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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]

Families of children with Down syndrome experience complex lives and needs, yet the few existing studies on these families are written in conventional academic prose that is not optimal for knowledge translation beyond academia, particularly for busy healthcare professionals. In this paper, we Depart Radically in Academic Writing (DRAW) (Mackinlay, 2022) and present data poetry and two case studies that draw upon semi-structured interviews with mothers, fathers, and siblings, who were interviewed separately about their experiences of having a child/sibling with Down syndrome. We introduce our interdisciplinary team that includes academics and clinicians to contextualise our focus on research translation. We demonstrate that writing with creative criticality (i.e. 'DRAWing') contributes an embodied and affective understanding of research participants' stories, which is largely lacking in the academic literature on families of children with Down syndrome and the sociology of health and illness field more broadly. Moreover, DRAWing can impact audiences emotionally as well as intellectually (Richardson, 2003, p. 924), which has important knowledge translation implications for both healthcare professionals and these families. DRAWing can capture healthcare professionals' attention, prompting them to critically reflect on their practices and opportunities for improving care and treatment for these families. [ABSTRACT FROM AUTHOR]

The production of sociological knowledge in Australian universities is explored through an empirical study of research papers published in a selection of academic outlets between 1960 and 2011. Drawing on theories concerning scholarly practices, institutional formation and the sociology of knowledge, questions are posed about the factors that shape and structure the production of sociological knowledge about health and medicine. The concept of intellectual schools is examined, with evidence sought for the presence of these 'knowledge networks' in the Australian context. The study suggests the formation and maintenance of schools are subject to structural factors within the university sector, specifically the relative wealth and prestige of the university and the dictates of the higher education market. [ABSTRACT FROM AUTHOR]

Genital fashioning practices, such as Brazilian waxing and female genital cosmetic surgery, have become increasingly prevalent within contemporary western societies. This paper explores the role of genital fashioning in the construction of contemporary femininity. It uses in-depth interviews and focus groups with Australian women aged 18–30 to investigate female genitalia as a site of alteration. Drawing on broader understandings of the body as socially mediated, this paper contends that multiple modification practices are employed to produce genital appearance. It departs from previous investigations which consider genital fashioning practices in isolation. In identifying the scope of genital fashioning, this research reveals a continuum of genital fashioning practices, both physically and discursively mobilised by women to negotiate their identity, sexuality, and femininity. [ABSTRACT FROM AUTHOR]

An introduction to the articles within the issue of the journal on topics including need post-structuralist concerns of Deleuze and Guattari, sociological commentary on new developments in drugs and historical perspective on the development of anorexia nervosa, is presented.

This qualitative study investigates health care practitioners’ approaches to early childhood obesity in Denmark and their view on their own ability to initiate processes of change in affected families, and it asks the overall question of whether perceived barriers become real through practitioners’ reluctance to intervene in families labelled as ´problematic’. The paper identifies three approaches in the practitioners’ narratives: the socially oriented, the individually oriented, and the mixed. The individually oriented approach was based on a logic resembling individualistic explanatory models of behaviour change, and was related to a positive perspective on their own ability to move families towards healthier habits by health care practitioners. The socially oriented approach borrowed elements from a sociological perspective, which seemed to lead to resigned pessimism in the face of the complexity of the problem of childhood overweight and a reluctance to address early childhood overweight in some families. In practitioners of all three types, widespread cultural essentialism was found. Non-western, ethnic minority background was seen as determining family habits and making preventive action especially difficult. Based on this, the current paper discusses whether individual actions and choices are being ascribed too much explanatory power, and the health system's biased perceptions too little. [ABSTRACT FROM AUTHOR]

Objectives: The study is an exploratory study of a media event in Australia based on the publication of two separate systematic analyses of complementary medicine (CM) therapies. The objective of the study was to measure the scientific quality of Australian newspaper media reports about two international peer-reviewed research papers reporting results on complementary medicines published in biomedical journals during Feb/March 2007. For purposes of clarity, we refer to the papers as the ‘Antioxidant Study’ (Bjelakovic et al 2007) and the ‘Prenatal Multivitamin Study’ (Goh et al 2007). Methods: We sourced articles that were published about the two research papers in mainstream metropolitan and national Australian newspapers during February and March 2007. We then applied a model of analysis called the Index of Scientific Quality (ISQ) to measure the scientific quality of the news reports. Results: We identified 14 newspaper articles and one newswire article about the Antioxidant Study and two newspaper articles about the Prenatal Multivitamin Study. Of the seven ISQ criteria, ‘validity’ and ‘precision’ were rated the least adequate, ‘important consequences’ of the research were reported partially in the Antioxidant Study and wholly in the Prenatal Multivitamin Study, and ‘opinion from fact’ was adequate in the majority of articles. Conclusion: This exploratory study conveyed an overall inadequacy in the scientific quality of the newspaper reporting about the two CM studies in major metropolitan and national Australian newspapers. Whilst we found that journalists were careful to attribute opinions to their sources, their reports conveyed a very limited understanding of biomedical research methodologies and a subsequent incapacity to scrutinise these methodologies with rigour. [ABSTRACT FROM AUTHOR]

