Health Discourse Research Articles

The End of 'Responsible Gambling': Reinvigorating Gambling Studies

This paper argues that gambling research has, since the neoliberal-inspired period of gambling legalisation in the late twentieth century, been dominated by a specific discourse, that of ‘responsible gambling’. This discourse originated in a conjunction of rationalities of government and capital, in the process of which commercial gambling was legitimated. Its liberalisation represented an extension of rationalities and technologies to form a new market from what had previously been an unlawful activity. The problems and harms associated with this liberalisation became subject to claims from some pockets of expertise, notably psy-sciences, and thus became a focus for analysis. As a consequence, gambling research has been characterised by a discourse of individual pathology as the focus of study. The orthodoxy formed from this discourse constitutes a system or apparatus of economic and quasi-medical power, in which reflexive relations between gambling operators, governments, charities, and some researchers, have been significant. These reflexive relations have largely constituted the field of gambling research. This paper contends that the orthodoxy of gambling research has failed to prevent harm arising from gambling and has restricted the expansion of knowledge. A systemic critique of the orthodox discourses and technologies that constitute much of gambling research is required to address these categories. This would also address a lack of diversity in theoretical framings of gambling research priorities. Alternative ways of conceptualising the problem of legalised gambling have emerged, most clearly under the discourse of ‘public health’. The current competition between these two discourses might be categorised as between an orthodoxy (‘responsible gambling’) and a heterodoxy (‘public health’). Extending the heterodoxy into a critical public health discourse may provide a basis for rapid expansion and diversification of the research field, particularly along paths that expand knowledge, facilitate effective regulation of harmful products, and prevent harm to individuals, communities, and populations.

“Being a Girl Has Become a Public Health Problem!”: Feminist Organizations Both Resisting and Reproducing Postfeminist Mental Health Discourses

ABSTRACT An apparent decline in youth mental health in the Nordic countries has received a lot of attention over the last decade, and young women have been described as a particularly vulnerable group. To combat the problem, political debate has centred on solutions at the individual level, despite significant evidence of the associations between structural factors and adverse mental health. In this article, I explore how two feminist support organizations working for young women in Sweden (tjejjourer) frame and address girls’ mental health as a problem of feminist concern. Interviews with staff, organizational documents, websites, social media, and other communications were analysed following Snow and Benford’s theory on collective action frames, to identify the organizations’ problem diagnoses, solutions, and motivational frames for action. The results show that the organizations both reiterate and resist a postfeminist discourse on mental health. There is notable friction between structural problem diagnoses, based on intersectional analyses of power, and political demands and support oriented towards the individual. In conclusion, I argue that this friction may be a result of the organizations’ adoption of discourses on risk, vulnerability, and mental health itself, but also that the complex relationship between structural critique and individual care is indispensable for feminist organizing.

Bridging the gap: integrating political analysis into public health discourse for structural change.

Bridging the gap: integrating political analysis into public health discourse for structural change.

Participatory presence – social connectedness through collaborative art practices

ABSTRACT In a post-Covid context, the term presence has become the subject of renewed academic focus, amplified by mass phenomena such as Zoom fatigue and online classroom teaching. The prism of new materialism allows for a new reading of relationships between technology and human sensing, physical and virtual presence and copresence, with possible design implications: Current research in public health and social-environment discourse is interested in the effect of presence on well-being. As a theoretical framework, new materialism provides a lens that foregrounds complex relations between affect and technology, enabling us, through interventions like the KIMA: Colour participatory artwork, to interrogate the broad discourse on mediated presence and social connectivity. This paper provides an overview of the AHRC-funded research project, 'p_ART_icipate!', which is a collaborative investigation led by the University of Greenwich, CNWL NHS Foundation Trust, and Brunel University. This paper describes one of the case studies within the project, ‘KIMA Colour’, a collaboration with the art collective Analema Group, the National Gallery and the Royal National Institute of the Blind (RNIB). The case study explores the effect of collective cultural experiences and participatory art on a sense of social connectivity and copresence. In collaboration with RNIB and a group of visually impaired individuals, the team asked how we can design meaningful and accessible online interfaces that actively contribute to a sense of ‘participatory presence’. Findings suggest a possible link between the experience, presence and social connectedness. This research aims to contribute to our understanding of participatory art and to provide recommendations for accessibility and facilitation designc for participatory online interfaces.

