Understanding snacking through a practice theory lens

This article approaches snacking from a practice theory perspective in order to understand how this reframing may afford new insights. In doing so it also contributes to sociological thinking on eating practices and their reproduction as well as reflecting upon the ontological assertions of practice theory and its theory of social change. In particular this article argues that the re‐conceptualisation serves to clarify a sociological research agenda for eating practices associated with snacking. It is argued that setting snacking within routine temporalities and spatialities and as bound up in the recursivity between practices and relations is especially important for thinking about snacking sociologically. In common with applications of practice theory in the field of sustainability transitions the aim is to move beyond individualistic assumptions of behaviour change and instead situate snacking as an eating practice with health implications that has emerged within the social, temporal, economic and cultural organisation of everyday life.     

The power of place: space and time in women's and community health centres in South Australia

This paper focuses on the importance of time and space in an Australian medical setting. It draws on research findings from a one year project that aimed to explore community perspectives of, and experiences of medical services in three South Australian women's and community health centres. Both qualitative and quantitative methods of data collection and analysis were used in order to address these objectives. A significant finding was the way in which participants described the organisation and experience of time and space in these centres and how this impacted on their health and well being and that of the community. In analysing these spatio-temporal dimensions and the underlying philosophical structures of women's and community health centres, this paper argues that experiences associated with space and time have a positive effect on health status by: diminishing barriers to health services, improving quality of care, increasing community participation, providing safe places for social interaction and strengthening people's sense of belonging or attachment to a particular community and place. Based on these findings, the authors conclude that the spatio-temporal dimensions of health care provision have empowering and positive impacts on a community's health, a significant finding that has implications for the maintenance and future funding of this style of health service.     

Seek, and ye shall find: Accessing the global epidemiological literature in different languages

The thematic series 'Beyond English: Accessing the global epidemiological literature' in Emerging Themes in Epidemiology highlights the wealth of epidemiological and public health literature in the major languages of the world, and the bibliographic databases through which they can be searched and accessed. This editorial suggests that all systematic reviews in epidemiology and public health should include literature published in the major languages of the world and that the use of regional and non-English bibliographic databases should become routine.     

Globalisation and health inequalities: can a human rights paradigm create space for civil society action?

While neoliberal globalisation is associated with increasing inequalities, global integration has simultaneously strengthened the dissemination of human rights discourse across the world. This paper explores the seeming contradiction that globalisation is conceived as disempowering nations states’ ability to act in their population’s interests, yet implementation of human rights obligations requires effective states to deliver socio-economic entitlements, such as health. Central to the actions required of the state to build a health system based on a human rights approach is the notion of accountability. Two case studies are used to explore the constraints on states meeting their human rights obligations regarding health, the first drawing on data from interviews with parliamentarians responsible for health in East and Southern Africa, and the second reflecting on the response to the HIV/AIDS epidemic in South Africa. The case studies illustrate the importance of a human rights paradigm in strengthening parliamentary oversight over the executive in ways that prioritise pro-poor protections and in increasing leverage for resources for the health sector within parliamentary processes. Further, a rights framework creates the space for civil society action to engage with the legislature to hold public officials accountable and confirms the importance of rights as enabling civil society mobilization, reinforcing community agency to advance health rights for poor communities. In this context, critical assessment of state incapacity to meet claims to health rights raises questions as to the diffusion of accountability rife under modern international aid systems. Such diffusion of accountability opens the door to ‘cunning’ states to deflect rights claims of their populations. We argue that human rights, as both a normative framework for legal challenges and as a means to create room for active civil society engagement provide a means to contest both the real and the purported constraints imposed by globalisation.     

Modeling the epidemic waves of AH1N1/09 influenza around the world

The 2009 swine flu pandemic was a global outbreak of a new strain of H1N1 influenza virus and there are more than 14,000 confirmed deaths worldwide. The aim of this paper is to propose new mathematical models to study different dynamics of H1N1 influenza virus spread in selected regions around the world. Spatial and temporal elements are included in these models to reproduce the dynamics of AH1N1/09 virus. Different models are used since H1N1 influenza virus spread in regions with different contact structures are not the same. We rely on time series notifications of individuals to estimate some of the parameters of the models. We find that, in order to reproduce the time series data and the spread of the disease, it is convenient to suggest spatio-temporal models. Regions with only one wave are modeled with the classical SEIR model and regions with multiple waves using models with spatio-temporal elements. These results help to explain and understand about potential mechanisms behind the spread of AH1N1 influenza virus in different regions around the world.     

