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Traditionally, health system performance assessments have focused on evaluating the health system itself, with less concern about the broader impacts of improved population health beyond the sector. However, in today's [...]

Underage drinking is a global public health problem that is accentuated in Western cultures due to the wide acceptance of alcohol use as a normative behavior among adults. Global rates [...]

The media are central arenas for actors challenging government practice, as those who succeed in publicly defining issues can influence public perceptions and policy outcomes. Taking into account the widespread civic participation in health media coverage, this study explores actor influence on the media framing of a contentious health policy issue, before and after a policy change. By means of media texts analysis, it analyses the relation between actor frames and the dominant media frames on the issue of priority setting of innovative pharmaceuticals. While confirming that actors vary in their ability to influence the media, the findings contend traditional conceptions that representation equates media influence and shed light on factors that affect frame influence. [ABSTRACT FROM AUTHOR]

: Introduction: The meaningful involvement of persons affected by a disease is a unique aspect of the HIV response that places people living with (PLHIV) and those directly affected by HIV (peers) at the centre of the design, development and implementation of service delivery and research and policy making. The principle of greater involvement of PLHIV (GIPA) has and will increasingly ensure equitable access to services and engagement of marginalized groups in the HIV response, and to health services more broadly. This paper describes the history, current place in the HIV response and potential future role of PLHIV and communities in health responses. Discussion: Historically, the role of communities of PLHIV and peers in service delivery, research and drug development, advocacy, social and political accountability, resource mobilization and social and human rights protection is well documented. Their leadership and engagement have contributed directly to improved outcomes in access to HIV treatment, prevention, support and care services around the world. Their continued and expanded role is especially important for the future success of HIV responses in sub‐Saharan Africa, where the HIV burden remains the greatest. The lessons learned from the leadership and involvement of communities of PLHIV and peers in the HIV response hold value beyond HIV responses. The models and approaches they have efficiently and effectively utilized have relevant applications in addressing shortfalls in health systems in the COVID‐19 era, as well as broader, more integrated health challenges as countries move to develop and operationalize universal health coverage (UHC). However, neither HIV nor other health and development targets can be met if their contributions are not adequately recognized, valued and funded. Conclusions: The past three decades have demonstrated that communities of PLHIV and their peers are instrumental in sustaining engagement and advocacy for health equity and financing for health and ensuring that the human rights of all people are recognized and upheld. Quality and effective integration of health systems and UHC can be more effectively designed, implemented and sustained with communities of PLHIV and peers at the centre., INTRODUCTION The principle of meaningful and greater involvement of people living with HIV/AIDS (GIPA) was first articulated at a conference in the United States [1] and then expanded globally [2]. [...]

More than 250 declarations proclaiming racism a public health crisis have been passed in localities across the U.S., according to an APHA tracking project. As of July, leaders in 21 [...]

The Institute of Medicine ( IOM) is one of the nation's more influential health-related non-profit organizations. It plays a large role in shaping health policy by commissioning panels to develop 'white papers' describing research and recommendations on a variety of health topics. These white paper publications are often used to help make policy decisions at the legislative and executive levels. Such a prominent institution might seem like a natural ally for policy-related collaborative efforts. As community psychologists, we strongly endorse efforts to positively influence public policy at the national level. However, while serving on influential panels and commissions like the IOM might seem to be very much part of the ethos of our discipline, there are occasions when such institutions are pursuing a mission that inadvertently has the potential to instigate divisive friction among community activists and organizations. A case study is presented whereby I describe my decision not to accept an invitation to serve on a controversial IOM panel. I explore the ethical challenges regarding maintaining my independence from this institution and its attempt to redefine chronic fatigue syndrome ( CFS) and myalgic encephalomyelitis ( ME), as well as the process of searching for alternative avenues for collaborating with community activists to influence policy related to these debilitating illnesses. [ABSTRACT FROM AUTHOR]

