Public Health Narratives Research Articles

5.I. Scientific session: Epidemiological insights into vaccine hesitancy in Europe: building bridges and overcoming barriers

Abstract Vaccine hesitancy remains a pivotal challenge in public health, undermining immunization efforts and the containment of infectious diseases across Europe. This scientific session aims to dissect the complex nature of vaccine hesitancy, uncovering epidemiological trends and barriers to vaccine acceptance, particularly in diverse demographic contexts. The objective is to facilitate a comprehensive understanding among public health stakeholders and to foster actionable strategies through enriched dialogue and interaction. This session will delve into recent studies and projects that highlight the variability of vaccine hesitancy within Europe. First, an exploration of COVID-19 vaccine acceptance will reveal how sociodemographic factors influence vaccine-related behaviors across 20 European nations. This will be complemented by an analysis of targeted interventions designed to enhance vaccine uptake among migrant populations, drawing lessons from the RIVER-EU project. Additionally, a focus on national efforts to combat measles vaccine hesitancy will provide a case study on the challenges and successes in altering public health narratives. Based on the feedback received on last year’s session, the format is intended not only to provide a platform to present empirical evidence and insights but also to encourage a participatory environment where attendees can exchange ideas and propose innovative solutions. For this reason, the session will engage the audience through an interactive discussion period at the end of each of the three presentations, stimulating thought-provoking dialogues that could lead to effective and innovative public health practices. Fostering international and interdisciplinary collaboration in the field of vaccine hesitancy is key for continued monitoring and reporting on the vaccine hesitancy phenomenon and inspiring actionable solutions. Key messages • Sociodemographic factors are associated with vaccine hesitancy across Europe indicating the potential for targeted strategies. • A platform to share insights and inspire actionable public health solutions to combat vaccine hesitancy amomg European public health professionals is needed.

What Is Our Added Value? A Systematic Analysis of Epidemic Narratives in the Social Work Literature

Abstract This article addresses social work’s singular conceptual and analytical contribution to the field of epidemics. A systematic literature review was conducted to analyze how social work studies overlap to construct epidemic narratives. The author collected 601 articles from the Social Services Abstracts database and carried out a targeted search within 20 social work journals. Five epidemic narratives were identified: (1) a psychosocial consequences narrative, (2) a social work competence narrative, (3) a social risk factors narrative, (4) a misinformation narrative, and (5) a power matrix narrative. Results highlighted the social success of psychosocial perspectives prevalent in classic public health narratives. This understanding relies on a “politics of access” perspective and advocates for the improvement of current social services. The findings revealed that social work does not have a conceptual specificity in the field of epidemics but, rather, its current distinctive contribution mostly lies in its use of social work–centric inquiries that analyze social work practices and describe the consequences experienced by social work actors during epidemics. The author argued that the social work literature could benefit from analyses informed by a “politic of emancipation” that are less prominent in the analyzed studies. Avenues for future research are considered.

Bridging the nature–cultural heritage gap: evaluating sustainable entanglements through cemeteries in urban Asia

The expanding footprint of urban Asian settlements and increasing living standards have put pressure on cemetery sites. Public health narratives and the sanctity associated with death matters in Asian urban landscapes have fed into the rhetoric of cemeteries as undesirable heritage spaces. Often lacking protection, many cemeteries have been exhumed, cleared, and relocated to allow room for new developments and infrastructure, risking the survival of this quiet element of the urban cultural patrimony. Within an Asian context, synergies between nature and cultural heritage preservation are not prevalent in major cities like Singapore, Hong Kong, Tokyo, Manila, Kuala Lumpur, and Bangkok. In light of increasing recognition of urban cemeteries as multi-valued sites with both natural and cultural heritage values, this paper turns to deconstructing the nature–cultural binary and the concept of entanglement to frame an investigation of collaborative interactions. A focused study on Asian urban cemeteries follows, examining existing trends and adapted mix uses and highlighting the region’s unique conservation challenges. The analysis reveals three major typologies encapsulating the region’s current nature–cultural heritage entangled preservation approaches: sustainable compromises, memories, and everyday sustainability. To conclude, the paper distils respectful alternative futures for these spaces to be better integrated into the modern textures of the cities, unlocking functional recourses to destruction or oblivion.

