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Abstract
There have been calls for some time for a new approach to public health in the United Kingdom and beyond. This is consequent on the recognition and acceptance that health problems often have a complex and multi-faceted aetiology. At the same time, policies which utilise insights from research in behavioural economics and psychology ('behavioural science') have gained prominence on the political agenda. The relationship between the social determinants of health (SDoH) and behavioural science in health policy has not hitherto been explored. Given the on-going presence of strategies based on findings from behavioural science in policy-making on the political agenda, an examination of this is warranted. This paper begins by looking at the place of the SDoH within public health, before outlining, in brief, the recent drive towards utilising behavioural science to formulate law and public policy. We then examine the relationship between this and the SDoH. We argue that behavioural public health policy is, to a certain extent, blind to the social and other determinants of health. In section three, we examine ways in which such policies may perpetuate and/or exacerbate health inequities and social injustices. We argue that problems in this respect may be compounded by assumptions and practices which are built into some behavioural science methodologies. We also argue that incremental individual gains may not be enough. As such, population-level measures are sometimes necessary. In section four we defend this contention, arguing that an equitable and justifiable public health requires such measures.
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Affiliation(s)
- Kathryn MacKay
- Politics, Philosophy, and Religion Department, Lancaster University, Lancaster, UK
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152
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Kandt J. Social practice, plural lifestyles and health inequalities in the United Kingdom. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:1294-1311. [PMID: 30105754 PMCID: PMC6849800 DOI: 10.1111/1467-9566.12780] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Persistent health inequalities pose a continued research and policy challenge in the United Kingdom and elsewhere. Current approaches to health research and promotion are predicated on a distinction between wider, social structural causes and individual, health-related behaviours often conceived of as lifestyle choices. Drawing on Bourdieu's theory of social practice, this paper develops an integrated perspective by observing associations between health and structured lifestyle practices. Using the UK Understanding Society household survey, a taxonomy of eight lifestyle clusters is identified, which exhibit significant health inequalities on a number of indicators. But the plurality of practices and subjective orientations inherent in the taxonomy reveals a finer, more complex differentiation of the social gradient in health. In addition, lifestyle appears to at least in parts mediate the relationship between social, material conditions and health. A feature of the taxonomy is that it admits a relational and contextual apprehension of health-relevant, behavioural aspects within a more holistic notion of lifestyles. Based on this view, strategic approaches can be developed that respond to group-specific situations and pathways and their varying roots in upstream or downstream domains of policy.
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Affiliation(s)
- Jens Kandt
- The Bartlett Centre for Advanced Spatial AnalysisUniversity College LondonLondonUK
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153
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Harvey M, McGladrey M. Explaining the origins and distribution of health and disease: an analysis of epidemiologic theory in core Master of Public Health coursework in the United States. CRITICAL PUBLIC HEALTH 2018. [DOI: 10.1080/09581596.2018.1535698] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Michael Harvey
- Department of Health Science and Recreation, San José State University, San Jose, CA, USA
| | - Margaret McGladrey
- Tisch College of Civic Life and Department of Sociology, Tufts University, Medford, USA
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154
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Baum F, Delany-Crowe T, Fisher M, MacDougall C, Harris P, McDermott D, Marinova D. Qualitative protocol for understanding the contribution of Australian policy in the urban planning, justice, energy and environment sectors to promoting health and health equity. BMJ Open 2018; 8:e025358. [PMID: 30287616 PMCID: PMC6173260 DOI: 10.1136/bmjopen-2018-025358] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION A well-established body of literature demonstrates that health and equity are strongly influenced by the consequences of governments' policy and resultant actions (or inactions) outside the health sector. Consequently, the United Nations, and its agency the WHO, have called for national leadership and whole-of-government action to understand and address the health impacts of policies in all sectors. This research responds to that call by investigating how policymaking in four sectors-urban planning, justice, energy and environment-may influence the social determinants of health and health equity (SDH/HE). METHODS AND ANALYSIS The research design is informed by a critical qualitative approach. Three successive stages are included in the design. The first involves analysing all strategic policy documents and selected legislative documents from the four sectors (n=583). The document analysis is based on a coding framework developed to identify alignment between the documents and the SDH/HE. Two policies that demonstrate good practice in regard to SDH/HE will be selected from each sector during the second stage for embedded case study analysis (total n=8). This is intended to illuminate which factors have supported recognition and action on SDH/HE in the selected policies. The third stage involves progressive theoretical integration and development to understand political and institutional facilitators and barriers to action on SDH/HE, both within and between sectors. ETHICS AND DISSEMINATION The research will provide much needed evidence about how coherent whole-of-government action on SDH/HE can be advanced and contribute knowledge about how health-enhancing policy activity in the four sectors may be optimised. Learnings from the research will be shared via a project advisory group, policy briefings, academic papers, conference presentations and research symposia. Ethics approval has been secured for the embedded case studies, which involve research participants.
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Affiliation(s)
- Fran Baum
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
| | - Toni Delany-Crowe
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
| | - Matthew Fisher
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
| | - Colin MacDougall
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia
| | - Patrick Harris
- Menzies Centre for Health Policy, University of Sydney, Sydney, New South Wales, Australia
| | - Dennis McDermott
- Poche Centre for Indigenous Health and Wellbeing, Flinders University, Adelaide, South Australia, Australia
| | - Dora Marinova
- Sustainability Policy Institute, Curtin University, Perth, Western Australia, Australia
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155
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Effect of electronic screening and brief intervention on hazardous or harmful drinking among adults in the hospital outpatient setting: A randomized, double-blind, controlled trial. Drug Alcohol Depend 2018; 191:78-85. [PMID: 30096637 DOI: 10.1016/j.drugalcdep.2018.06.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 05/22/2018] [Accepted: 06/26/2018] [Indexed: 11/20/2022]
Abstract
BACKGROUND Most trials of electronic alcohol screening and brief intervention (e-SBI) have been conducted in young people. The aim of this study was to evaluate the effect of e-SBI in adults with hazardous or harmful drinking. METHODS This individually randomized, parallel, two-group, double-blind controlled trial was conducted in the outpatient department of a large public hospital in Australia. Consenting adults who scored 5-9 on the AUDIT-C (837/3225; 26%) were randomized in a 1:1 ratio by computer to screening alone (442/837; 53%) or to 10 min of assessment and personalized feedback on their alcohol consumption (comparisons with medical guidelines and age and sex-specific norms), peak blood alcohol concentration, expenditure on alcohol, and risk of alcohol dependence (395/837; 47%). The two primary outcomes, assessed six months after randomization, were the number of standard drinks (10 g ethanol) consumed by participants in the last seven days and their AUDIT score. RESULTS 693/837 (83%) and 635/837 (76%) participants were followed-up at 6 and 12 months, respectively. There was no statistically significant difference between the groups in the median number of standard drinks consumed in the last seven days (intervention: 12; control: 10.5; rate ratio, 1.12 [95% confidence interval, 0.96-1.31]; P = .17) or in their median AUDIT score (intervention: 7; control: 7; mean difference, 0.28 [-0.42 to 0.98]; P = .44). CONCLUSION These results do not support the implementation of an e-SBI program comprising personalized feedback and normative feedback for adults with hazardous or harmful drinking in the hospital outpatient setting.