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There is significant literature demonstrating the interpenetrability of identity and space, yet there is almost no work that explores the co-production of queer identities and healthcare spaces. We use Lefebvre's triad of (social) space to explore how the social spaces of South African healthcare facilities shape and are shaped by queer service-users, drawing on data from interviews and focus group discussions with 29 queer service-users and 14 representatives of organisations. Findings reveal that healthcare spaces are produced by the spatial ordering of health policy inattentive to queer health needs; the enduring symbolic representations of queerness as pathological or 'un-African'; and various identity assertions and practices of individuals, including queer service-users and healthcare providers. As a result, healthcare spaces are overwhelmingly heteronormative, although queer service-users' subversive practices suggest alternative spatial configurations. However, such resistance relies on individual empowered action and risks disciplining responses. Wider efforts are needed to transform the material and ideological space of healthcare facilities through law and policy reform and continuing professional training for healthcare providers. [ABSTRACT FROM AUTHOR]

This article examines the ways in which childhood mortality as an ideological tool is constituted as a shared moral order in modern society. The examination of record‐keeping as an ideological practice that produces a governable and self‐regulating population allows us to identify how and where it is incorporated into social life as an everyday morality. Under this moral order, death must be constituted as a medical necessity, rendering it culturally relevant, in order for social life to continue to be considered a meaningful and purposeful endeavour. The child's status in society as a sacred citizen ensures that children's deaths are constituted in even more particular ways, so that the possibility of medically ‘unnecessary’ child death remains morally unthinkable and thus does not expose the ideological underpinnings that continue to produce social life as a moral and thus meaningful affair. [ABSTRACT FROM AUTHOR]

Bleeding emergencies can be encountered in many clinical settings. While there are some key common principles, a focussed targeted approach is also needed for optimum patient outcome depending on the scenario, for example trauma, obstetric, acute gastrointestinal. Coherent multidisciplinary management with explicitly clear communication in particular between clinical and laboratory teams is essential. Major haemorrhage protocols developed in consensus between key teams and based on national guidelines where available will help support management in these clinically fraught situations. Important lessons can be learnt with review of adverse events in patients with major haemorrhage and by reporting these to haemovigilance schemes. There has been a shift to early use of empirical blood and component ratios particularly in trauma. Further research is needed to help define a more evidence-based approach to management of patients with significant haemorrhage which is seen in a variety of clinical disciplines. [ABSTRACT FROM AUTHOR]

The Canadian public health sector's foundational values of social justice and equity, and its mandate to promote population health, make it ideally situated to take a strong lead in addressing persistent and unacceptable inequities in health between socially disadvantaged, marginalized or excluded groups and the general population. There is currently much attention paid to improving understanding of pathways to health equity and development of effective population health interventions to reduce health inequities. Strengthening the capacity of the public health sector to develop, implement and sustain equity-focused population health initiatives--including readiness to engage in a social justice-based equity framework for public health--is an equally essential area that has received less attention. Unfortunately, there is evidence that current capacity of the Canadian public health sector to address inequities is highly variable. The first step in developing a sustained approach to improving capacity for health equity action is the identification of what this type of capacity entails. This paper outlines a Conceptual Framework of Organizational Capacity for Public Health Equity Action (OC-PHEA), grounded in the experience of Canadian public health equity champions, that can guide research, dialogue, reflection and action on public health capacity development to achieve health equity goals. KEY WORDS: Public health practice; capacity building; health services research; disparities, health status; vulnerable populations Le secteur canadien de la sante publique, avec ses valeurs fondamentales de justice sociale et d'equite et son mandat de promotion de la sante des populations, est idealement situe pour jouer un role de premier plan face aux iniquites en sante persistantes et inacceptables entre les groupes socialement defavorises, marginalises ou exclus et la population generale. On essaie beaucoup, en ce moment, de mieux comprendre les voies de l'equite en sante et d'elaborer des interventions efficaces en sante des populations pour reduire les iniquites en sante. Une mesure tout aussi essentielle et pourtant moins reconnue est de renforcer les capacites du secteur de la sante publique a elaborer, a mettre en oeuvre et a soutenir des initiatives de sante des populations axees sur l'equite--y compris la volonte d'employer en sante publique une grille d'equite basee sur la justice sociale. Malheureusement, il semble que la capacite actuelle du secteur canadien de la sante publique d'aborder les iniquites varie considerablement. La premiere etape, si l'on veut mettre au point une approche soutenue en vue d'ameliorer les capacites d'agir sur l'equite en sante, est de determiner ce qu'une telle capacite implique. Notre article definit un ' cadre conceptuel de la capacite organisationnelle pour une action de la sante publique en matiere d'equite ', ancre dans l'experience des champions de la sante publique canadienne sur la question de l'equite, pour orienter la recherche, le dialogue, la reflexion et l'action sur le renforcement des capacites en sante publique et atteindre les objectifs d'equite en sante. MOTS CLES: pratique en sante publique; renforcement des capacites; recherche en services de sante; disparites d'etat sanitaire; populations vulnerables, The need to address growing health inequities--those disparities or inequalities in health between population groups that are systematically associated with underlying social disadvantage (1) --is an increasingly articulated global health [...]

