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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]

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]

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]

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]

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]

Developing a deep and contextualised understanding of risk is important for public health responses to young people's alcohol consumption, which is frequently positioned as an outcome of risky behaviour. This paper expands conceptualisations of risk to encompass its wider social and cultural context through a social practice exploration of young people's controlled and managed intoxicated alcohol consumption practice. We report data from a fourteen-month qualitative study of the alcohol consumption practices of 23 young people in England, drawing on group interviews and social media interactions. Our findings provide a nuanced understanding of risk-taking, demonstrating that risk is an important aspect of the ongoing participation and performance in alcohol consumption practice and that health information and advice can be and was frequently incorporated into drinking practice without contributing to fundamental change. This raises new questions about the effectiveness of health interventions that focus on the individual, discussed in the final section of the paper. [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]

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]

This paper explores public health policy implementation through partnership working at the local level by examining how local actors from public health, and the wider workforce make sense of and work on social inequalities in health. An ethnographic case study was used to examine policy implementation in one local strategic partnership in north-west England during a period of significant resource constraint. Semi-structured interviews were the primary method of data generation. Sensitising concepts from figurational sociology were used to develop a theoretical account of how local policy implementation directed at narrowing social inequalities in health tended to give rise to relatively fragmented and short-term services, projects and practices, which focused on lifestyle factors and behaviour change. Theorising partnership work as figurations goes some way to explaining the apparent paradox among participants who expressed a relatively detached appreciation of wider social influences, alongside emotional involvement in their work. This process of individualisation explains how local professionals tended to conceptualise health inequality and the social determinants of health as personal troubles. Individualisation meant that the social reality of working in partnerships on difficult issues was simplified. Thus, any scope for working on the social determinants of health tended to be overlooked. The extent to which this was intentional or a matter of struggling to see opportunities, or a mixture of the two, was difficult to discern. Although the policy landscape has changed, the findings give some insight into understanding how local collaborative processes reproduce local public health work underpinned by lifestyle choices. [ABSTRACT FROM AUTHOR]

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]

Involving young people in their own healthcare is a global priority, yet we know little about how this might work in practice. In this paper, co-produced between academic researchers and people with lived experiences of sickle cell and its treatment, we examine how young people with sickle cell disease attempt to use their expertise in their own condition during emergency hospital admissions and through encounters with healthcare workers who are not sickle cell specialists. Our qualitative longitudinal research in England examined young people's experiences of hospital encounters via repeat and one-off interviews. We show that young people's expertise is sometimes undermined, including not being taken seriously when they report pain. They face barriers to care in non-specialist wards, particularly when they are alone with nobody to advocate for them. Although healthcare services use rhetoric that encourages young people to take control of their health and act as patient experts, in practice young people's expertise is routinely ignored. To improve health service quality, and meet the needs of young people, young people's own expertise must be better supported in routine interactions with healthcare providers. [ABSTRACT FROM AUTHOR]

This paper draws on the experiences of two researchers working to develop critical accounts of fatness with very different research participants – town planners and English Channel swimmers. Drawing across our encounters with these different participants, we explore the ‘doing’ of critical research through attending to the embodied encounters which take place in the ‘field’. In so doing, we reflect on moments where we have both, as part of the research encounter, not only found ourselves simply in fat-phobic contexts, but also effectively complicit in those contexts in our roles as interlocutors. In this paper, we explore the tensions inherent in those encounters for us (in all our multiple social, professional and embodied subjectivities), and ask what attending to these embodied confrontations (or the avoidance of confrontation) might mean for the critical research process – both in terms of the impact on practice and outputs of research for individual researchers and the participants with whom they are working. In doing so, we focus on what attention to the research encounter adds to debates about ‘impact’ in social science, about the doing of scholar-activism and about the role of the researcher’s body in the research encounter. [ABSTRACT FROM PUBLISHER]

