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The sale of raw drinking milk from cows is banned in Australia due to regulatory requirements that all milk must be pasteurised. Such a prohibition is based on concern about public health and safety risks, and was upheld in the most recent review of raw milk product regulation undertaken by Food Standards Australia New Zealand (FSANZ). However, this decision is not one that is universally accepted, with some people challenging the conclusion that raw milk is dangerous, and choosing to still source and drink it. In this paper, the contested regulation of raw milk is examined by questioning the normative assumption that the object in question, raw milk, is a singular entity, and one which is always dangerous. Drawing on analysis of six FSANZ documents released as part of its raw milk review, this paper discusses the practices that stabilise raw milk as always risky; processes that are found to wash away the possibility of other, potentially safe, versions of raw milk. It concludes by finding that such stabilisation has tangible impacts for public health policy and regulation, including limiting the parameters within which debate can occur, and precluding the possibility that other versions of raw milk could exist, or be accounted for in food safety regulation. [ABSTRACT FROM AUTHOR]

Violence and abuse against people with intellectual disabilities are internationally recognised as a pervasive social problem. Recent years have seen the development and implementation of preventative strategies, yet only few of them have been rigorously evaluated. The present paper aims to identify preventative abuse strategies for people with intellectual disabilities and explore the evidence about their quality and effectiveness. A scoping review method was implemented, and a comprehensive search of 14 online databases identified six peer-reviewed articles, published between January 2007 and June 2019, that reported on evaluation of violence prevention strategies designed for adults with intellectual disabilities. Each program and its evaluation were critically and systematically reviewed. Overall, the analysis reveals the strategies' core elements, and highlights strengths and gaps in delivery and evaluation. More rigorous evaluation is required to establish the effectiveness of violence prevention strategies and to advance evidence-based practice in this field. IMPLICATIONS The social work profession has a critical role in the development, implementation, and evaluation of violence prevention strategies for adults with intellectual disabilities. Design of violence prevention strategies needs to be multifaceted, and embedded within the social and cultural environments of people with intellectual disabilities. Violence prevention strategies need to evolve from focusing solely on risk reduction to a broader approach encompassing the safety of adults with intellectual disabilities as part of their human rights. [ABSTRACT FROM AUTHOR]

In this paper we examine how popular media reporting positions dating and hookup app use as a 'social problem' that impacts on health and wellbeing. The paper adopts a mixed-methods media studies approach to create and analyse a dataset of over 6,000 international news articles published within a 12-month period, drawing on thematic content analysis and inductive and deductive techniques. These analyses are framed in relation to online consultations with Australian sexual health professionals and app users. Applying Briggs and Hallin's theory of biocommunicability (2007) – which proposes that contemporary health professionals' scientific framing of public health problems are, in part, shaped by popular media discourses – we identify a significant category of supportive discussions of safer app use within social news and lifestyle reporting. This discursive space features what we have termed 'vernacular pedagogies' of app use, revealing app users' safety strategies, and their experiences of pleasure and playfulness. We argue that an analysis of popular media can provide valuable insights into how everyday experiences of safety, risk and wellbeing are being shaped and contested with dating and hookup app use, and that these insights can be used to develop meaningful health promotion strategies. [ABSTRACT FROM AUTHOR]

Communicating health information quickly and effectively with diverse populations has been essential during the COVID-19 pandemic. However, health communication practices are often top down and poorly designed to rapidly meet diverse health literacy, cultural and contextual needs of the population. This paper describes a research and practice partnership focused on health literacy, multicultural health, and community engagement to address COVID-19 in Australia. The partnership became influential in the local and state-based response to the COVID-19 Delta outbreak in Western and South Western Sydney, an area of high cultural and socioeconomic diversity. Our approach, bringing together academic researchers and frontline health staff working with multicultural populations using a model of co-design and community engagement and action via the "4 M model," has been successful. It supported the Western Sydney community to achieve some of the highest vaccination rates in the world (>90%). There is an ongoing need to engage respectfully and responsively with communities to address specific challenges that they face and tailor communications and supports accordingly for successful pandemic management. Combining co-designed empirical research with community engagement and action ensures needs are robustly identified and can be appropriately addressed to support an effective public health response. [ABSTRACT FROM AUTHOR]

This paper examines the multiple tensions arising in an Australian university and public sector collaboration that aimed to investigate an obesity intervention. A key site of conflict with the external collaborators emerged when we, the researchers, focusing on the experiences of marginalized local people, presented research findings that were at odds with the dominant understanding of obesity that framed the public health intervention. From those with a range of roles in the public sector, we received claims of misrepresentation and requests to change or not publicly release certain research findings. Drawing on the 'policy learning framework' of Dunlop and Radaelli, we examine these epistemic conflicts and point to the Achilles' heels of the 'engagement and impact' agenda. From the perspective of government, the inherent weakness stems from the lack of control in a partnership, and from the perspective of academics, it is the danger of undermining trust in universities and the knowledge academics produce, through the process of engaging with government and being party to research that is designed to shore up a position that government has already decided upon. This case study has implications for academic and government collaborators who may benefit from explicit planning about how to negotiate discord around the processes of learning that occur in and across research, policy, and practice. [ABSTRACT FROM AUTHOR]