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156
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Gorman E. Promoting health: the primary health care approach, 6th edn. LynTalbotGlendaVerrinder Published by Elsevier Australia, 2018. Paperback, 460 pages with index. ISBN: 9780729542579 RRP $84.95. Health Promot J Austr 2018. [DOI: 10.1002/hpja.194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Affiliation(s)
- Emma Gorman
- Faculty of Social Sciences University of Wollongong Wollongong NSW Australia
- Office of Preventive Health Liverpool Hospital Liverpool NSW Australia
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157
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Farrell LC, Moore VM, Warin MJ, Street JM. Why do the public support or oppose obesity prevention regulations? Results from a South Australian population survey. Health Promot J Austr 2018; 30:47-59. [PMID: 29999550 DOI: 10.1002/hpja.185] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 07/08/2018] [Indexed: 12/13/2022] Open
Abstract
ISSUE ADDRESSED Australian policymakers have acknowledged that implementing obesity prevention regulations is likely to be facilitated or hindered by public opinion. Accordingly, we investigated public views about possible regulations. METHODS Cross-sectional survey of 2732 persons, designed to be representative of South Australians aged 15 years and over. Questions examined views about four obesity prevention regulations (mandatory front-of-pack nutrition labelling for packaged foods; zoning restrictions to prohibit fast food outlets near schools; taxes on unhealthy high fat foods; and taxes on sugar-sweetened beverages). Levels of support (Likert scale) for each intervention and reasons for support/opposition were ascertained. RESULTS Views about the regulations were mixed: support was highest for mandatory nutrition labelling (90%) and lowest for taxes (40%-42%). High levels of support for labelling were generally underpinned by a belief that this regulation would educate "Other" people about nutrition. Lower levels of support for zoning restrictions and taxes were associated with concerns about government overreach and the questionable effectiveness of these regulations in changing behaviours. Levels of support for each regulation, and reasons for support or opposition, differed by gender and socio-economic status. CONCLUSION Socio-demographic differences in support appeared to reflect gendered responsibilities for food provision and concerns about the material constraints of socio-economic deprivation. Engagement with target populations may offer insights to optimise the acceptability of regulations and minimise unintended social consequences. SO WHAT?: Resistance to regulations amongst socio-economically disadvantaged target populations warrants attention from public health advocates. Failure to accommodate concerns identified may further marginalise these groups.
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Affiliation(s)
- Lucy C Farrell
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Vivienne M Moore
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Megan J Warin
- Department of Gender Studies and Social Analysis, University of Adelaide, Adelaide, South Australia, Australia
| | - Jackie M Street
- School of Public Health, University of Adelaide, Adelaide, South Australia, Australia
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158
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MacDonald S, Murphy S, Elliott E. Controlling food, controlling relationships: exploring the meanings and dynamics of family food practices through the diary-interview approach. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:779-792. [PMID: 29633278 DOI: 10.1111/1467-9566.12725] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Potential merits of a social practice perspective for examining the meanings and dynamics of family food include moving beyond individual behaviour, and exploring how practices emerge, develop and change. However, researchers have struggled to encourage reflection on mundane practices, and how to understand associated meanings. Drawing on a study of families in South Wales, this article reflects on the value of the diary-interview approach in addressing these methodological challenges, and aims to explore and understand the dynamics of control across family contexts. Contemporary practice theories distinguish between practices as 'performances' and practices as 'entities' and the diary-interview method facilitated an examination of these dimensions. Detailed accounts of daily 'performances' (through diaries), alongside reflection on underlying contexts and 'entities' (through interviews), illustrated the entanglement of control, practices and context. The article adds further complexity to the concept of practice 'bundles' which facilitated an understanding of how food was interrelated with other practices - across family contexts and across generations. Sociological approaches with a practices perspective at the core, offer potential for developing public health interventions by acknowledging: the relational meaning of food; the embeddedness of food within everyday practices; and the need to consider interventions across a range of policy areas.
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Affiliation(s)
- Sarah MacDonald
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, UK
| | - Simon Murphy
- Centre for the Development and Evaluation of Complex Interventions for Public Health Improvement (DECIPHer), School of Social Sciences, Cardiff University, UK
| | - Eva Elliott
- School of Social Sciences, Cardiff University, UK
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159
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Agide FD, Shakibazadeh E. Contextualizing Ottawa Charter Frameworks for Type 2 Diabetes Prevention: A Professional Perspective as a Review. Ethiop J Health Sci 2018; 28:355-364. [PMID: 29983536 PMCID: PMC6016361 DOI: 10.4314/ejhs.v28i3.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Type 2 Diabetes remains one of the deadliest non-communicable diseases in the world. Systematically articulating the health issues with emerging policies is very important in preventing chronic diseases like diabetes. This article aims to integrate Ottawa Charter frameworks in prevention of Type 2 diabetes and the way the charter's application should bring amicable changes if applied as planned. METHOD We used the aim of the study as a method derivative. Then, we applied the five actions of Ottawa Charter frameworks. We also described and stated the existing scientific literature (knowledge) about the prevention of diabetes. After thoroughly reviewing, possible intervention strategies were included with a brief discussion by comparing different literatures. In our case, diabetes prevention is facilitated by those actions and conditions. EVIDENCE Setting appropriate goals, lifestyle modifications, appropriate self-monitoring of blood glucose, medications, regular monitoring for complications, and laboratory assessment are important factors to be endorsed within Ottawa Charter five actions. Lifestyle interventions and physical activities are the most important factors recommended in different reviews and interventions. However, none of the studies had integrated disease prevention with existing policy. CONCLUSION Type 2 Diabetes directed health promotion interventions implemented in various countries were not integrated into Ottawa charter frameworks. As field experts, we believe that applying all the basic principles of health promotion and the idea of Ottawa Charter articulation is very important in disease prevention and behavioral change. Therefore, field specialists should figure out the problem of policy integration through policy evaluation researches.
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Affiliation(s)
- Feleke Doyore Agide
- Department of Health Education and Promotion, School of Public Health, International Campus, Tehran University of Medical Sciences, Tehran, Iran
- Department of Public Health Officer, College of Medicine and Health Sciences, Wachemo University, Hossana, Ethiopia
| | - Elham Shakibazadeh
- Department of Health Education and Promotion, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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160
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Scantlebury RJ, Moody A, Oyebode O, Mindell JS. Has the UK Healthy Start voucher scheme been associated with an increased fruit and vegetable intake among target families? Analysis of Health Survey for England data, 2001–2014. J Epidemiol Community Health 2018. [DOI: 10.1136/jech-2017-209954] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundHealthy Start (HS) is a UK government programme, introduced in 2006, providing vouchers to pregnant women or families with children aged <4 who are in receipt of certain benefits. Vouchers can be exchanged for fruit and vegetables (F&V), milk or infant formula. We sought to identify any association between HS and F&V intake.MethodsWe analysed repeated cross-sectional data from the Health Survey for England. Study participants were classified into one of four groups: one HS-eligible group and three control groups, meeting only the income or demographic or no eligibility criterion. Outcome measures were mean F&V intake and the proportions of participants consuming ≥3 and ≥1 portion/day. Outcomes were compared across the four groups over four time periods: 2001–2003, 2004–2006, 2007–2009 and 2010–2014. Regression analyses examined whether F&V intake among HS-eligible participants had a significantly different rate of change from those in the control groups.ResultsThe change in mean F&V consumption over time was similar in HS-eligible adults and children to that of the control groups. Likewise, the change in odds of consuming ≥3 or ≥1 portion of F&V/day over time was similar among HS-eligible participants and control groups.ConclusionThis study found that during the period 2001–2003 to 2010–2014, F&V consumption among adults and children in households deemed eligible for HS changed similarly to that of other adults and children. Potential explanations include that vouchers may have been spent on milk or infant formula, or that vouchers helped protect F&V consumption in low-income households.
