Showing papers in "Health Sociology Review in 2009"

Moorn (Black)? Djardak (White)? How come I don’t fit in Mum? Exploring the racial identity of Australian Aboriginal children and youth

Abstract: This study explored the racial identity of Indigenous children and youth who attended urban, state and private primary and secondary schools in the Noongar1 region of urban Perth in Western Austral...

School-based cognitive-behavioural interventions: A systematic review of effects and inequalities

Abstract: ttle is known about the impact of preventive interventions on inequalities in young people's mental health. We conducted a systematic review of mental health promotion interventions based on cognitive behavioural therapy (CBT) delivered in schools to young people aged 11-19. Meta-analysis of 17 high quality randomised controlled trials (RCTs) showed a reduction in symptoms of depression, which was generally short term. Interventions for people with clinical risk factors or existing symptoms were more effective, with benefits lasting up to six months. We also found that CBT may be more effective for young people from families with middle to high socioeconomic status (SES) than for those from low SES backgrounds. However, this finding was based on a meta-regression with only six studies. A lack of long-term follow-up data and a failure to report subgroup analyses prevented further conclusions being drawn about the effect of these types of interventions on mental health inequalities.

Parental Work Schedules and Adolescent Depression.

Abstract: Using a large contemporary United States data set, the National Longitudinal Survey of Youth-Child Supplement (NLSY-CS), this paper examines the relationship between parental work schedules and adolescent depression at age 13 or 14, paying particular attention to the mechanisms that may explain this relationship. Analysis based on structural equation modelling showed that increased work at night by mothers was significantly associated with a lower quality of home environment and fewer meals together, and this mediator was significantly linked to increased risks for adolescent depression. In addition, evening work by fathers was significantly associated with lower paternal closeness and this mediator was significantly associated with increases in adolescent depression. In contrast, irregular shifts by both mothers and fathers increased the likelihood of mothers knowing where the child was and this relationship in turn reduced adolescent depression. Implications and avenues for future research are d...

Social determinants of child health and well-being

Abstract: This editorial provides a critical review of the progress in social determinants of health research over the last two decades, suggesting new perspectives which may further our understanding of persistent social inequalities in health. It highlights the global significance of the Special Issue setting it in the context of the recently released WHO Commission on Social Determinants of Health Final Report (CSDH 2008). The editorial introduces individual papers in the Special Issue and discusses how they are in line with, complement or provide feedback to, the WHO CSDH Final Report and its call for actions to close the health gap in a generation. Finally, based on the articles in this Special Issue and emerging themes of the global research and policy literature, it outlines a number of significant directions for future research and actions, from both methodological and theoretical points of view. (editor abstract)

A sociological focus on “expert patients”

Abstract: The increase of chronic illness as a leading cause of death has given rise to self-care and expert patient initiatives. Caring for chronically ill people places a tremendous economic burden on the ...

‘Naught but a story’: Narratives of successful AA recovery

Abstract: The study invited individuals who used AA groups and philosophy as the mainstay of their recovery to talk about their ongoing relationship to AA, with the aim of understanding the factors that have helped them to achieve and sustain change. Interpretive phenomenological analysis (IPA) was performed on nine transcribed interviews of participants who were continually sober from alcohol/drugs for a minimum of nine years (abstinence mean = 14 years). The method was used to discern themes and identify the concepts of recovery participants had found helpful. A number of themes are examined in the paper, including how subjects made sense of their addiction, initial appraisals of AA/NA meetings, concepts of acceptance and surrender, character change, spiritual change and evaluations of continuing progress. We argue that there are many roads to recovery from addiction and the ‘AA/Fellowship route’ offers a set of principles and narrative forms that have the attraction of consistency and coherency. The pape...