Echoes from the past: How America's major moments shaped mental health policies through a young adult lens.

This commentary examines key mental health policies across four transformative historical periods in America: the aftermath of World War II (1939-1946), the Civil Rights Movement (1954-1968), the Great Recession (2007-2009), and the COVID-19 pandemic (2020-2023). The post-WWII era established today's foundational mental health system, emphasizing military personnel, as reflected in the National Mental Health Act of 1946. During the Civil Rights Movement, the focus shifted toward community equality, leading to the Community Mental Health Act of 1963. The economic challenges of the Great Recession, especially affecting young adults, prompted a deep dive into the Affordable Care Act. The social isolation and economic suffering from the COVID-19 pandemic led to the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The article highlights the need for a more inclusive policy development approach, one that recognizes and integrates the unique perspectives of young adults in shaping mental health policies and discourse. It concludes with recommendations to guide future policy evolution for enhanced mental health and societal well-being. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Sociocultural context of exclusive breastfeeding in Africa: A narrative review.

Although exclusive breastfeeding (EBF) has many benefits, it is not commonly practiced in several countries as a result of context-specific challenges. EBF practice is thus a global health discourse because over 200 million children suffer from malnutrition despite the abundance of human milk. The risk of starvation remains very high among African children with less than 40% of them exclusively breastfed. In Africa, the adoption or nonadherence to EBF is a sociocultural issue. Hence, this narrative review examined the sociocultural context of EBF in the region. PubMed, Google Scholar, and Scopus were searched using keywords related to EBF and Africa. Relevant data from selected studies were synthesized narratively and reported using a structured narrative format. EBF is strongly rooted in every culture and is a culturally determined behavior. Some believe that colostrum is dirty and harmful to newborns and, thus, needs to be purified. Despite the belief that human milk is the best food for babies, mothers often complement human milk with other foods right from birth because of perceived lactation inadequacy. Most African mothers believe in prelacteal feeding to help cleanse the infant's gastrointestinal tract for digestion, quench thirst, flush the bladder and help the mother to rest after childbirth before breastfeeding (BF) is initiated. The role of significant others was equally found important in the decision and duration of BF. The availability of family support (especially from grandmothers and husbands) reportedly encouraged EBF in Africa. The duration and exclusivity of BF in Africa are negatively associated with demographic variables like young age, low level of education, being unmarried, low income, out of employment, and parity (first-time mother). While there have been some efforts and policies to improve EBF, it is important to consider context-specific challenges and sociocultural factors. There is a need for more deliberate efforts to encourage mothers through the implementation of effective best practices concerning EBF in Africa.

Twitter Analysis of Health Care Workers' Sentiment and Discourse Regarding Post-COVID-19 Condition in Children and Young People: Mixed Methods Study.