Transgender health in medical education

Transforming our world the 2030 agenda for sustainable development is working towards a world that reflects equity, with universal respect for human dignity, pledging to leave no one behind. However, transgender and gender-diverse individuals experience significant health inequities, including negative health outcomes and multiple barriers to accessing care. In this article, we first highlight the health inequities that transgender and gender-diverse people face globally. We describe important aspects of transgender and gender-diverse health care, including the design and provision of health services, epidemiological considerations, transition-related care, changes in transition-related goals, cultural considerations, and political and legal issues. We then review the existing global literature on incorporating transgender health into medical curricula. We make a case for prioritizing improved education in medical schools on the specific health needs of transgender and gender-diverse people as part of addressing global health inequities in care. Our recommendations for comprehensive education on transgender health include cultural humility and anti-oppression training; involvement of transgender and gender-diverse community members; integration of transgender and gender-diverse health into curricula; practice-focused and in situ training; staff development in medical schools; and improving access to careers in medicine for transgender and gender-diverse people.     

Imperial or postcolonial governance? Dissecting the genealogy of a global public health strategy

During the last decades of the 20th century it became increasingly apparent that the inter-relationship between globalisation and health is extremely complex. This complexity is highlighted in debates surrounding the re-emergence of infectious diseases, where it is recognised that the processes of globalisation have combined to create the conditions where once localised, microbial hazards have come to pose a threat to many western nations. By contrast, in an emerging literature relating to the epidemic of non-communicable diseases, and reflected in the WHO 'Global strategy on diet, physical activity and health', it is the so-called 'western lifestyle' that has been cast as the main threat to a population's health. This paper explores critically global responses to this development. Building on our interest in questions of governance and the ethical management of the healthy body, we examine whether the global strategy, in seeking to contain the influence of a 'western lifestyle', also promotes contemporary 'western-inspired' approaches to public health practices. The paper indicates that a partial reading of the WHO strategy suggests that certain countries, especially those outside the West, are being captured or 'enframed' by the integrative ambitions of a western 'imperial' vision of global health. However, when interpreted critically through a postcolonial lens, we argue that 'integration' is more complex, and that the subtle and dynamic relations of power that exist between countries of the West/non-West, are exposed.     

Risks,rights and regulation: An overview

In contemporary social science debate the notion of risk society and the theory of globalisation have merged into a single view of the predominantly negative consequences of technological change. Globalisation theory, emerging from world systems theory, has addressed fundamental cultural and social features of the global system, but has so far neglected important aspects of medical technology, drug industries, health regulation and markets for body parts. These developments could be conceptualised as 'iatro-globalisation'. This article is critical of many aspects of the contemporary sociology of risk, especially because 'risk' is typically poorly defined and confused with 'hazard'. The article considers how notions of risk and regulation could be seen as a global dynamic of medicine and health care. The question about global risks and their control is fundamentally a question about politics, namely the possibility of global governance and the protection of rights.     

Model Parameter Estimation and Uncertainty: A Report of the ISPOR-SMDM Modeling Good Research Practices Task Force-6

A model's purpose is to inform medical decisions and health care resource allocation. Modelers employ quantitative methods to structure the clinical, epidemiological, and economic evidence base and gain qualitative insight to assist decision makers in making better decisions. From a policy perspective, the value of a model-based analysis lies not simply in its ability to generate a precise point estimate for a specific outcome but also in the systematic examination and responsible reporting of uncertainty surrounding this outcome and the ultimate decision being addressed. Different concepts relating to uncertainty in decision modeling are explored. Stochastic (first-order) uncertainty is distinguished from both parameter (second-order) uncertainty and from heterogeneity, with structural uncertainty relating to the model itself forming another level of uncertainty to consider. The article argues that the estimation of point estimates and uncertainty in parameters is part of a single process and explores the link between parameter uncertainty through to decision uncertainty and the relationship to value of information analysis. The article also makes extensive recommendations around the reporting of uncertainty, in terms of both deterministic sensitivity analysis techniques and probabilistic methods. Expected value of perfect information is argued to be the most appropriate presentational technique, alongside cost-effectiveness acceptability curves, for representing decision uncertainty from probabilistic analysis.     

