Improving health in deprived communities: What can residents teach us?

The purpose of this paper is to illustrate how residents of disadvantaged communities believe where they live influences their health. The authors describe focus group work they have undertaken with older and younger adults resident in three neighbourhoods in the West Midlands region of England, which are participating in the New Deal for Communities initiative. Drawing on the narratives of residents, examples are given of specific ‘pathways’ they described linking place to health experiences. Resident discussions highlight a number of key points. First, health was conceived in physical and non-physical terms: participants spoke of health not only in terms of physical disease or illness, but also as ‘being happy’, ‘having confidence’, ‘contentment’ and ‘peace of mind’. Second, place was seen by residents to impact on health through three core levers—physical structures (for example housing quality, visual amenity), social structures (for example, friendliness of neighbours, community norms) and service provision (for example, public transport, local police). Although the influence of each lever was described separately in certain instances, their interplay with health was often complex and intertwined. Third, although groups were not prompted to compare themselves with others, discussions frequently included comparison with other areas, and also consideration of what ‘others’ must think of them. Finally, it was noted that ‘fear’ was a common node in many of the pathways that residents described linking aspects of place with their health.     

Complaints in long-term care facilities for older persons: Why residents do not give ‘free advice’

In health care policies, the right to complain is presented as a key patient right. Complaints are also seen as a potential vehicle for quality improvement. However, in long-term care facilities for older persons in the Netherlands, relatively few complaints are registered.An explorative qualitative study was performed at three long-term care facilities to examine the ways in which different relevant actors define and relate to complaints. We conducted observations and semi-structured interviews with 76 persons: residents, their family members, nurses, volunteers, middle (facility) and upper (institutional) managers and complaint handling personnel.Long-term care facilities are social contexts obeying complex social and cultural norms. There are great differences in how complaining and complaints are perceived. For most residents, ‘complaining’ had strong negative connotations: they expected it would lead to undesirable social consequences that could not outweigh possible advantages. To nurses it was important to hear of residents’ dissatisfactions but communicative aspects were challenging. Institutional managers saw complaints as ‘free advice’ they wished to use to enhance the quality of the care provision. Complaint managers underlined the procedural aspects to complaints.A more appropriate and productive policy on complaints in this health care sector should take these differences into account.     

Habitus and responsible dog-ownership: reconsidering the health promotion implications of ‘dog-shaped’ holes in people’s lives

Responsible dog ownership has been identified as a point of intervention to promote physical activity, based upon an expectation of dog walking in public space. Nevertheless, quantitative research has found variability among owners in their dog walking. In this study, we explore the implications for health promotion of such variability. We do so by drawing on the concepts of habitus and social capital to analyse qualitative interviews. Participants were recruited from a social network in a cosmopolitan city with a policy framework intended to ensure equitable access to public space for dog walkers. The analysis confirms dog ownership can promote both physical activity and social capital, to the extent of mutual reinforcement. Yet we identified patterns of care in which dogs could influence people’s emotional well-being without promoting physical activity. In particular, some owners were not capable of extensive dog walking but still benefited emotionally from dog ownership and from interpersonal interactions facilitated by dog ownership. Some participants’ dogs, however, could not be walked in public without risking public safety and social sanctions. Responsible dog ownership can therefore also entail not exercising dogs. Contra to the emerging ideal in health promotion, a ‘dog-shaped hole’ in someone’s life does not always take the form of a walking companion.     

To live with a wagging tailed assistant – Service and hearing dog ownership from the perspective of Swedish owners

Individuals who have a functional or health impairment, are often in great need of conventional healthcare, social care and support, as well as help from family and friends. The use of dogs may be an important assistive support for this population. Assistance dogs are trained to assist with their owners’ specific needs. The aim of this study is to explore service and hearing dog ownership from the owner´s perspective, by examining the owner's expectations before training a dog, and experiences after having a certified dog. This study was designed as a longitudinal intervention study with pre-post design. The participants included in the study trained their own dogs to become service or hearing dogs. A number of open-ended questions were answered by the participants before the training of the dog started, three months after the dog was certified, and 1–3 years after the first follow-up. Data were analysed using thematic content analysis. The participants’ expectations of what the dog would contribute after being certified was high. Their perceived experiences in many ways reflected their expectations. For example, they perceived that the dog contributed to improved health status, a more active lifestyle, improved ability to feel secure, and that they had become more independent. They also felt that the dog had strengthened their social relationships. Negative experiences were also identified. Not being allowed to bring their dog into public places and negative attitudes from other people were examples of this. This study shows that individuals being supported by an assistance dog experience the dog as an invaluable help in their everyday life. By improving the owners’ lives in many ways, a certified service or hearing dog is a novel and important assistive support for people with a functional or health impairment.     

