Showing papers in "Critical Public Health in 2019"
TL;DR: Citizen science engages members of the public in research design, data collection, and analysis, in asking and answering questions about the world around them as discussed by the authors. But to date, population health science has not relied heavily on citizen contributions, and there is additional potential to mainstream population health through wider, less intensive opportunities to be involved in our science.
Abstract: Citizen science engages members of the public in research design, data collection, and analysis – in asking and answering questions about the world around them. The United States, European Union, and Australia have placed citizen science at the forefront of national science policy. Journals such as Science, Nature and Bioscience regularly feature projects conducted by citizens. Citizen science engages millions of people worldwide. However, to date, population health science has not relied heavily on citizen contributions. Although community-based participatory action research remains a strong foundational method to engage those affected by public health problems, there is additional potential to mainstream population health through wider, less intensive opportunities to be involved in our science. If we are to tackle the complex challenges that face population health then new avenues are needed to capture the energy and attention of citizens who may not feel affected by public health problems, i.e...
49 citations
TL;DR: This article responds to the dissatisfaction with established approaches to social science engagement with public health that have developed out of Straus’ early distinction between sociology in and of medicine with a mode of scholarly practice that aims to transform public health.
Abstract: This article is about a mode of scholarly practice we call critical social science with public health. The article responds to our dissatisfaction with established approaches to social science enga...
40 citations
TL;DR: Policy actors’ views of the challenges in achieving coordinated and coherent NCD policy across health and trade sectors are explored and the role of competing frames, power asymmetries and interests in constraining policy coherence is identified.
Abstract: Noncommunicable diseases (NCDs) kill 40 million people each year and are the cause of 70% of global deaths annually. Proximal risk factors include tobacco use, physical inactivity, the harmful use ...
34 citations
TL;DR: It is argued that avoiding the use of the term ‘food swamp’ can lead to a better understanding of food-related public health crises associated with the global industrial food system, thereby altering the discourse.
Abstract: A growing body of literature explores the connection between the retail environment and diet in North America. Scholars have coined the term ‘food swamp’ to describe neighbourhoods that are dominat...
31 citations
TL;DR: It is argued that without intervention current trends will continue, and these techniques will be used primarily to promote junk food, sugar-sweetened beverages, and other unhealthy products, thus increasing health disparities, and worsening health outcomes.
Abstract: The confluence of new ways to quickly gather, analyze, and use large volumes of information – so-called ‘Big Data’ – coupled with the widespread adoption of digital devices, has transformed...
30 citations
TL;DR: In this paper, government intervention for the prevention of lifestyle-related chronic disease was discussed. But the authors often conceptualise such efforts as "nanny state" and derailing wider wider health care reform.
Abstract: Critics of government intervention for the prevention of lifestyle-related chronic disease often conceptualise such efforts as ‘nanny state’, reflecting a neoliberal perspective and derailing wider...
29 citations
TL;DR: It is argued that as the challenges of the Anthropocene are upon us, it is urgent that public health researchers and practitioners rethink the skills they are teaching and prepare ourselves to radically adjust their approach.
Abstract: Health scholars have long been calling for a new approach to understanding and responding to public health challenges, recognizing the dynamic influence of social and ecological processes and the i...
24 citations
TL;DR: It is argued that digital storytelling serves as a critical narrative intervention, whereby participants’ engagement in the storytelling process enables them to collaboratively interrogate and potentially address prior trauma, bolster a sense of social support and solidarity, and potentially recalibrate stigmatizing conversations about them.
Abstract: This article focuses on findings of a two-year pilot research study focused on addressing sexual and reproductive health inequities faced by adolescent women of Puerto Rican descent living on the mainland United States. Working with three groups of young women, in the pilot study we gathered ethnographic data in and around a group-based digital storytelling process to inform the development of a larger intervention. Digital stories are short (1-3 minute), participant produced videos that synthesize still and moving image, a voiceover recording of the participant telling her story, and background music and text to document personal experiences. Based on narrative analysis of digital stories and field notes written in and around the digital storytelling workshop process, as well as follow-up individual interviews with workshop participants, our findings center on the ways that trauma has specifically shaped participants' sexual and reproductive health experiences. We argue that digital storytelling serves as a critical narrative intervention, whereby participants' engagement in the storytelling process enables them to collaboratively interrogate and potentially address prior trauma, bolster a sense of social support and solidarity, and potentially recalibrate stigmatizing conversations about them. We introduce our project methodology, and then present key findings on trauma as it informs sexual and reproductive health practices, with digital storytelling showcased as a modality for critical narrative intervention. We conclude by discussing implications for critical public health research and practice.
