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Many western countries have experienced increased rates of youth suicide over recent years. This has been an issue of particular concern in New Zealand, since it had the highest rate of youth suicide among OECD countries in the mid-1990s. However, while attention is drawn to the now declining youth suicide rate by politicians and policy-makers, what is obscured is a cohort effect. In this paper we will argue that a cohort effect is clearly visible; suicide rates among 15-24 year olds came to the fore in the mid-1980s, peaking 10 years later, and were displaced by that among 25-35 year olds by the late-1990s. Further, this century has been characterised by the rise of suicide rates among 35-44 year olds. This effect correlates with a dramatic downturn in the New Zealand economy in a five-year period bracketing 1970. We argue for an increased focus on social and economic factors underlying suicide. [ABSTRACT FROM AUTHOR]

Despite almost two decades of reform under Australia's National Mental Health Strategy, the life circumstances of many people with mental illness seem little improved. While lack of rehabilitation, housing and community support services have been blamed for policy shortfalls, there is also concern that mental health services may impede rather than facilitate recovery from mental illness. To explore this particular concern, this paper reports data from a project which evaluated a group mentorship programme for new graduate nurses working in an Australian public mental health service. Prominent among the problems raised in mentorship group discussions were: the arduous nature of mental health work; the uncaring attitudes and practices of many veteran nursing staff; and the maltreatment and neglect of service users. These participants characterised mental health facilities as tough security-minded places, where staff act more as risk-managers rather than therapists, and all service users are treated as if they might be dangerous. They also perceived a connection between the dismissive ways in which they were often treated by veteran colleagues and the widespread mistreatment of service users. [ABSTRACT FROM AUTHOR]

This paper reports on a qualitative study of UK mental health practitioners' experiences of working with the contested condition, dangerous and severe personality disorder (DSPD). Our interviews focused on the issues of treatability, risk assessment and decision-making in multi-disciplinary teams. We discuss the approach of values-based medicine (VBM) as a useful framework for interpreting the data: respondents cited both explicit values (based on occupational training) and implicit values (based on personal beliefs and subjective perceptions). There was evidence of conflicting values -- within individuals, between occupational groups, and between individuals in occupational groups -- which led to widespread uncertainty and caution about whether and how those with 'dangerous' personality disorders could be treated. These disputes were resolved by a 'slide to pragmatism', whereby practitioners, reluctantly acknowledging their own empowerment in the process, sought to make whichever choice was least risky for their own professional reputation, and most pragmatic, given the resources available. [ABSTRACT FROM AUTHOR]

Understandings of culture and multiculture are broad and deeply embedded in every day talk and practices. In an increasingly globalised world, how we understand and work with these terms affects how parents and their families experience health care services and the support intended by health care professionals. This is particularly important for parents who are new to Australia. In this paper we report on findings from an ethnographic study undertaken across two community child and family health nursing sites in South Australia. Using examples, we explore how child and family health nurses appear to understand and use constructs of culture and multiculture during everyday, intercultural communication with parents who are new to Australia and Australian health services. By analysing these understandings through postcolonial and feminist theories we found pervading evidence that neo-colonial constructs of a white western monoculture shaped intercultural communication practice. We conclude by reflecting on how these constructs might be addressed to improve intercultural communication in child and family health settings. [ABSTRACT FROM AUTHOR]

Contemporary health policy increasingly positions responsibility for the management of health with the individual which reflects newer neo-liberal discourses of health. Such an approach can be seen as problematic in the context of men's health, with men tending to be seen as largely 'irresponsible' towards their own health. This paper addresses this question by drawing on qualitative data on how men conceptualise responsibility for health. Whilst the desire to be responsible for health was borne by most of the men in the study, this was not always reflected in practice. There was also evidence of strategies that men adopted for either divesting themselves of responsibility for health or for legitimising lack of responsibility. In some instances, acting 'irresponsibly' was what defined participants as 'real men'. The implications of these findings for men's health policy are discussed with specific reference to the recent publication of Ireland's National Men's Health Policy. [ABSTRACT FROM AUTHOR]

The emphasis on a sexualised muscular body ideal in gay social and cultural settings has been described as facilitating body image dissatisfaction among gay men. Drawing on a concept of reflexive embodiment, this paper uses qualitative interviews to analyse gay men's embodiment practices in relation to discourses and norms that can be found across and beyond any coherent notion of 'gay subculture'. The findings reveal body image to be more complex than a limited focus on subculture or dissatisfaction can account for. In particular, gay men negotiate a gay pride discourse in which the muscular male body generates both social status and self-esteem, and deploy notions of everyday masculinity that imply rationality and control to resist gendered assumptions about gay men's body image relationships. [ABSTRACT FROM AUTHOR]

Food is a significant part of the daily worship, health and social life of individuals across cultures and religions. This is especially the case for vegetarian religious minorities such as the Indian sub-continental borne Hare Krishna movement, the Christian Seventh-Day Adventist Church and various Buddhist groups. These devotees define spirituality as more than simply the state or quality of being committed to 'God', religion and immaterial spiritual concerns. This paper argues that there are visible, tangible and even biological frames of reference from which spirituality within the aforementioned religious groups should be considered. The concept of bio-spirituality introduced here, embodies and grounds matters pertinent to faith, health and worship in the everyday social actions and interactions of devotees both inside and outside the sphere of the temple or church. Bio-spirituality is a conceptual tool that accounts for the relationship between supernatural belief, and the natural physical environment. It was formulated to encapsulate the social, nutritional and spiritual dimensions of 18 self-identified religious vegetarians who were interviewed as part of larger qualitative study of alternative food habits and practices. [ABSTRACT FROM AUTHOR]