It behoves the Australian Curriculum: Health and Physical Education (HPE) to provide an education for children and young people that accounts for future trends and new health challenges, but what such a curriculum should look like is a challenge in itself. As the Lead Writer of the curriculum’s background Shape Paper, supported by an Advisory Panel under the auspices of the Australian Curriculum, Assessment and Reporting Authority, I will outline and reflect upon where HPE may be heading in Australia with a focus on its relationship to public health. ‘Sacred ties and fresh eyes’ reminds us that some of those providing input, commentary and exerting influence over curriculum directions have an enduring sense of what the curriculum should address while others are looking for new ways of seeing health education. An ensuing dilemma is that new ways of seeing may not have the accumulated evidence of traditional practices nor the authority of programmatic, biophysical research. Rather they are informed by a constellation of factors, including research that provides a persuasive and credible solution in the eyes of many. Bernstein’s concepts of field, classification and frame are useful for making sense of the patterns of power and influence in the curriculum-making exercise. [ABSTRACT FROM PUBLISHER]

Drawing on Foucault's conceptualisation of power, this paper examines public health as a distinctly modern regime of governance. An account of the historical regulation of drug use is traced in order to examine socio-historical shifts and lines of continuity in contemporary technologies of harm reduction. Using qualitative interview data, we examined practices of power in the context of contemporary drug use, including self-governance using techniques of monitoring, self-management and self-tracking. Participants' accounts revealed that they were encouraged to self-govern their drug use through a variety of reformist technologies that are embedded in harm-reduction programs. It is argued that participants' subjectivity is formed at the intersection of authoritative governance and self-governance, through ethical practices of the self which have emerged from disciplinary health practices, and incorporate the body as the site of power. We illustrate this by drawing a distinction between hygienist and sanitationist practices of public health. These governmental practices, which are embedded in public health programs, encourage people who use drugs to transform themselves into moral citizens, aligning their ethical practices with governing interests. [ABSTRACT FROM AUTHOR]

This paper is prompted by a series of recent high-profile decisions emanating from the apex courts in the US and Australia – namely,MayoandMyriad– on the patent eligibility of gene-based inventions. Adopting a comparative approach, this paper critically examines whether isolated gene sequences and diagnostic methods qualify as patentable subject matter in several leading jurisdictions, including the US, Australia, Europe and the UK. An attempt will also be made, after carefully considering various arguments on both sides of the policy debate, at predicting what the future might hold (or, perhaps more accurately, at suggesting what the future ought to be) for gene patenting and the patenting of diagnostic methods in the global biotechnology landscape. [ABSTRACT FROM PUBLISHER]

At present, Australian sex(uality) education curricula aim to equip students with information which facilitates ‘healthy’ sexual choices as they develop. However, this is not neutral information, but rather socially and culturally regulated discourse which encodes a normative binary of sexuality. The largely US-focused sexuality education literature tends to categorise curricula as belonging to either ‘comprehensive’ or ‘conservative’ factions, consisting of progressive, secular approaches or religious- or abstinence-based programmes, respectively. Neither of these factions, however, appear to be able to cater for the integration of issues relevant to gay, lesbian, bisexual, transgender, intersex and queer (GLBTIQ) students nor does this binary conceptualisation represent the reality of Australian sexuality education policy and practice. This paper argues that contemporary sexuality education has a fundamentally neoliberal focus, which aims to assimilate GLBTIQ people into existing normative frameworks (economic and social), rather than challenge them. Such an approach does not foster critical student understandings of oppression, power or morality. The development of critical literacy around sexuality is regarded as essential to meaningfully address the complex needs of GLBTIQ students. The paper explores missing queer discourses within Australian teaching resources. The inclusion of these would benefit GLBTIQ students by bringing previously silenced issues to the fore. [ABSTRACT FROM PUBLISHER]

Australian community arts and mental health is described through its 40-year history with peaks of activity coinciding with federal labor governments and the establishment of four independent health promotion agencies from the late 1980s. The paper then takes a thematic approach to discussing the development of national approaches to supporting arts and health practice, data sources, current research and evaluation and advocacy challenges. The paper concludes by suggesting that under the current federal labor government arts and health may benefit from increasing recognition of the intrinsic benefits of arts participation and cultural rights. [ABSTRACT FROM AUTHOR]

Our choice for care at the end of our lives is constrained by many factors, including the options available to us, our capacity to choose and the social structures that constrain our options and therefore our choices. Working with the interaction between personal agency and social constraints is a core public health activity. An intentional public health approach to palliative and end-of-life care can elucidate the direct relationship between our social circumstances and the quality of our end of life and uncover the implications of structural inequity for end-of-life choice. The approach reorients systems and settings to achieve accessible and equitable palliative and end of-life care for all, and identifies contributions that all jurisdictions, settings, organisations, sectors and communities can make to improving end-of-life care outcomes. Frameworks that support this shift in practice and policy are however in their infancy. Implementation frameworks that can structure and guide 'how' to translate public health palliative care concepts into sustainable practice are needed. This paper reports on an evidence-based Australian public health palliative care framework designed to achieve this. [ABSTRACT FROM AUTHOR]

Trade agreements influence the distribution of money, goods, services and daily living conditions – the social determinants of health and health equity, which ultimately impacts differentially on health within and between countries. In order to advance health equity as a trade policy goal, greater understanding is needed of how different actors frame their interests in order to shape government priorities, thus helping to identify competing agendas across policy communities. This paper reports on a study of how policy actors framed their interests for the Trans Pacific Partnership agreement. We analysed 88 submissions made by industry actors, not for profit organisations, unions, researchers and individual citizens to the Australian government during treaty negotiations. We show that policy actors' ideas of the purpose of trade agreements are shaped by competing underlying assumptions of the role of the state, market and society. We identify three primary framings: a dominant neoliberal market frame, and counter frames for the public interest and state sovereignty. Our analysis highlights the potential enabling and constraining impact of policy frames for health equity. In particular, the current dominant market framing largely excludes the social determinants of health and health equity. We argue that advocacy needs to tackle head on the underlying assumptions of market framings in order to open up space for the social. We identify successful examples of health framing for equity as well as opportunities for engagement with 'non-traditional' allies on shared issues of concern. [ABSTRACT FROM AUTHOR]