Cognitive dissonance and mindset perturbations during crisis: "eco-socio-psycho-somatic" perspectives.

Mandatory and restrictive health regulations during the corona pandemic caused psychic disorders in many people, which even led to clinically relevant mental disorders. At the same time, there was gradually a polarization of opinions among the population. In order to improve future pandemic management, an integrative understanding of these psychosocial processes therefore seems useful. Here we start theoretically with the mental effects of inconsistencies of the information environment by referring to concepts such as the theory of cognitive dissonance. In a next step, we use the psychodynamic theory to understand the affective-motivational defense mechanisms underlying these cognitive states and processes. However, a broader theoretical framework of psychoanalysis seems to make sense, because self-referential processing also influences the style of thinking. For this reason, we use a more comprehensive psychological systems theoretical framework model to integrate these different perspectives. This integrative view refers in part to basic knowledge of health psychology regarding the resistance of unhealthy ways of thinking and behaviors and the possibilities for interventions for change. We then extend this model to a broader picture that also covers the relationship between men and their environment. This results in the perspective of a multidimensional socioecological theoretical framework, which as a heuristic reference model and related to other ecological approaches could also be helpful for various theoretical questions for public health, and could provide a better public understanding of health issues. In line with this perspective, we hypothesize that with regard to the coronavirus disease 2019 pandemic, the acceptance of public health narratives could be increased if a more consistent picture of the scientific descriptions and explanations of the pandemic - similar to the model proposed - could be provided, which would enable the understanding of the origin, course and countermeasures, and thus could have positive collective psycho-hygienic effects.

Disease Discourse through Sentiment and Network Analysis

In the realm of public health, the discourse surrounding diseases significantly impacts awareness, funding, and stigma. Traditional methods of analyzing disease mentions often overlook the intricate relationships and sentiments expressed in text, which can provide deeper insights into public perception and information dissemination. Existing literature on disease discourse primarily focuses on quantitative metrics such as disease frequency counts or associations based on semantic similarity. However, such analyses rarely account for the sentiment of the discourse, which can play a critical role in shaping public perception and response to health information. Moreover, the complexity of textual data and the subtleties of language usage present significant challenges for extracting meaningful patterns, especially when considering the emotional context of disease-related discussions. This study introduces a novel approach that integrates sentiment analysis and network visualization to examine the discourse on diseases within a comprehensive textual dataset. By applying the TextBlob library, we analyze sentence-level sentiment and categorize it as positive or negative. Utilizing these sentiment scores, we construct two distinct network graphs to depict the relationships between diseases based on their co-occurrence within sentiment-laden sentences. The analysis reveals contrasting landscapes of disease discourse: the positive sentiment network highlights diseases frequently mentioned in the context of successful treatment or optimistic outcomes, forming distinct clusters around well-managed conditions. In contrast, the negative sentiment network elucidates diseases that coalesce around shared public concerns, fears, or complications, marking out critical areas for public health intervention. The findings underscore the importance of sentiment in understanding disease discourse, offering a novel perspective that can assist public health officials in tailoring communication strategies. By recognizing patterns in disease associations within negative contexts, interventions can be more effectively targeted to address misconceptions and alleviate public health anxieties. Conversely, identifying diseases with strong positive connections can guide campaigns to bolster preventive measures and highlight medical advancements. This methodology serves as a blueprint for leveraging sentiment analysis in the exploration of health-related textual data, paving the way for more nuanced and actionable insights into public health narratives.

The use of radiotherapy, surgery and chemotherapy in the curative treatment of cancer: results from the FORTY (Favourable Outcomes from RadioTherapY) project.

