Public Health Discourse Research Articles

In sickness and in health: The politics of public health and their implications during the COVID‐19 pandemic

AbstractPolitics is a major player in health, sickness, and death affairs. This article reviews the role of politics in public health and its impact on health outcomes, mortality ratios, and death scenarios amongst the most vulnerable populations. Furthermore, the article explains the reasons behind the absence of politics from health and public health discourses; and examines the role of politics during the mis/management of COVID‐19 pandemic. Drawing on Foucault's biopower, Mebmbe's necropolitics, and Butler's precarity, the article illuminates how public health policies are highly political insofar as they offer some individuals access to life but create possibilities of death for others. During COVID‐19, politics enabled governors to put at risk the most vulnerable groups, the precariat, namely refugees, asylum seekers, stateless, and immigrants, the majority of whom were impoverished. The article presents COVID‐19 as an example of a crisis that unmasks these politics, claiming that these politics are not new but rather a continuum of previous invisible policies that COVID‐19 unmasked and intensified. The article describes how the politics of health entail privileging individuals with capital value who can benefit the state's interests and maintains its power.

Strengthening health promotion practice: capacity development for a transdisciplinary field.

The growing burden of non-communicable and newly emerging communicable diseases, multi-morbidity, increasing health inequalities, the health effects of climate change and natural disasters and the revolution in communication technology require a shift of focus towards more preventive, people-centred and community-based health services. This has implications for the health workforce, which needs to develop new capacities and skills, many of which are at the core of health promotion. Health promotion is thus being mainstreamed into modern public health. For health promotion, this offers both opportunities and challenges. A stronger focus on the enablers of health enhances the strategic importance of health promotion's whole-of-society approach to health, showcases the achievements of health promotion with regard to core professional competencies, and helps build public health capacity with health promotion accents. On the other hand, mainstreaming health promotion can weaken its organizational capacity and visibility, and bears the risk of it being absorbed into a traditional public health discourse dominated by medical professions. To address these challenges and grasp the opportunities, it is essential for the health promotion workforce to position itself within the diversifying primary care and public health field. Taking the transdisciplinary status of health promotion and existing capacity development systems in primary and secondary prevention and health promotion as reference points, this paper considers the possibilities to integrate and implement health promotion capacities within and across disciplinary boundaries, arguing that the contribution of health promotion to public health development lies in the complementary nature of specialist and mainstreamed health promotion.

Annika Mann. Reading Contagion: The Hazards of Reading in the Age of Print.

Annika Mann. <i>Reading Contagion: The Hazards of Reading in the Age of Print</i>.

Normal Island: COVID-19, Border Control, and Viral Nationalism in UK Public Health Discourse.

In this contribution, I present emergent analysis of a preoccupation with managing COVID-19 through border control, among non-Governmental public health actors and commentators. Through a reading of statements, tweets, and interviews from the 'Independent Sage' group - individually and collectively - I show how the language of border control, and of maintaining immunity within the national boundaries of the UK, has been a notable theme in the group's analysis. To theorize this emphasis, I draw comparison with the phenomenon of 'green nationalism', in which the urgency of climate action has been turned to overtly nationalistic ends; I sketch the outlines of what I call 'viral nationalism,' a political ecology that understands the pandemic as an event occurring differentially between nation states, and thus sees pandemic management as, inter alia, a work of involuntary detention at securitized borders. I conclude with some general remarks on the relationship between public health, immunity, and national feeling in the UK.

5.Q. Workshop: Participatory health research with refugees: Voices, experiences, and methodologies

