What is health? A deconstruction of the World Health Organization 1948 definition.

Containing Contagion: The Politics of Disease Outbreaks in Southeast Asia. Sara E. Davies. Johns Hopkins University Press, Baltimore, USA, 2019, pp. xii + 212. ISBN 978-1-421-42739-3 (pbk). It is impossible to read Sara E. Davies' Containing Contagion in 2020 without evaluating its arguments in light of the dramatic rise of COVID-19 in the year since its publication. Given these developments, the book stands as an invaluable resource for anyone seeking to understand ‘how we got here’, in terms of the range of state responses to the current pandemic and beyond. Containing Contagion opens with rich insights into the historical and political processes that brought about the multiple phases of increased international collaboration that have shaped contemporary international health norms. Where the book's most significant value lies, however, is in its firmly-rooted, empirical exploration of how certain factors work for and against the successful real-world diffusion of these norms. This exploration takes place in Southeast Asia, a region where the uptake of collective health security measures is increasingly important, and one that is well-known for resistance to external adjudication on matters such as human rights. Davies' distinctive approach to assessing collective health security performance in Southeast Asia places more emphasis on values, networks and the normative capacity of health securitization instruments, than on questions of differentials in technical capacities, political systems or public resource mobilization (though she does also account for these). In doing so, she provides a framework through which challenges as well as opportunities can be identified and extrapolated to other regions. For Davies, ‘the Southeast Asian experience provides important insight on how to begin collective realization of a duty to report outbreak events’ (p. 3). The book is divided into six interrelated areas of inquiry, which are briefly explored here. In Chapter One, Davies provides a historical account of the negotiation and adoption in 2005 of the revised International Health Regulations (IHR), described as ‘a significant diplomatic coup for the WHO’ (p. 16). For newcomers to international public health politics, the chapter also provides a helpful introduction to previous iterations of the IHR and the developments that led to its 2005 revision and re-adoption. This background orients the reader to this instrument's significance, especially in its potential to dramatically reshape global responses to infectious disease outbreaks. The chapter then explores dominant narratives that have emerged since 2005 that have sought to evaluate the practical implementation of the new IHR. These include concerns about the decentralized structure of the World Health Organization (WHO) itself, which can be seen to inhibit country accountability in relation to the IHR core capacities. Compounding this is the fact that the regulations are non-binding, and so are not rigidly complied with, monitored or evaluated in the same way that a treaty would be, such as via treaty body review and civil society shadow reports. Relatedly, there is no funding mechanism that supports low- and middle-income countries to fully implement its requirements. This leaves it ‘largely up to states individually to secure the investment needed to achieve the IHR core capacities’ (p. 33). While setting out these critiques, particularly as they intensified following the 2009 swine flu and 2014 Ebola outbreaks, Davies cautions that such narratives of compliance failure can risk ‘downplaying what has been achieved in a short time, and the very real evidence that the IHR have exerted considerable “compliance pull” across a sizable majority of states’ (p. 41). This sets up her own line of enquiry, along the following lines: In a region where consistent relevant gains have been made since 2005, what role has the adoption of the revised IHR played in realizing these? This is treated less as a question of benchmarks, and more as one of internalization. Such internalization, or norm diffusion, is particularly remarkable in the case of ASEAN, a region where member states are particularly committed to the principle of non-interference regarding domestic affairs. In Chapter Two, Davies walks the reader through the political context of Southeast Asia in relation to the management of infectious disease outbreaks. By highlighting regional specificities, she helps the reader to better understand the complex and changing conditions that can affect national IHR compliance—conditions which Davies is careful to point out are as political as they are technical or financial. This examination explores the region's underlying challenges, including health inequality, governance-related issues and a longstanding resistance to international norms. In Chapter Three, the book examines the real-world experiences of ASEAN in the mid-2000s as a region increasingly confronted with infectious disease outbreaks. SARS, followed soon after by H5N1, created a ‘compulsion to