Inequalities in the social determinants of health (SDH), which drive avoidable health disparities between different individuals or groups, is a major concern for a number of international organisations, including the World Health Organization (WHO). Despite this, the pathways to changing inequalities in the SDH remain elusive. The methodologies and concepts within system science are now viewed as important domains of knowledge, ideas and skills for tackling issues of inequality, which are increasingly understood as emergent properties of complex systems. In this paper, we introduce and expand the concept of adaptive policies to reduce inequalities in the distribution of the SDH. The concept of adaptive policy for health equity was developed through reviewing the literature on learning and adaptive policies. Using a series of illustrative examples from education and poverty alleviation, which have their basis in real world policies, we demonstrate how an adaptive policy approach is more suited to the management of the emergent properties of inequalities in the SDH than traditional policy approaches. This is because they are better placed to handle future uncertainties. Our intention is that these examples are illustrative, rather than prescriptive, and serve to create a conversation regarding appropriate adaptive policies for progressing policy action on the SDH. [ABSTRACT FROM AUTHOR]

Background: Despite available evidence for optimal management of spinal pain, poor adherence to guidelines and wide variations in healthcare services persist. One of the objectives of the Canadian Chiropractic Guideline Initiative is to develop and evaluate targeted theory- and evidence-informed interventions to improve the management of non-specific neck pain by chiropractors. In order to systematically develop a knowledge translation (KT) intervention underpinned by the Theoretical Domains Framework (TDF), we explored the factors perceived to influence the use of multimodal care to manage non-specific neck pain, and mapped behaviour change techniques to key theoretical domains. Methods: Individual telephone interviews exploring beliefs about managing neck pain were conducted with a purposive sample of 13 chiropractors. The interview guide was based upon the TDF. Interviews were digitally recorded, transcribed verbatim and analysed by two independent assessors using thematic content analysis. A 15-member expert panel formally met to design a KT intervention. Results: Nine TDF domains were identified as likely relevant. Key beliefs (and relevant domains of the TDF) included the following: influence of formal training, colleagues and patients on clinicians (Social Influences); availability of educational material (Environmental Context and Resources); and better clinical outcomes reinforcing the use of multimodal care (Reinforcement). Facilitating factors considered important included better communication (Skills); audits of patients' treatment-related outcomes (Behavioural Regulation); awareness and agreement with guidelines (Knowledge); and tailoring of multimodal care (Memory, Attention and Decision Processes). Clinicians conveyed conflicting beliefs about perceived threats to professional autonomy (Social/Professional Role and Identity) and speed of recovery from either applying or ignoring the practice recommendations (Beliefs about Consequences). The expert panel mapped behaviour change techniques to key theoretical domains and identified relevant KT strategies and modes of delivery to increase the use of multimodal care among chiropractors. Conclusions: A multifaceted KT educational intervention targeting chiropractors' management of neck pain was developed. The KT intervention consisted of an online education webinar series, clinical vignettes and a video underpinned by the Brief Action Planning model. The intervention was designed to reflect key theoretical domains, behaviour change techniques and intervention components. The effectiveness of the proposed intervention remains to be tested. [ABSTRACT FROM AUTHOR]

