Healthy publics: enabling cultures and environments for health

Public-engagement strategies of the South Asian COVID-19 Task Force: The role of racialized healthcare workers in COVID-19 mitigation in Ontario

The COVID-19 pandemic began in late 2019 and its uneven impact across different communities globally was quickly evident. In Canada, South Asian communities were disproportionately affected. In response, the South Asian COVID-19 Task Force (SACTF) emerged, seeking to address the unique challenges faced by the South Asian community. The embedded single case study design was employed to explore the role of SACTF in COVID-19 mitigation in Ontario. Informed by critical race theory and a public engagement conceptual framework published by the Canadian Health Services Research Foundation (2010), we analyzed how contexts guided the goals, processes, and outcomes of SACTF activities. We conducted one-on-one semi-structured interviews and focus group discussions with SACTF's Board of Directors and analyzed SACTF-produced knowledge dissemination materials and media coverage of SACTF spanning March 2020 to February 2022. SACTF's success in educating and advocating for South Asians offers important insights into the gaps in public health communication and the inequities in healthcare delivery. It emphasizes the importance of tailoring emergency responses to community-specific needs and the role of racialized healthcare workers in facilitating trust-building within minority communities. By incorporating insights of racialized healthcare workers in health system decision-making, both public engagement and community health outcomes can be improved. This study contributes to a nuanced understanding of community-centric pandemic responses and demonstrates the need for diverse representation in decision-making processes for long-term health system resilience. Both healthcare knowledge and lived experiences made SACTF alert to how pandemics unfold differently and have differential effects on racialized populations. SACTF's responses offer practical recommendations for future pandemic preparedness and emergency responses, emphasizing the role of advocacy groups in addressing public health gaps and serving as crucial allies for communities and governments.

Environmental protection is more important to European citizens of all political persuasions than economic growth: A 14-country study in the marine context

To focus on voters' priorities, Bill Clinton's campaign famously used the slogan, "It's the economy stupid." With growing environmental crises, is this still true? We explored this issue for the marine sector, using representatively-weighted survey data from 14 European countries (N = 11,130). Citizens were asked about their own and policy makers' (perceived) preferences for marine-related economic, environmental, and human health policy goals. Results found the public consistently prioritised environmental protection and, to a lesser extent, health over economic growth. However, the public believed that policy makers cared less about the environment and health, but more about the economy than they did themselves. These patterns were consistent across all countries, all points of the political spectrum, and among coastal and inland residents. Marine policy makers who care about public opinion, may want to start considering that, at least for the European public, it is increasingly about "the environment, stupid!".

Culturally sensitive neonatal palliative care: a critical review

Although there are known disparities in neonatal and perinatal deaths across cultural groups, less is known about how cultural diversity impacts neonatal palliative care. This article critically reviews available literature and sets out key questions that need to be addressed to enhance neonatal palliative care provision for culturally diverse families. We begin by critically reviewing the challenges to recording, categorizing and understanding data which need to be addressed to enable a true reflection of the health disparities in neonatal mortality. We then consider whose voices frame the current neonatal palliative care agenda, and, importantly, whose perspectives are missing; what this means in terms of limiting current understanding and how the inclusion of diverse perspectives can potentially help address current inequities in service provision. Utilizing these insights, we make recommendations towards setting a research agenda, including key areas for future enquiry and methodological and practice-based considerations.

What and how can we learn from complex global problems for antimicrobial resistance policy? A comparative study combining historical and foresight approaches

OBJECTIVES

To (i) develop a methodology for using historical and comparative perspectives to inform policy and (ii) provide evidence for antimicrobial-resistance (AMR) policymaking by drawing on lessons from climate change and tobacco control.

METHODS

Using a qualitative design, we systematically examined two other complex, large-scale policy issues-climate change and tobacco control-to identify what relevance to AMR can be learned from how these issues have evolved over time. During 2018-2020, we employed a five-stage approach to conducting an exploratory study involving a review of secondary historical analysis, identification of drivers of change, prioritisation of the identified drivers, scenario generation and elicitation of possible policy responses. We sought to disrupt more 'traditional' policy and research spaces to create an alternative where, stimulated by historical analysis, academics (including historians) and policymakers could come together to challenge norms and practices and think creatively about AMR policy design.

RESULTS

An iterative process of analysis and engagement resulted in lessons for AMR policy concerning persistent evidence gaps and uncertainty, the need for cross-sector involvement and a collective effort through global governance, the demand for new interventions through more investment in research and innovation, and recognising the dynamic relationship between social change and policy to change people's attitudes and behaviours are crucial towards tackling AMR.

CONCLUSION

We draw on new methodological lessons around the pragmatism of future- and policy-oriented approaches incorporating robust historical and comparative analysis. The study demonstrates proof of concept and offers a reproducible method to advance further methodology, including transferrable policies that could tackle health problems, such as AMR.