cooperate’ (p. 83). Crucially, these outbreak events were accompanied by the securitization of health and infectious disease discourse. Davies argues that by creating ‘an environment where ASEAN states recognized the threat as shared and understood that collective action was needed’, an observable normative shift took place (p. 83). Further, the emergence of health securitization discourses appears to have complemented rather than run counter to the region's principle of non-interference, as security threats became appreciated as collective threats to regional security. Chapter Four details the creation of the unique regional implementation program developed to pursue IHR compliance in Southeast Asia: the Asia Pacific Strategy for Emerging Diseases (APSED). Of particular importance was APSED's emphasis on the need to implement the IHR not only nationally but regionally. Such a focus on the regional dimension stood at odds with the approach taken by WHO headquarters, where emphasis was placed firmly on national-level and international-level responsibility. In Chapter Five, Davies impressively surveys surveillance reports relating to the ASEAN states from 1996 to 2010, thereby tracking the changing performance in disease surveillance and response during this period. We see here how the reporting practice of disease outbreak events—even among the most recalcitrant of ASEAN states—changed under the normative influence of the APSED framework. The analysis also reveals the significance of differentiation between states' reporting practices. This differentiation is examined in detail in the final chapter (Chapter Six). Davies shows that ‘the trend toward enhanced detection and reporting is at most risk in two areas: follow-up verification of initial disease outbreak reports and confronting the political situations that affect state capacity to detect and respond’ (p. 116). Despite these challenges, and differences in terms of individual state capacities, her overall argument is that Southeast Asia as a whole exhibited stronger compliance with the IHR reporting requirements, with increased formal reporting widely evident. The media reported this as a monumental failure on behalf of the WHO, and a thousand articles bloomed examining where the WHO had gone wrong. In addition to the debate about the WHO's response were questions about the efficacy of the IHR revisions in shaping state behaviour in response to public health emergencies (p. 30). This quote could potentially be repeated verbatim in 2020, in relation to COVID-19. For instance, Lee (2020) writes of an ‘unprecedented pandemic and [a] splintered global response’, and calls for a new instrument altogether to overcome fragmentation. Ferhani and Rushton (2020: 460) write that bordering practices during the COVID-19 pandemic ‘have highlighted some major limitations in the way the IHR (and the WHO) conceptualize the functioning and location of national borders’. For Stuckelberger and Urbina (2020: 113), COVID-19 is a ‘game changer’ and calls for ‘a revision of IHR as well as a more biological, clinical and community-centered preparedness strategy’. Time will tell whether, like Containing Contagion, a regionally-specific, ASEAN-wide analysis would look more favourably on the practical implementation of containment measures during COVID-19. An additional area of exploration for future research could be to draw links between the securitization of health discourse, (which Davies demonstrates was a framing strategy utilized by, among others, APSED and WHO to encourage compliance with IHR measures), and the wave of human rights violations committed by states in the wake of COVID-19. Such crackdowns, under the guise of ‘defending’ against the ‘threat’ of COVID are an increasingly documented phenomenon among hybrid regimes in particular, including those within ASEAN (Grundy-Warr & Lin, 2020: 499). Leaders of hybrid regimes, while not invoking the IHR itself (which implores countries to uphold human rights principles), have consistently applied heavily securitized language to justify drastic and arguably disproportionate measures taken to ‘combat’ COVID-19. Such measures include militarized lockdown zones, arrests and arbitrary detention of activists and opposition figures, increased surveillance, and the introduction of vague and far-reaching emergency laws (Seewald, 2020; Spadaro, 2020). Much has been written on how the securitization of aid discourse of the mid-2000s provided a normative vehicle for leaders to justify repression, and the deleterious effect this has had on political space for civil society (Fowler, 2008). Perhaps we are likewise now witnessing the flow-on effects of a deliberate institutional strategy to securitize public health discourse in hybrid regimes in order to encourage norm diffusion. Containing Contagion is truly a book that will only increase in significance and relevance in the coming years, providing as it does an essential foundation on IHR internalization and reporting compliance. It will act as a springboard for much future research into pressing issues of increasing global significance for us all.