In January 2017, the 'abortion pill' was finally used legally in Canada. This paper provides a sociotechnical analysis of the controversy surrounding RU486 in Canada, focusing on its entry into public discourse, 1990-1995. The case study draws primarily on statements made about the pill, both in Canadian media and in various actors' print communications. Using approaches from science and technology studies, the analysis identifies the multiple human and nonhuman actors, their discursive mobilizations of RU486 and each other, and their contingent alliances, illustrating how RU486 mediates and shapes the communication that attempts to define it. Unpacking the network's complexity illuminates how these sense-making practices established the early setting of the technology's path, a first step in understanding why Canada has been a laggard in making the pill available. The discussion illustrates the tensions, instabilities, and reversals in the network that have hindered RU486's movement from development to diffusion. Finally, the paper suggests a framework for future sociological research on controversial reproductive technologies in their shift from discursive to material diffusion, one that recognises the integral role of women as users. [ABSTRACT FROM AUTHOR]

There has been much talk in sociological circles of bodies as 'projects' or 'choices,' but surprisingly little examination of how these projects and choices are experienced. Consumer culture has been described as heralding a new era in body-self relations, but few have explored the experience of body-self relations. Body-self relations emerged as central to understanding in this study of the experience of the body at different ages (20-30, 45-55 and 70+ years), demonstrating the utility of empirical investigations in this area. This paper describes an orientation to the body that was common to the sample of 20 young people (aged 20-30 years) interviewed as part of this study. This orientation informed their health-related behaviours such as diet and exercise, but some participants found it to be problematic. Their voices demonstrate that bodily 'choices' may actually be experienced as irrational and even psychopathological compulsions. This experiential perspective suggests that normality may be continuous with pathology, and that differences are of degree rather than kind. The findings have implications for the treatment and prevention of eating disorders and obesity. [ABSTRACT FROM AUTHOR]

The advent of post-industrialism in western societies saw social theorists pay greater attention to the blurring of traditional work and life conceptual categories and the growing role of service professions. Further, much of the theorisation around the human service professions has focussed on occupational stress and professional burnout. This focus on the challenges to worker health has limited considerations of how human service professionals can thrive, and not just survive, in demanding employment contexts. In response, the paper considers the 'lifeworld' as a conceptual resource that can encourage new ways of thinking about the work of human service professionals, as well as reworks this resource using the concept of affect to expand consideration of the interconnected, inter-subjective, bodily and emotive nature of human service work. The paper concludes by presenting a heuristic tool that can make these concepts more accessible to professional discourses and can facilitate their use within collaborative research with the human service professions. [ABSTRACT FROM AUTHOR]

The large number of international medical graduates (IMGs) working in Australia, and many other countries around the world, has received significant attention from the media, governments and academia. These institutions utilise a number of classificatory schemes in order to categorise IMGs. Such classification is often stigmatising, yet goes largely unquestioned. In this paper I show that the 'official naming' of IMGs in Australia, as well as the naming of IMGs by staff in hospitals, is historically, politically and socially produced. Following Bourdieu's call to also study how the classified classify, the paper goes on to examine ways in which IMGs name and categorise each other, drawing on ethnographic research. I argue that IMGs use classification themselves, strategically, in order to modify their marginalised position within the 'social space' of the hospital. The article questions taken-for-granted assumptions about classified groups such as IMGs and leaves an opening for change. [ABSTRACT FROM AUTHOR]

The need for the poor, the marginalised and socially excluded to live healthier and longer lives has in recent times become paramount in the development literature and policy discussions seeking to achieve the Millennium Development Goals (MDGs). In response to this, attempts are being made to redirect the research focus to examine socio-economic factors underpinning disease occurrence and ill health for health planning policies and practices to benefit the poor and vulnerable in society. Tliis paper explores the relationship between socio-economic conditions and health outcomes. It identifies and examines through participatory rural assessment techniques, basic socio- economic factors acting as significant pathways through which poverty increases the susceptibility of rural households to diseases. It seeks to address the reasons why the poor are poorer in health in rural communities of the Amansie West district of Ghana. This paper thus emphasises how social stratification and inequalities could affect quality of life of people in any given society, hence supporting the theory of social suffering and its implications on societal health. [ABSTRACT FROM AUTHOR]

