Search

By analysing debates between member states of the World Health Organisation (WHO) over health inequities experienced by sexual and gender minorities (SGMs) from 2013 through to 2015 and 2016, this paper interrogates a WHO decision to 'do nothing', and the relationship between this decision and the production of ignorance and non-knowledge. This paper problematises state representatives' discursive practices regarding the lack of evidence on SGM health inequalities, drawing on the sociology of ignorance. Informed by the sociology of nothing, two analytical categories – non-recognition (omissive) and mis-recognition (commissive) of SGM communities – are proposed to critically understand the production of 'no-bodies' and the tolerance of the lack of evidence. The lack of evidence, rather than prompting WHO action, was used as a rationale for intentionally neglecting the health concerns of particular social groups due to their invisibility in health research. Therefore, the paper argues that the lack of evidence in itself is symptomatic of the existence of SGM health inequities, which require the WHO to take action such as formally expressing concerns about and endorsing research on the topic. [ABSTRACT FROM AUTHOR]

This paper examines how Ebola survivors in Sierra Leone are enacting biological citizenship to effect responsive and accountable engagement with their government. Disaster survivors are often left without avenues to hold policymakers accountable, but, recently, injured or disabled people have taken legal action against their governments over issues such as negligence, delays, damaged property, and death. However, in Sierra Leone, members of the Ebola survivors' association have sued the government at the ECOWAS Community Court of Justice over a less conventional issue: corruption. After audit reports uncovered instances of financial impropriety that compromised the country's response to the 2013–2016 Ebola outbreak, two plaintiffs sued the government with the argument that corruption and the failure of the government to hold the culprits accountable constitute abuses of the rights to life and health of those affected by the disaster, and the entire population. Based on this case, the paper argues that the lawsuit is an attempt to redefine corruption as a health hazard and a human rights violation. This challenges authorities to give serious attention to how financial improprieties affect the ability of state agencies to guarantee equitable, dignified healthcare, and to take the post-disaster rehabilitation of survivors as a critical component of reconstruction programmes. Ultimately, the lawsuit might set a precedent for other disaster survivors to demand equitable and dignified access to health and proper rehabilitation. This paper draws on scholarly literature, official documents, and conversations with some of the survivors and their lawyer to make this argument. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has disrupted societies globally. Public health institutions were tasked with responding to the pandemic in a dynamic and uncertain context. This paper sheds light on the experiences of COVID-19 response actors as they navigated multi-dimensional crises associated with the pandemic in general and vaccine hesitancy in particular. This research was conducted during the initial phase of the COVID-19 vaccine rollout in Flanders, Belgium. Participants included informants across all levels of the COVID-19 vaccination strategy including but not limited to those producing scientific knowledge, providing policy input, or implementing public health directives locally. 'Crisis' was identified as a recurring theme in interviews with informants. The paper highlights multi-dimensional crises experienced by informants such as the: (i) crisis of prioritization, (ii) crisis of communication, (iii) crisis of the changing image of science, (iv) crisis of epistemic agency and autonomy, and (v) crisis of trust. [ABSTRACT FROM AUTHOR]

In some countries, far-reaching 'lockdown' measures to contain the spread of coronavirus were implemented early in 2020. In Austria, these early measures were met with a high degree of compliance among the country's population. In this paper, we draw upon qualitative interviews, and ask how people made sense of the restrictions imposed during the first lockdown in April 2020 and what shaped their compliance. Empirical research has so far tried to explain compliance by means of people's disposition and motivations as well as demographic and social characteristics. Instead of focussing on who is compliant, we aim to understand how people practice compliance. We do this by approaching compliance through the concepts of values and practice. First, our findings indicate that people assess whether measures are suitable and legitimate in relation to the values of science, the law, and morality. Second, people assign additional personal value to compliance by stressing its positive implications on their own lives. By adopting a nuanced perspective on compliance as inextricably linked to peoples' values and practices, our paper critically contributes to the political and scholarly discussion of pandemic public health measures. Understanding compliance through the lens of values shows how people make sense of the measures in the context of their everyday lives, helping us to move away from a binary understanding of (non-)compliance that has become morally charged. [ABSTRACT FROM AUTHOR]