Background: HIV case-finding and linkage to care are critical for control of HIV transmission. In Kenya, >50% of seropositive individuals are unaware of their status. Assisted partner notification is a public health strategy that provides HIV testing to individuals with sexual exposure to HIV and are at risk of infection and disease. This parallel, cluster-randomized controlled trial will evaluate the effectiveness, cost-effectiveness, and feasibility of implementing HIV assisted partner notification services at HIV testing sites (clusters) in Kenya. Methods/design: Eighteen sites were selected among health facilities in Kenya with well-established, high-volume HIV testing programs, to reflect diverse communities and health-care settings. Restricted randomization was used to balance site characteristics between study arms (n = 9 per arm). Sixty individuals testing HIV positive ('index partners') will be enrolled per site (inclusion criteria: =18 years, positive HIV test at a study site, willing to disclose sexual partners, and never enrolled for HIV care; exclusion criteria: pregnancy or high risk of intimate partner violence). Index partners provide names and contact information for all sexual partners in the past 3 years. At intervention sites, study staff immediately contact sexual partners to notify them of exposure, offer HIV testing, and link to care if HIV seropositive. At control sites, passive partner referral is performed according to national guidelines, and assisted partner notification is delayed by 6 weeks. Primary outcomes, assessed 6 weeks after index partner enrollment and analyzed at the cluster level, are the number of partners accepting HIV testing and number of HIV infections diagnosed and linked to care per index partner. Secondary outcomes are the incremental cost-effectiveness of partner notification and the costs of identifying >1 partner per index case. Participants are closely monitored for adverse outcomes, particularly intimate partner violence. The study is unblinded due to practical limitations. Discussion: This rigorously designed trial will inform policy decisions regarding implementation of HIV partner notification services in Kenya, with possible application to other parts of sub-Saharan Africa. Examination of effectiveness and cost-effectiveness in diverse settings will enable targeted application and define best practices. [ABSTRACT FROM AUTHOR]

Background: In their article on "Evidence-based de-implementation for contradicted, unproven, and aspiring healthcare practices," Prasad and Ioannidis (IS 9:1, 2014) referred to extra-scientific "entrenched practices and other biases" that hinder evidence-based de-implementation. Discussion: Using the case example of the de-implementation of radical mastectomy, we disaggregated "entrenched practices and other biases" and analyzed the historical, economic, professional, and social forces that presented resistance to de-implementation. We found that these extra-scientific factors operated to sustain a commitment to radical mastectomy, even after the evidence slated the procedure for de-implementation, because the factors holding radical mastectomy in place were beyond the control of individual clinicians. Summary: We propose to expand de-implementation theory through the inclusion of extra-scientific factors. If the outcome to which we aim is appropriate and timely de-implementation, social scientific analysis will illuminate the context within which the healthcare practitioner practices and, in doing so, facilitate de-implementation by pointing to avenues that lead to systems change. The implications of our analysis lead us to contend that intervening in the broader context in which clinicians work--the social, political, and economic realms--rather than focusing on healthcare professionals' behavior, may indeed be a fruitful approach to effect change. [ABSTRACT FROM AUTHOR]

Background: To reduce the health inequity, it is necessary to measure and monitor these inequalities. In this regard, in Iran a plan was developed and accordingly 52 indicators to measure equity in health were developed and announced by the Ministry of Health in collaboration with other sectors. This study aims to obtain a deeper understanding of the development of health equity indicators and identify their implementation challenges and proposed solutions from the perspective of policy makers and executives responsible for the indicators development and implementation. Methods: In this qualitative study, data were gathered using semi-structured interviews with 15 Stakeholders involved in the development and implementation of these health equity indicators (at national and provincial levels), and the review and analysis of relevant documents including meeting minutes, working plans and working progress reports. Data were analyzed using a framework analysis approach. Results: Four main themes were identified, including the concept of equity in health and its importance, the use of health equity indicators and process of indicators development, challenges of development and implementation of the indicators and laying the groundwork for the establishment of indicators. The findings showed that policy makers' viewpoint on concepts and indicators is different from those of executives and their perceptions have little in common. The establishment of indicators requires accurate stakeholders' understanding and accurate insight into the issue of equity in health, political will, financing, training and empowerment of organization's employees, legal requirements, and finally a clear action plan. Conclusion: The development of the indicators requires a shared understanding among policy makers and executives. As the attention has been focused recently on the issue, in addition to knowledge improvement, proper solutions with an intersect oral collaboration approach in order to tackle challenges should be considered. [ABSTRACT FROM AUTHOR]

The goals of the Central California Regional Obesity Prevention Program (CCROPP) are to promote safe places for physical activity, increase access to fresh fruits and vegetables, and support community and youth engagement in local and regional efforts to change nutrition and physical activity environments for obesity prevention. CCROPP has created a community-driven policy and environmental change model for obesity prevention with local and regional elements in low-income, disadvantaged ethnic and rural communities in a climate of poor resources and inadequate infrastructure. Evaluation data collected from 2005-2009 demonstrate that CCROPP has made progress in changing nutrition and physical activity environments by mobilizing community members, engaging and influencing policymakers, and forming organizational partnerships. (Am J Public Health. 2010;100:2124-2128. doi: 10.2105/AJPH.2010.203588.)

