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The study invited individuals who used AA groups and philosophy as the mainstay of their recovery to talk about their ongoing relationship to AA, with the aim of understanding the factors that have helped them to achieve and sustain change. Interpretive phenomenological analysis (IPA) was performed on nine transcribed interviews of participants who were continually sober from alcohol/drugs for a minimum of nine years (abstinence mean = 14 years). The method was used to discern themes and identify the concepts of recovery participants had found helpful. A number of themes are examined in the paper, including how subjects made sense of their addiction, initial appraisals of AA/NA meetings, concepts of acceptance and surrender, character change, spiritual change and evaluations of continuing progress. We argue that there are many roads to recovery from addiction and the ‘AA/Fellowship route’ offers a set of principles and narrative forms that have the attraction of consistency and coherency. The paper shows that as personal identity is continually construed, participants find that what can be called ‘Fellowship narratives’ and structures assist them greatly in appraising the past, re-building their lives and finding direction. In addition, spiritual and other values help them to effectively address and resolve key issues and self-governance. We propose that addiction services can benefit from incorporating more emphasis on the role of narratives, identity and values in the recovery process. [ABSTRACT FROM AUTHOR]

This paper focuses on the way drug users (DUs) play an active role in implementing public health policies by their involvement in self-support groups, thus providing new forms of patients' expertise. Expertise of this nature may seem paradoxical, in that it confers qualities to populations whose practices are unlawful and whose identity is stigmatised. A qualitative method including semi directive interviews (57) and ethnographic observations was used for this research. A thematic content analysis was done from empirical data following an inductive logic. This paper aims to show how a DUs' organisation finds a place in the social arena in the political context of harm reduction, succeeds in building the French DUs' health and welfare conditions as a legitimate cause, and elaborates a specific rhetoric centered around life skills and citizenship. The new forms of patients' expertise, based on life experiences, contribute to enhancing the value of practical, emotional and subjective knowledge that sometimes questions specialist knowledge. This claim for citizenship is often used as a sort of magic incantation, and content may be lacking if public health policies are not accompanied by broader policies that attempt to take into account the political, legal, economical and social conditions of stigmatised social groups like DUs. [ABSTRACT FROM AUTHOR]

This Editorial provides a critical review of the progress in social determinants of health research over the last two decades, suggesting new perspectives which may further our understanding of persistent social inequalities in health. It highlights the global significance of the Special Issue setting it in the context of the recently released WHO Commission on Social Determinants of Health Final Report (CSDH 2008). The Editorial introduces individual papers in the Special Issue and discusses how they are in line with, complement or provide feedback to, the WHO CSDH Final Report and its call for actions to close the health gap in a generation. Finally, based on the articles in this Special Issue and emerging themes of the global research and policy literature, it outlines a number of significant directions for future research and actions, from both methodological and theoretical points of view. [ABSTRACT FROM AUTHOR]

There is growing recognition that investment by governments on children in their early years is an important part of social policy. However there is currently little information either about how much governments invest on children of different ages, or about what the optimum investment in the early years would look like. Using currently available Australian datasets, this article explores two approaches to estimate the adequacy of investment in early childhood; comparing government expenditure between countries, and analysing one country (in this case Australia) in terms of expenditure over time on children of different ages. We find that, overall, Australia spends more than the average of OECD countries on the early years, but that a much higher proportion of this expenditure is spent on cash transfers to parents rather than on early care and education. Furthermore, spending on the early years has grown proportionately to spending on older children over the past several years. The paper ends with a number of suggestions for further research which will refine the analysis of investment in the early years. [ABSTRACT FROM AUTHOR]

In this paper, results are reported from a five year qualitative study involving a stakeholder analysis of a hospital-based centre for integrative medicine. The objective of the study was to identify the barriers and the facilitators for creating integrative medicine in this setting. The study documented the timeline of the Centre from its very hopeful beginning to its demise. The paper focuses on the administrative implementation process, examining the original expectations in light of the organisational culture, business model, impact of policies and regulations, and the trade-offs made between the original goals and those attained within this environment. One of the most troubling aspects arising from this case study was that no corrective mechanism was in place for program design flexibility once previously created policies were deemed harmful to the Centre. When the major assumptions on which the Centre was founded, turned out to be false, there was no turning back and the Centre collapsed. [ABSTRACT FROM AUTHOR]

