The Australian Government's ‘Social Inclusion Agenda’: the intersection between public health and social policy

Social exclusion and social inclusion have been popular policy themes in the UK and Europe, and made more modest appearances in countries such as Canada and New Zealand, for over a decade. In 2007, the Australian Government became the latest country in this trend of structuring social policy around issues of exclusion, launching its ‘Social Inclusion Agenda’ (SIA). The SIA aims to increase social and economic participation through a reorientation of social services and increased attention to issues of equity. At the same time, there has been international consensus on the importance of the social determinants of health (such as education, income and gender) for individuals and populations. The SIA has the potential to make a substantive contribution to the social determinants of health and hence the health and wellbeing of the population. However, much will depend on the extent to which international discourses of inclusion, exclusion, structural inequality and third way politics are taken up, adapted or discarded in the Australian context. At this formative stage of the SIA's development, the public health community is in a unique position to contribute to the development and direction of the SIA to secure the potential health gains it offers. This article outlines the formulation of social inclusion policy in Australia, and discusses the potential promises and pitfalls of a social inclusion approach. Our examination of the Australian experience of social inclusion policy provides an opportunity to reflect on the relationship between social inclusion and health internationally.     

‘Call me if you need’: Social support experiences under economic and social change

ABSTRACT

Social interactions play an important role in people’s life and people’s health but their scope and intensity tend to decrease with age, challenging social support dynamics and increasing the risk of social isolation and helplessness. In Portugal, policymakers still seem to rely on traditional social relations in eldercare, while contextual changes and trends are redefining family roles and behaviors and defying the established social support structure. In this work, we aim to examine the scope, structure and experiences of the informal social support network available in the country for stroke patients 6 months after their discharge from the acute care unit in the context of a larger study. The results seem to confirm the importance of family as a source of social support and shed light on different bonding experiences with non-kin social groups, such as neighbors and friends. A coordinated care provision, combining formal and informal support is vital and beneficial for patients, their caregivers and the care system.     

‘The Troubles’, geographies of mental health in Northern Ireland and re-conceptualizing social capital

Current research suggests that the presence of social capital (Putnam, 1993 Putnam, RD. 1993. The prosperous community: Social capital and public life. American prospect, 13: 35–42.  [Google Scholar]) in a community setting positively affects physical and psychological health and well-being. Indeed, McKenzie et al. (2002 McKenzie, K, Whitley, B and Weich, S. 2002. Social capital and mental health. British journal of psychiatry, 181: 280–283. [Crossref], [PubMed], [Web of Science ®] [Google Scholar]) highlighted the impact of social context on mental health and noted that social capital may be influential in the incidence and prevalence of mental illness. The authors suggested that studies of the geographies of mental health could also be useful in understanding the relationship between social capital and psychological health and well-being but note that this relationship is likely to be complex. The purpose of this paper is to develop the commentary from McKenzie et al. further and consider the relationship between social capital, psychological health and a society experiencing conflict. Social capital is often described as the glue that holds society together, producing a positive environment for a community to foster and thrive. Little attention has focused on the relationship between social capital and psychological health and well-being when specific communities experience (and/or contribute to) political strife and civil disorder. One would assume that social capital at the horizontal level is minimal in these cases as civil conflict acts as a barrier to its production. This would have a deleterious effect on psychological health and well-being. The issues outlined above are explored in the context of one region of the United Kingdom currently experiencing civil conflict: Northern Ireland. Social capital theory is re-conceptualized in this light.     

Closure of ‘third places’? Exploring potential consequences for collective health and wellbeing

In unassuming neighborhood locales, such as coffee shops, hair salons, and malls, people meet to socialize, express themselves, and support one another. These ‘third places’ enrich social interaction, sense of community, and belonging outside of the home and workplace. Yet third places are closing across the United States. Americans may be losing access to key services, goods, and amenities, in addition to community sites that help buffer against loneliness, stress, and alienation. The relevance of third places to health and quality life is under-researched. These sites may support wellbeing through mechanisms of stimulation, support, protection, and care. We call on researchers to investigate how third places contribute to wellbeing and consider the consequences that the disappearance of such places has for public health. Future research on third places may be mobilized to innovatively reduce health disparities and improve quality of life.     

