The New Public Health
Abstract
This third edition of Fran Baum's The New Public Health is the most comprehensive book available on the new public health. It offers students the opportunity to gain a sense of the scope of the new public health visions, and combines theoretical and practical material to assist students to understand the social and economic determinants of health. Based on the premise of previous editions - that the new public health offers the chance of greatly improved equity by raising health world health standards - this new edition has been fully revised to reflect recent changes in the theory and practice of the new public health.
PART ONE - APPROACHES TO PUBLIC HEALTH ; 1. Understanding health - definitions and perspectives ; 2. A history of public health ; 3. The new public health evolves ; PART TWO - POLITICAL ECONOMY OF PUBLIC HEALTH ; 4. Politics and ideologies: the invisible hands of public health ; 5. Globalisation and health ; PART THREE - RESEARCHING PUBLIC HEALTH ; 6. Research for a new public health ; 7. Epidemiology and public health ; 8. Survey research methods in public health ; 9. Qualitative research methods ; 10. Planning and evaluation of community-based health promotion ; PART FOUR - HEALTH INEQUITIES: PROFILES, PATTERNS AND EXPLANATIONS ; 11. Changing health and illness profiles in the twenty first century: Global and Australian perspectives ; 12. Patterns of Health Inequities in Australia ; 13. The social determinants of health inequity ; PART FIVE - UNHEALTHY ENVIRONMENTS: GLOBAL AND AUSTRALIAN PERSPECTIVES ; 14. Global physical threats to the environment and public health ; 15. Urbanisation, population, communities and environments: Global trends ; PART SIX - HEALTHY SOCIETIES AND ENVIRONMENTS ; 16. Healthy economic policies ; 17. Sustainable infrastructure for health and well-being ; 18. Creating more equitable societies ; PART SEVEN - HEALTH PROMOTION STRATEGIES FOR ACHIEVING HEALTHY AND EQUITABLE SOCIETIES ; 19. Medical interventions ; 20. Behavioural health promotion and its limitations ; 21. Participation and health promotion ; 22. Community development in health ; 23. Healthy settings, cities, communities and organisations: Strategies for the twenty-first century ; 24. Public health policy ; PART EIGHT - PUBLIC HEALTH IN THE TWENTY-FIRST CENTURY ; 25. Linking the local, national and global ; Appendix: Public health keywords
... What is lacking, however, is a critical examination of the material and discursive effects of addressing GBV as a public health problem, which the healthcare system should address through daring to ask. A critical public health perspective, that problematizes new normativities, challenges taken for granted assumptions, analyses unintended effects of public health interventions and looks for ways to address them, provides a fruitful approach to engage in such examination [15,16] With this commentary, my purpose is to start to open up such an examination and to argue for why it is needed. In doing this I am guided by four research questions: i) Is GBV a public health problem? ...
... In public health, we focus on problems that affect a large proportion of the population and/or are unequally distributed. We are especially interested in analysing how social factors (such as class, racialization, disability, or gender) influence health and access to support [15,16]. Public health is highly political and visionary. ...
... Public health is highly political and visionary. In the words of Frances Baum, the new public health aims not only to improve the health of the population, but also to make the world more fair and just [15]. ...
In this comment I analyze the effects of approaching gender-based violence as a public health problem, that the health system should address through ‘daring to ask’. I acknowledge the potential of the ‘daring to ask’ strategy, but I also argue that asking has effects, and that we should be aware of them.
... [17][18][19] In this paper we understand public health as defined by Winslow "the art and science of preventing disease, prolonging life and promoting health through the organized efforts of society." 20 Contemporary public health has been discussed widely for example, by Kickbusch and Baum [21][22][23] and is described as the totality of the activities organized by societies collectively (though led by governments) to protect people from disease and to promote their health. This includes promotion of equity between different groups of the society, working across all sectors, and adaption of policies supporting health. ...
... Furthermore, the model emphasizes community involvement as citizens participation and engagement in public health operation as crucial for integrated care development; this requires focusing holistically on the whole family and community and providing support, that empowers both the individual and their community within their environment. These elements are not only part of the health care system but are parts of the broader social determinants of health (and the essential public health operations) [21][22][23]45 that play an important role for the citizens' health and well-being. ...
... Our findings show that the contemporary public health has rarely been incorporated to the identified models/frameworks including promotion of equity between different groups of the society, working across all sectors, and adaption of policies supporting health. According to Kickbusch and Baum 22,23 the new public health is based on a belief that the participation of communities in activities to promote health is essential. Furthermore, one of the greatest benefits of the public health approach is the identification of community health needs and reorienting health care delivery and services to address these needs. ...
Background
Many health care systems attempt to develop an integrated care approach that is a whole population health-oriented system. However, knowledge of strategies to support this effort are scarce and fragmented. The aim of the current paper is to investigate existing concepts of integrated care and their elements from a public health perspective and to propose an elaborated approach that could be applied to explore the public health orientation of integrated care.
Design and methods
We applied a scoping review approach. A literature search was conducted in Embase, Medline, CINAHL, Scopus and Web of Science for the period 2000–2020 yielding 16 studies for inclusion.
Results
Across the papers, 14 frameworks were identified. Nine of these referred to the Chronic Care Model (CCM). Service delivery, person-centeredness, IT systems design and utilization and decision support were identified as the core elements of most of the included frameworks. The descriptions of these elements were mainly clinical-oriented focusing particularly on clinical care processes and treatment of diseases instead of wider determinants of population health.
