatory treatment aimed at suppressing dissent, including the unjustified retraction of their published research. Such practices have previously been discussed in other controversial fields in science (e.g., AIDS, the environment, and water fluoridation) but not in the field of vaccines. The purpose of this study was to analyze, for the first time, the subjective views of researchers whose papers were retracted. Study participants are active researchers, most with international reputations in their respective fields. They perceived retraction as a means of censoring and silencing critical voices with the aim of preserving the pro-vaccination agenda of interested parties. Participants also reported additional measures aimed at harming them personally and professionally. These findings point to the need for a fair, open, and honest discourse about the safety of vaccines for the benefit of public health and the restoration of trust in science and medicine. [ABSTRACT FROM AUTHOR]

Drawing from social epidemiology literature on structural racism, and rooted in critical race theory and critical theory related to narrative power, this paper uses satire and humor as commentary on mainstream U.S. public health discourse related to the role of "race" (properly understood, racism) in shaping inequities observed via COVID-19. Taking the form of a "RACISM-20" fact sheet, this paper transposes structural racism and COVID-19. In doing so, it accentuates how individualist, ahistoric, and pathologizing "downstream" frames of health risks/solutions curtail productive dialogue and action to advance racial and health equity. In the spirit of "racial emancipatory humor", this work represents a potential pedagogical tool to discuss and critique dominant frames of racial(ized) risks, "vulnerability", and responsibility – both in the context of COVID-19 and within broader discourse of racial health inequities, including as related to racialized police violence. In this capacity, this "fact sheet" serves as an example health promotion product of critical resistance and counternarrative. [ABSTRACT FROM AUTHOR]

Health care systems around the globe are currently orienting themselves towards 'personalized medicine', a medical care regime aimed at individualizing prevention, diagnosis, and treatment of disease through proliferating amounts and sources of data, including genetic information. In Denmark, national health policies on personalized medicine focus on harnessing the potentials of genomic science and technology to bring knowledge about patient-specific genetic variation into clinical application. A major hope is to improve public health and prevent common diseases by integrating genomic information in health care, yet to act preventively, a temporal path has to be established defining what kind of knowledge to create and to act upon, and when. This paper explores the temporal orderings of medical knowledge in two different areas: health policy and clinical practice. Examining policy papers on personalized medicine issued by Danish governmental and research institutions, and, comparing them with contemporary practices of using genetic information in preventive cardiac health care, we demonstrate that genetic knowledge-making is ordered around two different conceptual views of time: namely the sequential order and the speed with which such knowledge is produced. We argue that the visions of knowledge-making and early intervention through genomic science and technology as conveyed in policy papers on personalized medicine, challenge preexisting practices and understandings of what constitutes timely prevention and actionable knowledge within clinical care. We close the article discussing how prevention through genomics amplifies the significance of the clinical space for public health as a site for sense-making and translation of controversial genetic knowledge. [ABSTRACT FROM AUTHOR]

In this paper we explore the role of precarity theory in bringing new perspectives to public mental health. The paper draws on a qualitative, participatory research study carried out in Glasgow that illuminates the entangled and complex relations between the social, bio-political, cultural, economic, and environmental conditions that produce mental health and ill health. Through the accounts of Sassy Queen, Tony, Simba, John, and Rhianna, we explore the attrition of everyday lives that are lived in constant states of crisis, the forms of precarity that it precipitates, and how this plays out for them concerning how they talk about and experience 'mental health'. Their experience provides an alternative vantage point to understanding mental distress to those which are made possible through recourse to prevalent social determinant and behavioural models of public health. The paper concludes that the operations of the political as everyday biopolitics must become more visible within public health, and this requires interdisciplinary and narrative approaches to fully understand the border zone between macro-level politics and the biopolitics of everyday life. [ABSTRACT FROM AUTHOR]

In April 2013 the local public health function in England was returned from the National Health Service (NHS) to local government, reversing the transfer to the NHS made in 1974 with the abolition of the medical officer of health. Although many in the field had long felt that local government was the appropriate home for public health given its wide-ranging responsibilities for the social determinants of health, the timing was poor. Local government was in the third year of what continued to be an unprecedented ten-year period of austerity imposed by central government with cumulative cuts of the order of 40% for many local authorities. And despite an initial commitment to a ring-fenced public health grant, this grant has been cut each year since 2015–2016 in addition to the wider local authority funding cuts which have had inevitable knock-on effects on the public health function. Crucial public health services such as early years, smoking cessation and sexual health services have all been cut. Despite these cuts the UK government continues to claim a commitment to improving public health and tackling inequalities in health. This study examines the government's discourse on funding local public health services, and the ways in which it has responded to critics through a detailed documentary analysis of key government white papers, ministerial statements and its responses to criticisms, particularly from parliamentary select committees and professional bodies. The paper concludes by considering the implications for effective local public health action in a national regime of austerity. [ABSTRACT FROM AUTHOR]