This paper locates the new public health movement's concerns with the social model of health, ‘expert’ and ‘lay’ knowledge and public participation in policy-making in the context of social ageing. Data from a focus-group study, undertaken in Greater Manchester in collaboration with a voluntary organization, are used to demonstrate how individuals connect physical health, well-being and public health in their own theories of growing and being older. The study had the explicit purpose of contributing to policy-making by calling upon ‘ordinary’, as opposed to ‘expert’, thinking about becoming and being older. The paper has three major themes. First, an examination of the relationship between methods employed in the study and ‘end users’ of the research. Second, outlining the ways in which individuals link ‘good’ health, well-being and public health to their own theories of ageing. Finally, the paper concludes with a consideration of the study's implication for the debate surrounding social capital, public participation and public health. [ABSTRACT FROM AUTHOR]

Much public health research considers interventions that influence and are influenced by both individuals’ health and the society around them; this can be described as a complex system. We consider the role of explanation alongside statistical inference as crucial to obtaining credible and useful insights, particularly in light of concerns about a ‘crisis of replication’, and reflect on the difficulty in researching complex systems. In this paper, we make a connection with Lipton’s philosophy of inference to the best explanation, and offer some tentative practical recommendations, extending suggestions from different fields. An extended hypothetical example is given on introducing ‘sugar tax’ in England. [ABSTRACT FROM PUBLISHER]

The aim of this paper is to consider 'New' Labour's socio-economic and health policies, discuss how they influence preventive health strategies aimed at men, and identify the implications for managers, researchers and practitioners working to improve public health in the primary care sector in England. Policy, theoretical work and empirical research are analysed, critically, to develop the arguments in the paper. Although men may be perceived as a 'hard to reach group', insufficient consideration has been given to how health policy facilitates or restricts successful preventive health work with men. The 'gender duty', which has recently been introduced in England, presents an opportunity to build on earlier successful public health work with men. There is some evidence that innovative public health strategies, informed by an understanding of gender, with men are being developed. This may enable primary care trusts to more successfully, and creatively, target and engage men in health improvement activities. However, the current dominant ideology in public health policy in England is grounded in a perspective that emphasises biomedical, neo-liberal and psychological explanations of health and which neglects the relationship between gender and health inequalities. Recognition of the links between gender, poverty, and the concomitant inequalities, is a priority when planning preventive health work with men. If such inequalities are to be redressed, social and economic policies underpinned by values of equity and social justice are needed, incorporating a more nuanced understanding of the role of gender in 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]

To ensure delivery of public health, research is needed on the impact of social, economic, environmental and service-related influences on population health and well-being. This paper reports on a study of the current level of medical and non-medical academic public health R&D capacity, capability and concerns in England. A web-based quantitative survey ascertained details of staff, postgraduate students and research activity in university departments of public health and a sample of wider public health academic and non-academic institutions. In addition, a qualitative survey of selected institutions used focus groups and semi-structured telephone interviews. Although there had been an increase in staffing over the previous decade, the academic workforce was predominantly female and young. Several major deficits in capabilities were uncovered including: lack of secure funding and critical mass to build programmes of work; lack of depth and expertise in academic departments; lack of career pathways; lack of structured training funding; and a need to improve CPD. Concerns were: teaching and research balance; recruitment and retention; identity; conflict between RAE, NHS and multidisciplinary working; medical versus non-medical differentials; and sustainability. A number of recommendations are made but it is recognized that a paradigm shift is required to change the current situation of Public Health research, and that this is unlikely to be initiated from within the current academic structure. [ABSTRACT FROM AUTHOR]

A growing number of countries are beginning to move from acknowledging the existence of health inequalities to developing policies to reduce them. Many of these policies consist of complex interventions, operating at a number of levels, which aim to make a positive contribution to health improvement in deprived communities. Evaluating the efficacy of such initiatives poses particular challenges for evaluation. This paper argues that there is real potential in applying a theory-based approach to the evaluation of complex community-based initiatives. Using practical examples from the national evaluation of Health Action Zones in England, the paper outlines the key components of such an approach and argues that theory-based evaluation can strengthen programme design and implementation, as well as promote policy and practice learning about the most effective interventions for health improvement. We conclude that sophisticated theory building social change mechanisms in community settings is essential if real learning is to be generated from concerted efforts to achieve social change. [ABSTRACT FROM AUTHOR]