The COVID-19 pandemic has had a significant global impact, with millions of cases and deaths. Research highlights the persistence of symptoms over time (post-COVID-19 condition), a situation of particular concern in children and young people with symptoms. Social media such as Twitter (subsequently rebranded as X) could provide valuable information on the impact of the post-COVID-19 condition on this demographic. With a social media analysis of the discourse surrounding the prevalence of post-COVID-19 condition in children and young people, we aimed to explore the perceptions of health care workers (HCWs) concerning post-COVID-19 condition in children and young people in the United Kingdom between January 2021 and January 2022. This will allow us to contribute to the emerging knowledge on post-COVID-19 condition and identify critical areas and future directions for researchers and policy makers. From a pragmatic paradigm, we used a mixed methods approach. Through discourse, keyword, sentiment, and image analyses, using Pulsar and InfraNodus, we analyzed the discourse about the experience of post-COVID-19 condition in children and young people in the United Kingdom shared on Twitter between January 1, 2021, and January 31, 2022, from a sample of HCWs with Twitter accounts whose biography identifies them as HCWs. We obtained 300,000 tweets, out of which (after filtering for relevant tweets) we performed an in-depth qualitative sample analysis of 2588 tweets. The HCWs were responsive to announcements issued by the authorities regarding the management of the COVID-19 pandemic in the United Kingdom. The most frequent sentiment expressed was negative. The main themes were uncertainty about the future, policies and regulations, managing and addressing the COVID-19 pandemic and post-COVID-19 condition in children and young people, vaccination, using Twitter to share scientific literature and management strategies, and clinical and personal experiences. The perceptions described on Twitter by HCWs concerning the presence of the post-COVID-19 condition in children and young people appear to be a relevant and timely issue and responsive to the declarations and guidelines issued by health authorities over time. We recommend further support and training strategies for health workers and school staff regarding the manifestations and treatment of children and young people with post-COVID-19 condition.

“Dissecting the paradox: spirituality and yoga in mental wellbeing.”

ABSTRACT This research critically examines the intricate interplay between spirituality and yoga, assessing their collective impact on mental wellbeing. Amidst yoga’s transcultural proliferation, transcending its indigenous spiritual roots, this study probes the intricacies inherent in its adaptation as a mental health intervention. The research utilizes qualitative and ethnographic methodologies to dissect yoga’s therapeutic efficacy, juxtaposing its spiritual genesis with secular manifestations. Central to this analysis is the exploration of whether the secularization of yoga practices dilutes or maintains their therapeutic potential. Navigating the nuanced dynamics from both global and Indian perspectives, this study contributes to a sophisticated understanding of yoga’s evolving role within contemporary mental health paradigms. By examining the paradoxical coexistence of spiritual and secular dimensions in yoga, the research aims to inform and enhance mental health service frameworks, addressing a significant lacuna in current mental health discourse.

Depleted Nerves

This essay explores the impact of shell-shock on individual soldiers, the collective understanding of wartime trauma during and after the First World War, and the discourse of mental health in the medical field and public sphere. Additionally, it aims to identify when the discourse of psychological trauma began to shift toward more contemporary understandings of mental health. In order to draw out the voices of Canadian soldiers who were not able to openly discuss their emotions due to the stigmatisation surrounding shell-shock, this study will utilise various sources such as soldier diaries, battalion orders, and the Library and Archives of Canada database. Moreover, this essay aims to uncover how shell-shock was suppressed by wartime officials and those with the power to appropriately aid soldiers inflicted with shell-shock. In order to search for the reticence and silence of shell-shock, I examine the censorship of soldiers' experiences on the homefront, the secrecy surrounding war-related trauma in the general public, and the hyper-masculinized attitudes within battalions that viewed shell-shock symptoms as a manifestation of mental weakness. While I focus primarily on Canadian soldiers during World War I within this essay, it is acknowledged that all soldiers, hospital staff, and those affected by the war were susceptible to various forms of Post Traumatic Stress Disorder.

Reimagining our futures together: An early bird's‐eye view of inclusive organizational behavior

SummaryThe world has witnessed high‐intensity and low‐occurrence crises such as the COVID‐19 pandemic that have radically changed not only the discourses of health and safety but also permanently changed the realities of the workplace. The COVID‐19 pandemic‐related new normal has resulted in the exponential increase in the acceptance of “homeplace” or “work from home” in work‐related domains. With this sudden dramatic shift in the way the present and future work is being conceptualized, there is every reason to believe that employees struggle with a plethora of intertwined thoughts and emotions, particularly a heightened sense of social isolation and exclusion from their work environment. The present study is an attempt to address this concern in the broader ambit of inclusive organizational behavior. Using an interpretivist research approach, we dwell on the genesis of organizational behavior in changing times, particularly digitalization and social isolation. We employ inductive analysis of the employee data generated over two waves and use grounded theory to explain how inclusive behavior could be fostered within organizations. Our study provides an early conceptualization of inclusive organizational behavior by identifying four factors, namely, inclusive support, inclusive work design, inclusive culture, and inclusive mindset. Furthermore, based on the findings of the study, a three‐tier model of inclusive organizational behavior is proposed that links individual, group, and system‐level dynamics in the organizations.