Waste has become a pivotal public health and environmental problem during the COVID-19 pandemic. In this interdisciplinary review, we move beyond the 'coronalitter' and 'coronawaste' discourses, which have come to dominate public imaginaries of waste, to consider less-visible dimensions of waste infrastructures and systems. We demonstrate how waste is coming to matter in new ways that offer opportunities for reconfiguring health research. By examining the literature addressing the impacts of COVID-19 on the geographies of waste, we shed light on how waste is being problematised and researched through logics of public, environmental, and occupational health. We argue that these logics structure understandings and practice, whilst drawing attention to the overlaps and limits that allow links across disciplinary silos and problem domains to be forged. Developing a multi-logics approach, the paper outlines a research agenda for approaching waste as a critical public health problem at a time of intersecting health crises. [ABSTRACT FROM AUTHOR]

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

Rigorous evaluations of the effects of vertical public health enterprises on the health systems of low-income countries usefully identify the public health and ethical costs of those initiatives. They reveal that such narrowly focused public health ventures undermine the efforts of those countries to establish and maintain adequately resourced and well-developed national health systems, including comprehensive primary care programs. This paper argues that the scope of assessments of vertical public health ventures should be broadened to include gender as an additional axis of analysis. When members of socio-economically marginalized populations are sick with conditions that are not covered by fragmented and inadequate public health programs or disease-specific vertical public health schemes, their untreated illnesses add to the gendered familial caregiving responsibilities of the female members of their households. Those women and girls have to perform their 'normal' familial care work, work outside the home for pay, and take care of the unwell family members for whom the household cannot afford treatment. Given that women and girls from low-income households already shoulder a disproportionate amount of care work for their families, their health and life prospects are further affected by the amplification of their caregiving responsibilities. This paper argues that analyses of the impact of vertical public health initiatives should also track this gendered consequence of those enterprises because it is a crucial public health and ethical matter. [ABSTRACT FROM AUTHOR]

Ethnic diversity and racism have not featured strongly in English research, policy or practice centred on understanding and addressing health inequalities. However, the COVID-19 pandemic and the Black Lives Matter movement have shone fresh light on deep-rooted ethnic inequalities and mobilised large segments of the population into anti-racist demonstration. These recent developments suggest that, despite strong counterforces within national government and the mainstream media, there could be a shift towards greater public awareness of racism and potentially a willingness to take individual and collective action. This paper addresses these developments, and specifically engages with the contested notion of 'allyship'. We bring together the experiences of 25 young adults living across England and prior literature to raise questions about whether and how racialized White individuals can play a role in dismantling systemic racism and reducing ethnic inequalities in health. Our analysis reveals a variety of complexities and obstacles to effective and widespread allyship. Findings suggest the need to nurture contingent, responsive and reflexive forms of allyship that can attend to the harms inflicted upon racially minoritized people as well as push for systemic transformation. White allyship will need to take a variety of forms, but it must be underpinned by an understanding of racism as institutional and systemic and a commitment to tackling interlocking systems of oppression through solidarity. The issues addressed are relevant to those occupying public health research, policy and practice roles, as well as members of the public, in England and other multi-racial settings. [ABSTRACT FROM AUTHOR]

When trying to understand childhood obesity, policymakers and healthcare professionals most often make use of behavioural sciences and biomedical perspectives. This approach assumes that fatness is unhealthy and caused by people making 'bad choices' about their diet and physical activity. Increasingly not only parents, but also children, are considered to be individually responsible for their weight, their health, and through that, for the 'obesity epidemic'. Drawing on critical obesity/weight studies and practice theory, this paper challenges the individualistic and weight-based view of health, and the heuristic of 'individual food choice', and through that such a framing of childhood obesity. It does so by focusing on the experiences of young people medically identified as overweight, who are trying to lose weight. Looking at two domains of children's lives, their family and peers, the paper demonstrates how young people experience and negotiate the individualized health advice, and what sort of consequences this has for their daily lives, and their mental and physical wellbeing. The article is based on observations of interactions between families and healthcare professionals, conversations with children and parents, as well as participant observation at youth summer weight loss camps, which were part of a larger ethnographic research project conducted in 2018–2019 in Poland. The paper concludes by proposing to reframe how we think about childhood obesity, and consider young people's knowledge and lived experiences when re-designing policy interventions and wellbeing promotion programmes, that is, to work with, and not on, children. [ABSTRACT FROM AUTHOR]