It is now widely accepted that context matters in evaluations of the health inequalities impact of community-based social initiatives. Systems thinking offers a lens for uncovering the dynamic relationship between such initiatives and their social contexts. However, there are very few examples that show how a systems approach can be applied in practice and what kinds of evidence are produced when this happens. In this paper, we use data from ethnographic fieldwork embedded within a multi-site mixed method evaluation to demonstrate how a systems approach can be applied in practice to evaluate the early stages of an area-based empowerment initiative – Big Local (funded by the Big Lottery Fund and delivered by Local Trust). Taking place in 150 different local areas in England and underpinned by an ethos of resident-led collective action, Big Local offers an illustration of the applicability of a systems approach to better understand the change processes that emerge as social initiatives embed and co-evolve within a series of local contexts. Findings reveal which parts of the social system are likely to be changed, by what mechanisms, and with what implications. They also raise some salient considerations for knowledge generation and methods development in public health evaluation, particularly for the evaluation of social initiatives where change does not necessarily happen in linear or predictable ways. We suggest future evaluations of such initiatives require the use of more flexible designs, encompassing qualitative approaches capable of capturing the complexity of relational systems processes, alongside more traditional quantitative methods. [ABSTRACT FROM PUBLISHER]

Gypsies, Roma and Travellers (GRT) experience a significantly high number of measles cases and have low levels of measles, mumps and rubella (MMR) immunisation. There is little evidence on: why immunisation levels are low; beliefs and practices surrounding the MMR vaccine; or the factors that promote or hinder uptake. This paper presents data from five focus groups with 16 GRT mothers in Kent, South East England. Between them, they had 35 children of whom just under half had not received the course of vaccinations. Focus groups explored the issues GRT parents consider when making vaccination decisions in the context of wider social, ideological, material and practical considerations. Four interrelated themes were identified: way of life and access; engaging with health care staff; perceptions and evaluations of risk; and strategies to minimise MMR-related risks. Our findings provide little support for explanations that emphasise cultural values or practices in shaping immunisation behaviour. Poor service provision, situational constraints related to living circumstances, and multifaceted and severe health issues, which precede and inform decisions over childhood immunisation, were more significant in explaining low uptake. [ABSTRACT FROM PUBLISHER]

Recent health policy in England has demanded greater involvement of patients and the public in the commissioning of health and social care services. Public involvement is seen as a means of driving up service quality, reducing health inequalities and achieving value in commissioning decisions. This paper presents a summary and analysis of the forms that public involvement in commissioning are to take, along with empirical analysis from a qualitative study of service-user involvement. It is argued that the diversity of constituencies covered by the notion of 'public involvement', and the breadth of aims that public involvement is expected to achieve, require careful disaggregation. Public involvement in commissioning may encompass a variety of interest groups, whose inputs may include population needs assessment, evaluation of service quality, advocacy of the interests of a particular patient group or service, or a combination of all of these. Each of these roles may be legitimate, but there are significant tensions between them. The extent to which the structures for public involvement proposed recognize these possible tensions is arguably limited. Notably, new Local Involvement Networks (LINks), which will feed into commissioning decisions, are set as the arbiters of these different interests, a demanding role which will require considerable skill, tenacity and robustness if it is to be fulfilled effectively. [ABSTRACT FROM AUTHOR]

Teenage pregnancy has been labelled as a major social and health problem and has become a key policy area in several industrialized countries. In England, current policy aims (1) to halve teenage pregnancy rates for under-18s by 2010, and (2) to reduce teenage parents' risk of social exclusion by supporting their participation in education, training and employment. Official statistics are published on the rate of teenage pregnancy but not on the number of teenage mothers. In this paper we calculate the number of teenage mothers aged 15-17 in England in 2001 using routine data on fertility, stillbirths and mortality. We find that there were approximately 30,000 teenage mothers in England in 2001. This is a calculation which could, and should, be produced regularly by the Office for National Statistics. By only producing statistics on the rate of teenage pregnancy and not the number of teenage mothers, the first policy goal is thereby given precedence. [ABSTRACT FROM AUTHOR]

