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An introduction to the journal is presented in which the editor discusses the various topics within the issue, including the temporalities of illness, behaviouralism, and the processes of disease causation and management.

This paper proposes the term misdirection as a process by which attention is diverted from certain scientific approaches in the malaria elimination paradigm to justify specific methodological, scientific and political decisions. Misdirection, as it applies in magic, creates a sort of tunnel vision in which attention is diverted away from any action occurring outside the frame of the current paradigm. A crucial component of this misdirection process is the global standardization of intervention methodologies operating independent of local social contexts and the perceived impossibility to 'localize' such interventions. This conviction requires – and is simultaneously supported by- the production of decontextualized evidence through the application of methodologies aiming at generalizability, in detriment of social context and variability. This process produces pseudo measurements and conclusions that are at the same time real in their adherence to paradigmatically valid methodologies and fake as they either remain empty of empirical significance or whose validity cannot be assessed as we have lost sight of the (local, social, cultural) variation it has decided to ignore. Using the example of research on the effectiveness of bed nets and topical repellents as malaria prevention tools and their expected use within the current paradigm of malaria elimination, we show how the inherent ambiguity of the pseudo allows consequent misdirection processes. [ABSTRACT FROM AUTHOR]

Drawing on Isabelle Stengers' discussion of the investigation of Mesmer and the starring role that experimentation plays in the rationality of modern medicine, this paper examines longstanding tensions between the realms of evidence based medicine and complementary and alternative medicine. While evidence based medicine often claims the ability to demarcate between pseudoscience and science, and complementary and alternative medicine often claims that evidence based medicine involves a kind of pseudo-logic that is unable to capture all forms of efficacy, I argue that both of these claims are unfounded. Unpacking the similarities between the commission that evaluated Mesmer's magnetism and the structure of evidence based medicine, a significant gap is revealed in today's system of knowledge production within medicine. In order to demonstrate the efficacy of a novel treatment within a randomized controlled trial, the treatment must be shown to improve clinical outcomes significantly more than a placebo control. However, some treatments improve clinical outcomes, but operate primarily through placebo responses, leading to effective medicines being labelled 'ineffective' within randomized controlled trials. This phenomenon is known as the efficacy paradox and appears most frequently in chronic conditions and in relation to complementary and alternative medicine, in which placebo responses are common. It is argued that the realms of evidence based medicine and complementary and alternative medicine have much to learn from each other, in that one has neglected the vast potential of producing clinical benefit through placebo responses, while the other has neglected the understanding that can be gained through experimentation. [ABSTRACT FROM AUTHOR]

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

'Preparing for the next epidemic' has been a recurrent theme in global health in recent years. Starting with SARS, by way of the Avian influenza, and intensifying after the 2013-2016 Ebola outbreak, the urgency of preparing for the next health disaster has been recommended by numerous global health stakeholders. Recommendations and global partnerships are aligned with the many action proposals that have been formulated by international political actors, including the WHO, that have made 'preparedness for the next epidemic' a new paradigm, alongside prevention. The intent of this commentary is to argue the need to discuss some aspects of the preparedness paradigm from both health and democratic perspectives. We believe preparedness reveals a new and problematic biopolitical orientation in global health. Our argument is that preparedness enacts a model that: (i) reconfigures knowledge about epidemics by disconnecting them from the social and historical contexts in which they arise and (ii) imposes new modalities of intervention that raise issues for democratic autonomy. After first tracing back the genealogy of the preparedness paradigm, this paper then discusses some of the issues at stake for both health and democracy. [ABSTRACT FROM AUTHOR]

Although health researchers have begun to examine the forms of violence and power dynamics that play out in the intimate relationships of female sex workers (FSWs) in India, this knowledge has tended to focus on the perspectives of women, leaving men's motivations and attitudes relatively unexamined. This paper examines the contours of masculinity and gender norms from the perspective of the intimate partners of FSWs. Based on six months of ethnographic research in Northern Karnataka, the study employed two focus group discussions (FGDs) with Devadasi FSWs (N = 17), as well as four FGDs (N = 34) and 30 in-depth interviews with their intimate partners. Given the precarious labour conditions in this region, tensions developed in the participants' relationships with FSWs, as these men were unable to meet local ideals of manhood. Violence became a way that men attempted to re-secure a sense of control in their relationships with women, and to fulfil fantasies of male power. We recommend that programs engaging men not only address intimate partner violence but also attend to the social and structural realities surrounding these men's daily lived experiences. [ABSTRACT FROM AUTHOR]