Radiotherapy, surgery and chemotherapy play key roles in the curative treatment of cancer, alone and in combination. Quantifying their roles is essential for equipment provision and workforce planning. The estimate that 40% of cancer patients are cured by RT has been used extensively to inform and influence policy but is relatively old and warrants review. Patient, tumour and treatment event data was obtained for the 5 year period from 2009 to 2013, allowing a further 5 years for survival outcomes to be known. We analysed patient-level data on utilisation of surgery, radiotherapy, and chemotherapy in cancer patients in England. Data were sourced from Public Health England, using National Cancer Registrations, the National Radiotherapy Dataset (RTDS) and the Systemic Anti-Cancer Therapy Dataset (SACT). All tumour sites (excluding C44) and ages were included. We analysed three cohorts: all patients [n = 1,029,569], patients who survived 5 years or more [n = 537,970] and patients who survived <5 years [n = 491,599]. Overall cancer-specific 5-year survival was 52%, and in those patients, surgery was the most common curative treatment, with 80% receiving surgery, alone or in combination; radiotherapy was delivered to 39% and chemotherapy to 29%; 45% received two and 13% all three modalities. The high proportion receiving multi-modality treatment emphasises the importance of integrated, resourced, multidisciplinary cancer care. Radiotherapy was delivered to almost 40% of patients who survived 5 years which underlines its importance in cancer management. The results are essential in planning cancer services. They also inform the public health narrative.

A tale of two rivers: development, destruction, and despair in Ongata Rongai, Kenya.

Ongata Rongai is a rapidly growing peri-urban space in Nairobi Metropolitan, Kenya. The last 10 years have seen exponential population growth and building development leading to overcrowding and pressure on water and environmental resources. This original research sheds light on interactions among humans, animals, and this rapidly changing urban environment. It is therefore a quintessentially One Health study. Qualitative and ethnographically informed methods are employed to better understand the impact of rapid growth on the riparian environment and the effect of this on those who depend on it. The reflexive use of archival material and a historical ethnographic approach enabled in-depth narratives to address these issues within a longitudinal context, and the use of deliberate walking alongside visual methodologies and more traditional anthropological methods make this study novel both in terms of methodological approach and findings. This study finds that people cite high levels of pollution from solid waste and sewage have made the rivers almost unusable and a hazardous place for both humans and animals. Yet, in the past, these rivers played key roles in daily life. There is frustration with structural-level actors' moribund attitude to the environment. The poor health of the rivers and riparian environment leads to human and animal health challenges, increased pressure on water resources, and economic pressure due to a loss of livelihoods. The study contributes to what is currently a fairly small literature on urban riparian spaces globally, but one which is of growing and vital importance given the rapidly increasing percentage of humans who now reside in urban spaces. It contributes to WASH and urban clean water knowledge as well as One Health, public health, and urban growth narratives, and directly addresses challenges faced by SDG 6.

Reimagining Our Public Health Systems: The Robert Wood Johnson Foundation's National Commission to Transform Public Health Data Systems.

Reimagining Our Public Health Systems: The Robert Wood Johnson Foundation's National Commission to Transform Public Health Data Systems.

1.P. Skills building seminar: Taking the elevator pitch to the next level: how to convince a policymaker in less than 2 minutes

