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This concluding paper draws together the dominant themes across the papers published in this issue. The majority of the papers clearly point to disparities between the aims of policy-makers and mental health workers. Using a variety of perspectives and methods, the authors of these insightful papers argue that modernist, rational approaches to structuring and evaluating services are at odds with the professional needs of mental health workers. At one level this critique is self-evident given the messiness and uncertainties inherent in working with service users whose individual problems require flexible approaches tailored from a broad and evolving practice-base. For some authors, the focus is epistemological and methodological; they offer much needed examples of analysing policy construction, interpreting statistics and the concurrent application of the widely used concepts of medicalisation and structural inequality. Together, the papers indicate that the progress of mental health reform in many western countries remains inconsistent and, in some cases, obstructive to effective professional practice. [ABSTRACT FROM AUTHOR]

Poor health and disease and the nature of interventions to ameliorate them typically generate opportunities and costs. What diseases are prevalent, which interventions are favoured and what factors fuel the nature of health interventions are recurrent concerns for political economists. This paper examines the prevailing viewpoints about what health policy works and what does not. Drawing on evidence from developing countries, it shows that there are many deficiencies in the prevailing orthodoxy which emphasises state, market, and civil society solutions. The paper suggests that health policy debate must be refrained around poverty and social inequality, constructs which are often subordinated to attaining grand ideological goals. [ABSTRACT FROM AUTHOR]

In this brief paper, I argue that the coronavirus pandemic is functioning like an ethnomethodological 'breaching experiment'. In short, it is putting a gigantic spanner in the works of neoliberal governance, in the process exposing the widening cracks and fissures of what I have called the 'fractured society'. I begin by recalling Garfinkel's notion of the breaching experiment and by listing the principal attributes of the fractured society. I then explore the response to the coronavirus in the UK, from the government's initial commitment to 'herd immunity' to its present policy of 'muddling through'. The bulk of the remainder of this contribution addresses precisely how this global health crisis shines a harsh and unforgiving searchlight on the strategies and policies pursued by governments in the UK since 2010, and most especially after the passing of the Health and Social Care Act of 2012. In the closing paragraphs, I examine possible scenarios for a post-fractured society, making particular use of Fraser's concepts on 'reactionary' versus 'progressive populism', and conclude with a comment on sociology and engagement. [ABSTRACT FROM AUTHOR]

As Leader of the Opposition in 1987, the current Prime Minister of Australia John Howard, stated unequivocally that he would dismantle Medicare at his first opportunity. By April 2000, the Health Minister in a Howard-led government proudly proclaimed to the Australian Parliament the Coalition was 'the best friend Medicare ever had'. Such a shift in ideology and policy position appears remarkable, overturning more than 60 years of conservative opposition to a universal, publicly funded, health care system. This paper traces the shift from the lead-up to the 1996 election until 2000, interrogating official policy texts to map how the Coalition reconfigured its own policy narrative about the Australian health care system. This paper argues that in order to understand contemporary reforms to the health care system, we must consider the way in which those reforms provide solutions to discursively, rather than objectively constructed, policy problems. [ABSTRACT FROM AUTHOR]

In the past decades, public health has increasingly addressed what has been called the children's obesity 'epidemic', most notably through large-scale initiatives promoting physical activity. Through a discourse analysis the current paper critically examines such efforts in Canadian and Australian public health. Public health websites in Canada and Australia were examined for information concerning children's health, physical activity and obesity and explored for how these issues were represented in the discourse. Bacchi's (2009) 'What's the problem represented to be?' approach to discourse analysis guided our interrogation of the taken-for-granted assumptions underlying Canadian and Australian public health discourse, the ideological and political influences involved in its construction, and the knowledge base upon which it rests. The article calls for critical reflection on how children's physical and leisure activities are being advanced. [ABSTRACT FROM AUTHOR]

This article deals with the social democratic aspiration of equitable access to health care in Bulgaria, a country in transition since 1989 from communism and a command economy to democracy and a free market. The focus is on access to health services and resources after the introduction of a universal health insurance system, with particular reference to formal and informal out-of-pocket payments for health care. The paper reports empirical results from a national household expenditure survey, supplemented with a semi-structured interview, conducted at the end of the survey period (April-May 2002). The results bring to light the groups in society who suffer most in this scenario: the poor, Roma, older persons and those living in towns and villages. The study reveals that the stated aim of the National Health Insurance Fund, to provide equitable access to health care, is a mirage rather than a reality, as the vast bulk of health care is self funded. This paper has particular significance for understanding the challenges faced by post-communist states in their attempts to achieve social democratic health care reforms. [ABSTRACT FROM AUTHOR]

The question we raise in this paper is whether the educational gradient in avoidable mortality differs from overall and non-avoidable mortality among men and women in Norway. By avoidable deaths we refer to deaths caused by diseases that are either treatable if given appropriate medical care, or preventable if available preventive measures were implemented. The data set is derived from official administrative registers and includes all Norwegian men (1 107 427) and women (1 087 842) aged 25-67 years with information about status alive/dead during the period 1994-1999. Adjusted for sociodemographic and socioeconomic factors, education forms a marked and independent gradient in overall and non-avoidable mortality and an even steeper gradient in avoidable mortality - in particular in ischemic heart disease and preventable deaths. The educational gradient is shallower for deaths considered treatable by health care, but is still present. These patterns apply to men and women alike. The findings of our study suggest that health care and health policies may play a role in reducing inequalities in deaths that are 'avoidable, unnecessary and unjust'. [ABSTRACT FROM AUTHOR]

