Critical Public Health

of change' model has greatly influenced health promotion practice in the USA, Australia and the UK since the late 1980s. Application of the model has shaped service planning, provision and implementation. 'Stages of change' also has impacted on training agendas at local, regional and national levels. Associated areas of motivational interviewing and brief intervention have led health promotion initiatives in areas such as smoking cessation and alcohol-reduction policies. A number of critiques have recently challenged the 'stages of change' model and health promotion orthodoxy. This review examines these critiques, with a focus on the 'scienti c' status of 'stages of change'. The review also examines a data-based approach to stages of change, model adequacy, the social and ideological context of change theories in health promotion contexts, levels of explanation and prediction in the 'stages of change' framework. Some reasons are offered for the apparent popularity of the model amongst health promotion workers. Recommendations are made about alternative conceptual frameworks.

The transtheoretical or 'stages of change' model has greatly influenced health promotion practice in the USA, Australia and the UK since the late 1980s. Application of the model has shaped service planning, provision and implementation. 'Stages of change' also has impacted on training agendas at local, regional and national levels. Associated areas of motivational interviewing and brief intervention have led health promotion initiatives in areas such as smoking cessation and alcohol-reduction policies. A number of critiques have recently challenged the 'stages of change' model and health promotion orthodoxy. This review examines these critiques, with a focus on the 'scienti c' status of 'stages of change'. The review also examines a data-based approach to stages of change, model adequacy, the social and ideological context of change theories in health promotion contexts, levels of explanation and prediction in the 'stages of change' framework. Some reasons are offered for the apparent popularity of the model amongst health promotion workers.

The purpose of the study was to broaden understanding of structural racism by examining the relationships between Indigenous peoples and nation-states in the context of education and how this affects Indigenous lives. This thesis delves into understanding both the theoretical and methodological contributions that more critical analyses can have on: the role of de-colonial approaches to Indigenous health research methodologies so that the most urgent health inequities are addressed through more rigorous and Indigenous specific research processes; and to improve our understanding of the complex interactions that historical and contemporary legacies of residential schools and boarding schools have on the health and well-being of Indigenous populations in Canada and Finland.

The idea of a social dimension of health is widely accepted as unavoidable and relevant for public health. This article proposes a reflection around the notion of the social examining some of the manifold ways in which it might be inherited by researchers, professionals, administrative staff and material settings involved in the practices of public health care. It will be argued that this inheritance has deep consequences for efforts of care inasmuch these different versions of the social characterise, circumscribe and reframe the health-society relation, modifying the scope under which public health issues are tackled or dismissed. To ground this seemingly abstract discussion I will work considering a specific public health problem: the case of frequent attenders in public health. Drawing on two approaches from the Sociology of Health (i.e. illness-behaviour and the user-professional relation) and the field of Science and Technology Studies, I will show how these ways of framing the study of frequent attenders assume and simultaneously promote three different versions of the social. The article aims to explore how social research in these traditions participate in the achievement and promotion of specific health-society relations, in which certain notions of the social operate helping or limiting research and care efforts by creating richer or poorer possibilities for posing, examining and facing the problems of public health.

Abstract:  Establishing a plausible model of women’s agency in reproductive decision making is crucial to both public health and medical anthropology research. The role of religion and women’s spirituality is one crucial and sometimes neglected component of such decisions. This article is based on ethnographic research conducted at a shelter for homeless, mostly African American mothers in the Southeastern United States. Methods included fourteen months of intermittent participant observation that included conversations with residents and staff members and participation in mandatory educational programming and on-site focus groups, one researcher-initiated focus group, and a series of in-depth, semi-structured interviews with sixteen shelter residents aged 18-37. Our research, which constitutes one module of an interdisciplinary study involving anthropologists, public health researchers and religion scholars, demonstrates the inadequacy of rational choice models that emphasize intentionality and planning, but are at odds with the vernacular ethos of pregnancy as a “blessing” or unplanned gift. Our findings confirm previous research that shows young and disadvantaged women may view pregnancy and motherhood as opportunities to improve their lives in ways that mediate against acceptance of family planning models.  We also argue that women’s agency may be shaped by religious or spiritual idioms that mediate against a public health ideal of full human control over reproductive outcomes. We suggest that a broader ethnography of women’s reproductive agency should locate “blessing” along a continuum of constructs of indeterminacy (cf. Jackson  2013: 31-33) that also include “luck,” “fate,” and some women’s recognition that agentive capacities are not always realistically concentrated in their hands. With this phenomenological approach in mind, we also question the widespread distinction between “religion” and “spirituality” in contemporary public health discourse. 