Contemporary Western societies focus considerable policy and media attention on the 'epidemic of childhood obesity'. In this paper we examine the mobilisation of notions of responsibility and consumption in these discussions, and consider the implications they have for women as mothers. In particular, we are interested to explore the potential conflicts mothers face as care providers and nurturers when responsible care is framed as withholding or managing the food consumption of children. We argue that the competing discursive frameworks around mothers' food provision invite further theorisation that explicitly addresses nourishment and consumption as elements of maternal practice and care. We draw on the work of Neysmith and Reitsma-Street (2005) regarding 'provisioning' to undertake a critical examination of the discourses in the 'childhood obesity' epidemic, with particular attention to Australian media and policy discussions. According to Neysmith and Reitsma-Street, mothers are central to social 'provisioning', that is, the labour that secures the necessities of life. This provisioning framework captures paid market work and unpaid caring labour, policy settings and social locations, allowing for a rich conceptualisation of the conditions mothers negotiate as they provide for their children. Taking up the possibilities of this framework, we argue that, insofar as health risks and responsibilities are largely individualised, mothering is framed as primarily about giving, and childhood obesity is considered a disease of affluence and over-consumption, imperatives for maternal provisioning and nurture are potentially in conflict with critiques of consumption and excess. [ABSTRACT FROM AUTHOR]

Despite recent critiques of contemporary obesity discourses that link 'modern Western lifestyles' to an 'obesity epidemic', the population's weight remains a central concern of current dietary guidelines. Food choices that are considered beneficial to maintaining a certain weight are understood to play a key role in one's health. This concern reflects medico-moral assumptions about the properties of food and what people should eat. However, the impact of obesity discourses on different individuals and social groups is rarely considered, although there is some evidence that people do generate, reflect and resist the norms and standards set for them, including those that relate to food/weight. In this paper, we will examine the perspectives on fatness and food choice amongst Black and White women and men living in Vancouver and Halifax, Canada. With this examination, we will challenge conventional assumptions about the singular 'modern Western lifestyle' that leads to obesity concerns by teasing out some of the social, cultural and political contexts within which people conceptualise issues regarding weight and make their food choices. By examining the experiences of both women and men we will also provide important insights into the gendered ways in which people engage with obesity discourses and the injunction to 'eat healthily' as a form of weight management. [ABSTRACT FROM AUTHOR]

O'Malley and Valverde point out that in the 21st century, pleasure is a warrantable motive for drug and alcohol use only when it is attached to the idea of moderation. This presents a problem for those researchers who wish to theorise about those individuals who use drugs deliberately to induce intoxication. This paper uses unconventional means to come to an understanding of intoxication. It uses the stories of interviewed former heroin addicts, published autobiographies, biographies and even some fictional accounts to come to an understanding of the difficulties of dealing with intoxication and the drug-using subject. It also uses the accounts that Michel Foucault gave about his own use of drugs and its relationship to an ethics of pleasure and resistance. The article uses theories of risk and edgework to understand the underlying meanings of intoxication to many drug users. [ABSTRACT FROM AUTHOR]

The relationship between ethnicity and the use of ‘party drugs’ (e.g., methamphetamine and ecstasy) has received little attention in Australia. This paper focuses on ethnicity and party drug use within the context of dance parties and clubs in Melbourne, Australia's second largest city. The young people who participated in our research, many of whom are long-time dance party attendees, or ‘old skool ravers’, frequently made claims to the possession of subcultural capital by labelling as ‘muzzas’ those they perceived to be outsiders to the dance scene. Muzzas are defined as heavily muscled young men, commonly of Southern European or Middle Eastern background, who use cocaine and steroids, have ‘no class’ and dance in an overly aggressive way. Although the old skool ravers were often from similar ethnic backgrounds to muzzas, they rarely drew on ethnicity in forming their own identities. They did, however, explicitly invoke ethnicity in the distinctions they created between themselves and muzzas. Their claims to subcultural capital are based on notions of nostalgia and an authentic involvement in the dance scene, and on their perceived distance from a mainstream culture consisting of ‘normal people’. [ABSTRACT FROM AUTHOR]

Knowledge about disease and illness usually emerges as a result of complex social negotiations among those with a stake in the outcomes of this knowledge. These negotiations can involve a range of agents and discursive avenues, some of which are contradictory and paradoxical. This is especially true for the blood-borne virus hepatitis C, the medical, social and political features of which – associations with injecting drug use, ‘tainted blood’ scandals and HIV – render it a controversial disease involving a range of highly motivated stakeholders. In this paper I analyse one such set of agents in the process of disease knowledge negotiation: self-help books on hepatitis C. In conducting this analysis I offer insights into the content of the books and the way they construct hepatitis C and those who have it. I do this by mapping three key issues helping to shape the way hepatitis C is constituted in these books: HIV, injecting drug use and iatrogenic (medically caused) transmission, and by exploring the implications of the themes of emotion, risk and guilt that arise in the playing out of these issues. In the process I aim to make sense of the complexity of disease, its social constitution and its role in shaping social phenomena such as stigma. [ABSTRACT FROM AUTHOR]