This paper examines the way some public health campaigns in Australia have been caught within a paradigm shift in the management of 'risk society'. It details this paradigm shift in terms of an intensification of political technologies of 'pre-emption' in response to incalculable threats to physical security. The challenge this presents to public health programs, particularly those dealing with 'life style' health problems such as obesity, depression, and drugs (illegal and legal), is that, in pursuing admirable aims of the prevention of ill-health in the population, such campaigns need to avoid reproducing (and indeed should counter) the harmful effects of the pre-emptive approach to security. Using the example of 'quit smoking' campaigns of 2006-7, key features of the preemption paradigm are outlined, particularly the conservative comportment toward the future that it fosters. With reference to Foucault's concept of 'political technologies of bodies' and Merleau-Ponty's ideas about the temporality and intercorporeality of bodies, the paper also explores deleterious effects of this approach to risk and health on human agency, well-being, and social relations in general. The negative impact of the pre-emption approach is outlined in terms of the way it tends to dampen the openness (or 'potentiality') of bodies toward the future, the world, and other people. However, the temporality and intercorporeality of bodies also explains the operation of resistance by human agents to both the paradigm of pre-emption and the health prevention strategies that employ its way of thinking. This provides the basis for a gesture toward a more 'democratic', respectful, and effective approach to the promotion of health and well-being. [ABSTRACT FROM AUTHOR]

Health researchers in a number of settings are expressing concern about the 'gap' between what we 'know' about the social determinants of health and of health inequalities, and the lack of action based upon this 'knowledge'. Indeed, the 'know-do gap' has become almost a mantra echoed across international and some national institutional sites. This paper examines how the 'problem' of the 'gap' is understood and represented in dominant and sub-dominant conceptualisations. It highlights what is missing from these representations: adequate reflection on changing modes of governance of research management. Where once there was a degree of separation between research production and government policy, increasingly there is congruence between these governmental functions. This congruence means that the problem we face today is not a 'gap' but rather a 'fit' between what we 'know' and what we (don't) do regarding SDH. [ABSTRACT FROM AUTHOR]

Social theory provides a lens through which we can analyse the role of trust in health systems. However, the majority of theoretically informed trust literature addresses 'institutional' or 'interpersonal' trust individually, failing to investigate trust as determined by a 'web' of mutually interacting relationships between individuals and social systems. Current theoretical assumptions are also problematic as they fail to recognise the role that social factors (such as socio-economic status, class and age) play in an individual's willingness to trust. Through the analysis and critique of existing social theories of trust, this paper demonstrates a need for further empirical research into the multidimensionality of trusting relationships, while suggesting new directions for research in public health. [ABSTRACT FROM AUTHOR]

The aim of this paper is to review issues related to early intervention in mental health among adolescent students, and to specifically evaluate a school-based, early intervention program, which sought to address issues of mental health among students in a rural community in southern Australia. The early intervention program began in 2004 as school counsellors and local health professionals sought to address the difficulties rural secondary school students encountered in accessing support services. The paper seeks to explore the effectiveness of this school-based, early intervention for students, in decreasing the level of crises among students or the seriousness of associated outcomes to mental health issues, including dis-engagement from formal education. [ABSTRACT FROM AUTHOR]

The decline in indicators of human development linked to rising social inequalities, despite post-modern society's unprecedented economic prosperity, has been called 'modernity's paradox' (Keating and Hertzman 1999). Scholars of developmental health suggest that micro-level influences from the social, economic and psychological circumstances in early life may explain social inequalities across the lifespan. However, children's poor developmental and health outcomes are also a product of the wider contexts of their lives. This paper extends the human developmental framework by linking the proximal determinants of health and well-being with macro-level forces. It reviews recent changes in the political, economic and social environments in developed countries, to provide insights into the recent trends in poor outcomes in children and youth, which remain paradoxical given the expectations of economic prosperity and the advances in medical and other technologies. The paper concludes with policy and research recommendations to reduce social disparities in child outcomes. [ABSTRACT FROM AUTHOR]

In 2004 and 2005 the West Australian Labor Government significantly amended the Workers Compensation and Injury Management Act 1981 (WA) (the Act). These amendments followed over a decade of shifting power plays and uncertainty for the many stakeholders in the system. The significance of these state-based reforms cannot be underestimated, providing a localised example of a broader contestation between the interests of private business and the shifting terrain of industrial citizenship. This article documents the last decade of workers compensation reforms within Western Australia and a summary of changes which ultimately took effect in November 2005. In keeping with the post-modern emphasis on context, this paper locates the Western Australian changes within a broader discussion of the shifting landscape of rights and entitlements engendered through neo-liberal discourse. In particular, as this paper explores, the changes to Western Australian workers compensation policy can be read as a reflection on the way employers, government and the insurance industry interpret and engage with the continuing realignment of worker entitlements. [ABSTRACT FROM AUTHOR]