Keywords:  Agency, Contraception, Unintended Pregnancy, Spirituality/Religion, Homelessness, African American Women, Public Health

Health promotion views collaborations between local governments and citizens as key to improving health and lessening inequities in urban areas. Public parks, which are typically managed by local governments, are key settings for promoting physical activity, positive social interactions and overall well-being. Yet research on civic participation in park management is essentially absent from the health promotion literature. When the City of Calgary began to implement a new policy on off-leash dogs in parks, we had an opportunity to study civic participation in decision-making. We did so by examining policy documents, participating in meetings and conducting interviews. Off-leash parks have particular relevance for health promotion because they may support physical activity and networking for some, but may escalate conflict and deter park use amongst others. In this case study, the local government engaged citizens in developing an overarching off-leash policy for the city as a whole and in implementing the new policy at the level of neighbourhoods. Of the first three parks to be considered under the new policy, an off-leash area was ultimately designated in just one: a park located in a disadvantaged neighbourhood. By exploring this unexpected outcome, our case study suggests that public engagement, as practiced by local policymakers, may differ from community participation, as endorsed in health promotion. Further reflection on the meaning of ‘public’ is warranted in public health.

Between 1984 and 1996, public health authorities in Israel maintained a secret policy of discarding blood donations made by Ethiopian-Israeli citizens and immigrants. Officials later attempted to justify this policy on the grounds that immigrants from Ethiopia were subject to high rates of infectious disease (especially HIV). In 1996, this led to an explosive and violent confrontation between Ethiopian-Israeli protestors and agents of the state, including police and public health authorities. This essay explores the cultural and political context of that confrontation, including the discourse of political violence which it occasioned. The conflict between Ethiopian-Israelis and the state was located within a wider set of political contexts, including the Israeli-Palestinian conflict, which was linked to it through a shared trope of “spilled blood” common to both. Cultural analyses which ignore this dynamic political context are in danger of seriously misrepresenting the meaning of the “Blood Affair” to its participants. At the same time, this essay also engages a critical analysis of the public health policies which led to the crisis. Public health and nationalist discourse reinforced one another at the expense of Ethiopian immigrants in general, and so-called “Feres Mura” Ethiopians in particular.

In this talk I consider why so much of our research in psychology is trivial and what we might do to overcome this. I consider how our research processes have been historically shaped and how particular approaches and types of knowledge have come to be privileged and valued over other possibilities. I discuss and critique a range of issues that contribute to the trivialising of research – how the assumptions we make and the methods we adopt create and constrain the type of knowledge we produce (and reproduce), particularly in relation to the ideology of psychology, the invisibility of epistemological assumptions, the practices of theorisation, and strictures on methodology and method. I suggest some possibilities for addressing these concerns, particularly in relation to research training and publication, and argue that we have a pressing need to attend to how we might improve the quality of contemporary psychological research.

Introduction: Electronic cigarette (e-cigarette) use, or vaping, is increasing against a backdrop of declining smoking rates. E-cigarettes contain fewer toxicants than cigarettes but their appearance and mode of use has the potential to satisfy the habitual aspects of smoking. To date, we know little about lay perceptions of the safety of using e-cigarettes in pregnancy.
Methods: We conducted a thematic discourse analysis of 13 online discussion forum threads that discussed e-cigarette use during pregnancy. We focussed on the major discursive strategies that forum posters used to debate the safety of e-cigarette use during pregnancy.
Results: We identified three distinct ways in which forum posters debated the safety of using e-cigarettes during pregnancy: (1) Quitting (nicotine) cold-turkey is unsafe; (2) vaping is the lesser of two evils; (3) vaping is not worth the risk.
Conclusion:  Discussions about the safety of e-cigarettes drew on the premise that (1) immediate cessation of nicotine was potentially harmful and unsafe, (2) e-cigarettes were a harm reduction tool, or (3) vaping could be dangerous and should be avoided. While these arguments are not necessarily specific to pregnancy (beside mentions of foetal-specific risks), this analysis points to the need to educate and support women about harm reduction options.
Implications: Health professionals should be aware that some women may be currently using or considering using e-cigarettes in an effort to quit or reduce smoking. It is important health professionals are equipped to educate women with accurate up-to-date and balanced information about the risks and benefits of e-cigarette use during pregnancy.