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161
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Stevely AK, Buykx P, Brown J, Beard E, Michie S, Meier PS, Holmes J. Exposure to revised drinking guidelines and 'COM-B' determinants of behaviour change: descriptive analysis of a monthly cross-sectional survey in England. BMC Public Health 2018; 18:251. [PMID: 29444647 PMCID: PMC5813355 DOI: 10.1186/s12889-018-5129-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Accepted: 01/30/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND January 2016 saw the publication of proposed revisions to the UK's lower risk drinking guidelines but no sustained promotional activity. This paper aims to explore the impact of publishing guidelines without sustained promotional activity on reported guideline exposure and determinants of behaviour (capability, opportunity and motivation) proposed by the COM-B model. METHODS Data were collected by a monthly repeat cross-sectional survey of adults (18+) resident in England over 15 months between November 2015 and January 2017 from a total of 16,779 drinkers, as part of the Alcohol Toolkit Study. Trends and associated 95% confidence intervals were described in the proportion of reported exposure to guidelines in the past month and measures of the capability, opportunity and motivation to consume alcohol within drinking guidelines. RESULTS There was a rise in reported exposure to drinking guidelines in January 2016 (57.6-80.6%) which did not reoccur in January 2017. Following the increase in January 2016, reported exposure reduced slowly but remained significantly higher than in December 2015. In February 2016, there was an increase in measures of capability (31.1% reported tracking units of alcohol consumption and 87.8% considered it easier to drink safely) and opportunity (84.0% perceived their lifestyle as conducive to drinking within guidelines). This change was not maintained in subsequent months. Other measures showed marginal changes between January and February 2016 with no evidence of change in subsequent months. CONCLUSIONS Following the publication of revised drinking guideline in January 2016, there was a transient increase in exposure to guidelines, and capability and opportunity to drink within the guidelines that diminished over time. The transience and size of the changes indicate that behaviour change is unlikely. Well-designed, theory-based promotional campaigns may be required for drinking guidelines to be an effective public health intervention.
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Affiliation(s)
- Abigail K Stevely
- School of Health and Related Research, University of Sheffield, Sheffield, UK.
| | - Penny Buykx
- Sheffield Alcohol Research Group, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
- UK Centre for Tobacco and Alcohol Studies (UKCTAS), Nottingham, UK
| | - Jamie Brown
- UK Centre for Tobacco and Alcohol Studies (UKCTAS), Nottingham, UK
- Department of Behavioural Science and Health, University College London, London, UK
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Emma Beard
- UK Centre for Tobacco and Alcohol Studies (UKCTAS), Nottingham, UK
- Department of Behavioural Science and Health, University College London, London, UK
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Susan Michie
- Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Petra S Meier
- Sheffield Alcohol Research Group, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
- UK Centre for Tobacco and Alcohol Studies (UKCTAS), Nottingham, UK
| | - John Holmes
- Sheffield Alcohol Research Group, School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
- UK Centre for Tobacco and Alcohol Studies (UKCTAS), Nottingham, UK
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162
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Carey G, Malbon E, Crammond B, Pescud M, Baker P. Can the sociology of social problems help us to understand and manage 'lifestyle drift'? Health Promot Int 2018; 32:755-761. [PMID: 26747659 DOI: 10.1093/heapro/dav116] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
Lifestyle drift is increasingly seen as a barrier to broad action on the social determinants of health. The term is currently used in the population health literature to describe how broad policy initiatives for tackling inequalities in health that start off with social determinants (upstream) approach drift downstream to largely individual lifestyle factors, as well as the general trend of investing a the individual level. Lifestyle drift occurs despite the on-going efforts of public health advocates, such as anti-obesity campaigners, to draw attention to the social factors which shape health behavior and outcomes. In this article, we explore whether the sociology of social problems can help understand lifestyle drift in the context of obesity. Specifically, we apply Jamrozik and Nocella's residualist conversion model to the problem of obesity in order to explore whether such an approach can provide greater insight into the processes that underpin lifestyle drift and inform our attempts to mitigate it.
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Affiliation(s)
- Gemma Carey
- Regulatory Institutions Network, Australian National University, Canberra, Australia
| | - Eleanor Malbon
- Regulatory Institutions Network, Australian National University, Canberra, Australia
| | | | - Melanie Pescud
- Regulatory Institutions Network, Australian National University, Canberra, Australia
| | - Philip Baker
- Regulatory Institutions Network, Australian National University, Canberra, Australia
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163
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O'Hara L, Taylor J, Barnes M. The invisibilization of health promotion in Australian public health initiatives. Health Promot Int 2018; 33:49-59. [PMID: 27436410 DOI: 10.1093/heapro/daw051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The field of health promotion has arguably shifted over the past thirty years from being socially proactive to biomedically defensive. In many countries this has been accompanied by a gradual decline, or in some cases the almost complete removal of health promotion designated positions within Government health departments. The language or discourse used to describe the practice and discipline of health promotion is reflective of such changes. In this study, critical discourse analysis was used to determine the representation of health promotion as a practice and a discipline within 10 Australian Government weight-related public health initiatives. The analysis revealed the invisibilization of critical health promotion in favour of an agenda described as 'preventive health'. This was achieved primarily through the textual practices of overlexicalization and lexical suppression. Excluding document titles, there were 437 uses of the terms health promotion, illness prevention, disease prevention, preventive health, preventative health in the documents analysed. The term 'health promotion' was used sparingly (16% of total terms), and in many instances was coupled with the term 'illness prevention'. Conversely, the terms 'preventive health' and 'preventative health' were used extensively, and primarily used alone. The progressive invisibilization of critical health promotion has implications for the perceptions and practice of those identifying as health promotion professionals and for people with whom we work to address the social and structural determinants of health and wellbeing. Language matters, and the language and intent of critical health promotion will struggle to survive if its speakers are professionally unidentifiable or invisible.
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Affiliation(s)
- Lily O'Hara
- Emirates College for Advanced Education, Abu Dhabi, United Arab Emirates
| | - Jane Taylor
- University of the Sunshine Coast, Sippy Downs, QLD 4556, Australia
| | - Margaret Barnes
- University of the Sunshine Coast, Sippy Downs, QLD 4556, Australia
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164
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Hyett N, Kenny A, Dickson-Swift V. Re-imagining occupational therapy clients as communities: Presenting the community-centred practice framework. Scand J Occup Ther 2018; 26:246-260. [DOI: 10.1080/11038128.2017.1423374] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Nerida Hyett
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Amanda Kenny
- La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
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165
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Wiltshire GR, Fullagar S, Stevinson C. Exploring parkrun as a social context for collective health practices: running with and against the moral imperatives of health responsibilisation. SOCIOLOGY OF HEALTH & ILLNESS 2018; 40:3-17. [PMID: 28990198 DOI: 10.1111/1467-9566.12622] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
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. The purpose of this paper is to examine how parkrun - an increasingly popular, regular, community-based 5 km 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 they 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.
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166
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Baum F, Friel S. Politics, policies and processes: a multidisciplinary and multimethods research programme on policies on the social determinants of health inequity in Australia. BMJ Open 2017; 7:e017772. [PMID: 29273655 PMCID: PMC5778301 DOI: 10.1136/bmjopen-2017-017772] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION The development and implementation of multisectoral policy to improve health and reduce health inequities has been slow and uneven. Evidence is largely focused on the facts of health inequities rather than understanding the political and policy processes. This 5-year funded programme of research investigates how these processes could function more effectively to improve equitable population health. METHODS AND ANALYSIS The programme of work is organised in four work packages using four themes (macroeconomics and infrastructure, land use and urban environments, health systems and racism) related to the structural drivers shaping the distribution of power, money and resources and daily living conditions. Policy case studies will use publicly available documents (policy documents, published evaluations, media coverage) and interviews with informants (policy-makers, former politicians, civil society, private sector) (~25 per case). NVIVO software will be used to analyse the documents to see how 'social and health equity' is included and conceptualised. The interview data will include qualitative descriptive and theory-driven critical discourse analysis. Our quantitative methodological work assessing the impact of public policy on health equity is experimental that is in its infancy but promises to provide the type of evidence demanded by policy-makers. ETHICS AND DISSEMINATION Our programme is recognising the inherently political nature of the uptake, formulation and implementation of policy. The early stages of our work indicate its feasibility. Our work is aided by a Critical Policy Reference Group. Multiple ethics approvals have been obtained with the foundation approval from the Social and Behavioural Ethics Committee, Flinders University (Project No: 6786).The theoretical, methodological and policy engagement processes established will provide improved evidence for policy-makers who wish to reduce health inequities and inform a new generation of policy savvy knowledge on social determinants.