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.     

The spirit of the intervention: reflections on social effectiveness in public health intervention research

This paper suggests that public health intervention research would benefit from more thorough considerations of the social dynamics in which public health interventions are embedded. Rather than simply asking ‘What works?’, researchers should examine the social effectiveness of intervention programmes; i.e. (i) the creation of shared understandings among researchers and practitioners and (ii) the ways in which programmes reconfigure social relationships. Drawing on the theoretical work of philosopher Charles Taylor and sociologist Marcel Mauss, we suggest that the term ‘the spirit of the intervention’ may enable researchers to further articulate – and hence discuss – the source of an intervention’s social effectiveness. The empirical impetus of the paper lies in our experiences as an interdisciplinary team of researchers, trained in social science and public health and now working within intervention research. We describe our attempts at reconciling the methodological requirements of an effect evaluation, modelled on the randomised clinical trial, with a process of intervention development grounded in ethnographic methods. In particular, we discuss how we have grappled with the schism between fidelity and adaptation, which is a key methodological issue in intervention research. While public health intervention research tends to conceptualise programmes as fixed and bounded entities, we argue that ‘the spirit of the intervention’ offers a conceptual starting point for reflections on programmes as on-going social processes. In order to capture and explore this dimension of public health interventions, a great deal of potential lies in a further engagement between intervention research, ethnographic methods and social theory.     

‘When the dog bites’: What can we learn about health geography from newspaper coverage in a ‘model city’ for dog-bite prevention?

Despite calls for the adoption of ‘One-Health’ approaches, dog-bite injuries remain neglected in healthcare and public health, and our study may help to understand why. Media coverage can influence policy directions, including policies that address dogs. We collected articles (n = 65) published in two local newspapers, 2012–2017, then carried out an ethnographically-informed discourse analysis of the dog-bite reports. The newspapers portrayed dog-bites mainly as matters of public disorder, as opposed to priorities for healthcare and public health. Even as our study took place in a city that has shown dog-bite reductions without recourse to ‘breed bans’ or restrictions (i.e., breed-specific legislation), journalists still tended to emphasize dog breed as a narrative element in explaining dog-bite incidents. Nonetheless, the news coverage did not reproduce a ‘nature versus nurture’ dichotomy. Rather, the journalists presented dog breed, and presumably associated aggressive behaviour, as entanglements with social, economic, and cultural contexts. Meanwhile, the news stories reduced contextual complexity to geographic locations, as codes for community reputation, in attributing causality and morality.     

Alcohol,ideological schisms and a science of corporate behaviours on health

Consensus is fast building in the public health community around the need to research and address the ‘industrial epidemics’ of non-communicable disease across both Global North and South. However, while it is agreed that the effects of corporate behaviour on health are serious, there have been limited attempts to map out what a ‘science’ of these interrelationships might be. To do this requires actively engaging with the ways in which corporate actors generate and shape risk behaviours, public perceptions and influence policy. Moving forward, this ‘science’ will inevitably require critical reflection on the consequences of the deepening ‘ideological schism’ within the public health community in its attitudes towards industry. To date, of all the ‘unhealthy commodities industries’, alcohol has arguably received the least empirical attention from researchers. This gap is even more significant given the growing adversity between the public health community and the industry from the national scale to that of the WHO. This paper explores the nature of the ideological schism within alcohol research and its significance for the future development both of a ‘science’ of the effects of corporate behaviour on health and the advocacy that will be needed to change future regulatory and business environments in more health-promoting ways.     