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

Globally, indigenous peoples live with stark disparities in health when compared with national populations. The disparities arise from a combination of factors that relate to the social and economic determinants of health, combined with disenfranchisement, and a rapid destruction of indigenous health systems, forests, natural resources and indigenous knowledge. In Malaysia, the indigenous peoples, known as the Orang Asli or 'Original People', are often viewed by authorities as 'backward, ignorant and resistant to modern health services', and therefore responsible for their poor state of health. This view situates the problem in the indigenous community, with the state as the benevolent provider of progress and improvement including health services. Orang Asli responses to this benevolence ranges from pragmatism to resignation to resistance. Drawing on a two-year ethnographic study, this paper explores, from the perspective of the Orang Asli, the dynamics of state and non-state societies, the structure and role of indigenous health systems and the effects of socio-economic transition in shaping Orang Asli responses to modern health services. Already burdened with poorer health compared with the national population, there is a growing problem of non-communicable diseases among the Orang Asli. Addressing this will require a shift from the benevolent dependency-creating approach commonly adopted by state public health services to one that is inclusive, responsive and participatory. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses eco-social models that look beyond traditional disciplinary models, the nature of the frameworks to which students of public health are exposed, and the importance of better-informed strategies when engaging with Alaska Natives in research.

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

Timely and continued access to high-cost medicines for the management of chronic illnesses such as multiple sclerosis, are often constricted by its affordability for patients. Health systems also face challenges in arranging sustainable financing for populations with chronic illness in need of equitable and long-term access to high-cost medicines. In many low-to-middle income countries, pluralistic health payers within and beyond the public system contribute to health financing. The structures, processes and dynamics of access through these payers however, may have limitations and negative consequences for patients. In this paper, we present vignettes of case experiences from working individuals with multiple sclerosis in Malaysia, on their experiences and encounters when seeking access through public and private health payers. The Malaysian case and experience is an example of the public-private health care system challenges in providing sufficient access and financing to high-cost medicines. Themes include limited and interrupted hospital access, requirements to prove individual socio-economic deservingness for reimbursement, and confronting discrimination from employers as discretionary payers of medical care. These discussions reinforce the value of universal health access, pooled systems of financing and risk sharing to provide comprehensive health care access and reduce economic and health vulnerabilities in patients. [ABSTRACT FROM AUTHOR]

The confluence of new ways to quickly gather, analyze, and use large volumes of information - so-called 'Big Data' - coupled with the widespread adoption of digital devices, has transformed marketing, including food marketing. However, the effects on health of the marriage between Big Data and digital food marketing are largely un-researched and unknown. In the midst of ongoing global concern about obesity, there is a need for public health scholars to be informed of the nature and extent of Big Data's impact on marketing in order to create new research agendas, methods, and evidence-based approaches that will be effective in today's highly dynamic digital marketplace. In this paper, we identify six key features of this new Big Data food marketing system, explore how they depart from traditional forms of advertising, marketing, and retail operations, and offer suggestions for research strategies and public health interventions. While there is some evidence to suggest that data analytics and digital technologies could be harnessed to help address obesity and chronic disease, we argue that without intervention current trends will continue, and these techniques will be used primarily to promote junk food, sugar-sweetened beverages, and other unhealthy products, thus increasing health disparities, and worsening health outcomes. [ABSTRACT FROM AUTHOR]

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

Obesity and neoliberalism are two concepts that generate plenty of concern and debate, arguably leading to more heat than light when terms like ‘epidemic’ are thrown into the fray. Drawing from critical weight studies, this paper offers critical commentary on the recent designation of obesity as a ‘neoliberal epidemic’ that can be attributed to energy-dense foods and a toxic mode of political economic organization. After delineating neoliberalism and the use of this concept in health studies, discussion turns towards contrasting invocations in the ‘fat field’ before seeking to navigate a course through this terrain. In addition to contributing to critical weight studies and the obesity debate, this commentary engages discussions on the perils of invoking neoliberalism in public health critique. In conclusion, we move from critique to hope with reference to epistemologies derived from alternative health practices, notably frameworks incorporating Indigenous knowledge(s). [ABSTRACT FROM AUTHOR]

