Everyday places,heterosexist spaces and risk in contemporary Sweden

Subjective feelings of risk are a central feature of everyday life, and evidence shows that people who do not conform to contemporary normative notions are often more exposed to everyday risks than others. Despite this, normative notions are rarely acknowledged as risk objects. By drawing on the theory of ‘doing’ and ‘undoing’ risk, which combines intersectional and risk theory, this study contributes new perspectives on the everyday risks in contemporary society that face people who many would label as being ‘at risk’ – lesbian, gay, bisexual and transgender people. The study consists of five focus group interviews with lesbian, gay, bisexual and transgender people of different ages in Sweden. Findings pinpoint risks and how these are done and un-done in different spheres of interviewees’ lives: the emotional risks prevailing in their private lives; the risk of discrimination at work and in relations with other institutions; and the risk of violence and harassment in public places. These risks are all related to the heteronormative order in which the mere fact of being lesbian, gay, bisexual and transgender is perceived as a risk.     

Eudaimonic Well‐being: Its Importance and Relevance to Occupational Therapy for Humanity

Contemporary critique of the philosophy and theory of occupational therapy has asserted that the mainstream of the profession holds a westernized view of the world and that occupational therapy has been shackled to notions of health/illness and the medical establishment for too long, hampering movement into social and political spheres. Strategies and developments have been proposed to combat these biases, which have included increased cultural relativism and a re‐focus on the subjective experience of occupation. The value placed on “being” in occupational therapy philosophy is described alongside the related terms of occupational integrity and spirituality. Drawing on theory and research from psychology, this paper proposes the construct of eudaimonic well‐being as both relevant and valuable to occupational therapy in re‐conceptualizing the profession, countering some of the central tensions in the identity of the profession and re‐asserting that well‐being through occupation is for all and for humanity. Finally, the paper proposes that well‐being, in a eudaimonic sense, should be advertised and evidenced as a routine outcome of occupational therapy and consolidated into occupational therapy models as a relevant and meaningful concept. Copyright © 2011 John Wiley & Sons, Ltd.     

‘Standing up to the beast’: contradictory notions of control,un/certainty and risk in the endometriosis self-help literature

There have been several studies exploring the role public institutions, especially the media, play in the dissemination of information about health risks. To date, scholars have neglected the role that health self-help literature plays in risk communication. In this article, I examine how risks are constructed in self-help literature written for women with the chronic gynaecological condition endometriosis. In addition to informing readers about the risk factors associated with the disease, self-help authors suggest women can access an ‘inner power’ to avoid risks with a view to overcoming the disease. In this sense, self-help authors construct the self as both ontologically separate from and superior to the body and as capable of mastering the accidental, uncontrollable and unpredictable event of illness. Several problems with this approach are examined and it is argued that self-help books are replete with contradictory notions of certainty, uncertainty, control and risk. Endometriosis is constructed as capable of being prevented for three principal reasons: it is consistent with the neoliberal philosophy of health, the health promotion enterprise and the philosophy of the self-help movement itself, which constructs an autonomous self capable of overcoming any obstacle, including illness. I conclude that neoliberalism and self-help literature have a symbiotic relationship. Indeed, health self-help literature is the perfect tool of neo-liberalism. These findings have implications for sociological analyses of risk and health promotion, demonstrating the central role that health self-help literature plays in mediating risks and encouraging the neoliberal health promotion enterprise.     

Exploring Identities Through the Internet: Youth Experiences Online

How do youth experience their online interactions? This article presents youth voices talking about their online experiences and how they perceive these interactions to have influenced their lives highlighting three themes: the notion of “wowness” experiences of freedom, power, and connectedness; and expanding notions of self and identities. It explores how parameters of the Internet (anonymity, interactivity, and connectivity) assist in enabling powerful relations and interactions that benefit some youth very positively. Virtual interactions and online spaces are seen as further sites of interaction in which youth can explore their identities and sense of themselves.     

Does NHS Direct empower patients?

NHS Direct is a 24h telephone helpline established in England and Wales, UK to offer advice and information for people about health, illness and the National Health Service (NHS) so that they are better able to care for themselves and their families. In 2001/2002 we undertook in-depth home interviews with 60 users of the service in two NHS Direct sites in England. In this paper we consider the extent to which NHS Direct facilitates patient empowerment in terms of helping people to be in control of their health and health care interactions. Our research suggests that NHS Direct facilitates patient empowerment by enabling patients to self care and to access health advice and services. It is also seen to offer the prerequisites for empowerment perceived to be lacking in the wider NHS, including time, respect, listening, support, and information. The service also functions by offering an alternative contact point for people seeking to avoid being labelled 'time wasters' by other busy health care providers. In the context of a wider health service which appears to problematise individuals' ability to make decisions about the appropriateness of seeking health care, NHS Direct legitimises help-seeking actions. Empowerment in the context of NHS Direct has been associated with self care as a way of reducing 'unnecessary' demand on health services. However, health professional and patient perspectives on what is considered necessary demand differ, and in certain contexts, patient empowerment may involve service use as well as self care. Further, our data reveal the context-dependent nature of a concept like empowerment. For example, when people are ill, in pain, or anxious about a loved one, they may value being cared for more than being empowered. Our research suggests that, in addition to its other functions, NHS Direct is also valued as contributing to a sense of being cared for.     

