‘Live Beautiful,Live Well’ (‘Vivir Bonito,Vivir Bien’) in Nicaragua: Environmental health citizenship in a post-neoliberal context

ABSTRACT

The concepts Vivir Bien and Buen Vivir, often translated as ‘living well’ or ‘collective well-being,’ are central to contemporary social medicine reforms in Latin America. Owing to increasing social inequalities, notably in the public healthcare sector, Vivir Bien has regional significance as it redefines the neoliberal development goals from economic improvement to so-called post-neoliberal social goals of harmonious co-existence between society and the physical environment. To examine how this abstract concept is conceptualised, is incorporated into, and shapes state-sponsored public health strategies, I analyze the ‘Vivir Limpio, Vivir Sano, Vivir Bonito, Vivir Bien?…?!’ (‘Live Clean, Live Healthy, Live Beautiful, Live Well?…?!’) national campaign in Nicaragua that began in 2013. The campaign promotes normative socio-political ideals around environmental health citizenship, including the adoption of indigenous grammars and solidarity. However, analyses of dozens of interviews and 143 household surveys in four historically impoverished, untidy, and unhygienic communities suggest that the campaign’s discourses do not resonate with citizens or their socio-economic contexts. In highlighting discrepancies between state-sponsored normative sociopolitical ideals and citizens’ lived realities and perspectives, this paper introduces the term ‘post-neoliberal citizenship’ to reflect contemporary – and changing – conceptualizations of health, wellbeing, and citizenship in post-neoliberal Latin America.     

Hygienic food handling behaviours. An application of the Theory of Planned Behaviour

It is estimated that 5.4 million Australians get sick annually from eating contaminated food and that up to 20% of this illness results from food handling behaviour. A study was undertaken to investigate the efficacy of the Theory of Planned Behaviour (TPB) including past behaviour in predicting safe food handling intention and behaviour. One hundred and nine participants completed questionnaires regarding their attitudes, perceived behavioural control (PBC), subjective norm, intentions and past behaviour. Behaviour was measured 4 weeks later. The TPB predicted a high proportion of variance in both intentions and behaviour, and past behaviour/habit was found to be the strongest predictor of behaviour. The results of the present study suggest interventions aimed at increasing safe food handling intentions should focus on the impact of normative influences and perceptions of control over their food handling environment; whereas interventions to change actual behaviour should attempt to increase hygienic food handling as a habitual behaviour.     

Who you know, where you live: social capital, neighbourhood and health

This article examines the degree to which relationships between social capital and health are embedded in local geographical contexts and influenced by demographic factors, socio-economic status, health behaviours and coping skills. Using data from a telephone survey of a random sample of adults (N=1504 respondents, response rate=60%), the article determines if relationships between involvement in voluntary associations and various measures of individual health are associated with neighbourhood of residence in the mid-sized city of Hamilton, Canada. Associational involvement and overweight status (assessed by body-mass score) were weakly but significantly related after controlling for the other variables; involvement had relationships with self-rated health and emotional distress before but not after controlling for socio-economic status, health behaviours and coping skills. Relationships between neighbourhood of residence and two health outcomes, self-rated health and overweight status, were statistically significant before and after controlling for the other characteristics of respondents; neighbourhood of residence was not a significant predictor of number of chronic conditions and emotional distress in multivariate models. The neighbourhood and associational involvement relationships with health were not dependent upon one another, suggesting that neighbourhood of residence did not help to explain the positive health effects of this particular measure of social capital.     

‘Because I’ve been extremely careful’: HIV seroconversion,responsibility, citizenship and the neo-liberal drug-using subject

In this article, we examine how injection drug users who do not attribute their HIV infection to engaging in HIV risk behaviours take up and critique discourses of individual responsibility and citizenship relating to HIV risk and HIV prevention. We draw on data from a study in Vancouver, Canada (2006–2009) in which we interviewed individuals living with HIV who had a history of injection drug use. In this paper, we focus on six cases studies of participants who did not attribute their HIV infection to engaging in HIV risk behaviours. We found that in striving to present themselves as responsible HIV citizens who did not engage in HIV risk behaviours, these participants drew on individually focused HIV prevention discourses. By identifying themselves in these ways, they were able to present themselves as ‘deserving’ HIV citizens and avoid the blame associated with being HIV positive. However, in rejecting the view that they and their risk behaviours were to blame for their HIV infection and by developing an explanation that drew on broader social, structural and historical factors, these individuals were developing a tentative critique of focus on individual responsibility in HIV transmission as opposed to dangers of infection arising from the socio-economic environment. By framing the risk of infection in environmental rather than individual risk-behaviour terms, these individuals redistributed responsibility to reflect the social-structural realities of their lives. In this article, we reflect on the implications of these findings for public health measures such as risk prevention messages. We argue that it is important that such messages are not restricted to individual risk prevention but also include a focus of broader shared responsibilities of HIV.     