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Affiliation(s)
- Fran Baum
- Southgate Institute for Health, Society and Equity, College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Sharon Friel
- School of Regulation and Global Governance (RegNet), College of Asia and the Pacific, The Australian National University, Canberra, Australia
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Peñalvo JL, Cudhea F, Micha R, Rehm CD, Afshin A, Whitsel L, Wilde P, Gaziano T, Pearson-Stuttard J, O'Flaherty M, Capewell S, Mozaffarian D. The potential impact of food taxes and subsidies on cardiovascular disease and diabetes burden and disparities in the United States. BMC Med 2017; 15:208. [PMID: 29178869 PMCID: PMC5702980 DOI: 10.1186/s12916-017-0971-9] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 11/01/2017] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Fiscal interventions are promising strategies to improve diets, reduce cardiovascular disease and diabetes (cardiometabolic diseases; CMD), and address health disparities. The aim of this study is to estimate the impact of specific dietary taxes and subsidies on CMD deaths and disparities in the US. METHODS Using nationally representative data, we used a comparative risk assessment to model the potential effects on total CMD deaths and disparities of price subsidies (10%, 30%) on fruits, vegetables, whole grains, and nuts/seeds and taxes (10%, 30%) on processed meat, unprocessed red meats, and sugar-sweetened beverages. We modeled two gradients of price-responsiveness by education, an indicator of socioeconomic status (SES), based on global price elasticities (18% greater price-responsiveness in low vs. high SES) and recent national experiences with taxes on sugar-sweetened beverages (65% greater price-responsiveness in low vs. high SES). RESULTS Each price intervention would reduce CMD deaths. Overall, the largest proportional reductions were seen in stroke, followed by diabetes and coronary heart disease. Jointly altering prices of all seven dietary factors (10% each, with 18% greater price-responsiveness by SES) would prevent 23,174 (95% UI 22,024-24,595) CMD deaths/year, corresponding to 3.1% (95% UI 2.9-3.4) of CMD deaths among Americans with a lower than high school education, 3.6% (95% UI 3.3-3.8) among high school graduates/some college, and 2.9% (95% UI 2.7-3.5) among college graduates. Applying a 30% price change and larger price-responsiveness (65%) in low SES, the corresponding reductions were 10.9% (95% UI 9.2-10.8), 9.8% (95% UI 9.1-10.4), and 6.7% (95% UI 6.2-7.6). The latter scenario would reduce disparities in CMD between Americans with lower than high school versus a college education by 3.5 (95% UI 2.3-4.5) percentage points. CONCLUSIONS Modest taxes and subsidies for key dietary factors could meaningfully reduce CMD and improve US disparities.
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Affiliation(s)
- José L Peñalvo
- Friedman School of Nutrition Science & Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA.
| | - Frederick Cudhea
- Friedman School of Nutrition Science & Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA
| | - Renata Micha
- Friedman School of Nutrition Science & Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA
| | - Colin D Rehm
- Montefiore Medical Center, New York, NY, 10467, USA
| | - Ashkan Afshin
- Institute for Health Metrics and Evaluation (IHME) at the University of Washington, Seattle, WA, 98121, USA
| | - Laurie Whitsel
- American Heart Association (AHA), Washington, DC, 20036, USA
| | - Parke Wilde
- Friedman School of Nutrition Science & Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA
| | - Tom Gaziano
- Divisions of Cardiovascular Medicine, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Jonathan Pearson-Stuttard
- School of Public Health, Imperial College London, London, W2 1PG, UK
- Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GL, UK
| | - Martin O'Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GL, UK
| | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool, L69 3GL, UK
| | - Dariush Mozaffarian
- Friedman School of Nutrition Science & Policy, Tufts University, 150 Harrison Ave, Boston, MA, 02111, USA
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168
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Warin M. Information is not knowledge: Cooking and eating as skilled practice in Australian obesity education. AUSTRALIAN JOURNAL OF ANTHROPOLOGY 2017. [DOI: 10.1111/taja.12260] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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169
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Breheny M, Severinsen C. Is social isolation a public health issue? A media analysis in Aotearoa/New Zealand. CRITICAL PUBLIC HEALTH 2017. [DOI: 10.1080/09581596.2017.1400162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Mary Breheny
- School of Public Health, Massey University , Palmerston North, New Zealand
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170
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Iversen C. Now or never: smoking cessation discussions in the face of serious illness. SOCIOLOGY OF HEALTH & ILLNESS 2017; 39:1330-1348. [PMID: 28681921 DOI: 10.1111/1467-9566.12588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Sociological research on medical discussions of lifestyle suggests that smoking patients may be seen as knowingly causing their medical problems. Therefore, it may be interactionally problematic for doctors to raise the issue of smoking cessation in relation to patients' serious health problems. While a serious illness can be expected to bring to the fore the relevance of smoking cessation advice, it may also give rise to questions about patients' right to treatment. This study uses conversation analysis to explicate how patients and doctors manage issues of responsibility in smoking cessation discussions in the face of a serious medical problem that strongly correlates with smoking. The findings show that whilst ill health can be referred to in a confrontational manner, it can also give smoking cessation a 'now or never' status that downplays patients' responsibility for not having quit before. Based on these findings, the paper concludes that for warranting further smoking cessation advice, how doctors and patients verbalise the link between smoking and a serious medical problem matters more than whether they do so.
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Affiliation(s)
- Clara Iversen
- The Department of Sociology, Uppsala University, Sweden
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171
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Hyett N, Kenny A, Dickson-Swift V. Approaches for building community participation: A qualitative case study of Canadian food security programs. OTJR-OCCUPATION PARTICIPATION AND HEALTH 2017; 37:199-209. [PMID: 28849999 DOI: 10.1177/1539449217727117] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There is increasing opportunity and support for occupational therapists to expand their scope of practice in community settings. However, evidence is needed to increase occupational therapists' knowledge, confidence, and capacity with building community participation and adopting community-centered practice roles. The purpose of this study is to improve occupational therapists' understanding of an approach to building community participation, through case study of a network of Canadian food security programs. Qualitative case study was utilized. Data were semistructured interviews, field observations, documents, and online social media. Thematic analysis was used to identify and describe four themes that relate to processes used to build community participation. The four themes were use of multiple methods, good leaders are fundamental, growing participation via social media, and leveraging outcomes. Occupational therapists can utilize an approach for building community participation that incorporates resource mobilization. Challenges of sustainability and social exclusion must be addressed.
