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Traditionally, studies of work practices within Science and Technology Studies focus on uses of technological devices. By doing so, studies have shown how human actions are formed and transformed by the use of technology. In this paper we transfer inspiration from STS and ANT to a type of work which is characterized by its non-technological character, namely immaterial work, exemplified by service work in the wellness industry. Based on observations from Swedish hotel spas made by the ethnologist Tom O’Dell, we examine the production of immaterial goods such as wellness and serenity. Often, service work is described as emotion work that takes place in face-to-face interactions. By means of ANT we challenge this description, emphasizing the roles that various materials and actors play in producing experiences of wellness. For example towels, oil, and water seem crucial in constituting spa products. Moreover, we highlight the work that customers carry out to enable the production of their own well-being. Inspired by the French ANT-sociologists Antoine Hennion and Emilie Gomart we suggest that spa guests use spa products to make these products influence them. In other words, attachments to objects are made to let these objects become active. Thus, we conclude that the work of producing spa experiences consists in the emotion work that service workers carry out, together with the materi als that they employ and the preparations that customers make.

Contemporary disease self-management programs aim to renegotiate the terms on which patients participate in their own health care. Though the notion of ‘patient 2.0’ has mainly been used to speak to patient empowerment through IT, we therefore propose to view self-management as eliciting “the patient” in a different shape. In this paper, we explore the embedded assumptions, imagined potentials and concrete practices of the Stanford Chronic Disease Self-Management Program (CDSMP), in order to understand how this program reconfigures a particular form of global patient. To analyse this process we consider the CDSMP as a traveling technology. First, we demonstrate that its successful globalization has been enabled by tying together specific forms of theorizing, evidence-basing, and scripting in a theory-methods package. Second, we show that the globalization of the program entails various forms of localization in the national health care setting of Denmark. In this context, we examine different kinds of efforts required to maintain the ‘global’ identity of the program even as it is ‘localized’. In particular, we show that the insertion of the program into Danish health care generates frictions. Such frictions are brought to light comparatively as Danish health care policy-makers, practitioners, consultants and chronic patients engage with and reflect upon the characteristics of the program. We argue that this analysis holds implications for ‘patient 2.0’, both as practical accomplishment and as a conceptual tool for social studies of medicine and health care.

PurposeSince the emergence of new public health in the 1970s, health has not merely been considered the absence of disease, but physical, mental and social wellbeing. This article seeks to analyzes the implications of this broad concept of health at an organizational level.Design/methodology/approachThe paper presents a qualitative case study of boundary drawing in a Danish municipal agency in charge of planning and conducting health promoting and disease preventing activities from 1989 to 2005. The theoretical framework draws on Niklas Luhmann's organization theory.FindingsTwo different organizational answers were found to the challenges inherent in the broad concept of new public health. First, the organization tried to increase its size and incorporate as many aspects of the environment as possible. This expansive strategy jeopardised the identity of the organization. Second, the organization tried to keep clear and tight boundaries and from this position irritate entities in the environment. This limitative strategy made the organization spend relatively more energy on organizing and controlling itself than on public health work.Practical implicationsThe case study shows how a broad concept of health makes boundary management topical in organizations dealing with health promotion and disease prevention. Organizations in charge of public health activities need to reflect on how they can create intelligent compensations for the disadvantages involved in an expansive or a limitative strategy.Originality/valueThe broad concept of health inherent in new public health has been widely accepted and yet its challenges to organizational boundary drawing have attracted little attention. This paper provides an analysis of these challenges.

As already recognized, though little theorized within International Relations, the capacity of technology to ensure the achievement of preset policy goals is often grossly overrated. Drawing on Science and Technology Studies, this chapter proposes a lens to investigate global encounters, which take the technologies, involved in such encounters seriously both analytically and methodologically. This approach provides the opportunity not only to see how technology plays an important part in shaping global encounters and gets shaped itself in the process. It also allows us to appreciate the complex and productive nature of the friction these encounters produce. The proposed lens is used to analyze a specific global encounter illustrative of the way in which technologies increasingly become central to global encounters concerning health. In this encounter Danish and Indonesian partners are engaged in implementing a Danish developed quality assurance software for diabetes management in Indonesian primary care. We analyze what is at stake for the partners and what role the technology plays in shaping these stakes. The analysis points to the ambiguous and often contentious nature of technology in global encounters. The challenges met as the technology moves from Danish health care to an Indonesian context cannot be explained with reference to generalizing notions such as structural barriers, local culture or stakeholder interests. Instead attention to the frictions of global encounters provides insights to the conditions for and effects of movement of health technologies across geographical borders and thus to research at the intersection of Global Health and International Relations.

Despite three decades of reform Denmark’s health sector is still struggling to provide coordinated care for an ageing population with a high burden of chronic disease. Andreas Rudkjobing and colleagues describe recent initiatives to improve continuity of care

Denmark has a tradition of a decentralized health system. However, during recent years, reforms and policy initiatives have gradually centralized the health system in different ways. The structural reform of 2007 merged the old counties into fewer bigger regions, and the old municipalities likewise. The hospital structure is undergoing similar reforms, with fewer, bigger and more specialized hospitals. Furthermore, a more centralized approach to planning and regulation has been taking place over recent years. This is evident in the new national planning of medical specialties as well as the establishment of a nationwide accreditation system, the Danish Healthcare Quality Programme, which sets national standards for health system providers in Denmark. Efforts have also been made to ensure coherent patient pathways - at the moment for cancer and heart disease - that are similar nationwide. These efforts also aim at improving intersectoral cooperation. Financially, recent years have seen the introduction of a higher degree of activity-based financing in the public health sector, combined with the traditional global budgeting.A number of challenges remain in the Danish health care system. The consequences of the recent reforms and centralization initiatives are yet to be fully evaluated. Before this happens, a full overview of what future reforms should target is not possible. Denmark continues to lag behind the other Nordic countries in regards to some health indicators, such as life expectancy. A number of risk factors may be the cause of this: alcohol intake and obesity continue to be problems, whereas smoking habits are improving. The level of socioeconomic inequalities in health also continues to be a challenge. The organization of the Danish health care system will have to take a number of challenges into account in the future. These include changes in disease patterns, with an ageing population with chronic and long-term diseases; ensuring sufficient staffing; and deciding how to improve public health initiatives that target prevention of diseases and favour health improvements.