Matthew Fisher

Bio: Matthew Fisher is an academic researcher from Flinders University. The author has contributed to research in topics: Social determinants of health & Health equity. The author has an hindex of 15, co-authored 59 publications receiving 1023 citations.

Why Behavioural Health Promotion Endures Despite Its Failure to Reduce Health Inequities

Abstract: Increasing rates of chronic conditions have resulted in governments targeting health behaviour such as smoking, eating high-fat diets, or physical inactivity known to increase risk for these conditions. In the process, many have become preoccupied with disease prevention policies focused excessively and narrowly on behavioural health-promotion strategies. These aim to improve health status by persuading individuals to change their health behaviour. At the same time, health promotion policy often fails to incorporate an understanding of the social determinants of health, which recognises that health behaviour itself is greatly influenced by peoples' environmental, socioeconomic and cultural settings, and that chronic diseases and health behaviour such as smoking are more prevalent among the socially or economically disadvantaged. We identify several reasons why behavioural forms of health promotion are inadequate for addressing social inequities in health and point to a dilemma that, despite these inadequacies and increasing evidence of the social determinants of health, behavioural approaches and policies have strong appeal to governments. In conclusion, the article promotes strategies addressing social determinants that are likely to reduce health inequities. The article also concludes that evidence alone will not result in health policies aimed at equity and that political values and will, and the pressure of civil society are also crucial.

The Social Determinants of Mental Health: Implications for Research and Health Promotion

Abstract: Social determinants of health have come to greater prominence through the recent work of the WHO Commission on the Social Determinants of Health, and the Marmot Review of Health Inequalities in England. These reports also have significant implications for promotion of mental health in developed countries. In particular they reflect a growing research interest in the view that certain adverse social conditions may detrimentally affect mental or physical health by acting as chronic stressors. However, although the case for chronic arousal of stress systems as a risk factor for mental health is empirically well-founded, questions remain about how and why psychological exposure to certain kinds of proximal social conditions might contribute to such arousal. In this paper we argue that combining evidence and ideas from a number of disciplines, including public health research and psychiatry, presents an opportunity to understand the relationship better, and so inform complementary strategies in treatment, prevention and health promotion.

Assessing the health impact of transnational corporations: its importance and a framework

Abstract: The adverse health and equity impacts of transnational corporations’ (TNCs) practices have become central public health concerns as TNCs increasingly dominate global trade and investment and shape national economies. Despite this, methodologies have been lacking with which to study the health equity impacts of individual corporations and thus to inform actions to mitigate or reverse negative and increase positive impacts. This paper reports on a framework designed to conduct corporate health impact assessment (CHIA), developed at a meeting held at the Rockefeller Foundation Bellagio Center in May 2015. On the basis of the deliberations at the meeting it was recommended that the CHIA should be based on ex post assessment and follow the standard HIA steps of screening, scoping, identification, assessment, decision-making and recommendations. A framework to conduct the CHIA was developed and designed to be applied to a TNC’s practices internationally, and within countries to enable comparison of practices and health impacts in different settings. The meeting participants proposed that impacts should be assessed according to the TNC’s global and national operating context; its organisational structure, political and business practices (including the type, distribution and marketing of its products); and workforce and working conditions, social factors, the environment, consumption patterns, and economic conditions within countries. We anticipate that the results of the CHIA will be used by civil society for capacity building and advocacy purposes, by governments to inform regulatory decision-making, and by TNCs to lessen their negative health impacts on health and fulfil commitments made to corporate social responsibility.

Practice guideline for the treatment of patients with eating disorders (revision). American Psychiatric Association Work Group on Eating Disorders.