24 citations
TL;DR: Findings suggest that a section of the population who may have higher health care needs face greater barriers in accessing services, and social policies and comprehensive anti-discrimination legislation might help to address some of the barriers this population faces.
Abstract: Since late 2009, Greece has been dealing with the effects of a debt crisis. The neoliberal principles embedded in the three structural adjustment programmes that the country accepted have required radical cuts in health care funding, which in turn have led to widening inequalities in health. This article focuses on access to health care for people with disabilities in Greece in the context of these structural adjustments. We investigate possible differences in unmet health care needs between people with and without disabilities, using de-identified cross-sectional data from the European Health Interview Survey. The sample included 5,400 community-dwelling men and women aged 15 years and over. The results of the logistic regressions showed that people with disabilities report higher unmet health care needs, with cost, transportation, and long waiting lists being significant barriers; experience of all barriers was positively associated with low socioeconomic status. These findings suggest that a section of the population who may have higher health care needs face greater barriers in accessing services. Austerity policies impact on access to health care in both direct and indirect ways, producing long-term disadvantage for disabled people. Social policies and comprehensive anti-discrimination legislation might help to address some of the barriers this population faces.
24 citations
TL;DR: There was convergence on how interviewees viewed their role in mitigating health inequalities through their work with individual patients, but greater variation was found when describing the boundaries of their role and how far these extended beyond individual encounters, suggesting that while there is a degree of what Metzl and Hansen deem ‘structural competency’ amongst some GPs working in disadvantaged areas, the scope remains to deepen this competency more broadly.
Abstract: Scotland is faced with pernicious health inequalities, which stem from inequalities in living conditions and the societal structures that create them. While action is needed to address the wider structural causes of health inequalities, the role of general practitioners (GPs) merits attention due to health care’s potential to mitigate or exacerbate health inequalities. Minimal research, however, has explored how GPs understand the fundamental causes of health inequalities nor how they conceptualise their role in mitigating these. This paper aims to fill this gap using in-depth qualitative interviews with 24 GPs working in some of Scotland’s most socio-economically disadvantaged, urban areas. Using Raphael’s SDH discourse framework, this paper found clear linkages between GPs’ perceptions of their patients, how they defined the ‘problem’ of health inequalities, and what they thought could be done to tackle them in disadvantaged areas. In general, there was convergence on how interviewees viewed the...
23 citations
TL;DR: It is argued that Alfred North Whitehead’s concept of ‘abstraction’ can provide an alternative appreciation of some key aspects of the processes of knowledge-production of RCTs to enable a recasting of the problem of generalization.
Abstract: This article takes up biomedical and public health concerns about the difficulty of generalizing or extrapolating measurements of efficacy produced by the method of the randomized control trial (RCT) to wider populations. While explanations for the difficulty may be deduced from social studies of science that reveal the contingent and situated nature of trial findings, new conceptual tools are required to allow for the practical value associated with the possibility of their extrapolation. We argue that Alfred North Whitehead’s concept of 'abstraction' can provide an alternative appreciation of some key aspects of the processes of knowledge-production of RCTs to enable a recasting of the problem of generalization. By proposing that generalization depends on relevant abstractions, we direct attention to the situated forms of care that this calls for. After showing the conceptual difference that the process of abstraction makes for understanding and extrapolating the situated nature of a research finding, we offer an interpretation of possible forms of care at work in efforts to devise Ebola adaptive trials. The example is offered as one possible basis for a reformulation of the logic of generalization.
TL;DR: It is suggested that an SPT approach entailing data coding to multiple sub-elements supports the identification of diverse configurations of drinking practice within heterogeneous subpopulations.
Abstract: As a group, middle-aged same-sex attracted women (SSAW) appear to consume more alcohol than exclusively heterosexual women in the same age range; however, few studies document their collect...
TL;DR: It is argued that fieldworkers’ masking and making up data signal the need for greater attention by those designing its research, to better understand and address why and how these practices unfold.