Using data from the Nairobi Urban Health and Demographic Surveillance System (NUHDSS), this paper seeks to understand the characteristics of adolescent girls who are circumcised in Kenya. The paper discusses the determinants of female circumcision in two Nairobi informal settlements. It is based on detailed information collected from young persons aged 12-24 targeting major transition events such as first sex, childbirth, marriage, and circumcision. Out of 4058 adolescents and young people interviewed 2010 were adolescent girls and young women. Out of the total number of interviewees, the 527 girls and young women on whom this paper is based are from ethnic communities that practice circumcision. We used the life-table technique to estimate the median age at circumcision and logistic regression to analyse the relationship between female circumcision and adolescent sexuality, controlling for other characteristics. The type of stay within the demographic surveillance area (DSA), religion, ethnicity, residential location and mother's education were associated with being circumcised. Current school attendance was not associated with being circumcised but if one had never attended school then they were more likely to be circumcised. For policy making, it is imperative to explore the nature of social networks within which circumcision decisions are taken and enforced. [ABSTRACT FROM AUTHOR]

This paper draws upon literature from economics, and the human capital and equity fields in order to present a theoretical framework for a new multidimensional measure of poverty for Australia. Poverty is about having low living standards; but its measurement has traditionally focused only on an individual's income or on other dimensions of living standards that are not appropriate for contemporary Australian society, such as calorie intake. There are two additional capabilities individuals require for adequate living standards: health and education. Each of these is required for basic functioning within modern society, but have traditionally been ignored by measures of poverty. This paper argues that health is a basic capability people need for a fulfilling life, allowing individuals to participate in activities essential in modern society, and that education can also be seen in this light. As such it is vital that health and education be included in measures of poverty. In order to move Australian poverty measurement forward and build upon the work of the past, poverty measurement must move its focus away from only looking at low income, and take a holistic focus on the living standards of individuals by incorporating assessments of health and education. [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]

This paper examines the differential incorporation of acupuncture and homeopathy into the medical establishment in Portugal. While the former has been incorporated into the medical establishment, the latter is still banned by the Medical Council, yet remains in practice by medical doctors in the country. Drawing on the insider viewpoints of medical doctors committed to these two therapies, the findings of this paper suggest that the rhetoric of insufficient scientific evidence of homeopathy still prevails within the medical establishment. However, two other factors were emphasised: the medical prejudice or 'resistance to innovation' of the Portuguese Medical Council and the idiosyncrasies of acupuncture and homeopathy, which have made them amendable to biomedicine (or not). This paper argues that the differential responses of the Portuguese medical establishment to acupuncture and homeopathy are due to reasons beyond that given of the medical rhetoric of insufficient scientific evidence for homeopathy, and which extend to issues of professional status and power. This paper suggests that the emerging commercial interest of the pharmaceutical industry in homeopathy's pharmacopeia worldwide could enhance homeopathy's status in the country and could therefore pressurise the medical orthodoxy to redress its position towards this therapy. [ABSTRACT FROM AUTHOR]

This paper explores the intersection of gender and class concerning welfare clients with medically unexplained symptoms. The study is conducted in Denmark using qualitative interviews with welfare officers and clients. The paper's focus is on how issues of gender and class intersect in the negotiation of illness among welfare officers and clients. The particular client group in question consists of individuals that are defined by their lack of a bio-medical diagnosis. Their 'lack' of identity accentuates how gender and class become central in the categorisation practices, constructing the ill person as either bio-medically sick or as a person who may be suffering but only from diffuse psychological problems. The paper shows that it is predominantly poorly educated women without a bio-medical diagnosis that welfare officers describe as suffering from psychological problems despite the fact that the women themselves focus on physical ailments in their illness stories. Men and better-educated women are described by the welfare officers as tired and exhausted or truly stressed after a long working life. [ABSTRACT FROM AUTHOR]

Feminised caring occupations like nursing and social work are popularly considered to be respectable occupations for women. This objective of this paper is to investigate the role of respectability in paid caring work by women within nursing and social work. This paper draws on Ball's conceptualisation of respectability as a heuristic device in the analyses of 39 in-depth interviews with women who work and study in nursing and social work. The paper finds that normality, morality, impression management and esteem are central to the operation of respectability in the paid caring occupations and concludes with recommendations for rethinking the relationship between respectability and these occupations. [ABSTRACT FROM AUTHOR]