This paper explores the relationship between the prominent aetiological frameworks for mental illness in Australian psychiatry, and ideas and strategies for preventing mental illness. Data is drawn from the Australian and New Zealand Journal of Psychiatry for the period 1967-2005, and textbooks used to teach the psychiatric component of the medical degree at six Australian universities since 1950. Content analysis of the journal demonstrates that social aetiological models dominated Australian psychiatry until 1985 and the rise of biological models. This represented a shift in the focus of mental health prevention from the social environment to the individual, and the re-location of psychopathology from social relationships to social and biological risk factors. A consequence of this new focus has been the re-targeting of mental health strategies toward individuals and their exposure to social and biological risk factors. [ABSTRACT FROM AUTHOR]

The goal of this paper is to explore the experiences of exclusion and inclusion of both low and higher-income people within a 'social determinants of health framework'. In the first phase of this research, individual interviews with 60 high-income and 59 low-income participants, and group interviews with 34 low-income participants were conducted. During the second phase, 1671 higher and low-income participants were surveyed by telephone. The findings revealed that inadequate financial resources, ill-health, and unwelcoming behaviours inhibited participation in community activities among low-income respondents. Higher-income earners were more likely to engage in social and group civic activities. Participants in the low-income category were less able to participate in desired activities due to user fees and poor health. Data revealed significant relationships between self-rated health and measures of exclusion and inclusion. Based on the responses of participants, the paper concludes that structural rather than interpersonal change contributes significantly to increased levels of social inclusion, and ultimately, improvements in health outcomes. [ABSTRACT FROM AUTHOR]

This paper explores the development of the sociology of death. It begins by tracing some of the major trends in sociology more generally that have influenced understandings of the social impact of mortality. The question is then raised as to why sociologists of death have hitherto largely failed to research into working-class cultures of death. Following a brief discussion of some of the literature that has considered working-class practices, a number of explanations are offered for this relative neglect: that social class is no longer relevant in postmodern societies; that the creation of death studies as a specialism in sociology has isolated academics from the conceptual concerns of mainstream sociology; that the personal-political agendas of middle-class academics working in this field have shaped the preoccupations of researchers. The last of these explanations is explored in greater depth by linking work on death to the sociology of the body and that of the emotions. To examine some key social class distinctions, the assertion of working-class stoicism is contrasted with a middle-class privileging of verbal communication. The paper concludes with an appeal to sociologists of death to reinstate social class as a significant factor in understandings of the social nature of mortality. [ABSTRACT FROM AUTHOR]

This paper examines the expansion of death and grief from private experience and spaces, into more public spheres via a range of media events and communication technologies. This shift is increasingly acknowledged and documented in death studies and media research. The modern experience of 'sequestered death' has passed. Death images and events are now thoroughly mediated by the visual and communication technologies used and accessed by a vast number of citizens across the globe. At the same time, the proliferation and accessibility of death imagery and narratives does not necessarily mean that the Western world has moved forward and beyond 'death denial'. Indeed, one of the key arguments of this paper is that mediated death - death as televisual, cinematic, and journalistic image and narrative - does not necessarily equate to a familiarity, and especially an existential acceptance of death, as it is faced and experienced in everyday life and relationships. Indeed, what we may be facing, and witnessing, is a widening gap and experiential differential between media/technological death culture and 'real life' contexts and temporalities of death and bereavement. [ABSTRACT FROM AUTHOR]

This paper provides a critical overview of recent arguments within the field of research on death and dying. In so doing, it explores reasons for researchers choosing to work in this area, and how these might relate to questions of personal experience and the wider cultural and social contexts of researchers' everyday lives. It discusses not only the sequestration of death thesis, but also arguments which suggest there has been a revival of Romanticism associated with the maintenance of bonds between the living and the death. Finally, it explores the critique that the anomic terror arguably associated with death, has been assumed rather than examined. [ABSTRACT FROM AUTHOR]