Through interviews with users and providers of anti-ageing medicine in Australia as well as the analysis of various internet sites, anti-ageing clinics, journals and magazines dealing with anti-ageing medicine, this paper will argue that the anti-ageing industry in Australia is an example of how ‘mediascapes’ operate, seeking in this case to replicate the American model while developing a more localized practice meeting local needs, cultural orientations and regulatory frameworks. The products being studied here include some which have been on the market for many years in the Complementary and Alternative Medicine (CAM) industry, but have only recently been rebranded as ‘anti-ageing’. These include vitamins, anti-oxidants, supplements such as beta-carotene, selenium and coenzyme Q10, homeopathic products, exercise and diet programs. Other products that have been recently labelled as ‘anti-ageing’ and are included in this study are hormone therapies, testosterone, melatonin, Human Growth Hormone (HGH), and Dehydroepiandrosterone (DHEA). These products have been previously trialled and used in the treatment of medical problems such as heart disease, sexual dysfunction, cognitive and memory loss problems, and hormonal deficiency. Current medical research on stem cells, particularly embryonic stem cells, has also fallen within the realm of anti-ageing treatments developed from this research area and available primarily in countries with limited regulation and control over the use and availability of embryonic stem cells in the context of the private anti-ageing clinic. The differences and similarities between the practice of anti-ageing medicine in Australia and in America highlight current tensions and correspondences in the manner in which ageing is being constructed, managed and experienced. They are indicative of the impact that social policy directions, regulatory frameworks and economic policies have on the way in which ageing individuals and society at large approach the experience of old age. [ABSTRACT FROM AUTHOR]

This essay critically examines the process of governmentality as revealed in the construction and resistance to the categorisation and classification of ‘Healthy Senior Citizenship’. This also includes an illustrative analysis of data from a national UK qualitative interview study of the input into the policy process of older adults in voluntary and community organisations. The paper demonstrates how governmentality finds its expression within the construction of healthy senior citizenship as synonymous with activity and participation within the technologies of collaboration and consultation. The conclusion reflects upon developing a critical sociology of old age in order to scrutinize conceptions of the ‘problems’ of governing an ageing population in post-welfarist or advanced liberal states. [ABSTRACT FROM AUTHOR]

The 21st century will be characterised by aged and ageing nations, making eldercare a growing concern. Most eldercare in most nations will be provided informally, primarily by female family members. Helping these people understand the dimensions of eldercare is a key to effective and cost-effective caregiving. The Person-Environment Model (Lawton and Nahemow 1973) is proposed as a theoretical framework for understanding, assessing, and optimising family-based caregiving. This paper presents findings from a qualitative study of informal rehabilitation caregiving provided to elderly stroke survivors in Thailand. Four main rehabilitation dimensions (biological, psychological, social, spiritual) are identified, as are three main caregiver needs (information, assistance, and support). We suggest that while the Person-Environment Model is useful in developed nations, it is perhaps more valuable in societies where fewer options to family-based eldercare exist, and thus where effective informal eldercare is more critical. Implications for education and training of health care providers are also discussed. [ABSTRACT FROM AUTHOR]

This paper examines the extent to which US citizenship status affects the probability of a person's having a usual source of care and the predictors associated with access to health care among non-citizens. The research is founded on the analysis of data from the 2005 California Health Interview Survey (CHIS) (n = 33,187 adults, ages 18–64). Guided by a modified Andersen model of access to health care, the researchers conducted a series of logistic regression analyses using the survey data to compare native-born citizens with non-citizens who were 1.6 times less likely to access a usual source of care. Among non-citizens, insurance status, shorter duration of residence in the United States, and lower levels of English proficiency were related to a lower probability of having a usual source of care. Based on this research it is argued that affordable health care and health insurance options and access to culturally and linguistically sensitive services are needed to increase access to health care among these identified subgroups of non-citizens. [ABSTRACT FROM AUTHOR]

This paper reports on a case study which examined mental health service users and carers, public housing tenants and non-government organisations' (NGO) participation and representation within policy processes. A particular focus was influence upon policies aimed at achieving housing outcomes for people with a psychiatric disability. The research was a case study of a period of mental health system reform in South Australia (2000–2005) and involved primarily qualitative research; interviews, focus groups and participant observation, as well as document analysis. Participants (n = 92) included service user and carer representatives, public servants from across the health, housing and disability sectors, and NGO professionals from across sectors. The study found that the community participation that existed during the reform period was largely an end in itself rather than a means for groups to shape policy processes, including housing policy. A number of barriers to service users and NGOs influencing policy agenda setting and implementation were determined and described. A range of strategies and processes to enhance community participation, representation and accountability in policy processes are recommended. These include cross-sectoral policy development and accountability mechanisms, advocacy coalitions across sectors for policy agenda setting, public forums involving both service users and professionals, and challenging ‘consumerist’ discourses on participation. Such strategies could facilitate policy debates on housing for people with a psychiatric disability, counter dominant professional interests within policy networks, and help to address community stigma. [ABSTRACT FROM AUTHOR]