Learning from the past,looking to the future: Exploring our place with Indigenous Australians

This paper aims to explore ways in which we as occupational therapists in Australia can participate in enabling a different and better future for all Australians. In doing so, it is necessary to explore our history and our cultures, both individually and collectively as a profession, and to understand the ways in which these shape who we are and what we do. As occupational therapists, we have valuable knowledge and skills that have the potential to contribute in a positive way to the health and educational outcomes of Indigenous Australians. As a profession operating in Australia, we also have a responsibility to reach this potential. This paper aims to present some of these contributions and to provide examples of practical and culturally safe ways in which we can take action.     

“I Am What You Make Me. I Am Who I Am”

The growing accessibility of digital technologies has led to an increase in media projects enabling young people to connect and communicate with international peers. These projects are often uncritically celebrated as opportunities for young people to learn something about a cultural “Other” and, in so doing, enhance their tolerance of difference, their consciousness of global issues, and their appreciation of diversity. Projects conceptualised in this way, however, risk reinforcing problematic notions of multiculturalism. This article describes the Durban Plymouth Story Exchange, a youth media project facilitated by the author. The project attempted to use the creation and exchange of audio recordings between young people in Durban, South Africa and Plymouth, UK to encourage self-reflection, self-expression and cultural learning. By putting knowledge of self rather than knowledge of the Other at the centre of this project, the author/facilitator hoped the project would avoid some of the pitfalls of conventional multiculturalism.     

The future of health planning

What is the future of health planning? Will the profession survive? What will health planners be doing thirty years from now? The answers to these questions depend in part on prognostication and in part on the collective will of the profession to shape its own destiny. You ought to be doing something about the future in addition to waiting around for it. If by nature you are impatient for the good life, don't wait for it--invent it. The science of design is the sovereign science of the 21st century. A design for health requires us to answer three questions: (1) What should be done? (values) (2) How can it be done? (knowledge) (3) Who can do it? (power) To the degree health planners help society in its search for answers to these three questions, it will secure its own future as a profession. To the degree it fails in this quest, it will continue in its current mechanistic preoccupations and will eventually pass into irrevelance and obscurity. The impact of twenty-four societal trends are projected, as are the effects of the trends on the health planning profession and the images of its practitioners.     

Creating self and shaping the world

Every day, through their daily occupations, people create and recreate themselves and shape the world in some way. This ongoing process is an important factor in maintaining or enhancing health for individuals and communities, as well as professional associations. It can also be a major determinant of dysfunction, disease, disability or death should regular engagement in occupation not meet the needs of the people or sustain a healthy environment. In order to illustrate how occupational therapists can create themselves and shape the world in a positive way, this paper tells the stories of three women, Octavia Hill, Elizabeth Casson and Betty McIntyre, who in different ways, places and times, pioneered our profession. The paper includes brief discussion about some of the influences on, and the influence of, these women and about how knowing and reflecting on their stories can influence our future. In part, this includes the need for us to understand the depth and strength of our heritage and the power of taking a proactive stance towards increasing sociopolitical awareness of occupational therapists' distinctive and often unappreciated view of the relationship between occupation and health.     

‘I didn't want to pass that on to my child,being afraid to go to the dentist': making sense of oral health through narratives of connectedness over the life course

While previous sociological research on oral health has identified the relevance of personal relationships, there is more scope to analyse the mouth through a lens of connectedness. Recent qualitative interviews with 43 older people (65+) in England and Scotland found that participants constructed relational narratives to make sense of their oral health practices. By drawing on ideas of family practices, family display and personal life, we illustrate how the mouth can be understood relationally. Participants presented their own embodied experiences as connected to the actions of their parents. Narratives also reflected how, as parents and grandparents themselves, participants tried to shape the experiences of others. In this way, oral health practices were conceptualised as being about family. This can be seen in self‐narratives that demonstrated how participants located themselves as embedded in webs of ongoing relationships. We highlight the importance of narrated practices of thinking and feeling, whereby participants imagined doing oral health, and indeed family, in different ways. We thereby demonstrate how oral health practices are constituted through family connectedness and at the same time how these practices contribute to the constitution of family. Policy should therefore pay attention to family relations when promoting improvements in oral health practices.     