It is well recognised that bereavement deals a significant impact on all individuals and societies, and yearning to be with a recent decedent is a common and almost universal grief response. How we strive to mitigate our loss by maintaining a sense of being in the presence of our loved one is not so well appreciated, yet this elicits perhaps the most evident and popular practical response among the recently bereaved. Although over thirty-three million visits are made to Australian cemeteries each year, understanding this behaviour and meeting the real needs of these visitors have attracted little consideration, even among those responsible for managing and providing such facilities. This paper draws on the author's twenty-four years' experience in the operation of small and large, provincial and urban cemeteries, and national sociological field research into personal and social values of the cemetery or memorial park. Quantitative studies involving over 3,000 cemetery visitors throughout Australia furnished vital generalisations, and complementary in-depth qualitative investigation of over two dozen cases identified personal values of visitation to mourners within different social and cultural contexts. This paper presents a summary of key findings. To literally millions of recently bereaved Australians the cemetery provides a vital focal point for remembrance of the deceased, with the grave or memorial site becoming a crucial locus for working through personal grief. [ABSTRACT FROM AUTHOR]

Social capital is attracting increasing attention, particularly as a means of improving health status. However, much of the work on social capital employs Putnam's (1995) formulation of the concept. This view suggests social capital produces generalised benefits, thus presenting an anomaly between the higher stocks of social capital in Australian rural communities relative to urban areas, and their poorer health status. This paper presents data on the experience of same-sex attracted (SSA) women living in rural communities in South Australia. It suggests Bourdieu's account of social capital is more theoretically and empirically compelling than that of Putnam's, because of its capacity to explain the harmful psycho-social consequences of exclusion for those who are samesex attracted. Moreover, the different experiences of younger and older samesex attracted people in rural Australia indicates the need to take seriously the claim that social capital is unequally distributed and experienced in different ways. A conclusion of this paper is that blanket claims to increase and enhance social capital should be treated cautiously because of the adverse consequences for some groups. [ABSTRACT FROM AUTHOR]

This paper examines the social gradient in self-reported health in Argentina, and at the provincial level, explores the extent to which self-reported health and mortality indicators provide dissonant health profiles. This study is based on a secondary analysis of Argentina's 2001 Survey of Living Conditions. A significant gradient in self-reported health was observed by income quintile, but self-reported health and mortality indicators were not significantly correlated at the provincial level. Respondents from deprived regions were most likely to report being in good health, despite living in areas with low life expectancy and high infant mortality; in other words, respondents from areas of poor population health nevertheless report good individual health. Unless acknowledged, this will ultimately lead to an underestimate of the social gradient in health. The implications of this notion for tests of the income inequality hypothesis are discussed. [ABSTRACT FROM AUTHOR]

In this analytic review, the authors consider the 'boom' in demand for the services of practitioners of modalities of complementary and alternative medicine (CAM). The evidence for the increase in demand for these services is reviewed and explanations for this phenomenon considered and evaluated. Two particular explanations are considered: the postmodern thesis and the gendered spirituality thesis, as well as more general changes in society. Finally the paper considers the role of the social sciences in the legitimation and increasing use of CAM. The paper concludes that the trend is likely to continue, as will the role of social scientists in observing and documenting CAM. [ABSTRACT FROM AUTHOR]

This is an account of various unsuccessful efforts to combat petrol-sniffing in River Town, a remote Aboriginal settlement in north Australia. The paper provides insights into the dynamics of remote Aboriginal settlements, highlighting the dissonance between non-Aboriginal service providers and the Aboriginal residents. Attention is drawn to the need for more involvement of Aboriginal people in policy making and program implementation. The paper suggests also that there is a need for adequate resources to resolve the problems experienced in settlements such as River Town. [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]

This paper examines the primarily sociological and anthropological literature that discusses the current challenges posed by the 'modernisation' of herbal knowledge through its co-option by biomedicine. Through this examination we identify evidence for a trend which suggests this co-option is a tactical strategy to preserve biomedical dominance through control of the knowledge base of 'other' medicines. Having identified such a trend, we examine the invention of the term 'complementary and alternative medicine' (CAM), suggesting that the universalising of non-orthodox health care practices under this construct is a problematic symptom of biomedical co-option. We then go on to argue that a possible outcome of biomedical co-option is an epistemological bifurcation between 'traditionally' orientated and 'biomedically' informed herbal knowledge and practice, a phenomenon whose implications demand serious recognition and analysis, not only in the academic literature, but also in wider public debates. [ABSTRACT FROM AUTHOR]