This chapter moves beyond the social construction of mental health and illness, to engage with post-structuralist debates that emphasis the material, discursive and affective workings of power. Foucault's work has significantly shaped how mental illness has been problematized and made thinkable as an historical category. Focussing on the power-knowledge relations that shape particular regimes of truth, Foucauldian scholarship has explored the dividing practices that constitute normal/abnormal subjects. Central to his argument about the capillary-like operation of power in disciplinary societies is the notion of biopower that operates through health/illness discourses to regulate the conduct of individuals and populations. Contemporary scholars such as Rose and Abi-Rached (2013) have extended this work to consider how the rise of neuroscience is shaping mental health categories from schizophrenia to depression via new vocabularies and images of the brain. The chapter will argue that the shifting power-knowledge relations of biomedicine continue to map out the epistemological landscape of mental health services in ways that also incite critique and contestation from consumer, survivor, anti-psychiatry and mad movements. The discursive shift to recovery-focused services raises questions about the tensions between empowering and normalising practices in advanced liberal societies. The chapter concludes by considering the scholarly critiques of Foucault's work in light of emerging post-humanist debates.

Hospitals seem to be places where harm reduction approaches could have great benefit but few have responded to the needs of people who use drugs. Drawing on recent theoretical contributions to harm reduction from health geography, we examine how the implementation of harm reduction is shaped by space and contested understandings of place and health. We examine how drug use and harm reduction approaches pose challenges and offer opportunities in hospital-based care using interview data from people living with HIV and who were or had recently been admitted to a hospital with an innovative harm reduction policy. Our data reveal the contested spatial arrangements (and the related practices and corporeal relations) that occur due to the discordance between harm reduction and hospital regulatory policy. Rather than de-stigmatising drug use at Casey House Hospital, the adoption of the harm reduction policy sparked inter-client conflict, reproduced dominant discourses about health and drug users, and highlights the challenges of sharing space when drug use is involved. The hospital setting produces particular ways of being for people who use and those who do not use drugs and the demarcation of space in a drug using context. Moving forward, harm reduction practice and research needs to consider more than just interactions between drug users and healthcare providers, or the role of administrative policies; it needs to position ethics at the forefront of understanding the collisions between people, drug use, place, and space. We raise questions about the relationship between subjectivity and spatial arrangements in mediating the success of harm reduction.

The rise of global health as a field of study and site of intervention has animated significant critical social science engagements. Of these, medical anthropology has arguably emerged as the ascendant in the field with its growing corpus of writing and advocacy largely animated by the discipline’s ‘suffering slot’. This paper thus applies a geographical critique to anthropology’s moral, humanitarian impulse to give voice to suffering by exploring the spatial consequences of this mode of scholarship. It argues that the suffering slot inevitably leads global health researchers to certain archetypal spaces and that, in turn, these places: (i) are overwhelmingly biomedical; (ii) come to function as ‘truth spots’ in the production and circulation of global health knowledge and (iii) perpetuate a global health riddled with ‘ignorance spots’. Given this, the paper asks what happens if we look beyond suffering to consider the hidden geographies of global health that might then be revealed. It argues that in order to develop a richer topography of global health knowledge and critique, we must also consider those spaces where pleasure and suffering intersect in ways that challenge the humanitarian impulse and crisis-led readings of health. These other archetypal spaces of global health – gyms, bars, supermarkets and more – are not flippant distractions from the grave reality of human suffering, but rather spaces that condition the genesis of suffering and where affliction is put aside in favour of pleasure. In arguing that we need to be far more attuned to the non-medical spaces where global health is produced, experienced and challenged, the paper also articulates how geography might productively meet anthropology in critical studies of global health.

The global burden of mortality and morbidity attributable to noncommunicable diseases (NCDs) now exceeds that of infectious disease. Yet, concern is mounting that global political prioritisation and action have stalled. The failure of NCDs to capture public and political imaginations has been ascribed to a number of reasons, with some recently contending that the very name of the disease classification is to blame. In this piece, I reflect critically on why discourse about NCDs has not compelled global action proportionate to the magnitude of the suffering these diseases cause. Failure to act on NCDs, I argue, is not a failure of terminology alone.

"How does the state imagine the people? In what ways does it come to know the targets of its policies? This paper examines the transformation of the state through a focus on the visions implied in tools and practices of results-based management in state bureaucracies. When scholars have discussed the state’s vision or imagination they have often critically examined how the state constructs aggregates of the population as a whole.
But an emphasis on or critique of aggregation can only be the beginning of understanding the multiple and sometimes contradictory ways in which people are imagined in governance
today. Results-based management has created a new way in which the state imagines people. In some policy arenas citizens have been turned into “beneficiaries” through the practices of state managers. Beneficiaries differ from citizen in a number of ways: Citizens are thought to benefit from policies with broad goals; beneficiaries are shown to benefit from specific interventions. Citizens are owed service; beneficiaries are selected for intervention if it suits specific funding priorities. Citizens are the origins of politics and the end of policies; beneficiaries are a means to an organization’s success."