In Australia, fluoridation was first endorsed as an effective, safe and equitable means of improving population oral health over fifty years ago. However, recent opposition to attempts to introduce the measure in several regional Victorian towns has demonstrated that it remains a highly controversial health policy. This paper investigates the history of the Victorian fluoridation debate within a national and international context. It finds that although the evidence concerning fluoridation has advanced considerably, the essential arguments put forward by proponents and opponents have remained largely unchanged over that time. Protagonists incorporate the same scientific evidence yet come to polarised and unshakeable conclusions. I argue that the concept of deep structure ideation is a useful means to understand how this occurs. Furthermore, analysis of the ideas and social processes that determine a partisan position in the fluoridation debate makes this an important case study for approaching other durable scientific controversies. [ABSTRACT FROM AUTHOR]

This paper challenges the notion of a shared social identity resulting from a self care skills training programme through exploring the engagement, experience and outcomes of participants from different social groups: sub-Saharan asylum seekers and gay men. In the former group norms and values about priorities and management of HIV differed significantly from the programme's underlying philosophy of individualism. Some needs were similar, but learning self-management skills was not the priority it was for gay men as pressing needs arising from their asylum status (to address social problems, access welfare and achieve marginal residential status) overwhelmed self care attempts. A focus on self-efficacy and individual behaviour change is likely to leave unaddressed social and material needs, inadvertently adding insult to injury. However, alternative benefits included sharing ‘experience’ and the perceived ‘problem’ that being an asylum seeker posed to other people. The contexts of location, needs, identities and social position are important in understanding self care support innovations. [ABSTRACT FROM AUTHOR]

Healthy eating in schools is central to UK Government attempts to redress nutritional deficiencies and combat childhood obesity. However, there is little consideration of the local, contextual spatial factors that contribute to the ways in which particular policy initiatives are experienced at the school level. This paper presents findings from an evaluation of the 'Eat Well Do Well' programme in Kingston-upon-Hull, UK: an innovative scheme providing free, healthy food to all primary school children. Data is presented from an ethnographic study of two case study schools illustrating how notions of 'spatiality' augment our understanding of the ways policy intention is mediated. We consider the potential of primary school meals policy to address health inequalities using the concept of 'spatiality' to examine the interconnections between the aesthetic, temporal, social and spatial elements of school dining environments. We conclude optimistically, suggesting that an engagement by health policy developers with what we call the 'spatial imagination', might be useful in examining and developing factors that ensure the effectiveness of interventions addressing the determinants of ill health. [ABSTRACT FROM AUTHOR]

This study explored the racial identity of Indigenous children and youth who attended urban, state and private primary and secondary schools in the Noongar[i] region of urban Perth in Western Australia. Thirty five Australian Indigenous children aged 8-12 were interviewed and 120 youth aged 13-17 participated in focus groups. Transcripts were analysed and common themes were identified by extracting relevant responses and their meanings. The components of racial identity for children aged 7-12 and youth were very similar such that culture, family, language and appearance featured. The most reported element of racial identity for young children was culture which comprised of eight sub-elements. Young people however, reported that a strong sense of self was the most important contributor to their racial identity and it comprised of ten sub-elements. Indigenous youth perceived that their racial identity is exposed to others' attitudes, values and behaviours because according to them 'identity is about what you look like and how others see you'. [i] Noongar can be spelled in a number of ways and this paper has adopted the above spelling. Noongar is a collective term that denotes Aboriginal people of the south-west of Western Australia (Palmer & Collard 1993). [ABSTRACT FROM AUTHOR]

Breastfeeding is the optimal nutrition for infants and requires the infant and mother to spend significant time together. In July 2006 the Australian Government introduced the Family Law Amendment (Shared Parental Responsibility) Act 2006 (Cth) (the Shared Parental Responsibility Act 2006) which puts in place a legal presumption of shared parental responsibility for children after separation and which emphasises 'equal time' parenting arrangements. The expectation of 'equal time' or substantial and significant parenting arrangements becomes problematic when considering breastfed children. Decisions about parenting of children under the Family Law Act 1975 (Cth) are required to be made with the 'best interests of the child' as the paramount consideration; a central tenet of the Act which remains in place following the Shared Parental Responsibility Act 2006. There appears to be a tension in determining the best interests of the child in cases where children are breastfed and their father is seeking equal or substantial shared care arrangements. This article begins a discussion about the decisions regarding 'shared parenting' of breastfed children that do not always appear to be in the best interests of children's health and well-being. Two cases from an on-going study to investigate breastfeeding women's experiences of the implementation of the Act will be used to illustrate that the court made decisions for breastfeeding mothers are not consistent and compromise the ability of women to continue breast feeding. The paper argues that the Shared Parental Responsibility Act 2006, and the decisions made, can work at a macro-level to produce social and health disparities for these children. Further questions are raised about the best interests of children when domestic violence and/or abuse are present. The impact of this new law on the continued breastfeeding of very young children is an unacknowledged consequence and a public health concern. [ABSTRACT FROM AUTHOR]