Self-Support for Drug Users in the Context of Harm Reduction Policy: A Lay Expertise Defined by Drug Users' Life Skills and Citizenship

Abstract: This paper focuses on the way drug users (DUs) play an active role in implementing public health policies by their involvement in self-support groups, thus providing new forms of patients' expertise. Expertise of this nature may seem paradoxical, in that it confers qualities to populations whose practices are unlawful and whose identity is stigmatised. A qualitative method including semi directive interviews (57) and ethnographic observations was used for this research. A thematic content analysis was done from empirical data following an inductive logic. This paper aims to show how a DUs' organisation finds a place in the social arena in the political context of harm reduction, succeeds in building the French DUs' health and welfare conditions as a legitimate cause, and elaborates a specific rhetoric centered around life skills and citizenship. The new forms of patients' expertise, based on life experiences, contribute to enhancing the value of practical, emotional and subjective knowledge that sometimes questions specialist knowledge. This claim for citizenship is often used as a sort of magic incantation, and content may be lacking if public health policies are not accompanied by broader policies that attempt to take into account the political, legal, economical and social conditions of stigmatised social groups like DUs.

The relationship between policy and place: The role of school meals in addressing health inequalities

Abstract: Healthy eating in schools is central to UK Government attempts to redress nutritional deficiencies and combat childhood obesity. However, there is little consideration of the local, contextual spatial factors that contribute to the ways in which particular policy initiatives are experienced at the school level. This paper presents findings from an evaluation of the ‘Eat Well Do Well’ programme in Kingston-upon-Hull, UK: an innovative scheme providing free, healthy food to all primary school children. Data is presented from an ethnographic study of two case study schools illustrating how notions of ‘spatiality’ augment our understanding of the ways policy intention is mediated. We consider the potential of primary school meals policy to address health inequalities using the concept of ‘spatiality’ to examine the interconnections between the aesthetic, temporal, social and spatial elements of school dining environments. We conclude optimistically, suggesting that an engagement by health policy devel...

Ageing well, ageing productively: The essential contribution of Australia’s ageing population to the social and economic prosperity of the nation

Abstract: In Australia we have become preoccupied with the potential adverse impact of our ageing population on our health and social systems. The projected cost of having increasing proportions of our population in the over 70s, retired, chronically ill category of the demographic profile is emerging as a major challenge for governments and private insurers: so much so in fact that the government is now urging older people to stay at work longer. In America, new approaches to the management and self-management of chronic diseases have been invoked to encourage and support older people to improve their quality of life and reduce their recourse to and dependence upon health care technologies, clinical interventions and health care management systems. Unless this is achieved, it is argued, the cost of looking after this emerging 'bubble' of elderly people will become increasingly unsustainable as fewer and fewer (proportionately) younger people work to pay the taxes that support ageing, retired, sick and dependent populations. This paper argues that we are at real risk of having our economic wealth and productivity impeded and truncated by the financial burden of looking after high demand and high cost dependants at the aged end of the social demographic. This paper offers an alternative view of our ageing population, as well as highlighting some of the assets we have in our elderly populations, and providing suggestions as to an alternative view of the phenomenon of ageing that incorporates elements such as flexible working arrangements and the application of new, enabling technologies. This approach to our ageing population dilemma is predicated on a concept of lifelong learning and social participation along with better preventive and early intervention systems of health care.

Disparities in access to health care among non-citizens in the United States

Abstract: This paper examines the extent to which US citizenship status affects the probability of a person’s having a usual source of care and the predictors associated with access to health care among non-citizens. The research is founded on the analysis of data from the 2005 California Health Interview Survey (CHIS) (n = 33,187 adults, ages 18–64). Guided by a modified Andersen model of access to health care, the researchers conducted a series of logistic regression analyses using the survey data to compare native-born citizens with non-citizens who were 1.6 times less likely to access a usual source of care. Among non-citizens, insurance status, shorter duration of residence in the United States, and lower levels of English proficiency were related to a lower probability of having a usual source of care. Based on this research it is argued that affordable health care and health insurance options and access to culturally and linguistically sensitive services are needed to increase access to health care a...

The third shift: Health, work and expertise among women with endometriosis

Abstract: This paper explores the experiences of twenty Australian women living with the chronic and incurable gynaecological condition endometriosis. It examines how women become experts in their own care and the ramifications of these processes for women. Women experience patient expertise as a form of work, described here as a ‘third shift’ performed in addition to women’s paid and unpaid work. It argues that both benefits and problems flow from such work, which involves the acquisition of expertise about a chronic illness and associated processes of self-management. The central argument of this paper is that the responsibilities associated with becoming an expert endometriosis patient can both reduce and compound existing stresses for women living with this chronic illness. It concludes with some suggestions about improvements to support women living with this chronic condition.