Changing care and prevention needs for global public health: In pursuit of a comprehensive perspective

Abstract An assessment of changing care and prevention needs in the framework of global public health should not be just a technical exercise of 'standard' demographic and epidemiological analysis; rather, it should also involve a reflection on the conditions of the production of such knowledge. In this article, we start by outlining some key dimensions of change in demographic and epidemiological patterns as well as their drivers; second, we address in more depth the question of whether current scientific practice is generating all the questions needed to improve global health in the coming years, and define potentially effective strategies for positive change. Significant demographic changes (i.e., reductions in earlier mortality and fertility; ageing and urbanisation) are leading to the emergence of chronic diseases in the Global South, as well, although patterns are very diverse, and early mortality and disability will still remain high for a few decades in certain areas. Such inequality in health patterns seems to parallel globalisation processes, and results from the effects of social and structural determinants. To better understand those relationships, we must improve our thinking about causality as well as our standard views of what constitutes 'good evidence'.     

'Dealing with sperm': comparing lesbians' clinical and non-clinical donor conception processes

A growing body of literature investigates heterosexual donor conception and there is now also a small body of work which investigates the experiences of single women and lesbian couples. Both of these focus on a clinical setting. Women, notably single and lesbians, also undertake non-clinical donor conception, and insufficient consideration has been paid to these self-arranged reproductive practices, and how they may compare with the clinical ones. Seeking to fill this gap, this paper explores women's experiences of accessing donor sperm inside and outside reproductive health clinics by drawing on a qualitative interview study with 25 lesbian couples in England and Wales with experiences of jointly pursuing donor conception. The paper explores the differences embedded in the two conception routes with regard to donor recruitment, access to donor sperm over time, space and the management of sperm as a bodily fluid. Utilising the framework of 'ontological choreography' developed by Thompson (2005), as well as Douglas's (1966) work around bodies, dirt and disgust, the paper argues that the clinic functions as a containment for legal as well as practical and bodily dimensions of donor conception, and this in turn shapes practices and perceptions of self-arranged conception.     

Globalisation and public health

At the dawn of the 21st century, globalisation is a word that has become a part of everyday communication in all corners of the world. It is a concept that for some holds the promise of a new and brighter future, while for others it represents a threat that needs to be confronted and counteracted. In the area of public health, a wide range of claims have been made about the various impacts, both positive and negative, that can be attributed to globalisation. In the ever expanding literature on globalisation and health, it has become apparent that considerable confusion is emerging in both the ways that terminology is applied and concepts are defined. The determinants of health are increasingly multisectoral, and in tackling these challenges it is necessary to take a multidisciplinary approach that includes policy analyses in such areas as trade, environment, defence/security, foreign policy, and international law. In assembling the terms for this glossary, we have attempted to demonstrate the richness of the globalisation and public health debate, and in so doing have selected some of the core terms that require definition. We hope that this glossary will help to clarify this interesting and challenging area, and will also serve as a useful entry point to this new debate in public health.     

The ‘world of yoga’: The production and reproduction of therapeutic landscapes

Yoga is becoming more and more fashionable all around the world. This activity, partly considered as therapeutic, reveals contemporary ways of producing global practices. Via a questionnaire completed by individuals at yoga centres in India and France, the paper analyses this phenomenon using the concept of therapeutic landscapes. Furthermore, it examines how these therapeutic landscapes are influenced by globalisation.     

Arts and health as a practice of liminality: Managing the spaces of transformation for social and emotional wellbeing with primary school children

Intervention to enhance wellbeing through participation in the creative arts has a transformative potential, but the spatialities to this are poorly theorised. The paper examines arts-based interventions in two primary schools in which small groups of children are taken out of their everyday classrooms to participate in weekly sessions. The paper argues that such intervention is usefully seen as a practice of liminality, a distinct time and space that needs careful management to realise a transformative potential. Such management involves negotiating multiple sources of tension to balance different modes of power, forms of art practices and permeability of the liminal time-space.     