Abstract Since a number of years the European Public Health Association (EUPHA), the European Public Health Conferences and other organisations have been working hard to translate the evidence in a such a format that policymakers take notice. For example, the WHO Regional Office for Europe works on ‘telling the public health narrative’ and provides factsheets and infographics, in order to effectively communicate public health messages to policymakers. At the European Public Health Conference so-called pitch presentations were introduced (at Glasgow 2014), where researchers are asked to present their work in 5 minutes with maximum 5 slides (no animations), as a way to learn to present key messages from research in just a few minutes. EUPHA has organised several skills building workshops on translation of evidence in the past years, including the 2019 session ‘making the elevator pitch work’, then in 2020 ‘making the elevator pitch more effective’, and last year ‘making the elevator pitch perfect’. Building forward on those three successful and well-attended workshops, the current workshop will follow up on this series and dive deeper into communicating the evidence through the elevator pitch. Lessons learned at the previous elevator pitch workshops: – Have a clear ask (keep it simple). – Appeal to the policymaker's own interests and priorities. – Spell out how action will be beneficial for the policymaker. – Be aware of upcoming elections. – Built a relationship with the assistants of politicians. – Considering the ‘policy window’. – Make the comparison with the policy plan. – Propose an action the politician should undertake. – Identifying the relevant stakeholders and groups affected by the problem. The importance of effectively communicating the evidence to policymakers is highlighted by infodemics, e.g. called out by the WHO and UN in the context of the COVID-19 pandemic with the spreading of mis- and disinformation about the pandemic. Considering the physical distancing measures that were in place the past years, which made teleworking (working from home) more common, the workshop will also cover virtual tactics. Communicating the science in an increasingly virtual world has made it a whole different kind of sports. In this skills-building workshop, we will select a number of abstracts that have been accepted by the International Scientific Committee as posters and we will invite the presenting authors to this dare: Present your work and key messages in less than 2 minutes. In order to see whether the policymaker/politician is convinced, we are organising a small panel of policymakers and politicians and ask them to give their feedback. Are they interested? Do they remember the key message? And if all goes well, do you get an invitation to come back and present more of your work? Key messages • Being able to present your key messages anywhere, anytime is needed (including virtual tactics). • Telling the public health narrative and telling a story are important skills for public health professionals to have. Speakers/Panellists Marleen Bekker EUPHA (PHPP)

Legal implications of the climate-health crisis: A case study analysis of the role of public health in climate litigation.

BackgroundStrong scientific evidence affirms that climate change is now a public health emergency. Increasingly, climate litigation brought against governments and corporations utilizes international human rights, environmental and climate laws and policies to seek accountability for climate-destructive and health-harming actions. The health impacts of climate change make litigation an important means of pursuing justice and strategically challenging legal systems. Yet there is scant documentation in the literature of the role that public health has played in climate litigation and the legal weight public health narratives are given in such contexts. Therefore, we assessed to what extent courts of law have used public health harm in legal adjudication and sought to provide practical recommendations to address barriers to positioning legal arguments in public health-centric frames.MethodsWe reviewed legal databases to identify all publicly reported, documented, cases of climate litigation filed in any country or jurisdiction between 1990 and September 2020. For the 1641 cases identified, we quantified the frequency of cases where health concerns were explicitly or implicitly raised.FindingsCase numbers are trending upwards, notably in high income countries. Resolution remains pending in over half of cases as the majority were initiated in the past three years. Cases were primarily based in climate and human rights law and brought by a wide range of groups and individuals predominantly against governments. About half of the decided cases found in favour for the plaintiffs. Based on this, we selected the 65 cases that were directly linked to public health. We found economic forces and pricing of health risks play a key role, as courts are challenged by litigants to adjudicate on the responsibility for health impacts.ConclusionsWhile courts of law are receptive to public health science, significant legal reform is needed to enhance leveraging of public health evidence in legal judgements of climate litigation cases. The integration of a public health mandate into a new eco-centric legal paradigm will optimize its potential to promote human well-being—the core objective underpinning both international law, human rights, and public health. Existing legal doctrines and practices can be enhanced to increase the weight of public health arguments in climate legal action and consequently ensure legal rulings in climate litigation prioritize, protect and promote public health.

4.N. Skills building seminar: Making the elevator pitch perfect: how to convince a policymaker in less than 2 minutes