In this paper, we outline a critical reparative justice/care approach to adolescent reproductive health as an alternative to the standard public health response to 'teenage pregnancy'. Joining an increasing body of critical scholarship that calls for nuance in understanding reproduction amongst young people, we draw, in this paper, on data generated from an ethnographic study conducted in antenatal care units in an Eastern Cape township in South Africa. To illustrate the approach we propose, we home in on five case studies that highlight the variability of young women's lives, the multiple injustices they experience, and the agency they demonstrate in negotiating their way through pregnancy and birth. Injustices evident in these cases centre on sexual violence, rape myths, education system failures, health system failures, shaming and stigmatising practices, socio-economic precariousness, absent male partners, and denial of services. We outline how the reparative justice approach that highlights repair and support for social and health injustices at the individual and collective level as well as at the material and symbolic level may be taken up to ensure reproductive justice for young pregnant women. [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]

Foodborne illness is a major public health concern, often approached by focusing on socio-demographic groups who are considered most ‘vulnerable’ to foodborne disease such as elderly people or pregnant women. Based on a review of existing literature and original research with UK consumers, this paper proposes an alternative approach to analysing vulnerability to foodborne illness. Challenging conventional approaches that focus on the inherent vulnerability of particular socio-demographic groups, the paper emphasises the context-specific and situational nature of vulnerability and the practices and pathways through which people negotiate specific threats which may, in turn, affect their future vulnerabilities. The paper also addresses the gap between lay and expert knowledge that may increase exposure to particular food-related risks. Evidence is provided from research on the food safety and health implications of consumers’ everyday domestic practices including behaviours that do not comply with current ‘best practice’ advice. The evidence supports a turn from notions of inherent vulnerability, based on the membership of certain socio-demographic groups, towards a more nuanced understanding of situational vulnerability, based on the context and logic informing specific social practices. [ABSTRACT FROM AUTHOR]

It is now well-recognised that antimicrobial resistance (AMR), or the ability of organisms to resist currently available antibiotics and other antimicrobial drugs, represents one of the greatest dangers to human health in the 21st Century. As of 2022, AMR is a top-10 global public health threat. Various national and transnational initiatives have been implemented to address accelerating AMR, and the pressure to find local and global solutions is increasing. Despite this urgency, surprisingly limited progress is being made in rolling back or even slowing resistance. A multitude of perspectives exist regarding why this is the case. Key concerns include an enduring dependency on market-driven drug development, the lacklustre governance and habitual over-prescribing of remaining antimicrobial resources, and rampant short-termism across societies. While rarely presented in such terms, these disparate issues all speak to the social production of vulnerability. Yet vulnerability is rarely discussed in the AMR literature, except in terms of 'disproportionate effects' of AMR. In this paper, we offer a reconceptualisation of vulnerability as manifest in the AMR scene, showing that vulnerability is both a predictable consequence of AMR and, critically, productive of AMR to begin with. We underline why comprehending vulnerability as embodied, assembled, multivalent and reproduced through surveillance matters for international efforts to combat resistance. [ABSTRACT FROM AUTHOR]

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

Mobile applications for digital contact tracing have been developed and introduced around the world in response to the COVID-19 pandemic. Proposed as a tool to support 'traditional' forms of contact-tracing carried out to monitor contagion, these apps have triggered an intense debate with respect to their legal and ethical permissibility, social desirability and general feasibility. Based on a large-scale study including qualitative data from 349 interviews conducted in nine European countries (Austria, Belgium, France, Germany, Ireland, Italy, the Netherlands, German-speaking Switzerland, the United Kingdom), this paper shows that the binary framing often found in surveys and polls, which contrasts privacy concerns with the usefulness of these interventions for public health, does not capture the depth, breadth, and nuances of people's positions towards COVID-19 contact-tracing apps. The paper provides a detailed account of how people arrive at certain normative positions by analysing the argumentative patterns, tropes and (moral) repertoires underpinning people's perspectives on digital contact-tracing. Specifically, we identified a spectrum comprising five normative positions towards the use of COVID-19 contact-tracing apps: opposition, scepticism of feasibility, pondered deliberation, resignation, and support. We describe these stances and analyse the diversity of assumptions and values that underlie the normative orientations of our interviewees. We conclude by arguing that policy attempts to develop and implement these and other digital responses to the pandemic should move beyond the reiteration of binary framings, and instead cater to the variety of values, concerns and expectations that citizens voice in discussions about these types of public health interventions. [ABSTRACT FROM AUTHOR]