In 2008, The Council of Australian Governments set a target to increase by 5% the proportion of Australian adults at a healthy body weight by 2017, over a 2009 baseline. Target setting is a critical component of public health policy for obesity prevention; however, there is currently no context within which to choose such targets. We analyzed the changes in current weight gain that would be required to meet Australian targets. By using transition-based multistate life tables to project obesity prevalence, we found that meeting national healthy weight targets by 2017 will require a 75% reduction in current 5-year weight gain. A reliable model of future body weight prevalence is critical to set, evaluate, and monitor national obesity targets. (Am J Public Health. 2010;100:2033-2037. doi: 10.2105/AJPH.2010.200337)

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1468-0009.2010.00604.x Byline: NORALOU P. ROOS (1), LESLIE L. ROOS (1), MARNI BROWNELL (1), EMMA L. FULLER (1) Keywords: Administrative data; registry; population health; policy analysis Abstract: Context: Information-rich environments, with access and funding provided by government, make it possible to organize longitudinal administrative data to support analyses of policy-relevant questions. This paper describes insights into children's well-being and social equity obtained from data available in Manitoba, Canada, and highlights findings that have engaged policymakers. Methods: Analyses draw on Manitoba-linked data providing information over time (going back to 1970 in some files) and across space (with residential location documented every six months) for each provincial resident. Routinely collected data from the Ministries of Health, Education, and Family Services and Consumer Affairs have been integrated with a population registry. Findings: Identifying risk factors and presenting outcomes by social groups and by local communities capture the attention of policymakers. Linking an individual's area of residence to census and health data has led to developing measures of population health status and socioeconomic status. These measures focus on whether delivery patterns track health and educational needs, and a population registry makes it possible to describe who is (and is not) served by each program. Conclusions: The nature of health and social research has been changed by the development of information-rich environments. Many findings in Manitoba could not be replicated without a population registry. Engaging decision makers through effective presentations can ensure continuing support for diverse efforts based on these environments, and this article suggests ways of better communicating with policymakers. Author Affiliation: (1)University of Manitoba; University of Western Australia Article note: Address correspondence to: Noralou P. Roos, Manitoba Centre for Health Policy, Department of Community Health Sciences, Faculty of Medicine, University of Manitoba, RM 408-727 McDermot Avenue, Winnipeg, MB R3E 3P5 (email: Noralou_Roos@cpe.umanitoba.ca).

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2010.05.017 Byline: Eric Racine (a)(b)(c)(d)(e)(f), Sarah Waldman (g)(h), Jarett Rosenberg (i), Judy Illes (g)(j)(k) Abstract: Technological innovations in neuroscience have opened new windows to the understanding of brain function and the neuronal underpinnings of brain activity in neuropsychiatric disorders and social behavior. Public interest and support for neuroscience research through initiatives like the Decade of the Brain project and increasingly diverse brain-related initiatives have created new interfaces between neuroscience and society. Against this backdrop of dynamic innovation, we set out to examine how different features of neuroscience are depicted in print media. We used the 'guided news' function of the LexisNexis Academic database with keyword searches to find news articles published between 1995 and 2004 in major U.S. and U.K. English-language news sources. We performed searches on headlines, lead paragraphs, and body terms to maximize search yields. All articles were coded for overall tone of coverage, details on reported studies, presence of ethical, legal, and social discussion as well as the emerging interpretations of neuroscience - in the form of neuro-essentialism, neuro-realism, and neuro-policy. We found that print media coverage of the use of neurotechnology for diagnosis or therapy in neuropsychiatric disorders was generally optimistic. We also found that, even within articles that were identified as research reports, many did not provide details about research studies. We also gained additional insights into the previously identified phenomena of neuro-essentialism, neuro-realism, and neuro-policy showing some profound impacts of neuroscience on personal identity and policy-making. Our results highlight the implications of transfer of neuroscience knowledge to society given the substantial and authoritative weight ascribed to neuroscience knowledge in defining who we are. We also discuss the impact of these findings on neuroscience and on the respective contributions of the social sciences and the biological sciences in contemporary psychiatry and mental health policy. Author Affiliation: (a) Neuroethics Research Unit, Institut de recherches cliniques de Montreal, 110 avenue des Pins Ouest, Montreal, Quebec H2W 1R7, Canada (b) Department of Neurology and Neurosurgery, McGill University, 3801 University Street, Montreal, Quebec H3A 2B4, Canada (c) Department of Medicine (Division of Experimental Medicine), McGill University, 1110 avenue des Pins Ouest, Montreal, Quebec H3A 1A3, Canada (d) Biomedical Ethics Unit, McGill University, 3647 Peel Street, Montreal, Quebec H3A 1X1, Canada (e) Department of Medicine, Universite de Montreal, C.P. 6128, Succ. Centre-Ville, Montreal, Quebec H3T 3J7, Canada (f) Department of Preventive and Social Medicine, Universite de Montreal, C.P. 6128, Succursale Centre-ville, Montreal, Quebec H3C 3J7, Canada (g) Stanford Center for Biomedical Ethics, Stanford University, 1215 Welch Road, Stanford, CA 94305-5417, USA (h) HB-Rex Program, Program in Human Biology, Stanford University, 450 Serra Mall, Stanford, CA 94305-2160, USA (i) Department of Radiology, Stanford University, 300 Pasteur Drive, Stanford, CA 94305-5105, USA (j) Department of Pediatrics, Stanford University, 300 Pasteur Drive, Stanford, CA 94305-5208, USA (k) National Core for Neuroethics, University of British Columbia Hospital, 2211 Wesbrook Mall, Vancouver, BC V6T 2B5, Canada