Social capital and health: the problematic roles of social networks and social surveys

Abstract: Social capital, social networks, social support and health have all been linked, both theoretically and empirically. However, the relationships between them are far from clear. Surveys of social capital and health often use measures of social networks and social support in order to measure social capital, and this is problematic for two reasons. First, theoretical assumptions about social networks and social support being part of social capital are contestable. Second, the measures used inadequately reflect the complexity and ambivalence of social relationships, often assuming that all social ties and contacts are of similarly value, are mutually reinforcing, and, in some studies, are based on neighbourhoods. All these assumptions should be questioned. Progress in our understanding requires more qualitative research and improved choice of indicators in surveys; social network analysis may be a useful source of methodological and empirical insight.

Risk, insurance, preparedness and the disappearance of the population: The case of pandemic influenza

Abstract: The Australian response to the threat of pandemic influenza is part of a broader shift in public health and governance. This shift in approach to risk - from insurance to preparedness - has been triggered by the emergence of incalculable, global, catastrophic risks. Familiar, insurance-driven approaches to governing risk work by intervening at the level of the population. However, incalculable risks of the scale posed by pandemic influenza exceed the scope of insurance. Now preparedness driven approaches are coming to the fore in public health. Preparedness focuses on protecting infrastructures and on guaranteeing the continuity of the political and economic order, and it entails discontinuous, temporal and localised expert responses. Importantly, this approach suggests that there is no need to look at the socio-historical contexts of disease; the population is of little direct concern. This, we suggest, raises doubts about how public health strategies which unfold in accordance with preparedness will recognise and tackle inequities. Finally, we consider the imperative to 'secure the nation' that preparedness brings to public health.

Toxic Exposures: Contested Illnesses and the Environmental Health Movement

Abstract: TOXIC EXPOSURES: CONTESTED ILLNESSES AND THE ENVIRONMENTAL HEALTH MOVEMENT Phil Brown New York: Columbia University Press 2007. 356 pp, AUD36.40 ISBN 978 0 231 12948-0Toxic Exposures: Contested Illnesses and the Environmental Health Movement makes an important contribution to the future directions of environmental health, thereby also filling a vacant niche in mainstream public health. The book offers an informed and critical discussion on the clinical, social and political implications of the environmental contribution to illnesses. The author reviews evidence on the environmental components of breast cancer clusters, asthma, and the Gulf War Syndrome, the three 'contested illnesses' of the book. In choosing such a diverse set of conditions and tracking the range of public and professional responses. Brown is able to support the argument that the lack of public health recognition of this field is not an accident. He suggests that it arises from professional, social and political avoidance of engaging with environmentally-driven pathologies in general. He then offers a comprehensive proposal for a different practice of environmental health.Brown questions the capacity of standard epidemiology to determine the level, cause or even the existence of risk for any of the three examples. He cites investigations that have been discouraged, unfunded, discounted and even suppressed. It is not only the sources of the illnesses that are contested, it is their very existence. Brown follows pathways by which an environment component of illness has been denied: in the case of cancer clusters, denial by epidemiologists; for asthma by corporate denial of polluting the air; and for the Gulf War Syndrome by the authorities responsible for the war. In each of his examples it is not official channels but private suffering and public interest that have led to further investigation. The conclusion is that concerned social movements make a crucial contribution to responding to the complex health risks emerging from global environmental change.The three contested illnesses, while very different in clinical terms, have been selected because they challenge standardised forms of research and practice. For all three, the basic cause is unknown, the symptoms are diverse, and the correct response is a matter of debate. All three demonstrate the marked difference in the effectiveness of official and community responses. The review confirms that standard approaches have been unsuited to addressing the increasing importance of environmental toxicity. Since epidemiological and population health methods have already been recognised as unable to pick up small clusters or individual vulnerability, why continue to use them in this area. Brown asks. Level-of-harm studies give unreliable results when the nature of the risk is not well understood, as in all three sample cases. Studies have claimed that each of them is psychologically based, with the implicit footnote of blaming the victim.The book provides far more than an incisive critique of current responses to environmental health issues. It offers a framework for what Brown describes as a public epidemiology based on citizen-science alliances. The goal is environmental justice. The language indicates a different vocabulary, signalling a very different environmental health practice. The book develops just such a practice, using practical examples. …