Contemporary notions of childhood overweight and obesity have become increasingly influential in curriculum and pedagogy in school-based Health and Physical Education (HPE). Teachers' delivery of HPE subject matter and related school practices are likely to have a considerable impact on the attitudes and beliefs of the children they teach, particularly in the primary school. It thus becomes important to consider the ways of thinking about and doing health (discourse positions on health) that teachers bring to their teaching of HPE. This paper examines pre-service teachers' positions in relation to the health discourses to better understand what teachers, in this case beginning teachers, bring to their teaching of HPE and interactions with children in primary schools. It draws on a Foucauldian approach to discourse analysis to analyse pre-service teachers' qualitative survey and interview responses to questions about meanings of health. Three key positions emerged, signifying Agreement, Disagreement and Negotiated positions in relation to the dominant discourses of health and the body.

This round table workshop is jointly organized by the WHO Collaborating Centre for Health Literacy at the TU Munich, the WHO Health Promotion Department in Geneva, members of the WHO Health Behaviour in School-Aged Children (HBSC) Study, EuroHealthNet and the Schools4Health Consortium, and the EUPHA Health Literacy and Child and Adolescent Public Health Sections. The event will serve as a platform to present, explore, and discuss the latest research developments and policy implications regarding child, adolescent and school health and health literacy, both in Europe and worldwide. Despite its importance, low health literacy remains widespread across all population groups and is closely linked to poorer health outcomes and increased health inequalities. Individuals from lower socioeconomic backgrounds are especially at risk, reinforcing the need for targeted interventions to address these disparities. Recognizing its importance, investment in health literacy has become a key priority within the EU's Horizon Europe Programme, the World Health Organization, and at governmental levels across Europe. In today's digital era, social media has become a dominant source of health information, especially for schoolchildren. While it offers opportunities for rapid information sharing, it also increases the risk of exposure to misinformation. However, health literacy is often not systematically integrated into school curricula, although it can have lasting positive impacts on both health and academic outcomes. This underscores the urgency (1) of equipping students with critical thinking skills to safely navigate information ecosystems and (2) to develop a global mechanism to monitor health literacy development in countries, schools, and education systems. In this round table workshop with five key health literacy and public health experts, these topics will underpin the discussion and draw on examples from WHO's global school (health) literacy survey, the health literacy competency framework for schools, and the decade-spanning European HBSC study. After a short introduction by the chairs, the panel members will share a short 2-to-3-minute statement from their point of view in relation to the ongoing WHO health literacy activities, highlighting synergies with the HBSC and Schools4Health studies as well as the WHO European School Health Network (SHE/ENHPS). Following the short statement, the chairs will prepare individual questions for each panellist and engage them in a discussion, which shortly after will open towards the audience for them to participate actively with the panellists in a 30-minute discussion, also using the online Slido platform.Key messages• The round table workshop will discuss a much-needed global strategy and road map on school health literacy and present collaboration opportunities for research, practice and policy.• Equipping students with health literacy and critical thinking is vital to combat misinformation, support wellbeing in the digital age, and can be achieved through school health literacy action.Speakers/PanellistsFaten Ben AbdelazizWHO, Geneva, SwitzerlandTina PurnatHarvard University, Boston, MA, USALeena PaakkariUniversity of Jyväskylä, Jyväskylä, FinlandCaroline CostongsEuroHealthNet, Brussels, Belgium

The performative act of “coming out” authenticates a homosexual identity and in the South African context the coming out narrative has gained such momentum that it is now regarded as an imperative for closeted homosexuals by the Lesbian and Gay Equality Project (LGEP). However, coming out has been critiqued by queer theorists who argue that it is problematic because it forces a person into an already established identity category, strengthens the regulation of sexual categories and is complicit in the reconstitution of these categories. In this paper, these queer critiques of coming out will be employed in order to explore the question of why a person is compelled to confess to the ‘truth’ about their homosexuality in South Africa. The data for this exploration is drawn from three non-fiction gay and lesbian books: “Male Homosexuality in South Africa: Identity Formation, Culture and Crises” (1992) by Gordon Isaacs and Brian McKendrick, “Tommy Boys, Lesbian Men and Ancestral Wives: Female Same-Sex Practices in Africa” (2005) by Ruth Morgan and Saskia Wieringa, and “Performing Queer: Shaping Sexualities 1994-2004 – Volume 1” (2005) edited by Mikki van Zyl and Melissa Steyn. The data was analysed using content analysis and the findings show how homosexuality is extricated from negative discourses of abnormality, promiscuity and fraudulence and reformulated into positive discourses associated with identity politics, normality and progress. In such positive discourses, a person is compelled into disclosure because it is viewed as a necessary step to combat homophobia and conservative family and social norms. This paper argues that as long as the coming out narrative is embedded in the positive discourses of progress, health and enlightenment, it will remain immune to critique of the role that it plays in strengthening heterosexuality as unitary and normative. Finally, this paper suggests that refusing to succumb to the pressure of categorisation could potentially undermine the constraints of the homosexual/heterosexual binary on which the categories of male and female are contingent.