The twentieth century has witnessed an epidemic of metaphors in our attempt to make sense of sexuality and sexual health. This paper explores some of those constructs in order to gain insights into how we think, and ultimately how we practice. While many metaphors come from the wider culture, our health care institutions are a product of that same culture and we cannot help but be influenced by them and use the metaphors ourselves (Plummer 1995). In this paper, we will examine the use of notions of contamination, transmission and contagion to describe non-infectious social phenomena such as homosexuality and homophobia. Social constructionism discusses sexuality and gender, not as essential characteristics, but as socially produced, reproduced and transmitted, with the latter's symbolic similarity to infection transmission. However, while non-hegemonic expressions of gender and sexuality are viewed through these metaphors, the hegemonic variations remain unproblematised. As such, the unproblematised hegemonic representations are more likely to be viewed by the public as bearing essential qualities. [ABSTRACT FROM AUTHOR]

This paper draws on qualitative data from eighteen interviews with heterosexual women about their experiences of sex with men. Drawing on ideals of individualism and free choice, women construct a citizenship discourse in which they and others are positioned as active sexual subjects with rights and responsibilities to sexual choice, pleasure and fulfilment. Critical examination of respondents' discourse reveals how it is profoundly gendered, based on masculine forms of sexual desire and masculine understandings of pleasure. The paper argues that, despite its gendered nature, the inherent reciprocity of the citizenship discourse (as produced through the link between rights and responsibilities) generates the possibility for women to negotiate their sexual freedom and promote their sexual health and safety. [ABSTRACT FROM AUTHOR]

This paper draws on the example of Samoa to argue that Western models of health promotion and suicide prevention, especially those which draw on conventional understandings of social capital, are not appropriate for non-Western communities, for they are generally not sensitive to cultural beliefs, values and rituals. As such, the value of homogenously promoting social capital as an adjunct to suicide prevention strategies needs to be questioned. Suicide prevention and resilience strategies must be culturally relevant and developed 'by the people for the people', to address the nature of the suicide problem in Samoa. [ABSTRACT FROM AUTHOR]

An editorial is presented on how the politics of colonization continues to shape academic knowledge production, as a productive problem for health sociology. Topics include range of posthuman dilemmas across diverse health issues as they grapple with the ethical, ontological and epistemological relations of knowing and doing health; and posthuman perspectives enables the authors to generate health sociology knowledge beyond humanist assumptions, ideals and logics and rethink health care.

This study examines experiences of living with chronic illness for haemodialysis patients. In order to understand these experiences the paper takes an existential-phenomenological approach. Interviews of seven participants (five males, two females) were collected in a haemodialysis clinic. Based upon the participants experiences three core themes emerged: (1) the challenges of living with chronic renal failure; (2) body changes and embodiment; (3) their illness experience and social relationships. The findings suggest that the illness experience of chronic renal failure is an on-going struggle to attain a sense of control. We suggest that where a sense of control is limited this can create a sense of powerlessness. Further, the illness experience was not solely restricted to the individual, but also affected wider social relationships. It is only through taking into account the context of patients experience of illness that clinicians/nurses can meaningfully draw on all aspects of evidence to reach integrated clinical judgement. [ABSTRACT FROM AUTHOR]

Studies that focus on the effects of both the division of household chores and of financial contributions on the mental health of couples are scarce. This paper expands on previous research by paying attention to the variation of this relationship among three types of households: Male breadwinner, one-and-a-half-earner and dual-earner. Using paired data from the 10th wave of the Panel Study of Belgian Households, collected in 2001, we perform separate linear regressions for men (N = 1054) and women (N = 1054). The results suggest that in one-and-a-half-earner households, women's employment has a negative effect on their partner's depression level and that in dual-earner households, the effect of women's employment is only negative if men are not the major breadwinner. Crossover effects of depression between partners seem to mediate part of the aforementioned associations. [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]

This paper sets out to explore the Australian instance of a significant international problem: Intergenerational solidarity and the willingness of younger generations to support the future care of older people. It draws on Bengston's intergenerational solidarity theory, in particular his conception of normative solidarity relative to filial obligations, to analyse data from the Australian Survey of Social Attitudes. This data demonstrates evidence of intergenerational solidarity at the policy level and a need for a continued role for government in the provision of residential care, insurance schemes, and the payment of income to full time and occasional carers. At the family level there is less support for the role of adult children in the payment of formal care or the provision of informal care. There is also a significant difference between men and women concerning the direct provision of informal care to ageing parents. Suggestions for future research are highlighted. [ABSTRACT FROM AUTHOR]