Barcelona Salut als Barris: Twelve years’ experience of tackling social health inequalities through community-based interventions

Community health can reduce inequalities in health and improve the health of the most disadvantaged populations. In 2007, Barcelona Salut als Barris (Barcelona Health in the Neighbourhoods) was launched, a community health programme to reduce social inequalities in health. In 2018, this programme reached the 25 most disadvantaged neighbourhoods of the city. This article shares the lessons learned after 12 years of work. The programme was initially funded by a research grant and the funds were maintained during the economic crisis and were tripled when the programme became a political priority in the last municipal government. During the 12-year period, partnerships with stakeholders were generally stable and productive. Maximum community participation was obtained in the detection of health assets and needs and in action plans. During 2018, Barcelona Salut als Barris worked with more than 460 agents that co-produced 183 interventions involving more than 13,600 people. Most of the interventions assessed showed improvements in the health of participants, which could help to reduce health inequalities. The greatest difficulties were: a) citizen participation, b) the sustainability of working groups over the years, c) conflicts of interest, d) the sustainability of interventions, e) reaching certain minority groups and f) evaluation. The increase in resources in the last period contributed to the maturity and expansion of the programme. Key factors in its scope and results were political will, strong technical capacity and methodology, strong intersectoral partnerships and continued community work.     

‘Anytime,anywhere’: vaping as social practice

This article examines the use of e-cigarettes, or vaping, as a social practice. It builds on recent work which argues that theories of social practice can provide effective new ways of conceptualising and responding to public health challenges such as smoking and sedentariness by shifting the focus from individual behaviour. Instead these theories attend to the development and persistence of practices which are enacted across time and space. The article draws on data from a 2014 online survey of Australian vapers, specifically responses to open-ended questions about vaping and its place in daily life. It highlights the way vaping has been established as a practice through a range of factors including the increasing burdens of smoking and the online availability of e-cigarettes and vaping information and advice. Most survey respondents were positive about vaping and constituted it as the opposite of smoking in its ability to improve well-being and transform life for the better. In contrast to smoking, vaping was presented as a practice which opened up space and time, for example as inside the home became a location where nicotine could be consumed. The article also examines the way vaping enables nicotine addiction to be experienced differently, as a form of habitual consumption in which elements of control and choice remain present. The article is limited by its reliance on written responses and the non-representative nature of the survey sample, however it suggests the benefits of naturalistic research on vaping as a social practice.     

Health by association? Social capital, social theory, and the political economy of public health

Three perspectives on the efficacy of social capital have been explored in the public health literature. A "social support" perspective argues that informal networks are central to objective and subjective welfare; an "inequality" thesis posits that widening economic disparities have eroded citizens' sense of social justice and inclusion, which in turn has led to heightened anxiety and compromised rising life expectancies; a "political economy" approach sees the primary determinant of poor health outcomes as the socially and politically mediated exclusion from material resources. A more comprehensive but grounded theory of social capital is presented that develops a distinction between bonding, bridging, and linking social capital. It is argued that this framework helps to reconcile these three perspectives, incorporating a broader reading of history, politics, and the empirical evidence regarding the mechanisms connecting types of network structure and state-society relations to public health outcomes.     

‘Gaining health and wellbeing from birth to three’: a web-based positive parenting programme for primary care settings

ABSTRACT

Current models of pediatric care include parental support as part of health promotion in the early years. This study introduces the modality of e-health by describing the universal ‘Gaining Health and Wellbeing from Birth to Three’ programme, reporting on the level of programme satisfaction among 249 parents and 350 professionals. The average level of satisfaction was very high for both groups. The professionals showed significantly higher rates than the parents in the ‘Activity’ factor, but there were no significant differences with regard to the ‘Programme experience’ and ‘Parenting impact’ factors. Parents living in single-parent families were more satisfied, whereas professionals who were more heavily engaged with the Internet were less satisfied with the parenting impact of the programme. In sum, this study has demonstrated that a cost-efficient (brief and fully automated) structured programme was able to reach a large population of participants and satisfy their expectations about the programme.     