Using a large contemporary United States data set, the National Longitudinal Survey of Youth-Child Supplement (NLSY-CS), this paper examines the relationship between parental work schedules and adolescent depression at age 13 or 14, paying particular attention to the mechanisms that may explain this relationship. Analysis based on structural equation modelling showed that increased work at night by mothers was significantly associated with a lower quality of home environment and fewer meals together, and this mediator was significantly linked to increased risks for adolescent depression. In addition, evening work by fathers was significantly associated with lower paternal closeness and this mediator was significantly associated with increases in adolescent depression. In contrast, irregular shifts by both mothers and fathers increased the likelihood of mothers knowing where the child was and this relationship in turn reduced adolescent depression. Implications and avenues for future research are discussed. [ABSTRACT FROM AUTHOR]

This paper discusses the perspectives of 18 people who were living with HIV/AIDS in Melbourne, Australia, and who were using complementary and alternative medicine (CAM) alongside biomedicine. I argue that although people may perceive the holistic focus of CAM to be more desirable than the more pathogenic focus of biomedicine, a holistic approach is also associated with limitations. In this study, participants were motivated to use CAM because of the perceived limitations of biomedicine and also because of a desire to have control over how their illness was managed. However the majority of participants were not interested in the philosophical principles of CAM, rather in whether these therapies were effective and manageable. These findings suggest that although people may hold different beliefs about CAM as compared with biomedicine, an approach to healthcare that has a practical focus on both clinical outcomes and patient wellbeing may be acceptable to most people. [ABSTRACT FROM AUTHOR]

New Zealand research suggests that CAM use by GPs has decreased, while referral to CAM practitioners by GPs has increased, and that patients often do not tell their health practitioners when they are using CAM. The New Zealand Medical Council has developed guidelines for GPs who use CAM. However, there is no research in New Zealand that looks at how patients and GPs respond to CAM issues in the consultation. This paper uses data collected for two research projects on doctor-patient interaction. For this research, consultations between 105 patients and nine GPs were video-recorded. In this data set, all doctors but one were 'orthodox' and to some degree reserved judgement on CAM, albeit remaining cautious in how they made this evident. Patients on the other hand demonstrated a variety of strategies to get CAM on the agenda, and GPs were careful to couch any criticism in such a way as to protect the 'face' of patients. [ABSTRACT FROM AUTHOR]

Many critics have previously examined the ways in which the pervasive construction of the family in Western nations - that of the heterosexual nuclear family - is normalised and naturalised in a range of contexts. This paper examines discourses of genetics and the 'family' in a series of UK newspaper articles, many of which are non-normative family forms, including families who have used assisted reproductive technologies, and lesbian and gay parented families. We analyse the ways in which genetic discourse is employed in these articles in relation to complex social and psychological issues regarding identity, psychological adjustment, and appropriate parenting and family structures. In particular, genetically-unrelated families (or those who use technologies to produce genetically-related offspring) are constructed as problematic and, thus, we argue that dominant genetic discourses function to reproduce, and construct as 'natural', socially-conservative notions of the family, further marginalising non-heteronormative families. [ABSTRACT FROM AUTHOR]

As Australian reproductive health continues to be shaped by legal and social heterosexism, lesbian women seeking to conceive are often reliant upon gay men to act as known donors. As previous legal cases demonstrate, this can result in contestations between donors and recipients that result in negative well-being outcomes for both parties, and which highlight the limitations of coalitionism within gay and lesbian communities. Using data collected via interviews with Australian gay men who have acted as known donors, this paper examines some of the ways in which such men experience the negotiating of sperm donation, and how this is often shaped by normative assumptions surrounding lesbian parenting and reproduction. Importantly, the findings also emphasise the positive experiences of sperm donation of some gay men. Suggestions are made for opportunities to increase the likelihood of positive outcomes for negotiations between donors and recipients, with a particular focus upon children’s rights as citizens. See also: Riggs D (2007) Becoming parent: Lesbians, gay men and family, PostPressed, Brisbane. [ABSTRACT FROM AUTHOR]

This article analyses the seven year long Victorian political, policy and law reform debate over eligibility criteria for assisted reproductive technology (ART), emphasising the ways in which medicalised discourse and assumptions framed the arguments advanced by various stakeholders. It argues that despite the positive political, social justice and health gains for lesbian and gay prospective parents and their children that were ultimately achieved, the case made for the decriminalisation of self-insemination and increased access to clinical ART services also involved some disappointing political and intellectual compromises along the way. Although lesbian activism regarding ART eligibility criteria was often consistent with a position of what could be called ‘constructive medicalisation' (Broom & Woodward 1996), the debate also demonstrated how easily constructive medicalisation arguments were side-lined in favour of arguments drawing on dominant medicalised discourses about infertility treatment and risk. [ABSTRACT FROM AUTHOR]