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

Pre-exposure prophylaxis (PrEP) is currently being trialed for seronegative gay and other men who have sex with men (GMSM) at risk of HIV infection in England. However, research from other countries where PrEP is available shows limited literacy and uptake by GMSM at risk of HIV. We collected focus group data from 18 GMSM (13 HIV− and 5 HIV+) from Leicester, an ethnically diverse city in the English Midlands. Data were analysed using thematic analysis and three themes are presented. The first theme 'I can't get my head around people like that': Representations of PrEP users within and beyond gay communities explores how PrEP users are vilified by some GMSM and the wider media. The second theme, 'There's a culture of anti-trust': PrEP, stigma and the interpersonal politics of HIV disclosure discusses how PrEP influences HIV disclosure and sexual decision-making in casual sero-discordant sexual encounters in a context where seropositive men experienced pervasive HIV stigma and HIV− men were suspicious of HIV+ sexual partners. In the final theme, 'I'm still suspicious': Discourses of doubt and distrust participants voiced concern over the safety of PrEP and the motives of drug companies, healthcare agencies and PrEP activists. We consider these findings through a critical lens of wider theorising around the relationship between public health agencies and GMSM communities and consider the impact of these perspectives on likely engagement with PrEP in an English context. We call for more critically informed and nuanced ways of promoting health and well-being amongst men from these communities. [ABSTRACT FROM AUTHOR]

Engaging the community in initiatives to improve health and inequalities is a prominent feature of contemporary public health approaches. Yet, how ‘community’ might be differently interpreted and experienced through mechanisms of engagement is little understood, with potential implications for how the pathways of effect of such initiatives, and their impacts on health inequalities, might be evaluated. This study sought to explore how community was enacted through the delivery of an area-based, empowerment initiative underway in disadvantaged areas of England. An ethnographic approach was used to identify enactments of community arising around the core activities and decision-making processes of the resident-led initiative in two sites. Enactments comprised ‘boundary work’: the ongoing assertion and negotiation of boundaries around who or what was, and was not, eligible to contribute to decision-making, and / or benefit from the initiative. Boundary work arose around practices of connecting with and consulting residents, protecting locally defined interests and autonomy, negotiating different sets of interests, and navigating representation. The multiple, shifting enactments of community and its boundaries highlight implications for understanding processes of inclusion and exclusion inherent to community engagement, and for interpreting pathways between collective empowerment and improved health. The study also raises questions for evaluating similar complex, community initiatives, where community cannot be taken as a fixed analytical unit, but something continually in process through the interplay between the initiative and the wider context. This must inform interpretations of how, and for whom, community engagement might – or might not – improve health. [ABSTRACT FROM PUBLISHER]

The theory of human functioning and school organisation informed by Basil Bernstein’s sociology of education suggests that to gain the commitment and promote the health of students, particularly those from disadvantaged backgrounds, schools require radical transformations eroding various ‘boundaries’: between and among staff and students; between students’ academic learning and broader social development and welfare; and between schools and their local communities. Existing research examining this theory has reported associations between school-level proxy measures of student commitment and lower rates of student smoking, drinking alcohol, use of drugs and violence. But this research has not directly assessed whether reduced school boundaries explain this. We piloted a new scale derived from teacher reports to measure unhealthy school boundaries and examined its inter-item reliability and its criterion validity in terms of associations with various measures of school commitment and smoking. Data on boundaries came from 101 teachers across 40 schools. Data on student commitment and smoking came from 6667 students. We assessed reliability by examining correlations between scale-items and criterion validity in terms of associations with student-reported commitment and smoking. Inter-item reliability was sub-optimal but better within the subscales about boundaries between academic/broader learning and schools/local communities. The scale had good criterion validity, strongly associated with reduced student-reported school commitment and increased student-reported smoking. We reflect on the implications of these findings in terms of critical perspectives on health promotion in schools and the strengths and limitations of quantitative research in examining health behaviours as opposed to practices. [ABSTRACT FROM PUBLISHER]