While commentaries about life extension from biogerontologists, demographers, geneticists and ethicists have increased in recent years, these have paid little attention to the public policy implications of life extension or the perspectives of community members and policymakers themselves. This paper draws on the findings from a three-year research project about strong life extension which involved interviews with community members, and state and federal policymakers. The paper explores and compares the views of community members and policymakers about policy priorities arising from life extension, and examines these within the context of existing literature and available evidence. Thus the paper provides an important evidence base to inform policy development on life extension and argues that general community perspectives are important to consider in public and policy debates about the development and regulation of life extension. [ABSTRACT FROM AUTHOR]

This paper explores a number of the ways in which globalization can accentuate the uncertainties and risks borne by Australians with retirement savings in superannuation funds or who are receiving superannuation benefits. It begins by addressing the impact of globalization on job prospects as a result of off-shoring. It then turns its attention to the impact of globalization on domestic inflation. The third area addressed by this paper is the vulnerability of superannuation funds to the ‘regular’ financial crises of the world financial system. Here, particular attention is given to the way international hedge funds operate in bear markets. Finally, the paper describes the increasing prominence of sovereign wealth funds and explores the implications of their growing role for future superannuation fund earnings. A major conclusion of the paper is that the certainty of the financial uncertainties and risks associated with the occupational superannuation pillar means that Australia's retirement income system needs to be modified in order to limit the exposure of workers' retirement savings and benefits in payment to some of the consequences of a globalized financial system. [ABSTRACT FROM AUTHOR]

This paper explores the experiences of twenty Australian women living with the chronic and incurable gynaecological condition endometriosis. It examines how women become experts in their own care and the ramifications of these processes for women. Women experience patient expertise as a form of work, described here as a ‘third shift’ performed in addition to women's paid and unpaid work. It argues that both benefits and problems flow from such work, which involves the acquisition of expertise about a chronic illness and associated processes of self-management. The central argument of this paper is that the responsibilities associated with becoming an expert endometriosis patient can both reduce and compound existing stresses for women living with this chronic illness. It concludes with some suggestions about improvements to support women living with this chronic condition. [ABSTRACT FROM AUTHOR]

This paper investigates variations in policy responses to perceptions of social inequities in infant mortality in Canada, Chile, Sweden and the United Kingdom. It outlines patterns and trends in inequalities in infant mortality and some other birth outcomes, distinguishing between the use of routine data in some settings and research evidence in others. It suggests that some distinctive approaches about policies to reduce inequalities can be identified in the four countries. A number of emerging issues are also identified. One concerns the focus of interventions. Another relates to the use of targets. The third concern relates to the ways in which health inequalities are measured and monitored. Finally, the paper recommends the need for more research into areas such as the effectiveness of interventions, the nature of the problems facing ethnic minorities and the possible role of different social welfare regimes in achieving desired outcomes. [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]

The current preoccupation with body weight in western cultures is arguably unprecedented. The obesity crisis has engaged not only health communities, but numerous other public and private organisations, and, in so doing, has created moral alarm as well as a medical crisis. This paper examines the development of obesity and will discuss the ways in which fatness has been rationalised within health discourses. It will explore the way that the corpulent body, once historically considered as a physiological state, is now regarded as a state of moral pathology representing an 'epidemic'. The prospect of this disease sweeping through populations, reaching into virtually every social group, is presented as all the more frightening when no known effective prevention or cure is at hand. The paper will look at the ways in which new forms of government have developed with the panoptic capacity to gaze across populations and objectify the everyday activities of individuals. This 'government of girth' reaches an apogee in the problematisation of children and body weight. Three subject positions in childhood provide a number of opportunities to problematise children: the sick child, the anti-social child, and the innocent child. Each of these amplifies concern about the state of health of children, the permissive nature of parenting and potential moral social decay. [ABSTRACT FROM AUTHOR]

This paper explores the potential of community development interventions to contribute to improvements in Aboriginal health, the theory underpinning community development interventions, and the methods used to evaluate such interventions. This paper is based on a review of health literature to identify Australian and international examples of interventions utilising a community development approach with a view to directly addressing a health issue and contributing to the empowerment of Aboriginal people. Seventeen articles published over a ten year period from 1994 were identified which met the criteria for community development with a specific empowerment objective. Aboriginal communities are undoubtedly engaged in community development with the aim of improving health outcomes for their own communities. We argue that interventions promoting empowerment and control should be included as part of an overall strategy to reduce health inequalities in Aboriginal settings. There is an urgent need for further research in this area, particularly research which can engage with unpublished examples of community development in Aboriginal health contexts. [ABSTRACT FROM AUTHOR]