This paper contributes to debate in Australia about sexuality-based restrictions on access to Assisted Reproduction Services, particularly sperm donation by gay and bi-sexual men. It utilises content analysis of print-media and reveals that the public image of sperm donation is saturated with concern about risk, particularly risk to heterosexual donors and their property, from claims made by recipient women and their children. In contrast, a detailed analysis of the profiles of men who register to donate sperm through the Australian Sperm Donor Registry reveals that most donors are open to identity disclosure. However a marked difference is evident between heterosexual and gay/bisexual donors with the latter being significantly more likely to desire contact with children born of their donations. It appears sperm donation offers gay and bi/sexual men an opportunity for family formation and parenting which is denied by Australian laws and clinical practices that exclude them from Assisted Reproduction Services and adoption. [ABSTRACT FROM AUTHOR]

Preventing disease is by definition a valuable objective, and most debates have revolved around improving the effectiveness of prevention. In this discussion, I explore the latent functions - the unintended consequences - of what I call the 'project of prevention'. Although many latent functions are welcome, some have undesirable effects, and it is therefore important to instigate a rich exchange between innovative theory and rigorous research to minimise such effects. I argue that the hazards are particularly acute in the absence of a reflexive and critical awareness of the political environment and the cultural economy within which prevention occurs. In the paper, I sketch the challenges to mobilising that awareness, show some of the limitations of the conventional theoretical approaches to prevention, and point to directions for developing more fruitful perspectives. [ABSTRACT FROM AUTHOR]

In popular, academic and policy discourses it is taken for granted that consumption plays a vital role in the obesity epidemic. Mass consumption, associated changes to 'lifestyle' and the emergence of 'obesogenic' environments are viewed as underpinning the dramatic rise in the prevalence of overweight and obesity. As a result, excess body weight has transitioned from risk factor to 'disease' status, with overconsumption identified as the principal culprit. Using mall walking as a case study, this paper aims to critique the way in which consumption is understood within the obesity literature. Rather than view consumption within a dualist framework of either 'neoliberal choice' or 'modern evil', we seek to establish a theoretical foundation for consumption in obesity literature. Mall walking provides a unique opportunity to examine the multiple, complex and contradictory facets of consumption, of how bodies and spaces are reappropriated and transformed by people who are located in an environment that is characterised as 'obesogenic'. In addition to the generation of identities and social relations, mall walking highlights the inherent paradoxes of consumption: of how consumption is positioned as the problem, and at the same time, as the solution to excess. It is via the ethnographic examination of bodies engaged in consumer spaces that new possibilities for thinking about the analytical relationship between obesity and consumption are opened up. [ABSTRACT FROM AUTHOR]

This paper develops discourse analysis of Australian press representations of dying during the operation of the Northern Territory of Australia's Rights of the Terminally Ill Act 1995 (McInerney 2006). Operating in tandem, the discourses of aesthetics and embodiment constructed contemporary dying as an intolerable corporeal state. The body in disarray is attractive to media imperatives of drama and crisis, and dominated press reports during the analysed period. Such images functioned as absolute justification for a medicallyinduced requested death. Modern equating of physical integrity and personal dignity supports such responses to dying. The requested death interventions of euthanasia and physician-assisted suicide were depicted as halting the physical deteriorations associated with terminal illness and thereby redeeming the dying person, by providing them with the opportunity to reclaim the social status lost via their progressive corporeal decline. [ABSTRACT FROM AUTHOR]

This paper reports on a recent population-based study of the last months of life of 1071 people in Western Australia who died from a chronic condition. Data was collected from death certificates and telephone interviews of primary carers who acted as proxies providing second hand accounts of the severity of the deceased person's symptoms and sources of concerns, their awareness and acceptance of dying, and experiences of the health care system. We present descriptive statistics and quotes supporting our premise that dying in Australia is largely mismanaged. We base our assertions on three themes: dying with multiple conditions and symptoms; awareness and acceptance of dying; and support during the dying process. Each theme illustrates the difficulty of self-managing complex conditions, the failure of the health care system to acknowledge this complexity, and the need for a more radical and social approach to the management of dying. [ABSTRACT FROM AUTHOR]

The aim of this paper is to explore how the avoidance of death preoccupies the focus of most health professionals, including policy makers, in the western world, and the implications of this for the lives of people with chronic diseases. Avoiding death has become the ultimate challenge in the provision of contemporary healthcare. An implication of this way of thinking for people with chronic diseases is that their chronic disease is then positioned as something which will produce a death which could have been avoided. Such a death is then viewed as failure, not only biological, but also social. However, such failure is also position [ABSTRACT FROM AUTHOR]

The four years from 2001 to 2005 saw the roll out of an innovative social enterprise on one of Melbourne's high rise public housing estates, Atherton Gardens. It provided residents with access to personal computers, computer training, an intranet, internet and email, as well as establishing a training room, open access computer lab, repairs workshop and a help desk service for computer users. This paper reports on a three year research project which was undertaken to assess the impact of this initiative and to analyse its effects, not only on residents' access to and use of new forms of information and communication technologies, but also the less tangible effects of an electronic network on health, social capital and community well-being. [ABSTRACT FROM AUTHOR]