Background: Alcohol use is a common phenomenon within Australian culture. While there has been significant focus on alcohol use among young Australians, there has been little on health promotion or early interventions focussing on older Australians. Methods: This paper presents the findings of an explorative study that used four interactive focus group workshops to ask the question: Is an existing World Health Organisation alcohol and drug screening tool called the Alcohol, Smoking and Substance Involvement Screening Test (originally developed for young people) acceptable and suitable for older people? The data were analysed based on the question using thematic coding. Results: Participants generally considered that they would be more comfortable talking with their health providers about their alcohol and drug use rather than filling out the Alcohol, Smoking and Substance Involvement Screening Test themselves. This suggests that the tool should be modified to accommodate the differences in health status that reflect life events of the different older age groups. Conclusion: Due to potential complex medical and diverse range of pharmacotherapies common among this age group, it is recommended that, if the tool is used, it be administered by health practitioners such as nurses. [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]

This paper explores the place of risk and risk management within contemporary Australian drug policy debates, focusing on the Howard Government's Tough on Drugs strategy. In exploring the conceptual bases of this strategy, this paper suggests that the characterisations of risk discernible in Australian debates have been dominated by a narrow group of 'expert' discourses leading to a range of gaps and omissions in the development of drugs policies. Furthermore the paper suggests that such omissions have significant implications for the development of harm reduction strategies within young drug using populations in Australia and elsewhere. In developing these arguments, the paper draws upon the work of Ulrich Beck and Anthony Giddens. Of particular interest is Beck's account of the tension between 'expert' and 'non-expert' risk assessments within contemporary risk management debates. In privileging more 'expert' risk knowledges, this paper suggests that Australian drug policies have ignored the range of 'non-expert' risk management strategies that exist within young drug using populations, and concludes that this ignorance of the culture and the context of young people's drug use further undermines the efficacy of health promotion efforts within these populations. [ABSTRACT FROM AUTHOR]

Public health efforts to lift childhood vaccination rates can be supported or undermined by media representations of parents. Polarising representations neglect the large range of ‘middle-ground’ positions people occupy, potentially alienating parents. In recent years, Australian public health actors have tried to better engage journalists to avoid this. As these efforts have unfolded, the main national immunisation policy lever has become more punitive. This paper examines whether Australian newspaper representations of parents have changed, by comparing 153 newspaper articles from two periods: 1997-1998 (prior to the development of a public health lobby targeting the media; when the first national childhood immunisation policy was introduced) and; 2015-2016 (5 years after advocacy groups began working with the media; and when the national policy took a punitive turn). We analyse patterns and shifts (between 1997-1998 and 2015-2016) in the portrayal of parents as complacent, alternative, hesitant and as choosing. Australian newspaper portrayals of parents are broadly aligned with the policy targets of the day. In 2015-2016, there was less negative representation of parents who occupy the ‘middle-ground’ between vaccine acceptance and rejection. However, coverage of alternative parents (vaccine objectors) intensified in quantity and negativity. Concurrently, there were new (minority) portrayals of vaccine objectors as invisible, and as victims being denied choice. This signals that reporting may simultaneously align with national policy targets and destabilise public health efforts to avoid polarising misrepresentations of parents, characterisations likely to undermine trust in public health. Rather than ‘blame the media’, this analysis illuminates conflicts within public health. [ABSTRACT FROM AUTHOR]

In this paper, we examine a situated example of the media’s (re)production of shared understandings around smoking, pregnancy and health. Through a discursive lens, we address the way in which Australian media personality Chrissie Swan accounted, on radio, for her continued smoking while pregnant after photographic evidence of her tobacco use entered the public domain. We argue that Swan’s account of her smoking privileges a version of ‘the good mother’ as solely responsible for the health of her foetus, and right to feel ashamed when putting this at risk. A construction of smoking as a (medicalised, irrational) addiction enables her to manage a positive identity in the face of this construction: she presents as being ‘thwarted’ in her quitting efforts by a force beyond her control. Ultimately, we argue that the version of ‘good motherhood’ constructed in Swan’s account is paradoxical, and may serve both to support, and constrain, pregnant smokers’ capacity to sustain quitting behaviours over the long term. In turn, we argue that ‘moralising’ anti-smoking interventions aimed at pregnant women may be less useful than an approach that interrogates the range of socio-cultural expectations of ‘good motherhood’ by which pregnant women are simultaneously positioned. [ABSTRACT FROM AUTHOR]

While grappling with their traditional core business of imbuing students with official curricular knowledge, schools have simultaneously, increasing demands to take on health promotion responsibilities. This paper examines the mandated implementation of the Eat Well Be Active (EWBA) Action Plan and its subsidiary ‘Smart’ policies in schools in the state of Queensland, Australia. Within the context of health promotion, the interaction between the health and education policy interfaces was explored. In particular, we paid close attention to the responses of the schools and their staff to the convergence of various health policies within their institutions. Drawing on Bernstein's concept of field, this paper reports our analyses of responses within the reproduction field to the imperatives of the Smart policies. The results suggest that there exists a disjunction between the recontextualising and reproduction fields in terms of the EWBA policy intent and implementation. [ABSTRACT FROM PUBLISHER]