The success of 'ageing-in-place' aged care policy in Australia relies heavily on the unpaid work of informal carers. While there is a wealth of research regarding informal carers more generally, we know relatively little about the experiences of the 'sandwich generation': Adult children (mainly daughters) who provide care for a parent while often juggling paid work and the care of their own children or grandchildren. In this paper I undertake a critical analysis of 'ageing-in-place' policy through the lens of 'sandwich generation' carers of people with dementia. Drawing from a composite case study, I argue that these carers are located at the interstices of powerful discourses such as 'individualisation' and 'care' and explore how the everyday practice of care is negotiated within these spaces. Inhabiting these spaces can be costly for carers and we need to consider how policies can better support intergenerational carers if 'ageing-in-place' is to be sustainable. [ABSTRACT FROM AUTHOR]

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]

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]

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]

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 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]

In this article, we review critical research on mobile and wearable health technologies focused on the promotion of 'healthy lifestyles'. We begin by discussing key governmental and policy interests which indicate a shift towards greater digital integration in health care. Subsequently, we review relevant research literature, which highlights concerns about inclusion, social justice, and ownership of mobile health data, which we argue, provoke a series of key sociological questions that are in need of additional investigation. We examine the expansion of what counts as health data, as a basis for advocating the need for greater research into this area. Finally, we consider how digital devices raise questions about the reconfiguration of relationships, behaviours, and concepts of individuality. [ABSTRACT FROM AUTHOR]

The care of a person living at home near the end of their life is predominantly provided by family carers with the support of health services such as palliative care. In addition, informal caring networks also contribute at times to the support provided to the dying person and their carer. In this way, these networks can promote social capital in the communities from which they are drawn. This social approach to end of life care enhances community capacity to provide support to those dying at home and their carers. This article examines relevant published literature to explore the conceptual foundations of informal caring networks, examining the place of social capital and community development in the provision of end of life care at home, particularly in the Australian context. [ABSTRACT FROM AUTHOR]

Australia leads the world in the mass adoption of Human Papillomavirus (HPV) vaccines, a new frontier in mass vaccination programmes. This article reports on participatory workshops with the first generation of young Australian women to participate in the HPV mass vaccination programme. In particular, it addresses the themes of trust and confidence. A substantial literature highlights the growing realm of active trust at the expense of habitual confidence in 'risk society'. Another line of inquiry highlights the preference of governments for policies designed to enhance confidence rather than trust. This study finds that participants were guided by confidence in their adoption of the HPV vaccine, at the expense of trust. Participants readily transferred their confidence in the existing vaccination regime to the HPV mass vaccination programme, notwithstanding its novel features. Yet participants expressed growing misgivings about their informed consent and the 'marketing' of the vaccine in the course of workshops, reflecting failure to achieve their active trust. [ABSTRACT FROM AUTHOR]

Explaining the trajectory of Australian health policies over the last century requires an analysis of different political regimes and their dreams of order for managing risk. Crook reverses the Beckian axiom that risk is the unintended outcome of the failure of industrial societies, arguing for an understanding of risk within a Foucauldian and Actor Network Theory of governmentality. Risk becomes a mechanism for the realisation of different dreams of order. The welfare state was the risk management mechanism of organised capitalism. Individual aspirations of reflexive individuals form the risk management mechanism of neo-liberal regimes. As competing risk discourses destabilise the field of maternity care, key actors (including doctors, midwives, women and policymakers) form themselves into neo-traditional communities in ongoing struggles to have their risk claims institutionalised within policies and protocols that further legitimise their interests. These struggles around risk and power are evident in recent debates over maternity policy in the context of the 2009 Maternity Services Review and the policy aftermath. [ABSTRACT FROM AUTHOR]

Against a backdrop of economic globalisation, where welfare practitioners fi nd themselves caught between modernising policy reform and demanding practice realities, there is an urgent need to rethink the relationship between research, evaluation and professional practice. In this article three perspectives concerned with accountability, critical knowledge production and development will be examined as a basis for understanding the different methodological discourses on evaluation. The debate between evidence-based practice (EBP) and critical practice (CP) is deployed to highlight a choice facing both the practitioner and researcher between producing two competing kinds of knowledge for practice. The former is based upon technical know how and skills that may be equated with a 'search for certainty' and found increasingly in technocratic systems of accountability; whilst the latter is concerned with critical exploration and development in promoting more emancipatory forms of practice that may be equated with the 'creative use of uncertainty'. Drawing on practice examples and research from the fi eld of mental health, it is argued that balancing accountability, critical knowledge production and development offers a valid paradigm for achieving effective practice evaluation alongside a broader commitment to social justice. [ABSTRACT FROM AUTHOR]

Many countries, including Australia, are currently experiencing severe shortages of professional, para-professional, and semi-professional workers in their health care systems. This is generally conceived as a problem stemming from rising demand in health care services or the production of inadequate numbers of health related graduates. A qualitative study of health care workers in the Australian context challenges the adequacy of this supply-demand approach to the health care system; and demonstrates that solutions lie in the conceptualisation of the health sector as a socio-cultural system. Findings indicate the extent to which policies independently formulated for the health, education, finance, and industry sectors have, in combination, inadvertently impacted on the functioning of the health care system, and some policy mechanisms, such as privatisation and marketisation, have fundamentally eroded its structural framework. Conclusions can therefore be drawn about the relationship between workforce shortages and the neo-liberal orientation of recent governments. [ABSTRACT FROM AUTHOR]