In order to combat the COVID-19 pandemic, policymakers around the globe have increasingly invested in digital health technologies to support the 'test, track and trace' approach of containing the spread of the novel coronavirus. These technologies include mobile 'contact tracing' applications (apps), which can trace individuals likely to have come into contact with those who have reported symptoms or tested positive for the virus and request that they self-isolate. This paper takes a critical public health perspective that advocates for 'genuine participation' in public health interventions and emphasises the need to take citizen's knowledge into account during public health decision-making. In doing so, it presents and discusses the findings of a UK interview study that explored public views on the possibility of using a COVID-19 contact-tracing app public health intervention at the time the United Kingdom (UK) Government announced their decision to develop such a technology. Findings illustrated interviewees' range and degree of understandings, misconceptions, and concerns about the possibility of using an app. In particular, concerns about privacy and surveillance predominated. Interviewees associated these concerns much more broadly than health by identifying with pre-existent British national narratives associated with individual liberty and autonomy. In extending and contributing to ongoing sociological research with public health, we argue that understanding and responding to these matters is vital, and that our findings demonstrate the need for a forward-looking, anticipatory strategy for public engagement as part of the responsible innovation of the COVID-19 contact-tracing app in the UK. [ABSTRACT FROM AUTHOR]

'Complexity' is theorised as a characteristic of modern food systems that poses a challenge to improving population diets. This paper seeks to explore the discursive deployment of 'complexity' in the context of public health. Doing so helps inform a more critical assessment of commercial and political determinants of health, and of 'complexity' as a prevailing frame for public health issues. Qualitative methods were used to explore 'responsibility' for healthy eating in the food system in the United Kingdom. Discourse analysis was conducted on corporate and government documents, and interviews with industry and government stakeholders. The aim was to examine the implications of 'complexity' within discourses of dietary public health. 'Complexity' was used not only to characterise dietary public health problems but also as a rhetorical device in public health narratives. It performed two main discursive functions: firstly, to represent diet-health problems as so multi-layered and difficult that they are intractable. Secondly, and despite this acknowledged complexity, to deflect from food system actions for improving diet to 'simpler' and non-food interventions, by industry and government. These uses of 'complexity' serve to attribute primary responsibility to individuals for dietary choice and to obscure inaction by government and industry, who have most control over the determinants of those choices. In short, 'complexity' can be used discursively to generate a smokescreen masking policy inaction in addressing public health problems. [ABSTRACT FROM AUTHOR]

This paper explores the joint roles of law and biomedicine in constituting the boundary between legitimate and illegitimate (and genuine and 'pseudo') traditional healing. It argues that, as law and biomedicine have grown to share common understandings of the nature of knowledge, they have come to act as converging colonizing forces that displace and alter 'other' forms of knowing and ordering. Even as regulatory systems set out to recognize some forms of traditional medicine, they continue to operate on assumptions that disqualify knowledge, products, and actors, that do not resemble their biomedical counterparts. This leaves traditional healing systems potentially having to either operate outside the law or adapt to it by transforming themselves, potentially beyond the point of recognition, to fit better into the systems provided by law and biomedicine. The paper explores the series of dilemma this creates for those seeking to 'regulate better' traditional medicine. [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]

The horror of the devastating Grenfell Tower fire, and the shock that 'it could happen here', in 21st century Britain, led politicians, professionals, and community workers to proclaim that 'Grenfell changes everything'. Affected people, turned into activists by the disaster, committed to ensuring that such a disaster could never happen again, by demanding changes to regulations and policy. Whereas public health literature addressing activism focuses on strategies and conditions for 'successful' collective action, the experience of activism after Grenfell has been characterised by frustrating partial wins, inertia, delay, and setback. This paper seeks to theorise the activist condition of seeking change that is refused and to do so in a way that values the agency and care of (thwarted) activism. Inspired by Haraway's 'staying with the trouble' and critical scholarship on hope, and drawing on three years of knowledge exchange and ethnographic engagement with the community response after Grenfell, I explore the trajectories of six activist change efforts: a fire safety campaign, engagements with a Public Inquiry, campaigns to preserve community assets, community gardening, silent walks, and provision of support to children at a community centre, each addressing social determinants of health and 'staying with the trouble' in different ways. I argue that setbacks do not invalidate a struggle or warrant despair, but that in insisting on caring for others' lives, activism succeeds in instantiating a caring world. Beyond hope and despair is the staying power of communities who value human life and solidarity and keep fighting for them. [ABSTRACT FROM AUTHOR]

The paper documents environmental health conditions and healthcare access challenges faced by internally displaced people (IDPs) from Borno State living in informal settlements in Lagos, Nigeria, in 2020, during the early stages of the COVID-19 pandemic. This qualitative study with 32 IDPs suggests a high vulnerability to COVID-19. Their accommodation often lacked basic sanitation including water and toilet facilities; overcrowding and high population density restricted ability to adhere to social distancing; and IDPs experienced serious consequences from lockdown, as the majority depended on daily wages, and did not receive food packages or other support from the State. Finally, there were obstacles to accessing healthcare. We highlight the importance of an integrated approach, consolidating the efforts of communities, non-governmental organisations, environmental and public health, and international organisations to address the health and well-being issues of IDPs in urban informal settlements. [ABSTRACT FROM AUTHOR]

