Critical Public Health

The legislation of health warning labels on cigarette packaging is a major focus for tobacco control internationally and is a key component of the World Health Organization’s Framework Convention on Tobacco Control. This population-level intervention is broadly supported as a vital measure for warning people about the health consequences of smoking. However, some components of this approach warrant close critical inspection. Through a qualitative content analysis of the imagery used on health warning labels from 4 countries, we consider how this imagery depicts people that smoke. By critically analyzing this aspect of the visual culture of tobacco control, we argue that this imagery has the potential for unintended consequences, and obscures the social and embodied contexts in which smoking is experienced.

Psychological understandings and individualistic theories of human behaviour and behaviour change have dominated both academic research and interventions at the ‘coalface’ of public health. Meanwhile, efforts to understand persistent inequalities in health point to structural factors, but fail to show exactly how these translate into the daily lives (and hence health) of different sectors of the population. In this paper, we suggest that social theories of practice provide an alternative paradigm to both approaches, informing significantly new ways of conceptualising and responding to some of the most pressing contemporary challenges in public health. We introduce and discuss the relevance of such an approach with reference to tobacco smoking, focusing on the life course of smoking as a practice, rather than on the characteristics of individual smokers or on broad social determinants of health. This move forces us to consider the material and symbolic elements of which smoking is comprised, and to follow the ways in which these elements have changed over time. Some of these developments have to do with the relation between smoking and other practices such as drinking alcohol, relaxing and socialising. We suggest that intervening in the future of smoking depends, in part, on understanding the nature of these alliances, and how sets of practices co-evolve. We conclude by reflecting on the implications of taking social practices as the central focus of public health policy, commenting on the benefits of such a paradigmatic turn, and on the challenges that this presents for established methods, policies and programmes.

Call for abstracts:
9th Biennial Conference of the International Society of Critical Health Psychology (ISCHP), 12-15 July, 2015

The ISCHP brings together health scholars who are interested in exploring ongoing and emerging issues in critical research, critical theory and critical practice in relation to health and health care. This shared interest in critical approaches to healthcare is exemplified in the theme of the 9th Biennial Conference, ‘Health, Health Care and Social Justice’.

The call for abstracts for the 9th Biennial Conference of the International Society of Critical Health Psychology (ISCHP) is now open.

The ISCHP invites conference abstract submissions that take a critical stance on any aspect of health, health care and social justice. The conference will be broadly structured under the following conference themes:
·        Health systems, histories, and politics
·        Critical health education, interventions and treatment
·        Critical theory and methods in health research
·        Health and health care in social and communicative contexts

The following formats for presentations are welcomed:
1.    Poster
2.    Individual paper:This is a paper presentation followed by questions/discussion.
3.    Symposium:A symposium is organised around a common topic. A range of formats for the presentation of symposia is available. These are: four paper presentations; three paper presentations and discussant; round-table discussions; soap-box presentations; debates; pecha kucha sessions; and five-minute challenge sessions.

Abstract submission forms are available on the conference website. To find out more about this conference, please visit www.ischp2015.co.za.

We look forward to seeing you in Grahamstown!

Regards,
ISCHP Conference Team
www.ischp2015.co.za
email: conference@ru.ac.za

The public health approach to alcohol control focusses on efforts to reduce overall consumption and therefore the prevalence of “harmful” drinking and its negative health and social consequences.  Within this logic, evidence is corralled in favour of three particular strategies: tax increases; restricting access; and bans on alcohol advertising. In turn, it is argued that these strategies represent the most cost-effective and efficient ways to reduce consumption and its harms. However, the majority of the evidence base from which these recommendations stem derives from studies from countries of the Global North, and in particular, North America, Western Europe and Australasia.  Yet, as the WHO has been quick to note in its Global Strategy to Reduce the Harmful Use of Alcohol, countries of the Global South actually bear the greatest burden of alcohol-related harms. Geographical and anthropological approaches to health and wellbeing remind us that health and consumption practices are inherently contextual, rendering the logic and possibility of global ”best buys” for alcohol control a fallacy. Moreover, they may also engender a homogenisation of national alcohol control strategies. Yet, local contexts must always be inculcated within public health policy endeavours if they are to be plausible and sustainable. In many countries of the Global South, the janus-faced importance of alcohol as a source of income, but also of gross harms, needs to be reconciled. And, such questions will only ever preclude the possibility of the universalist policy solutions that has become so deeply enshrined in the public health literature.