Because the HIV/AIDS crisis in Kenya is causing the death and disablement of so many prime- aged adults, households are increasingly being headed by adolescents and the elderly. The purpose of this paper is to examine the health status of one of the most vulnerable groups in Kenyan society - adolescent women - and to explore how the type of household head impacts on their health status. Using data from the 2003 Kenya Demographic and Health Survey (KDHS), an indicator of illness signs was used as the dependent variable for health status. Significant differences were found in the health status of adolescent women in households headed by adolescents, prime-aged adults, and the elderly. Even when controlling for demographic factors, residing in an adolescent headed household increased the odds that an adolescent woman would have recently experienced some signs of illness. Other factors which also increased the odds of illness were being married and being in the older age group (20-24). Wealth barely had any impact on illness. Service providers need to pay special attention to the needs of adolescents in non-adult headed households. [ABSTRACT FROM AUTHOR]

With rapid developments in life-prolonging technologies and increases in average life expectancy, euthanasia has become an increasingly topical issue. This paper contributes to the euthanasia debate an analysis of Australian attitudes to assisted suicide, active non-voluntary as well as passive non-voluntary euthanasia. Between 1993 and 2002, Australians supported access to voluntary euthanasia of the terminally ill, but had reservations when death was not imminent. The age of patients was relatively unimportant in these considerations. Non-voluntary euthanasia of babies and adults received widespread approval only when particular situations could be defined as 'letting die' rather than 'killing'. [ABSTRACT FROM AUTHOR]

This paper examines the governance of the medical profession in the UK. As in many other countries, external and internal pressures have brought a shift in relations between the state and medicine. From a relatively protected position within the British NHS, where clinical autonomy, social status and involvement in a corporatist politics, the context in which doctors practise has undergone radical change. In common with many countries, the UK has turned to competitive markets, and state-sponsored regulatory measures to boost performance. As a consequence, state domination of the health policy agenda has increased replacing a corporatist politics and doctors' individual clinical autonomy has been reduced. Moreover, the existing system of self-governance is in question. It is argued that, nevertheless, there is evidence of different forms of accommodation. The medical profession continues to control a valued knowledge base, retains its social standing and is able to reap economic rewards. A more plural form of medical leadership may emerge better suited to assuring quality in patient care. [ABSTRACT FROM AUTHOR]

There has been a renewed interest in collaborative models of health care delivered by 'interdisciplinary teams' of providers across several health care systems. This growing phenomenon raises a host of issues related to the management of professional boundaries and the contemporary state of medical dominance. In this paper, we undertake a critical analysis of the factors both promoting and impeding collaborative care models of primary and mental health care in Canada and the U.S. The data our arguments are based upon include a combination of documentary and interview data from key stakeholders influential in various collaborative care initiatives. Based on these data, we develop a conceptual model of the various levels of influence, focusing in particular on the macro (regulatory/funding) and meso (institutional) factors. Our comparative policy and institutional analysis reveals the similarities and differences in the influences of the broader contexts in Canada and the U.S., and by extension the different ways that the structural embeddedness of medical dominance impinges upon and reacts to recent policy changes regarding collaborative health care teams. [ABSTRACT FROM AUTHOR]

This paper deals with the dynamics of medical dominance and patient choice, primarily within the Britain, with reference to a range of other European countries too (including Germany, France and Greece) for comparative purposes. It will draw upon two concepts in particular: 'responsibilisation' and 'proto-professionalism', the first undermining medical dominance the latter reinforcing it. The ongoing influence of a neo-liberal and managerialist agenda has eroded the certainties of the welfare state and the assumptions underpinning the dominant role of the medical profession, which has been subjected to increasing external state regulation and control (Dent 2003a). These reforms, which are associated with New Public Management, have been aimed at bringing the cost and quality of health care more effectively under the control of the state. This has involved redefining the compact or contract between the medical profession, public and the state. In this project greater emphasis is being formally given to the wishes of patients. Rather than the physician claiming to be the patient's voice it is now the state administration's assertion to have provided the patient with their own voice(s) - and choices. [ABSTRACT FROM AUTHOR]

This paper addresses two questions. Firstly: are the risk regimes faced, and perceived, by pregnant women in rural Lao PDR substantially different from those experienced by pregnant women in western societies? Secondly, if the Lao experiences and perceptions are different, can improvements in maternal health in Lao PDR be achieved without Laotians inheriting the risk regimes of late modernity experienced by many women in western societies? Secondary analysis is undertaken of data collected in 2005 for the evaluation of a pilot maternity waiting home in Bolikhan, Lao PDR. The results suggest significantly different risk perceptions and experiences between Lao and western communities, based on contrasting views of embodiment, identity construction and cosmologies. In the Lao rural communities studied, there is little evidence yet of 'risk society' despite the introduction of western technologies and practices to improve maternal mortality and morbidity. It is argued that 'risk society' can be avoided. [ABSTRACT FROM AUTHOR]

This paper examines the use of the categories bisexual and men who have sex with men (MSM) in sex, sexuality and sexual health research. We study the deployment of these categories in the research literature, using sets of studies published between 1990 and 2004 (bisexual set: n = 2,859; MSM set: n = 986). These sets were established using an approach developed by the authors in an earlier review of sexual health literature for the World Health Organisation (WHO). The approach uses insights from Weberian methodology. We ascribe value to research outcomes which provide contextually sensitive evidence for the design and/or evaluation of sexual health interventions, and are concerned about the creation within research of subjects who become reduced to risky or at-risk groups, or subject of public health surveillance and control. The categories bisexual and MSM are mostly ascribed without attention to social or cultural settings, and to designate risky or at-risk populations or behaviours. [ABSTRACT FROM AUTHOR]