Abstract: A. CODING SYSTEM: Each recommendation is identified as falling into one of three categories of endorsement, indicated by a bracketed Roman numeral following the statement. The three categories represent varying levels of clinical confidence regarding the recommendations: [I] recommended with substantial clinical confidence. [II] recommended with moderate clinical confidence. [III] may be recommended on the basis of individual circumstances. B. GENERAL CONSIDERATIONS: Patients with eating disorders display a broad range of symptoms that frequently occur along a continuum between those of anorexia nervosa and bulimia nervosa. The care of patients with eating disorders involves a comprehensive array of approaches. These guidelines contain the clinical factors that need to be considered when treating a patient with anorexia nervosa or bulimia nervosa. 1. Choosing a site of treatment: Pretreatment evaluation of the patient with an eating disorder is essential for determining the appropriate setting of treatment. The most important physical parameters that affect this decision are weight and cardiac and metabolic status [I]. Patients should be psychiatrically hospitalized before they become medically unstable (i.e., display abnormal vital signs) [I]. The decision to hospitalize should be based on psychiatric, behavioral, and general medical factors [I]. These include rapid or persistent decline in oral intake and decline in weight despite outpatient or partial hospitalization interventions, the presence of additional stressors that interfere with the patient's ability to eat (e.g., intercurrent viral illnesses), prior knowledge of weight at which instability is likely to occur, or comorbid psychiatric problems that merit hospitalization. Most patients with uncomplicated bulimia nervosa do not require hospitalization. However, the indications for hospitalization for these patients can include severe disabling symptoms that have not responded to outpatient treatment, serious concurrent general medical problems (e.g., metabolic abnormalities, hematemesis, vital sign changes, and the appearance of uncontrolled vomiting), suicidality, psychiatric disturbances that warrant hospitalization independent of the eating disorders diagnosis, or severe concurrent alcohol or drug abuse. Decisions to hospitalize on a psychiatric versus a general medical or adolescent/pediatric unit depend on the patient's general medical status, the skills and abilities of local psychiatric and general medical staffs, and the availability of suitable intensive outpatient, partial and day hospitalization, and aftercare programs to care for the patient's general medical and psychiatric problems. 2. Psychiatric management: Psychiatric management forms the foundation of treatment for patients with eating disorders and should be instituted for all patients in combination with other specific treatment modalities. Important components of psychiatric management for patients with eating disorders are as follows: establish and maintain a therapeutic alliance; coordinate care and collaborate with other clinicians; assess and monitor eating disorder symptoms and behaviors; assess and monitor the patient's general medical condition; assess and monitor the patient's psychiatric status and safety; and provide family assessment and treatment [I]. 3. Choice of specific treatments for anorexia nervosa: The aims of treatment for patients with anorexia nervosa are to 1) restore patients to healthy weight (at which means and normal ovulation in females, normal sexual drive and hormone levels in males, and normal physical and sexual growth and development in children and adolescents are restored); 2) treat physical complications; 3) enhance patients' motivations to cooperate in the restoration of healthy eating patterns and to participate in treatment; 4) provide education regarding healthy nutrition and eating patterns; 5) correct core maladaptive thoughts, attitudes, and feelings related to the eating disorder; 6) treat associated psychiatric conditions, including defects in mood regulation, self-esteem, and behavior; 7) enlist family support and provide family counseling and therapy where appropriate; and 8) prevent relapse. a. Nutritional rehabilitation: A program of nutritional rehabilitation should be established for all patients who are significantly underweight [I]. Nutritional rehabilitation programs should establish healthy target weights and have expected rates of controlled weight gain (e.g., 2-3 lb/week for most inpatient and 0.5-1 lb/week for most outpatient programs). Intake levels should usually start at 30-40 kcal/kg per day (approximately 1000-1600 kcal/day) and should be advanced progressively. During the weight gain phase, this may be increased to as high as 70-100 kcal/kg per day. During weight maintenance and for ongoing growth and development in children and adolescents, intake levels should be 40-60 kcal/kg per day. Patients who require higher caloric intakes may be discarding food, vomiting, or exercising frequently or have more nonexercise motor activity (e.g., fidgeting); others may have a truly higher metabolic rate. Patients also benefit from vitamin and mineral supplements (and in particular may require phosphorus before serum hypophosphatemia occurs). Medical monitoring during refeeding is essential [I]. It should include assessment of vital