Multiple crises and global health: new and necessary frontiers of health politics

The world economy is entering an era of multiple crises, involving finance, food security and global environmental change. This article assesses the implications for global public health, describes the contours of post-2007 crises in food security and finance, and then briefly indicates the probable health impacts. There follows a discussion of the crisis of climate change, one that will unfold over a longer time frame but with manifestations that may already be upon us. The article then discusses the political economy of responses to these crises, noting the formidable obstacles that exist to equitable resolution. The article concludes by noting the threat that such crises present to recent progress in global health, arguing that global health researchers and practitioners must become more familiar with the relevant social processes, and that proposed solutions that neglect the continuing importance of the nation-state are misdirected.     

Global health in public policy: finding the right frame?

One of health promotion's major contributions has been its discursive challenge to biomedical and even behavioural models of health and illness. The concept of social determinants of health is now widely accepted by health authorities in many parts of the world. When health promoters focus on these determinants, however, it is often at local or national scales. Contemporary globalisation demands a more critical appraisal of how many health problems have become inherently global in cause and consequence. In making such an appraisal, it is helpful to consider how global health is presently being framed to determine which arguments are most likely to be health-promoting for the greatest number. This article reviews five such frames: health as security, as development, as global public good, as commodity, and as human right. Most offer some useful argumentation to health promotion, although the rights-based frame, when supported by ethical reasoning (a moral voice), is the most consistent with health promotion's more empowering roots.     

Discounting and health benefits.

This paper argues that non-monetary health benefits should not be discounted at the same rate as variables expressed in monetary terms. It argues instead that the appropriate discount rate should be at or close to zero. It explores the various influences of rising income, age and pure time preference on the relative value of current and future health states. It examines various arguments advanced to justify the current practice of discounting health benefits at the same rate as monetary costs. These include uncertainty and delay. The article concludes with an analysis of the likely impact of adopting a zero discount rate on the ranking of health interventions.     

Temporalities of mental distress: digital immediacy and the meaning of ‘crisis’ in online support

The Internet is increasingly used to seek support by those suffering with mental distress (Bauman, S. and Rivers, I. Mental Health and the Digital Age. Basingstoke: Palgrave Macmillan; 2015). Drawing on research on a major online peer support forum, we analyse discussions around acute distress, self‐harm and suicide. The paper argues that new temporalities of mental health ‘crisis’ are emerging through the intersection of the immediacy of online support, the chronicity of underlying distress and the punctuated nature of professional support. Online support adds a layer of temporal immediacy that does not traditionally feature in other forms of support (e.g. professional in‐person services). This shifts the meaning of a mental health ‘crisis’ from acute to processual, and can lead to definitions of ‘crisis’ being used when not desired nor necessarily accurate. By attending to the layering of temporalities at the intersections of professional in‐person, and online support, we demonstrate how parameters of crisis support are set – by whom, for whom and in relation to whose bodies. This has implications for professional clinical practice internationally in relation to the increased digitisation of support and the meanings of ‘crisis’ that emerge.     

Multiple crises and global health: New and necessary frontiers of health politics

Abstract

The world economy is entering an era of multiple crises, involving finance, food security and global environmental change. This article assesses the implications for global public health, describes the contours of post-2007 crises in food security and finance, and then briefly indicates the probable health impacts. There follows a discussion of the crisis of climate change, one that will unfold over a longer time frame but with manifestations that may already be upon us. The article then discusses the political economy of responses to these crises, noting the formidable obstacles that exist to equitable resolution. The article concludes by noting the threat that such crises present to recent progress in global health, arguing that global health researchers and practitioners must become more familiar with the relevant social processes, and that proposed solutions that neglect the continuing importance of the nation-state are misdirected.     

Understanding global health governance as a complex adaptive system

The transition from international to global health reflects the rapid growth in the numbers and nature of stakeholders in health, as well as the constant change embodied in the process of globalisation itself. This paper argues that global health governance shares the characteristics of complex adaptive systems, with its multiple and diverse players, and their polyvalent and constantly evolving relationships, and rich and dynamic interactions. The sheer quantum of initiatives, the multiple networks through which stakeholders (re)configure their influence, the range of contexts in which development for health is played out – all compound the complexity of this system. This paper maps out the characteristics of complex adaptive systems as they apply to global health governance, linking them to developments in the past two decades, and the multiple responses to these changes. Examining global health governance through the frame of complexity theory offers insight into the current dynamics of governance, and while providing a framework for making meaning of the whole, opens up ways of accessing this complexity through local points of engagement.