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2009.08.001 Byline: Jin Young Choi Abstract: Immigrant health care is the product of the dynamic interaction between societal factors and the individual's socio-economic and cultural characteristics. Our knowledge about immigrant health care, however, has been limited to individual characteristics, without paying attention to the social context in which immigrants reside. This paper explores the effects of social contexts on access to health care among recent immigrants. As a natural experiment, it compares health care experiences of three immigrant groups in Hawaii - Filipinos, Koreans, and Marshallese - who are situated in different social contexts including immigrant health policy, ethnic community, and individual networks. Through household surveys conducted between October 2005 and January 2006, information of 378 recent immigrant adults on health care access, health insurance status, socio-demographic characteristics, linguistic and cultural factors, health status, ethnic community social capital, and social networks was obtained. The results of analyses show that Marshallese respondents have better access to health care than the other two groups, in spite of their lowest socioeconomic status. The high insurance rate of the Marshallese, mainly associated with a state health policy that provides health insurance assistance for the Marshallese, is the major contributor of their greater health care access. While Filipino immigrants do not benefit from state insurance assistance, high levels of health care resources and social capital within the Filipino community enable them to have significantly better health care access than Koreans, who have higher income and educational attainment. Interestingly, the advanced family/kinship networks are associated with better levels of immigrant health care access, while the increase of co-ethnic friend networks is related to lower access to health care. This study implies that restoration of immigrants' eligibility for public health insurance assistance, development of health care resources and social capital within ethnic communities, and mobilization of immigrant networks would be effective starting points to improve health care access among immigrants. Author Affiliation: Sam Houston State University, Department of Sociology, 1901 Avenue I, Huntsville, Texas 77341, United States Article Note: (footnote) [star] I would like to express my gratitude to Sang-Hyop Lee, Ichiro Kawachi, anonymous reviewers, and the editor whose comments and suggestions have greatly improved the paper.

To authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1467-9566.2009.01179.x Byline: Carly W. Butler (1), Susan Danby (2), Michael Emmison (3), Karen Thorpe (4) Keywords: telehealth; nurse; child health; policy; conversation analysis Abstract: Abstract Child Health Line is a 24-hour Australian helpline that offers information and support for parents and families on child development and parenting. The helpline guidelines suggest that nurses should not offer medical advice; they do, however, regularly receive calls seeking such advice. This paper examines how the service guidelines are talked into being through the nurses' management of callers' requests for medical advice and information, and shows how nurses orient to the boundaries of their professional role and institutionally regulated authority. Three ways in which the child health nurses manage medical advice and information seeking are discussed: using membership as a nurse to establish boundaries of expertise, privileging parental authority regarding decision making about seeking treatment for their child, and respecifying a 'medical' problem as a child development issue. The paper contributes to research on medical authority, and nurse authority in particular, by demonstrating the impact of institutional roles and guidelines on displays of knowledge and expertise. More generally, it contributes to an understanding of the interactional enactment and consequences of service guidelines for telehealth practice, with implications for training, policy and service delivery. Author Affiliation: (1)School of Journalism and Communication, The University of Queensland, Australia (2)School of Early Childhood, Queensland University of Technology, Australia (3)School of Social Science, The University of Queensland, Australia (4)School of Psychology and Counselling, Queensland University of Technology, Australia Article note: Address for correspondence: Susan Danby, School of Early Childhood, Queensland University of Technology, Kelvin Grove Campus, GPO Box 2434, Brisbane Qld 4001, Australia e-mail: s.danby@qut.edu.au