The usefulness of neoliberalism as a theoretical concept in health research has been debated. This paper argues that when the concept of neoliberalism is used precisely and concretely, it provides an important and valid framework to analyse how health systems have been transformed over the last several decades. This claim is illustrated through the case of the Irish nursing home sector, which, over the last 20 years, has been turned upside down: from a mostly public system, it has been restructured into a mostly private, for-profit one. Privatisation, a quintessential neoliberal outcome, is analysed in detail. It was fostered by several neoliberal policies and has benefitted Irish (and to some extent global) economic elites. Tax incentives for private home operators and government budgetary constraints have limited state involvement in service provision and supported the expansion of the private sector. Private home staff are subject to more ‘flexible’ working conditions, which benefits employers. Moreover, the government plans to build new public nursing homes via public-private partnerships, which amount to privatisation. Also, global nursing home chains have begun to enter the Irish market, which offers profitable opportunities to international investors. However, international research shows that quality of care tends to be lower in private homes, due to cost cutting to increase profits. [ABSTRACT FROM AUTHOR]

Research suggests that food insecurity exacerbates the harms experienced by people who use drugs (PWUD). Therefore, improving the food security status can help PWUD reduce drug-related harms. This paper identifies a knowledge gap in public health and harm reduction literatures regarding the relationship between food and harm reduction. We argue that there needs to be a more comprehensive and systematic model of food provision in harm reduction services. Our argument is based on a qualitative case study of 42 people who currently use, or have used drugs in Vancouver, Canada and of staff of 27 programs that provide harm reduction services in the city. The research demonstrates how PWUD experience the effects of drug use on their food consumption, how they access food, and how they practice self-care. It also shows how harm reduction services, while they often provide food, are unable to systematically address the dietary-related harms associated with drug use. This presents an opportunity and a challenge for these organizations and for harm reduction as a public health approach. We call for more research to be done on food as harm reduction and for stable publically funded food provision in harm reduction-oriented services. [ABSTRACT FROM AUTHOR]

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

This paper underscores the imperative for enhanced data disaggregation within the Australian Burden of Disease Studies (ABDS). While the ABDS offers a detailed assessment of disease burden, it falls short in providing systematic, disaggregated data – key to equitable healthcare and informed policymaking. Given Australia’s rich linguistic, ethnic, and cultural tapestry, aggregated health data often obscures the true extent of health disparities among diverse groups. The absence of detailed health data can precipitate unforeseen inequities with profound societal repercussions, including social unrest, diminished trust in healthcare and governance, economic downturns, educational gaps, mental health crises, political challenges, and stigmatisation. Such disparities undermine confidence in health systems and advisories, potentially fostering scepticism towards official health communications. Health disparities can lead to economic inadequacies, inflated healthcare expenditures, and stunted economic growth. Communities suffering from poor health are economically disadvantaged, and unexpected health inequities can derail educational achievements, particularly for students from underprivileged backgrounds who may face additional obstacles due to health-related absences or resource scarcity. The mental health burden from health disparities can escalate community-wide psychological distress, manifesting in heightened depression, anxiety, and trauma rates. The stigmatisation of certain groups exacerbates societal divisions and impedes unity. Politically, health inequities demand attention, with leaders facing scrutiny over their handling of these issues. Nevertheless, such challenges can catalyse community solidarity and advocacy for systemic change, fostering resilience. Addressing these disparities necessitates a comprehensive strategy encompassing disaggregated data access, equitable healthcare provision, policy reform, and community involvement. The ABDS 2023 report that Australians lost 5.6 million years of potential healthy life, with chronic disease imposing a more significant toll than premature mortality. The primary contributors to this burden were cancers, mental health conditions, and substance abuse disorders. However, this collective data fails to illuminate the disparate disease impacts on culturally, ethnically, and linguistically diverse populations. The ABD Study highlighted that in 2018, Indigenous Australians lost nearly 240,000 years of healthy life due to illness and early death, equating to 289 years per 1,000 individuals. Conditions like diabetes, cardiovascular diseases, renal disorders, strokes, and respiratory issues were more prevalent among individuals with limited English proficiency compared to fluent speakers. Gestational diabetes rates were notably higher in South Asian, Vietnamese, and African migrants compared to the native-born populace. The article emphasises the critical role of disaggregated health data in shaping effective health policies, optimising resource allocation, and promoting equitable health outcomes aligned with the Sustainable Development Goals. It advocates for integrating such data in public health practices to mitigate health disparities and enhance the welfare of all Australians. Ensuring the widespread availability of legally mandated disaggregated health data is vital for identifying, monitoring, and addressing health disparities within Australia’s multicultural society.