Australia is rapidly becoming home to an increasing number of Polynesians. While the Maori/Pacific Islander 'economic migrant' may appear fit and healthy, statistically the incidence of diabetes, hypertension and cardiovascular disease is extremely high. When this profile is coupled with family reunion migration of older relatives who are living longer, it represents an escalation of current and future outlay for Australian health services. Qualitative semi-structured interviews were conducted with 67 Polynesian migrants in regard to their perceptions of health and illness, and their experience of health services in Sydney and the Hunter region of New South Wales. Three key respondents, all Polynesian nurses practising in Australia, were also interviewed. The findings indicate a concentration of disadvantage concerning educational achievement, skill levels and health literacy that reinforce the process whereby social disadvantage impacts on health outcomes. This study also reveals a nexus of issues around cultural behaviours and poverty that contribute to the incidence of obesity-related illness and limit compliance with recommended preventative measures and treatments. This paper includes a discussion of the socio-political context of health delivery to Maori and Pacific Islander migrants and how the contraction of services under neoliberal 'belt tightening' undermines potential capacity to treat culturally and linguistically diverse (CALD) populations effectively. As Australian scholarship has traditionally concentrated on Melanesia, there is very little research on Polynesians who are one of our burgeoning migrant groups. This study therefore makes a timely contribution to redressing the lack of literature on Polynesian health, cultural practices and socio-economic positioning in this country. [ABSTRACT FROM AUTHOR]

There has been a tendency for researchers and practitioners to overlook the needs and experiences of children and young people in relation to disasters. In this paper, we report on our exploration of the question of whether to involve children and young people in post-bushfire research, and if so how? In considering children's rights in this context we were guided by a number of conceptions of the child (reflecting research debates within the Sociology of Childhood): The citizen child; the child at risk; and the developing child. We engaged in formal, progressive consultations with experts internationally and with bushfire affected community partners. This study determined that research with children post-bushfires was an important, ethical and appropriate activity, provided the methodology was sensitive and allowed children to provide informed consent and to have a sense of control over the issues being discussed. We conclude that carefully considering a rights approach materially changed the final methodology that includes the perspectives of children and young people in research about recovery from traumatic disasters, while still respecting their right to be safe and supported. [ABSTRACT FROM AUTHOR]

Dominant explanations of young people's health risk behaviours echo essentialist notions of perceived invulnerability and risk misperception. Rural youth, however, are considered particularly 'at-risk'. In this paper I argue for a need to challenge rural youth discourses, as they can have counterproductive implications. To evidence this need I draw on interview data from research that examined sexual (and other) risk perceptions among young rural Tasmanians. Findings revealed that participants were aware of rural youth stereotypes and often sought to distinguish themselves from these; were cognisant of their susceptibility to risk; and employed particular strategies to reduce the risks they faced. While these strategies are not perfect or foolproof, they nonetheless signify young people's efforts to mitigate health risks. It is important to recognise this. [ABSTRACT FROM AUTHOR]

Postgraduate physician assistant (PA) programs designed to train individuals for the workplace have existed since the advent of the profession itself. These residency programs continue to grow in number despite the lack of outcome data supporting improvements in PA learning, effects on career development, or improved patient care. Leadership bodies of the PA profession in the US have been at odds regarding the meaning and ramification of postgraduate programs on specialty credentialing, accreditation standards, insurance reimbursement, and employment. Using Bourdieu's cultural conflict theory as a framework, we analyze the issues confronting postgraduate PA training programs. Our paper discusses implications related to shifts in power amongst the different stakeholders concluding that, although formal postgraduate PA training can be beneficial to both the PA and the medicine, considerations related to underlying agendas need attention. [ABSTRACT FROM AUTHOR]

Much of the medical literature on patient compliance explores why patients fail to follow practitioners' instructions. This paper explores perspectives on 'compliance' expressed in online discussion groups for kidney patients. Discourse analysis was used to investigate how contributors conceptualise knowledge and the role of the renal patient. In the discussion groups, patients were sometimes seen to have better understanding of the details of their illness than some practitioners, a focus born of inhabiting their situation and therefore having more at stake. Some patients set themselves the task of supervising their own care, double checking the work of practitioners. This did not threaten biomedical knowledge, but these counter-discourses challenge professional boundaries by making it the prerogative of patients to obtain biomedical knowledge. I explore issues of surveillance and frustration, and the potential usefulness of patients' overseeing their own safety, while flagging the potential plight of less 'empowered' or motivated patients. [ABSTRACT FROM AUTHOR]