Academic, policy, and public concerns are intensifying around how to respond to increasing mental health problems amongst young people in OECD countries such as the UK and Australia. In this paper we make the case that public knowledge about mental health promotion, help-seeking, support and recovery can be understood as an enactment of public pedagogy—as knowledge practices and processes that are produced within and beyond formal spaces of learning. We explore the question of how new pedagogic modes of address are produced through digital technologies—social media, gamified therapies, e-mental health literacy, wearable technology—as they invite particular ways of knowing embodied distress as " mental illness or ill health. " The rapid growth of formal and informal pedagogical sites for learning about youth mental health raises questions about the affective arrangements that produce new kinds of (ab)normal in the digital era. Through a posthumanist perspective that connects critical mental health studies and public pedagogy, this paper offers an original contribution that theorises pedagogic sites within the cultural formation of public-personal knowledge about mental (ill) health.

How does militarism reshape indigenous peoples' relationships with settler states? In this article, we explore how military service both opens up and forecloses avenues for indigenous groups to claim new modes of responsibility, care and relationality from the state. Through a discussion of New Zealand Māori nuclear test veterans' recent legal claims through the Waitangi Tribunal, we detail the range of ways that Māori veterans utilize and rework ethnic identity categories to encompass wider notions of citizenship, care and responsibility, and challenge neoliberal models of reparations. Claimants argue that their ongoing wellbeing sits at the centre of their partnership with the state, revealing how uneasily the Māori military body fits within mainstream logics of Treaty claim-making. Seeking healthcare and wellbeing here does not demand greater autonomy or independence, but requires ongoing interdependence, practices of care and attention to ongoing intergenerational obligations that, like radiation harm, have no clear endpoints.

Transgender (trans) people experience high rates of mental health issues including depression and suicidality. Improving access to transition-related medicine such as hormones and surgeries is suggested as an important mechanism to address these mental health issues. Yet clinicians experience challenges assessing and referring trans people for transition-related medicine. Standardized assessment protocols have been therefore recommended to optimize care. Although standardized protocols are purported to expand access to hormones and surgeries for trans people, it is unclear whether these tools achieve this goal. We therefore conducted an institutional ethnography to explicate how standardized readiness assessments coordinate access to hormones and surgeries in Canada. We analyzed key texts, talked with trans people, clinicians, clinician-educators, and administrators (total n=22), and observed clinician-education workshops. In the context of determining transition readiness, standardized protocols direct clinicians to explore alternative diagnoses and assess the degree to which any complex mental health condition is “managed” prior to initiating hormones or surgeries. In response, we found that trans patients downplay or withhold mental health concerns from clinicians, or otherwise do additional work (e.g., take up unwanted psychiatric interventions) to convince providers they are “mentally ready” to transition. This phenomenon is paradoxical in that transition-related medicine is recommended to mitigate trans people’s psychosocial distress, but when patients reveal symptoms of distress they encounter significant barriers to treatment. We conclude that the logic underpinning pre-transition “mental readiness” assessments discredits the claim that standardized protocols optimize access to hormones and surgeries.

The disappointing results of many public health interventions have been attributed in part to the lack of meaningful community engagement in the planning, implementation, and evaluation of these initiatives. Community-based participatory research (CBPR) has emerged as an alternative research paradigm that directly involves community members in all aspects of the research process. Their involvement is often said to be an empowering experience that builds capacity. In this paper, we interrogate these assumptions, drawing on interview data from a qualitative study investigating the experiences of 18 peer researchers (PRs) recruited from nine CBPR studies in Toronto, Canada. These individuals brought to their respective projects experience of homelessness, living with HIV, being an immigrant or refugee, identifying as transgender, and of having a mental illness. The reflections of PRs are compared to those of other research team members collected in separate focus groups. Findings from these interviews are discussed with an attention to Foucault’s concept of ‘governmentality’, and compared against popular community-based research principles developed by Israel and colleagues. While PRs spoke about participating in CBPR initiatives to share their experience and improve conditions for their communities, these emancipatory goals were often subsumed within corporatist research environments that limited participation. Overall, this study offers a much-needed theoretical engagement with this popular research approach and raises critical questions about the limits of community engagement in collaborative public health research.

Buruli ulcer is a necrotizing skin infection that largely affects poor people in the tropics. In Ghana, federal policies promise free treatment to all individuals with the disease. Yet, this research found there is a tension between official policy narratives and the lived experiences of people in endemic regions. I demonstrate that as top-down government channels struggle to provide sick people with care, new treatment assemblages emerge in rural areas. I use the experiences of two individuals and one group of practitioners—the pirate, hybrid herbalist, and practitioners for profit—to detail the social relationships and practices governing Buruli ulcer treatment. These treatment assemblages reflect diverse knowledge and economic forms and represent lines of flight from official, and exclusionary, systems of disease surveillance. In contrast with existing literature on Buruli ulcer in Africa, I argue rural people’s engagement with “traditional” medicine is often the result of policy failures and the disease is under-represented in national case counts. This work contributes to a growing body of critical political ecologies of health by examining the ways non-humans (e.g. Mycobacterium ulcerans, wild plants, anti-biotics), policy, desire, and prosaic practices combine to shape disease and treatment dynamics.