Global health organisations are increasingly involved in large-scale health interventions in countries in the Global South, partnering with states to implement programmes to strengthen national health systems and promote Universal Health Coverage (UHC). Drawing on an ethnography of a large-scale global health partnership between the Zambian state and the Clinton Foundation, this paper examines the novel configurations of sovereignty that are created by these large-scale global health partnerships. It shows how officials from the Clinton Foundation came to believe that senior Zambian government actors had granted them the authority to implement the programme outside of the formal channels of the government health system. I conceptualise this as an informal mode of 'outsourcing sovereignty' and show how it led Clinton Foundation employees to behave as de facto state actors in rural Zambia. This paper contributes to the broader critical task of describing and analysing new forms of governmental pluralism in contemporary global health and highlights some of the politically troubling consequences when sovereignty is informally outsourced in this way. [ABSTRACT FROM AUTHOR]

In this paper, we view health strategies in the field of personalised medicine as performative actions which articulate the development desired for a given society and demonstrate and affirm values and visions for that society. Based on a qualitative study in Denmark, we show how political actors and policy documents articulate visions for personalised medicine through a distinct sociotechnical imaginary. This sociotechnical imaginary mobilises the distinction between non-profit public and for-profit private organisations, placing personalised medicine in the public domain as the self-evidently desirable future for Danish health care In the Danish case, the issue of implementing personalised medicine becomes an opportunity to revisit the vision for the welfare state and verify public institutions as a shared space for state and citizens. While Danish political actors see personalised medicine as transformative, they articulate this transformation as being steered by public actors, at the same time downplaying the role of private companies. Where public health studies have focused on how political investments into personalised medicine may marginalise specific groups and populations, the Danish case shows that also powerful transnational players may be excluded from political discourse. It teaches us not to treat personalised medicine as one phenomenon, but to pay direct attention to the local contexts in which it operates and shapes what 'public' and 'health' become. [ABSTRACT FROM AUTHOR]

Rigorous evaluations of the effects of vertical public health enterprises on the health systems of low-income countries usefully identify the public health and ethical costs of those initiatives. They reveal that such narrowly focused public health ventures undermine the efforts of those countries to establish and maintain adequately resourced and well-developed national health systems, including comprehensive primary care programs. This paper argues that the scope of assessments of vertical public health ventures should be broadened to include gender as an additional axis of analysis. When members of socio-economically marginalized populations are sick with conditions that are not covered by fragmented and inadequate public health programs or disease-specific vertical public health schemes, their untreated illnesses add to the gendered familial caregiving responsibilities of the female members of their households. Those women and girls have to perform their 'normal' familial care work, work outside the home for pay, and take care of the unwell family members for whom the household cannot afford treatment. Given that women and girls from low-income households already shoulder a disproportionate amount of care work for their families, their health and life prospects are further affected by the amplification of their caregiving responsibilities. This paper argues that analyses of the impact of vertical public health initiatives should also track this gendered consequence of those enterprises because it is a crucial public health and ethical matter. [ABSTRACT FROM AUTHOR]

Noncommunicable diseases (NCDs) are a complex category composed of five diseases and five behavioural and environmental risk factors. These are, in turn, represented by multiple constituencies and communities of expertise and interest. This fractured landscape is evidenced by and magnified through an abject lack of conferences devoted to the category of NCDs. One of the very few is the NCD Alliance Forum, most recently held in February 2020 in Sharjah, United Arab Emirates. With the first Forum held in 2015 and another in 2017, these events offer powerful insight into the key actors, advocacy strategies, debates and aspirations of those working in the 'NCD space'. Using the Forum as its object of research and analysis, this paper critically reflects on two persistent questions facing NCD advocates. First, how might NCDs be more like infectious diseases in cultivating a sense of urgency and action? Second, is NCD advocacy a 'movement' or a 'community' of loosely connected actors? Set against the emerging COVID-19 outbreak, which at the time of the Forum was limited to China and a handful of other countries, the Forum offered a unique opportunity to reflect upon the significant challenges facing NCD advocates across global north and south. COVID-19 only highlights how rising rates of NCDs have made global populations vulnerable to emerging infectious diseases. Yet, as the paper concludes, with the COVID-19 pandemic continuing to rage, the future of NCD advocacy and funding looks ever more fragile even as evidence of its need continues to grow. [ABSTRACT FROM AUTHOR]