Since a number of years, the European Public Health Association (EUPHA), the European Public Health Conferences and other oganisations, have been working hard to translate the evidence in a such a format that policymakers take notice. For example, the WHO Regional Office for Europe works on ‘telling the public health narrative' and provides factsheets and infographics, in order to effectively communicate public health messages to policymakers. Over the years, EUPHA has organised several skills building workshops on translation of evidence in the past years. At the European Public Health Conference in Glasgow 2014, so-called pitch presentations were introduced where researchers are asked to present their work in 5 minutes with maximum 5 slides (no animations), as a way to learn to present key messages from research in just a few minutes. Since 2018, EUPHA organises this elevator pitch skills-building exercise with great success. Building forward on two successful and well-attended skills-building sessions, the current workshop will be a follow-up workshop in this series and is about perfecting the elevator pitch. Lessons learned at the previous elevator pitch workshops: Have a clear ask (keep it simple).Appeal to the policymaker's own interests and priorities.Spell out how action will be beneficial for the policymaker.Be aware of upcoming elections.Built a relationship with the assistants of politicians.Considering the ‘policy window'.Make the comparison with the policy plan.Identifying the relevant stakeholders and groups affected by the problem. The importance of effectively communicating the evidence to policymakers is highlighted by infodemics, e.g. last year called out by the WHO and UN in the context of the COVID-19 pandemic with the spreading of mis- and disinformation about the pandemic. In the context of physical distancing measures, the workshop will also cover virtual tactics. As in the era of teleworking (working from home), advocacy has become a whole different kind of sports. In this skills-building session, we will select a number of abstracts from young professionals/students that have been accepted by the International Scientific Committee as posters and we will invite the presenting authors to this dare: Present your work and key messages in less than 2 minutes. In order to see whether the policymaker is convinced, we are organising a small panel of policymakers and ask them to give their feedback. Are they interested? Do they remember the key message? And if all goes well, do you get an invitation to come back and present more of your work?Key messages Being able to present your key messages anywhere, anytime is needed (including virtual tactics).Telling the public health narrative and telling a story are important skills for public health professionals to have.

Fermentation in Post-antibiotic Worlds

The ethnographic focus of this paper is a group of sourdough bakers based in Finland, with a specific view on a fermentation workshop in 2019. In this workshop, emerging human-microbe relations were drawn, bringing attention to a post-antibiotic world. Studying bread making necessitates a more-than-human analysis that foregrounds microbes as central characters situated in the political climate of increasing populism and the Anthropocene. In this paper I describe bakers, termed microbiohackers, putting forward critiques of capitalism that link ecological extraction, political oppression, and industrial food production. Crafting an alternative to the dominant public health narrative of microbes as a threat and antimicrobial resistance, I use the notion of diffraction to discuss the complex entanglements of the microbial/material and social/political. In the hands of the bakers, fermentation, sourdough, and antimicrobial resistance present an opportunity to question dualisms of how microbes are thought about and to create emergent post-antibiotic futures.

Old, Broken, Disposable: Critical Discourse Analysis of the Public Health Narrative About At-Risk Populations During the COVID-19 Pandemic in Costa Rica

During February and March, in Costa Rica, as well as in many other countries in Latin America, public health authorities and government officials insisted that there was no reason to panic or to hoard toilet paper, canned food, and disinfectants. Even though, by this time, the World Health Organization had declared that transmission of the viral infection caused by the novel coronavirus (SARS-Cov-2) had reached the level of pandemic, these health authorities and elected officials asserted that most people need not feel afraid. After all, they claimed, the disease caused by this virus appeared to be mild in most cases, that is, except in people older than 70 years of age and people with concomitant health issues such hypertension or diabetes. The purpose of this paper is to demonstrate that the epistemic authority from which the dominant narrative about COVID-19 has emerged in Costa Rica is rooted in extended and normalized discriminatory and oppressive ideologies regarding the value of people and their bodies. This official discourse is an expression of the condescending and paternalistic tradition of medical epistemology in the country. With this paper, therefore, I make a critical contribution to the exploration of the following questions. How does this narrative discourse affect older people, people with disabilities, and people who live with physical circumstances such as hypertension or diabetes? Does this narrative discourse help the general public, fairly and in a dignify manner, to understand the risks of contagion with respect to COVID-19 and the preventative measures required to avoid the infection?

Towards a contemporary social care 'prevention narrative' of principled complexity: An integrative literature review.