Until recently, permanent residents in caravan parks were often absent from discussions about homelessness and housing in the Australian context. When permanent residency was recognised and legislated for in the 1980s, efforts were made to ensure scope for standard community infrastructure such as roads, sewerage and community gathering places. Although the number of long term caravan parks in Australia has recently decreased, on the edge of Melbourne some parks are expanding to cater for a growing clientele reflecting a new and partly de-institutionalised society. This society is characterised by mobile, temporary and casualised work and changing, volatile family relationships; each trend creating a need for different forms of housing. In this paper, preliminary interviews with ten caravan park managers from the outskirts of Melbourne reveal their role in the complex relationship between space, community formation and social solidarity: a relationship which directly impacts on the health and well-being of caravan park residents. [ABSTRACT FROM AUTHOR]

This paper examines the association between civic engagement and self-rated health among a sample of adults living in refugee camps in Jordan. The analysis is based on a cross-sectional sample survey of all households residing in Palestinian refugee camps in Jordan, and interviewed in the spring and summer of 1999. The outcome variable is self-rated health. Associations between civic engagement and self-rated health are assessed using ?2 tests and logistic regression models. Findings from a logistic regression model show that civic engagement, as measured primarily by membership in clubs and other civic groups, has a significant association with self-rated health net of the effects of demographic, human capital and health risk factors. The final model shows that the effects of control variables are in the anticipated direction, with age, marital status, health risk, education and poverty statistically significant. However, the findings pertaining to civic engagement hold for men but not women. We conclude that civic engagement is a powerful and significant predictor of self-rated health status among refugee men living in poor communities, but not for women. Low literacy and persisting patriarchy may account for the non-significant association between civic engagement and health status among women in this context. [ABSTRACT FROM AUTHOR]

There is an emerging trend to recognise the importance of fathers in health service provision. This is consistent with feminist objectives to re-shape fatherhood to enhance gender equity in the home and in the workplace. How best to include fathers in services, overwhelmingly utilised by mothers, is now a topic of considerable interest. However, the desire to re-shape fatherhood in ways conducive to gender equity is easily co-opted by conservative political agendas which do not seek to re-shape fatherhood but re-claim the rights of fathers by re-instating paternal authority within the family. This cooption is facilitated by new fatherhood discourses utilised by many service providers which blame mothers for the lack of fathers' involvement in early infant care. The paper argues that mother-blaming is aggravated by service providers who fail to understand the nature and extent of maternal anxiety and by unrealistic images of the new father. [ABSTRACT FROM AUTHOR]

The traditional stronghold of medical dominance, and thus the construction of the medical labour market, has been challenged by a number of contemporary trends. While the social, economic and cultural trends driving this shift have been explored, the significance of geography as a key determinant in the construction of the medical labour market has yet to be addressed in detail. This paper examines how geographical arrangements have shaped the credentialist requirements for overseas-trained doctors and thus the nature and shape of the stratified medical labour market. The research traces the assessment and accreditation of overseas-trained general practitioners in NSW, focusing specifically on the registration process defining the last decade. Throughout this period the process has been significantly transformed: in the 1990s there was only one pathway to assessment, registration and subsequent entry to the labour market, there are now multiple pathways. An examination of this historical change illustrates how credentialist requirements are negotiated and renegotiated by the various stakeholders in light of shifting spatial demands. [ABSTRACT FROM AUTHOR]

This paper begins with a review of the Chinese government's reforms on the personnel system in the public health care sector since 1978. These policies were designed to give greater economic autonomy to the public health facilities and public doctors in order to stimulate productivity, but failed to satisfy the medical workers. As public employees whose professional knowledge and skills have long been considered as public property, Chinese doctors have been engaged in 'unofficial conduct' to increase income. This 'conduct', which includes taking 'red packets', 'drug kickbacks' and 'moonlighting', is argued to be an unofficial form of the privatisation of professional knowledge and skills. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the editor discusses articles in the issue on topics including the critical importance of sociological theory; and the role of bio-medical, bio-mechanical, and bio- digital technologies in sex, sexual health, and intimacy.

There are numerous ways that researchers can creatively approach social research and translation. This article discusses elements from the first stages of a novel project that centres social research translation in the form of a public exhibition. 'Creative Approaches to Health Information Ecologies' is a project by a multidisciplinary research team in collaboration with an Australian health consumer organisation. The project uses creative workshop methods to explore how people learn, think, and feel about their bodies and health states, and brings attention to the significance of communities, places, spaces, objects, and other living things – the 'ecologies' of health information. It then builds on these insights to create an interactive exhibition of materials designed for public engagement. This reflexive article unpacks how this creative translation-centred collaboration contributed to the make-up of the project team, the project's research methods, and the process of making exhibition materials. We discuss what the research team learned from the process about creative collaboration, research-creation, and research translation. [ABSTRACT FROM AUTHOR]

An introduction to the journal is presented which discusses articles published within the issue on topics including reproductive health among Bolivian migrant women in Argentina, mechanisms for priority setting for the care of cancer patients, and social disparities and health inequalities.