With the popularity of co-creation research in public health and other fields, there is a need to strengthen its evidence-base by developing a framework based on meta-theoretical principles. The lack of applying meta-theoretical principles in co-creation research impedes the theory- and evidence building. Critical realism seems a promising candidate for providing meta-theoretical principles to enrich the evidence base of co-creation research in public health. To this purpose we searched for relevant papers on critical realism methodological principles, clarified and subsequently applied such principles to a co-creation public health case study. We provide explanatory steps to apply five principles; 1) focusing on understanding an event, like childhood overweight, 2) exploring the broader structure and context surrounding the event, 3) constructing hypotheses about the underlying mechanism(s) of an event, 4) empirical testing to corroborate those hypotheses, and 5) using multiple methods and triangulation. Further, this study shows that critical realism can enrich co-creation research in public health by iteratively building theory and evidence following the five proposed principles.

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

The idea of using schools for public health ends has a long and complex history. If anything, interest in the public health role of schools may actually be intensifying, perhaps driven by the attention given to a range of health matters affecting young people, notably mental illness, drugs and alcohol, and obesity. This paper deals predominantly with obesity but emerges out of our ongoing research into both the nature and consequences of policies and interventions that seek to use American public schools to prosecute public health goals. In particular, our focus is on the kinds of school-based interventions that widespread panic about childhood obesity has generated and their consequences for teachers. We take up this matter by examining how American teachers’ health – and the associated responsibilities and obligations to inspire health among young people – are discursively constructed in legislation, policy documents, and academic articles. Our review and analysis of these texts reveal the presence of three distinct discursive formations: teachers as health role models, teachers as fiscal liabilities, and teachers as instruments of policy compliance. These formations, we argue, suggest a novel and, in some cases, alarming trajectory in school-based obesity policies and interventions. [ABSTRACT FROM PUBLISHER]

The increasing amount of ‘unhealthy’ food consumed outside the home is thought to be a major contributory factor to growing levels of obesity. To tackle the problem and promote changes in catering and consumption behaviour, initiatives designed to encourage out-of-home caterers to provide healthier menus or adopt healthier cooking practices have been developed. Such voluntary agreements, rather than legislation, are the UK government’s preferred strategy. This paper reports on and explores issues arising from an evaluation of one such initiative – the Healthier Catering Commitment, piloted with over 80 independent businesses in London in the UK. Analysis of data on take-up of the scheme, and interviews with businesses and those involved in assessing them against the scheme’s criteria, suggests the extent to which businesses are prepared to make changes to their catering practices. Operational barriers as well as aspects of the local trading environment are shown to impact on the level of business commitment to the initiative. In considering the degree to which the scheme’s criteria inform, widen or restrict consumer choice, the paper adds to the debate on effective strategies for encouraging behaviour change. It also comments on the extent to which voluntary agreements are likely to be an effective means of ensuring a healthier food environment, and the extent to which government intervention is justified in the interests of improving public health and tackling health inequalities. [ABSTRACT FROM PUBLISHER]

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

Recognition of the health effects of social isolation has led to the media framing it as a public health issue. In this paper, we examine how the media frame social isolation among older people and how the public respond to this framing. Using framing analysis, we analysed an online article, embedded video content and 369 comments posted in response to this article. The article used a recognisable public health framing to understand the causes of social isolation as structural, supported by a video which presented the private face of a public health problem. The online comments largely resisted this framing, arguing that social isolation reflected an individual deficit, best remedied through individual actions such as joining groups or having a positive attitude. Families were also viewed as responsible for the social lives of their members, and social isolation was attributed to neglectful families. Commenters also suggested that alleviating social isolation was the responsibility of neighbours and volunteers. These three arguments accounted for 88% of the comments. Much less commonly, social isolation was described as due to the march of Western civilisation. This analysis shows how the public are active in their response to, and largely rejection of, framing social isolation as a public health issue. Although the health impacts of social isolation were endorsed, this was insufficient for structural explanations to prevail. Public health campaigners need to understand how individualising accounts of health issues are used to undermine public health explanations so as to most effectively challenge them. [ABSTRACT FROM AUTHOR]