Pisanie w stanie wyjątkowym i lektura jako czynność naprawcza. Genezy i pożytki z literatury kruchości

This article presents a theoretical framework and a network of concepts that could be useful in analyzing illness narratives. As a relatively new field of the humanities, the cultural discourse of health and illness is still in need of an appropriate methodology and a set of handy concepts, i.e. a foundational cultural theory fit to deal with texts con-cerned with the specific experience of health and illness. Here the key concepts are fragility, reparability, vulnerability and harm. While drawing on the idea of ‘writing in a state of emergency’, based on Giorgio Agamben’s discussion in The State of Exception, the article also offers the author’s own conceptions of a ‘fragile alliance’ and of reading illness narratives as a therapeutic (restorative) activity.

Missing in action: a scoping review of gender as the overlooked component in decolonial discourses

IntroductionRace and gender were intimately intertwined aspects of the colonial project, used as key categories of hierarchisation within both colonial and modern societies. As such, true decolonisation is only possible...

Homophobic Discourses and Their Soviet History in Estonia

In this article I discuss the links between homophobic discourses and the history of non-normative sex-gender subjects in Soviet Estonia. How was homosexuality seen and handled publicly during the Soviet period? What was the relationship between official discourse and non-normative sex-gender subjects? By working through a selection of archival materials on criminal investigations under the Pederasty Article of the Soviet Estonian Criminal Code and analysing the period’s sexual health discourse I outline an official discourse about non-normative sex-gender subjects in Soviet Estonia. I also analyse the manifestations of this official discourse in historical sources. In addition to the official discourse, the archival and ethnographic sources allow me to trace some of the experiences that differed and dissented from the repressive ideologies set by legal, medical, and social regulations.

Regional Inequalities in Diagnosis and Therapies in Greece regarding Autism Spectrum Disorders

IntroductionAutism spectrum disorders (ASD) represent a major public health concern on a global scale. The increasing prevalence of ASD worldwide, coupled with the arising demand for treatments, underscores its important role in the public mental health discourse. Ensuring the equitable integration of children with ASD and their families into all aspects of society becomes an imperative task, in order to eradicate the stigma associated with the broad spectrum of autism, encompassing both visible and concealed dimensions.ObjectivesThe primary objective of this study was to determine the crude prevalence of ASD in Greece nationwide, while also examining regional disparities in both prevalence and therapies. The study spanned a three-year period from February 2019 to February 2022 and relied on retrospective data sourced from the Greek National Organization for Healthcare Services Provision (EOPYY).MethodsEOPYY provided de-identified data, including information such as sex, age, diagnosis, and treatment for each child, facilitated by hashed social security numbers. Statistical analysis of the dataset was performed using the open-source statistical program R.ResultsA total of 18,245 children aged 2 -17 years were diagnosed with ASD in Greece, representing a nationwide crude prevalence rate of 1.16%. Regional disparities were evident, with prevalence rates ranging from 0.49% in the North Aegean to 1.57% in Crete. Over the three-year study period, a total of 15,328,327 non-medical therapies were prescribed, corresponding to an annual average of 264 therapies per child. Statistically significant differences between the thirteen regions in Greece were observed, ranging from 230 to 323 annual therapies per child.ConclusionsOur findings align Greece’s ASD prevalence with the global estimate of 1 in 100 children, as per the World Health Organization. Disparities between rural and urban areas in Greece may be attributed to differences in diagnostic procedures and the availability and accessibility of specialized services for autistic individuals. Thus, the establishment of a national surveillance system for ASD is recommended to enhance our understanding of the autism spectrum, monitor changes in prevalence, and identify potential contributing factors to autism conditions. Furthermore, these evidence-based results offer invaluable insights for crafting policies concerning healthcare, education, and employment for individuals with ASD in order to ensure the development of people with autism, their wellbeing, and a good quality of life.Disclosure of InterestNone Declared

Unraveling the Cross-Cultural Differences in Online Expression of Social Anxiety in Online Support Communities.