Prostate cancer support groups, health literacy and consumerism: are community-based volunteers re-defining older men's health?

In this article we describe the connections between prostate cancer support groups (PCSGs) and men's health literacy and consumer orientation to health care services. The study findings are drawn from participant observations conducted at 16 PCSGs in British Columbia, Canada and 54 individual interviews that focused on men's experiences of attending group meetings. Men's communication and interactions at PCSGs provide important insights for how men talk about and conceptualize health and illness. For example, biomedical language often predominated at group meetings, and men used numbers and measures to engage with risk discourses in linking prostate cancer markers to various treatment options and morbidity and mortality rates. Many groups afforded opportunities for men to interact with health care providers as a means to better understand the language and logic of prostate cancer management. The health literacy skills fostered at PCSGs along with specific group-informed strategies could be mobilized in the men's subsequent clinical consultations. Consumer discourses and strategies to contest power relations with health care professionals underpinned many men's search for prostate cancer information and their commitment to assisting other men. Key were patients' rights, and perhaps responsibility, to compare diverse health products and services in making decisions across the entire trajectory of their prostate cancer. Overall, the study findings reveal PCSGs as having the capacity to contest as well as align with medical expertise and services facilitating men's transition from patient to informed health care consumers. The processes through which this occurs may direct the design of older men's health promotion programs.     

Minding the gap: health and social care provider perceptions of parental communication and Black-Canadian youths’ sexual health

Abstract

Health and social care providers’ perceptions of Black-Canadian parent-youth sexual health communication has important implications for addressing knowledge gaps in the provision of services to young people and their parents. Providers’ perceptions are crucial as they often act as advisers in tailoring programmes or services to the perceived needs of parents and youth. To understand these perceptions, 17 semi-structured in-depth interviews were conducted with providers who worked with African, Caribbean or Black (ACB) parents and youth in Toronto, Ontario, Canada. Critical Race Theory was used to help guide the interpretation of findings. The findings revealed providers believed that many parents were unlikely to explicitly discuss sexual health or HIV prevention with young people. Additionally, providers perceived that the content of and approach to parent-youth sexual health communication differed between African and Caribbean clients. Moreover, providers believed that both parents’ and young people’s sex and gender impacted the quality, content and style of sexual health communication and had important implications for programme development. Overall, findings suggest a need for understanding the development of providers’ perceptions of this communication, ways to address these perceptions and further parent-provider collaboration to promote Black youths’ sexual health.     

‘Exotic no more’: Tuberculosis,public debt and global health in Berlin

ABSTRACT

Geographical divisions between North and South are coming increasingly undone in the field of global health. Settings in the global North, such as Berlin, are becoming linked up to those in the global South in manifold ways. In this article, I show through discourse analysis and ethnographic research how tuberculosis and its meanings have been transfigured in Western Europe through the worldwide circulation of the disease and its definition as a global health epidemic returning to the North from the South through global migration routes. I then draw attention to the ways in which public health professionals in Berlin make sense of locally implemented economic processes of debt and austerity that have been in effect since the early 2000s. Such processes of indebtedness and privatisation render the strong public health infrastructures that characterise the global North increasingly fragile, and are comparable to the structural adjustment policies that have been imposed upon countries in the global South. I argue that economic processes of austerity in Berlin complement the meaning of TB as an immigrants’ disease, while older meanings of TB as a disease of poverty resurface.     

Sports and martial arts activities for public health purposes: the musician’s risk profiles and exercise-based health care as a model

Purpose

The common saying that sports promote good health is in line with main results of sports medicine, but conflicting with the high amount of sports injuries and sports-related diseases. This paper contributes to the discussion of the pros and cons of sports, particularly of the martial arts. It intends to shed light on the benefits of sports in the general public and to explore the enormous and yet unexploited potential of individually tailored sport activities for public health.

Methods

Comparative analyses and meta-synthesis of empirical studies on the health benefits of sports. Musicians with very heterogeneous work-related risk profiles serve as a model for inductive generalisation.