To link to full-text access for this article, visit this link: http://dx.doi.org/10.1016/j.socscimed.2009.05.035 Byline: Blandine Bila (a)(b), Marc Egrot (c)(d) Abstract: Anthropological research in Burkina Faso indicates that more HIV-positive women than HIV-positive men are attending care facilities for people living with HIV/AIDS (PLWH) and accessing antiretroviral medicine. This article, situated in the field of study of interactions between gender and AIDS, offers a description of this asymmetry and an anthropological analysis of the socio-cultural determinants, through analysis of data from ethnographic research among PLWH and health actors. Examining social representations of femininity and masculinity in Burkinabe society and the organisation of the healthcare system in connection with gender shed light on the decision-making processes of both sexes around therapeutic choices and the itinerary of care. On the one hand, the social values attached to femininity, maternity and the status of wife create conditions for women that favour their attendance at care facilities for PLWH and encourage a widespread practice where wives take the place of their husbands in healthcare queues. Moreover, health policies and the effects of women's empowerment within the healthcare system strengthen women's access to health services. On the other hand, representations of masculinity are fully implicated in the cultural construction of men's reluctance to attend care facilities for PLWH. The values associated with this masculinity cause men to run great health, economic and social risks, not only for themselves, but also for their wives and children. By better understanding the interaction between gender, the experience of HIV and the institutional organisation of healthcare, we can identify ways to reduce men's reluctance to attend care facilities for PLWH and improve both prevention and treatment-oriented programmes. Author Affiliation: (a) Institut de Recherche en Sciences de la Sante (IRSS), Centre National de Recherche Scientifique et Technologique (CNRST), Ouagadougou, Burkina Faso (b) Centre de Recherche Cultures, Sante et Societes (CReCSS), Universite Paul Cezanne d'Aix-Marseille III, France (c) UMR 145 A'sida et maladies associeesA' de l'IRD, Institut de Recherche pour le Developpement, Universite de Montpellier I, France (d) FRE 7043 CNRS, Centre National de la Recherche Scientifique, Universite de Strasbourg, France Article Note: (footnote) [star] Translated from French by Sharon Calandra.

More and faster information will transform our experience of healthcare, according to policymakers, while social theorists have argued that medicine has become 'informatized': a new medical paradigm is being shaped. We question both the policy-led conflation of 'information' and 'healthcare' and ideas about the extent of the informatization of medicine, by exploring how these ideas resonate in medical wok revisiting our studies of expertise in two clinical domains where information technologies are central to practice. The projection of new information programmes as creating knowledge which is independent of space and time runs the risk of devaluing the experiential, haptic and affective knowledge of both apprentices and practitioners. Information, we argue, cannot underpin medicine unless it is recognized and defined as generative, dynamic and intimate, rather than storable and deliverable. KEY WORDS human--machine relations / information / intimacy / labour / medicine / mythology / practice