Kids’ lives in adult space and time: How home, community, school and adult work affect opportunity for teenagers in suburban Australia

Abstract: This study aimed to address significant gaps in our understanding of how teenagers live their lives within the spatial and temporal limitations imposed by an ‘adult’ world, and in the context of changing work and household patterns in Australia. By keeping home, community, school and parental work in equal focus it acknowledges that each of these spheres has the potential to provide resources and exert demands which will influence the opportunities available to teenagers as they transition through adolescence into adulthood. Methods: One hundred and seventy four boys and girls aged between 11 and 18 years took part in twenty two focus groups concerned with how characteristics of home, local community and parental work impact on various aspects of their lives. Teenagers were recruited from both state and private schools servicing three master planned communities and three traditional lower socioeconomic status suburbs in South Australia, Victoria and Queensland. Findings: there is a clear indicatio...

Informal Caregiving: Cross-cultural Applicability of the Person-environment Model

Abstract: The 21st century will be characterised by aged and ageing nations, making eldercare a growing concern. Most eldercare in most nations will be provided informally, primarily by female family members. Helping these people understand the dimensions of eldercare is a key to effective and cost-effective caregiving. The Person-Environment Model (Lawton and Nahemow 1973) is proposed as a theoretical framework for understanding, assessing, and optimising family-based caregiving. This paper presents findings from a qualitative study of informal rehabilitation caregiving provided to elderly stroke survivors in Thailand. Four main rehabilitation dimensions (biological, psychological, social, spiritual) are identified, as are three main caregiver needs (information, assistance, and support). We suggest that while the Person-Environment Model is useful in developed nations, it is perhaps more valuable in societies where fewer options to family-based eldercare exist, and thus where effective informal eldercare is more critical. Implications for education and training of health care providers are also discussed.

Silent witnesses: Child health and well-being in England and Australia and the health transition 1870–1940

Abstract: This study explores the 'black box' of changes in both the macro and micro - the societal and domestic - environment that transformed the health and wellbeing of children in England and Australia between 1870 and 1940 It argues that in addition to the control of environmental hazards and improved medical care, changes in family life made possible by the decline in the informal economy of casual work, provided the domestic security that enabled the major improvements in child health measures before immunisation and antibiotics The golden age of childhood came after World War II, with the relief of peace and unparalleled stability in marriages and home making Since the 1970s, however, capitalist societies have succumbed to a pursuit of affluence and individualism that has had profound psychic and physical effects and aggravated inequality and discontent: the obesity epidemic is the embodiment of that transformation (author abstract)

Family Law as a determinant of child health and welfare: shared parenting, breastfeeding and the best interests of the child.

Abstract: Breastfeeding is the optimal nutrition for infants and requires the infant and mother to spend significant time together. In July 2006 the Australian Government introduced the Family Law Amendment (Shared Parental Responsibility) Act 2006 (Cth) (the Shared Parental Responsibility Act 2006) which puts in place a legal presumption of shared parental responsibility for children after separation and which emphasises 'equal time' parenting arrangements. The expectation of 'equal time' or substantial and significant parenting arrangements becomes problematic when considering breastfed children. Decisions about parenting of children under the Family Law Act 1975 (Cth) are required to be made with the 'best interests of the child' as the paramount consideration; a central tenet of the Act which remains in place following the Shared Parental Responsibility Act 2006. There appears to be a tension in determining the best interests of the child in cases where children are breastfed and their father is seeking equal or substantial shared care arrangements. This article begins a discussion about the decisions regarding 'shared parenting' of breastfed children that do not always appear to be in the best interests of children's health and wellbeing. Two cases from an on- going study to investigate breastfeeding women's experiences of the implementation of the Act will be used to illustrate that the court made decisions for breastfeeding mothers are not consistent and compromise the ability of women to continue breast feeding. The paper argues that the Shared Parental Responsibility Act 2006, and the decisions made, can work at a macro-level to produce social and health disparities for these children. Further questions are raised about the best interests of children when domestic violence and/or abuse are present. The impact of this new law on the continued breastfeeding of very young children is an unacknowledged consequence and a public health concern. (author abstract)