Prevention has become increasingly central in social care policy and commissioning strategies within the United Kingdom (UK). Commonly there is reliance on understandings borrowed from the sphere of public health, leaning on a prevention discourse characterised by the 'upstream and downstream' metaphor. Whilst framing both structural factors and responses to individual circumstances, the public health approach nonetheless suggests linearity in a cause and effect relationship. Social care and illness follow many trajectories and this conceptualisation of prevention may limit its effectiveness and scope in social care. Undertaken as part of a commissioned evaluation of the Social Services and Wellbeing Act (2014) Wales, a systematic integrative review was conducted to establish the key current debates within prevention work, and how prevention is conceptually framed, implemented and evaluated within the social care context. The databases Scopus, ASSIA, CINAHL and Social Care Online were initially searched in September 2019 resulting in 52 documents being incorporated for analysis. A further re-run of searches was run in March 2021, identifying a further 14 documents, thereby creating a total of 66. Predominantly, these were journal articles or research reports (n=53), with the remainder guidance or strategy documents, briefings or process evaluations (n=13). These were categorised by their primary theme and focus, as well as document format and research method before undergoing thematic analysis. This highlighted the continued prominence of three-tiered, linear public health narratives in the framing of prevention for social care, with prevention work often categorised and enacted with inconsistency. Common drivers for prevention activity continue to be cost reduction and reduced dependence on the care system in the future. Through exploring prevention for older people and caregivers, we argue for an approach to prevention aligning with the complexities of the social world surrounding it. Building on developments in complexity theory in social science and healthcare, we offer an alternative view of social care prevention guided by principles rooted in the everyday realities of communities, service users and caregivers.

From Urban Renewal to the BeltLine: Atlanta’s Use of Public Health Narratives to Reshape the City

Since the early days of the planning profession, city agencies relied on a public health crisis narrative as a rationale for mass displacement efforts that targeted black communities. Over time, as cities gentrified with white, middle-class residents, the narrative shifted toward the city as a place of health. This article compares Atlanta’s redevelopment narratives from urban renewal to its current citywide greenway project, the BeltLine, to understand how city officials utilized public health language to rationalize displacement and how the narratives ran counter to residents’ lived experience.

Structural Inequity and Pregnancy Desires in Emerging Adulthood.

Public health discourses often claim that delaying pregnancy is associated with social and economic benefits. Yet research suggests that, for young people, structural inequity is most influential in future outcomes, regardless of childbearing. We conducted in-depth interviews with 50 young women (ages 18-24) and their male partners (n = 100) and investigated the influence of structural inequity on pregnancy desires and plans. Three themes emerged, stratified by social advantage. In the "Things Will Be Different Later" theme, socially advantaged participants envisioned that their future lives would surely be different due to achievement of educational, professional, and economic goals; thus, their pregnancy plans aligned with their desires, often reflected in use of highly effective contraception. In the "I Don't Have Everything I Need" theme, participants expressed delaying desired pregnancies (primarily through condom use) until they could contend with structural barriers. Their pregnancy plans, shifted by way of structural inequity, were not aligned with their desires. Under the "I'll Never Have Everything I Need" theme, socially disadvantaged participants expressed significant doubt about ever realizing ideal circumstances for pregnancy preparedness; as pregnancy prevention was not salient, these participants used condoms or no contraception. This analysis indicates that structural inequities constrain reproductive self-determination in emerging adulthood, creating a chasm between desired and actual childbearing that was reflected in contraceptive decision-making. Public health narratives emphasizing the importance of pregnancy prevention for socially disadvantaged groups without addressing the manifestation of structural inequity in their lives perpetuate reproductive oppression vis-à-vis emphasis on contraceptive use to ensure future economic success.

How food companies use social media to influence policy debates: a framework of Australian ultra-processed food industry Twitter data.

To understand if, and how, Australian ultra-processed food industry actors use Twitter to influence food and health policy debates and produce a conceptual framework to describe such influence. Twitter data of prominent industry actors were defined through purposive sampling and inductively coded to investigate possible influence on food and health policy debates. These are described using descriptive statistics and coded extracts. Australia. Twitter accounts of nine prominent ultra-processed food industry actors, including major trade associations. Ultra-processed food industry actors actively used Twitter to influence food and health policy debates. Seven overarching strategies were identified: co-opting public health narratives; opposing regulation; supporting voluntary, co- or self-regulation; engaging policy processes and decision-makers; linking regulatory environments to the need for ongoing profitability; affecting public perceptions and value judgements; and using ignorance claims to distort policy narratives. Each lobbying strategy is underpinned with tactics described throughout and captured in a framework. The current study creates a framework to monitor how food industry actors can use social media to influence food and health policy debates. As such, social media appears to be not only an important commercial determinant of health for brand marketing, but also an extension of lobbying practices to reshape public perceptions of corporate conduct and policy-making.