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

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]

The word 'vulnerable' is frequently used in public health research and practice. We use critical discourse analysis to explore the use of this term in articles published between January 2015 and January 2018 in the American Journal of Public Health and the Canadian Journal of Public Health. We find that terms such as 'vulnerable groups' are often vaguely defined or undefined, requiring the reader to 'fill in the blanks' as to who is vulnerable, why they are vulnerable, and what they are vulnerable to. Where terms such as 'vulnerable groups' are applied with some specificity, they are used as proxies for a wide range of groups, conditions and situations. Often, groups are constituted as inherently vulnerable, as authors imply that even if policies and processes change, group vulnerability will remain. Notably, populations and groups in power – and therefore responsible for generating structural vulnerability – are rarely examined. In our experience, researchers often use the word 'vulnerable' strategically to attract resources, policy interest and public concern. At the same time, we propose that the vagueness associated with terms such as 'vulnerable' conceals the structural nature of public health problems. We conclude that this vagueness can serve the political function of obscuring power relationships and limiting discussion of transformational change. [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 ongoing emergency for refugees is having profound and hidden health consequences for thousands of displaced persons who live in informal ‘makeshift’ camps across Europe. This interdisciplinary paper reports the results of the first environmental health assessment in such a location, in what was Europe’s largest informal refugee camp in 2016, in Calais, northern France. We detail the lack of facilities for sanitation, safe provision of food, water and shelter, demonstrating how conditions fall short of agreed international standards for formal refugee camps. Rather than the notion of migrants being the cause of health problems, this paper critically reveals the hidden materiality of bodily injury caused by poor health conditions, where the camp itself produces harm. Drawing upon theories of biopolitical exclusion, the paper concludes by (i) emphasising the empirical and conceptual themes that tie refugee politics and biologies together and (ii) makes a call for increased attention to makeshift camps as key sites of health exclusion in Europe and beyond. [ABSTRACT FROM PUBLISHER]

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

An increasingly common way that high rates of male suicide are understood is via men's ostensibly poorer abilities to talk about – and more generally seek help for – problems in general, and emotional problems specifically. This has led to the development of public mental health campaigns which urge men to 'speak up' more often about the problems they face. I argue that both the initial claim, and the enactment of this claim in public mental health campaigns, is problematic, resting on simplistic assumptions about men and gender difference, and serving to detract attention from structural drivers of suicide. Drawing on a narrative analysis of in-depth interviews with ten men who had self-harmed, thought about, or attempted suicide, this paper focuses attention on the content and contexts of 'talk'. I argue that public health campaigns promoting 'talk' in response to male suicide neglect the interpersonal and structural contexts in which talk occurs, including considerations of power and structural inequalities. [ABSTRACT FROM AUTHOR]

Discourse regarding public health problems disproportionately affecting marginalized communities may shape and sustain health inequities. Analyses of news media and public health communications in the wake of infectious disease outbreaks provides opportunities to examine how discourse produces dominant public perceptions about the drivers of health emergencies and who is responsible for protecting community health. Guided by Bacchi's "What is the Problem Represented to Be?" analytic approach, this paper critically examines the discursive construction of problems and solutions in news media (n = 35) and public health communication (n = 18 press releases, n = 1 governmental report) regarding an unprecedented hepatitis A outbreak in San Diego, California, USA (2016–2018) that disproportionately affected people experiencing homelessness. We organize our findings around three elements of problem and solution representation with respect to the outbreak: 1. The inequitable attribution of risk and deservingness; 2. assumptions divorced from socio-structural factors and perspectives of marginalized populations; and 3. political theatre as a means of blame-shifting and (in)action. Overall, our findings suggest that even when structural-level issues were acknowledged within news media and public health communication as undergirding the 'problem' of the hepatitis A outbreak, outbreak discourse focused on individual-level responsibility for both the causes of and solutions to it (e.g. vaccines, criminalization of homelessness), and on shifting blame between government actors. These findings have implications for understanding the role that news media and public health agencies play in shaping public perception of the causes, consequences and solutions to infectious disease outbreaks that disproportionately affect marginalized populations. [ABSTRACT FROM AUTHOR]

To address the intertwined health issues of our time, from climate change to colonialism, from mass extinction to mass consumption, this commentary argues that critical public health must grapple with relationality onto-epistemologically. In it, I offer the provocation that entangling ethnography, both as method and methodology, with critical posthumanism can offer the potential to hold the tensions, nuances and multiplicities needed to account for human-more-than-human relationality as multiple inputs of data. This argument is made in three parts: first, via a discussion of relationality within public health; second, by means of a cartography of critical posthumanism; and third, with a discussion of how a critical posthuman ethnography might disrupt anthropocentric approaches to health. The paper concludes with a discussion of the possibilities of, and potential for, critical posthuman ethnography in public health research. In summary, critical posthuman ethnography provides one way of methodologically approaching some of the intertwined health issues of our time. [ABSTRACT FROM AUTHOR]