Learning how relationships work: a thematic analysis of young people and relationship professionals' perspectives on relationships and relationship education

BACKGROUND

Relationships in various forms are an important source of meaning in people's lives that can benefit their health, wellbeing and happiness. Relationship distress is associated with public health problems such as alcohol misuse, obesity, poor mental health, and child poverty, whilst safe, stable, and nurturing relationships are potential protective factors. Despite increased emphasis on Relationship Education in schools, little is known about the views of relationship professionals on relationship education specifically, and how this contrasts with the views of young people (YP). This Wellcome Centre for the Cultures and Environments of Health funded Beacon project seeks to fill this gap by exploring their perspectives and inform the future development of relationship education.

METHODS

We conducted focus groups with YP (n = 4) and interviews with relationship professionals (n = 10). The data was then thematically analysed.

RESULTS

Themes from YP focus groups included: 'Good and bad relationships'; 'Learning about relationships'; 'the role of schools' and 'Beyond Relationship Education'. Themes from interviews with relationship professionals included: 'essential qualities of healthy relationships'; 'how YP learn to relate' and 'the role of Relationship Education in schools'.

CONCLUSIONS

YP and relationship professionals recognised the importance of building YP's relational capability in schools with a healthy relationship with oneself at its foundation. Relationship professionals emphasised the need for a developmental approach, stressing the need for flexibility, adaptability, commitment and resilience to maintain relationships over the life course. YP often presented dichotomous views, such as relationships being either good or bad relationships, and perceived a link between relationships and mental health. Although not the focus of current curriculum guidance, managing relationship breakdowns and relationship transitions through the life course were viewed as important with an emphasis on building relational skills. This research suggests that schools need improved Relationship Education support, including specialist expertise and resources, and guidance on signposting YP to external sources of help. There is also potential for positive relationship behaviours being modelled and integrated throughout curriculums and reflected in a school's ethos. Future research should explore co-development, evaluation and implementation of Relationship Education programmes with a range of stakeholders.

Women's voices, emotion and empathy: engaging different publics with 'everyday' health histories

This article explores our experiences on a Wellcome Trust-funded project on women's experiences of 'everyday health' in Britain between the 1960s and the 1990s. We explore issues around researching 'everyday health', including the generation and interpretation of source materials, and the role of empathy and emotion in interactions with different audiences as we share these materials in public engagement activities. We discuss three case studies of engagement activities to draw out potential uses of source materials and the responses of different audiences to these materials, and reflect on what we have learnt since embarking on these public engagement activities. We took into our interactions with different audiences the belief that fully historicised understandings of 'health' enrich individual lives and create new capacities for meaningful action now. The public engagement activities we carried out reinforced this belief, but also caused us to question some of our assumptions. In particular, an activity with trainee healthcare professionals designed to demonstrate how active and empathetic listening can prevent the unintentional infliction of harm in healthcare settings achieved this end-but did so in a way that was itself unintentionally insensitive to the pressures healthcare professionals face. Medical humanities can help to contextualise, nuance and improve healthcare practice-but only through active listening and dialogue across medicine and the humanities. We conclude by considering how these activities, which currently rely on the interpersonal relations of the team with audiences, might be adapted and preserved in digital form beyond the span of the project.

Publics and their health: 50 years of continuity and change

BACKGROUND

This article explores a set of changes and continuities in relation to public health and its publics in the UK since the establishment of the Faculty of Public Health in 1972.

METHODS

The article draws on historical research to produce a synthetic analysis of key changes and continuities in British public health since 1972.

RESULTS

Three key areas are identified. The first centres on the issue of who has responsibility for public health. The second examines the persistence of social and racial inequalities in population health. The third considers the 'return' of infectious disease as a threat to public health.

CONCLUSIONS

Despite the trend to place more responsibility for individual and collective health on the public itself, there was a proliferation in the actors and authorities involved in securing and protecting the health of the public. The strong linkages between health and structural inequality, and the challenges of addressing these, demonstrate that public health never was (and never can be) solely an individual matter. The appearance of new diseases, such as HIV/AIDS and the return of ones thought to have been conquered, like tuberculosis, raised profound questions for public health authorities and the people they cared for.