Results

For health promotion and to avoid adverse outcomes, sport activities must take one’s physical status and risk profiles into account and refer to well-adjusted training zones. This encompasses musculoskeletal and biomotor factors, behavioural means to rebalance the nervous system, cardiorespiratory fitness, mental health and psychological benefits, and active pain management and pain relief.

Conclusion

Sports organisations provide a wide spectrum of facilities for sports-oriented lifestyles; however, informal experience and relevant publications let us assume that they rather do not explore how to optimise preventative and health-related benefits, except for training with personal coaches. And yet, relatively simple screening methods and individually adjusted intensities, modes, and frequencies of trainings can enhance benefits and greatly contribute to public health, which would, however, require a stronger health awareness of providers and specific education of sports coaches.

     

‘Raising the Pulse’: The environmental,nutritional and health benefits of pulse-enhanced foods

Diet is a key modulator of non-communicable diseases, and food production represents a major cause of environmental degradation and greenhouse gas emissions. Yet, ‘nudging’ people to make better food choices is challenging, as factors including affordability, convenience and taste often take priority over the achievement of health and environmental benefits. The overall ‘Raising the Pulse’ project aim is to bring about a step change in the nutritional value of the UK consumers' diet, and to do so in a way that leads to improved health and greater sustainability within the UK food system. To achieve our objectives, UK-specific faba bean production systems that optimise both end users' diets and environmental and economic sustainability of production will be implemented in collaboration with key stakeholders (including industry, the retail sector and government). Palatable faba bean flours will be produced and used to develop ‘Raising the Pulse’ food products with improved nutritional profile and environmental value. Consumer focus groups and workshops will establish attitudes, preferences, drivers of and barriers to increased consumption of such products. They will inform the co-creation of sensory testing and University-wide intervention studies to evaluate the effects of pulses and ‘Raising the Pulse’ foods on diet quality, self-reported satiety, nutritional knowledge, consumer acceptance and market potential. Nutrient bioavailability and satiety will be evaluated in a randomised-controlled postprandial human study. Finally, a system model will be developed that predicts changes to land use, environment, business viability, nutrition and human health after substitution of existing less nutritionally beneficial and environmentally sustainable ingredients with pulses. Government health and sustainability priorities will be addressed, helping to define policy-relevant solutions with significant beneficial supply chain economic impacts and transformed sustainable food systems to improve consumer diet quality, health and the environment.     

Functional declines,social support,and mental health in the elderly: Does living in a state supportive of home and community-based services make a difference?

This study examines how acute and chronic stresses associated with functional declines in seniors and their spouses are moderated by their informal and formal support contexts. In the United States, states vary greatly in their support for home and community-based services (HCBS) for seniors with disabilities. This state-to-state variation allowed us to examine mental health effects of living in a society supportive of HCBS for the oldest old, who are at high risk for low or declining functions in daily activities and cognitive abilities. Using a ten-year panel study of a nationally representative sample of the oldest old (≥70 years old) covering the period 1993–2002, we conducted mixed-effects logistic regression analysis to incorporate time-varying characteristics of persons and states. As expected, low and declining functions in daily living and cognition constituted significant stressors among seniors and their spouse. Results demonstrated the important role of informal support available from non-spouse family/friends in lowering depression. Living in a state supportive of HCBS was associated with lower depression among seniors experiencing consistently low levels of function or recent functional declines, especially among those without informal support. Our findings were consistent with moderating or buffering models of formal support, suggesting that state HCBS support is effective mainly under conditions of high levels of stressors. Political will is needed to prepare US society to collectively support community-based long-term needs, given the difficulty of preparing ourselves fully for common, but often unexpected, functional declines in later life.     