'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. [ABSTRACT FROM AUTHOR]

Persistent health inequalities pose a challenge to researchers and policymakers. Decades of research have illuminated mechanisms that underlie health inequalities, now we must move beyond these observations to enable policies that can reduce them. In this paper, we highlight tensions in the field of health inequalities research regarding the relationship between social determinants and health outcomes, and the effectiveness of welfare policies. We draw on recent evidence to analyse and discuss these areas of debate and provide insight into the evidence on causality, welfare systems and policies aiming to address the social determinants of health inequalities. First, we examine the evidence that inequalities in the social determinants of health are causally related to health inequalities. Second, we discuss whether more egalitarian social policies provide a solution to redressing health inequalities. In conclusion, we suggest that current debates around causal understandings risk sending the field down 'rabbit holes' that distract from solution. We argue that, if we combine epidemiological evidence with the broader canon of social science evidence, the case for causal inference is sufficiently strong to suggest we now need to focus on effectively supporting and promoting research-informed policy responses to health inequalities. [ABSTRACT FROM AUTHOR]

Discourse regarding public health problems disproportionately affecting marginalized communities may shape and sustain health inequities. Analyses of news media and public health communications in the wake of infectious disease outbreaks provides opportunities to examine how discourse produces dominant public perceptions about the drivers of health emergencies and who is responsible for protecting community health. Guided by Bacchi's "What is the Problem Represented to Be?" analytic approach, this paper critically examines the discursive construction of problems and solutions in news media (n = 35) and public health communication (n = 18 press releases, n = 1 governmental report) regarding an unprecedented hepatitis A outbreak in San Diego, California, USA (2016–2018) that disproportionately affected people experiencing homelessness. We organize our findings around three elements of problem and solution representation with respect to the outbreak: 1. The inequitable attribution of risk and deservingness; 2. assumptions divorced from socio-structural factors and perspectives of marginalized populations; and 3. political theatre as a means of blame-shifting and (in)action. Overall, our findings suggest that even when structural-level issues were acknowledged within news media and public health communication as undergirding the 'problem' of the hepatitis A outbreak, outbreak discourse focused on individual-level responsibility for both the causes of and solutions to it (e.g. vaccines, criminalization of homelessness), and on shifting blame between government actors. These findings have implications for understanding the role that news media and public health agencies play in shaping public perception of the causes, consequences and solutions to infectious disease outbreaks that disproportionately affect marginalized populations. [ABSTRACT FROM AUTHOR]

This paper explores public health policy implementation through partnership working at the local level by examining how local actors from public health, and the wider workforce make sense of and work on social inequalities in health. An ethnographic case study was used to examine policy implementation in one local strategic partnership in north-west England during a period of significant resource constraint. Semi-structured interviews were the primary method of data generation. Sensitising concepts from figurational sociology were used to develop a theoretical account of how local policy implementation directed at narrowing social inequalities in health tended to give rise to relatively fragmented and short-term services, projects and practices, which focused on lifestyle factors and behaviour change. Theorising partnership work as figurations goes some way to explaining the apparent paradox among participants who expressed a relatively detached appreciation of wider social influences, alongside emotional involvement in their work. This process of individualisation explains how local professionals tended to conceptualise health inequality and the social determinants of health as personal troubles. Individualisation meant that the social reality of working in partnerships on difficult issues was simplified. Thus, any scope for working on the social determinants of health tended to be overlooked. The extent to which this was intentional or a matter of struggling to see opportunities, or a mixture of the two, was difficult to discern. Although the policy landscape has changed, the findings give some insight into understanding how local collaborative processes reproduce local public health work underpinned by lifestyle choices. [ABSTRACT FROM AUTHOR]

