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

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

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

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

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

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

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

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

This 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]

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

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

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

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

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

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

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

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]

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

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

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]

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

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

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]

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

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]

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

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]

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

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

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

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

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

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

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

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

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]

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

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

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