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

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

The importance of community involvement in public health research processes is well established. The literature is, however, less forthcoming about processes of community inclusion in public health project implementation, especially when it comes to projects focusing on key populations. The Step Up Project is the first multi-city harm reduction service provision project for people who inject drugs in South Africa. Since inception, the Project has made concerted efforts to work with and alongside people who actively identify as people who inject drugs. This paper outlines two features in relation to project-beneficiary dynamics that emerged in a qualitative project evaluation conducted by an external researcher and a funder representative. The first was that people accessing the project comfortably expressed criticisms of both themselves and the project, and noted when their behaviour contradicted project ideals. The second was the extent to which engagement with the project was reported to be fostering a renewed sense of personhood and right to exist in the world. These findings are, we suggest, in principle related to two forms of community engagement: consistent empathic response and community advisory groups. This implies that programmes need to focus on their mode of approach as much as on the content of their approach. It further implies that programme impact not be limited to quantitative assessment measures. [ABSTRACT FROM AUTHOR]

This paper explores the accountability relationships that arise between researchers, the community and community representative structures known as Community Advisory Boards (CABs). It draws on ethnographic and case study research that documented the history, recruitment, composition and representativeness of two CABs and their relationships with researchers and communities, carried out in two studies in Zambia between 2010 and 2014. The findings revealed contradictions, nuances and imbalances in actual community participation and representation. In both studies, the general population was not given the opportunity to participate in the election of their CAB representatives, and the elected CAB members themselves were initially told to have little or no direct contact with research participants whom they were supposed to represent (unless researchers dictated otherwise). Owing to the researchers’ monopoly of scientific knowledge, literacy and financial resources, power relations were imbalanced. Further, researchers were quick to ask for and formalise community commitment through the CABs whilst reticent about their own accountability to the community. Yet despite these imbalances and CABs lacking formal authority over researchers, CABs did have subtle powers arising from their wider influence in the community, which they could tap into to either support or resist research. To achieve a more balanced and open accountability between research stakeholders, more genuine participatory processes need to be built and sustained. [ABSTRACT FROM AUTHOR]

This paper analyzes a form of community engagement that differs from the way it is usually conceived and practiced in the domain of global health. This story takes place in the Cuban context and more specifically in a recent programme of oncology clinical trials implemented in primary healthcare (PHC) centres. By considering both the genealogy of this program and local interactions between PHC professionals and patients and their close relatives, I show that, in the context of Cuban socialist biomedicine, community engagement emerges as an implicit practice that forms part of the PHC professional ethos. I explore the ways cancer biomedicine is adapted in order to address specific needs and demands related to public acceptance of cancer in the Cuban society, diagnostic communication and palliative care. I argue that the way community engagement is enacted within Cuban socialist biomedicine is alternative to the global health dominant paradigm since it does strengthen existing relations between citizenry, health professions and public health infrastructures. Finally, by questioning the specificity of such socialist approach to community engagement, I suggest it greatly contributes to global health literature, because it creates continuity within existing state infrastructures rather than bypasses them, and, furthermore, offers a unique vantage on the treatment of chronic disease. [ABSTRACT FROM AUTHOR]

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

A resilient and responsive health system providing universal health coverage is one that is able to cope with both the commonplace conditions faced by the majority as well as rare conditions, particularly when experienced by more marginalised groups. This is critical to ensure that under the sustainable Development Goals agenda, no one is left behind. Low- and middle-income economies are in the process of refining their health systems to respond to the epidemiological and demographic transition. However, with economic development comes the requirement for an ethical transition; the need to justify, with some transparency, the allocation of resources for the less common, but often more expensive conditions. Drawing on a case study of a rare genetic condition, this paper highlights the various pathways in the system that support or hinder access to care, to identify the policy directions for rare diseases in resource constrained settings. [ABSTRACT FROM AUTHOR]

The Massachusetts experience of health care reform before the Affordable Care Act of 2010 reveals a moral economy of care in which expanded access was met by neoliberal demands for accountability and cost control. Publicly subsidized health insurance programs in the U.S. are deeply concerned with managing and regulating low-income residents’ access to and coverage for medications. By focusing our attention on the new forms of social relations invoked by specific techniques of governing, analyses of accountability can help us understand the ways in which subjectivities are shaped through their encounters with overarching social and economic structures. This paper presents qualitative findings from a four-year, prospective study that combined two waves of survey and chart-based data collection with four qualitative methods. Medicaid patients are made accountable to their medication regimens as they must track their supply and obtain refills promptly; regular blood tests carried out by health care providers verify their adherence. Both patients and their physicians are subject to cost savings measures such as changing lists of covered medications. Finally, patients struggle to pay ever-increasing out-of-pocket costs for their medications, expenses which may keep patients from taking their medications as prescribed. The fraught relationship between trust, accountability, and verification finds emphatic expression in the moral economy of health care, where the vulnerability of the sick and their hope for a cure confront policies designed to hold down costs. [ABSTRACT FROM PUBLISHER]