The workshop addresses important deficits in public health discourses: a) Refugees are talked about too often and heard too seldom; b) they are the subject of research, but seldom the beneficiaries. Participatory methodologies offer an alternative. Involving refugees as research partners provides an opportunity to share the epistemic power of defining and interpreting reality. Research partners are valued for their skills, knowledge, resources and experience. Furthermore, collaborations aim to both understand and change reality so that communities may also benefit. In practice, participatory health research employs a variety of methods, including narrative, art-based and audio-visual methods. For example, photovoice combines visual data and group discussion: Members of a community take photos of their living environments, discuss them in a group process and analyse their situation to initiate change. Pictures and stories constitute the experiential ground from which new knowledge is gained, criticism is voiced and changes are proposed. When using such tools, it becomes tangible how legal restrictions as well as limited access to health care, education and the labor market decrease the health chances of refugees. Everyday experiences of uncertainty, racism and exclusion (e.g. through housing in segregated camps) pose substantial risks. On the other hand, individual and collective agency exists despite these adverse circumstances. The workshop aims to bring together community partners and researchers to discuss participatory health research with refugees and migrant populations based on three examples from Germany: 1) a photovoice project with refugees in Munich describes the Bavarian camps and shelters from within, showing in pictures and words how they make you sick; 2) a participatory project with female refugees in Hannover shows how digital health promotion through video and social media is developed in times of COVID-19; 3) a participatory project applying community mapping with injecting drug users in Dortmund illustrates how knowledge can be co-created to better tailor harm reduction services to refugee and migrant groups. The first two presentations are part of a research collaboration on “Vulnerability and empowerment: Participatory approaches to health promotion with refugees” (EMPOW), funded by the German Research Foundation (2019-2022). The third presentation is based on a community-based project on participation, drug use and migration (PaSuMi) funded by the German Ministry of Health (2017-2020). The presentations provide a chance to get inspired by the voices and experiences of community partners and learn from their experience. The benefits and also the challenges of engaging in participatory methodologies are discussed in small groups with workshop participants. A digital forum (chat/padlet) will accompany the workshop to enable further interaction, commentary, and networking during and beyond the conference.Key messages Refugees are important partners in research on refugee health.Through participatory methods, the lived experience of refugees constitutes a meaningful starting point for knowledge production and health promotion.

The influence of social movements on policy change: delayed success in banning dog slaughter in Germany

ABSTRACT The Animal Welfare Movement, among other things, aims to change animal welfare policies. Why certain animal welfare campaigns have been more successful than others remains unclear. This article examines the course of such policy changes in animal welfare based on the 1986 ban on dog slaughter in Germany. It answers the research question: ‘How can we explain the influence of the animal welfare movement on policy change regarding the ban on dog slaughter?’ This article analyses the case of a long-delayed policy change, although the demand had received broad public and political support. Drawing on social movement studies, this article proposes that the delay is due to framing errors on the part of the animal welfare movement and argues that policy change could only take place through the help of allies in the field of politics. Using the process-tracing method, over 1,000 pages of policy documents and other relevant documents were analysed. The results show that the dog slaughter ban was delayed because policy makers feared that a morally motivated ban could be extended to other animal species. Only frame bridging with public health discourse by actors from the field of politics was able to overcome this barrier. This article contributes to social movement studies by analysing a case of frame bridging triggered by movement allies, thereby deepening our understanding of the relevance of the wider cultural environment of a contested policy and of interactions between movements and allies in policy change.

Medical decisions influenced by eugenics: Hungarian gynecological practices during the 1910s.

This study contributes to the discussion on the development of eugenics in Central-Eastern Europe by tracing the way that eugenic ideas entered into medical decision-making in Hungary. Through a case study that reviews the professional argumentation of the gynecological management of tuberculosis pregnancies, this paper shows that the subordination of individual reproductive rights to state interests was influenced by the ideas of eugenics, which had begun to enter into the professional public health discourse. A eugenically informed morality was envisioned, to guide decision-making in the interest of the Hungarian "race." This biopolitically important morality can be viewed as an early influence on the formulation of biological citizenship. Leading figures were divided on how to ensure such morality: some scholars argued that education is the key, others thought that the state, and state actors, should act radically in the interest of the population and decide on behalf of the individual. Radical methods, such as the termination of pregnancies and sterilization of women, were among the practices of gynecologists. Although abortion and sterilization were not widespread and never became official therapeutic solutions for tuberculosis pregnancies, they were nonetheless part of a discourse that preceded the eugenic institutions of the interwar years.

