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Physicians are well-known for safeguarding medical professionalism by performing institutional work in their daily practices. However, this study shows how opinion-making physicians in strategic arenas (i.e. national professional bodies, conferences and high-impact journals) advocate to reform medical professionalism by discursively framing physicians as leaders. The aim of this article is to critically investigate the use of leadership discourse by these opinion-making physicians. By performing a discursive analysis of key documents produced in these strategic arenas and additional observations of national conferences, this article investigates how leadership discourse is used and to what purpose. The following key uses of medical leadership discourses were identified: (1) regaining the lead in medical professionalism, (2) disrupting ‘old’ professional values, and (3) constructing the ‘modern’ physician. The analysis reveals that physicians as ‘leaders’ are expected to become team-players that work across disciplinary and organizational boundaries to improve the quality and affordability of care. In comparison to management that is negatively associated with NPM reform, leadership discourse is linked to positive institutional change, such as decentralization and integration of care. Yet, it is unclear to what extent leadership discourses are actually incorporated on the work floor and to what effect. Future studies could therefore investigate the uptake of leadership discourses by rank and file physicians to investigate whether leadership discourses are used in restricting or empowering ways. [ABSTRACT FROM AUTHOR]

The present paper analyses the emergence and characteristics of Israeli Medical Association (IMA) discourse on health inequality in Israel during the years 1977–2010. The IMA addressed the issue of health inequality at a relatively late stage in time (2000), as compared to other OECD countries such as the UK, and did so in a relatively limited way, focusing primarily on professional or economic interests. The dominant discourses on health inequalities within the IMA are biomedical and behavioral, characterized by a focus on medical and/or cultural and behavioral differences, the predominant use of medical terminology, and an individualistic rather than a structural conceptualization of the social characteristics of health differences. Additionally, IMA discourses emphasize certain aspects of health inequality such as the geographical and material inequities, and in doing so overlook the role played by class, nationality and the unequal structure of citizenship. Paradoxically, by disregarding the latter, the IMA's discourse on health inequality has the potential to reinforce the structural causes of these inequities. Our research is based on a textual critical discourse analysis (CDA) of hundreds of documents from the IMA's scientific medical journal, the IMA's members journal and public IMA documents such as press-releases, Knesset protocols, publications, and public surveys. By providing knowledge on the different ways in which the IMA, a key stakeholder in the health field, de-codifies, understands, explains, and attempts to deal with health inequality, the article illuminates possible implications on health policy and seeks to evaluate the direct interventions carried out by the IMA, or by other actors influenced by it, pertaining to health inequality. [ABSTRACT FROM AUTHOR]

After decades of refugee displacement, Somalis are at increased risk for poor mental health. However, uptake of treatment referrals in primary care is low among Somalis compared to other refugee groups. The objective of this analysis was to understand specific resistances to US mental health care contributing to this gap in coverage. One hundred and sixty-eight Somali men and women over the age of 14, participated in 28 focus group from October 2017 to November 2018 discussing wellbeing and healthcare in the US. Transcripts were analyzed based on critical discourse theory, informed by the theoretical work of Michel Foucault. This study identified two primary discourses, one biomedical and the other driven by Somali community mental health knowledge and social practice. Mental health as an object of Muslim faith, nosological fusion of psychiatric illness terms, and stigmatization and internal social control to limit disclosure were discussed. US mental health services were described as giving off a bad vibe, and represented external institutions of power, exacerbated by perceived discrimination. Somali youth occupied social bridging positions between cultural vs. US knowledge and practice. Three negotiating discourses emerged wherein participants created discursive solutions to these sites of resistance, including 1) how the social acceptability of seeking psychological care might be increased while maintaining Somali emotional resilience, 2) stressing the need to seek medical care as a practical supplement to spiritual care, and 3) highlighting the need for Somali youth to enter health fields. Findings suggest that intervention strategies not only ensure that services are culturally appropriate and sensitive to religion, but also consider that services are potentially seen as both an extension of US institutional power and an affront to Somali identity making. Overcoming these challenges may involve nurturing the negotiating discourses taken up by communities. • Biomedical mental health discourse is incongruent with Somali identity making. • Participants found their own discursive solutions to these incongruencies. • Cultural values of pragmatism and bravery may offset mental health stigma. • Somali youth hold vast social and societal potential to bridge this divide. • Successful interventions will nurture communities' existing discursive solutions. [ABSTRACT FROM AUTHOR]