Bridging the gap between science and indigenous cosmologies: Rheumatic Heart Disease Champions4Change

Australia has articulated a commitment to eliminate rheumatic heart disease (RHD) by 2031. Business as usual will not achieve this goal. Diverse sectors need to work together in implementing complementary strategies towards this ambitious target. Rheumatic Heart Disease Australia’s ‘Champions4Change’ program is one important element that provides a novel and vital approach. Champions4Change is a culturally safe program of people living with acute rheumatic fever (ARF) and rheumatic heart disease (RHD). The Champions support each other, advocate for ending RHD, design education and awareness programs and inform resource and program development through their lived experiences. New approaches that acknowledge the complex and challenging environments in which ARF/RHD exist are required to eliminate RHD and improve care for those living with ARF/RHD. Approaches taken by the program include local engagement, improved capacity and opportunities for Champions and their communities to make self-determined decisions based on culturally informed information. This paper highlights success stories using culture and locally appropriate approaches to improve community knowledge and awareness of RHD. We describe the rationale, development and purpose of Champions4Change, illustrating how this is far more than a peer-support group, and provides benefits for health services and researchers, as well as empowering community members.

An Introduction to Engaged Phenomenology

In this article, I introduce engaged phenomenology as an approach through which phenomenologists can more explicitly and critically consider the generative conditions and implications of their research. I make an explicit link between philosophical insights from critical and generative phenomenology and the ethical and methodological insights offered by engaged research methods-a community-oriented approach to the generation of shared understanding for the mutual benefit of all stakeholders in research. The article consists of (a) a review of these respective strands of inquiry, (b) an overview and critique of mainstream qualitative methodologies in phenomenology, and (c) suggestions for those interested in working through engaged phenomenology as an approach to both theory and research praxis.

Protocol: Mapping social networks, social influence and sexual health among youth in rural KwaZulu-Natal, the Sixhumene cohort study

Background: Sexual behaviour and sexually transmitted infections are strongly affected by social connections, and interventions are often adapted more readily when diffused through social networks. However, evidence on how young people acquire ideas and change behaviour through the influence of important social contacts is not well understood in high-HIV-prevalence settings, with the result that past peer-led HIV-prevention interventions have had limited success. Methods: We therefore designed a cohort study (named Sixhumene or 'we are connected') to follow young people in three rural and small-town communities in uMkhanyakude district, KwaZulu-Natal, South Africa, and the people that these youth identify as important in their lives. We will interview them five times over three years, at each visit collecting information on their socioeconomic, social and sexual health lives, and testing them for HIV and herpes simplex virus 2 (HSV-2). We will use this information to understand how these young people's sexual health decisions are formed. This will include evaluating how poor sexual health outcomes are correlated across social networks, how youth mimic the attitudes and behaviours of those around them, who is at greatest risk of acquiring HIV and HSV-2, and who might be most influential within communities and thus best able to promote protective interventions. Discussion: The information gathered through this study will allow us to describe social connection and influence spread through these real-world social networks, and how this leads to sexual health outcomes. Sixhumene will provide vital inputs for mathematical models of communities and spreading processes, as well as inform the development of effective interventions to protect the sexual health of community members through appropriate targeting with optimised messaging requiring fewer resources.

The experience of people with psychosocial disabilities of living independently and being included in the community in war-affected settings: A review of the literature

This article explores the experience of people with psychosocial disabilities with independent living and community inclusion in war-affected settings. While the UN CRPD obliges states to protect the rights of persons with psychosocial disabilities to community living (Article 19) in contexts of war (Article 11), information is lacking about people's lived experience. We reviewed studies published between 1980 and 2020, exploring concepts central to the CRPD's Article 19. Sixteen articles met the inclusion criteria. Findings indicate that support for persons with psychosocial disabilities is lacking while also being insufficiently described; little information is available about types of mental health and psychosocial support services; and data are almost absent about access to community services available for the general population. To ensure independent living and community integration in contexts of war, we emphasize the need for comprehensive and intersectional approaches that are locally relevant, participatory, and based on human rights.

Co-production for or against the university: student loneliness and the commodification of impact in Covid-19

PURPOSE

This paper explores the dissonance between co-production and expectations of impact in a research project on student loneliness over the 2019/2020 academic year. Specific characteristics of the project - the subject matter, interpolation of a global respiratory pandemic, informal systems of care that arose among students, and role of the university in providing the context and funding for the research - brought co-production into heightened tension with the instrumentalisation of project outputs.

STUDY DESIGN/METHODOLOGY/APPROACH

Our project consisted of a series of workshops, research meetings, and mixed-methods online journalling between 2019-2020. This paper is primarily a critical reflection on that research, based on observations by and conversations between the authors, together with discourse analysis of research data.

FINDINGS

We argue that co-producing research with students on university contexts elevates existing tensions between co-production and institutional valuations of impact; that co-production with students who had experienced loneliness made necessary space for otherwise absent support and care; that our responsibility to advocate for our evidence and co-researchers came into friction with how the university felt our research could be useful; and that each of these converging considerations are interconnected symptoms of the ongoing marketisation of HE.

ORIGINALITY/VALUE

This paper provides a novel analysis of co-production, impact, and higher education in the context of an original research project with specific challenges and constraints. It is a valuable contribution to methodological literatures on co-production, multidisciplinary research into student loneliness, and reflexive work on the difficult uses of evidence in university contexts.