Individuals suffering from social anxiety disorder (SAD) are increasingly turning to online support communities for self-disclosure and social support. Despite the extensive body of research on online mental health discourses, the cultural nuances within SAD-related discussions remain underexplored. In this study, we examine the cultural differences in online expression of social anxiety by analyzing individuals' self-disclosure and support-seeking behaviors in social media posts. Using two-week data (n = 1,681) from two SAD support communities on the Reddit and Douban groups, we used both qualitative thematic analysis and quantitative semantic analysis to discern prevalent themes and linguistic attributes characterizing these online expressions. Our findings not only uncover common themes such as sharing personal experiences and seeking mutual validations in both communities but also identify their divergences, as Western users primarily sought advice and information in posts, whereas Chinese users were more inclined toward networking. Cultural variations in language use were evident, particularly in individuals' affect and their expression of personal and social concerns. Western users were more likely to convey negative emotions and delve into personal matters related to SAD, whereas Chinese users tended to grapple more with workplace anxieties. This study contributes to the cultural understanding of online mental health discourses and offers insights for crafting culturally sensitive interventions and supports for people with SAD.

Pervasiveness of health information in everyday life in Germany: insights from a photo-elicitation diary study on implicit health knowledge using the documentary method

Abstract Aim In an information society, the complexity of health discourses and media–technological developments touch upon processes of finding, understanding, appraising, and using information. Encounters with health information in everyday life are omnipresent. Hence, applying perceived health information to lifeworlds becomes challenging. We were therefore particularly interested in understanding appraisals and practices regarding random encounters with health information. Subject and methods A photo-elicitation diary study was designed and conducted to collect data from encounters with health information in everyday life. Drawing on a sociology of knowledge approach and using the documentary method, appraisal patterns of health information were reconstructed. Results Four appraisal patterns were reconstructed: control, optimization, responsibility, and confidence. Conclusion The findings contribute to a critical reflection on the pervasiveness of health information in lifeworlds, also referred to as infodemic. The identified appraisal patterns and orientation frames offer insights into the impact of random encounters with health information in everyday life; they also provide a foundation for critically discussing quality criteria for health information in a diverse society, and can inform initiatives for strengthening individual and collective health literacy.

Animal Health Discourse during Ecological Crises in the Media-Lessons Learnt from the Flood in Thessaly from the One Health Perspective.

Due to the increasing risk of extreme events caused by climate change (i.e., floods, fires and hurricanes) or wars, European veterinary public health may need some improvement. Utilizing a mix of qualitative (participatory observation) and quantitative methods (Internet mining), we analyzed the Greek media's responses to the millennial flood in Thessaly (September 2023), focusing on animal health (including wild, companion animals and livestock) and public sentiment towards epizootic/epidemic threats. The study revealed a gap in crisis management plans regarding veterinary-related issues, emphasizing the need for comprehensive emergency response strategies. Our findings show how (i) the lay referral system is projecting the perception of epidemic threats into the population; (ii) the emotional load of images of animal carcasses is misused by media creators aiming for a big audience; and (iii) pets' owners are creating online communities for the searching and treatment of their pets. Our results stress the importance of integrating crisis communication in consecutive phases of the discourse, such as the following: (i) weather change; (ii) acute flood; (iii) recovery; and (iv) outbreaks, into veterinary practices to better prepare for such disasters.