This paper concerns itself with some of the consequences of legislatively supported public health interventions into smoking. These have emerged from the legislative environment of 'smokefree' in Australia, and centrally concern the constitution of public space under its operation; the conceptualisation of risk which circulates within it; and the way in which agency may be imagined in public health framings of smoking. I make a critical anthropological analysis of the ways in which risk, agency and a certain kind of public are imagined and brought to bear on smokers in particular ways. The paper is equally an invitation into the social practice of smoking, as it is undertaken by smokers and as I have ethnographically encountered smoking practice since I began work in the area in 2005. Both the critical analysis and the invitation are difficult to make in a context where research on smoking is increasingly expected to contribute to a public health cessation agenda. [ABSTRACT FROM AUTHOR]

In most developed countries, competent patients have the legal right to refuse any medical treatment; Advance Care Planning mechanisms extend this right to non-competent patients. However, some groups, including lesbian, gay, bisexual, transgender and intersex (LGBTI) people, risk their wishes not being respected if they lose capacity, more than others. Little is known about medical practitioners' knowledge of, or attitudes to, the law in this area, especially in relation to LGBTI people, or how the law influences their decision-making. An Australian postal survey explored knowledge and attitudes of medical specialists to legal issues relating to withdrawing/ withholding life-sustaining treatment from adults without capacity. One scenario (the focus of this paper) asked which of four plausible substitute decision-makers, including a same-sex partner, had the legal authority to make such decisions. The overall response rate was 32% (867/2702). Less than one-third of respondents correctly identified the same-sex partner as the legally authorised decision-maker. LGBTI people face multiple obstacles to having their end-of-life wishes respected. Where healthcare providers are also ignorant of the partner's legal right to make such decisions, the problem is compounded. Improved legal education for clinicians and promotion of educational resources for members of the LGBTI community is needed. [ABSTRACT FROM AUTHOR]

Introduction: The aim of this paper was to provide an in-depth analysis of all stillbirth causation over a period of 10 years in a busy maternity unit located in a socioeconomically disadvantaged urban area, with an emphasis on overlapping pathology.Materials and Methods: A retrospective analysis of all structurally normal stillbirths in singleton pregnancies born during 2002-2012. The PSANZ stillbirth classification was used; per stillbirth subgroup main risk factors were evaluated.Results: Out of 130 cases, 43% showed overlapping pathologies. In the remaining 74 (56%) cases, the following single pathologies were found: IUGR 20 (15%), infection 12 (9%), abruption 8 (6%), placental thrombotic pathology 8 (6%), miscellaneous 6 stillbirths (5%), and 20 cases (15%) unexplained. Smoking was a risk factor for stillbirth associated with abruption (OR 3.639), infection (OR 2.271), and thrombotic pathology (OR 2.168). Drug use had an association with (placental) infection (OR 3.598). Obesity showed a significant association with IUGR (OR 3.782) and abruption (OR 9.040). Thrombophilia risk analysis for the overall group of stillbirths showed significant results for Protein S (OR 8.889) and homocysteine >90th centile (OR 2.087).Conclusions: Overlapping pathology was identified in 43% of stillbirths. Infection, IUGR, and abruption were the most important single cause of stillbirth. [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]

Introduction: Researchers frequently complete outstanding work in the road safety area that, if put into practice, could reduce the deaths and injuries resulting from road crashes. Parliamentary committees working for Westminster style parliaments can provide these researchers with opportunities to help transfer their research directly into practice. Method: This paper fills a gap in our understanding of the role of parliamentary committees in the road safety policy development process by reviewing existing literature. It firstly considers the work that Australian road safety committees have completed to date and then identifies corresponding improvements in practices. The contribution that researchers can make to this process is also reviewed. Results: Parliamentary committees have made important contributions to the development of road safety policy and legislation within Australia. This review found that researchers have an important role to play in the development of this policy and legislation. Conclusions: Researchers should actively participate in the work of parliamentary road safety committees by providing road safety suggestions based on empirical evidence and consideration of the local road safety issues within that jurisdiction. [ABSTRACT FROM AUTHOR]

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

Rural Australia faces unique issues in workforce management and health care delivery. This paper provides an integrated review of the existing literature describing the work of practice nurses in rural Australia and the perceptions of consumers. Distinct differences are evident in the role of the practice nurse between rural and metropolitan practices. A key difference is that the rural practice nurse is known within the community and plays an important role in care coordination. Findings from two studies of consumer perceptions of the role of PN in rural areas suggest that the more remotely located the consumer, the greater is their perception that the nurse works under the direct supervision of the doctor. Currently, remotely located residents do not support an expanded autonomous role for the nurse. Greater research is required to develop the role of the practice nurse in rural Australia. [ABSTRACT FROM AUTHOR]

A roundtable discussion was held with 29 experienced Public Health researchers and policy makers from 9 countries at an international conference in Australia. Their experiences were discussed about establishing and maintaining research projects and health programs in developing countries. This paper aims to (1) Highlight methodological issues relevant to the conduct of research and development in low income settings as discussed at the roundtable; (2) List the main barriers in implementing research and project initiatives in low-income settings; and (3) present recommendations for meeting researchers' needs across cultures without jeopardising methodological rigour. Lessons learnt on barriers for the conduct of methodologically sound research were classified in four domains: investigator factors, community factors, strategic factors and methodological factors. Proposed solutions emerged in the areas of strategic guidelines, attitudinal changes and methodological approaches. Practical solutions to individual and systematic barriers were also suggested. It is hoped that these recommendations will influence current practice and assist other researchers in preparing and undertaking appropriate research methods and health program delivery strategies in low-income settings. [ABSTRACT FROM AUTHOR]

The term ‘workforce development’ is increasingly popular in the health-care field. It appears to encompass a range of human and organizational development activity. However, there has been limited explication of the concept of workforce development in Australian health care at area health service levels. It is timely to develop a framework for workforce development and processes to guide any evaluation of the implementation of workforce development strategies. This paper presents a framework that has been developed through consultative processes in an area health service and an associated review of literature. [ABSTRACT FROM AUTHOR]