12.I. Skills building seminar: Making the elevator pitch more effective: how to convince a policymaker in less than 2 minutes

Abstract Since a number of years, the European Public Health Association (EUPHA), the European Public Health Conferences and other associations, have been working hard to translate the evidence in a such a format that policymakers take notice. For example, the WHO Regional Office for Europe works on 'telling the public health narrative' and provides factsheets and infographics, in order to effectively communicate public health messages to policymakers. At the European Public Health Conference so-called pitch presentations were introduced (at Glasgow 2014), where researchers are asked to present their work in 5 minutes with maximum 5 slides (no animations), as a way to learn to present key messages from research in just a few minutes. EUPHA has organised several skills building workshops on translation of evidence in the past years, including last year's session 'making the elevator pitch work'. Lessons learned during this workshop in Marseille are: Have a clear ask (keep it simple)Appeal to the policymaker's own interests and prioritiesSpell out how action will be beneficial for the policymakerBe aware of upcoming electionsBuilt a relationship with the assistants of politicians Following the great interest in last year's workshop, this workshop will complement the outcomes of the 'lessons learned' with additional tips for convincing a policymaker. The list of lessons learned will be expended by reflecting on models of knowledge translation. Models of knowledge translation and evidence informed policymaking are abundant. Some key aspects that can be added to the list are: considering the 'policy window', making the comparison with the policy plans, identifying the relevant stakeholders and groups affected by the problem. In this skills-building workshop, we will select a number of abstracts that have been accepted by the International Scientific Committee as posters and we will invite the presenting authors to this dare: Present your work and key messages in less than 2 minutes. In order to see whether the policymaker is convinced, we are organising a small panel of policymakers and ask them to give their feedback. Are they interested? Do they remember the key message? And if all goes well, do you get an invitation to come back and present more of your work? Key messages Being able to present your key messages anywhere, anytime is needed. Telling the public health narrative and telling a story are important skills for public health professionals to have.

Secrets and Silence: Agency of Young Women Managing HIV Disclosure

ABSTRACT Drawing on a 12-month ethnography with young women living with HIV in Zambia, we explore their everyday strategies to avoid unintentional disclosure of their HIV status. Young women practiced secrecy with sexual partners, through hiding their antiretroviral therapy and using veiled language around HIV. Whilst remaining silent about their HIV status enabled them to maintain identities beyond HIV, this secrecy triggered feelings of guilt and anxiety, suggesting that their agency was “bounded” by the context of persistent stigma. These strategies to hide their HIV status question public health narratives urging disclosure, and support disclosure-counseling approaches that champions choice.

‘Complexity’ as a rhetorical smokescreen for UK public health inaction on diet

ABSTRACT ‘Complexity’ is theorised as a characteristic of modern food systems that poses a challenge to improving population diets. This paper seeks to explore the discursive deployment of ‘complexity’ in the context of public health. Doing so helps inform a more critical assessment of commercial and political determinants of health, and of ‘complexity’ as a prevailing frame for public health issues. Qualitative methods were used to explore ‘responsibility’ for healthy eating in the food system in the United Kingdom. Discourse analysis was conducted on corporate and government documents, and interviews with industry and government stakeholders. The aim was to examine the implications of ‘complexity’ within discourses of dietary public health. ‘Complexity’ was used not only to characterise dietary public health problems but also as a rhetorical device in public health narratives. It performed two main discursive functions: firstly, to represent diet-health problems as so multi-layered and difficult that they are intractable. Secondly, and despite this acknowledged complexity, to deflect from food system actions for improving diet to ‘simpler’ and non-food interventions, by industry and government. These uses of ‘complexity’ serve to attribute primary responsibility to individuals for dietary choice and to obscure inaction by government and industry, who have most control over the determinants of those choices. In short, ‘complexity’ can be used discursively to generate a smokescreen masking policy inaction in addressing public health problems.