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Affiliation(s)
- Nerida Hyett
- 1 La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Amanda Kenny
- 1 La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
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172
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Martins AVV, Chehuen Neto JA, Ferreira RE, Souza DZDO, Pereira FPDS, Gasparoni JM. As atitudes e o conhecimento sobre práticas de vida saudáveis de uma amostra da população de Juiz de Fora. HU REVISTA 2017. [DOI: 10.34019/1982-8047.2017.v43.2608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
O novo pentáculo do bem-estar refere-se a cinco características do estilo de vida que auxiliam a promoção da saúde individual: níveis de stress, características nutricionais, atividades físicas habituais, comportamento preventivo e qualidade dos relacionamentos humanos. Ao percebermos a dificuldade na alteração do estilo de vida dos pacientes e, também, em atuar na prevenção de doenças ou no seu tratamento, buscamos identificar os obstáculos na mudança para um estilo de vida saudável, além de avaliar hábitos de vida e conhecimento sobre práticas saudáveis. Assim, elaboramos um estudo transversal, descritivo e quantitativo realizado na cidade de Juiz de Fora - MG, coletando-se dados a partir do questionário validado, novo pentáculo do bem-estar, com amostra de 462 indivíduos. A maioria dos entrevistados têm noções dos hábitos saudáveis, com 55,2% da amostra baseando-se em orientações médicas; 93,7% acreditam nos benefícios da mudança de estilo de vida; 92,2% supõe que hábitos saudáveis atuais repercutem no futuro e 53,6% realizam algum tipo de atividade física. De modo geral, a amostra mantém hábitos nutricionais satisfatórios, 61,9% relataram ingesta diária de 05 porções de vegetais e 53,7% evitavam alimentos gordurosos e/ou doces. As dificuldades encontradas relacionam-se principalmente aos fatores culturais, vinculadas às crenças. Quanto as possibilidades/efetividades de mudanças; a falta de tempo foi a segunda maior dificuldade encontrada. Ao fim, concluiu-se que o perfil que melhor cuida da própria saúde compreende aqueles com nível de escolaridade mais elevado, menores de 34 anos e que recebem quatro ou mais salários mínimos por mês, independente do sexo.
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173
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Perpetuating the utopia of health behaviourism: A case study of the Canadian Men’s Health Foundation’s Don’t Change Much initiative. SOCIAL THEORY & HEALTH 2017. [DOI: 10.1057/s41285-017-0040-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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174
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Fletcher RA. The social life of health behaviors: The political economy and cultural context of health practices. ECONOMIC ANTHROPOLOGY 2017. [DOI: 10.1002/sea2.12089] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rebecca Adkins Fletcher
- Department of Appalachian Studies; East Tennessee State University; Johnson City TN 37614 USA
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175
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Promoting health in schools: Theoretical reflections on the settings approach versus nudge tactics. SOCIAL THEORY & HEALTH 2017. [DOI: 10.1057/s41285-017-0036-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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176
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Baum F, Freeman T, Lawless A, Labonte R, Sanders D. What is the difference between comprehensive and selective primary health care? Evidence from a five-year longitudinal realist case study in South Australia. BMJ Open 2017; 7:e015271. [PMID: 28455425 PMCID: PMC5719653 DOI: 10.1136/bmjopen-2016-015271] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/15/2017] [Accepted: 03/28/2017] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Since the WHO's Alma Ata Declaration on Primary Health Care (PHC) there has been debate about the advisability of adopting comprehensive or selective PHC. Proponents of the latter argue that a more selective approach will enable interim gains while proponents of a comprehensive approach argue that it is needed to address the underlying causes of ill health and improve health outcomes sustainably. METHODS This research is based on four case studies of government-funded and run PHC services in Adelaide, South Australia. Program logic models were constructed from interviews and workshops. The initial model represented relatively comprehensive service provision in 2010. Subsequent interviews in 2013 permitted the construction of a selective PHC program logic model following a series of restructuring service changes. RESULTS Comparison of the PHC service program logic models before and after restructuring illustrates the changes to the operating context, underlying mechanisms, service qualities, activities, activity outcomes and anticipated community health outcomes. The PHC services moved from focusing on a range of community, group and individual clinical activities to a focus on the management of people with chronic disease. Under the more comprehensive model, activities were along a continuum of promotive, preventive, rehabilitative and curative. Under the selective model, the focus moved to rehabilitative and curative with very little other activities. CONCLUSION The study demonstrates the difference between selective and comprehensive approaches to PHC in a rich country setting and is useful in informing debates on PHC especially in the context of the Sustainable Development Goals.
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Affiliation(s)
- Fran Baum
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
| | - Toby Freeman
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
| | - Angela Lawless
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
| | - Ronald Labonte
- Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - David Sanders
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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177
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Holman D, Lynch R, Reeves A. How do health behaviour interventions take account of social context? A literature trend and co-citation analysis. Health (London) 2017; 22:389-410. [PMID: 28504005 PMCID: PMC6377061 DOI: 10.1177/1363459317695630] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In recent years, health behaviour interventions have received a great deal of attention in both research and policy as a means of encouraging people to lead healthier lives. The emphasis of such interventions has varied over time, in terms of level of intervention (e.g. individual vs community) and drawing on different disciplinary perspectives. Recently, a number of critiques have focused on how health behaviour interventions sometimes sideline issues of social context, framing health as a matter of individual choice and, by implication, a personal responsibility. Part of this criticism is that health behaviour interventions often do not draw on alternative social science understandings of the structured and contextual aspects of behaviour and health. Yet to our knowledge, no study has attempted to empirically assess the extent to which, and in what ways, the health behaviour intervention field has paid attention to social context. In this article, we undertake this task using bibliometric techniques in order to map out the health behaviour intervention field. We find that the number of health behaviour interventions has grown rapidly in recent years, especially since around 2006, and that references to social science disciplines and concepts that foreground issues of social context are rare and, relatively speaking, constitute less of the field post 2006. More quantifiable concepts are used most, and those more close to the complexities of social context are mentioned least. The document co-citation analysis suggests that pre 2006, documents referring to social context were relatively diffuse in the network of key citations, but post 2006 this influence had largely diminished. The journal co-citation analysis shows less disciplinary overlap post 2006. At present, health behaviour interventions are continuing to focus on individualised approaches drawn from behavioural psychology and behavioural economics. Our findings lend empirical support to a number of recent papers that suggest more interdisciplinary collaboration is needed to advance the field.
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Affiliation(s)
- Daniel Holman
- Daniel Holman, Department of Sociological
Studies, University of Sheffield, Elmfield, Northumberland Road, Sheffield S10
2TU, UK.
| | | | - Aaron Reeves
- London School of Economics and Political
Science, UK
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178
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Khayatzadeh-Mahani A, Ruckert A, Labonté R. Obesity prevention: co-framing for intersectoral ‘buy-in’. CRITICAL PUBLIC HEALTH 2017. [DOI: 10.1080/09581596.2017.1282604] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Akram Khayatzadeh-Mahani
- School of Public Policy, University of Calgary, Calgary, Canada
- Health Services Management Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | - Arne Ruckert
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
| | - Ronald Labonté
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Canada
- Canada Research Chair, Globalization and Health Equity Research Unit, University of Ottawa, Ottawa, Canada
- Faculty of Health Sciences, Flinders University of South Australia, Adelaide, Australia
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179
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Merrild CH, Andersen RS, Risør MB, Vedsted P. Resisting "Reason": A Comparative Anthropological Study of Social Differences and Resistance toward Health Promotion and Illness Prevention in Denmark. Med Anthropol Q 2016; 31:218-236. [PMID: 27130785 DOI: 10.1111/maq.12295] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 12/14/2015] [Accepted: 04/11/2016] [Indexed: 11/28/2022]
Abstract
Social differences in health and illness are well documented in Denmark. However, little is known about how health practices are manifested in the everyday lives of different social classes. We propose acts of resistance and formation of health subjectivities as helpful concepts to develop our understanding of how dominant health discourses are appropriated by different social classes and transformed into different practices promoting health and preventing illness. Based on fieldwork in two different social classes, we discuss how these practices both overtly and subtly challenge the normative power of the health promotion discourse. These diverse and ambiguous forms of everyday resistance illustrate how and when situated concerns move social actors to subjectively appropriate health promotion messages. Overall, the different forms of resistance elucidate how the standardized awareness and education campaigns may perpetuate the very inequalities they try to diminish.