Numerous critical analyses have already established the profoundly gendered nature of normative body ‘ideals’ and weight-management practices in Western cultures. Such studies have, amongst other things, elucidated how body dissatisfaction, ‘dieting’ and other weight-loss practices are discursively constituted as both feminised and feminising. Critiquing the over-determined normativity of thinness as a key index of femininity, these analyses have also highlighted how fatness, as abjected flesh, is equated with the feminine and how, in the context of an alleged ‘obesity crisis’, ‘fat’ men, as well as women and children, risk stigmatisation. An emergent research literature now explores men’s engagement with body ‘ideals’, weight management and ‘body projects’ more generally. This article builds on that work, exploring the negotiation of embodied masculinities in the weight-related talk of men who risked being labelled ‘overweight’ or ‘obese’. Drawing on interviews (N = 37), the study illustrates how ‘big’ men attempted to shield their threatened masculine identities by contrasting their own bodily bigness, corporeal concerns and embodied practices with those of women and girls. Also attentive to sexualities, ethnicity and class, this article illustrates the context-specific, intersectional and contested nature of embodied masculinities and body projects in these ‘epidemic’ times. [ABSTRACT FROM PUBLISHER]

Tackling alcohol-related harms crosses agency and professional boundaries, requiring collaboration between health, criminal justice, education and social welfare institutions. It is a key component of most multi-component programmes in the United States, Australia and Europe. Partnership working, already embedded in service delivery structures, is a core mechanism for delivery of the new UK Government Alcohol Strategy. This article reports findings from a study of alcohol partnerships across England. The findings are based on a mix of open discussion interviews with key informants and on semi-structured telephone interviews with 90 professionals with roles in local alcohol partnerships. Interviewees reported the challenges of working within a complex network of interlinked partnerships, often within hierarchies under an umbrella partnership, some of them having a formal duty of partnership. The new alcohol strategy has emerged at a time of extensive reorganisation within health, social care and criminal justice structures. Further development of a partnership model for policy implementation would benefit from consideration of the incompatibility arising from required collaboration and from tensions between institutional and professional cultures. A clearer analysis of which aspects of partnership working provide ‘added value’ is needed. [ABSTRACT FROM PUBLISHER]

Health promotion (HP) amongst older people is an increasingly prominent policy concern for governments. The development of an evidence-base and the advocacy of effective interventions in the light of this act as legitimation tools for the overall HP phenomenon – assisting the growth of state and non-state funding for public health initiatives for older people. In structuring decision-making as to which individual projects/initiatives receive funding, frameworks for acknowledging efficacy impact on formats of HP work both positively and negatively. Drawing on recent research across the EU and focusing on the specific national contexts of Austria and England, this comparative policy analysis triangulates best-practice modelling, evaluation data and interviews with project coordinators to explore how policy contexts impact on the nature and format of HP interventions. Amidst a developing awareness of what effective practice looks like, successful HP initiatives must advocate their legitimacy within narrow rules of quality, where measurable outcomes have become the keys which unlock financial resources. Findings across both countries suggest that this instrumentalisation of legitimation, driven by economic pressures and bureaucratic generalisability, threatens the rationality of HP. From a Habermasian perspective, tensions emerge between projects’ remaining reflexive towards processes and their need to articulate the ‘success’ of the interventions in a language of outcomes. Over time, in an era where resources are increasingly scarce and competition over these intensifies, a danger exists whereby the instrumentality of HP begins to separate from, and impinge upon, the capacity for projects to think and act holistically. [ABSTRACT FROM PUBLISHER]