Abstract: This paper centres on the roles and contributions of fieldworkers-local data-collectors in Global Health research in postcolonial contexts. It is informed by two separate ethnographies, conducted in two different East African biomedical research institutions. It discusses how common characterisations of fieldworkers as 'low-skilled' and 'local' make them attractive to research institutions in two important ways - as community-embedded data-collectors thus facilitating community participation and as being unlikely to fabricate data because they lack the skills to avoid detection. This paper questions these assumptions. It draws on Daston's idea of the 'scientific persona' and Fanon's concepts of mask-making to explore how fieldworkers construct identities and data within their liminal roles. Fieldworkers create particular pseudo-personae or masks for getting and staying employed. They dumb-down CVs and emphasise their similarities with community members in ways which are partially 'real' but also 'fake'. These constructed identities provide fieldworkers with a persona that allows them to fabricate or modify data without raising suspicions. They frequently engage in practices known as 'genuine fake' data fabrication which is data perceived as factually correct and verifiable yet methodologically incorrect, hence it is real and fake in varying degrees. We understand the 'pseudo' as the blurry space between real and fake where fieldworkers construct their identities and data. Given the seemingly laudable aims of Global Health, we argue that fieldworkers' masking and making up data signal the need for greater attention by those designing its research, to better understand and address why and how these practices unfold.
TL;DR: A recent controversy in evidence-making regarding the curative potential of new treatments for hepatitis C and the publication of a systematic review conducted by the Cochrane Collaboration is looked back on.
Abstract: Contested science presents a problem for ‘evidence-based’ public health intervention. Taking a perspective that treats evidence as constituted through the practices which make it, we treat controve...
TL;DR: Results indicate that counties with high inequality may foster an environment of anger and resentment that ultimately leads to mass shootings.
Abstract: This study explores whether population-level measures of income inequality and poverty rates are associated with mass shootings in the United States. We test these potential connections by examining the incidence rate of mass shootings using random effects negative binomial regressions for a panel data-set that included 3144 counties for the years 1990–2015. According to the adjusted models, income inequality is significantly associated with the three or more victim-related injuries (incidence rate ratio [IRR] = 1.39; 95% confidence interval [CI] = 1.11, 1.67; P < .001) and four or more victim-related deaths definition of mass shootings (IRR = 1.36; 95% CI = 1.08, 1.64; P < .01). However, poverty rates lack a reliable association with the three or more injuries (IRR = 1.07; 95% CI = .75, 1.39) and four or more deaths definition (IRR = .95; 95% CI = .71, 1.19). When considered in conjunction with the literature on inequality and crime, these results indicate that counties with high inequality may f...
TL;DR: In this paper, the authors analyzed the structure of the social space of Colombia's health system and the transversal space of the health care industry. But they did not analyze the relationship between the two spaces.
Abstract: In 1993, Law 100 introduced major reforms to Colombia’s health system and regulated the health care industry. We analyzed the structure of the social space of Colombia’s health system and the trans...
TL;DR: It is argued that preparedness enacts a model that reconfigures knowledge about epidemics by disconnecting them from the social and historical contexts in which they arise and imposes new modalities of intervention that raise issues for democratic autonomy.
Abstract: ‘Preparing for the next epidemic’ has been a recurrent theme in global health in recent years. Starting with SARS, by way of the Avian influenza, and intensifying after the 2013–2016 Ebola outbreak...
TL;DR: The medicalization of violence has involved various public health initiatives, with the USA based violence prevention initiative as mentioned in this paper, with the goal of reducing the number of deaths due to violence in recent years.
Abstract: Violence has in recent years been framed as a public health problem. The medicalization of violence has involved various public health initiatives, with the USA based violence prevention initiative...
TL;DR: Three systems methods were used to identify and examine underlying patterns and structures that influenced system-wide behaviors and enable the development and initiation of an evaluation approach based on systems thinking and complexity science principles, concepts, and methods.
Abstract: Persistent challenges to public health and well-being are being addressed though complex interventions. Complex interventions are intentional processes designed to shift and realign the form and fu...
TL;DR: It is argued that the realms of evidence based medicine and complementary and alternative medicine have much to learn from each other, in that one has neglected the vast potential of producing clinical benefit through placebo responses, while the other has neglected the understanding that can be gained through experimentation.
Abstract: Drawing on Isabelle Stengers’ discussion of the investigation of Mesmer and the starring role that experimentation plays in the rationality of modern medicine, this paper examines longstanding tens...
TL;DR: What practices constitute healthcare in urban and rural Cambodian settings; what differentiates these practices from clinical ‘good practice’ guidelines in conventional medicine; and which mechanisms patients, drug sellers and medical doctors have developed to navigate a health care system that at the same time enables, encourages, and sanctions such unregulated practices are explored.