More than 20 years have elapsed since the book that is the subject of this special edition was published. The aim in this scene-setting introductory paper is to undertake a stock-taking of status of doctors, doctoring and professionalism as we head into the 21st century. It considers the various challenges to medical dominance of health systems including neo-liberalism and economic rationalism, a growth in consumerism and associated litigiousness, the change from a cottage industry basis to mass markets as medicine has been industrialised, the rise of complementary and alternative medicine (CAM) and changing roles of other health care professionals. [ABSTRACT FROM AUTHOR]

This paper explores the contemporary relevance of sociological theorisations centred on medical power, including the medical dominance and deprofessionalisation theses. To achieve this it examines two issues that have been tentatively linked to the relative decline of the power and autonomy of biomedicine - complementary and alternative medicine (CAM) and the Internet-informed patient. Drawing on these two different but interconnected social phenomena, this paper reflects on the potential limitations of power-based theorisations of the medical profession and its relationship to patients and other non-biomedically situated professional groups. It is argued that power-based conceptual schemas may not adequately reflect the non-linear and complex strategic adaptations that are occurring among professional groups. [ABSTRACT FROM AUTHOR]

This paper discusses the role of video-based research methods in social research. The paper situates these methods in the context of rising levels of visibility of professionals in government-funded organisations. The paper argues that while visual research may appear to play an ambiguous role in these organisations, it can also enable practitioners to confront the encroaching demands of post-bureaucratic work. To ground its argument, the paper presents an account of a video-ethnographic project currently underway in a local metropolitan hospital. This project focuses on negotiating understandings about existing care practices among a team of multi-disciplinary clinicians. Visual data gathered as part of that project are presented to specify issues which have thus far arisen during the project. Against this empirical background, the paper turns to considering the ambiguous potential of video-based research. The argument developed here is that, besides potentially exacerbating the pressure already imposed on clinicians - thanks to audit, surveillance and risk minimisation - video-based research may provide staff with new resources and opportunities for shaping their increasingly public and visible work practices. [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]

The aim of this paper is to propose a conceptual framework for exploring the ways in which class and gender interact in occupational fields. In recent years, very little research has been specifically concerned with the relationship between gender and class. Much of the literature which grapples with the question of how gender and class interact contains theoretical limitations which appear to stem from a reliance on categorical theories of both class and gender. In this paper it is proposed that, when used in conjunction, the approaches of Bourdieu and Butler provide a framework for exploring class and gender in terms of embodied practice. In order to illustrate the possibilities enabled by 'appropriating Bourdieu and adding Butler', the paper suggests ways in which this conceptual framework makes possible the examination of the complex relations between gender and class within one particular area of 'women's work': the field of nursing. [ABSTRACT FROM AUTHOR]

This paper sets out some of the parameters of social intervention in the family in Australia around the turn of the 20th century in ways which permit interventions in Aboriginal and non-Aboriginal populations to be broadly compared and contrasted. It focuses on forms of intervention underpinned by the kind of liberal political reasoning that allowed administrators to intervene on the basis of assessments of the capacity of families to govern themselves (Hindess 2000, 2001). The paper draws on archival material in Victoria, and the evidence of interventions in Aboriginal populations focuses on the removal of Aboriginal children from their communities in various parts of the state during this period. 'Race' comes to be constructed in terms that allow legislators and administrators to make discriminations within Aboriginal populations in order to manage them. [ABSTRACT FROM AUTHOR]

Health in Western society has become viewed as an achievement: something people are supposed to work at to enhance their quality of life or risk chronic illness and premature death. This is evident in the research documenting the close connection between chronic illnesses and health lifestyles. Almost all of this research is based on Western populations and much of it treats health behaviour and lifestyles as matters of individual choice or agency. While agency is important, structural conditions can 'act back' on individuals to configure their lifestyles in particular ways. The focus of this paper is to apply a new theoretical model to an Asian context. This model features a convergence between agency and structure and is supported by studies in Western countries. If the model is to have global relevance, it needs to be representative of health lifestyles in Asia as well. Unfortunately, there very few relevant studies available in Asia. Consequently, the intent of this paper is to not only present an initial theoretical framework for such studies, but also to call attention to the need for research in Asia on this topic. Everyone has a health lifestyle and Asians are no exception, as their lifestyles undoubtedly play a decisive role in determining health in the Pacific region. [ABSTRACT FROM AUTHOR]