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Affiliation(s)
| | - Rikke Sand Andersen
- Research Unit for General Practice, Aarhus University, Denmark.,Department of Culture and Society, Aarhus University, Denmark
| | - Mette Bech Risør
- Department of Community Medicine, UiT The Arctic University of Norway, Tromsø
| | - Peter Vedsted
- Research Unit for General Practice, Aarhus University, Denmark.,Diagnostic Center, Silkeborg Hospital, Denmark
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180
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Bunn C, Wyke S, Gray CM, Maclean A, Hunt K. 'Coz football is what we all have': masculinities, practice, performance and effervescence in a gender-sensitised weight-loss and healthy living programme for men. SOCIOLOGY OF HEALTH & ILLNESS 2016; 38:812-28. [PMID: 26864994 PMCID: PMC4950300 DOI: 10.1111/1467-9566.12402] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
In this paper we use a social practice approach to explore men's experience of Football Fans in Training (FFIT), a group-based weight management programme for men that harnesses men's symbolic attachment to professional football clubs to engage them in lifestyle change. FFIT is delivered by community coaches in clubs' stadia and is gender-sensitised in relation to context, content and style of delivery. Using a 'toolkit' of concepts from the work of Bourdieu, Goffman and Durkheim we analysed data from 13 focus group discussions with participants, and fieldwork notes from programme observations to investigate the appeal and success of FFIT, and how it worked to support change. Our analysis builds on our work on the importance of shared symbolic commitment to the football club and being with 'men like me' to understand how the interaction context facilitated 'effervescent' experiences. These experiences encouraged men to make changes to their diet and physical activity, talk about them, practice performing them and implement them in their lives. Thus a social practice approach illuminated the social processes through which lifestyle change was achieved, and we argue that it can deepen and enrich both intervention design and evaluation.
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Affiliation(s)
- Christopher Bunn
- Institute of Health and WellbeingUniversity of GlasgowScotlandUK
| | - Sally Wyke
- Institute of Health and WellbeingUniversity of GlasgowScotlandUK
| | - Cindy M. Gray
- Institute of Health and WellbeingUniversity of GlasgowScotlandUK
| | - Alice Maclean
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowScotlandUK
| | - Kate Hunt
- MRC/CSO Social and Public Health Sciences UnitUniversity of GlasgowScotlandUK
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181
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Bissell P, Peacock M, Blackburn J, Smith C. The discordant pleasures of everyday eating: Reflections on the social gradient in obesity under neo-liberalism. Soc Sci Med 2016; 159:14-21. [DOI: 10.1016/j.socscimed.2016.04.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 04/20/2016] [Accepted: 04/22/2016] [Indexed: 11/29/2022]
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182
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Atanasova D, Koteyko N. Obesity frames and counter-frames in British and German online newspapers. Health (London) 2016; 21:650-669. [DOI: 10.1177/1363459316649764] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
By featuring news articles highlighting certain aspects of obesity and backgrounding others, the media can frame these aspects as especially applicable to how obesity should be understood and addressed. Despite the highest rates in Europe, news reports from Britain and Germany have come under little scholarly scrutiny. In this article, we explore frames and their frequency of use in British and German online newspapers. Our findings reveal a dominant cross-national framing of obesity in terms of ‘self-control’, which places a more pronounced emphasis on individual responsibility than demonstrated by earlier studies and may contribute to a culture of weight bias and stigma. The results also reveal evidence for cross-national efforts to challenge this individualising framing with counter-frames of ‘acceptance’ and ‘coming out’. We argue that this is a positive development, which demonstrates the potential of media frames to function not only as possible contributors to weight bias and stigma but also as mechanisms for countering entrenched social conceptions of obesity.
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183
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Fisher M, Baum FE, MacDougall C, Newman L, McDermott D, Phillips C. Intersectoral action on SDH and equity in Australian health policy. Health Promot Int 2016; 32:953-963. [DOI: 10.1093/heapro/daw035] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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184
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Farrell LC, Warin MJ, Moore VM, Street JM. Emotion in obesity discourse: understanding public attitudes towards regulations for obesity prevention. SOCIOLOGY OF HEALTH & ILLNESS 2016; 38:543-558. [PMID: 26564262 DOI: 10.1111/1467-9566.12378] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Intense concern about obesity in the public imagination and in political, academic and media discourses has catalysed advocacy efforts to implement regulatory measures to reduce the occurrence of obesity in Australia and elsewhere. This article explores public attitudes towards the possible implementation of regulations to address obesity by analysing emotions within popular discourses. Drawing on reader comments attached to obesity-relevant news articles published on Australian news and current affairs websites, we examine how popular anxieties about the 'obesity crisis' and vitriol directed at obese individuals circulate alongside understandings of the appropriate role of government to legitimise regulatory reform to address obesity. Employing Ahmed's theorisation of 'affective economies' and broader literature on emotional cultures, we argue that obesity regulations achieve popular support within affective economies oriented to neoliberal and individualist constructions of obesity. These economies preclude constructions of obesity as a structural problem in popular discourse; instead positioning anti-obesity regulations as a government-endorsed vehicle for discrimination directed at obese people. Findings implicate a new set of ethical challenges for those championing regulatory reform for obesity prevention.
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Affiliation(s)
- Lucy C Farrell
- School of Public Health, University of Adelaide, Australia
| | - Megan J Warin
- Discipline of Gender Studies and Social Analysis, University of Adelaide, Australia
- Fay Gale Centre for Research on Gender, University of Adelaide, Australia
| | - Vivienne M Moore
- School of Public Health, University of Adelaide, Australia
- Fay Gale Centre for Research on Gender, University of Adelaide, Australia
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185
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Glasgow S, Schrecker T. The double burden of neoliberalism? Noncommunicable disease policies and the global political economy of risk. Health Place 2016; 39:204-11. [DOI: 10.1016/j.healthplace.2016.04.003] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 05/26/2015] [Accepted: 06/15/2015] [Indexed: 12/25/2022]
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186
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Fry D, Zask A. Applying the Ottawa Charter to inform health promotion programme design. Health Promot Int 2016; 32:901-912. [PMID: 27099241 DOI: 10.1093/heapro/daw022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Denise Fry
- Community Health Services, Sydney Local Health District, Level 2, 18 Marsden St, Camperdown, NSW 2050, Australia
| | - Avigdor Zask
- Health Promotion Unit, Northern NSW Local Health District, PO Box 498, Lismore, NSW2480, Australia
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187
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Socio-economic divergence in public opinions about preventive obesity regulations: Is the purpose to ‘make some things cheaper, more affordable’ or to ‘help them get over their own ignorance’? Soc Sci Med 2016; 154:1-8. [DOI: 10.1016/j.socscimed.2016.02.028] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Revised: 02/13/2016] [Accepted: 02/16/2016] [Indexed: 11/21/2022]
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188
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189
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Walking groups in socioeconomically deprived communities: A qualitative study using photo elicitation. Health Place 2016; 39:26-33. [PMID: 26922515 PMCID: PMC4889783 DOI: 10.1016/j.healthplace.2016.02.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 02/09/2016] [Accepted: 02/14/2016] [Indexed: 11/24/2022]
Abstract
Walking groups can benefit health but uptake is more likely amongst those who are socially well-situated and need them least. This study worked with a new walking group in a community in England with poor health and socio-economic indicators to understand non-participation and barriers to involvement. It used a qualitative approach. Participant generated photographs captured the physical and social environments in which they walked and these were used with semi-structured interviews to inductively explore walking group participation and the wider social context of walking. We found that prior to joining there were low expectations of any health benefit and walking groups were not viewed as ‘proper’ activity. The group format and social expectations presented a barrier to joining. Having joined participants described a developing awareness of the health benefits of walking. The shared sense of achieving health goals with others sustained the group rather than socialising, per se. We suggest that walking group participation is a complex social practice. Promoting walking groups as a social activity for this group of people may well have been counter-productive. Photo-elicited interviews explored physical and social environments for walking. Group walking was not viewed as effective exercise with health benefits. Group format and social expectations represented a barrier to these participants. The walking group was sustained by achievement of goals rather than sociability. Promoting walking groups as a social activity can be counter-productive.