‘Big Food’ and ‘gamified’ products: promotion,packaging, and the promise of fun

The promise of ‘fun’ is an increasingly common strategy used by Big Food in the promotion of packaged products. Gamification, or ‘making it fun’, has been identified as a top consumer packaged goods trend for 2014, and is finding its way into the spectrum of packaged goods and target markets. Once solely the preserve of children’s fare, fun is now applied to ‘junk’ food, ‘healthy’ food, snack food, ‘adult’ food, and ‘kids’ food. The rise and implications of such marketing has yet to be explored, and this article draws from the critical literature in food studies, current food marketing campaigns, and primary research from the trade press to map and critique ‘fun’ in association with food promotion. I argue that the promise of fun – while positioned as a playful, edible ‘pause’ in a hectic world – works to occlude some significant health, attitudinal and policy considerations related to the industrial diet. The seemingly lightweight focus on fun as a driver in food promotion promises a more embodied level of engagement than does a focus on nutritionism. However, ‘fun’ can simultaneously work to reconfigure relationships with food, increase consumption, and distance processed foodstuffs from issues of nutrients, as well as the non-communicable diseases associated with excessive consumption of highly processed fare.     

A community-based survey on Syrian refugee women’s health and its predictors in Şanliurfa,Turkey

ABSTRACT

Reproductive characteristics, mental health symptoms, micronutrient deficiencies, and symptoms of sexually transmitted infections (STIs) were determined among married Syrian refugee women aged 15–49 years who were living outside of camps in 2015, using probability sampling. Of the 458 participants, 51.3 percent married before the age of 18 years. Early-age marriages and number of desired children increased after the war. In multivariable analyses, education (adjusted odds ratio [aOR] = 1.2; 95% confidence interval [CI] = 1.2–1.3) and length of stay in ?anl?urfa (aOR = 1.2; 95% CI = 1.1–1.2) were independently associated with early marriage. Approximately 16 percent of women were pregnant, and 26.7 percent of them had not received prenatal care; 47.7 percent had had a pregnancy loss; 50.8 percent reported symptoms of STIs. Of those who were sexually active, 37.8 percent were not using contraception. The prevalence of iron, B₁₂, and folic acid deficiencies was 50 percent, 45.6 percent, and 10.5 percent, respectively. Early marriage (aOR = 2.2; 95% CI = 1.4–3.5) and number of desired children (aOR = 5.03; 95% CI = 3.2–7.9) were associated with not using contraception. Most (89.7 percent) women reported at least two mental health symptoms; lack of social support (aOR = 2.6; 95% CI = 1.3–5.3), language barrier (aOR = 2.3; 95% CI = 1.01–5.2), and B₁₂ deficiency (aOR = 1.8; 95% CI = 1.01–3.4) were associated with such symptoms. The findings demonstrate the need for reproductive health and psychosocial services.     

Use of the terms ‘race’, ‘ethnicity’, and ‘national origins’: A review of articles in the American journal of public health, 1980–1989

Objectives: To assess the use of the categories of race, ethnicity, and national origin in recent public health research.

Methods: We reviewed all research articles on human populations published in the American Journal of Public Health from January 1980 through December 1989. Articles were classified by (1) mention of the categories, (2) use of the categories, (3) presence of explicit definitions, and (4) definitional criteria.

Results: Specific categories (e.g. ‘black’, ‘Chinese’, ‘Hispanic') or generic categories (e.g. ‘race’, ‘ethnicity’, ‘national origin') were mentioned in 461 (50.4%) of 914 articles on human populations. In most studies (65.1%), single categories (e.g. race or ethnicity) were considered; in 1.3% of studies, two terms (e.g. both race and ethnicity) were examined independently; in 1.3%, categories were used interchangeably; in 5.6% of the studies, combined categories (e.g. race‐ethnicity) were used; and in 27.5% of the studies, specific population groups were named without reference to a generic category. Explicit definitions of categories were present in only 8.4% of the articles in which the categories were considered. Absence of explicit definitions and use of combined and interchangeable categories suggest a lack of clarity and conceptual consistency in research on race, ethnicity, and national origin‐related topics.

Conclusion: To improve our assessment of differences in health status among racial, ethnic, and national origin groups, research involving these categories should assess their validity and should define concepts clearly, explicitly, and consistently. Such research would minimize misclassification, improve the interpretation of findings, facilitate comparison among studies, and enhance the understanding of causes underlying differences in health status among populations of different racial, ethnic, and national origins.