Mot luuk problems in Northeast Thailand: why women's own health concerns matter as much as disease rates

In this paper, we consider women's illness experiences, above and beyond the presence of clinically identifiable disease. In Northeast Thailand, epidemiological data suggest that the prevalence of major women's reproductive tract infections is relatively low and not a cause for significant public health attention. Conversely, we found that self-reported rates of gynecological complaints are high and a significant women's health concern in rural Northeast villages. Women's embodied experiences and interpretations of these complaints affect their lives dramatically. Moreover, women's responses to gynecological problems (regardless of diagnosed morbidity) constitute an important health issue in their own right. In this regard, we document the dangers of women's self-treatment practices that rely largely on small doses of medically inappropriate antibiotics, the manner in which family life and sexual relations are disrupted by fears that gynecological problems will progress to cervical cancer, health care seeking patterns and expectations from health staff, and most importantly, how women's concerns about the seriousness of recurrent ailments result in substantial suffering. This study demonstrates why attention to women's own health concerns is as important to address in health programs as rates of disease, and why common gynecological problems and work-related complaints are important to take seriously rather than dismiss as psychological or routine and expected. We argue that there is a strong need to conduct ethnographic research on women's health problems as a complement to, and not merely a support for, epidemiological research. An evidence-based approach to health policy needs to be accompanied by a more humanistic approach to understanding health care needs.     

Creating ‘therapeutic landscapes’ for mental health carers in inpatient settings: A dynamic perspective on permeability and inclusivity

Although there has been a shift toward treatment in the home and the community, in the UK, inpatient facilities are still important in modern mental health care. ‘Informal carers’, including family members, often play an essential role, not only in providing care in the community but also in care of patients during periods of hospitalisation. UK National Health Service policies increasingly consider the position of these carers as ‘partners’ in the care process, but relatively little attention has been paid to their position within the hospital settings where treatment is provided for inpatients. This paper contributes to geographical work on carers experiences, by reporting how this issue emerged through a study focused on perceptions of a newly built hospital, compared with the inpatient facilities it replaced. We draw on qualitative research findings from discussion groups and interviews with informal carers. The material considered here focused especially on carers' views of aspects of the hospital environment that were important for wellbeing of carers and the people they look after. The carers' views were supplemented by relevant material drawn from other interviews from our wider study, which included service users and members of hospital staff. These accounts revealed how informal carers experienced the hospital environment; we interpret our findings through a conceptual framework that emphasises carers' experiences of a ‘journey’ along a ‘caring pathway’ to and through the hospital space. This perspective allows us to make a connection between three bodies of literature. The first relates to phenomenological interpretations of one's environmental perception, formed as one moves through the world. The second derives from the literature concerning ‘permeability’ of hospital institutions. Bringing these ideas together provides an innovative, dynamic perspective on a third strand of literature from health geography that examines hospitals as ‘therapeutic landscapes’. The analysis helps to explore the extent to which carers in this study were positioned as ‘outsiders’ in the hospital space.     

Psychosocial care experiences of patients with COVID-19 at home in Iran: A qualitative study

Due to the onset peak of COVID-19, as well as a shortage of human resources, physical environment, protective and medical equipment in hospitals, many patients with mild to moderate symptoms of COVID-19 are pushed to home care. This condition not only raises public health concerns but also causes a number of psychosocial problems. Therefore, this study intends to examine the psychosocial experiences of patients with COVID-19 after passing the crisis stage. A qualitative study with a conventional content analysis method was used. Thirty participants were selected using purposeful sampling from Khoy Educational and Medical Centers from 20 March to 20 June 2020. In-depth semi-structured interviews were used to collect data. Data were analysed by continuous comparative analysis using MAXQDA 10 software. The concepts extracted from data analysis identified eight subthemes and three main themes. Social rejection theme includes three subthemes: ‘Insularity of the patient’, ‘Concealment’ and ‘patient as the life-threatening center’. Lack of support theme consists of three subthemes including: ‘financial concerns’, ‘non-response of the treatment team after discharge’ and ‘concerns about the persistent condition of the disease’. Efforts to gain mental peace theme has two subthemes: ‘recourse to spirituality’ and ‘strengthening hope’. According to the results of the present study, it is necessary to examine the psychological and social needs of patients. Also, by identifying high-risk groups, supportive psychological networks such as telephone, internet and on-site medical services to help patients, medical worker and others affected in overcoming psychological problems should be increased. Providing free service packages such as the Internet, free financial aid to damaged jobs and creating the necessary platforms for online shopping and payment services, as well as training on how to plan and practice rehabilitation at home for patients and family caregivers can be helpful.     