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190
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Warbrick I, Wilson D, Boulton A. Provider, father, and bro--Sedentary Māori men and their thoughts on physical activity. Int J Equity Health 2016; 15:22. [PMID: 26846319 PMCID: PMC4743325 DOI: 10.1186/s12939-016-0313-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 02/01/2016] [Indexed: 11/25/2022] Open
Abstract
Background Māori (indigenous peoples of New Zealand) men have a disproportionate prevalence of lifestyle-related illnesses and are targeted for national physical activity initiatives. While physical activity impacts on physical and mental health and overall wellbeing, current approaches to health promotion often lack cultural relevance. Having better understanding and incorporating relevant cultural values and motivators into program designs could improve the success of health initiatives for indigenous and minority men. Nevertheless, little is known about Māori men’s preferences, attitudes, or perspectives about physical activity, which are often interpreted through a colonized or dominant Western lens. Understanding perspectives of those groups whose values do not align with dominant cultural approaches will better equip health promoters and trainers to develop relevant community initiatives and private programs for indigenous and minority men. Methods An indigenous research approach informed a qualitative study with 18 sedentary, ‘overweight’ Māori men aged 28 to 72 years. From 2014 to 2015 these men participated in three focus group discussions aimed at understanding their views about physical activity and exercise. Data were thematically analysed and interpeted using a Māori worldview. Results Four key themes were identified – Cameraderie and ‘Bro-ship’; Adulthood Distractions and Priorities; Problems with Contemporary Gym Culture; and Provider Orientation. Key motivators for physical activity included a sense of ‘brotherhood’ in sport and physical activity and accountability to others. Participants reported the need to highlight the value of people and relationships, and having an orientation to the collective to enhance physical activity experiences for Māori men in general. Modern lifestyle distractions (such as being time deficient, and family responsibilities) along with other priorities contributed to difficulties incorporating physical activity into their daily lives. In addition, particular aspects and characteristics of the modern fitness culture and gym environment acted as barriers to adherence to physical activity. Conclusions Sedentary Māori men understand the importance of physical activity well, and have a desire to be more active. Nevertheless, they find it difficult to do so while balancing other priorities, especially cultural obligations to community and whānau (immediate and wider family). This research provides valuable insight for those promoting physical activity or designing health initiatives so that they better resonate with indigenous and minority men.
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Affiliation(s)
- Isaac Warbrick
- Taupua Waiora Centre for Māori Health Research, School of Public Health & Psychosocial Studies, Auckland University of Technology, Private Bag 92 006, Auckland, 1142, New Zealand.
| | - Denise Wilson
- Taupua Waiora Centre for Māori Health Research, School of Public Health & Psychosocial Studies, Auckland University of Technology, Private Bag 92 006, Auckland, 1142, New Zealand.
| | - Amohia Boulton
- Whakauae Research Services Ltd, PO Box 102, Whanganui, 4540, New Zealand.
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191
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Nourpanah S, Martin FS. ‘Sound Health Starts from Education’: the social construction of obesity in Iranian public health discourse. CRITICAL PUBLIC HEALTH 2015. [DOI: 10.1080/09581596.2015.1123809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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192
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The social distribution of dietary patterns. Traditional, modern and healthy eating among women in a Latin American city. Appetite 2015; 92:43-50. [DOI: 10.1016/j.appet.2015.05.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 05/02/2015] [Accepted: 05/05/2015] [Indexed: 11/23/2022]
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193
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Glasgow S, Schrecker T. The double burden of neoliberalism? Noncommunicable disease policies and the global political economy of risk. Health Place 2015; 34:279-86. [DOI: 10.1016/j.healthplace.2015.06.005] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2014] [Revised: 05/26/2015] [Accepted: 06/15/2015] [Indexed: 01/08/2023]
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194
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Rod MH, Høybye MT. A case of standardization? Implementing health promotion guidelines in Denmark. Health Promot Int 2015; 31:692-703. [DOI: 10.1093/heapro/dav026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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195
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Thompson JJ, Nichter M. Is There a Role for Complementary and Alternative Medicine in Preventive and Promotive Health? An Anthropological Assessment in the Context of U.S. Health Reform. Med Anthropol Q 2015; 30:80-99. [PMID: 25316618 DOI: 10.1111/maq.12153] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Chronic conditions associated with lifestyle and modifiable behaviors are the leading causes of morbidity and mortality in the United States. The implementation of the Affordable Care Act offers an historic opportunity to consider novel approaches to addressing the nation's public health concerns. We adopt an anticipatory anthropological perspective to consider lifestyle behavior change as common ground shared by practitioners of both biomedicine and common forms of complementary and alternative medicine (CAM). At issue is whether CAM practitioners might play a more proactive and publicly endorsed role in delivering preventive and promotive health services to address these needs. Recognizing that this is a contentious issue, we consider two constructive roles for engaged medical anthropologists: (1) as culture brokers helping to facilitate interprofessional communities of preventive and promotive health practice and (2) in collaboration with health service researchers developing patient-near evaluations of preventive and promotive health services on patient well-being and behavior change.
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Affiliation(s)
- Jennifer Jo Thompson
- Department of Crop and Soil Sciences, Department of Anthropology, University of Georgia.
| | - Mark Nichter
- School of Anthropology, Department of Family and Community Medicine, School of Public Health, University of Arizona
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196
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Star A, Hay P, Quirk F, Mond J. Perceived discrimination and favourable regard toward underweight, normal weight and obese eating disorder sufferers: implications for obesity and eating disorder population health campaigns. BMC OBESITY 2015. [PMID: 26217519 PMCID: PMC4511013 DOI: 10.1186/s40608-014-0032-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Background Obesity stigma has been shown to increase binge eating, whilst positive regard for eating disorders (EDs) may increase dietary restriction which can also lead to binge eating and weight gain. In the context of increasing prevalence of both obesity and EDs exploring community attitudes towards these illnesses may uncover new variables worthy of consideration in population health campaigns. The aim of the study was to explore community perceived stigma and conversely favourable regard toward eating disorder (ED) sufferers of varying weight status, and understand how the attitudes of obese individuals may differ from those of non-obese individuals. Data for this purpose were derived from interviews with individuals participating in a general population health survey. Vignettes of an underweight female with Anorexia Nervosa (AN), a normal weight male with an atypical eating disorder (NWED) and an obese female with Binge Eating Disorder (BED) were presented to three randomly selected sub-samples of n = 983, 1033 and 1030 respectively. Questions followed that assessed participants’ attitudes towards and beliefs about the person described in the vignette and their eating behaviours. Results Sixty-six per cent of participants who responded to the obese BED vignette believed that there would be discrimination against the person described (primarily because of her weight). Corresponding figures were for the AN and NWED vignettes were 48% and 35%, respectively. A positive regard for weight-loss or body-image-enhancing ED behaviours was reported ‘occasionally’ or more often by 8.8% of respondents to the AN vignette and by 27.5% of respondents to the NWED vignette. Positive regard for ED behaviours was significantly more likely in obese participants (AN: 15%; NWED: 43%). Conclusion The findings support integrated ED and obesity prevention programs that address weight stigma and the social desirability of ED behaviours in vulnerable individuals.