signs as well as food and fluid intake and output; monitoring of electrolytes (including phosphorus); and observation for edema, rapid weight gain (associated primarily with fluid overload), congestive heart failure, and gastrointestinal symptoms, particularly constipation and bloating. For children and adolescents who are severely malnourished (weight <70% of the standard body weight), cardiac monitoring may be useful, especially at night. Physical activity should be adapted to the food intake and energy expenditure of the patient. Nutritional rehabilitation programs should also include helping patients deal with their concerns about weight gain and body image changes, educating them about the risks of their eating disorder, and providing ongoing support to patients and their families [I]. b. Psychosocial interventions: The establishment and maintenance of a psychotherapeutically informed relationship is beneficial [II]. Once weight gain has started, formal psychotherapy may be very helpful. There is no clear evidence that any specific form of psychotherapy is superior for all patients. Psychosocial interventions need to be informed by understanding psychodynamic conflicts, cognitive development, psychological defenses, and complexity of family relationships as well as the presence of other psychiatric disorders. Psychotherapy alone is generally not sufficient to treat severely malnourished patients with anorexia nervosa. Ongoing treatment with individual psychotherapeutic interventions is usually required for at least a year and may take 5-6 years because of the enduring nature of many of the psychopathologic features of anorexia nervosa and the need for support during recovery. Family therapy and couples psychotherapy are frequently useful for the alleviation of both the symptoms of the eating disorder and the problems in familial relationships that may be contributing to the maintenance of these disorders [II]. Group psychotherapy is sometimes used as an adjunctive treatment for anorexia nervosa, but caution must be taken that patients do not compete to be the thinnest or sickest patient or become excessively demoralized through bearing witness to the difficult, ongoing struggles of other patients in the group. c. Medications: Psychotropic medications should not be used as the sole or primary treatment for anorexia nervosa [I]. The role for antidepressants is usually best assessed following weight gain, when the psychological effects of malnutrition are resolving. These medications should be considered for the prevention of relapse among weight-restored patients or to treat associated features of anorexia nervosa, such as depression or obsessive-compulsive problems [II]. 4. Choice of specific treatments for bulimia nervosa: a. Nutritional rehabilitation/counseling: Nutritional counseling as an adjunct to other treatment modalities may be useful for reducing behaviors related to the eating disorder, minimizing food restriction, increasing the variety of foods eaten, and encouraging healthy but not excessive exercise patterns [I]. b. Psychosocial interventions: Psychosocial interventions should be chosen on the basis of a comprehensive evaluation of the individual patient, considering cognitive and psychological development, psychodynamic issues, cognitive style, comorbid psychopathology, patient preferences, and family situation [I]. Cognitive behavioral psychotherapy is the psychosocial treatment for which the most evidence for efficacy currently exists, but controlled trials have also shown interpersonal psychotherapy to be very useful. Behavioral techniques (e.g., planned meals, self-monitoring) may also be helpful. Clinical reports have indicated that psychodynamic and psychoanalytic approaches in individual or group format may be useful once bingeing and purging are improving. Patients with concurrent anorexia nervosa or severe personality disorders may benefit from extended psychotherapy. Family therapy should be considered whenever possible, especially for adolescents still living with parents or older patients with ongoing conflicted interactions with parents [II].

Role of WHO.

Abstract: OVERVIEW The GRA Marketing Internship Program is offered to students who are interested in gaining valuable work experience through efforts in marketing, membership, sales, and events. Interns work directly to assist the Director of Marketing and Communications on various tasks relating to upcoming GRA events. During this internship, students will work a minimum of 10 hours a week and a maximum of 20 hours a week. Students are encouraged to earn credit for their internship, however this is a paid internship. Students interested in obtaining credit for their internship must consult their academic advisor or the intern coordinator at their academic unit.

Process and Reality

Abstract: In discussing the philosophical system put forward in PR, we need to point out that not only does Whitehead introduce a novel terminology, but the work itself is somewhat amorphous in character, and this despite his attempt to state a categoreal scheme — a general scheme of ideas in terms of which all our experience is to be described. There is also a considerable amount of overlap between the various parts of this book. It might have been a clearer and more effective work if Whitehead had engaged in some judicious pruning before publication.