Of the many critiques of the Millennium Development Goals, their lack of commitment to reducing the global non-communicable disease (NCDs) burden has been taken up with the most vigour by advocacy groups. With the remit of the UN’s post-2015 Sustainable Development Goals slowly closing in, the sense of urgency in ensuring that NCDs not only feature prominently within this new global agenda but are also tied to binding targets and objectives, is growing. This political task makes substantial use of epidemiological evidence as to the magnitude, prevalence, geographic distribution and broader consequences of the NCD burden. Advocates also argue for the globalisation of the risk factors for NCDs (alcohol, smoking, sedentarism, diet) and, therefore, their increasing ubiquity and social normalisation. Most importantly for Global Health, however, is an attempt to correct an outdated epidemiological transition model that understates the extent to which NCDs now disproportionately contribute to the burden of disease in countries of the Global South as well as their syndemic nature. Yet, infectious and tropical diseases remain the mainstay of Global Health funding and, therefore, research. This raises questions as to the ways in which certain diseases capture public attention, how they mobilise political support, evoke affective responses, an ethic of care and, as a result, entrench themselves as global priorities. This paper thus critically explores the notion of charisma in relation to NCDs. It asks how diseases attain charismatic status and, as a corollary, why some diseases struggle to become charismatic in the eyes of policy makers and the public. The dialectical and fluid relationship between disease and charisma is significant in that it helps shed light on the politics of Global Health priority setting. It also points to the limits of and barriers facing Global Health advocacy for NCDs and, as a result, should identify avenues for charisma creation.

During the past decade or so, organization studies has witnessed a small but growing interest in the human body, in health, and in the management of life beyond organizational boundaries. In light of this development, this paper investigates how the New Public Health seeks to construct and manage people as healthy bodies beyond the boundaries of formal work organizations. The paper does so through a discourse analysis of a UK health campaign on healthy eating. Drawing on Foucault’s notion of governmentality, the paper discusses the power, limitations and subversion of this campaign by problematizing the neo-liberal managerialism that it actualizes. Finally, it discusses what implications this has for the New Public Health and for organization studies.
Keywords: Embodiment, governmentality, health promotion, neo-liberal management, power, resistance.

Current concerns about a childhood obesity crisis and children's physical activity levels have combined to justify fitness lessons as a physical education practice in New Zealand primary (elementary) schools. Researchers focused on children's understandings of fitness lessons argue that they construct fitness as a quest for an ‘ideal’ (skinny or muscular) body. The conflation of fitness with thinness, however, is complex and problematic. In this paper, we draw from research conducted with a class of primary school children in New Zealand. Drawing on the theoretical tools of Foucault and utilizing a visual methods approach, we examine how children experience school fitness lessons and construct notions of fitness, health and body. The children's responses illustrated that obesity discourses and body pedagogies ‘collided’ in a way that shaped understandings of fitness lessons in ways inextricably connected with the avoidance of being fat. The children assumed that fitness lessons increased fitness and that being fit was demonstrated by a ‘correct’ corporeal appearance. We argue that body pedagogies inside and outside the school gates shape children's ideas about the body in ways which exclude other understandings of bodies, health, and physical activity.

Despite women’s awareness of the risks of smoking in pregnancy to the developing foetus, a significant minority continue to smoke during pregnancy. In this article, we use a discourse analytic approach to analyse interviews with 12 Australian women who smoked during a recent pregnancy. We used these data to examine how women accounted for their smoking and identities in the light of the implicit but ever-present discourse that smoking in pregnancy harms babies. We found that the women in our study deployed two rhetorical devices in their talk, ‘stacking the facts’ and ‘smoking for health’, allowing them to situate their smoking within a discourse of risk or as a potential benefit to their health. Women ‘stacked the facts’ by citing personal observable evidence (such as birthweight) to draw conclusions about the risks of smoking in pregnancy to the baby. ‘Stacking the facts’ allowed women to show how they had evaded the risks and their babies were healthy. This device also allowed women to deny or cast doubt over the risks of smoking in pregnancy. Women’s accounts of ‘smoking for health’ involved positioning quitting as stressful and, as a result, more harmful than continuing to smoke a reduced amount. We found complex and counter-intuitive ways in which women dealt with the discourse that smoking in pregnancy harms babies and how these ways of accounting served to protect their identities. We argue that health promotion messages conveying the risks of smoking in pregnancy would benefit from contextualising these messages within women’s personal accounts (e.g. by ‘stacking the facts’ or ‘smoking for health’) and hence providing more ‘realistic’ health risk messages.