Background : Consumer consultants are people who have suffered from a mental illness requiring treatment in a public facility, and who are employed in public mental health services to put forward a consumer perspective. Aims : The aim of this study was to investigate the experience of consumer consultants in the Victorian public mental health program. Method : The paper traces the development of the consumer consultant program in Victoria, Australia and examines the literature on barriers to consumer participation in mental health services. The paper then outlines a qualitative study of the experiences of consumer consultants, focussing on their perceived areas of influence, areas of difficulty and their suggestions for improvement. Results : Organizational influences that affect the work of the consumer consultants are discussed and two "ideal types" of services outlined. Service red has institutional barriers that hinder the work of consumer consultants, whereas service green has institutional features that facilitate their work. Conclusions : Consumer consultants have made real gains in providing effective representation of the consumer perspective, resulting in service improvement, but the results have been uneven, and many significant barriers persist. Declaration of interest : The first and third author work in public mental health services. This study was carried out in part fulfilment of a Master of Social Work. [ABSTRACT FROM AUTHOR]

Australians are not taking up their full allowance of annual holidays which could, in time, lead to issues of community health as well as impact on the viability of the domestic tourism industry. As a response, government tourism organisations in Australia have allocated funds to encourage domestic holidays. However, competition for discretionary income from other sources of recreational activities will continue to impact on this sector, requiring more than direct tourism promotion. This paper considers one such competing aspect of discretionary spending, namely gambling, and its likely effect on tourism expenditure. It examines the role of demarketing as a means to limit gambling expenditure and increase tourism. A range of demarketing and remarketing strategies are proposed as integrated elements of gambling and tourism planning. Such a proposal has the potential to restructure regional communities in such a way as to contribute to the building of community and personal well-being. [ABSTRACT FROM AUTHOR]

Purpose: Those travelling overseas for work or leisure including male expatriates, longer-term and frequent travellers (ELoFTs) may be at heightened risk for a range of health and wellbeing issues. Social support may mediate this risk. However, from a public health perspective, little is written about how ELoFTs access health information and support and the role of their social networks in facilitating health and wellbeing outcomes. This research was part of a study examining social network processes of Australian male ELoFTs travelling, living, or working in Southeast Asia (SEA). Methods: Symbolic Interactionism and Grounded Theory were the conceptual framework and methodology supporting semi-structured, in-depth interviews (n = 25) conducted in Australia and Thailand with Australian male ELoFTs to SEA, aged 18 years or older. Results: Findings highlight supports that assist ELoFT transition and adjustment to country of destination or manage their transnational experience. Influential places, people, and points in the migration journey mediated engagement with social support. Conclusions: ELoFT social networks and the support provided within them may provide a mechanism for intervention across a range of public health issues. Findings may support the development of policy and practice across industries charged with supporting successful ELoFT adjustment. [ABSTRACT FROM AUTHOR]

In this paper we report the findings from an evaluation of the introduction of sensory modulation (SM) in an acute mental health inpatient unit. It was expected that SM could be used to help settle patients experiencing high levels of disturbance and that as a result, there would be less need for use of more restrictive seclusion practices. The evaluation took place in a hospital in south-east Queensland, Australia. SM was introduced in one acute unit while the other served as a control. The evaluation comprised two studies. In the first study we aimed to determine whether SM reduced the level of disturbance among patients given the opportunity to use it. In the second study we aimed to find out whether the introduction of SM reduced the frequency and duration of seclusion. In study 1, we found that most patients reported marked reduction in disturbance after using SM and there was a very large effect size for the group as a whole. In study 2, we found that frequency of seclusion dropped dramatically in the unit that introduced SM but rose slightly in the unit that did not have access to SM. The change in seclusion rate was highly significant (χ2 = 49.1, df = 1, p < 0.001). Results are discussed, having reference to the limitations inherent in a naturalistic study. [ABSTRACT FROM AUTHOR]

Surveillance has always been intricately connected to both the theory and practice of public health. The salience of epidemiologic method, particularly the enumeration of ‘risk factors’ and the interpolation of different population ‘groups’, underscores this reality. However, in the post 9/11 era, there has been a conflation between public health and ‘national security’ concerns. Consequently, border control, imagined as a frontier where the two most readily connect, now co-opts public health concerns, for instance ‘threats’ to legitimate specific forms of securitisation, including the case of infectious diseases such as tuberculosis. In this paper, we highlight the manner in which the Australian border control regime functions as a technology of surveillance in relation to the ‘threat’ of TB and the effects it both produces for individuals and affected communities. Specifically, we highlight how spectacles enacted in the name of border control need to be carefully attended to, lest they ultimately serve to undermine the goals of public health itself. [ABSTRACT FROM PUBLISHER]

This paper examines key aspects of the Australian public's response to swine flu through an analysis of interviews and focus groups with people deemed “at risk” by medical authorities. The wider context for the study is provided by risk theory, research on public responses to emerging infectious diseases (EID) and the concept of biocommunicability. We focus on reflexivity in engaging with media, views on the government's response, and vigilance and behaviour change. EID fatigue, a predisposition toward distrusting the media, personal circumstances and location within particular social networks, shaped responses to news reporting of swine flu. People did not link swine flu to already stigmatised groups because they identified it as “resident” in the community. The continuing dependency of lay publics upon governments and expert systems may help to explain the lack of criticism directed at more traditionally powerful groups. Distancing took a variety of forms. While newspapers emphasised the “novel” and “deadly” swine flu narrative, audiences readily described it as just another flu and were unconcerned about contracting it. However, some imagined that others were more vulnerable to the effects of media reporting. Some reported searching the internet for information, which may explain the differences between how they saw it and how it was reported. Also influential was the fact that their lived experiences did not bear out the novelty or seriousness of swine flu. Our discussion is informed by our concurrent analyses of media coverage and interviews with EID experts and journalists involved in the reporting. [ABSTRACT FROM PUBLISHER]