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]

Misinformation has been identified as a major threat to public confidence in vaccines, particularly during epidemics. As a response, social listening has become a popular and heuristic public health tool for detecting misinformation and adapting vaccine communication. In this article, we take a critical stance on the normalised approach to social listening which solely relies on the analysis of online discourses. We highlight that the current social listening paradigm inherited a reductionist and utilitarian approach from commercial marketing that struggles to grasp – and even misrepresents – the complexity of health-related perceptions and knowledge. This study draws from online COVID-19 vaccines discourses in Guinea and ethnographic fieldwork among Guinean healthcare workers. While the online social listening showcased a predominance of individual and collective safety concerns, distrust towards African elites and Western actors, fieldwork revealed that healthcare workers' vaccine perceptions were more nuanced and largely shaped by complex kinship relations spanning across online and offline social landscapes. Furthermore, healthcare workers often displayed frontstage and backstage vaccine discourses, their vaccines related representations and claims could evolve depending on the context of enunciation. We advocate for grounding social listening in global health to avoid disconnection from the public. Failure to accomplish this could result in a detached and hegemonic form of 'social hearing', rather than authentic social listening. In light of this, the transdisciplinary methodology exemplified in this paper represents one possible solution. [ABSTRACT FROM AUTHOR]

Like many areas of public health, sexual and reproductive health is concerned with politically contentious matters such as abortion and LGBT+ rights. Global setbacks at the hands of the far right highlight the extent to which the rights and practices underpinning sexual and reproductive health are politically mediated. Yet the political is often occluded in mainstream sexual and reproductive health responses. In this paper, I consider the recent travails of sexual and reproductive health in order to critique technocratic knowledge forms that dominate both sexual and reproductive health and public health responses. Exploring sexual and reproductive health responses across time and space, I identify alternative knowledge forms and approaches relevant to public health. [ABSTRACT FROM AUTHOR]

This paper reports on an action-oriented research study providing decision support to three local authorities in England on the prioritisation of public health investment and disinvestment decisions. We adopted a political science perspective, using the multiple streams framework to investigate the use of prioritisation tools in public health spending decisions at a time of severe financial constraints. The challenges and implications of their potential use in everyday practice were explored. Twenty-nine interviews were conducted before the targeted decision support occurred and 19 interviews after the decision support had been delivered. Interviews were held with locally elected politicians, officers and public health professionals based within local government, NHS commissioners and the local independent consumer watchdog for health and social care. Targeted workshops with local stakeholders were facilitated in each site by health economist members of the project team. Structured observational notes were recorded during these workshops and integrated with the interview data. Many respondents expressed an interest in prioritisation tools although some scepticism was expressed about their value and impact on decision-making. This paper analyses the enablers and barriers to adopting priority-setting tools in a local government environment that by definition is political. The findings suggest that the adoption of priority-setting tools in decision-making processes in public health poses some significant challenges within local government and that certain enabling factors have to be present. [ABSTRACT FROM PUBLISHER]

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

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]

An introduction is presented in which the editor discusses articles in the issue on topics including the policies around COVID technologies, techno-solutionism exacerbating existing social inequalities and mistrust in governments and digital contact tracing as a case for how public health and policy approaches governing the pandemic across the globe.

Presents an editorial regarding articles found in the December 2004 issue of "Critical Public Health" on the topic of harm reduction. Statement that early harm reduction efforts in the field of HIV centered primarily on the provision of needle and syringe programs for injecting drug users; Discussion of the variation and penetration of the harm-reduction construct in public health practice; Statement that the articles address HIV, Hepatitis C, drugs and injection drugs, and alcohol and sexual risk; Reference to an article on policies and practices to address HIV/AIDS in prison settings; Article that deals with sexual health and risk management among gay and bisexual men; Limitations of purely educational interventions.

In recent years, mobile health (mHealth) technologies have received increasing attention from industry and researchers. Such technologies have been the focus of both criticism and high expectations. In this paper, we analyze the integration of mHealth tools in everyday life. Insights into the actual use of such tools have empirical importance and could contribute to our theoretical understanding of mHealth technologies. Our research is based on 23 interviews with the participants of a smartphone-based mobile health intervention aimed at increasing physical activity. We followed the principles of grounded theory during data collection and our analysis is framed by the domestication approach. Our results reveal that the intervention design can result in the participants feeling ill-represented by the reductive nature of the data they generate. The results also reveal the inadequacy between biomedical standards and the social contexts of use. In addition, we describe how middle-class users perceive step-counting through the prism of a moralizing ethos of self-responsibility. Our research has practical implications for the developers and participants of mHealth interventions and theoretical implications regarding mHealth as a societal practice. We also suggest that mHealth-related public policies may fail to reach certain population groups, namely those who do not share the values that surround those technologies and their uses. [ABSTRACT FROM AUTHOR]