This paper explores how tensions and power differentials within public mental health interact with the practices of media production in entertainment television. I present the findings of a qualitative study involving semi-structured interviews with story consultants from mental health organisations and Senior Executives, Producers and script-writers from UK television series (n = 14). Story advisors welcome the opportunity to reach larger and younger audiences in distinct ways and to share the ‘lived experience’ of mental distress through well-researched characters. They accept their relative lack of power to negotiate dramatic storylines which conflate mental distress with criminality and may undermine their anti-stigma ideals. The ‘medical model’ is prioritised in mainstream television drama and the causes of mental distress framed in biomedical terms. Storylines tend to emphasise the certain benefits of medication and marginalise self-management of conditions. Television industry professionals recognise their anti-stigma public service role and are receptive to working with programme consultants to help create authentic characters. Perceptions of the nature of drama as requiring resolution may help to explain the principal focus on biomedical conceptualisations of mental distress. Medication provides a relatively simple on-screen solution to resolve complex stories. Entertainment television operates within limited ideological frames. Mental distress and stigma are addressed at an individual, not collective level. Debates within the survivor movement and public mental health concerning medication, treatment and recovery tend to be obscured. These might provide a productive alternative vein of storytelling that could broaden our understanding of the social meaning of suffering and thus help challenge stigma. [ABSTRACT FROM AUTHOR]

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

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]

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

An introduction is presented in which the editor discusses articles in the issue on topics including how issues such as trust in government shape responses to contact tracing, the policy responses to COVID-19 that have exacerbated social divisions and undermined social justice and the ethnic inequalities in exposure to risk among health works in the British National Health Service (NHS).

In recent years, analyses of mainstream media constructions of the obesity ‘epidemic’ have proliferated within fat studies. Of less attention has been the visual representation of obesity. This paper presents an analysis of one particular form of graphic representation of obesity, that of the ‘fat (d)evolution’ image. This image parodies the iconography of the ‘march of progress’ – a series of figures of ascending height illustrating the evolution of mankind from ape to modern man. The fat (d)evolution image features an additional fat figure (and in some cases a final stage represented by a pig) frequently of declining height, thereby visualising obesity as a ‘kind of’ devolution. The paper analyses a sample of 18 such images that have appeared on book covers, websites and in media reports. It explores the confluence of discourses that produce the images’ multiple meanings and locates them within narratives of evolution and the ‘obesogenic environment’. Given the often comedic intent of the images, the analysis subsequently discusses the function of this humour, before considering how the images’ construction of fatness is also underpinned by discourses of gender, race and class. The findings suggest that the rhetorical success of these images relies on a radical ‘othering’ which intensifies the dehumanisation of fatness. [ABSTRACT FROM PUBLISHER]

Race and reproductive politics have been intimately entwined in Britain over centuries of colonialism and imperialism. As a critical reading of the autobiography of formerly enslaved Mary Prince testifies, African Caribbean women entered Britain against an established backdrop of racialised mythologies of errant black female sexuality and hyperfertility. Such beliefs prevail, producing disparities in black women°s reproductive choices, and informing and shaping public policy. Despite the evidence of racialised disparities in their reproductive choices, health and care, there is a paucity of scholarship addressing African Caribbean women°s reproductive experiences. Appreciating the historical function of race is vital to understanding contemporary reproductive experiences of black women, whose bodies continue to be critical sites in the exercise of state power. This position paper outlines some disparities in African Caribbean women°s reproductive experiences in relation to contraception, abortion and infertility in contemporary UK, and calls for greater research into their reproductive experiences, in order to better understand and meet their reproductive needs. [ABSTRACT FROM PUBLISHER]

