Search

Objective: This paper reports on a programme which sought to engage individuals and groups who are underrepresented in the UK labour market. The programme aimed to improve access to employment opportunities and provide practical support in job applications. The focus was on encouraging people to seek employment in the health and social care sectors and on tackling health inequalities in the region. Design: Qualitative inquiry. Setting: Leeds, UK. Method: Using focus groups and interviews, the paper explores key learning from the programme and the experience of programme delivery, both from the perspective of the professionals working on the programme and the individuals participating. Results: A co-ordinated strategic partnership where key agencies share common purpose is critical. The value of a localised strategy to engage communities was an important mechanism for success. Targeting schools and businesses provided opportunities to reach individuals who might usually find employment services difficult to access. The programme sought to put people’s aspirations at the heart of delivery, offering choice and tailored opportunities to develop their careers. This could include developing specific skills or raising awareness of potential careers. The programme promoted opportunities by removing barriers in the job application process. A range of positive health outcomes were reported for participants engaging in the programme that require further exploration. Conclusion: Meaningful employment is an important health determinant, but some communities face barriers to employment and consequently find the labour market difficult to access. Findings suggest a range of ways to engage people in meaningful employment and support.

This paper sought to explore how hospitals can be reconfigured to adopting more ‘health-promoting’ approaches and values. Specifically, the paper focuses on the role of hospital chaplaincy and argues that spiritual care should be considered alongside other health domains. Using semi-structured interviews, the aim of the paper is to explore the experiences of patients who accepted (n=10) and declined (n=10) hospital chaplaincy services. Data were analysed drawing on principles of Interpretative Phenomenological Analysis (IPA). The findings suggested that participants who accessed chaplaincy services reported using the chaplains for pastoral, religious and spiritual care which contributed positively to their sense of well being. This included religious rituals and supportive conversations. The majority of these participants had existing links with a faith institution. Participants who declined chaplaincy services reported having personal religious or spiritual beliefs. Other reasons cited, included: that the offer was made close to discharge; they had different support mechanisms; and were unaware of what the chaplaincy service offered. Participants identified a number of skills and attributes they associated with chaplains. They perceived them as being religious but available to all, somebody to talk to who was perceived as impartial with a shared knowledge and understanding. The paper concludes by highlighting the important role of chaplaincy as part of a holistic health-promoting hospital. This has implications not only for the design, delivery and promotion of chaplaincy services but also for health promotion more broadly to consider spiritual needs.

People struggle to tell their story of living with pain and when they do it is articulated in a way that may not be understood, heard or taken seriously. Unmasking Pain is an artist-led project that explored creative approaches to tell stories of life with pain. The project was led by a dance theatre company that specialises in storytelling and emotional experiences for players and audiences. The project involved artists and people living with ongoing pain co-creating activities and environments to curiously explore "oneself", through imagination and creative expression. This article discusses insights and perspectives emerging from the project. The project revealed the power of art to make-sense of oneself with or without pain, and how art facilitates expression of complex inner experience and personal stories. People described Unmasking Pain as "explorative joy despite pain", and "a new set of rules" that contrasts with those experienced during clinical encounters. We discuss how art has the potential to improve clinical encounters and promote health and well-being, and whether artist-led activities are an intervention, therapy, or something else. Pain rehabilitation specialists from the project described Unmasking Pain as "freeing-up thinking", allowing conceptual thought beyond the biopsychosocial model of pain. We conclude that art has the potential to shift people living with pain from "I can't do, I am not willing to do it" to "Perhaps I can, I'll give it a go, I enjoyed".

Purpose The paper offers commissioners and practitioners insights into how a gender and culturally sensitive Covid-19 vaccination clinic was set up in a local area that was experiencing lower uptake rates. Design/methodology/approach This paper seeks to examine and share a city-wide approach to improve vaccine uptake in a large metropolitan city in the UK. Findings In mitigating inequalities and ensuring underserved populations have access to the Covid-19 vaccine, there is a need to work with communities to develop vaccine clinics that provide a local, convenient and trusted offer that meets the needs of residents. Originality/value Developing a local Covid vaccine offer that meets cultural needs focusing on an area of low uptake in a large metropolitan city.

Employment is a key determinant of health and is consistent with a range of positive health, social and economic outcomes for individuals and communities. This paper focuses on an innovative skills and employment project undertaken in Leeds, a large metropolitan city in the United Kingdom. It sought to create an employment pathway from the community into hospital-based employment, mirroring theoretical aspects of the health-promoting hospital philosophy, or more broadly a settings approach to health promotion which seeks greater levels of social justice. Using qualitative methodology with key constituents of the programme, the research identified an approach to connecting local communities with paid employment roles in a local hospital. The research focussed on the conception, design and delivery of the programme and has showed the elements required to increase the likelihood of success. This includes providing a bespoke support and tailored intervention package for individuals and strong partnership working between delivery partners and strategic groups. While the focus of the research is not on outcomes, there are examples of instances where individuals had gained employment and skills; increases in confidence; and evidence of the programme raising aspirations for themselves and others.