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

Public health advocates aim to maximise affordable access to good quality essential medicines. This goal often conflicts with the profitseeking ambitions of the pharmaceutical industry. Since the World Trade Organisation's Trade-Related Aspects of Intellectual Property Rights agreement, the extension and enforcement of intellectual property (IP) rights has become the dominant discourse in global medicines governance. Public health advocates operating within this framework face significant obstacles and challenges. This paper presents an historical perspective to the contemporary debate over medicines and patents by examining the evolution of international medicines governance between the 1940s and 1970s. This research indicates that debates around IP and medicines were more advanced in terms of equity and access in the 1960s and 1970s than they are today. While acknowledging the existence of obstacles and challenges for advocates, the paper argues that alternative frameworks can and should be reasserted in global debates about medicines governance. [ABSTRACT FROM AUTHOR]

This paper draws on interview and ethnographic data to describe donor accounts of blood donation in England, and how this contrasts to their responses when invited to also participate in two associated public health research studies. Donor views about usual blood donation combine the general, if flexible, theme of altruism with powerful notions of the social collective, giving rise to the sense that they are making tangible, physical ties and constructing a social body through the act of donation. However, their accounts of research participation are more open and ambiguous. At the core of this is the sense that they do not know what exactly they are ‘giving’, since the research is ultimately about collecting information, rather than substance. Equally, the donor-participants are not sure who they are giving it to, since they have no sense of the social collective that potentially might benefit from the research. The paper argues that the concept of ‘the population’ in public health is not only a term that is alien and abstract for the blood donors, but increasingly is a post hoc category for large-scale epidemiological studies. As a result, rather than supporting the obvious assumption that individual bodies make up populations, in practice, particular population renderings determine the nature of individual bodies. In so doing, the need to address ideas of ‘the social’, as distinct from ‘the population’, is increasingly unnecessary in much of public health research. [ABSTRACT FROM PUBLISHER]

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]

America faces an obesity epidemic affecting both children and adults – one broadly tied to increased consumption of sugar-sweetened beverages (SSBs). Since 2012, taxes have been proposed as an effective means of reducing SSB consumption and raising revenue. Such taxes have been the subject of voter referendums and have elicited persuasion campaigns by stakeholder groups interested in their passage or failure. This paper provides a picture of the evolution of tactics used to address the public on the subject of SSB taxes, and the persuasive setting of voter referendums as a whole. This study gathered and analyzed pro- and anti-tax messaging from all US SSB tax referendums from 2012 through 2018. The methods and strategies used in each campaign are identified. Common themes and arguments are distinguished and a set of decisions that appeared to heavily influence referendum outcomes are discussed. In summary: (1) Tax proponents must offer a cohesive justification of a new tax, while opponents can sow doubt about it from a number of contradictory directions. (2) The overt politicization of tax debates is an effective anti-tax method. (3) Associating anti-tax messages with the SSB industry can provide a stronger pro-tax framing than the direct public health or tax revenue arguments. (4) Anti-tax messages framing an SSB tax as a 'grocery tax' may be effective, but only if the claim not subjected to strong media or legal scrutiny. [ABSTRACT FROM AUTHOR]

A significant body of critical scholarship exists problematizing the dominant behavioural-individualist approaches to public health policy and intervention, and practice theories have been noted for their potential in providing an alternative. Children's physical activity in primary school settings continues to be a major area of attention in public health, yet no critical examination of a practice theory approach exists in this context. This paper addresses this gap by applying the prevalent three-elements model of practices to the case of children's school-based physical activity. Drawing on focus group, interview and observation data from pupils, staff and parents at one primary school setting in England, our analysis highlights; first, how the configurations of (a) physical resources (e.g. playground space and equipment), (b) practical know-how (e.g. a skilled understanding of performing the activity), and (c) the socio-cultural significance of practices (e.g. the values and meanings of the activity) impact how, and whether children's physical activity happens, and is sustained or interrupted; and second, by showing how physically active practices are contingent on being simultaneously in harmony or conflict with other routinized practices of the school day. We conclude that the three-elements model offers a helpful framework for understanding school physical activity which de-centres the individual, but that there are challenges in using this analysis to support primary schools as they attempt to enable physically active practices more effectively. Further research is required to develop and evaluate a practice theory approach to promoting children's physical activity. [ABSTRACT FROM AUTHOR]