Enabling occupation in the 21st Century: Making good intentions a reality

Occupational therapists intend to collaborate with individuals, groups, agencies, and organizations in their search for meaningful occupations to promote health and justice. Since the 1997 publication of Enabling Occupation: An Occupational Therapy Perspective, Canada's latest guidelines on client-centred practice, the author has interwoven her ethnographic research in mental health services and client-centred practice to raise awareness of disjunctures between intentions and actual practice. Her 1999 Keynote Presentation at OT Australia's 20th National Conference in Canberra offers stories of George and Martha as allegories of the potential for enabling occupation in the 21st century. George presents a story of enabling occupation directly with people in need; Martha's story is about organizing services for enabling occupation. Through these stories, Dr Townsend calls occupational therapists to develop the language, organization and practice needed to make the profession's good intentions a reality in the 21st century.     

Everyday Occupations and the Process of Redefinition: A Study of How Meaning in Occupation Influences Redefinition of Identity in Women with a Disability

The purpose of this qualitative study is to examine how debilitating diseases or accidents can influence occupation and identity. Ten women facing disabilities as adults were interviewed. Data are analysed with a phenomenologic-hermeneutic approach, and indicate that changed or reduced everyday occupations influence their interaction and presentation of self, which again has consequences to their identity. Early in the process of redefinition, a variety of occupational strategies help keep the identity as disabled at a distance. The women are keeping their jobs as long as possible, they hold on to their usual routines, they avoid places where they have to struggle doing, they barely talk about their occupational problems, avoid technical aids and membership in an interest organization for people with a disability. After some time the strategies change, making it possible to invest time and energy in meaningful occupations, to join interest organisations for disabled people, and engage in occupations tied to their role as women as well as leisure activities. Involvement in meaningful occupations tended to influence the way in which the women viewed themselves and brought about a redefinition of the meaning of disability.     

Gesundheitliche Aufklärung als Risikokommunikation

Those seeking to educate the public about health need to communicate health risks effectively. This involves providing evidence-based information about factors and behaviors that are dangerous to people’s health and making recommendations regarding how risks can be avoided or minimized. This communication usually aims to motivate people to act in a way that promotes health or prevents disease. Organized ‘health education’ that seeks to communicate risks is always embedded in a contextual framework that in turn influences the issues and content to be communicated and the form of communication that is chosen. The scope of available scientific knowledge is an important part of this framework as is the extent to which risks are presented in the media as being dangerous. The media’s message has a strong influence on how the public and specific subgroups within it react. The article describes conditions that contribute to successful risk communication based on the example of HIV/AIDS prevention. We chose this particular case because it can serve as an example of how to deal with future epidemics that may potentially generate substantial media coverage. This field report shows how risk communication about HIV/AIDS in the mass media in Germany in the mid-1980s elicited a risk consciousness among the general public that in itself was in danger of becoming a health risk, especially for people affected by the disease, and how ‘health education’ responded to this challenge. It concludes by describing how these experiences with risk communication can be applied to similar types of risk communication today.     

Professional autonomy and surveillance: the case of public reporting in cardiac surgery

Professional autonomy has come under greater scrutiny due to managerialism, consumerism, information and communication technologies (ICT), and the changing composition of professions themselves. This scrutiny is often portrayed as a tension between professional and managerial logics. Recently, medical autonomy has increasingly been shaped in terms of transparency, where publication of clinical performance (via ICT) might be a more pervasive form of surveillance. Such transparency may have the potential for a more explicit managerial logic but is contested by clinicians. This paper applies notions of surveillance to public reporting of cardiac surgery, involving the online publication of mortality rates of named surgeons. It draws on qualitative data from a case‐study of cardiac surgeons in one hospital, incorporating interviews with health care managers and national policymakers in England. We examine how managerial logics are mediated by professional autonomy, generating patterns of enrolment, resistance and reactivity to public reporting. The managerial ‘gaze' of public reporting is becoming widespread but the surgical specialty is accommodating it, leading to a re‐assertion of knowledge, based on professional definitions. The paper assesses whether this form of surveillance is challenging to or being assimilated by the medical profession, thereby recasting the profession itself.     