Global governance of non-communicable diseases (NCDs) has moved beyond the World Health Organization (WHO) to become a shared responsibility of WHO, the United Nations General Assembly, and other willing stakeholders. Despite the significant attention NCDs have received, progress towards global goals and political commitments remains disappointing. This lack of progress calls for greater attention to be given to how actions taken at the international level can lead to improvements in health at the country level. This paper reviews progress in the global response to NCDs by highlighting the role of pathways – both current and potential – for translating global aspirations into national actions that improve health outcomes. Important pathways to national action include the development of normative instruments, political accountability mechanisms, provision of economic support and technical assistance, and other forms of engagement we refer to as 'institutional pathways'. We find that global leadership on NCDs has focused predominantly on generating a suite of normative instruments for influencing national policy, together with global targets and reporting processes but with inadequate development assistance for NCDs, or investment in capacity building. We point to the distinctively legal and regulatory nature of many priority interventions identified by WHO for NCD prevention and control, arguing that legal capacity building of both government and civil society stakeholders is a vital, cost-effective yet neglected pathway for strengthening national responses. We outline a modest vision for global, regional and national leadership in capacity-building and in promoting the role for law in NCD prevention and control. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses articles in the issue on topics including how issues such as trust in government shape responses to contact tracing, the policy responses to COVID-19 that have exacerbated social divisions and undermined social justice and the ethnic inequalities in exposure to risk among health works in the British National Health Service (NHS).

England now has a policy framework for Fetal Alcohol Spectrum Disorder (FASD). This proposes a suite of healthcare interventions, some of which attend to assessment and support for those who may be diagnosed with the disorder. Others, which are the focus of this commentary, have a stated goal of FASD prevention, to be achieved through embedding activities around alcohol abstention within maternity services and reproductive healthcare. Critical engagement with alcohol abstinence advocacy to pregnant women in this journal has linked this aspect of health promotion to larger debates about risk, moral panic, neoliberalism, self-surveillance, and forms of citizenship. The new English policies on FASD have, however, been the subject of relatively little academic engagement so far. In this commentary, after an initial summary of points from the relevant literature in Critical Public Health, we take public debate about the new English policy as our point of departure, highlighting the precautionary approach, the emphasis on monitoring, and contraceptive advocacy for at-risk women. We suggest an important shift in English policy, from presenting women as managers of risk via self-surveillance, to positioning them as in need of routine management and 'other-surveillance' within healthcare systems. This raises more general questions about the meaning of 'autonomy' and 'support' in healthcare. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) is often characterised as a 'crisis', requiring action by public, private, and third-sector stakeholders to achieve strategic change. Crisis narratives are powerful and may be co-opted to privilege solutions promoted by influential groups. In relation to AMR, this applies particularly to the pharmaceutical and medical diagnostics industries. Given the associated risk of inefficient use of public funds, critical attention must be paid to how the promoted 'solutions' to the AMR crisis are constructed, and their symbolic and material effects on health policy. We conducted a critical discourse analysis (CDA) of the seventy-one written submissions to the UK House of Commons Health and Social Care Committee's 2018 inquiry into AMR. Two researchers collaboratively coded the findings and categorised the submissions. We applied the Policy Dystopia Model to further analyse the proposed solutions and ascertain the discursive and instrumental arguments in the industry submissions to the Committee. We found that industry submissions deployed economic and governance discursive strategies, articulating three main 'market paradoxical' arguments: (i) interference but non-interference; (ii) power but powerlessness; and (iii) for-profit but not-for-profit. The industry submissions also drew upon instrumental strategies including: coalition management, information management, and direct involvement and influence in policymaking. Our analysis suggests that commercial interests deploy crisis narratives to advocate for solutions involving market deregulation and industry subsidies. Thus, the solutions presented to the Committee were heavily shaped by a technocratic-industrial complex. This contributes to influencing what is seen as possible and acceptable in the global AMR policy landscape. [ABSTRACT FROM AUTHOR]