The Index of Evidence: speculative methodologies in response to the post-truth era

The past year has shown that even the fundamental idea of ‘evidence’ – in health contexts, but also more broadly - is coming under increasing strain. This open letter argues that the current crises of evidence and knowledge in which we find ourselves demands new speculative methodologies. It introduces the Index of Evidence – a Beacon Project funded by Exeter University’s Wellcome Centre for Cultures and Environments of Health - as one example of such a methodology, outlining its theoretical foundations and process. The key innovation of this project is to rethink the form and presentation that research can take. Using the conceptual and material affordances of the index, it merges the creative and critical in ways that aim to make an important contribution to more inter-connected, theoretically sophisticated thinking around evidence.

Follow *the* science? On the marginal role of the social sciences in the COVID-19 pandemic

In this paper, we use the case of the COVID-19 pandemic in Europe to address the question of what kind of knowledge we should incorporate into public health policy. We show that policy-making during the COVID-19 pandemic has been biomedicine-centric in that its evidential basis marginalised input from non-biomedical disciplines. We then argue that in particular the social sciences could contribute essential expertise and evidence to public health policy in times of biomedical emergencies and that we should thus strive for a tighter integration of the social sciences in future evidence-based policy-making. This demand faces challenges on different levels, which we identify and discuss as potential inhibitors for a more pluralistic evidential basis.

Heart's Ease: Eudaimonia, Musicking in the Pandemic, and Its Implications for Music Education

This article will review the themes found in the literature on eudaimonia: ethical behaviour, a sense of meaning and purpose, autonomy – being able to make wise decisions and manage behaviour, contemplation, relationship with spirits of the ancestors and celestial beings and relationships of mutuality, respect. It will use these to critique various events online during the pandemic, such as the Embodiment conference, the SHIFT conference and the ZOOM peace choir. These developments related to music and wellbeing will be used to interrogate the purposes of music education and what might be learned from these new developments in relation to technology in relation to themes, such as values, orality and literacy, process and product.

Delivering a childhood obesity prevention intervention using Islamic religious settings in the UK: What is most important to the stakeholders?

Ten per cent of the childhood population in the UK are of South Asian (SA) origin. Within this population, over 40% are living with overweight or obesity. The majority of SA children are Muslim and attend Islamic religious settings (IRS) daily after school. Because of their reach and influence, IRS may be an appropriate channel for obesity prevention initiatives. We conducted 20 in-depth interviews with parents of children attending IRS, 20 with Islamic leaders, and 3 focus group discussions with 26 managers and workers of IRS in Bradford and Birmingham. Topic guides were developed, interviews and focus group discussions were audio-recorded, transcribed, and analysed thematically. Muslim parents, Islamic leaders and IRS staff were supportive of the delivery of obesity prevention interventions for children using IRS. Participants identified important components of an intervention including: Prophet Muhammad (PBUH) as a role model for healthy lifestyle; healthy diet, physical activity, and organisational behaviour change within IRS. Participants suggested that Islamic narrative on healthy diet and physical fitness could increase delivery uptake. Staff showed willingness to conduct physical activity sessions for boys and girls. Barriers for the intervention delivery were poor funding systems and time constraints for staff. All participant groups thought that it would be possible to deliver a childhood obesity prevention intervention. Interventions should be co-designed, culturally and religiously sensitive and combine the scientific guidelines on healthy living with Islamic narrative on importance of healthy diet consumption and physical activity.

Planetary healthy publics after COVID-19

COVID-19 is a sign of a global malaise. The pandemic is an outcome of what we term a planetary dysbiosis, for which underlining drivers include inequality and the exploitation and extraction of human and non-human labours. The implication is that the usual fixes to outbreaks of infectious diseases (ie, surveillance, pharmaceutical measures, and non-pharmaceutical measures) will be insufficient without a thorough reappraisal of and investment in planetary health. Given the heterogeneity and diversity of environments and populations, we envisage these actions as a matter for the generation of new kinds of public, requiring widespread and multiple forms of engagement to generate lasting solutions. We use and extend the concept of healthy publics to suggest a movement that can start to reclaim planetary health as a collective and ongoing issue.

The geography of the US's mishandling of COVID-19: A commentary on the politics of science in democracies

During the pandemic, many prominent global leaders and scholars have called for placing science above politics. This commentary argues that such rhetoric dangerously oversimplifies science and politics as insular from democracy and geographical context. The theory of co-construction from science and technology studies reveals the pandemic's geographic intersection with other threats to democracy, such as rising inequality and authoritarianism. Since COVID-19 figures to be central to the politics of the future, the field of geography helps to contextualise the importance of problematic trends that hinder the capacity for democracies to respond to present and future crises.