From the 'Expert Patient' to 'Expert Family': A Feasibility Study on Family Learning for People with Long-term Conditions in Italy

Abstract: The Italian welfare system has been identified as a 'familistic' system since the family is mainly responsible for taking care of its members in times of vulnerability. This situation seems to be a problem, not only because of the financial, social and psycho-social costs borne by families, but also because care work may be provided by the various caregivers with insufficient competence. As such, public services should foster family participation in their care-assistance plan, enhance their competences, and sustain them at an emotional level. This approach widens the notions of the 'expert patient'. It is the family that should become competent and involved as much as possible in the care processes. One way to achieve this aim is by implementing a programme of Family Learning for people with long-term conditions. This has been the object of an innovative feasibility study conducted in 2008 in a region of central Italy. This study explored whether families are actually ready to take on the self-management of long-term conditions and which surrounding conditions are necessary to manage them.

‘Healthy Senior Citizenship’ in voluntary and community organisations: A study in governmentality

Abstract: This essay critically examines the process of governmentality as revealed in the construction and resistance to the categorisation and classification of 'Healthy Senior Citizenship'. This also includes an illustrative analysis of data from a national UK qualitative interview study of the input into the policy process of older adults in voluntary and community organisations. The paper demonstrates how governmentality finds its expression within the construction of healthy senior citizenship as synonymous with activity and participation within the technologies of collaboration and consultation. The conclusion reflects upon developing a critical sociology of old age in order to scrutinize conceptions of the 'problems' of governing an ageing population in post-welfarist or advanced liberal states.

Seeing Red: Critical Narrative in Adhd Research

Abstract: SEEING RED: CRITICAL NARRATIVE IN ADHD RESEARCH Brenton Prosser Teneriffe, Queensland: Post Pressed, 317 pp, ISBN 978-1-876682-92-7The lines of debate surrounding ADHD have been well-established for decades. Concerns about the validity of ADHD, and its numerous historical precursors, have extensive empirical and theoretical support. On the other hand, we have the reality of millions of school-age children (mostly boys between the ages of nine and fourteen) who are diagnosed with ADHD, identify as ADHD, and carry this identity with them into adulthood. We are left with the 'Great ADHD Debate', comprised by two endlessly polarised discourses and social practices. Eric Prosser's Seeing Red changes this markedly.Page one of the book begins with a poem, 'Red The Squirrel', written by one of Prosser's research participants. Like an ADHD child struggling with the rules of a classroom setting, Red is 'naturally full of energy/and not suited to sitting still'. As the poem continues, we see that Red 'couldn't seem to learn anything because the teacher just droned away'. The poem illustrates the embodiment of two contradictory identities: the ADHD-diagnosed medical subject on one hand, and the high energy, under-stimulated kid on the other.Implied in the presentation of this poem is the complex nature of the ADHD diagnosis and self identity process. It asks us, as clinicians and researchers: how valuable is it to debate the etiology of ADHD when Red is alive and well in our schools and homes? Red is an embodiment of contradiction, one of the realities of standing out, of being different. As the many wonderful examples of poetry and prose in Seeing Red illustrate, having unconventional behavior 'medicalised', does not encompass the entirety of a person's identity.The channel through which Prosser argues for this new perspective toward ADHD is the use of 'critical narrative'. Stemming from a perspective rooted in contemporary social theory and qualitative analysis, this text provides one interesting vignette after another about the experience of ADHD children and their parents. Whether the use of these multiple perspectives accomplishes the task of being 'critical' in the true social theory sense is debatable. At several points, various narratives are presented, but they are not clearly situated in any specifi c social theory. Perhaps the author did not adequately locate the data within an established theoretical framework, an interpretation suggested by the various social theory references appearing throughout the text (Habermas, Hall, Foucault, McLaren, etc), often without clear connection to each other. On the other hand, there is tremendous freedom in reading these various narratives, and the experiences that they describe. Especially within the context of ADHD, which is a diagnosis under so much clinical and cultural scrutiny, it may be effective to allow the narratives to speak for themselves without having to be presented in a self-consciously theoretical fashion.Despite the book's shortcomings in situating an analysis within a body of social theory, Prosser's attempt to bring in a variety of subjectivities into the explanation of the ADHD experience is groundbreaking, and may very well advance the qualitative discussion of ADHD. …