Much to the frustration of road safety researchers, practitioners and advocates, road deaths and injuries have not been widely accepted as a major public health threat. Currently, road trauma is one of the biggest killers and causes of serious and disabling injuries in the world. While there has been considerable research on the causes of road injury and ways of mitigating the problem, there is still reluctance to systematically and sufficiently do what can be done to reduce this problem globally. This paper takes an historical review of the road trauma problem and responses to it. In examining developments in road transport and road injury, it is clear that the main impediment to reducing road deaths and injury has been a misguided preference of economic advancement over public health risk management. It is misguided because road trauma has impeded and does still impede the capacity of economies to develop. The challenge for societies now is to look at this false dichotomy - that of road development and motorisation versus road safety - and begin to make the right choices in favour of human society advancement through the development and management of safe road-traffic systems. A new 'Safe Systems' approach is emerging in Australia and spreading globally as a guiding principle for road safety. The evolution of this approach is traced and illustrated in this article. The need for finding ways to engender a stronger global political commitment to road safety is demonstrated. [ABSTRACT FROM AUTHOR]

The Australian Federal Government health agenda is advocating an extension of public health principles across all levels of the health sector. Since mental health nurses have long been proponents of public health and health promoting behaviours, an opportunity exists for this specialty of nursing to extend their influence and contribution within health. Solution focused nursing (SFN), a model that emerged from mental health practice, offers a framework to assist mental health nurses and leaders to more clearly practise public health principles within nursing and articulate that practice – for it is in the articulation of practice that nurses and nursing is made visible and valued. This paper aims to expand on and reiterate the SFN model, showing how it connects to public health principles and develops the mental health nurse's role – particularly in those clinical areas that require more than medical management and illness stabilization. [ABSTRACT FROM AUTHOR]

Background/Aims: Syringe dispensing machines were introduced into needle syringe programs (NSPs) two decades ago. The few published studies on dispensing machines have focused on feedback of machine users and service providers' feedback has rarely been reported. This study obtained the feedback of health staff of NSPs, other sectors of Drug Misuse Treatment Services and of other health services adjoining dispensing machines on the role and effectiveness of dispensing machines. Methods: Between August and November 2006, questionnaires were anonymously completed by NSP and drug misuser treatment staff in an Area Health Service in Sydney, as well as by the staff of two nondrug-related health services located adjacent to needle syringe dispensing machines. The questionnaire was available in either paper or Internet based forms. Results: Almost 80% of 94 participants rated dispensing machines as either moderately successful or successful in reducing sharing of needles and syringes. Staff considered that introduction of these machines to NSPs had improved services for injecting drug users without increasing unsafe disposal of used equipment, community drug use, or vandalism. However 78% of respondents felt that dispensing machines either reduce or may reduce IDUs' opportunity for staff contact and hence opportunity for engagement or education. The study limitations were noted. Conclusion: Syringe dispensing machines are perceived to be a successful and appropriate outlet of NSPs that complement other outlets. Lack of staff-user contact was seen as their main disadvantage. [ABSTRACT FROM AUTHOR]

The increasing political significance of private health insurance can be located in an altered understanding of the role of individuals and the State in protecting citizens' welfare. In common with other Western societies, contemporary Australia is marked by an expectation that people will fund their own needs and identify and manage their own risks throughout their life course. However, we lack information on how people come to make their decisions. In particular, there is no analysis of why people choose to invest in private health insurance. This paper reports on an exploratory study investigating the motivations for the uptake of private health insurance. Taking a socio-cultural approach, the study indicates that while people's stated reasons for buying health insurance show some surface similarities with the reasoning expected of neo-liberal citizens, a closer reading of the data indicates they do not approach their decisions in a rational or calculative way. They rely less on weighing evidence (e.g. relevant statistics, the provisions of their contract with the insurance provider and their own experiences) than they do on trust in an impersonal system, i.e. they believe people and systems will not harm them in future situations (Gilson 2003). [ABSTRACT FROM AUTHOR]

This paper provides a thematic review of the literature on cancer in Aboriginal people in Australia, focusing on experiences in diagnosis, treatment and care as well as addressing sociocultural factors to guide the public health response to poorer treatment outcomes. A search of both medical and social scientific databases for journal articles published between 1995 and 2006 show that cancer incidence and possibly survival and mortality data are likely to be underestimated in Aboriginal people. Aboriginal people are more likely to die from cancer than non-Aboriginal Australians. There are significant differences between the cancer experiences of those living in the city and in rural or remote areas. There is also a relative absence of literature on cancer in Aboriginal men, who are likely to have particular needs during diagnosis, treatment and care. In drawing conclusions from these data, it can be seen that Aboriginal people with cancer have poorer outcomes than non-Aboriginal Australians, and there is a need for further research in the patterns of care and predictors of outcomes in Aboriginal men and women with cancer. Particular attention should be given to the different needs and experiences of Aboriginal people in urban or rural/remote areas. These findings indicate an urgent need to allocate additional resources to the treatment and care of Aboriginal people with cancer, in addition to screening interventions. There is also a continuing need to acknowledge cultural differences in the health beliefs of Aboriginal people and to work in partnership with Aboriginal community controlled health organisations. [ABSTRACT FROM AUTHOR]