Structural approaches to promoting health focus on policies and practices affecting health at the community level and concentrate on systems and forces of society, including distribution of power, that foster disadvantage and diminish health and well-being. In this paper we advocate consideration of structural approaches to explore macro level influences on the burden of persistent pain on society. We argue that health promotion is an appropriate discipline to ameliorate painogenic environments and that a "settings approach" offers a crucial vehicle to do this. We encourage consideration of socio-ecological frameworks to explore factors affecting human development at individual, interpersonal, organizational, societal, and environmental levels because persistent pain is multifaceted and complex and unlikely to be understood from a single level of analysis. We acknowledge criticisms that the structural approach may appear unachievable due to its heavy reliance on inter-sectoral collaboration. We argue that a settings approach may offer solutions because it straddles "practical" and cross-sectorial forces impacting on the health of people. A healthy settings approach invests in social systems where health is not the primary remit and utilises synergistic action between settings to promote greater health gains. We offer the example of obesogenic environments being a useful concept to develop strategies to tackle childhood obesity in school-settings, community-settings, shops, and sports clubs; and that this settings approach has been more effective than one organisation tackling the issue in isolation. We argue that a settings approach should prove useful for understanding painogenic environments and tackling the burden of persistent pain.

Background Local government has become a key constituent for addressing health inequalities and influencing the health of individuals and communities in England. Lauded as an effective approach to tackle the multiple determinants of health, there are concerns that generating and utilising research evidence to inform decision-making and action is a challenge. This research was conducted in a local authority situated in the north of England and addressed the research question – ‘What is the capacity to collaborate and deliver research?’. The study explored the assets that exist to foster a stronger research culture, identified barriers and opportunities for developing research capacity, and how a sustainable research system could be developed to impact on local residents’ health and reduce health inequalities. Methods This was a qualitative study utilising semi-structured interviews and focus groups. The study used an embedded researcher (ER) who was digitally embedded within the local authority for four months to conduct the data collection. Senior Managers were purposively sampled from across the local authority to take part in interviews. Three focus groups included representation from across the local authority. Framework analysis was conducted to develop the themes which were informed by the Research Capacity Development framework. Results Tensions between research led decision making and the political and cultural context of local government were identified as a barrier to developing research which addressed health inequalities. Research was not prioritised through an organisational strategy and was led sporadically by research active employees. A recognition across leaders that a culture shift to an organisation which used research evidence to develop policy and commission services was needed. Building relationships and infrastructure across local government, place-based collaborators and academic institutions was required. The embedded researcher approach is o

Strategies to reduce the burden of persistent pain in society are rooted in a biomedical paradigm. These strategies are located downstream, managing persistent pain once it has become a problem. Upstream activities that create social conditions to promote health and wellbeing are likely to help, yet health promotion discourse and research is lacking in pain literature. In this article we argue that the subjective nature of pain has not sat comfortably with the objective nature of medical practice. We argue that the dominance of the biomedical paradigm, with a simplistic ‘bottom-up’ model of pain being an inevitable consequence of tissue damage, has been detrimental to the health and well-being of people living with persistent pain. Evidence from neuroscience suggests that bodily pain emerges as perceptual inference based on a wide variety of contextual inputs to the brain. We argue that this supports community, societal and environmental solutions to facilitate whole-person care. We call for more salutogenic orientations to understand how people living with persistent pain can continue to flourish and function with good health. We suggest a need for ‘upstream’ solutions using communitybased approaches to address cultural, environmental, economic, and social determinants of health, guided by principles of equity, civil society, and social justice. As a starting point, we recommend appraising the ways human society appreciates the aetiology, actions, and solutions towards alleviating persistent pain.

Objectives: Gambling is a public health concern, given the multiplicity of harms for individuals, families and communities. This paper reports on the commissioning and delivery of a problem gambling treatment service in a metropolitan area in England where the concentration of problem gambling is often higher than the national average. Study design: A cross-sectional study, using purposively sampled ‘experts’ and stakeholders involved in the conception and set-up of the service. Methods: Individual semi-structured interviews were used to ascertain the depth of information required to fully appreciate the nuances and complexities of the service. Eight participants took part in the interviews with an additional respondent providing written comments in relation to the interview schedule as a workaround to accommodate the organisational impacts of Covid-19. Results: The paper identifies several factors contributing to the successful delivery of the service. Well-managed collaborative provision with expertise from across sectors is critical, but this needs to be balanced against the challenges faced by bridging cultural variances in practice and language. Adopting evidence-based models of delivery was central to practice and moreover geographical location is a key consideration to encourage access for those facing gambling problems and discourage feelings of stigma. Conclusions: This paper offers a unique contribution to understanding more about the provision of gambling treatment services. This is crucial given that greater numbers of people face challenges as a consequence of gambling harms and such services should be seen part of forming a coherent public health response.