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Affiliation(s)
- Anita Star
- Private Practice, Albury, 2640 New South Wales Australia ; School of Medicine and Dentistry, James Cook University, Townsville, Queensland 4811 Australia
| | - Phillipa Hay
- School of Medicine and Dentistry, James Cook University, Townsville, Queensland 4811 Australia ; School of Medicine, University of Western Sydney, Locked bag 1797, Penrith, New South Wales 2751 Australia
| | - Frances Quirk
- School of Medicine and Dentistry, James Cook University, Townsville, Queensland 4811 Australia ; School of Medicine, Deakin University, Melbourne, 3125 Victoria Australia ; Research Directorate, Barwon Health, Geelong, 3220 Victoria Australia
| | - Jonathan Mond
- School of Medicine, University of Western Sydney, Locked bag 1797, Penrith, New South Wales 2751 Australia ; Department of Psychology, Macquarie University, Sydney, New South Wales 2129 Australia
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197
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De Souza EST, De Araújo LF, De Alencar DO, Dos Santos SEB, Silva WA, Ferreira CA, Baddini-Martinez J. Does ethnic ancestry play a role in smoking? AN ACAD BRAS CIENC 2015; 87:447-53. [PMID: 25651157 DOI: 10.1590/0001-3765201520140187] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 09/08/2014] [Indexed: 11/22/2022] Open
Abstract
The higher proportion of smokers among Black people in Brazil has been attributed to socioeconomic disparities, but genetic factors could also contribute for this finding. This study aimed at investigating associations between smoking status with genetically defined ethnic ancestry and socioeconomic features in Brazilians. Blood samples were collected from 448 volunteers (66.7% male; age: 37.1 ± 11.4 years) classified as current smokers (CS: 60.9%), former smokers (FS: 8.9%) and never smokers (NS: 30.1%). Individual interethnic admixtures were determined using a 48 insertion-deletion polymorphisms ancestry-informative-marker panel. CS showed a lower amount of European ancestry than NS (0.837 ± 0.243 X 0.883 ± 0.194, p ≤ 0.05) and FS (0.837 ± 0.243 X 0.864 ± 0.230, p ≤ 0.05), and a higher proportion of African Sub-Saharan ancestry than FS (0.128 ± 0.222 X 0.07 ± 0.174, p ≤ 0.05) and NS (0.128 ± 0.222 X 0.085 ± 0.178, p ≤ 0.05). NS reported a higher number of years in school than CS (11.2 ± 3.7 X 8.9 ± 3.8, p ≤ 0.001). CS were less common in economic Class A (30%) and more common in Class B (56.8%). In multivariate analysis, only lower number of school years and lower economic class were associated with higher chances for CS. The use of genetic molecular markers for characterizing ethnic background confirmed that socioeconomic disparities are the main determinants of higher smoking rates among Blacks in Brazil.
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Affiliation(s)
- Elisa S T De Souza
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Luiza F De Araújo
- Departamento de Genética, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Dayse O De Alencar
- Departamento de Patologia, Universidade Federal do Pará, Belém, PA, Brasil
| | | | - Wilson A Silva
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - Cristiane A Ferreira
- Departamento de Genética, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
| | - José Baddini-Martinez
- Departamento de Clínica Médica, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil
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198
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Pound P, Campbell R. Locating and applying sociological theories of risk-taking to develop public health interventions for adolescents. HEALTH SOCIOLOGY REVIEW : THE JOURNAL OF THE HEALTH SECTION OF THE AUSTRALIAN SOCIOLOGICAL ASSOCIATION 2015; 24:64-80. [PMID: 25999784 PMCID: PMC4409085 DOI: 10.1080/14461242.2015.1008537] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Accepted: 11/03/2014] [Indexed: 05/25/2023]
Abstract
Sociological theories seldom inform public health interventions at the community level. The reasons for this are unclear but may include difficulties in finding, understanding or operationalising theories. We conducted a study to explore the feasibility of locating sociological theories within a specific field of public health, adolescent risk-taking, and to consider their potential for practical application. We identified a range of sociological theories. These explained risk-taking: (i) as being due to lack of social integration; (ii) as a consequence of isolation from mainstream society; (iii) as a rite of passage; (iv) as a response to social constraints; (v) as resistance; (vi) as an aspect of adolescent development; (vii) by the theory of the 'habitus'; (viii) by situated rationality and social action theories; and (ix) as social practice. We consider these theories in terms of their potential to inform public health interventions for young people.
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Affiliation(s)
- Pandora Pound
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, BristolBS8 2PS, UK
| | - Rona Campbell
- School of Social and Community Medicine, University of Bristol, Canynge Hall, 39 Whatley Road, BristolBS8 2PS, UK
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199
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Jolley G, Freeman T, Baum F, Hurley C, Lawless A, Bentley M, Labonté R, Sanders D. Health policy in South Australia 2003-10: primary health care workforce perceptions of the impact of policy change on health promotion. Health Promot J Austr 2014; 25:116-24. [PMID: 25169802 DOI: 10.1071/he13088] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2013] [Accepted: 06/09/2014] [Indexed: 11/23/2022] Open
Abstract
ISSUE ADDRESSED This paper examines recent Australian health reform policies and considers how the primary health care (PHC) workforce experiences subsequent change and perceives its impact on health promotion practice. METHODS Health policy documents were analysed to determine their intended impact on health promotion. Interviews were conducted with 39 respondents from four State-funded PHC services to gain their perceptions of the impact of policy change on health promotion. RESULTS There have been a plethora of policy and strategy documents over the last decade relevant to PHC, and these suggest an intention to strengthen health promotion. However, respondents report that changes to the role and focus of PHC services have led to fewer opportunities for health promotion. Services are struggling to engage in health promotion activity, while funding and policy directions are prioritised to targeted, individual behaviour change. CONCLUSION The experience of PHC workforce respondents in South Australia suggests that, despite policy intentions, health promotion practice is much reduced. Our research suggests that rigorous evaluation of health sector reforms should be undertaken to assess both intended and unintended outcomes in terms of service quality and delivery. SO WHAT? Health promoters are experiencing a contradictory policy and practice environment, and this research should assist health promoters in advocating for more government accountability in the implementation of policies in order to advance comprehensive PHC.
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Affiliation(s)
- Gwyn Jolley
- Southgate Institute for Health, Society, and Equity, Faculty of Health Sciences, Flinders University, Adelaide, SA 5042, Australia
| | - Toby Freeman
- Southgate Institute for Health, Society, and Equity, Faculty of Health Sciences, Flinders University, Adelaide, SA 5042, Australia
| | - Fran Baum
- Southgate Institute for Health, Society, and Equity, Faculty of Health Sciences, Flinders University, Adelaide, SA 5042, Australia
| | - Catherine Hurley
- Southgate Institute for Health, Society, and Equity, Faculty of Health Sciences, Flinders University, Adelaide, SA 5042, Australia
| | - Angela Lawless
- Southgate Institute for Health, Society, and Equity, Faculty of Health Sciences, Flinders University, Adelaide, SA 5042, Australia
| | - Michael Bentley
- Southgate Institute for Health, Society, and Equity, Faculty of Health Sciences, Flinders University, Adelaide, SA 5042, Australia
| | - Ronald Labonté
- Faculty of Medicine, Institute of Population Health, University of Ottawa, Ottawa, ON, K1N 6N5, Canada
| | - David Sanders
- School of Public Health, University of the Western Cape, Cape Town, Bellville 7535, South Africa
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200
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Mohammed SA, Cooke CL, Ezeonwu M, Stevens CA. Sowing the Seeds of Change: Social Justice as Praxis in Undergraduate Nursing Education. J Nurs Educ 2014; 53:488-93. [DOI: 10.3928/01484834-20140805-03] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 04/23/2014] [Indexed: 11/20/2022]
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