Sustainable Development Goals (SDGs): Assessing the Contribution of Higher Education Programmes

Universities are engines of societal transformation and can nurture future citizens and navigate them towards sustainability through their educational programmes. Here, we developed an assessment framework for educational institutions to evaluate the contribution of their educational programmes to sustainability by reviewing the alignment of their intended learning outcomes to the enabling conditions for a vision of sustainability based on the Sustainable Development Goals (SDGs). The tool is based on a systemic grouping of the SDGs into eight sustainability attributes, namely, Safe Operating Space, Just Operating Space, Resilient Sustainable Behaviours, Alternative Economic Models, Health and Wellbeing, Collaboration, Diversity and Inclusion, and Transparency and Governance, and uses a word code developed specifically for each sustainability attribute to assess the coverage of the SDGs in master’s programmes’ learning outcomes. The tool uses multi-criteria analysis to compare and rank programmes according to the alignment of their learning outcomes to the sustainability attributes and their contribution to sustainability. It was first tested using data from a University’s eighteen master’s programmes on a range of subjects and subsequently applied to compare forty UK and European master’s programmes focusing on environment and sustainability. Findings demonstrate that even environmental programmes face some important gaps related to health, wellbeing, diversity, inclusion, and collaboration, amongst others, and reinforce the need for all universities to understand the contribution of their programmes to sustainability. The application of the tool can generate empirical evidence on the effectiveness of university programmes and establish a strong argument regarding the potential of education as a tool for achieving the SDGs.

Tackling child malnutrition in Jamaica, 1962-2020

On the eve of independence in 1962, malnutrition was the largest single cause of death in Jamaica for children under one. Although child malnutrition rates have rapidly declined since 1962, today Jamaica experiences a double burden of malnutrition: the coexistence of pockets of high child malnutrition with rising levels of childhood obesity. Based on a wide range of sources, including public documents, newspaper reports, scientific studies and reports by international agencies, this article examines a gradual decline in child malnutrition and the rise of the double burden of malnutrition in Jamaica from independence to the present. It will first of all show that changes in the global economy and overseas loans and aid both aided and limited the ability of the Jamaican government to lower child malnutrition levels and also contributed to a rise in childhood obesity. Second, it will illustrate that a traditional deficit-led approach to child malnutrition was followed in post-independent Jamaica, focussing on the public and individuals as targets for intervention and using quantitative measures to trace progress. And third, it will question whether the double burden of child malnutrition will give rise to 'healthy publics'-'dynamic collectives of people, ideas and environments that can enable health and well-being'.

The Roses Ocean and Human Health Chair: A New Way to Engage the Public in Oceans and Human Health Challenges

Involving and engaging stakeholders is crucial for studying and managing the complex interactions between marine ecosystems and human health and wellbeing. The Oceans and Human Health Chair was founded in the town of Roses (Catalonia, Spain, NW Mediterranean) in 2018, the fruit of a regional partnership between various stakeholders, and for the purpose of leading the way to better health and wellbeing through ocean research and conservation. The Chair is located in an area of the Mediterranean with a notable fishing, tourist, and seafaring tradition and is close to a marine reserve, providing the opportunity to observe diverse environmental conditions and coastal and maritime activities. The Chair is a case study demonstrating that local, collaborative, transdisciplinary, trans-sector, and bottom-up approaches offer tremendous opportunities for engaging coastal communities to help support long-lasting solutions that benefit everyone, and especially those living by the sea or making their living from the goods and services provided by the sea. Furthermore, the Chair has successfully integrated most of its experts in oceans and human health from the most prestigious institutions in Catalonia. The Chair focuses on three main topics identified by local stakeholders: Fish and Health; Leisure, Health, and Wellbeing; and Medicines from the Sea. Led by stakeholder engagement, the Chair can serve as a novel approach within the oceans and human health field of study to tackle a variety of environmental and public health challenges related to both communicable and non-communicable diseases, within the context of sociocultural issues. Drawing on the example provided by the Chair, four principles are established to encourage improved participatory processes in the oceans and human health field: bottom-up, “think local”, transdisciplinary and trans-sectorial, and “balance the many voices”.