Abstract: Cambodia has experienced an impressive economic growth in the last two decades that has not been matched by equal investments in public health care. In combination with other historical and sociocu...
TL;DR: In the twenty-first century, the public health model is increasingly taking centre-stage in global responses to violence as discussed by the authors, based on impressive claims of success, interventions such as Cure Violence...
Abstract: In the twenty-first century, the public health model is increasingly taking centre-stage in global responses to violence. Based on impressive claims of success, interventions such as Cure Violence ...
TL;DR: In this paper, the concept of pseudo as a means of challenging the confidence with which many within global health approach ideas and praxis in terms of binary oppositions, is presented.
Abstract: This introductory article presents the concept of the pseudo as a means of challenging the confidence with which many within global health approach ideas and praxis in terms of binary oppositions, ...
TL;DR: The term misdirection is proposed as a process by which attention is diverted from certain scientific approaches in the malaria elimination paradigm to justify specific methodological, scientific and political decisions.
Abstract: This paper proposes the term misdirection as a process by which attention is diverted from certain scientific approaches in the malaria elimination paradigm to justify specific methodological, scie...
TL;DR: The global vaccine development is driven by logics that can run counter to local understandings, needs, and contexts as mentioned in this paper, which is not a good fit for local understanding, needs and contexts.
Abstract: Global vaccine development is driven by logics that can run counter to local understandings, needs, and contexts. In a global industrial complex, dependent on financial market logics that prioritiz...
TL;DR: It is argued that the way in which the mental health system observes the voices of users is less a result of the actual status of users’ organisations than of the changing needs of mental health policy for ‘user representation’.
Abstract: In western mental health systems, the involvement of user organisations has become an important dimension of contemporary policy development. But the processes constituting users as a relevant/irrelevant group have received little investigation, especially outside the English-speaking world. Drawing on Luhmann’s theory of society, this article presents a reconstruction of involvement initiatives in mental health policy in Chile between 1990 and 2005. It is based on 17 oral history interviews with policy-makers, high-level professionals, involved users, ex-users, and family activists, drawing also on relevant policy documents. Five processes are identified. In the early 1990s, the relevance of family groups as care providers in the context of deinstitutionalisation shaped the first encounters between psychiatry and community. Later, user groups became relevant as political supporters of the Mental Health Department’s funding requests, and in their capacity to legitimise decisions on involuntary tre...
TL;DR: The study draws on the sociology of translation and treats policy implementation as a non-linear process of (re)interpretation involving different actors in plural, mutually interwoven, non-hierarchical networks.
Abstract: The aim of this paper is to discuss the ways in which the setting approach to health promotion in schools, as part of knowledge-based international policies and guidelines, is embedded in the Danis...
TL;DR: As law and biomedicine have grown to share common understandings of the nature of knowledge, they have come to act as converging colonizing forces that displace and alter ‘other’ forms of knowing and ordering.
Abstract: This paper explores the joint roles of law and biomedicine in constituting the boundary between legitimate and illegitimate (and genuine and ‘pseudo’) traditional healing. It argues that, as law an...
TL;DR: Key findings include a wavering commitment to reducing health inequities as well as indeterminate support for community participation and an abdication of ‘health governance’ for reorienting health services toward HP.
Abstract: Policy contexts for health promotion (HP) are often reported to be unsupportive. However, in South Australia, there is a long history of support. This paper reports on the research question: To what extent were key South Australian (SA) policies and strategic documents supportive of HP and health system building blocks for HP from 2003 to 2013? Twenty SA government documents were examined through an analysis of HP (goal, actions and strategies) and World Health Organization health system building blocks. The policy and practice context changed from strong support for HP in 2003 to its near abandonment in 2013. Key findings include: a wavering commitment to reducing health inequities as well as indeterminate support for community participation. In terms of leadership and governance for HP, there was an abdication of ‘health governance’ for reorienting health services toward HP, although there was a strong focus on ‘governance for health’ through intersectoral collaboration. Other system building bl...
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TL;DR: This commentary takes up activities in three health domains where effort goes into the appearance of global health prowess and accomplishment: health security; health innovation; and health finance, and shows how global health finance has already evolved in ways that makes suffering profitable.
Abstract: Globally, human health is improving. Aggregate world health data indicate enormous improvement over the last 100 years. Life expectancy, vaccination, and sanitation rates are higher. Rates of infec...