Search

Mainstream youth mental health services struggle to comprehend the connection between colonisation and service provision for Aboriginal young people. This is the consensus agreed by Aboriginal Elders from Perth, Western Australia and young Aboriginal leaders within their communities (Wright, Culbong, Crisp, Biedermann, & Lin (2019). 1–7). What is required is a more nuanced, culturally relevant approach to both an understanding of the impact of colonisation on mental health and help-seeking behaviour if they are to provide equitable access for Aboriginal young people. In this paper, we report on a three-year participatory action research (PAR) project conducted on Whadjuk Nyoongar country in Perth, Western Australia. An innovative model of care framework developed from the project and described in this paper, focuses on key components that both inform and assist service providers in improving service provision to Aboriginal young people. The model, depicted as a tree, symbolises strength and growth, with the 'roots' of the tree, holding trust, culture and spirit. This paper details a culturally-safe co-design process that was held and directed with Elders, in partnership with young people, youth mental health service staff and youth policy staff. [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]

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]

Racial discrimination is primarily conceptualised and dealt with at the individual level in health research and practice. Most conceptualisations, and the measures which follow, are grounded in stress-coping theories thus reinforcing individual level understandings. This draws attention away from how structures and systems reproduce racial discrimination, and further supports the very racial categorisations upon which racism depends. The purpose of this paper is to discuss the relevance of critical theoretical perspectives in conceptualising racial discrimination and how it is taken-up and measured in health research. Drawing on Indigenous, Black and material feminist, intersectional, critical race, postcolonial and political economy perspectives, we propose that racial discrimination can most usefully be understood as a relational socio-historical concept. Racial discrimination understood at the systemic level in research and measurement will support more effective policies and practices to mitigate intersecting forms of discrimination in healthcare. Critical theoretical approaches to studying racial discrimination in health research could inform future analyses needed to address and limit the harms perpetuated through individual and structural forms of discrimination. [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]

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]

In this paper we report on the findings from six focus groups conducted with Australian medical students. The focus groups discussed students' perceptions of conflicts of interest and the influence of commercial values in health care and medical education. Our research revealed that students were aware of a number of structural influences that affected the medical education they received and that had the potential to shape their attitudes and practices as they progressed in becoming a doctor. We found that the pressures of educational workload and anticipated career trajectories tended to have an individualising effect that limited the perceived possibility of collective action and response to structural influences. We interpreted these findings through the lens of neoliberal governmentality to articulate the way commercial interests are negotiated and normalised by medical students. Based on these findings, we suggest that medical education should not only explicitly alert students to effects of political and commercial influences on the healthcare system, but also encourage the collective agency of students and strategies that do not place unrealistic expectations on individuals to effect structural change. [ABSTRACT FROM AUTHOR]

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

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

Alcohol consumption is a significant public health concern in Australia, with men disproportionately represented in treatment for health issues related to heavy drinking. Despite this, little is known about the experiences of these men or the gender dynamics that may shape heavy drinking. Increasingly, the treatment of alcohol and other drug-related issues, including those related to heavy drinking, is based on a biopsychosocial approach. Within this framework, heavy drinking is understood as a symptom of individual pathology in the context of various social 'factors' that influence individual capacity to exercise agency. Following the work of Karen Barad, this article employs a feminist science studies account of agency to formulate heavy drinking as a gendered 'phenomenon': enacted and sustained through the 'intra-action' of other phenomena. Drawing on interviews with men who drink heavily, our analysis explores how the phenomenon of men's heavy drinking materialises through the intra-actions of gender, isolation and healthcare. We argue that heavy drinking is not a sign of failed individual agency but an expression of entangled agencies. In concluding, we suggest it is possible to enhance the well-being of men who drink heavily by addressing specific gendered intra-actions in the making of heavy drinking. [ABSTRACT FROM AUTHOR]

Food security is an evolving concept with various definitions and associated meanings. The way food security is understood by policy-makers impacts on how it gets addressed in public policy. This research uses an interpretive approach to uncover how food security is represented by stakeholders. Semi-structured interviews were conducted with 24 stakeholders in South Australia between June and September 2010. The findings reveal four dominant representations for food security that locate responsibility for the issue across different stakeholders, namely individuals, governments, communities and private enterprise. These representations hold different underlying assumptions about the role of government in addressing the issue; the neo-liberal perspective supports a reduced role for government whereas the social determinants of health perspective calls for greater government intervention. Food security activists may need a greater awareness of how they represent the issue in order to change public policy action in this area. The approach taken in this research is relevant to other public policy problems and contexts. [ABSTRACT FROM AUTHOR]

In this article, we examine the ways transitions are constructed and represented within healthcare settings vis-à-vis lived experiences. Drawing on in-depth interviews with transgender people and data from a document analysis, we examine how transgender peoples' experiences fit within conceptualisations of transition(s) in healthcare guidance documents used in England. We take up Pearce's ([2018]. Understanding trans health. Bristol: Policy Press) suggestion to (re)think trans beyond 'condition', and rather as 'movement', to view being trans as a social identity rather than a defect. Our findings show how trans people and transitions are imagined through often linear narratives of movement in/out of transition. Through this framing, fluidity and gender liminal spaces are made invisible, where health care is imagined for certain transitions but not others. Our analysis attends to tensions that emerge in the complexity of transition(s) as well as the intricate ways in which transgender people are responding to often restrictive ontologies of medical transition. As a conceptual tool, 'trans as movement' can be used to create space for more expansive ontologies of gender that confront the harms and restrictions imposed by the gender binary, and offer alternative ways of (re)imagining multiplicity in transition trajectories and futures for both those in healthcare delivery, and for trans patients. [ABSTRACT FROM AUTHOR]