Humanities, criticality and transparency: global health histories and the foundations of inter-sectoral partnerships for the democratisation of knowledge

Historians of medicine have been influential actors in a broader movement to highlight the social, institutional and administrative benefits of historical research, and its relevance for national and international policy intended to extend and improve contemporary healthcare. Historical perspectives are fundamentally useful to health policy actors because questions about what it is to be healthy, to suffer disease or disability, and the presentation and acceptance of solutions are interwoven in culturally and historically complex webs of meaning. Historians, as they have examined the social and cultural social determinants of health, have also used their work as public engagement, educational and policy resource tools, demonstrating that history is an effective way of making key issues in science, medicine and well-being more administratively responsive and accessible to lay audiences. This article explores such issues through the case study of the long-running World Health Organization (WHO) Global Health Histories project. Established in late 2004, the project's enduring rationale has been that understanding the history of health helps the global public health community to respond to the challenges of today and help shape a healthier future. It has sought to do this by bringing together researchers and policy-makers into honest and democratic conversations and exchanges of ideas. The aim has been to stimulate a fusion between historical evidence and current policy approaches to many of the most urgent health issues. This article discusses the challenges and opportunities in bringing health history and policy together, and explores the importance of explaining historical method and the need to convince policy partners how history is evidence-based, that it can access and provide useful strategic information from archives of major institutions, and, therefore, a useful contributor to making policy initiatives adaptable and acceptable within complex polities and societies.

Evaluating care farming as a means to care for those in trauma and grief

The interrelationships between nature, health, and wellbeing are increasingly recognized and incorporated into therapeutic interventions. Care farming, the concept of utilizing agricultural places and practices for providing care, therapy, and rehabilitation, is a paradigmatic example of this shift. This mixed method study empirically evaluates the efficacy of care farming as an intervention for individuals affected by traumatic grief, a complex experiential condition. Both quantitative and qualitative results suggest this care farm intervention was beneficial, yielding significant reductions in subjective distress to grief intensity. The study's findings add to the growing body of evidence on care farming and support green care as a therapeutic potential for individuals affected by traumatic grief.

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Few interventions have been successfully tested with those suffering traumatic grief. Care farming is a potential alternative means toward provision of care for the traumatically grieving population.

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After a two-day, 10 h intervention, participants experienced significantly less subjective trauma and distress in pre/post tests using the TGI psychometric measures.

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Rich qualitative data reveal that participants felt supported, connected, and yielded therapeutic benefit.

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Given the lack of consensus on the use psychotropic medications for grief, green models, such as care farming, provide to care that is not limited to a medical model.

Public involvement in research about environmental change and health: A case study

Involving and engaging the public are crucial for effective prioritisation, dissemination and implementation of research about the complex interactions between environments and health. Involvement is also important to funders and policy makers who often see it as vital for building trust and justifying the investment of public money. In public health research, ‘the public’ can seem an amorphous target for researchers to engage with, and the short-term nature of research projects can be a challenge. Technocratic and pedagogical approaches have frequently met with resistance, so public involvement needs to be seen in the context of a history which includes contested truths, power inequalities and political activism. It is therefore vital for researchers and policy makers, as well as public contributors, to share best practice and to explore the challenges encountered in public involvement and engagement. This article presents a theoretically informed case study of the contributions made by the Health and Environment Public Engagement Group to the work of the National Institute for Health Research (NIHR) Health Protection Research Unit in Environmental Change and Health (HPRU-ECH). We describe how Health and Environment Public Engagement Group has provided researchers in the HPRU-ECH with a vehicle to support access to public views on multiple aspects of the research work across three workshops, discussion of ongoing research issues at meetings and supporting dissemination to local government partners, as well as public representation on the HPRU-ECH Advisory Board. We conclude that institutional support for standing public involvement groups can provide conduits for connecting public with policy makers and academic institutions. This can enable public involvement and engagement, which would be difficult, if not impossible, to achieve in individual short-term and unconnected research projects.

The violence of narrative: embodying responsibility for poverty-related stress

Narratives of self-responsibility are pervasive in neoliberally oriented contexts, and have been found to engender feelings of shame and failure amongst those affected by poverty. Here, we use findings from research in two low-income communities in south-west England to examine how these narratives become embodied within people's daily lives when they intersect with systems of welfare support and the current political drive to upscale treatment for common mental health conditions. Drawing on Bourdieu's notion of symbolic violence, we examine how narratives of self-responsibility and associated welfare reform strategies impact on the mental health of people living in economic hardship. The data show how such narratives inflict, sustain and exacerbate mental distress and suffering, and how they become naturalised and normalised by individuals themselves. We demonstrate how this situation pushes people to seek support from General Practitioners, and how clinical interactions can normalise, and in turn, medicalise, poverty-related distress. Whilst some people actively resist dominant narratives around self-responsibility, we argue that this is insufficient under broader sociocultural and political circumstances, to free themselves from the harms perpetuated by symbolic violence.

An engaged approach to exploring issues around poverty and mental health: A reflective evaluation of the research process from researchers and community partners involved in the DeStress study

Background

Involving patients, service users, carers and members of the public in research has been part of health policy and practice in the UK for the last 15 years. However, low‐income communities tend to remain marginalized from the co‐design and delivery of mental health research, perpetuating the potential for health inequalities. Greater understanding is therefore needed on how to meaningfully engage low‐income communities in mental health research.