... a , Rick Lines d & Ralf Jürgens a ... Small W Kain S Laliberte N Schechter M O'Shaughnessy M Spittal P (in press) Incarceration, addiction, and harm reduction: inmates' experience of injection drugs in prison Substance Use and Misuse [Web of Science ®] View all references). ...

In Canada, there have been recent increases in HIV infections among men who have sex with men (MSM), making HIV transmission among MSM a continuing public health concern. In this paper, we explore the rationales of MSM for the practice of unprotected sex in casual or anonymous encounters. We found that the men in our sample acknowledged their “transgressive” behaviour, engaged in numerous harm reduction strategies, and offered varied yet connected rationales for unprotected sex related to pleasure, knowledge, and social and physical locations. Based on these data, we offer a critical perspective on the traditional, psychological approaches to the design of HIV prevention, and contend that HIV prevention needs to become more inclusive and innovative by recognizing, addressing and engaging men’s diverse rationales for unprotected sex.

Drawing on the theoretical frameworks of
antiblackness and intersectionality and the concept of
viral visibility, this essay attends to the considerable
archive of research about endemic Kaposi’s sarcoma
(KS) in sub-Saharan Africa accrued during the mid-
20th century. This body of data was inexplicably
overlooked in Western research into KS during the first
decade of the AIDS epidemic, during which period
European and Mediterranean KS cases were most often
cited as precedents despite the volume of African data
available. This paper returns to the research on KS
conducted in Africa during the colonial and postcolonial
period to consider visibility, racial erasure, and discourses
of global epidemiology, suggesting that the
dynamics of medical research on HIV/AIDS have
proceeded according to a tacit paradigm of
antiblackness manifest in multiple exclusions of Africa
from global health agendas—most recently the exclusion
of the region from antiretroviral (ARV) drug
therapy during the first decades of the treatment’s availability.
During that decade KS all but disappeared
among people with access to ARV therapy while KS
became even more prevalent in sub-Saharan Africa,
escalating along with HIV.
Keywords Kaposi’s sarcoma . HIV. Africa . Viral
visibility . Viral intersectionality . Antiblackness

Critiques of public health policies to reduce physical inactivity have led to calls for practice-led research and the need to reduce the individualising effects of health promotion discourse. This paper examines how parkrun – an increasingly popular, regular, community-based 5km running event – comes to be understood as a ‘health practice’ that allows individuals to enact contemporary desires for better health in a collective social context. Taking a reflexive analytical approach, we use interview data from a geographically diverse sample of previously inactive parkrun participants (N=19) to explore two themes. First, we argue that parkrun offers a space for ‘collective bodywork’ whereby participants simultaneously enact personal body projects while also experience a sense of being “all in this together” which works to ameliorate certain individualising effects of health responsibilisation. Second, we examine how parkrun figures as a health practice that makes available the subject position of the ‘parkrunner’. In doing so, parkrun enables newly active participants to negotiate discourses of embodied risk to reconcile the otherwise paradoxical experience of being an ‘unfit-runner’. Findings contribute to sociological understandings of health and illness through new insights into the relation between health practices and emerging physical cultures, such as parkrun. Exploring parkrun as a social context for collective health practices: Running with and against the moral imperatives of health responsibilisation.

Background: Weight management is increasingly considered part of physiotherapists’ scope of practice in order to improve patient outcomes by, for example, reducing load on joints, or improving chronic pain. However, interactions with patients involving weight may result in patient perceptions of negative judgment from health professionals, which can result in poorer health outcomes. How physiotherapist/patient interactions involving weight are perceived by patients has not yet been investigated. Objectives: To explore patients’ perceptions of interactions with physiotherapists that involved weight, and investigate how these perceptions may inform physiotherapy practice. Design: Face-to-face interviews with physiotherapy patients, with follow up interviews conducted by telephone. Data were analysed thematically. Method: First interviews were held in a physiotherapy practice with follow up interviews conducted two weeks later. Interviews were audio recorded, transcribed and analysed using an inductive thematic method established by Braun and Clarke. Findings: Thirty interviews with 15 patients were analysed. Four main themes relevant to weight were identified: 1) perceptions of being ‘in physiotherapy’ including pre-conceptions, the physical environment, and exposing the body 2) emphasis placed on weight in physiotherapy interactions, 3) communication styles, and 4) perception of judgment. Conclusion: Some patients perceived negative weight judgments from elements of physiotherapy interactions and environments. Physiotherapists need to be aware of this perception because it may result in poorer patient outcomes and patients avoiding physiotherapy appointments. The results suggest strategies to counteract weight stigma include: adjusting the physical environment of the clinic, portraying an understanding of complex determinants of weight, and employing collaborative, non-judgmental communication styles.