The stillbirth of an Australian infant in the mid-2Oth Century was an event often left unacknowledged. Mothers of stillborn babies were often told to 'forget about it and have another baby'. Siblings of these babies were often not encouraged to discuss them, and were even left unaware of their birth and death. This paper explores this phenomenon in an Australian case study. When Nancy was born in 1937, her twin sister was stillborn. As was customary at that time, the deceased baby was buried unnamed in an unmarked plot without ceremony. Little was said of her thereafter. Seventy-three years later, Nancy finally undertook a number of activities with ritualised features that acknowledged, named, mourned and honoured her sister. [ABSTRACT FROM AUTHOR]

Evidence-based medicine (EBM) has been one of the most important movements in clinical medicine and public health in recent years. At the heart of the EBM movement lies the Cochrane Collaboration, an infl uential organisation that produces systematic assessments of healthcare interventions known as Cochrane reviews. Although Cochrane methods were initially designed to test the efficacy of medical therapies, the desire for 'evidence-based' practice has pushed the movement far beyond its initial scope into the assessment of complex social phenomena. Through an examination of one particular Cochrane review -- Physician advice for smoking cessation -- this paper highlights the limitations of EBM 'creep', and some of the more problematic conceptions of human nature underwriting Cochrane principles and methodologies. [ABSTRACT FROM AUTHOR]

Dementia education and management is a major challenge nationally. However in the remote Aboriginal context, where the prevalence of dementia is five times greater than the national rate, the challenge is made more complex by cultural and linguistic differences between providers and consumers. Tins paper presents findings from the evaluation of a targeted dementia awareness resource piloted in three Aboriginal languages as well as English. It focuses on the intercultural communication aspects of the evaluation adding to the limited body of knowledge about communications with speakers of Australian Aboriginal languages. It identifies elements of effective intercultural communication in dementia education, implications for health literacy and considers the difference that culturally safe intercultural communication can make to a single issue such as dementia awareness. [ABSTRACT FROM AUTHOR]

This paper explores how the structuring of places and time influence Aboriginal and Torres Strait Islander patient and carer experiences of health services. Face-to-face in-depth interviews were conducted with urban Aboriginal and Torres Strait Islander people with diabetes, chronic heart failure or chronic obstructive pulmonary disease as well as family carers (N = 19). Content analysis was undertaken. Participants report that each element of the time spent in Aboriginal Medical Services is seen as more valuable and worthwhile than in mainstream health services, from social and health sharing experiences in the waiting room to health care in clinical places; and that users feel they can rely on sufficient time and respectful care in their clinical consultation. Purposeful design of both physical and temporal aspects of health services is called for. We suggest re-introducing opportunities for spatiotemporal design in health care that have been limited by the segmented 'person as illness' design features of Australia's current mainstream health system. [ABSTRACT FROM AUTHOR]

New medicines represent exciting possibilities to individual patients for improved futures through reduced morbidity, as well as the potential for disappointment where promised outcomes are not forthcoming. For healthcare systems these technologies can enable enhanced effectiveness as well as spiralling costs, depending on value-for-money offered. Amidst uncertainty over efficacy and pricing, institutions such as the National Institute for Health and Clinical Excellence have been set up to regulate the cost-effectiveness of new products. The increased transparency of this new regulation, combined with inescapable uncertainties, leads to the heightened politicisation of decision-making and an insidious subjectivity beneath a veneer of rational-bureaucracy. This paper develops a theoretical framework for understanding the influence of hope within such contexts. Conceptualised here as ideological, affective and prone to lapsing into trust, hope is considered to shape the lifeworld-background of regulatory decisions and mask uncertainty around effectiveness. These processes challenge regulator legitimacy and effectiveness within polycentric regimes, through the distortion of communication and the manipulation of blame. [ABSTRACT FROM AUTHOR]

To date, sociology of health and medicine has engaged in only a limited way in debates about cognitive enhancement drugs and how they might affect or change the way we live our lives. In this review we explore the implications of the development of such drugs, both now and in the future, with particular reference to the changing drivers and dynamics of medicalisation or biomedicalisation over time. Whilst both concepts shed important light on these developments, pharmaceuticalisation provides a more precise sociological term of reference we suggest for tracing and tracking these trends in cognitive enhancing drugs over time. The paper ends with some further suggestions for a research agenda in this domain, drawing on concepts located at the nexus between science and technology studies (STS) and the sociology of health and biomedicine. [ABSTRACT FROM AUTHOR]