There are growing concerns in many industrialized Western societies about declining opportunities for children to play, and fears that this will have adverse health consequences for them. Informed by anti-obesity efforts, public health institutions have recently begun to advance active forms of play as a way of improving children’s physical health; however, promoting play for physical health might reshape meanings of play for children. We conducted photography and interview sessions with 25 Canadian children aged 7 to 11 years to examine their representations of play. Our findings suggest that for children, (a) play is an end in itself, (b) play involves but is more than active play, (c) there is ambivalence about scheduled play, and (d) risk is considered a pleasurable component of play. These findings point to a dissonance between children’s play promoted for physical health and the meaning of play for children as emotionally contingent, intrinsically motivated, and purposeless.

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.

Efforts to address homelessness in New Zealand are marked by competing discourses that construct it as a housing issue, or more radically, as an issue of social exclusion.  This paper presents a case study that illustrates the difficulties of reconciling these discourses when framing homelessness policy.  Research was conducted with a national organisation involved in advocating to the New Zealand government on homelessness policy.  Members of this group participated in focus groups exploring the meanings of home, homelessness and their advocacy work.  The paper traces the challenges presented to the politics of social action by recognising homelessness as an issue of social exclusion, but needing to frame it as an issue of housing to effect policy change. It argues that social activist groups must routinely make pragmatic and strategic compromises that challenge the integrity of their ideological positions and their conceptual understandings, and develop group practices that allow them to resolve the tensions that this can generate.

In recent years, HIV/AIDS programming has been transformed by an ostensibly ‘new’ procedure: male circumcision. This article examines the rise of male circumcision as the ‘right’ HIV prevention tool. Treating this controversial topic as a ‘matter of concern’ rather than a ‘matter of fact’, I examine the reasons why male circumcision came to be seen as a partial solution to the problem of HIV transmission in the twenty-first century and to what effect. Grounded in a close reading of the primary literature, I suggest that the embrace of male circumcision in HIV prevention must be understood in relation to three factors: (1) the rise of evidence-based medicine as the dominant paradigm for conceptualising medical knowledge, (2) the fraught politics of HIV/AIDS research and funding, which made the possibility of a biomedical intervention attractive and (3) underlying assumptions about the nature of African ‘culture’ and ‘sexuality’. I conclude by stressing the need to expand the parameters of the debate beyond the current polarised landscape, which presents us with a problematic either/or scenario regarding the efficacy of male circumcision.

This chapter considers research reflexivity rather than reflexivity as a theoretical endeavour; it is focussed on how researchers are located by and within the methodological practices of their research when conducting and reporting qualitative interpretive research in health psychology. Hence the chapter examines reflexive considerations of the assumptions underlying research practice, from the perspective of researchers and research consumers, and how these shape and direct the research and the outputs from it. The chapter reviews various forms of reflexivity and their impact on research practices and outcomes, alongside some discussion of the advantages and consequences of being reflexive in research.  Discussion of these issues opens up consideration of ethical issues in qualitative research, the value of a critical approach to research, and the importance of creativity in research practice. 

This article extends our understanding of the everyday practices of pharmaceuticalisation through an examination of moral concerns over medication practices in the household. Moral concerns of responsibility and discipline in relation to pharmaceutical consumption have been identified, such as passive or active medication practices, and adherence to orthodox or unorthodox accounts. This paper further delineates dimensions of the moral evaluations of pharmaceuticals. In 2009 and 2010 data were collected from 55 households across New Zealand and data collection techniques, such as photo- and diary-elicitation interviews, allowed the participants to develop and articulate reflective stories of the moral meaning of pharmaceuticals. Four repertoires were identified: a disordering society repertoire where pharmaceuticals evoke a society in an unnatural state; a disordering self repertoire where pharmaceuticals signify a moral failing of the individual; a disordering substances repertoire where pharmaceuticals signify a threat to one’s physical or mental equilibrium; a re-ordering substances repertoire where pharmaceuticals signify the restoration of function. The research demonstrated that the dichotomies of orthodox/unorthodox and compliance/resistance do not adequately capture how medications are used and understood in everyday practice. Attitudes change according to why pharmaceuticals are taken and who is taking them, their impacts on social relationships, and different views on the social or natural production of disease, the power of the pharmaceutical industry, and the role of health experts. Pharmaceuticals are tied to our identity, what we want to show of ourselves, and what sort of world we see ourselves living in. The ordering and disordering understandings of pharmaceuticals intersect with forms of pharmaceuticalised governance, where conduct is governed through pharmaceutical routines, and where self-responsibility entails following the prescription of other agents. Pharmaceuticals symbolise forms of governance with different sets of roles and responsibilities.