Modern health-care systems in OECD countries were built around hospitals and the preferences of organized medicine and are largely focused on acute-care services and services provided by doctors. Starting in the early 1980s, however, the professionalization in several countries of trades traditionally involved in health promotion, together with the constitution of a group of researchers in social epidemiology and the corresponding development of specialized schools and research centres, brought new actors into health policy-making worldwide. This led to the extension of contemporary health policy beyond the post-war bio-medical model into population health promotion and social policy. This article describes and analyses the means (and limitations) used by Canada and Sweden for extending the action radius of health policies. Results show that national policies in health promotion beyond the health sector contributed above all to developing and legitimizing an official discourse that presents social problems as factors affecting social inequalities in health. Health promotion represented a tool for maintaining central social norms, as national governments were re-defining their role in social policy. Les systemes modernes de soins de sante dans les pays de l'OCDE ont ete construits autour d'hopitaux et des preferences de la medecine organisee et sont essentiellement axes sur les services de soins intensifs de courte duree et les services medicaux. Cependant, depuis le debut des annees 1980, la professionnalisation des metiers traditionnellement impliques dans la promotion de la sante survenue dans plusieurs pays, associee a la constitution d'un groupe de chercheurs en epidemiologie sociale et le developpement d'ecoles et de centres de recherche specialises ont introduit de nouveaux acteurs dans l'elaboration de politiques en matiere de sante a l'echelle mondiale. Cela a entraine une transformation de la politique de la sante contemporaine, qui a depasse le modele biomedical d'apres-guerre pour s'etendre a la promotion de la sante de la population et a la politique sociale. Le present article decrit et analyse les moyens utilises par le Canada et la Suede pour etendre le rayon d'action des politiques de la sante et les limites auxquelles ils font face. Les resultats indiquent que les politiques nationales visant la promotion de la sante au-dela du secteur de la sante ont contribue avant tout a developper un discours officiel qui presente les problemes sociaux comme des facteurs ayant une incidence sur les inegalites sociales de la sante. La promotion de la sante a represente un outil pour maintenir des normes sociales nationales, alors que les gouvernements centraux redefinissaient leur role en matiere de politique sociale., The "new public health" (NPH) is an international professional movement for the promotion of health that tries to extend the "action radius" of public health beyond more traditional health interventions, [...]

Programs or policies that are effective in reducing social problems have several things in common: They acknowledge the realities of culture, respect the sociocultural underpinnings of the community, and are often built on an innovative understanding of the issues. Policies that are created without regard for the culture in which they are to operate are destined to fail. This study discusses cultural attributes of different motivations, benefits, and approaches to breast-feeding, depending on the development of their infrastructure, scientific understanding, reliance on myths to understand their environment, and social norms. It argues that in some cases ignorance and lack of scientific information result in policies (both formal and informal) that negatively impact breast-feeding, whereas in other cases cultural or social norms drive policy decisions. Three examples of policies that impact breast-feeding negatively are discussed in this article. Two of them relate to developing nations and the third occurred in the United States, although it could also occur anywhere people lack basic information about the impact of hormones on normal human physiology and human sexual response. KEYWORDS. Breast-feeding, health policy, infant, lactation and culture, women

In many European countries there is a public debate about the acceptability and regulation of enthanasia. In 2002, Belgium became the second country after the Netherlands to enact a law on euthanasia. Although euthanasia rarely occurs, the complexity of the clinical-ethical decision making surrounding euthanasia requests and the need for adequate support reported by caregivers, means that healthcare institutions increasingly need to consider how to responsibly handle euthanasia requests. The development of written ethics policies on euthanasia may be important to guarantee and maintain the quality of care for patients requesting euthanasia. The aim of this study was to determine the prevalence, development, position, and communication of written ethics policies on euthanasia in Flemish nursing homes. Data were obtained through a cross-sectional mail survey of general directors of all Catholic nursing homes in Flanders, Belgium. Of the 737 nursing homes invited to participate, 612 (83%) completed the questionnaire. Of these, only 15% had a written ethics policy on euthanasia. Presence of an ethics committee and membership of an umbrella organization were independent predictors of whether a nursing home had such a written ethics policy. The Act on Euthanasia and euthanasia guidelines advanced by professional organizations were the most frequent reasons (76% and 56%, respectively) and reference sources (92% and 64%, respectively) for developing ethics policies on euthanasia. Development of ethics policies occurred within a multidisciplinary context. In general, Flemish nursing homes applied the Act on Euthanasia restrictively by introducing palliative procedures in addition to legal due care criteria. The policy was communicated to the consulting general practitioner and nurses in 74% and 89% of nursing homes, respectively. Although the overall prevalence of ethics policies on euthanasia was low in Flemish nursing homes, institution administrators displayed growing awareness of bearing responsibility for stimulating dialogue and reflection about how to deal with euthanasia requests within their institution. Keywords: Belgium: Ethics policy; Euthanasia; Medical end-of-life decision making; Nursing homes; Palliative care