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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

Drawing on long experience as a sociologist in the health academy, I explore the challenges of practicing and teaching critical qualitative research in an environment dominated by very different scientific reasoning. I account for the transgressive positioning of qualitative research in the health sciences in terms of the role of social theory in interpretive research, rising interest in qualitative approaches among health professionals, research and educational doctrines that impede “value-added” analysis, and the ascendance of applied, post-positivist forms of qualitative research. Strategies for producing critical qualitative researchers who can both survive and thrive in the health arena include creation of institutional authority, prioritization of methodological depth over breadth, teaching pragmatic but non-compromising survival skills, and forging supportive communities of practice. I describe how one particular academic organization is engaging with these strategies and reflect on future prospects for educating critical qualitative researchers in the field of health. [ABSTRACT FROM AUTHOR]

This essay reflects on the proceedings of an invitational workshop on the nature and challenges of teaching qualitative research (QR) in health science settings. The context of this workshop is the increasing interest in QR in the health sciences and the inadequacy of pedagogy and institutional support for QR. We argue that there are special problems associated with teaching in an environment that embraces numerically based forms of knowledge and marginalizes unconventional research. Changes in the health research environment (e.g. applied research funding) and in the university environment (e.g. faster and briefer training) do not mesh easily with core premises of QR and can have a homogenizing, "dumbing down" effect on teaching. Teaching across wide disciplinary and professional divides, and among students with little or no social theory, can promote teaching QR as procedure, and at the lowest common denominator. Teachers must deal with the disruptive effects on students and other faculty of the critical dimensions of QR, and manage the structural constraints and political demands of thesis supervision. Despite the challenges of teaching "against the grain," the rewards and promise of teaching qualitative research in such environments remain, and we call for further discussion and leadership in this area. [ABSTRACT FROM AUTHOR]

Regarding smoking control in the workplace, small independent operations may differ from large workplaces or from small worksites that are branch units of large companies/organizations. We examined the relationships of worksite and company size to workplace smoking restrictions and programs, using data from a population-based telephone survey. Three worker groups, differentiated by worksite and company size, were compared. Small workplace workers were least knowledgeable about smoking restrictions, reported fewer restrictions in place, and were least willing to intervene in coworkers' smoking. As well, smoking-related programs, although generally uncommon, were reported least often by these workers. Branch workers were not uniformly similar to either small or large workplace workers. In policy and program interventions, organizational influences and/or attributes of individuals drawn to different-size work settings should be considered. [ABSTRACT FROM AUTHOR]