Health promotion, as one tool of hospital managers to reorient hospitals towards more client-oriented healthcare services, has been emphasized for almost three decades. Yet, it is recognized that change in hospitals is challenging and is more desired than substantially enacted. To overcome organizational challenges, health promotion has, so far, adapted organizational change strategies primarily applied in business organizations. However, in this paper, it is argued that such strategies do not adequately reflect the nature of hospitals as 'professional organizations'. To gain a better understanding of the challenges for health promotion reorientation, this paper combines well-established theories from the sociology of professions and organizational science. These theories provide a useful framework that advances the role of professionals as powerful agents within any reorientation efforts in hospitals. This framework guided the narrative review of empirical literature on critical dimensions along which professionals engage with reorientation efforts in hospitals. Accordingly, specific managerial strategies to facilitate health promotion reorientation are formulated. With its theoretical underpinnings and related empirical studies, the paper offers a new perspective on the challenges of implementing health promotion and proposes strategies that may help hospital managers to push forward health promotion reorientation in their organizations. [ABSTRACT FROM AUTHOR]

Once exceptional, a long life is now an everyday expectation for many citizens of the prosperous nations. The consequence of this transformation in life expectancy however has led to a set of contradictory responses, representing threats as much as opportunities. Old age is no longer a stable coherent part of the life course; its future is fragmented by the competing narratives of the third age (opportunity) and the fourth age (threat). While there is a tendency to frame this distinction primarily through the lens of socio-demography and/or 'stages of life,' this paper proposes an alternative model. This model argues that later life is now represented through two different, though not unrelated, paradigms. The first frames the third age as a network of cultural fields dominated by rising consumerism and changing social relationships, while the second frames the fourth age as a negatively developed social imaginary of 'real old age.' The central features of this imaginary, we suggest, are frailty, abjection and the 'othering' of the self. This paper elaborates this theorising of the fourth age, briefly outlining each of these three features before considering in more detail the nature of othering and its consequences for those affected by this particular imaginary. [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]

Following Howarth (2007), this paper examines the relationship between class culture and social distinction in the empirical area of death and dying. For Howarth (2007), the sociological neglect of the end-of-life cultural practices of working-class people carries the danger 'of privileging middle-class agendas for change, … [t]here is an urgent need for further studies … and a refinement of existing research to draw out social class distinctions' (p. 433). Drawing on Howarth (2007), and Bourdieu (1984), it is argued below that the connexion between death and class reflects and helps to reproduce class-based identities, advantages and conflicts. Whilst class culture can be a supportive resource for working-class people, for example, in ways which reflect solidarity, more typically the classed nature of death brings acute suffering. Relatedly, it is proposed that stereotypes of declining respectability are reflected in some middle-class conceptions of working-class practices and identity connected to death. Such thinking socially positions working-class tastes as objects of disgust, and working-class people as disgusting subjects. It is concluded that, whilst Howarth's call is much warranted, the debate also needs to problematise the normalisation of middle-class ways to die and grieve. [ABSTRACT FROM AUTHOR]

The concept of placebo has had a long history in medicine, and has evolved over time with the introduction of randomised controlled trials for testing health treatment, the increasing research done around the psychotherapies, the development of complementary and alternative medicine approaches to health, as well as the conceptual contributions from academic disciplines like psychology and anthropology. In recent years, discourses about placebo have pursued a number of key directions, and the current review paper explores these developments. For example, psychology has looked at placebo in terms of classical conditioning and the role of anxiety. Anthropology on the other hand has focused on the role of meaning and ritual in the placebo effect and psychotherapy research has encouraged an examination of the effects of the therapeutic relationship. Our review paper concludes by outlining directions ahead for future scholarship and research. [ABSTRACT FROM AUTHOR]

Women are at special risk for HIV/AIDS infection and disease progression due to an inter-related set of biopolitical factors. Biological factors that contribute to women's special vulnerability include hormonal, developmental, and immunological characteristics. Social and political factors such as poverty, gendered power relationships, and violence interact with biological factors to create an HIV risk profile among women. The approach of this paper is to review literatures that describe components of women's risks for HIV in order to create an integrated model of vulnerability. We present a syndemic model that calls attention to the importance of understanding the pathways of adverse interaction among interacting diseases and the social and political environments of sufferers. This paper synthesises known risk factors and analyses them through the lens of syndemics theory in order to demonstrate the biopolitical vulnerability of women to HIV. Applying a syndemic approach offers important implications for prevention and treatment of HIV among women. [ABSTRACT FROM AUTHOR]