Evidence suggests that despite the popularity and influence of key health equity concepts, they often fail to shift the thinking and actions of health workforces towards the social and structural determinants of health inequalities. These findings tend to be attributed to institutional constraints, along with the role of influential discourses which promote a focus on individuals and behaviours. However, questions have also been raised about the clarity and utility of the concepts themselves, and the extent to which the language they use works (or indeed fails to work) in reorienting thinking and action. The purpose of this study was to explore how partners in an applied health research collaboration in England interpreted the popular 'upstream-downstream' story, and what it means to work 'upstream' to reduce health inequalities. Where participants were not familiar with its academic or technical usage, the story was taken to be a metaphor for prevention generally, or it prompted a root cause analysis of the more discrete ways in which inequalities were encountered in participants' research or work. Even in instances where participants did hold more socio-political perspectives, these were often not evoked by the metaphor itself. Two of the 18 participants were unable to equate the metaphor with particular actions or ways of working, while others found it to be a poor fit with how they understood inequalities. The study findings illustrate and explain the challenges that arise when technical metaphors from the health equity literature are opened-up to interpretation by wider audiences. [ABSTRACT FROM AUTHOR]

The 'inclusion health' agenda aims to draw attention to health disadvantages accompanying experiences putatively characterised by social exclusion, such as homelessness, problem substance use, or imprisonment. However, its increasing prominence has surfaced conceptual uncertainties and potential tensions with other understandings of health inequalities. We undertook a discourse analysis of how recent health inequalities policy documents describe, explain, and make recommendations relating to inclusion health. Using the UK as a case study, and with reference to public health accounts of multi-level governance theory, we selected five recent health inequalities policy reviews covering Scotland, UK, European Union, and the World Health Organisation. All documents referred to some inclusion health concerns, though their relative emphasis differed between documents. Terms like inclusion, exclusion, and vulnerability were commonly used, but ill-defined and often ambiguous. Explanatory discourses were diverse, with a particular focus on intergenerational cycles and disproportionate exposure to risk, with a varying emphasis on individual versus structural factors. Few documents provided coherent explanatory accounts for the relationship between the issues of interest to inclusion health, their associations with poor health, and other axes of inequality. Our results suggest that health inequalities policymaking in a multi-level context may benefit from comprehensive conceptual frameworks which encompass diverse forms of social stratification, advantage, and disadvantage, and acknowledge potential tensions and trade-offs between different understandings. This may necessitate further theoretical and empirical work for inclusion health on its definitions, bounds, and how its scope of interest interacts with other forms of social and health inequality. [ABSTRACT FROM AUTHOR]

Multimorbidity has become an increasingly prominent lens through which public health focuses on the 'burden' of ill health in ageing populations, with the promise of a more upstream and holistic approach. We use a situational analysis (drawing on documentary analysis and interviews with service providers, policy actors and people living with multiple conditions) in south London, UK, to explore what this lens brings into focus, and what it obscures. Local initiatives mobilised the concept of multimorbidity in initiatives for integrating health care systems and for commissioning for prevention as well as care. However, as the latest of a series of historical attempts to address system fragmentation, these initiatives generated more complexity, and a system orientated to constant transformation, rather than repair or restoration. Service providers and patients continued to struggle to navigate the system. Dominant policy and practice narratives framed patient self-management as the primary route for addressing individualised risk factors on a trajectory to multimorbidity, whereas the narratives of those living with multiple conditions were more oriented to a relational model of health. The findings suggest possibilities and limitations for leveraging the concept of multimorbidity for public health. In this field, the promise arose from its potential to make spaces for a focus on populations, not patients with discrete diseases. Realising this promise, however, was limited by the inherent tensions of biomedical nosologies, which separate discrete diseases within individual bodies, and from epidemiological approaches that reify the socio-material contexts of failing health as risks for individuals. [ABSTRACT FROM AUTHOR]