The experience of individuals affected by Australia's international border closure during the COVID-19 pandemic

This study explored the experiences of individuals who reported being negatively affected by Australia's international border closure during the COVID-19 pandemic. Qualitative data from 1930 adults who responded to a cross-sectional online survey exploring the mental health and wellbeing of individuals affected by border closure were analysed using theoretical thematic analysis, drawing on understandings of the relationship between place and wellbeing. Four themes were identified: ‘Disconnection from family and social connections’, ‘Disconnection from a sense of home and belonging’, ‘Disconnection and sense of self’, and ‘A desire for reconnection’. Results provide a rich illustration of the relationship between disconnection from place and wellbeing during COVID-19 and highlight the need to support those affected and consider these adverse effects in future public health planning.     

‘To the horror of experts’: reading beneath scholarship on pro-ana online communities

Pro-ana online communities in which people share their experiences of eating disorders have attracted concern among scholars and health practitioners because of fears about their potential to encourage disordered eating. This article draws upon concepts from feminist psychoanalysis to ‘read beneath’ a selection of scholarly work on pro-ana communities and consider the implications of this reading for theory and practice in public health. In particular, we draw upon Julia Kristeva’s work to ‘uncover’ how sections of the academy have attempted to manage the horror inherent in the abject in relation to pro-ana. To support our reading we also draw upon critical feminist and sociocultural research on pro-ana, critical public health scholarship and the Foucauldian notion of ‘care of the self’. In accordance with our intent to overcome dichotomous thinking we locate our approach in the context of cultural studies of psychiatry, which is concerned less with clarity and non-contradiction than it is with the social, cultural and political relations of psychiatric knowledge production. This orientation is suited to capturing pro-ana’s complex relationship with medical/psychiatric authority and the nuanced subjectivities of those who participate in such communities. We invite public health scholars and practitioners to appreciate a way of engaging with pro-ana communities that is geared less towards the impetus to control, censor or clinically intervene and more towards understanding them as sites through which individuals living with eating disorders can be in the world, and that both reveal and help us understand the centrality of ambiguity and contradiction to subjectivity.     

The emergence of a ‘dose–response’ analogy in the health improvement domain of public health: a critical review

Public Health specialists have increasingly deployed the concept of ‘dose–response’ in areas such as diet (‘five-a-day’), alcohol (‘21 weekly units’) and physical activity (‘150 minutes of weekly activity’). Using these examples and a case study that sought to establish an optimal dose of physical activity for mental health gain, this article offers a critical assessment of the nature, robustness and function of ‘dose’ in public health. Drawing on a ‘sociology of knowledge’, the article argues that dose–response can best be considered an analogy that does not necessarily translate favourably from its original expression in toxicology to some public health domains – an over-extended analogy. Rather than having technical robustness, its attractiveness and utility is seen to lie in it possessing ‘cultural capital’, here, the ability to link behavioural concerns to clinical practice, to simplify complex ideas and to act as a regulatory form of behavioural governance. The article is skeptical of further empirical pursuits in identifying optimal doses and offers an alternative course for public health framing.     

北京市通州区某镇成人吸烟及戒烟相关信息分析

目的 了解农村地区成人吸烟现状,为制定适宜农村地区的控烟措施提供依据.方法 于2011年对北京市通州区永乐店地区参加永乐店卫生院年度健康体检的年龄在20岁及以上农村居民进行吸烟相关行为的问卷调查.结果 此次共调查18 238人,男性8 156人,女性10 082人.调查人群总吸烟率29.9％,现在吸烟率28.6％,男性吸烟率64.1％,女性吸烟率2.2％.调查人群开始吸烟的平均年龄为(19.82±7.09)岁;吸烟者平均每天吸(16.53±8.31)支;被动吸烟率61.6％;有38.5％的人有戒烟意愿,戒烟率为4.2％,2.3％的吸烟者知道戒烟门诊.最近一年有21.7％接受卫生服务的吸烟者得到过医生的戒烟建议.结论 吸烟是农村地区面临的一个严重危害居民健康的公共卫生问题,应加强居民控烟健康教育,提高社区医生戒烟技术,减少烟草使用带来的疾病负担.     