Households' source separation behaviour and solid waste disposal options in Ghana's Millennium City

Is Occupational Therapy Adequately Meeting the Needs of People With Chronic Pain?

Contemporary philosophy of mind is dominated by anti- individualism, which holds that a subject's thoughts are determined not only by what is inside her head but also by aspects of her environment. Despite its dominance, anti-individualism is subject to a daunting array of epistemological objections: that it is incompatible with the privileged access each subject has to her thoughts, that it undermines rationality, and, absurdly, that it provides a new route to a priori knowledge of the world. In this rigorous and persuasive study, Jessica Brown defends anti- individualism from these epistemological objections. The discussion has important consequences for key epistemological issues such as skepticism, closure, transmission, and the nature of knowledge and warrant.According to Brown's analysis, one main reason for thinking that anti-individualism is incompatible with privileged access is that it undermines a subject's introspective ability to distinguish types of thoughts. So diagnosed, the standard focus on a subject's reliability about her thoughts provides no adequate reply. Brown defuses the objection by appeal to the epistemological notion of a relevant alternative. Further, she argues that, given a proper understanding of rationality, anti- individualism is compatible with the notion that we are rational subjects. However, the discussion of rationality provides a new argument that anti-individualism is in tension with Fregean sense. Finally, Brown shows that anti-individualism does not create a new route to a priori knowledge of the world. While rejecting solutions that restrict the transmission of warrant, she argues that anti-individualists should deny that we have the type of knowledge that would be required to use a priori knowledge of thought content to gain a priori knowledge of the world.

Contemporary philosophy of mind is dominated by anti-individualism, which holds that a subject's thoughts are determined not only by what is inside her head but also by aspects of her environment. Despite its dominance, anti-individualism is subject to a daunting array of epistemological objections: that it is incompatible with the privileged access each subject has to her thoughts, that it undermines rationality, and, absurdly, that it provides a new route to a priori knowledge of the world. In this rigorous and persuasive study, Jessica Brown defends anti-individualism from these epistemological objections. The discussion has important consequences for key epistemological issues such as skepticism, closure, transmission, and the nature of knowledge and warrant. According to Brown's analysis, one main reason for thinking that anti-individualism is incompatible with privileged access is that it undermines a subject's introspective ability to distinguish types of thoughts. So diagnosed, the standard focus on a subject's reliability about her thoughts provides no adequate reply. Brown defuses the objection by appeal to the epistemological notion of a relevant alternative. Further, she argues that, given a proper understanding of rationality, anti-individualism is compatible with the notion that we are rational subjects. However, the discussion of rationality provides a new argument that anti-individualism is in tension with Fregean sense. Finally, Brown shows that anti-individualism does not create a new route to a priori knowledge of the world. While rejecting solutions that restrict the transmission of warrant, she argues that anti-individualists should deny that we have the type of knowledge that would be required to use a priori knowledge of thought content to gain a priori knowledge of the world. Bradford Books imprint

Beguiling a Victorian public obsessed with the pursuit of fitness, the International Health Exhibition opened in South Kensington in May 1884. Its expressed intent, to educate the public on a broad range of wellness topics, was greatly overshadowed by its dazzling display of proprietary medical commodities, salutary appliances, and faddish cures. While there were legitimate exhibits that dealt sincerely with issues of sanitation, hygiene, food, drink, and even child care, the event illuminated the extent to which personal and systemic therapeutic remedy and indeed health itself had become a lucrative industry. Less than three weeks before he joined the Fabian Society, the fledgling novelist Bernard Shaw visited one of the exhibition’s prominent attractions, Francis Galton’s Anthropometric Laboratory, to be quantified and measured. Chart 3655, created on 16 August 1884, contains the following collected data:

Introduction: US Power, North American Knowledge and the Cold War There is now a substantial literature which seeks to situate the influential Latin American theories of development which emerged during the Cold War in their wider political and historical context. And there is a large number of articles which look at the North American historiography of Latin America and at the study of inter-American relations. Unlike most of these studies, however, this article focuses more directly on the relationship between US power in, and the production of a professional North American knowledge about, Latin America during the Cold War. Building on imperial state theory, recent international relations theory derived from Gramsci, and discourse theory, it emphasises the need to locate the emergence and subsequent consolidation of Latin American studies at the height of the Cold War, in the context of the rise of the historical and social science professions and the vicissitudes of US foreign policy in Latin America. A brief discussion of theories of imperialism and the role ofthe imperial state in the projection of US hegemony will be followed by a critical examination of the structures and discourses of North American social science generally and Latin American studies more specifically. The centrality ofliberalism to North American academic and political activity throughout the twentieth century will be addressed, and the discursive creation of Latin America, with particular reference to the period from 1945 to the early 1990s, will be examined. It will be argued that Latin American studies, as a set of professional discourses and practices which emerged in North America during the first half of the twentieth century, and was consolidated during the Cold War, has facilitated the creation and maintenance of the institutions, inter-state relations, politico-economic structures and technologies that underpin the US hegemonic position in the Americas. In short the professional study of Latin America has been instrumental to the wider US effort to manage the interAmerican system.

As is long overdue, this paper attempts to expose "health development" professionals to the Human Rights discourse in the health sector. This paper is presented as an advocacy piece for an alternative to the existing "Health Sector Reform" (HSR). HSR is primarily advocated by the World Bank and is influencing World Health Organization (WHO) policy (WHO 2000). Literature concerning the contrasting of these two approaches to health is scarce. Consequently, for many readers, this paper will mark their first exposure to the human rights-based approach to work in health; for others, it will reinforce and refresh some of their already known key concepts.

Over the years, some critics argue that the dimension of spiritual well-being was missing from the World Health Organization’s (WHO) definition of health. Nevertheless, although the WHO’s definition has been criticized over the past 60 years, it has never been adapted. Spiritual well-being should not be confused with psychological well-being. Moreover, spirituality, personal beliefs and religiousness are not synonymous. Spirituality has received much interest in health care services; it can improve strategies for managing stress and can positively influence immune, cardiovascular (heart and blood vessels), hormonal, and nervous systems. For this reason, it may be implicated in a wide range of physical and mental health conditions, and I believe it’s time to review the WHO’s health definition, adding to it the ‘spiritual well-being’ dimension.

In recent years, dental clusters and networks have been established in primary care in many countries to improve access to services for the population and develop cooperation between providers. In Hungary, the first dental clusters were established in 2021, and currently, one-third of dental practices have already joined a cluster. The study aimed to gather and analyze early experiences regarding the motivation of participation in primary care dental clusters and experiences of implementation. Qualitative in-depth individual interviews with primary care dentists (n = 21). The study was designed to meet the COREQ criteria for reporting qualitative research. The research team members defined a purposive sample of interviewees. All interviews were conducted from March to April 2024. A qualitative content analysis method was used to analyze the interview transcripts. The WHO health system framework was chosen for the theoretical framework of the analysis. The motivations for joining a dental cluster were financial reasons, professional development and knowledge exchange. Lack of information and distrust were barriers to joining the dental clusters. Different professional management practices have developed within the clusters. In the interviewees' opinion, the population's access to preventive dental services has not yet changed substantially under the new operational model. The portfolio of services offered by dental clusters could be expanded to include a range of types of care. Digital health technologies and innovative solutions should be developed and widely adopted. In designing policy measures to promote the broader adoption of the dental cluster model, it is helpful to consider the different factors influencing dentists' decisions during implementation. Dental clusters can benefit the public and dentists, but further development of the model and improvement of the primary conditions for the operation of practices are essential.

Patient education in Finland

During the last decade empowerment has emerged as a socially desir able construct and as an organising principle for various forms of personal and social change which focus on exercising the ability to take control of one's life. One notable feature of this development is the appearance of 'empowerment' in a range of views, from the right as well as the left, and its espousal as a quasi-moral principle by a range of fields from human resource management to radical social work. As importantly, while empowerment remains in the domain of those who seek to empower themselves, a new ground has opened-up during this period for professionals, particularly from the fields of health and welfare, who seek to empower others.This paper examines the emergence of empowerment as pro fessional practice and argues that the ubiquitous presence of empower ment in current health and welfare discourses has important regulatory as well as liberatory implications for potential empowerment 'candi dates' and for practitioners, which may jeopardise the possibilities of maintaining a critical meaning for the term.