South Africa's long and arduous journey from colonial and apartheid-era care for people with mental illness to more comprehensive, equitable mental health care is well-described. Deeper engagement with the structural power dynamics involved in providing collaborative mental health services are less-well described, especially in its post-apartheid era. This conceptual article positions state and non-state mental health service providers - along with their relationships and conflicts - within Bourdieu's bureaucratic field. It is suggested that key internecine struggles in South Africa's post-apartheid socio-political arena have influenced the ways in which collaborative mental health care is provided. Drawing from two recent examples of conflict within the bureaucratic field, the article illustrates the ways in which neoliberal forces play out in contemporary South Africa's mental health service delivery. Struggles between the state and private healthcare in the Life Esidimeni tragedy receive focus, as well as the shifting of responsibility onto civil society. A court case between the state and a coalition of non-profit organisations provides further evidence that neoliberal rationalities significantly influences the position and power of non-state service providers. Unless serious consideration is given to these dynamics, collaborative mental health care in South Africa will remain out of reach. [ABSTRACT FROM AUTHOR]

Informed by Bourdieu and Passeron's theory of reproduction, we investigated relationships between the cultural and economic capitals of South Korean parents and the capitals and self-rated health of their adult children in cross-sectional survey data from the 2006 Korea Welfare Panel Study. Parental education and childhood economic circumstances manifested independent associations with the self-rated health of the adult respondents. Much of the connection between parental capitals and respondent self-rated health was explained by respondent education. Educational attainment and household income but not receipt of monetary inheritance from their parents were significantly associated with the self-rated health of the respondents. Lastly, parental educational attainment was associated with the self-rated health of the women but not the men over and above the capitals held by the respondents themselves. Our study illuminates the importance of the intergenerational transmission of multiple forms of capital in the production of good health for South Korean adults. In particular, we propose that wealthy and well-educated South Korean parents employ their capitals to develop math and linguistics skills in their children that facilitate good performance in the standardised university entrance exams, success in the labour and/or marriage markets and, ultimately, good self-rated health for their adult children. [ABSTRACT FROM AUTHOR]

This article revisits women's accounts of menstrual suppression and considers the value in using material feminist theory to discuss the concept of nature in this context. Whilst a sociological, poststructuralist framing of nature as discourse has been useful in challenging essentialist claims about women's bodies, I argue now that engaging with material feminism acknowledges both the material and discursive ways in which women talk about menstruation and its suppression. This article draws on qualitative data gathered in the aftermath of the approval of the first extended cycle oral contraceptive. In their narratives women struggled to unite the desire to frame their perceptions as natural whilst at the same time upholding the right to use synthetic interventions to control menstruation. Building on poststructural and embodiment theory, as well as drawing on the concept of 'naturecultures' [Haraway, D. (1991). Simians, cyborgs and women: The reinvention of nature. New York: Routledge], I argue it is helpful for health sociology to incorporate material feminism in order to advance understanding of ambivalence in relation to new reproductive technologies. [ABSTRACT FROM AUTHOR]

Health and wellbeing is defined internationally as a multi-dimensional and holistic concept, particularly within Indigenous worldviews. However, in Australia there is a lack of detailed frameworks supporting such definitions that are founded on Aboriginal knowledges. Tins study aimed to explore Aboriginal perspectives of child health and wellbeing in an urban setting. Qualitative interviews with 25 care-givers of Aboriginal children living in Melbourne, Australia were conducted. Aboriginal people and community controlled organisations were collaborative partners in all stages of the research. A conceptual fiamework of Aboriginal child health and wellbeing in an urban setting was developed comprising four main themes: Strong Culture; Strong Child; Strong Environment; and Strengths and Challenges. Aboriginal conceptions of culture are considered central to Aboriginal child health and wellbeing in an urban context. A holistic framework that privileges Aboriginal knowledge of child health and wellbeing has not previously been available. Further exploration of socio-ecological models within Aboriginal child health and wellbeing contexts is needed. This study identifies dimensions for further exploration in research, policy and practice. [ABSTRACT FROM AUTHOR]

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

Sex comparisons reveal men as more likely than women to die earlier and experience debilitating injury. Historically, this trend has been positioned as somewhat inevitable, an outcome of men's 'natural' biologically charged tendencies for risk-taking and reluctance around help-seeking. More recently, gender research has emerged to describe cultural norms about masculinity and explore their relationships to men's health and illness practices. Empirically, masculinities and men's health research has revealed diverse practices that suggest some men's risky health behaviours are amenable to change. This article provides a brief review of how masculinity has been understood in men's health research before making recommendations for where we might next go in theorising social constructions of masculinities. Specifically, a vignette drawn from a study examining young men's responses to the death of a peer is used to illustrate how the communities of practice framework can be applied, and might conceptually advance future masculinities and men's health research. [ABSTRACT FROM AUTHOR]