Systemic Obstacles to Addressing Research Misconduct in Higher Education: A Case Study.

Several widely publicized incidents of academic research misconduct, combined with the politicization of the role of science in public health and policy discourse (e.g., COVID, immunizations) threaten to undermine faith in the integrity of empirical research. Researchers often maintain that peer-review and study replication allow the field to self-police and self-correct; however, stark disparities between official reports of academic research misconduct and self-reports of academic researchers, specifically with regard to data fabrication, belie this argument. Further, systemic imperatives in academic settings often incentivize institutional responses that focus on minimizing reputational harm rather than the impact of fabricated data on the integrity of extant and future research.

Countering the potential re-emergence of a deadly infectious disease—Information warfare, identifying strategic threats, launching countermeasures

Eradicated infectious diseases like smallpox can re-emerge through accident or the designs of bioterrorists, and cause heavy casualties. Presently, the populace is largely susceptible as only a small percentage is vaccinated, and their immunity is likely to have waned. And when the disease re-emerges, the susceptible individuals may be manipulated by disinformation on Social Media to refuse vaccines. Thus, a combination of countermeasures consisting of antiviral drugs and vaccines and a range of policies for their application need to be investigated. Opinions regarding whether to receive vaccines evolve over time through social exchanges via networks that overlap with but are not identical to the disease propagation networks. These couple the spread of the biological and information contagion and necessitate a joint investigation of the two. We develop a computationally tractable metapopulation epidemiological model that captures the joint spatio-temporal evolution of an infectious disease (e.g., smallpox, COVID-19) and opinion dynamics. Considering smallpox, the computations based on the model show that opinion dynamics have a substantial impact on the fatality count. Towards understanding how perpetrators are likely to seed the infection, we identify a) the initial distribution of infected individuals that maximize the overall fatality count; and b) which habitation structures are more vulnerable to outbreaks. We assess the relative efficacy of different countermeasures and conclude that a combination of vaccines and drugs minimize the fatalities, and by itself, drugs reduce fatalities more than the vaccine. Accordingly, we assess the impact of increase in the supply of drugs and identify the most effective among a collection of policies for administering of drugs for various parameter combinations. Many of the observed patterns are stable to variations of a diverse set of parameters. Our findings provide a quantitative foundation for various important elements of public health discourse that have largely been conducted qualitatively.

Measles, Media and Memory: Journalism’s Role in Framing Collective Memory of Disease

Language used to describe measles in the press has altered significantly over the last sixty years, a shift that reflects changing perceptions of the disease within the medical community as well as broader changes in public health discourse. California, one of the most populous U.S. states and seat of the 2015 measles outbreak originating at Disneyland, presents an opportunity for observing these changes. This article offers a longitudinal case study of five decades of measles news coverage by the Los Angeles Times and the San Francisco Chronicle, which represented two of the largest news markets in California when the measles vaccine was released, in 1963, and during the 2015 outbreak. Measles reporting during this period displays patterns pointing to an active role for journalists in shaping public understanding of health and medical matters, especially as they recede from public memory, through the employment of available and circulating political and cultural frames. Moreover, journalistic frames in this period of reporting incorporated presentist descriptions of the disease, which imposed present values on the medical past, and which were constructed of decontextualized historical references that supported prevailing contemporary notions of the disease. Framing and the tendency toward presentism, in the context of shifting public health discourse, had the effect of communicating an increasingly severe sounding disease over time, and of shifting blame for that disease’s spread from nature to government to individuals. Journalistic framing and causal stories have much power to shape public understanding of medical matters as they recede from public memory.