A growing social science literature demonstrates that sleep is not merely a personal matter but also a political problem and a public health issue. Taking this as a point of departure, our article presents an analysis of sleeping practices amongst homeless drug users (HDUs) who make use of emergency hostels and night shelters in England. Data generated by way of qualitative interviews undertaken with 29 men and 11 women reveal that, as we might expect, securing sleep for this group is by no means easy. The strategies they pursue to find places to sleep are described, as are the threats and barriers to their sleeping. Emergency hostels and night shelters can afford a lifeline; providing warmth, water, food and access to support services. But if these are inadequately resourced they can be experienced as volatile environments and inimical to sleeping. It is argued here that although sleep is an essential prerequisite for health, for this population it can, somewhat ironically, be experienced as a risky behaviour. Vulnerable to both physical risks (e.g. inclement weather) and social threats (e.g. abuse and violence), falling asleep can exacerbate exposure to such dangers. These vulnerabilities are compounded by the social position of HDUs who live in socially and physically marginal places. It is this marginality that prevents them from being able to secure sleep that is both restful and restorative. [ABSTRACT FROM AUTHOR]

The objective of this study was to describe understandings that mothers and midwives have of ethnicity, and to explore barriers to the successful implementation of an ethnicity screening question for sickle cell/thalassaemia. Observation was made of 121 first antenatal interviews between midwife and mother in four contrasting areas of sickle cell prevalence in England. Taped interviews were undertaken with 111 mothers, and 115 interviews were recorded with 61 different midwives. Fieldwork data were gathered from 76 meetings, including preparatory workshops, liaison meetings and feedback sessions. 'Ethnicity' and 'family' are terms liable to variable interpretation. Both midwives and mothers implied belief in distinct 'racial' groups, disrupting scientifically accurate understandings of the relation between risk of sickle cell/thalassaemia and ethnic/family origins. Bookings were characterized by time pressures and a lack of explanation of sickle cell/thalassaemia. The mother was not permitted to self-assign ethnicity in 11.3% of observed encounters. The implementation of antenatal screening for sickle cell/thalassaemia based on an ethnicity screening question is weakened by a range of factors. Some midwives use intuition to select/exclude clients from the screening questions rather than implementing formal policy. The screening term 'ethnic/family origins' is vulnerable to varied interpretations by clients. The persistence of erroneous beliefs in 'racial' groups displaces correct understandings of the relation between ethnicity and risk of carrying genes associated with sickle cell or thalassaemia. Midwives require support in both ethnicity awareness and knowledge of sickle cell and thalassaemia, and more time at antenatal bookings to administer the ethnicity screening question. A challenge to the continued prevalence of scientific racism in popular discourse is required. [ABSTRACT FROM AUTHOR]

Despite the exponential growth in the number of studies addressing ethnicity and health, there is considerable debate about definitions of ethnicity, the appropriate use of ethnicity in health research and whether research focusing on ethnicity in the health field will ultimately result in reduced disadvantage or will simply contribute to the reification of ethnic origin as a cause of health problems. The authors present and discuss health outcomes among White (n = 227), African-Caribbean (n = 213) and Indian and Pakistani (n = 233) adults aged between 18 and 59 years living in Leeds as measured in a stratified population survey, with particular emphasis on the interaction between reports of health conditions and health status in relation to ethnicity and gender. The survey included both general and specific measures of health and impairment and was undertaken following extensive qualitative fieldwork. Overall the results of the study suggest that adults in both broad minority ethnic groups studied have a somewhat less favourable profile of physical and mental health and risk factors such as obesity and low birthweight. Despite an absence of ethnic differences in reporting of long-term conditions, minority groups had lower health status because those with long-term conditions were generally in worse health than their White counterparts. The study findings agree with previous research in suggesting that variation in health status was better explained by specific measures of actual limitations in daily activities than by general measures of limiting long-term illness. These data suggest that limiting long-term illness or disability questions may underestimate functional limitation relative to more specific measures and consequently their use in resource allocation may be problematic. [ABSTRACT FROM AUTHOR]