This paper draws parallels between the market trend in the English NHS and Polanyi's (1957) The Great Transformation: The political and economic origins of our time, Beacon Press: Boston (originally published in 1944 in the United States as The Great Transformation, Rinehart: and Co: New York, and in 1945 in England as Origins of our time, Gollancz: London) account of how the rise of markets provokes a self-protective counter-reaction that tries to re-embed economic relations in social relations. We report findings from a qualitative study of NHS contracting, which examines the recent move to harder-edged contracts with greater use of financial penalties and incentives. In practice, use of these techniques tended to be confined to nationally-mandated sections of the contract rather than emerging from local bilateral agreements, and when things went wrong the parties relied more on cooperative behaviour than on the provisions of the contract to find solutions. Making the current contracting system work depended more on existing relational networks than on the incentive structures created by recent 'marketisation' initiatives, but the inability of the market to evolve as expected has encouraged policy makers to publish plans for further radical reforms. [ABSTRACT FROM AUTHOR]

With the commodification of healthcare in general and of private health in particular, it is difficult not to acknowledge the growing influence of competition and 'the market' in shaping the way that nurses' work is managed by private hospitals and by nurses themselves. This paper explores the discourses shaping nurses' work in private healthcare, drawing upon data from an ethnographic study conducted in one Australian acute care private hospital. The framework for analysis relies on an exploration of the mentalities and governance of nurses' work in such a setting. The study shows how marketing and performance measures are believed to ensure the viability of the enterprise while simultaneously commodifying nurses' caring work. It is this work that remains invisible to the healthcare system and the hospitals where they work. [ABSTRACT FROM AUTHOR]

The authors describe the incremental approach to the marketisation of the English National Health Service (NHS) since the introduction of an 'internal market' in 1990 until the 2010 White Paper, 'Equity and Excellence: Liberating the NHS', and the subsequent Health and Social Care Bill published in January 2011. The introduction of a competitive market for a universal, tax-financed health system requires fundamental changes in regulation in order that market bureaucracy can be substituted for direct management. The components of reform are insufficiently captured by the framework of hierarchies and networks in new public management theories of decentralisation. [ABSTRACT FROM AUTHOR]

Public--private partnerships (P3s) with the for-profit private sector are increasingly used in Canada to deliver public infrastructure and support services within the health care sector (e.g., hospitals, clinics, community health centres). This paper examines the emergence and legacy of P3s in the Canadian health care sector, classifying them as a form of neoliberal accumulation by dispossession and discussing their inability to live up to proponents' promises. Economic and social costs are examined, and examples are drawn from operational P3 hospitals in Canada. The article also briefly examines how P3s have been affected by the recent global financial crisis, arguing that despite serious problems with the private finance component of these projects, ultimately the policy is poised to weather the storm. [ABSTRACT FROM AUTHOR]

In this paper we explore the ways in which corporations have become powerful actors in the political and economic landscapes, and the role the state has played in this development. Focusing on the pharmaceutical industry, we find that revolving door practices have been a key instrument in furthering the growth of corporate power, leading us to a reconsideration of the concepts of class struggle and the role of the state in the maintenance of the dominant class' privileges. We conclude that our findings lend support to Harvey's theory of neoliberalism as a specific project to restore power to the dominant class, and also to Marx's conception of state power subordinated to capitalist economic power. [ABSTRACT FROM AUTHOR]

The increased use of information technology in health care allows researchers to generate data on rates of medication use among population groups, raising questions as to whether these rates are too high or too low. This paper presents findings from a study of records of all prescription medication dispensed in one New Zealand region (Te Tāirawhiti) over a one year period. The study examined patterns of psychotropic medication use amongst older people, by age, gender, ethnicity and socio-economic position. It concludes that the chances of being defined as needing psychotropic medication, that is, of being 'medicalised', are not evenly spread through the elderly population. Gender, age and ethnicity impacted significantly on whether prescriptions were received. Our results suggest the need for a nuanced understanding of the medicalisation of unhappiness and deviant behaviour amongst the elderly which takes into account barriers to treatment for some social groups. [ABSTRACT FROM AUTHOR]