Pattern and determinants of self-medication among pregnant women attending antenatal clinics in primary health care facilities in Ogbomoso, Oyo State, Nigeria

Background: Self medication in pregnancy has continued to be on the front burner of the global public health discourse due to the increased incidence of abortion, foetal malformation and antimicrobial resistance that were found to be associated with it. Inspite of this burden, in Nigeria, most studies on self-medication were conducted on the general population with only a few carried out among pregnant women. Therefore, this study was carried out to determine the prevalence and factors associated with self-medication among pregnant women in Oyo State. Methods: The study was a hospital-based cross-sectional survey. A multi-stage sampling technique was used to select 347 pregnant women who attended antenatal clinics at 56 primary health care facilities in Ogbomoso. A semi-structured, interviewer-administered questionnaire was used to obtain information on the practice of self-medication. Data were analyzed using SPSS version 25; bivariate analysis was done using Chi-square and binary logistic regression was used to identify the predictors of self-medication in pregnancy. The level of statistical significance was set at p < 0.05. Results: The mean age of the respondents was 27.0 ± 6 years. The majority (76.6%) of the respondents had poor knowledge of self-medication. About half of the respondents self-medicated with the analgesics (83.1%), antibiotics (66.7%) and antimalarial drugs (28.9%). Nausea and vomiting (90.4%), diarrhoea (67.8%), back pain (62.1%) and fever (28.8%) were the common medical problems. The main reasons for self-medication were previous experience with the drugs (50.9%), the suggestion by family about the drugs (45.2%) and advice from the community pharmacists (31.6%). The proportion of the respondents who used herbal concoction was 30.0% and the reasons given for the herbal use were low cost (47.6%) and perceived efficacy (42.9%). The proportion of pregnant women who gave a history of abnormality in the previously born baby (ies) was 13.0%. Cleft lip (66.7%) was the most prevalent abnormality. The determinants of self-medication were age (aOR: 0.7, 95% CI: 0.33- 0.97), education (aOR: 0.7, 95% CI: 0.49 - 0.99), confidence in other health workers’ prescription (aOR: 0.4, 95% CI: 0.15 – 0.88), relief from discomfort (aOR: 2.8, 95% CI: 1.46 – 5.42) and suggestion by families (aOR: 3.6, 95% CI: 1.62 – 8.05). Conclusion: The prevalence of self-medication was high and was more pronounced among married, urban dwellers and those with post-basic education including the respondents aged 25 years and above. This may be explained by the higher proportion of the respondents with poor knowledge of self-medication. Health education, especially during antenatal clinics, on the dangers associated with self-medication in pregnancy, is therefore recommended.

Making ‘meanwhile. . .’: representing queer African youth through spontaneous collaborative graphic autoethnography

We present a participatory creative research project about the embodied experience of queer African youth, which brought together queer young people, academics and artists from Southern and East Africa (as the Qintu Collab) to produce popular media. We describe objectives and process and argue that this work can best be understood as collaborative graphic autoethnography. By working together, the Collab produced the anthology Meanwhile. . .: Graphic Short Stories About Everyday Queer Life in Southern and East Africa, that challenges dominant representations of African queerness, including pathologising public health discourses and heteronationalist political propaganda. This work also dialogically generated socially experienced embodied knowledge about the wellbeing, relationships, fears and aspirations of young queer people. Such collaboration pushes the boundaries of collaborative, autoethnographic and visual methods. Examining our experience shows the co-constructed nature of knowledge and reveals the considerable power of comics as analytical texts, and as basis for further analysis.

Failure to Feed: Women’s Experiences of Breastfeeding and the Implications for Health Promotion Practice

Breastfeeding has been recognized as an ideal nutrition source for infants and has become a priority in public health. Here we explore women’s experiences of breastfeeding and contextualize them within the current public health discourse. Data from 37 qualitative interviews with Canadian women show that, whereas successful breastfeeding can be a source of pride, unsuccessful attempts to breastfeed prompt mothers to experience negative emotions and feelings of personal failure. Results suggest that there is a need to change the health promotion discourse, to acknowledge that unsuccessful breastfeeding is possible, and to offer women various supports to deal with the disappointment.

The policy implications of 'thinking problematically': problematizing Big Food's role in obesity policymaking.