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

Unhealthy diets are increasing contributors to poor health and mortality in low- and middle-income countries (LMICs). Government interventions targeting the structural drivers of unhealthy diets are needed to prevent these illnesses, including nutrition labelling regulations that create healthier food environments. Yet, implementation remains slow and uneven. One explanation for slow implementation highlights the role of politics, including powerful ideological discourse and its strategic deployment by economically powerful actors. In this article, we advance research on the politics of nutrition policies by analysing political discourse on nutrition labelling regulations within an influential and under-studied global institution: the World Trade Organization (WTO). We identified WTO Technical Barriers to Trade (TBT) Committee meeting minutes with reference to nutrition labelling policies proposed by Thailand, Chile, Indonesia, Peru, Ecuador, Bolivia, and Uruguay (2007–2019; n = 47). We analysed the frames, narratives, and normative claims that feature in inter-country discourse within TBT meetings and examined how actors mobilize ideological and material sources of power via these statements. We find that informal government challenges to nutrition labelling proposals within the Committee featured a narrative that individualized the causes of and solutions to poor diet, downplayed harms from industrialised food products, and framed state regulation as harmful and unjust. These non-technical claims mobilised neoliberal ideology and rhetoric to contest the normative legitimacy of members' proposals and to de-socialize and de-politicize poor diets. Furthermore, high-income countries (HICs) re-framed policy goals to focus on individual determinants of poor nutrition whilst calling for their preferred policies to be adopted. Patterns of discourse within TBT meetings also had striking similarities with arguments raised by multi-national food corporations elsewhere. Our findings suggest that non-technical and ideological arguments raised during TBT meetings serve as inconspicuous tools through which nutrition labelling policies in LMICs are undermined by HICs, industry, and the powerful ideology of neoliberalism. • Critical discourse analysis of informal challenges to nutrition labelling polices. • Informal challenges occurred at the World Trade Organization (WTO), 2007–2019. • Challenges individualized, de-socialized, and de-politicized unhealthy diets. • Challenges invoked neoliberal ideology and industry rhetoric. • Discourse, and its deployment by powerful actors, may inconspicuously shape policy. [ABSTRACT FROM AUTHOR]

Social science literature has documented how the concept of diagnosis can be seen as an interactive process, imbued with uncertainty and contradiction, which undermines a straightforward notion of diagnosis as a way to identify underlying biological problems that cause disease. We contribute to this body of work by examining the process of resolving contradiction in autism diagnosis for adults and adolescents. Autism is a useful case study as diagnosis can be a complex and protracted process due to the heterogeneity of symptoms and the necessity to interpret behaviours that may be ambiguous. We audio-recorded and transcribed 18 specialist clinical assessment meetings in four teams in England, covering 88 cases in two adult, one child and one adolescent (14+) setting. We undertook a qualitative analysis of discursive processes and narrative case-building structure utilised by clinicians to counteract contradiction.We identified a three-part interactional pattern which allows clinicians to forward evidence for and against a diagnosis, facilitates their collaborative decision-making process and enables them to build a plausible narrative which accounts for the diagnostic decision. Pragmatism was found to operate as a strategy to help assign diagnosis within a condition which, diagnostically, is permeated by uncertainty and contradiction. Resolution of contradiction from different aspects of the assessment serves to create a narratively-coherent, intelligible clinical entity that is autism. • Diagnosis of autism in adults and young people can be complex and contradictory. • Discursive analysis examined how teams deliver a coherent diagnostic narrative. • An interactional pattern in team decision-making helps to resolve contradiction. • Considering social outcomes is used as a strategy to help assign diagnosis. • This decision-making process contributes to how we understand autism. [ABSTRACT FROM AUTHOR]