The new genetics ‘industry’ has emerged at a time of public ambivalence towards science, an ambivalence that could move to outright distrust when the commercial imperatives of increasingly market-oriented science gradually replace the more traditional imperative of ‘public good’. Genetics research and development is at the vanguard of the movement of science into the market economy and, as such, has come under intense public scrutiny. The political and social environment now demands public participation in the development of regulatory structures. Commercialization aims for rapid advances in research, leading to new genetic therapies and other public health benefits. However, this rapid progress has resulted in human tissue banks and genetic databases un(der)regulated in many countries, and challenges to accepted notions of privacy, ownership and consent. This paper presents an outline of the way Australia has embraced public participation in the development of a regulatory framework governing human genetic databanks. It argues that after a two-year, two-stage national inquiry into the protection of genetic information, the country now stands at a crossroads: it either addresses the recommendations of the inquiry—providing a model for the development of public trust in the human genetics industry, and in the state to regulate it, or continues to ignore the recommendations, fostering cynicism regarding the consultation process and an even greater level of distrust in the ability/willingness of the state to regulate the industry. [ABSTRACT FROM AUTHOR]

Objective Methodological criteria that characterise ethically sound community-based studies are often described in overviews but are rarely documented in clinical studies. Research investigating the health of Aboriginal Australians is often small-scale, descriptive and largely driven by non-Indigenous people. The ‘community-controlled’ model of research relating to Aboriginal peoples health is a form of ‘participatory’ research that shifts the balance of control towards those being researched. This paper describes the methodological issues and principles that underpin community-controlled health research; their practical application; and encourages their adoption in research involving Indigenous populations.Design Descriptive report of the methods used to conduct the landmark Aboriginal community-controlled multi-centre double-blind randomised controlled clinical ear trial investigating ototopical treatments for chronic suppurative otitis media.Results The characteristics of the community-controlled research model are illustrated under the headings of: setting the research agenda; research project planning and approval; conduct of research; and analysis, dissemination and application of findings.Conclusion The 22 methodological elements which defined the community-controlled design of the ear trial may assist community groups, external research bodies and funding agencies to improve the acceptability, quality and scope of research involving Indigenous peoples. Aboriginal community-controlled organisations are well placed to lead research, which can be interventional and of a high scientific standard without compromising the values and principles of those being researched. With over 120 Aboriginal community-controlled health services (ACCHSs) across Australia, the potential exists for these services to engage in multi-centre research to realise solutions to health problems faced by Indigenous Australians. [ABSTRACT FROM AUTHOR]

Australia commenced a nationally coordinated transformation of its public and private mental health services in 1993. This paper presents an overview of the changes in mental health service delivery using data from the 2004 Australian National Mental Health Report. In the 10 years from 1993 to 2002, government spending on mental health increased 65 percent in real terms, with a 145 percent growth in expenditure for community-based services. Government subsidies to the private psychiatrist sector have declined. Consumer and carer participation in service planning and delivery increased, measures to improve quality introduced and patient level outcome measures are being adopted widely. However, some consumers with specific needs have been neglected and the transformation has not been implemented uniformly across the country. [ABSTRACT FROM AUTHOR]

This paper focuses on newspaper coverage of the Marlene Sharp legal case in Australia, concerning a non-smoking bar worker who was awarded damages for laryngeal cancer caused by passive smoking. All Australian metropolitan and Victorian regional newspaper coverage of the case was obtained from a commercial media monitoring agency for the month of May 2001, yielding 100 articles for analysis. A qualitative text analysis was conducted on newspaper articles, coding for content, tone and frame. Coverage of the outcome of the Marlene Sharp case was predominantly positive for tobacco control, with positive coverage (45% of articles) outweighing negative coverage (13% of articles) by a factor of 3 to 1. The most commonly occurring frame (27% of articles) advanced the view that legislation to protect workers from secondhand smoke is appropriate, even overdue, and encouraged the government to create smoke-free policies to protect workers. Other common frames positive for tobacco control included ‘smoking as socially unacceptable’ (9%) and ‘smoking as a societal problem’ (9%). Of articles framed negatively for tobacco control, ‘individual rights’ (5%) and ‘system cynicism’ (5%) were most common. Legal cases present special opportunities for public health media advocates to bring a human face to the need to progress passage of smoke-free policies. [ABSTRACT FROM AUTHOR]

Drawing on extensive behavioural data from Sydney, this paper examines some of the strategies that gay men have devised to manage (as distinct from eliminate) risk of HIV transmission. Apart from negotiated safety and positive-positive sex, which have been practised for some time, the evidence presented here confirms the role of a number of other harm-reduction strategies, some safer than others. The challenge now for educators, both locally and elsewhere, is how to sustain safe sex and where appropriate build harm reduction into gay men's health education in the face of diverse and ever-changing gay communities. Recent rises in HIV infections have increased uncertainty and serve as a timely reminder that there are no easy solutions to what remain complex and difficult-to-grasp phenomena. [ABSTRACT FROM AUTHOR]

Complementary and Alternative Medicine (CAM) has become increasingly popular amongst healthcare consumers worldwide. As such, CAM is now an important public health issue with serious implications for healthcare organization and delivery. While previous studies have provided a profile of CAM users, there remains very limited analysis of CAM consumption over time. The purpose of this paper is to describe the changing use of CAM practitioners over time by 11,454 mid-age women in the Australian Longitudinal Study on Women's Health. Over the study period (1996-1998), 10% of women adopted the use of CAM and 9% relinquished CAM. The predominant factor found to be predictive of CAM. adoption was changes in health status. Specifically, those women experiencing more illness over time are more likely to adopt CAM than those experiencing no change or better health. CAM relinquishment was associated with use of non-prescription medications, where women were more likely to relinquish CAM if they never used non-prescription medications or if they stopped taking non-prescription medications. This paper constitutes an exploratory investigation into CAM use over time. As such, there is need for further research to provide in-depth examination of the adoption and relinquishment of CAM use over a longer time period. [ABSTRACT FROM AUTHOR]