Practitioners need to engage with the contested nature of public health policymaking. This study, stemming from a concern that the involvement of Big Food is not widely problematized in health promotion practice, used 'What's the Problem Represented to Be?' discourse analysis to examine how Big Food, as a discursive actor, reacted to and shaped a problem representation of childhood obesity. Analysis of Big Food documents, including Coca-Cola and Burger King, developed during the regulation of broadcast advertising to children in Ireland found that Big Food constructs the problem of childhood obesity in a way which privileges its role as policy actor; it draws on and undermines public health discourses of obesity; and it negates the impact of corporate practices on obesity and on related policymaking. An in-depth analysis of Big Food's own documents provides access to the processes of knowledge production and governing undertaken by Big Food. The study offers two tools of resistance for health promotion practitioners to interrogate and challenge Big Food-problematization as a policy tool and 'corporate influence' as a critical public health discourse.

Elijah's Nature

Existing scholarship struggles to theorize the relation between aesthetics, especially the aesthetics of catastrophe, and concerns with ecology and the environment. Mendelssohn's sacred oratorio Elijah premiered in 1846 at the birthplace of the steam engine in Birmingham, England. Commissioned by municipal reformers, Elijah constitutes a case study in disaster art. It was conceived as a vehicle for atmospheric repair, clean breathing, and moral healing for Black Country working populations. Its contexts include the development of biomedicine, public health discourse, and the history of air-purification systems, as well as the prophetic rhetoric of such firebrand modern Elijahs as the contemporaneous preacher-evangelist John Cumming. The popularity of the singing-class movement, moreover, aligns with the “great sanitary awakening” both because of its allegedly sanctifying spiritual potential, and because it was thought to fortify the lungs. Mendelssohn's oratorio was at once financed on the back of the profits of coal-fired energy systems and produced by well-meaning environmentalists to mitigate against the effects of heavy air pollution. The reception of the work is evidence of the extent to which the concerns of industry and the concerns of natural recovery co-constituted each other. Elijah deals in a cosmology—a way of narrating nature—that begins with the very real experience of ecological crisis. The endgame is to count the cost of a master narrative that sought natural recovery in an industrial enframement of global nature.

What Means Wellbeing? Distinction of Two Discourses on Well-being -Conceptual and Theoretical Reflections

The article offers a new contribution to an existing discussion about well-being in defining the difference between a public health discourse and a pedagogical discourse, and the difference between a causal logical and a reflectivity paradigm, build on empirical informed theoretical analysis. The principal conclusion is: If efforts to promote well-being can be seen as a cross-professional responsibility, it is crucial that the relevant professionals meet across these well-being discourses, that children and young people’s well-being is viewed as a complex matter and challenge, and that professionals are challenged on their understanding, and capable of meeting different expectations, of well-being.

Rethinking the use of ‘vulnerable’

Rethinking the use of ‘vulnerable’

War of conscience: antivaccination and the battle for medical freedom during World War I

The nineteenth century British antivaccination movement attracted popular and parliamentary support and ultimately saw the 1853 law which had made smallpox vaccination compulsory nullified by the 1898 ‘conscientious objector’ clause....

From Beveridge Britain to Birds Eye Britain: shaping knowledge about ‘healthy eating’ in the mid-to-late twentieth-century

ABSTRACT By the late 1980s, ‘healthy eating’ had largely failed as a public health discourse in Britain. Rather than providing consumers with a clear set of behavioural guidelines, it had fragmented into a confusing and ill-defined set of messages. In direct contrast to the anti-smoking campaign, which had succeeded in convincing large swathes of the British population to quit an unhealthy habit, the injunction to eat healthily failed to counteract rising levels of obesity in the 1990s, 2000s, and beyond. This article explores the emergence of a ‘healthy eating’ discourse in mid-to-late twentieth century Britain. It draws on a wide range of historical sources to consider how knowledge about food was re-fashioned across this period—by the state, by commercial actors, and by consumers themselves. While it is common to assert that the food and drink industry manipulated ‘ordinary people’ in this period, I argue that consumers were complicit in the shift towards unhealthy modes of consumption. They worked processed food products and ‘healthy eating’ messages into their everyday lives in contradictory ways. In turn, this article makes a strong case for histories of the everyday, arguing that ‘small’ histories of consumption can help to illuminate macro-level trends.

Repurposing the Ladder

Repurposing the Ladder