Background: The Scottish Prison Service (SPS) has been long regarded for its progressive policy approach to health promotion in prison. It is one of the few countries with a strategic plan for health promotion implementation. Given the paucity of understanding in relation to the concept of a health promoting prison, this study assessed routinely collected prison inspection data to understand and distil learning in regard the practical implementation of health-promoting prisons. Methods: Her Majesty's Chief Inspector of Prisons for Scotland (HMIPS) oversees the independent inspection of all prisons. This desk-based study analysed openly accessible inspection reports from a public repository. The sample was limited to inspection reports using the 2018 revised Standards to ensure comparability between reports. Eight unique inspection reports meeting this criterion were downloaded between January and October 2020. The prisons had their inspections undertaken between May 2018 and January 2020. Data from the reports which focused on ‘health and wellbeing’ were inductively coded using NVivo 12 to support thematic analysis. Results: Results are presented against the values and principles outlined in the SPS’ own framework for promoting health in prison. All of the institution reports contained evidence of fairness and justice in their prison and understandings of health inequalities were recognised by staff. There were also examples of mutual (peer) support between people in prison; good relationships between staff and prisoners; and strong health promotion leadership. Conversely, some environmental conditions hindered the development of health promotion – this included staffing shortages and some practices fostering health inequity. Even where a prison was reported as having health promotion activities in place these were focused on a narrow range of individual risk factors such as smoking cessation or substance misuse. Far less attention was paid to wider health determina

Although our systems of thought have long accustomed us to differentiate sharply between the human world of ‘culture’ and the animal world of ‘nature’, both sides of this very influential dichotomy are entangled in complex and indissoluble ways. The civet cat and its very special perfume—civet—provide a perfect example of this ‘merging’. The idea of taming the untamable, expressed in paintings of civet cats and textual sources, has been especially fruitful and became a promising preoccupation especially for artists like Joris Hoefnagel to enrich their work with an intellectual hybridity. The article shows how—in painting, perfume, and writing—nature and culture complemented one another, rather than standing in opposition. Owing to the animal’s odour, its mysterious nature, and debates about its (un)tamability, the image of the civet cat served as a focal point through which early modern Europeans wrestled with and redefined the realms of human and animal, of art and science, and of culture and nature.

The role of health promoters and educators in the current and future response to COVID-19 is critical, but, to date, under explored. This opinion paper offers a number of important contributions that this professional group may offer both in the immediate and future strategy of global public health. While the importance of a medical model of health cannot be underplayed, the social model of health suggests that some groups in society are being more disproportionately impacted than others. Health promotion has been committed to reducing inequalities and therefore offers ‘a voice’ to those most marginalised. The paper suggests that bottom-up approaches focusing on building individual and community control is essential and, moreover, the concepts of a settings approach in health promotion, the fostering of critical health literacy and ‘salutogenesis’ may be worthy of further debate and discussion.

Purpose: There is interest in promoting health in prison from governmental levels, but, to date, understanding how best to do this is unclear. This paper argues that nuanced understanding of context is required in order to understand health promotion in prison and examines the potential for empowerment, a cornerstone of health promotion practice, in high-security prison establishments. Design/methodology/approach: Independent prison inspections, conducted by Her Majesty’s Inspectorate of Prisons for England and Wales (HMIP), form a critical element in how prisons are assessed. Documentary analysis was undertaken on all eight high-security prison reports using framework analysis. Findings: Analysis revealed elements of prison life which were disempowering and antithetical to health promotion. While security imperatives were paramount, there were examples where this was disproportionate and disempowered individuals. The data shows examples where, even in these high-security contexts, empowerment can be fostered. These were exemplified in relation to peer approaches designed to improve health and where prisoners felt part of democratic processes where they could influence change. Practical implications: Both in the UK and internationally, there is a growing rhetoric for delivering effective health promotion interventions in prison, but limited understanding about how to operationalise this. This paper gives insight into how this could be done in a high-security prison environment. Originality/value: This is the first paper which looks at the potential for health promotion to be embedded in high-security prisons. It demonstrates features of prison life which act to disempower and also support individuals to take greater control over their health.

This paper seeks to critically discuss the current state of health promotion, arguing that ambiguity remains in its conceptual foundation, practice and education which is contributing to its decline in several parts of the world. Drawing on relevant literature, the paper re-examines the status of health promotion as a specialist discipline in its own right and suggests that the reaffirmation of this status can move health promotion from the margins to the mainstream of public health policy and practice. The paper briefly rehearses some common conceptualisations of health promotion before suggesting four tensions which, if resolved, could offer greater conceptual clarity and galvanise the contribution of the discipline in addressing individual and community health across the globe.