Rites of belonging: Grief, memorial and social action

Abstract: Since the first panels of the Australian AIDS Memorial Quilt were officially launched in Sydney in 1988, it has become a widely recognised memorial to people who have died from AIDS. This paper discusses how AIDS Memorials, namely the AIDS Quilt and the annual Candlelight Vigils, have challenged the stigma surrounding HIV/AIDS through creating public space for the expression of grief. The paper draws on the idea of ‘social movement frames’, demonstrating how, through the use of symbolic actions and ritualised performance, the political and ideological beliefs of the AIDS movement were expressed not only through articulated argument or attempt at rational persuasion, but through the demonstration of alternative cultural practice.

Ageing and Globalisation in a Moment of So-Called Crisis

Abstract: The global economic turmoil that has unfolded since August 2007 promises to change methods for the governance of ageing in ways yet unknown. Against this background, this paper asks how the demographic shifts associated with population ageing interact with other aspects of globalisation: the financialisation of economic systems, changing patterns of migration and transformations to health provision. The emphasis is on understanding the complex interplay between these processes and their relevance for rethinking approaches to population ageing in a time of uncertain transition. Questioning the tendency to understand these fields of change as precipitating distinct crises, the paper suggests that the relative predictability of global population ageing makes it an appropriate area in which to begin a reassessment of wider policy directions.

A protest vote? Users of anti-ageing medicine talk back

Abstract: While anti-ageing medicine may be defined by efforts to control human aging, individual motivation to utilise anti-ageing medicine proves to be multifaceted. Qualitative, in-depth interviews with 15 people who have used anti-ageing medicine reveal that the turn to anti-ageing medicine may be more about disillusionment with allopathic medicine than it is about controlling bodily aging. By contextualising people's use of anti-ageing medicine within their lifelong body regimen 'careers', and looking closely at the first career sequence, which is characterised by a questioning of tradition - the tradition of allopathic medicine - new perspectives behind the rise of anti-ageing medicine are offered. Shared grievances with mainstream medicine tend to be situated around both the medical delivery and the medical treatment. Rather than reject the values associated with biomedicine, as is often the case with alternative health enthusiasts (Siahpush 1998), those using anti-ageing medicine seek out an 'alternative' biomedicine that they perceive to offer more satisfactory solutions to their problems.

The Influence of Service Users and NGOs on Housing for People with Psychiatric Disability

Abstract: This paper reports on a case study which examined mental health service users and carers, public housing tenants and non-government organisations' (NGO) participation and representation within policy processes A particular focus was influence upon policies aimed at achieving housing outcomes for people with a psychiatric disability The research was a case study of a period of mental health system reform in South Australia (2000-2005) and involved primarily qualitative research; interviews, focus groups and participant observation, as well as document analysis Participants (n = 92) included service user and carer representatives, public servants from across the health, housing and disability sectors, and NGO professionals from across sectors The study found that the community participation that existed during the reform period was largely an end in itself rather than a means for groups to shape policy processes, including housing policy A number of barriers to service users and NGOs influencing policy agenda setting and implementation were determined and described A range of strategies and processes to enhance community participation, representation and accountability in policy processes are recommended These include cross-sectoral policy development and accountability mechanisms, advocacy coalitions across sectors for policy agenda setting, public forums involving both service users and professionals, and challenging 'consumerist' discourses on participation Such strategies could facilitate policy debates on housing for people with a psychiatric disability, counter dominant professional interests within policy networks, and help to address community stigma