The branding of ayurveda as a market strategy for the health consumer has become an important factor in the creation of 'New Age orientalist desire'. Using Vedic Village as a case, this paper shows how new age orientalism has been spread in modern India to middle class professionals, entrepreneurs and overseas health tourists. With this representation, ayurveda has become a wellness therapy instead of a means to restore health, and affluent people can now buy a package of 'ayurvedic healthy life' without changing their lifestyles. In addition to Euro-American health tourists, emerging middle class professionals and entrepreneurs in modern India have also become an integral part of the process of 'new age orientalization'. This paper concludes that the commodijied version of ayurveda, which has been developed in the West as part of 'wellness and spa culture', has become popular among the affluent middle class in India and abroad today, and through this the West has claimed and justifies authority over Eastern medicine. [ABSTRACT FROM AUTHOR]

This paper offers a study of the specialist field of the sociology of health and medicine, and examines its institutional development in Australia. A thesis is developed about the relationship between the field and the parent discipline of sociology. The formation of the discipline and the specialist field are proposed to have occurred in stages: the formative years, a period of inter-disciplinarity and collaboration, a stage of intensification and organisation, the years of institutional growth and specialisation, the decade of consolidation and fragmentation, and, its most recent phase, a time of 'new' internationalisation. Moreover, the institutionalisation of the sociology of health and medicine has closely followed the developmental trajectory of its parent discipline, even though its disciplinary boundaries have been, and continue to be, less rigid. [ABSTRACT FROM AUTHOR]

This paper presents the findings of a qualitative study of the impact of casualised and independent contractor work place arrangements on the psycho-social health of 72 workers in regional Victoria. It contributes to our understanding of the crisis in rural Australia in its use of qualitative methods focusing on the impact of work on health and well-being. There is some evidence in the literature that casualised work arrangement enhance the health and well-being of workers by giving them a sense of autonomy and freedom to negotiate their conditions of work. On the other hand, these arrangements may make an already vulnerable group even more vulnerable to uncertain work conditions, poor pay and uncertainty for their future with a significantly negative impact on their health and wellbeing. The results of these interviews support this latter perspective and show that these workers do not experience freedom and autonomy, but rather lowered social status, insecurity and serious limitations to their ability to manage their health, psychological wellbeing and social relations. [ABSTRACT FROM AUTHOR]

One of the obstacles to understanding the links between social inequality and mental health distress is the reliance on heterogeneous diagnostic categories. In this paper, it is argued that a solution to this problem is to explore more homogenous experiences of distress. This paper investigates one particular form of distress: paranoia. The relationship between social inequality and paranoia is then examined, focusing on two aspects. Firstly, it is argued that social inequality might affect the experience of paranoia itself since the experience of the surveillance encountered in the everyday use of public space may vary depending on one's location in social categories like gender, 'race' and culture and class (these social categories are, of course, themselves stratified by social inequality). Secondly, mental health service users' locations in these categories may influence the way that the plausibility of ostensibly paranoid claims are evaluated by mental health professionals. Within the discussion of each category, links are drawn between community and clinical samples to understand how the experience of paranoia may be influenced by these social categories. The paper concludes with implications for research and policy. [ABSTRACT FROM AUTHOR]

Nurse practitioners were introduced into Australia in 1990 to improve access to health care in isolated communities where medical doctors are scarce. The slow uptake of nurse practitioners in these areas has largely been the result of legislation not affording them access to provider numbers through the Medicare Australia Act 1973. This has denied nurse practitioners the opportunity to become primary care providers because they cannot prescribe medications and order diagnostic tests at rebated costs. Recently this Act changed, making provision for nurse practitioners. Ironically the enactment of the new legislation still prevents nurse practitioners from practicing effectively. This paper describes the discursive practices in legislation, driven by traditional power brokers, which perpetuate the traditional role of nurses as care givers and fails to support the evolution of nurse practitioners as care providers. These continued practices effectively prevent nurse practitioners from working to their potential, despite government reassurance under recent health care reform in Australia. [ABSTRACT FROM AUTHOR]

This paper reports on a qualitative study of the onset of acquired hearing impairment. The focus of attention is why a person seeks treatment. The Danish welfare state serves the population 'in need' such as those with an audiological need and gives them guidance on becoming hearing aid wearers in order to rehabilitate them back to 'normalcy'. However, within audiological research, noncompliance has attracted much attention as investigations have shown that more than 20 percent of hearing aids are very seldom, if ever, in use and 19 percent are used only occasionally. As shown in the paper the form a problem takes is in large part a product of micro-political struggles. Hence, at the onset 'need' is often embedded in social pressure from significant others. The paper examines these two discursive frameworks and their constitution of (hearing) problems and concludes that norms of disease are complex and epistemologically contested and can help explain why noncompliance is dominant when it comes to hearing rehabilitation for hearing impaired adults. [ABSTRACT FROM AUTHOR]