Parental rearing behaviours and eating disorders: the moderating role of core beliefs

OBJECTIVE: Core beliefs have been shown to mediate between eating psychopathology and dysfunctional parent-daughter interactions. However, the possible moderating role of core beliefs has been neglected. This study aimed to explore the hypothesis that core beliefs serve as moderator variables in the relationship between recalled parental rearing behaviours and eating psychopathology. METHOD: Sixty-six women with a current eating disorder completed self-report measures of parental rearing behaviours, core beliefs, and eating psychopathology. RESULTS: Three core beliefs were found to moderate the relationship between paternal rejection and aspects of eating psychopathology. The predictive validity of paternal rejection on aspects of eating symptomatology was found to decrease as dysfunctional core beliefs increased. DISCUSSION: When levels of social isolation, vulnerability to harm, and self-sacrifice core beliefs were high, recalled parental relationships were no longer relevant to current eating psychopathology. The findings provide further evidence that core beliefs are important factors in eating disorder psychopathology and may be clinically useful in identifying targets for treatment.     

Stakeholder experiences of using online spatial data visualisation tools for local public health decision support: A qualitative study

The distribution of food outlets within towns and cities and the provision of active travel infrastructure have been associated with health behaviours that can contribute to obesity risk. Decision-makers describe a lack of local data and research evidence as a barrier to policy adoption to improve the public's health. Online spatial data visualisation tools created by researchers can help to bridge this gap. We explored stakeholder experiences of using such tools for decision-support, with a focus on facilitators and barriers to use. We conducted 16 qualitative interviews with Public Health, Planning and Transport Planning professionals, who had used two recently-developed tools. Participants described the importance of tools being open access; their use in “story-telling”, particularly to non-experts; and more broadly their use even when imperfect. They expressed that ‘robustness’ of underpinning data was important, however this was not easily defined. Participants employed personal heuristics, principally based on endorsement and developer credibility, to determine suitability for use. We present key learning points for future developers to maximise engagement and impact.     

A conduit between epidemiological research and regional health policy

Objective : To transform data from a research setting into a format that could be used to support strategies encouraging healthy lifestyle choices and service planning within local government. Methods : Details of the health status and lifestyle behaviours of the Geelong, Victoria, population were generated independently by the Geelong Osteoporosis Study (GOS), a prospective population‐based cohort study. Recent GOS follow‐up phases provided evidence about patterns of unhealthy diet, physical inactivity, smoking and harmful alcohol use. These factors are well‐recognised modifiable risk factors for chronic disease; the dataset was complemented with prevalence estimates for musculoskeletal disease, obesity, diabetes, cardiovascular disease, asthma and cancer. Results : Data were provided to Healthy Together Geelong in aggregate form according to age, sex and suburb. A population statistics company used the data to project health outcomes by suburb for use by local council. This data exchange served as a conduit between epidemiological research and policy development. Conclusion and implications : Regional policy makers were informed by local evidence, rather than national or state health survey, thereby optimising potential intervention strategies.     

Who We Seek and What We Eat? Sources of Food Choice Inspirations and Their Associations with Adult Dietary Patterns before and during the COVID-19 Lockdown in New Zealand

Research shows the shaping of food choices often occurs at home, with the family widely recognised as significant in food decisions. However, in this digital age, our eating habits and decision-making processes are also determined by smartphone apps, celebrity chefs, and social media. The ‘COVID Kai Survey’ online questionnaire assessed cooking and shopping behaviours among New Zealanders during the 2020 COVID-19 ‘lockdown’ using a cross-sectional study design. This paper examines how sources of food choice inspirations (cooking-related advice and the reasons for recipe selection) are related to dietary patterns before and during the lockdown. Of the 2977 participants, those influenced by nutrition and health experts (50.9% before; 53.9% during the lockdown) scored higher for the healthy dietary pattern. Participants influenced by family and friends (35% before; 29% during the lockdown) had significantly higher scores for the healthy and the meat dietary patterns, whereas participants influenced by celebrity cooks (3.8% before; 5.2% during the lockdown) had significantly higher scores in the meat dietary pattern. There was no evidence that associations differed before and during the lockdown. The lockdown was related to modified food choice inspiration sources, notably an increase in ‘comforting’ recipes as a reason for recipe selection (75.8%), associated with higher scoring in the unhealthy dietary pattern during the lockdown. The lockdown in New Zealand saw an average decrease in nutritional quality of diets in the ‘COVID Kai Survey’, which could be partly explained by changes in food choice inspiration sources.