Objectives

To explore and articulate whether and how an engaged research approach facilitated knowledge coproduction relating to poverty and mental distress.

Setting

A reflective evaluation of community and researcher engagement in the DeStress study that took place in two low‐income areas of South‐west England.

Design

Reflective evaluation by the authors through on‐going feedback, a focus group and first‐person writing and discussion on experiences of working with the DeStress project, and how knowledge coproduction was influenced by an engaged research approach.

Results

An engaged research approach influenced the process and delivery of the DeStress project, creating a space where community partners felt empowered to coproduce knowledge relating to poverty‐related mental distress, treatment and the training of health professionals that would otherwise have been missed. We examine motivations for involvement, factors sustaining engagement, how coproduction influenced research analysis, findings and dissemination of outputs, and what involvement meant for different stakeholders.

Conclusion

Engaged research supported the coproduction of knowledge in mental health research with low‐income communities which led to multiple impacts.

Doing more with movement: constituting healthy publics in movement volunteering programmes

The recent phenomenon of movement volunteering programmes is a form of 'fitness philanthropy' that combines exercise with volunteering in order for physical activity to generate a more widely shared set of benefits. These newest practices of fitness philanthropy radically rework both exercise and volunteering through the ways in which these come together and take place outdoors and in the everyday spaces of the street or community. The paper explores these new practices through the movement volunteering programme 'GoodGym', in relation to the concept of 'healthy publics'. Fieldwork comprised ethnography, including participant observation, interviews, go-along interviews, conversations, photography and an end of fieldwork discussion workshop. We focus on the experiences of three different constituencies in GoodGym: the volunteers; the participants and passers-by; the space and atmosphere. The formation of these dynamic, multiple and shifting healthy publics emerge through the complex intersections of several processes. We draw particular attention to the centrality in the new fitness philanthropy practices of visibility and spectacle, sociality and merging mobilities in constituting healthy publics.

From more-than-human solidarity to multi-species biographical value: insights from a veterinary school about ethical dilemmas in One Health promotion

This article features a partnership between a veterinary school and a charity that aims to enhance the wellbeing of low-income people. Through this partnership, the charity periodically hosts veterinary clinics for clients and their pets. Even as the veterinarians and veterinary students duly examine people's pets, these pop-up clinics aim to help people and their pets. Hence our analysis revolves around the ethics of 'more-than-human solidarity'. By 'more-than-human solidarity', we mean efforts to help others that either center on or that implicate non-human beings. To delve into the ethical and sociological implications of subsidised veterinary services, and to assist with program planning, we conducted several in-depth interviews with veterinarians. Most substantively, we found that the veterinary school's outreach clinics give rise to multi-species biographical value, which is prized as a pedagogical resource for veterinary students. The veterinarians whom we interviewed felt troubled by the extent to which the pop-up clinics ultimately benefited the veterinary school, but also by the shortage of subsidised veterinary services in the vicinity. Based on these interviews and our own reflections, we invite more scholarship on cultural, economic and political influences that shape the lives of human beings and non-human animals alike.

Power, participation and their problems: A consideration of power dynamics in the use of participatory epidemiology for one health and zoonoses research

The use of Participatory Epidemiology in veterinary research intends to include livestock keepers and other local stakeholders in research processes and the development of solutions to animal health problems, including potentially zoonotic diseases. It can also be an attempt to bring some of the methods and insights of social science into a discipline largely shaped by natural science methods and ways of seeing the world. The introduction of participatory methodologies to veterinary epidemiology and disease surveillance follows a wider movement in development thinking, questioning the top-down nature of much post-second world war development efforts directed from the Global North towards the Global South. In the best cases, participatory methods can help to empower the poor and marginalised to participate in and have some control over research and interventions which affect them. Compiled from experience in multi-disciplinary One Health projects, this paper briefly traces the rise of participatory epidemiology before examining some of the limitations observed in its implementation and steps that might be taken to alleviate the problems observed. The three areas in which the operationalisation of Participatory Epidemiology in veterinary and One Health research could be improved are identified as: broadening the focus of engagement with communities beyond quantitative data extraction; taking note of the wider power structures in which research takes place, and questioning who speaks for a community when participatory methods are used. In particular, the focus falls on how researchers from different disciplines, including veterinary medicine and the social sciences, can work together to ensure that participatory epidemiology is employed in such a way that it improves the quality of life of both people and animals around the world.