As the number of older adults in the population increases, the rate of medical care use is expected to rise. As a result, geriatricians and gerontologists are researching predictors of medical care in later life, which includes ageism. Ageism within health care has been widely and frequently reported and it is thought to be a product of negative attitudes toward aging. The current review systematically explores the existing literature in this area and establishes seven themes within the research. From a predominantly American population of papers, themes that emerged were the following: physicians’ attitudes toward aging are complex and mixed; mixed associations among attitude, knowledge, and medical care; aging and disease symptom attributions among physicians; attitudes, knowledge, and exposure to older adults; the role of role models; the influence of the health care culture; and the influence of the health care system. These themes were considered separately and in tandem in order to explore avenues for future research that will clarify the influence that these psychosocial factors have on health care provided to older adults. [ABSTRACT FROM PUBLISHER]

The authors reflect on the issues of equity and power in public health and how to achieve a socially democratic public health by examining the views of Walby on social theory amidst the coronavirus pandemic. Also cited are S. Walby's focus on social democracy as a political philosophical factor on the relationship between a person and society, the intersection between effective governance and social justice, and how to balance the critical approaches to public health.

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

In recent years increasing media attention has highlighted the possibility that antidepressants may cause many disturbing side effects, including suicide. However, coverage of these issues has been criticised as negatively affecting people who suffer from depression. Employing the methods of discursive psychology, this paper examines how arguments are constructed for and against providing information about the full range of side effects of antidepressant medications, via the analysis of a public debate in which the potential side effects of SSRIs were the topic of concern. We demonstrate how one speaker draws on repertoires of consumer rights pitted against corporate profit motives to construct a case for the provision of warnings as a reasonable and obvious responsibility of pharmaceutical companies. The other speaker relies on separating practical from academic problems, and constructs the 'academic' question of serious side effects of SSRIs as a contentious and illegitimate concern in the public realm. The arguments employed by both opponents are discussed in terms of their rhetorical construction and social consequences. [ABSTRACT FROM AUTHOR]

This paper explores whether industry self-regulation of food advertising to children protects child rights. The New Zealand Advertising Standards Authority (ASA) system is analysed with respect to the United Nations Convention on the Rights of the Child (UNCROC). Content analysis of data sources such as the ASA website and key documents is used. Eight decisions on public complaints about advertising are analysed. This research finds that implementation of the codes includes partial, unjustified and inconsistent decision making by the complaints board; failure to implement changes to codes; and failure to prevent unhealthy food advertisements being developed and aired. The ASA system is found to be reactive, to have limited sanctions, to provide little incentive for restraint by advertisers, and to lack independent monitoring. This analysis suggests the New Zealand advertising standards system does not protect the rights of children by failing to enact the spirit of UNCROC and specifically by not adequately addressing Articles 3, 6 and 13. Given the extent of the harm to children worldwide of unhealthy eating patterns, the evidence of the contribution of marketing to poor nutrition and the findings of this research, it is concluded that government regulation of marketing of food to children should be implemented globally. This would assist governments to reduce the effects of one of the key environmental contributors to unhealthy eating patterns and enable them to meet their obligations in international law to protect the rights of children. [ABSTRACT FROM AUTHOR]

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]

Despite efforts to tighten the code of professional ethics amongst health workers by the Thai authorities, recent studies have shown that discrimination towards HIV-positive patients persists amongst nurses, thus compromising the quality of patient care. Using a framework of 'Othering', this paper examines the constructions of professional ethics and duties by a group of Thai nurses, with the aim of identifying problems with the existing approach to discrimination reduction. Twenty semi-structured interviews were conducted with qualified and trainee nurses from a Bangkok nursing college. Following a standard attitudinal measure of HIV-related stigma, participants were asked to explain the reasons behind their responses, and reflect on how these might have shaped their personal and professional encounters with HIV-positive patients. The findings showed that despite heightened awareness about the code of non-discrimination, biases towards HIV-positive patients were evident. Various strategies were employed to maintain a perception of the Self as being in line with the prescribed professional ethical guidelines while leaving personal biases towards HIV-positive patients unchanged. These included the dismissal of discrimination as conducts of 'Other' people (i.e. the lay public or unethical colleagues), redefining the nature of nursing duties to avoid providing certain services to HIV-positive patients (e.g. taking blood), and stigmatising patients on the basis of presumed/actual high-risk behaviours (e.g. injecting drug use) instead of HIV status. Broadening nurses' understanding of the distal factors relating to HIV transmission was discussed as an alternative approach for reducing nurses' biases towards patients with HIV/AIDS. [ABSTRACT FROM AUTHOR]

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

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

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

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