The Certainty of Uncertainty: Superannuation and Globalization

Abstract: This paper explores a number of the ways in which globalization can accentuate the uncertainties and risks borne by Australians with retirement savings in superannuation funds or who are receiving superannuation benefits. It begins by addressing the impact of globalization on job prospects as a result of off-shoring. It then turns its attention to the impact of globalization on domestic inflation. The third area addressed by this paper is the vulnerability of superannuation funds to the 'regular' financial crises of the world financial system. Here, particular attention is given to the way international hedge funds operate in bear markets. Finally, the paper describes the increasing prominence of sovereign wealth funds and explores the implications of their growing role for future superannuation fund earnings. A major conclusion of the paper is that the certainty of the financial uncertainties and risks associated with the occupational superannuation pillar means that Australia's retirement income system needs to be modified in order to limit the exposure of workers' retirement savings and benefits in payment to some of the consequences of a globalized financial system.

Inequalities in Infant Mortality: Patterns, Trends, Policy Responses and Emerging Issues in Canada, Chile, Sweden and the United Kingdom

Abstract: This paper investigates variations in policy responses to perceptions of social inequities in infant mortality in Canada, Chile, Sweden and the United Kingdom. It outlines patterns and trends in inequalities in infant mortality and some other birth outcomes, distinguishing between the use of routine data in some settings and research evidence in others. It suggests that some distinctive approaches about policies to reduce inequalities can be identified in the four countries. A number of emerging issues are also identified. One concerns the focus of interventions. Another relates to the use of targets. The third concern relates to the ways in which health inequalities are measured and monitored. Finally, the paper recommends the need for more research into areas such as the effectiveness of interventions, the nature of the problems facing ethnic minorities and the possible role of different social welfare regimes in achieving desired outcomes.

Obesity: The new global threat to healthy ageing and longevity

Abstract: Population ageing and increasing life expectancy are triumphs of modern times. However, advances in healthy ageing and longevity are not inevitable. Recent data suggest that future generations may not age in as good health as those who are currently over 65 years of age, particularly because of the rising prevalence of obesity. Obesity is a worldwide phenomenon associated with urbanisation and global changes to food availability, eating habits, and increasing sedentary activities. The current and future global impacts of this condition on health, health care expenditure, and human life expectancy are momentous.

Investment in early childhood in Australia: international comparisons and recent trends

Abstract: There is growing recognition that investment by governments on children in their early years is an important part of social policy. However there is currently little information either about how much governments invest on children of different ages, or about what the optimum investment in the early years would look like. Using currently available Australian datasets, this article explores two approaches to estimate the adequacy of investment in early childhood; comparing government expenditure between countries, and analysing one country (in this case Australia) in terms of expenditure over time on children of different ages. We find that, overall, Australia spends more than the average of OECD countries on the early years, but that a much higher proportion of this expenditure is spent on cash transfers to parents rather than on early care and education. Furthermore, spending on the early years has grown proportionately to spending on older children over the past several years. The paper ends with a number of suggestions for further research which will refine the analysis of investment in the early years. (author abstract)

Reflections of Inequalities: The Construction of HIV/AIDS in Africa in the Australian Print Media

Abstract: The HIV/AIDS pandemic in sub-Saharan Africa prompted industrialised nations to initiate a coordinated global response, which to date has been inadequate in reducing the pandemic's impact in Africa. To better understand this response, this article explores the portrayal of the pandemic in the Australian print media using critical discourse analysis to unpack the discourses surrounding the construction of the pandemic. In particular, it examines how issues of power, ideology, causation and responsibility are expressed and utilised to validate certain stances and responses. The findings demonstrate that the media presents a particular perspective on the pandemic that favours the agendas of industrialised nations. Linguistic devices uncovered racist, medical and development discourses that give voice to industrialised nations and silence those from sub-Saharan Africa, limiting discussion on alternative responses. These findings highlight the utility of critical discourse analysis in understanding power structures that construct and influence responses to public health issues.