Reorienting rabies research and practice: Lessons from India

In this article, we reflect on the institutional and everyday realities of people-street dog relations in India to develop a case for decolonised approaches to rabies and other zoonoses. Dog-mediated rabies in Asia and Africa continues be a major concern in transnational public health agendas despite extensive research and knowledge on its prevention. In India, which carries 35% of the global rabies burden and has large street dog populations, One Health-oriented dog population management programmes have been central to the control of this zoonotic disease. Yet, rabies continues to be a significant problem in the country. In this article, we address this impasse in rabies research and practice through investigations of interactions between people, policy, and street dogs. Drawing primarily on field and archival research in Chennai city, we track how street dogs are perceived by people, explore how these animals have come into interface with (public) health concerns over time, and examine the biosocial conditions that frame people-dog conflict (and thereby rabies). These analyses create a picture of the multidimensional character of people-dog relations to offer new insights on why One Health-oriented rabies initiatives have not borne out their full promise. In effect, the article makes a case for a shift in public health orientations-away from intervening on these animals as vectors to be managed, and towards enabling multispecies habitats. This, we argue, requires the decolonisation of approaches to dog-mediated rabies, and expanded conceptions of 'healthy more-than-human publics'. In conclusion, the article chalks out broader implications for public health approaches to zoonoses in a world marked by mutual risk and vulnerability that cuts across human and nonhuman animals.

Superman vs. Nick O'Teen: anti-smoking campaigns and children in 1980s Britain

In December 1980, the Health Education Council launched a campaign designed to discourage children from taking up smoking. Advertisements on TV and in comics and magazines featured a battle between Superman and the evil Nick O'Teen as he attempted to recruit children to his army of smokers. Children were also encouraged to join Superman in his fight by signing a pledge not to smoke, in return for which they received a poster and badges featuring the superhero. This article examines the design, production, delivery and reception of the Superman vs. Nick O'Teen campaign in order to probe the multi-faceted nature of the making of healthy publics in 1980s Britain. Children constituted a particularly problematic public. On the one hand, they were thought to be vulnerable and easily led towards unhealthy lifestyle choices. But on the other, children were also recognised as agents who might convince adults, as well as their peers not to smoke. This ambivalent conceptualisation of the child as a potential victim of malign influences, or potential rational agent and force for good, is typical of the 1980s, a time when the meanings of the child as consumer, agent, and citizen were undergoing increased ideological debate. This campaign also took place as ideas about health education, its place within public health policy and practice, and its relationship with the public, were in flux. The battle between Superman and Nick O'Teen was thus not just about smoking, but about particular ways of seeing and interacting with healthy (and unhealthy) publics.

Time to care: why the humanities and the social sciences belong in the science of health

Health is more than the absence of disease. It is also more than a biological phenomenon. It is inherently social, psychological, cultural and historical. While this has been recognised by major health actors for decades, open questions remain as to how to build systems that reflect the complexity of health, disease and sickness, and in a context that is increasingly technologised. We argue that an urgent change of approach is necessary. Methods and concepts from the humanities and social science must be embedded in the concepts and methods of the health sciences if we are to promote sustainable interventions capable of engaging with the recognised complexity of health, disease and sickness. Our vision is one of radical interdisciplinarity, integrating aspects of biological, psychological, social and humanities approaches across areas of urgent health need. Radical interdisciplinarity, we argue, entails the practical, methodological and conceptual integration of these approaches to health.

Socio-economic factors as indicators for various animal diseases in Sardinia

The need to consider the role of social factors in the efficacy of farm management and, consequently, in the onset and persistence of diseases typical to animal farms is increasingly being realized increasingly worldwide. Many risk analysis studies have been conducted to assess the role of various factors in the development of animal diseases; however, very few have accounted for the role of social factors. The aim of this work was to bridge this gap, with the main hypothesis that different socio-economic factors could be valid indicators for the occurrence of different animal diseases. A socio-economic analysis was performed using demographic characteristics of the farmers and data from 44 social indicators released by the Italian Statistician National Institute of Statistics (ISTAT) database. African swine fever (ASF) in wild boars (WB) and domestic pigs and other endemic animal diseases and zoonoses in Sardinia were considered, such as cistic echinococcosis (CE), contagious agalactia (CA), trichinellosis, West Nile disease (WND), and bluetongue (BT). Seven different negative binomial regression models were fitted using the number of cases between 2011-2017. Three indicators-cultural demand, employment rate, and legality-showed a statistically significant association with risk for all the diseases considered, but with varying effects. Some indicators, such as the age and sex of the farmer, material deprivation index, number of farms and animals, micro-criminality index, and rate of reported thefts were common to ASF, CA, trichinellosis, and CE cases. Others such as the forest surface and the energy produced from renewable sources were common to BT, WND, and ASF in WB. Tourism in seasons other than summer was a valid predictor of ASF and trichinellosis, while out-of-region hospital use had a statistically significant role in CE risk identification. These results may help understand the social context in which these diseases may occur and thus guide the design and implementation of additional risk management measures that go beyond well-known veterinary measures.