‘Maximising shareholder value’: a detailed insight into the corporate political activity of the Australian food industry

Objective: To gain deeper insight into the corporate political activity (CPA) of the Australian food industry from a public health perspective. Methods: Fifteen interviews with a purposive sample of current and former policy makers, public health advocates and academics who have closely interacted with food industry representatives or observed food industry behaviours. Results: All participants reported having directly experienced the CPA of the food industry during their careers, with the ‘information and messaging’ and ‘constituency building’ strategies most prominent. Participants expressed concern that food industry CPA strategies resulted in weakened policy responses to addressing diet‐related disease. Conclusions: This study provides direct evidence of food industry practices that have the potential to shape public health‐related policies and programs in Australia in ways that favour business interests at the expense of population health. Implications for public health: This evidence can inform policy makers and public health advocates and be used to adopt measures to ensure that public interests are put at the forefront as part of the policy development and implementation process.     

Pulled between contradictory expectations: Norwegian mother/child service and the ‘new’ public health discourse

In public health discourses in Western societies from the late 1970s onwards, redistribution of power from health professionals to individuals has been defined as a key strategy to foster what is called ‘healthy citizens’. The idea of changing the power relations between ‘experts’ and ‘non-experts’ by ‘empowering’ the latter, however, has not been problematized within the ‘new’ public health literature to any real extent. The present paper focuses on the mother/child service in Norway, and the discussion touches on some of the challenges and tensions that arise when the rhetoric of such notions as ‘empowerment’ is put into practice. This study indicates that the ‘new’ public health discourse is not in harmony with the problematic everyday life of the health service. The analysis is based on qualitative data drawn from interviews with public health nurses.     

Personal perspectives on patient and public involvement – stories about becoming and being an expert by experience

Patient and public involvement activities bring ‘lay participants’ and their accounts of lived experiences to the centre of health service development and delivery. For individuals, these accounts can provide an important resource, offering a sense of control and an opportunity to re-frame past events. Furthermore, as involvement activities and the use of personal accounts have become more prominent, it is timely to examine the involvement process from the perspective of the ‘lay participants’. Hence, the aim of this study is to explore how people become involved and how they construct the accounts of their lived experience. We analyse the stories of people with lived mental illness or caring experiences, who have become experts by experience (n = 13). We argue that becoming an expert by experience can help to re-contextualise past experiences and support the re-discovery of skills and expertise, leading experts by experience to construct both professionalised and politicised identities. The process has the potential to enforce narratives that portray illness experiences as motivators for social action and change. Additionally, we claim that the stories experts by experience share with health services and the public are not ‘lay accounts’ or ad hoc tales, but accounts constructed to serve specific purposes.     

‘Health and well-being’: Questioning the use of health concepts in public health policy and practice

In recent years, health and well-being have been ‘mainstreamed’ as a policy issue and have become the concern of a widening range of agencies. Simultaneously, increasing weight has been placed on the measurement of population health status, the implementation of evidence-based practice in public health and the more effective evaluation of policy interventions targeted at health gain and health inequalities. Thus, at a time when greater conceptual clarity is crucial, there are more stakeholders in ‘health’, each with a potentially different perspective and understanding of what ‘health’ is. In this study, we explore the need for greater conceptual clarity in relation to health, using the term ‘well-being’ as an exemplar. We draw on findings from a research project undertaken with community and professional groups in the Black Country and Shropshire that explored shared ways to measure aspects, and determinants, of health. We suggest a lack of attention to health concepts and their clarification, as indicated by the use of ‘well-being’ as an ill-defined tag to health, is having a negative impact on public health's ability to deliver health gain, and that commitment to clarifying concepts would lead to a range of benefits. At present, however, the term ‘well-being’ muddies the waters, acting more as an open-ended catch-all category than a clearly considered component of ‘health’.     

‘Zero Leprosy’ and other endgame strategies: Rhetoric vs. realism in public health campaigns

ABSTRACT

For over half a century, many public health campaigns related to infectious disease have focused on disease ‘eradication,’ rather than ‘control’ or ‘management.’ In this article, I will focus on the example of a recent global leprosy (Hansen’s Disease) control campaign, Triple Zero. Drawing on examples from other public health initiatives, this article explores how the language of ‘zero disease’ or ‘endgame strategies’ is appealing to certain audiences but how it can also be misleading and have unexpected and unintended consequences. Depending on the specific characteristics of the disease, the disease vectors, and the circumstances of transmission, ‘zero’ disease is rarely an achievable goal. In addition, when a disease is said to reach ‘zero,’ it is important to consider the possible implications for people with social, physical, or emotional sequeläe from the disease and who still may require follow-up treatment and care.