Being a Clinical Educator

What is it like to be a clinical educator? How do clinical educators experience and describe their continuing journey of becoming a clinical educator? Within the model developed in this research, dimensions of being a clinical educator were identified. These dimensions include (a) having a sense of self (and the impact of bringing self into the clinical educator’s role), (b) having a sense of relationship with others (and the place of this “interactive self” as a central feature of clinical education), (c) having a sense of being a clinical educator (and how this understanding relates to the previous two dimensions), (d) having a sense of agency (which is vital to the performance of many clinical education roles), (e) seeking dynamic self-congruence, and (e) growth as a clinical educator. This paper presents an overview of the model, discusses its strengths and limitations as a representation of speech pathology clinical educators’ experiences, and briefly considers its value for professional development.     

Occupational science: a renaissance of service to humankind through knowledge

The context for the development of occupational science, the study of the human as an occupational being, included the worldwide increase in the population of people with chronic impairments, decreased resources for people with handicaps, growth in the complexity of daily life and the global maturation of the profession of occupational therapy. Occupational science promises that occupational therapists will define the knowledge base of the profession and its appropriate scope of practice through scholarly work. Occupational scientists need to develop a fresh synthesis of ideas from those scholarly disciplines that view the human as a complex being who interacts with the environment by using occupation over the three time spans of evolution, human development and learning; occupation as agency; and viewing the person served as Homo occupacio, a dynamic, open human system. The occupational human engages in daily life through development of a repertoire of skills which adheres to the rules of culture. Such study will need to include the contexts in which people carry out their rounds of occupation. The ‘detective work’ of occupational scientists, contributing to but not bound by the immediate demands of occupational therapy practice, will be guided by the values and traditions of the field to ensure its relevance and ethical foundation. The most important tool of the world community of occupational therapists will be the mind of the occupational therapist, who, through knowledge of occupation, will foster human capability and influence health. Copyright © 2000 Whurr Publishers Ltd.     

Patterns and causes of health inequalities in later life: a Bourdieusian approach

This study explores the relationship between social class and health change in older people in a path analysis, using data from the English Longitudinal Study of Ageing (n = 6241) in a Bourdieusian theoretical framework. Bourdieu drew a distinction between the occupational characteristics by which people are classified and the secondary properties of class that relate to lifestyle (economic, cultural and social capitals). Our path model includes both occupational and secondary characteristics of objective social class as well as a measure of subjective social class. We investigate the effects of the predictors on change in three health outcomes (self‐rated health, number of symptoms of depression and number of difficulties with the activities of daily living). The analysis adds to Bourdieusian research by showing how the effects of objective social class on health are partially mediated by perceived social status. It also adds to substantive research on the relationship between class and health by suggesting that class‐related health inequalities do persist for older people, even for those who are not in paid employment. It suggests that a large amount of the effect of occupation on the health of older people is not direct but indirect; through their personal wealth and lifestyle.     

Sexuality and Disability: A Discussion on Care of the Self

The aim of this article is to bring together the notions of sexuality, disability and care of the self. This is done by illustrating the importance of care of the self and technologies of the self in the context of sexuality and disability. This paper is partly based on empirical data from a phenomenological study on perspectives of sexuality of Greek men with spinal cord injury. In this article we shift the focus from care offered from one person to another, to self care. Foucault??s work on the care of the self is used as an analytical lens to consider care as a discourse, with associated ideas and practices. In the care of the self what is important is the degree to which chosen practices help people live life as they choose and construct the self they desire. Like everybody, disabled people need to experiment, trying out different technologies of the self and different sexual possibilities. Care of the self is about enactment of identities and choice of how to live one??s life. In other words, it is about control of one??s body, power to guide representations of oneself and access to choices.     

Sri Lanka and the possibilities of achieving universal health coverage in a poor country

Sri Lanka has been lauded for providing good health coverage at a low cost despite having a modest per capita income. This article identifies the unique historical factors that enabled Sri Lanka to achieve near universal coverage, but it also discusses how this achievement is now being undermined by inadequate government investment in health services, the burdens of non-communicable diseases, and the growing privatisation of health services. In doing so, the article highlights the challenges of achieving and maintaining universal health coverage in a relatively low income country with a health system designed to treat infectious diseases and provide child and maternal health services as the country undergoes an epidemiological transition from infectious to non-communicable diseases. Using updated information on developments in the Sri Lankan health system, this article argues, in contrast with earlier publications, that Sri Lanka is no longer providing good health at a low cost. It shows that Sri Lanka’s low investment in health is detrimental and not an asset to achieving good health. The article also questions the possibilities of providing coverage for noncommunicable diseases at a low cost. The article has four main sections. The first details Sri Lanka’s accomplishments in moving toward universal health coverage. The second identifies the factors enabling Sri Lanka to do so. The third describes the equity and access challenges the health system now confronts. The fourth assesses what the Sri Lankan experience suggests about the requirements for universal health coverage when providing health services for treating non-communicable diseases becomes an important consideration.