Managers of multidisciplinary teams face difficult dilemmas in managing competing interests, diverse perspectives and interpersonal conflicts. This paper illustrates the potential of the theory of action methodology of Argyris and Schön (1974 , 1996 ) to illuminate these problems and contribute to their resolution. An empirical example of a depth-investigation with one multidisciplinary community health care team leader in Australia demonstrates that the theory of action offers a more accurate account of the causal dimensions of her dilemmas and provides more scope for effective intervention than her lay explanation will allow. It also provides a more satisfactory analysis of her difficulties with two common problems identified in the literature: defining the appropriate level of autonomy for team members and developing constructive dialogue across perceived discipline-based differences of opinion. Consequently the theory of action appears to offer enormous promise to managers of multidisciplinary teams wanting to understand and resolve their problems and develop a rigorous reflective practice. Further research on the viability of the theory to facilitate a self-correcting system that can promote learning even under conditions of stress and conflict is suggested and implications for learning and teaching for the multidisciplinary environment are briefly discussed. [ABSTRACT FROM AUTHOR]

This paper compares a government-commissioned health study of coal seam gas (CSG) developments in Queensland with international best-practice health impact assessment (HIA) methodologies. A literature review was conducted of (HIA) methods and health studies of CSG development areas in Queensland. Forty-eight interviews were conducted in the Darling Downs CSG region in Queensland. One Queensland Health report was identified but failed to meet HIA international best practice because 7 of 9 key steps were omitted. Interview participants reported poor consultation by government and industry within affected communities. Lack of and poor quality health data was found to exacerbate community tensions. We recommend application of HIAs, epidemiological studies, consultation with communities and consideration of social risks of poor quality health studies. [ABSTRACT FROM AUTHOR]

Bushfires, and resulting bushfire smoke, were major environmental, social and health crises in Australia in the summer of 2019–20. In Australia's national capital the smoke pollution index topped global charts, and public health communications were rapidly developed that advised people to stay indoors to avoid smoke exposure. Drawing on interviews with a diverse range of housed residents, we explore people's experiences of navigating public health advice and managing the bushfire smoke in relation to the materiality of their homes. Given the increasing likelihood of living with such crises in the Anthropocene, we highlight the need for future bushfire public health advice to recognise local housing geographies, residents' embodied vulnerabilities and the relational ways people live with their everyday built environment, and suggest possible policy responses. [ABSTRACT FROM AUTHOR]

The COVID-19 pandemic has elicited a wide range of national responses with an even wider range of outcomes in terms of infections and mortalities. Australia is a rare success story, keeping deaths comparatively low, and infections too, until the Omicron wave. What explains Australia's success? Typical explanations emphasise leaders' choices. We agree, but argue that leaders' choices, and whether these are implemented effectively, is shaped by the legacy of state transformation. Decades of neo-liberal reforms have hollowed out state capacity and confused lines of control and accountability, leaving Australia unprepared for the pandemic. Leaders thus abandoned plans and turned to ad hoc, simple to implement emergency measures - border closures and lockdowns. These averted large-scale outbreaks and deaths, but with diminishing returns as the Delta variant took hold. Conversely, Australia's regulatory state has struggled to deliver more sophisticated policy responses, even when leaders were apparently committed, including an effective quarantine system, crucial for border controls, and vaccination programme, essential for exiting the quagmire of lockdowns and closed borders, leading to a partial return to top-down governing. The Australian experience shows that to avoid a public health catastrophe or more damaging lockdowns in the next pandemic, states must relearn to govern. [ABSTRACT FROM AUTHOR]

The following article contributes to the emerging field of countering violent extremism (CVE) by proposing a framework to understand and categorise CVE programs, and applying this to Australia's CVE efforts from 2010 to 2014. The first section outlines the evolution of CVE as a policy tool. A framework to categorise CVE programs based on the public health model follows, using illustrative examples of CVE projects run in Western countries. This framework is then applied to CVE programs in Australia, providing a preliminary analysis of CVE policy and its impact. It finds that Australian CVE efforts have overwhelmingly focused on broadly targeted prevention programs that not only make success difficult to evaluate or demonstrate, but also raise the risk of stigmatising entire communities. Most significantly, this broad focus has meant that Australian CVE efforts have likely failed to reach those most in need of assistance. [ABSTRACT FROM AUTHOR]

Public health agencies tasked with improving the health of communities are poorly supported by many 'business-as-usual' funding practices. It is commonplace to call for more funding for health promotion, but additional funding could do more harm than good if, at the same time, we do not critically examine the micro-processes that lead to health enablement – micro-processes that are instigated or amplified by funding. We are currently engaged in a university-and-policy research partnership to identify how funding mechanisms may better serve the practice of community-based health promotion. We propose three primary considerations to inform the way funds are used to enable community-based health promotion. The first is a broader understanding and legitimising of the 'soft infrastructure' or resources required to enhance a community's capacity for change. The second is recognition of social relationships as key to increasing the availability and management of resources within communities. The third consideration understands communities to be complex systems and argues that funding models are needed to support the dynamic evolution of these systems. By neglecting these considerations, current funding practices may inadvertently privilege communities with pre-existing capacity for change, potentially perpetuating inequalities in health. To begin to address these issues, aspects of funding processes (e.g., stability, guidance, evaluation, and feedback requirements) could be designed to better support the flourishing of community practice. Above all, funders must recognise that they are actors in the health system and they, like other actors, should be reflexive and accountable for their actions. [ABSTRACT FROM AUTHOR]