We assess the extent and quality of High-Income Countries' (HIC) practices in monitoring Socioeconomic Inequalities in Health (SIH) through routine data collection/collation and analysis systems. Official websites of government authorities of eligible countries were examined for any reports containing data on SIH, which were assessed for quality from an epidemiological perspective, using published guidelines for monitoring of socioeconomic inequalities in health status.Despite the global commitment to Sustainable Development Goal 10, and recommendations of the WHO 2008 Commission of Social Determinants of Health, most of the thirty-six HIC whose websites were searched appear not to be routinely monitoring SIHs. Only seven HIC websites were found to have SIH monitoring reports that were readily discoverable on their official websites. Only two countries (England and Scotland) have been publishing such trends in detail for more than a half-decade. Although an SIH monitoring system is not itself a sufficient condition for reducing SIH, it is likely a necessary one. For countries that are planning to establish a system, lessons from others who have established such systems include the value of routinely and automatically post-coding of major health outcomes, with robust assignment of average socio-economic status to each local area. [ABSTRACT FROM AUTHOR]

Assumptions about time, value, labour, and health coalesce in the policy decision to extend the pension eligibility age in Australia from 65 to 67 years. Acknowledging the multiple, often incompatible ways in which time is conceptualised and experienced, we question the expectation of extending Australians' working lives. Drawing on semi-structured interviews with 19 male and female bus drivers over the age of 55 in Australia, we illustrate that older blue collar workers may accumulate chronic health conditions that not only limit their ability to maintain the strict time-discipline required to remain in the workforce, but also introduce demands on their time beyond paid employment (including those required for the management of chronic health conditions). Poor health, and the multiple ways in which it constrains labour participation and time, fosters diverse, unequal, and uneven experiences of the final years of work for these blue collar workers, which may not allow them to meet the policy expectation to work until the age of 67. We argue that by failing to acknowledge the long-term health effects of blue collar work and its work-limiting bodily effects, raising the pension age devalues industrial work histories and manual labour. Finally, acknowledging the social milestone of retirement, we question the moral dimensions of extending the pension eligibility age. [ABSTRACT FROM AUTHOR]

Public health agencies tasked with improving the health of communities are poorly supported by many 'business-as-usual' funding practices. It is commonplace to call for more funding for health promotion, but additional funding could do more harm than good if, at the same time, we do not critically examine the micro-processes that lead to health enablement – micro-processes that are instigated or amplified by funding. We are currently engaged in a university-and-policy research partnership to identify how funding mechanisms may better serve the practice of community-based health promotion. We propose three primary considerations to inform the way funds are used to enable community-based health promotion. The first is a broader understanding and legitimising of the 'soft infrastructure' or resources required to enhance a community's capacity for change. The second is recognition of social relationships as key to increasing the availability and management of resources within communities. The third consideration understands communities to be complex systems and argues that funding models are needed to support the dynamic evolution of these systems. By neglecting these considerations, current funding practices may inadvertently privilege communities with pre-existing capacity for change, potentially perpetuating inequalities in health. To begin to address these issues, aspects of funding processes (e.g., stability, guidance, evaluation, and feedback requirements) could be designed to better support the flourishing of community practice. Above all, funders must recognise that they are actors in the health system and they, like other actors, should be reflexive and accountable for their actions. [ABSTRACT FROM AUTHOR]

During the last two decades, there has been a significant reappearance of social movements as a response to social injustice, inequalities and diverse forms of discrimination. In the public health context, these movements constitute a democratic option to dampen the negative impact of health inequities on people's lives, by placing their real health needs in the public agenda. We explore the rise of the #bombadeinsulinaalAUGE movement in Chile, which was led by patients with type 1 diabetes. In 2015, these patients demanded that Michelle Bachelet's government incorporate the insulin pump into the universal health cover plan for diabetes. Through a qualitative approach, we analyse the repertoire of strategies undertaken by this movement to achieve its goal. We argue that the causes underlying the success of #bombadeinsulinaalAUGE stem from its ability to accommodate said repertoire in response to the political and institutional context, while creating collaborative interactions with the state. This study contributes to the understanding of the political consequences of social movements, providing insights from the Chilean context, where health movements are an emerging phenomenon. This topic is of interest to public health as social movements have the potential to transform health systems, improving the well-being of the general population. [ABSTRACT FROM AUTHOR]

The author reflects on the efforts to change the discursive practices and material conditions to transform public health in Great Britain. Also cited are a study on how the government and commercial players allegedly used the concept of complexity to justify their inaction against the structural drivers of poor dietary public health, and the criticisms against the concepts of resilience and survivorship in healthcare.