This paper examines how and why health has become a Corporate Social Responsibility (CSR) strategy for the global food and drink industry (FDI) in the context of current governmental and public calls to address mounting obesity rates. It argues that, despite the current prominence of health within CSR, there has not been a reciprocal interest by those adopting sociological approaches to the study of health and illness in the implications of this strategic uptake of health or in the viability and legitimacy of the state's own public health role. This omission is addressed through an empirical exploration of three contentions: first, that health and wellbeing may be used to secure brand value and consumer goodwill at a time when mounting obesity rates demand new levels of accountability from the FDI. Secondly, that the food industry, through CSR, may promote a narrow epidemiological understanding of obesity, shifting blame from 'foods' to 'diet' and from 'diet' to 'sedentarism'. Thirdly, that CSR reporting and its associated practices have enabled the food industry to assume some responsibility for obesity prevention, thereby problematising the state's role in addressing its own 'public health' crisis.

In this paper I test the methodological potential of a set of six questions, called the “What's the Problem Represented to be?,” or WPR approach, borrowed from the field of discursive policy analysis (Bacchi, 2012a) for doing critical health communication (CHC) research. WPR is generative for critical health researchers because it shares the goal of challenging implicit and explicit causality and correlation within discourse. I apply these questions to examine the case of legalized medical assistance in dying (MAiD) in Canada, arguing that their simplicity and capaciousness facilitate critical responses to care disparities. This particular case is edifying for CHC researchers, because ideals of good living, “dignified” death, and the role of medicine are all crystallized within legal, media, and medical discourse on assisted dying. Debating what death can or should look like depends on a clearer understanding of how the logics of embodied difference (especially ability, race, and gender) are always already stacking the odds against equal political participation in, and access to health. The WPR approach flips the “proper objects” of health-centered critical research, beginning by scrutinizing proposed solutions in order to rethink the problems implicit therein. Asking such questions as “How has this representation of the “problem” come about?,” “What effects are produced by this representation of the ‘problem'?” and “How has it been (or could it be) questioned, disrupted and replaced?” productively situates the researcher between the discursive practices governing health and health care praxis itself. Ultimately, I argue that the WPR method encapsulates some of the best critical perspectives from the corpus of CHC research praxis, making it a helpful tool for advancing health communication research.

Background: Many epidemiological studies report that alcoholics overwhelmingly smoke tobacco and vice versa, which suggests a possible functional interaction between ethanol and nicotine. Although nicotineethanol interaction is well documented within the central nervous system, the mechanism is not well understood. Therefore, it is important from a public health standpoint to understand the mechanisms involved in nicotine and ethanol functional interaction. The intracerebellar (ICB) administration of nicotine significantly attenuates ethanol ataxia through nicotinic acetylcholine receptor (nAChR) α 4 β 2 subtype. This study, an extension of earlier work, was intended to investigate the possible role of nAChR subtype α 7 in mitigating ethanol ataxia.

All multiracial societies have to grapple with the benefits versus the costs of the integration of minorities into majority communities. Indeed, in relation to the costs of integration, it could be argued that integration and assimilation increases non-White people’s exposure to racialized experiences and racism, which in turn predisposes them to mental illness. As such, it is worth considering the case of the UK, where Black integration and assimilation is particularly intense, and where the high rates of schizophrenia in the African-Caribbean population have been an area of concern for over three decades. This paper argues that the interplay between racial minority status stress, racism-induced stress, and racial bias in diagnosis may be significant factors influencing the high Black incidence rate of schizophrenia in the UK.

The public health approach to alcohol control focusses on efforts to reduce overall consumption and therefore the prevalence of “harmful” drinking and its negative health and social consequences.  Within this logic, evidence is corralled in favour of three particular strategies: tax increases; restricting access; and bans on alcohol advertising. In turn, it is argued that these strategies represent the most cost-effective and efficient ways to reduce consumption and its harms. However, the majority of the evidence base from which these recommendations stem derives from studies from countries of the Global North, and in particular, North America, Western Europe and Australasia.  Yet, as the WHO has been quick to note in its Global Strategy to Reduce the Harmful Use of Alcohol, countries of the Global South actually bear the greatest burden of alcohol-related harms. Geographical and anthropological approaches to health and wellbeing remind us that health and consumption practices are inherently contextual, rendering the logic and possibility of global ”best buys” for alcohol control a fallacy. Moreover, they may also engender a homogenisation of national alcohol control strategies. Yet, local contexts must always be inculcated within public health policy endeavours if they are to be plausible and sustainable. In many countries of the Global South, the janus-faced importance of alcohol as a source of income, but also of gross harms, needs to be reconciled. And, such questions will only ever preclude the possibility of the universalist policy solutions that has become so deeply enshrined in the public health literature.

