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People with primary bone cancer typically are young (usual age-at-onset 16-35 years old) and undergo arduous treatments. The current standard of care (turnout resection and limb reconstruction with or without chemotherapy) results in survival rates in excess of 60%, but also results in significant disability at a time when patients are choosing career paths, establishing their independence and embarking on new roles. To date, the nature of the relationship between experiences of osteosarcoma illness and experiences of vocation has remained unclear. This study sought to examine this relationship using qualitative narrative methodology. In-depth audiotaped interviews were conducted with 14 osteosarcoma survivors (8 men, 6 women) who were being treated at Mount Sinai Hospital, Toronto, Canada. Interview transcripts were analyzed for story typology and thematic content via constant comparison. Respondents reported engaging in three types of 'work': 'illness work', 'identity work' and 'vocational work'. Osteosarcoma illness represented a crisis for respondents, one which necessitated considerable illness work. Illness work was portrayed as all-consuming, whereby respondents were forced to stop vocational work for considerable periods. The illness crisis also precipitated 'identity work'. Respondents recounted a transformative process, of 'becoming other' to whom they had been prior to illness. As a result, respondents told of re-entering the vocational sphere with a different sense of themselves from when they left it. When patients return for surgical follow up, clinicians routinely ask, 'So, are you back to work yet?' expecting simple 'yes/no' answers. This study suggests that the answer is instead highly complex, and that patients could be seen as having been 'working' all along. This study offers a re-conceptualization of 'work' and 'return to work' in the context of osteosarcoma, with implications for clinical and return-to-work practices. Keywords: Experience of illness Narrative Return to work Osteosarcoma Identity Interviews

Community-based charitable food assistance programs have recently been established in several affluent nations to distribute public and corporate food donations to `the needy'. In Canada, food banks comprise the primary response to hunger and food insecurity, but problems of unmet food need persist. We conducted an ethnographic study of food bank work in southern Ontario to examine the functioning of these extra-governmental, charitable food assistance programs in relation to problems of unmet need. Our results suggest that the limited, variable and largely uncontrollable supply of food donations shaped the ways in which food assistance was defined and the practices that governed its distribution. Workers framed the food assistance as a supplement or form of acute hunger relief, but generally acknowledged that the food given was insufficient to fully meet the needs of those who sought assistance. In response to supply limitations, workers restricted both the frequency with which individual clients could receive assistance and the amount and selection of food that they received on any one occasion. Food giving was essentially a symbolic gesture, with the distribution of food assistance dissociated from clients' needs and unmet needs rendered invisible. We conclude that, structurally, food banks lack the capacity to respond to the food needs of those who seek assistance. Moreover, the invisibility of unmet need in food banks provides little impetus for either community groups or government to seek solutions to this problem. Keywords: Food assistance; Food banks; Food security; Ethnography; Canada

In this paper we examine the recent ascendancy of a 'population health' perspective on the 'determinants of health' in health policy circles as conceptualized by health economists and social epidemiologists such as Evans and Stoddart [Evans and Stoddart (1990) Producing health, consuming health care. Social Science & Medicine 31(12), 1347-1363]. Their view, that the financing of health care systems may actually be deleterious for the health status of populations by drawing attention away from the (economic) determinants of health, has arguably become the 'core' of the discourse of 'population health'. While applauding the efforts of these and other members of the Canadian Institute for Advanced Research for 'pushing the envelope', we nevertheless have misgivings about their conceptualization of both the 'problem' and its 'solutions', as well as about the implications of their perspective for policy. From our critique, we build an alternative point of view based on a political economy perspective. We point out that Evans and Stoddart's evidence is open to alternative interpretations-and, in fact, that their conclusions regarding the importance of wealth creation do not directly reflect the evidence presented, and are indicative of an oversimplified link between wealth and health. Their view also lacks an explicit substantive theory of society and of social change, and provides convenient cover for those who wish to dismantle the welfare state in the name of deficit reduction. Our alternative to the 'provider dominance' theory of Evans and Stoddart and colleagues stresses that the factors or forces producing health status, which Evans and Stoddart describe, are contained within a larger whole (advanced industrial capitalism) which gives the parts their character and shapes their interrelationships. We contend that this alternative view better explains both how we arrived at a situation in which health care systems are as costly or extensive as they are, and suggests different policy avenues to those enunciated by Evans, Stoddart and their confreres. Key words - inequities in health, population health, health care

Part-time, casual, contract, temporary and self-employment are some of the more commonly known forms of 'contingent work'. Recent employment surveys indicate an increase in these forms of work white permanent forms of employment have ostensibly declined. Contingent work has become a focus of concern for those interested in the effects of changing tabor market patterns on health. There are however two significant impediments to understanding the contingent work and health relationship. First, its current conceptual apparatus is diffuse and inconsistent. Definitions of contingent work and the assumptions that underlie its numerous descriptors differ within and across disciplines. Second, there is little conceptual clarity around what aspects of contingent work might be related to health. In this article, we distil and synthesize literature from a range of disciplines and develop a framework for conceptualizing contingent work and its relationship to health. We suggest that low reciprocity, uncertainty, discontinuity and marginality are core concepts that underlie many conceptuatizations of contingent work. Drawing on related theoretical insights and empirical findings from the literature, we identify possible structural social and psychological pathways between these four features of contingent work and ill health. [ABSTRACT FROM AUTHOR]

The purpose of this paper is to consider how gender, class and power have been addressed in the work stress literature and to propose an alternative approach that highlights the role of power in the development of work-related stress. We begin with a discussion and critique of prominent work-related stress models. The models' conceptualizations of work-related stress and their relationships to issues of class and gender are used as focal points for discussion. We show that explanations for gender or class differences in stress vary markedly by disciplinary perspective. Some models emphasize individual coping mechanisms, while other models focus on individual-level exposures or the work environment, in the production of work-related stress. Notions of power or control are often invoked in these models, but they tend to be narrowly conceptualized. Often the research presents a series of empirical findings rather than an integrated conceptual model which clearly specifies the pathways by which individual work experiences are linked to health and to the broader social context. Drawing on empirical findings and theoretical insights from a broad range of disciplinary perspectives, we build a conceptual framework relating power to work-related stress. This model can provide us with a deeper understanding of the determinants of stress, the relationships between stress and the broader social context, and the relationships between stress and social factors such as class and gender. Specifically, we suggest that power can influence work-related stress through the distribution of stressors in the workplace and via meaning. Copyright © 2001 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

On the basis of a qualitative study of health in small enterprises, this paper attempts to theorise the social production of illness and injury in the workplace. Particular features of working life in small workplaces, especially their personalised social relations and low polarisation of employer-employee interests, shape workers' perceptions of the employment relationship and of health in relation to work. Strained authority relations at work can form a key social context in which health and injury are constructed. In situations of conflictful supervisory relations, bodily experiences can become 'problematised'. Meanings attributed to health conditions and the quality of the employment relationship are transformed and merged, prompting a questioning of the legitimacy of power asymmetries in the workplace and recognition of the conflicting interests of labour and capital. Bodily experiences and ill-health offer possibilities for resistance and become mediators of broader social tensions. Unheeded illness claims deepen feelings of distrust and blame, further causing labour relations to deteriorate, and re-producing the social conditions for illness. [ABSTRACT FROM AUTHOR]

Examines the ascendancy of the `population health' perspective on the determinants of health, while highlighting the role of economics and social status on the acquisition of adequate health care. Reference to some of the social determinants of health status; Details on the ratio of health care expenditures to the gross national product.