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Community-based palliative care services and their integration with public health systems are of considerable contemporary interest. However, the conflicts that emerge in such a complex organizational field comprising multiple stakeholders with diverse interests remain under-examined. Our analysis of community-based palliative care in Kerala identifies four 'logic conflicts' that indicate competing frames of reference in an organizational field. These conflicts shape decision-making and coordination and manifest as: 1) professional versus community logics, 2) centralized versus decentralized governance logics, 3) generalist versus specialist care logics, 4) charity versus rights-based logics. We also identify two mechanisms – forming coalitions and fostering plurality – by which actors manage these conflicting logics. We discuss contributions to public health palliative care conversations and implications for nurturing and sustaining care communities. [ABSTRACT FROM AUTHOR]

Declarations on end-of-life issues are advocacy interventions that seek to influence policy, raise awareness and call others to action. Despite increasing prominence, they have attracted little attention from researchers. This study tracks the emergence, content, and purpose of declarations concerned with assisted dying and euthanasia, in the global context. The authors identified 62 assisted dying/euthanasia declarations covering 1974–2016 and analyzed them for originating organization, geographic scope, format, and stated viewpoint on assisted dying/euthanasia. The declarations emerged from diverse organizational settings and became more frequent over time. Most opposed assisted dying/euthanasia. [ABSTRACT FROM PUBLISHER]

Public Health specialists have increasingly deployed the concept of ‘dose–response’ in areas such as diet (‘five-a-day’), alcohol (‘21 weekly units’) and physical activity (‘150 minutes of weekly activity’). Using these examples and a case study that sought to establish an optimal dose of physical activity for mental health gain, this article offers a critical assessment of the nature, robustness and function of ‘dose’ in public health. Drawing on a ‘sociology of knowledge’, the article argues that dose–response can best be considered an analogy that does not necessarily translate favourably from its original expression in toxicology to some public health domains – an over-extended analogy. Rather than having technical robustness, its attractiveness and utility is seen to lie in it possessing ‘cultural capital’, here, the ability to link behavioural concerns to clinical practice, to simplify complex ideas and to act as a regulatory form of behavioural governance. The article is skeptical of further empirical pursuits in identifying optimal doses and offers an alternative course for public health framing. [ABSTRACT FROM PUBLISHER]

The article discusses various papers published within the issue, including "Health, Equity and Sustainable Development," "Re-orienting public health: rhetoric, challenges, and possibilities for sustainability," by P. Hanlon and "A green and healthy future: the settings approach to building health, equity and sustainability," by B. Poland and M. Dooris.

This paper reports on our experience of undertaking a Rapid Appraisal of Health and Social Needs (RNA) in West Cumbria, UK. RNA aims to identify community-defined problems and to collect intelligence for action rather than simply for documentation. The broad nature of the study is summarised and we reflect critically on methodological and structural issues that arose. A number of inter-related themes were significant: the limitations of a 'rapid' approach; within an action frame, the implications that arose from focusing on locality capacity-building; the ability that commissioning organisations had in this public health domain; and the way in which such organisations tend to construct 'needs'. These themes then are located in problematic contexts. Primarily, we were working with a fledgling NHS organisation, arguably set unrealistically high expectations to deliver innovative public health functions. Furthermore, the desire to see the NHS working more efficiently resulted in the expectation that the exercise should be done in a particular way—within a realist tradition of arriving at quick, simple and 'definitive' needs. We conclude by suggesting that if such work is to be meaningful then there needs to be a number of pre-cursors: an initial consensus on the nature of 'need'; an agreement between commissioners and researchers around common frameworks and realistic expectations of the process; and finally, an acceptance of the importance of history in this work and the way histories of local inter-agency work reflect embedded forms of local knowledge. We suggest that NHS volatility means that much of this knowledge is often lost. [ABSTRACT FROM AUTHOR]

The transtheoretical or ‘stages of change’ model has greatly influenced health promotion practice in the USA, Australia and the UK since the late 1980s. Application of the model has shaped service planning, provision and implementation. ‘Stages of change’ also has impacted on training agendas at local, regional and national levels. Associated areas of motivational interviewing and brief intervention have led health promotion initiatives in areas such as smoking cessation and alcohol-reduction policies. A number of critiques have recently challenged the ‘stages of change’ model and health promotion orthodoxy. This review examines these critiques, with a focus on the ‘scientific’ status of ‘stages of change’. The review also examines a data-based approach to stages of change, model adequacy, the social and ideological context of change theories in health promotion contexts, levels of explanation and prediction in the ‘stages of change’ framework. Some reasons are offered for the apparent popularity of the model amongst health promotion workers. Recommendations are made about alternative conceptual frameworks. [ABSTRACT FROM AUTHOR]