Despite heightened concerns about levels of obesity and overweight in Western societies, there is a relative absence of sociological research into the subjective experience of dieting, especially for men. This paper focuses on findings related to the male participants from a qualitative study of fourteen volunteers (six female and eight male) drawn from a larger clinical trial comparing two diet conditions. Semi-structured interviews were conducted in two stages to gain an in-depth understanding of the experience of dieting, and found that these men understood and practiced their dieting in different ways from the women, but also from each other, depending on their notions of masculinity. Some were eager to reframe their dieting in 'more manly' terms. The social support or sabotage received from friends and family is significant to these experiences of dieting. This paper discusses how men understand and practice dieting within the framework of gendered discourses and gendered relations that can make healthy eating hard to sustain. [ABSTRACT FROM AUTHOR]

Since 2003, avian influenza has recently spread around the world sparking fears of a potential pandemic. As a result of this, a range of explanations and expectations surrounding the phenomenon were generated. Such social representations of disease depict the issue under discussion and frame reactions to the event. This paper explores the social representations surrounding avian influenza in Australia. Methodologically, a textual analysis of media and government documents was conducted in order to uncover the social representations implicit in these accounts. This demonstrated a symbolic framing of avian influenza with reference to the Spanish Influenza pandemic (1918). Analytically, the study draws upon the concepts of social representations from Durkheim and of risk and symbolic risk in the work of Beck. Overall, it is argued that the framing of avian influenza as a risk, mediated through the collective memory of Spanish Influenza, characterised the nature of the social representations surrounding the phenomenon. This resulted in the production of symbolic solutions to the threat. [ABSTRACT FROM AUTHOR]

The pharmacologically addicted body has emerged in recent times as a dominant image shaping drug discourse. Implicit in this image is a drug desire that overpowers and over-determines the individual. A key feature of this particular drug user body is the body as degenerative with drugs as the cause of social suffering through reducing the social agency of the drug user. Likewise the image of the addict with a hardwired primitive desire for drugs use has also gained some ascendancy in scientific literature. Film, popular culture, ethnographic and scientific research can all draw on these images of desire to structure their narratives of drug use. In this paper I explore a different reading of two portrayals of drug desire. Using a range of analytic tools such as narrative analysis, semiotic and post-structuralist analysis I suggest an alternative way to engage with images of desire. Without arguing for a particular way of thinking about the desire to use drugs, this piece illuminates some key questions about images of drug desire. Through being performative, drug icons are productive; they make possible ways of conceptualising the drug user and the drug-using body. The performativity of the image can be thought through traditional semiotics, narrative performativity or, in a more abstract manner with contemporary theories of affect. The point of this essay is to open up another way of thinking about how images might create that of which they speak and in the process suggest a different configuration of desire to the primitive desire of the pharmacologically addicted body. [ABSTRACT FROM AUTHOR]

In Australia we have become preoccupied with the potential adverse impact of our ageing population on our health and social systems. The projected cost of having increasing proportions of our population in the over 70s, retired, chronically ill category of the demographic profile is emerging as a major challenge for governments and private insurers: so much so in fact that the government is now urging older people to stay at work longer. In America, new approaches to the management and self-management of chronic diseases have been invoked to encourage and support older people to improve their quality of life and reduce their recourse to and dependence upon health care technologies, clinical interventions and health care management systems. Unless this is achieved, it is argued, the cost of looking after this emerging ‘bubble’ of elderly people will become increasingly unsustainable as fewer and fewer (proportionately) younger people work to pay the taxes that support ageing, retired, sick and dependent populations. This paper argues that we are at real risk of having our economic wealth and productivity impeded and truncated by the financial burden of looking after high demand and high cost dependants at the aged end of the social demographic. This paper offers an alternative view of our ageing population, as well as highlighting some of the assets we have in our elderly populations, and providing suggestions as to an alternative view of the phenomenon of ageing that incorporates elements such as flexible working arrangements and the application of new, enabling technologies. This approach to our ageing population dilemma is predicated on a concept of lifelong learning and social participation along with better preventive and early intervention systems of health care. [ABSTRACT FROM AUTHOR]

The global economic turmoil that has unfolded since August 2007 promises to change methods for the governance of ageing in ways yet unknown. Against this background, this paper asks how the demographic shifts associated with population ageing interact with other aspects of globalisation: the financialisation of economic systems, changing patterns of migration and transformations to health provision. The emphasis is on understanding the complex interplay between these processes and their relevance for rethinking approaches to population ageing in a time of uncertain transition. Questioning the tendency to understand these fields of change as precipitating distinct crises, the paper suggests that the relative predictability of global population ageing makes it an appropriate area in which to begin a reassessment of wider policy directions. [ABSTRACT FROM AUTHOR]

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]