A substantial minority of Western women smoke during pregnancy. Understanding smoking from these women’s point of view may provide a richer understanding of experiences that are very often silenced, and provide some explanation for why pregnant women smoke despite widely disseminated public health campaigns urging them to stop. Strong social pressures directed at women to stop, justified mainly by arguments of protecting the foetus, are reinforced through the policing of women’s bodies, which is particularly powerful during pregnancy. This emerges in the form of criticism, confrontation and judgement, irrespective of individual women’s contexts and social backgrounds. Interviews with 11 Australian women who had smoked during recent pregnancies were conducted to explore their smoking-related experience of stigma. Thematic analysis examined their perceptions of stigma and surveillance, in the strong anti-smoking climate of Australia. Women’s talk constructed medical and social pressures as two separate dimensions of stigma, which they accepted or resisted, or – at times – did both. They also used discursive strategies to negotiate their position as ‘good mothers’ despite stigma, and spoke about the need to manage the contexts in which they smoked. The women’s talk suggests that directive, critical public health campaigns, and the associated social stigma, may actually make it harder for some to stop smoking. More supportive approaches that move away from a focus on individual responsibility, and from the assumption that pregnant women need to be coerced into healthy decision-making, might better assist some pregnant smokers to seek cessation support.

Issue addressed: There is increasing emphasis in the health promotion literature on the ethical imperative for the profession to move towards critical practice. A key challenge for health promotion is that critical practice appears both under-developed and under-practiced. This is evident in the omission of critical reflection from Australian and international competencies for health promotion practitioners.

Methods: A narrative literature review was undertaken to explore the current use of critical reflection in health promotion. Critical reflection models relevant to health promotion were identified and critiqued.

Results: There was a dearth of literature on critical reflection within health promotion, despite recognition of its potential to support critical practice. The discipline of critical social work provided literature on the use, effect and outcome of critical reflection in practice. The interdisciplinary critical reflection model was identified as the model most applicable to health promotion. Underpinned by critical theory, this model emphasises both critical and ethical practice.

Conclusions: Critical reflection is a core competency for health promotion practitioners to address the ethical imperative to move towards critical practice. There is a need to explore the application of a critical reflection model in health promotion to determine how it may support critical and ethical practice.

So what?: If health promotion is to meet its ethical responsibilities, then critical reflection needs to be articulated as a core health promotion competency and a model for its application in health promotion developed.

The rationalities of advanced liberalism shape the call for people to be more responsible for 'being active and eating well' , even those living with social disadvantage. We draw upon qualitative data to examine how sport and recreation policy and program officers within state and local levels of government frame and interpret the 'active living imperative' for healthy lifestyles. Our analysis identified major policy tensions between different levels of government that directly affect the success of government initiatives to increase physical activity. We present our analysis of four main themes: 1) the rise of the health agenda in sport and recreation policy and sport and recreation services enhanced role in health promotion; 2) the obesity epidemic as the instigator for the policy shift in sport and recreation; 3) tensions between government agendas and competing priorities; and 4) governments' proposed solutions to support active leisure in communities. Our analysis of the sport/recreation sector revealed competing priorities with the health promotion focus on reducing lifestyle risk and a need for more strategic cooperation between levels of government and different departments.

Perspectives into Better Communication Practices at this Conference

The "7th International Conference on Public Health and Nursing" scheduled during September 19-20, 2018 at Singapore..

The conference is with the Theme: Focusing on the Global Outbreaks and Upgrades towards Public Health and Nursing

For Abstract Submission Guidelines | For Reserving your slot | Proposals | Registration Posters | Accommodations

No doubt you have lots of queries... Why not get in touch..! Drop us your query with details and we will call you right away.