Perceptions of social media harms and potential management strategies: vaping case study

BackgroundThe social media landscape is now ubiquitous in people’s everyday lives. It is a space where culture, politics, economics and sociological and public health discourses occur. There is mounting evidence that e-cigarette products are being promoted and advertised on social media, a media platform particularly popular with young people. Our research aimed to understand industry professionals’ perceptions of social media harms and potential management strategies using vaping as a case study.MethodsA critical realist perspective guided reflexive thematic analysis of the qualitative in depth, semi structured interviews. Data collection occurred in January and February 2023 with 13 participants working in the areas of public health, digital media, law, governance, tobacco control and advocacy.ResultsTwo superordinate themes emerged from the data: (1) Fathoming a complex system (social media) that contained the subordinate themes of Traversing Boundaries (crossing borders, crossing sectors) and Ungovernable (global and local landscapes, vested interests, self-regulation and opacity). (2) Addressing complexity (social media)– that contained the subordinate themes of Strengthening Institutions (global to local, policy and legislation, individuals and organisations); Defanging Industry (responsibility and transparency, moderation and algorithms, complaints); and Engaging Citizens (raising awareness, framing messaging).ConclusionsThere was consensus among participants that e-cigarette related social media content can be harmful and government action is urgently needed. There was an identified need for the development of government led national-level regulatory frameworks, with government led appropriate legislation; identification of an organisation or organisations with suitable levels of regulatory power and resources to monitor, enforce and penalise noncompliant social media companies; accompanied by increased community awareness raising of harmful social media content and improved digital literacy.

Promoting social justice in the capitalist academy? Health equity and the Johns Hopkins University Michael Bloomberg School of Public Health

The past two decades have seen increasing mentions of health equity and the importance of addressing the social determinants of health in USA public health statements. Yet, there is little uptake of these concepts into USA public policy. We see this, in part, as being due to the unwillingness of the USA public health community – including its network of Masters of Public Health Programs – to address the fundamental cause of health inequities: the United States’ capitalist economic system which skews the distribution of the social determinants of health in favour of the wealthy and powerful. We illustrate this reluctance by examining how the Bloomberg School of Public Health of Johns Hopkins University conceptualises the promotion of health equity through its International Declaration of Health Rights. Nothing in the Declaration considers how the economic system threatens health yet it is presented as a model for public health education. We review its shortcomings and show how revision to it is unlikely since the School is endowed by its namesake billionaire Michael Bloomberg who has denounced any attempts at redistributing wealth and income in the service of public health. Evidence of how public health messaging is already shaped by powerful economic interests embedded within the United States’ capitalist system substantiates concerns that have been raised about such branding and its effects on public health discourse and action.

Communication in Healthcare Discourse: A Cultural and Linguistic Exploration of Exchanges between Healthcare Practitioners and Patients among Jukuns of Nigeria

This paper explored the cultural and linguistic aspects of health exchanges between healthcare practitioners and patients among the Jukuns of Wukari in Nigeria, within the health centres in the town. It focused on patient-healthcare-provider dynamics and found out how language and culture influenced healthcare communication within formal settings. Integrating ethnographic, sociolinguistic, and anthropological approaches, the study unveiled how language and culture impacted interactions and health-seeking behaviours in these centres. It revealed the roles of language and culture in understanding health information, healthcare provider-patient exchanges, and treatment adherence within the distinct sociolinguistic context of the Jukun. Using such qualitative techniques as interviews and observations in the health centres, the study captured the intricate verbal and nonverbal communication, specific cultural discourse patterns, and communication strategies used by patients and healthcare practitioners. Findings highlighted diverse cultural and linguistic methods employed by Jukuns, such as using proverbs, ironies, metaphors, and nonverbal cues, to express themselves in healthcare settings. The research showed that these methods could facilitate communication with familiar practitioners but might complicate interactions with those from different ethnic backgrounds. Ultimately, it offered crucial perspectives for refining healthcare provision, aligning with the precise linguistic and cultural contexts of the Jukun community within formal healthcare settings in Wukari and other parts of Jukunland. Based on the foregoing, the researchers recommended that health practitioners should make use of interpreters and familiarise themselves with the cultural and linguistic norms of their immediate communities for effective health discourse that would enhance quality healthcare delivery.