There are increasing levels of concern about policy and practice related to Lyme disease testing and diagnosis in the UK. A complex debate has emerged, with patient groups challenging clinical and testing practices. This paper focuses on four dimensions of diagnostic testing: accuracy, types of test, clinical application and test interpretation, to illustrate the divergence amongst and between official and patient group views. We explore these issues via analysis of information from sources including patient organisations' documents and statutory policy and professional publications, supplemented by data from an online questionnaire survey. Our analysis shows a lack of consistency in policy, consumerist strategies among patients, and official policy that inhibits illness identity and maintains hard boundaries between patients' experience and public health practice. We suggest that medical policy and practice have become entrenched in defensive testing and clinical protocol. We note recently emerging trends in consultation and patient group involvement, illustrating more participative public health governance. As a joint patient organisation-academic project, we contribute to understanding of patient organisation activism in public health by demonstrating our own collaborative, reflective 'evidence-based' activist research. Notably, in doing so we deploy a variety of forms of knowledge and 'evidence' beyond the often-acknowledged 'experiential' and 'embodied' forms. On this basis, we recommend that shared-decision-making and 'facilitational' advocacy would improve patients' empowerment and their experiences of testing and diagnosis. We argue that such reforms will enhance the perceived legitimacy of 'chronic' Lyme disease claims even under the prevailing conditions of scientific and medical uncertainty. [ABSTRACT FROM AUTHOR]

Global governance of non-communicable diseases (NCDs) has moved beyond the World Health Organization (WHO) to become a shared responsibility of WHO, the United Nations General Assembly, and other willing stakeholders. Despite the significant attention NCDs have received, progress towards global goals and political commitments remains disappointing. This lack of progress calls for greater attention to be given to how actions taken at the international level can lead to improvements in health at the country level. This paper reviews progress in the global response to NCDs by highlighting the role of pathways – both current and potential – for translating global aspirations into national actions that improve health outcomes. Important pathways to national action include the development of normative instruments, political accountability mechanisms, provision of economic support and technical assistance, and other forms of engagement we refer to as 'institutional pathways'. We find that global leadership on NCDs has focused predominantly on generating a suite of normative instruments for influencing national policy, together with global targets and reporting processes but with inadequate development assistance for NCDs, or investment in capacity building. We point to the distinctively legal and regulatory nature of many priority interventions identified by WHO for NCD prevention and control, arguing that legal capacity building of both government and civil society stakeholders is a vital, cost-effective yet neglected pathway for strengthening national responses. We outline a modest vision for global, regional and national leadership in capacity-building and in promoting the role for law in NCD prevention and control. [ABSTRACT FROM AUTHOR]

In the face of the ‘obesity epidemic’ public health has largely failed to engage with the human pleasures that surround eating. Pleasures are often linked to vulnerabilities and frailties that are part of being human. We argue in this paper that leaving human vulnerabilities and the pleasures that haunt them under-acknowledged and under-examined within public health contributes to the problems that public health tries to solve. While in some quarters debates revolve around the best ways of encouraging people to become responsible for and modify their own behaviour, the well-documented centuries of struggle with managing human vulnerabilities and pleasures helps to explain why this is no easy task. The mantra of restraint, reason, and rationality is very limited in the face of the importance of some pleasures, even small ones, in human lives. In unequal societies, people have unequal access to pleasures. People are presented with a landscape of temptation, encouraged to consume, and then unequally admonished for indulging according to their means. Understanding and democratising pleasures will involve public health grappling with pleasures, and all those concerned with health inequity asking hard questions about ethics, morality, and intervention. [ABSTRACT FROM AUTHOR]

How are changing times impacting on the possibility of collective agency by actors and agencies responding to domestic violence against women in London? The struggle against the domestic abuse of women was grounded in the 1970s women's liberation movement under the rallying cry of 'the personal is the political'. Over time, the domestic violence (DV) response has become professionalised and mainstreamed, located in public sector agencies and charities, with small feminist groups challenging gender inequalities in different settings. These combined efforts are having no impact on the incidence of DV, and recent years have seen dramatic cuts in DV services. A snowball sample of 25 professionals, policy makers and activists across the DV response engaged in semi-structured interviews exploring their work experiences, particularly experiences of 'multi-sectoral collaboration', the professional instantiation of collective agency. Thematic analysis depicted an exhausted and divided sector. Nearly all informants saw DV as rooted in gender inequalities, and viewed collaborative working as essential for tackling its interlocking individual and social drivers. However, contemporary feminism was seen as completely irrelevant to the daily realities of professionals' work. The paper explores how the current economic, political and cultural contexts of interviewees' work experiences were hostile to the practice of multi-sectoral collaboration. Such contexts actively militated against collaborator solidarity, the inclusion of survivor voices and a social change orientation – preconditions for effective collective agency in tackling such a complex and multi-level social problem. [ABSTRACT FROM AUTHOR]