For more details about the Conference please follow the link below:
https://publichealth-community.nursingconference.com/scientific-program

This paper explores recent developments in prison public health, recommending that future prison health policies and practices become more ‘upstream’ in their outlook and approach. It is argued that this will require much firmer acknowledgement of the significance of broad, systemic and structural determinants of prisoner health, particularly if the World Health organization’s vision for a ‘healthy prison’ is to be realized. Epidemiological evidence plainly shows that prisoners have experienced—and continue to experience—worse health than the general population, despite the fact that prison settings across the European Union have been targeted for health promotion by the World Health Organization since 1994. In 2005, WHO launched a new 10-year prison public health plan, which it envisages will begin to address key prison health determinants. In the UK, New Labour has identified prison health as a key public health objective within Choosing Health, although health interventions within prisons continue to be predominantly geared towards efficient and effective primary and secondary healthcare, and much less towards public health goals. This paper strives to open up the debate on prison public health, advocating a progressive and more sustainable approach to developing and commissioning health services for prisoners.

This article examines how social movements reconceptualized trans-health in Buenos Aires, Argentina. Looking ethnographically to medical and activist practice, the article analyzes "epidemiological biographies", or activist-produced community-based studies blending quantitative and narrative data. It draws on population health, feminist science studies, transgender studies, and social theory to discuss the circulation and implications of these publications. Specifically, it describes how epidemiological biographies disputed health behavioral models by defining state violence and criminalization as primary conditions endangering health and life expectancy among travestis and trans-people. The article analyzes how activist researchers made state violence legible through logics of population health, even as the concept of "population" also emerged from techniques of state control. In contrast with models that place individual behavior at the locus of health interventions, activists instead advanced interventions that contested state securitization and shifted resource distribution. Epidemiological biographies had a considerable effect on national trans-health politics, providing an evidentiary basis for several regulatory shifts. These studies emerged in part through collective political action that re-formulated dominant modes of statistical aggregation. This statistical turn-which I call "statistical collectivi-zation"-produced contradictory effects. At one level, it obscured differential conditions of criminalization and violence. At another, it directed attention to the markedly racialized, sexualized, classed, and gendered forms of subjugation that materialize in landscapes of trans-health, and prioritized materially distributive regulation over and above civil protections. Through these contradictory actions, social movements reformulated dominant notions of health by challenging state securitization and contesting state power. "The State is the main violator of the rights of travestis, by act or omission."-Lohana Berkins (2007). Contemporary trans-health has reoriented from twentieth-century transsexual medicine that centered on treatment of pathologized individuals towards community or collective health (Singer, 2006). 1 With this turn to group-level outcomes, population health has become a primary grid of intelligibility in this health field. Researchers-both academic and activist oriented-are mobilizing statistics to make claims for collective access to health and health care. By thinking in terms of aggregate trans-populations, researchers are defining the central problems facing trans-people and prefiguring the interventions that will address these problems. Some epidemiologists focus on improving health outcomes through individual-level behavior change supported by benevolent legal and medical policies. However, activist researchers have placed state violence and criminalization at the root of reduced life chances. In so doing, they have shown how experts and authorities such as police, medical experts, and judges are instigating state violence against certain trans-people rather than protecting them from conditions of imperilment. This article shows how Argentine activist researchers made state violence legible through the logics of population health, even as the concept of "population" also emerged from techniques of state control. Highlighting the uneven effects of state violence , they proposed interventions that differed markedly from those that centered on behavior change or enhanced securitization to improve conditions of health.

The health field is being subjected to a dictate that policy, practice and research should be informed by evidence. The mere generation of evidence, however, does not mean that policy and practice will act upon it. Utilisation and application of research findings (often equalled with 'evidence') is a political process following rationalities that are not necessarily similar to those of researchers. In response to this issue that evidence does not naturally finds its way into policy and practice (and back into research), the concept of 'knowledge ...

High scores on the Global Health Security Index (GHSI) have not correlated with country performance in relation to the COVID-19 pandemic, except perhaps inversely. Here, a number of 'internal' critiques of the index are discussed, before presenting a more far-reaching critical analysis of the GHSI as a technology of knowledge and global governance. I examine the ways in which the GHSI, like similar global indices, privileges the priorities of the global North, creates a 'one-size-fits-all' model, and acts to authorise, as universal, standards which may be inappropriate for most countries and for dealing with a pandemic.

This short paper explores the intersections between the newly-agreed urban and health Sustainable Development Goals (SDGs 3 and 11). It argues that while burgeoning studies theorising cities of the global south have thus far largely failed to engage with the formative role of health in the experience of urban life and politics, it is also the case that concern with “global” health (in the global south) has been slow to engage with the specific importance of the urban. As these two potentially mutually constitutive domains skirt past each other, the potentially unifying field of urban health remains arguably marginal and under-theorised within both biomedicine and social science.  The paper therefore asserts that a reinvigorated urban heath is not only crucial to the realisation of the urban and health SDGs, but also to capitalise on new, emergent research and impact opportunities that may emerge as the global health enterprise shifts to better reflect the contours of the SDGs.