Conclusions
A synthesized model is proposed that emphasizes the importance of mapping the unique needs and characteristics of the population it aims to serve, leans on the social determinants approach with a commitment to individual and community empowerment, health literacy and suggests reorienting services to meet the expressed needs of the population.
... Historically the practice of environmental health in Australia and other countries is largely associated with the sanitation movement founded in Britain in the mid-19th century (Baum, 2016;Brimblecombe, 2003;Hamlin, 1998;Lin, Smith, Fawkes, Robinson, & Gifford, 2014;Rosen, 2015). The sanitation movement is widely documented as being responsible for the first organised societal effort aimed at protecting and promoting public health (Kotchian, 1997;Lin et al., 2014;Moeller, 2011). ...
... These characteristics are essential in a societal context where responding to such issues requires multidisciplinary, coordinated and collaborative responses (Commonwealth Department of Health and Aged Care, 1999;Drew et al., 2000;Environmental Health Committee enHealth, 2009;Day 2016). Additionally, given the inherently political nature of public health (Baum, 2016), the ability to maintain professional practitioners, underpinned by these characteristics who have an independent, critical voice that can address societal needs in altruistic, competent and moralistic ways I contend is critical to achieving an equitable and sustainable societal future for all. ...
... Environmental health as a profession in England and Wales arose due to reforms initiated by the sanitation movement in the mid-19th century, as introduced in Chapter 1. These reforms principally involved the establishment of legal and administrative structures to enable communities to have expertise and authority to build works under the auspice of governments to reduce the spread of infectious diseases through the provision of clean water supplies, removal of wastes and improved living conditions (Aston & Seymour, 1998;Baum, 2016;Lin et al., 2014;Smith, 2008). These reforms also resulted in the enactment of the English Public ...
Global crises such as the COVID-19 pandemic and the increasing frequency of regional disasters such as catastrophic bushfires, earthquakes and floods are all indicators of the urgent need to improve societal practices aimed at preventing and addressing the negative impacts of human interaction with the environment. This thesis aims to contribute to addressing this problem by reporting on an empirical investigation into the variation in the ways environmental health professionals experienced the practice of environmental health.
Environmental health professionals (EHPs), the focus of this thesis, are professionals whose origins stem from the sanitation movement founded in Britain in the mid-19th century. In today’s context, this group contributes to protecting human health and the environment in various capacities. Supporting improvements to this area of practice continues to be a key strategy of the Australian Government to ensure this workforce is well equipped to deal with current and future challenges. These challenges include the evolving nature of environmental health problems, changes to the regulatory and operational environments associated with this area of practice, and a range of workforce issues having implications for the environmental health profession.
However, gaining improvements to the professional practice of environmental health presents several challenges. These challenges, I contend, relate to the complexities associated with the changing and evolving context of practice and the complexities inherent in the practice itself. As such, this thesis argues that current descriptions of the professional practice of environmental health are inadequate to deal with the complexities and uncertainties associated with current and future practice. What is required is a new conceptualisation of the professional practice of environmental health.
To establish a new conceptualisation of the professional practice of environmental health, two research questions were posed. Firstly, what are the variations in the ways environmental health professionals experience the practice of environmental health? Secondly, what are the critical variations between the ways environmental health professionals experience the practice of environmental health? I used a qualitative research approach known as phenomenography to answer these questions. The phenomenographic study involved semi-structured open-ended interviews with nineteen professionally qualified environmental health practitioners practising in an Australian context from diverse backgrounds and practice settings.
The investigation findings revealed four qualitatively different ways of experiencing the professional practice of environmental health: ‘protecting’, ‘helping’, ‘collaborating’, and ‘leading and innovating’. These different ways of experiencing practice are described in categories of description, found to be logically linked in a hierarchical order to form an outcome space. The categories were also linked by an expanding awareness of five themes: ‘outcome’, ‘impact’, ‘approach’, ‘agency’, and ‘role’. These themes supported the hierarchical relationship of the categories from less comprehensive ‘protecting’ to more comprehensive ‘leading and innovating’ ways of experiencing. The categories of description and outcome space represent a holistic experiential description of practice (HEDP) and a new and novel conceptualisation of the professional practice of environmental health.
There are several implications for improving practice arising from this research. This new way of conceptualising the professional practice of environmental health has the potential to act as a framework that can assist in improving professional practice and education for professional practice. In so doing, it can also help to address the challenges associated with the complex and interrelated relationship between society, the environmental health profession and education. This new conceptualisation and framework are the main contributions of this thesis. This thesis also makes several other contributions to the literature. Importantly, it provides insights into the qualitatively different ways environmental health professionals experience the practice of environmental health, an area of research that is currently absent from the literature.
... This approach may include education and behaviour change. Although intuitive, plausible and attractive to decision makers, it has not been as effective as many hoped (Baum, 2016). Movement? ...
... For PNG and Madang, climate change may be the biggest challenge for health systems and health promotion. One of the most appealing aspects of an ecological model is that it also acts to increase the effectiveness of medical and behavioural approaches by making healthy choices easier (Baum, 2016). Ecological health promotion seeks to maximise the participation of communities in making decisions about their own health. ...
... The adoption of an ecological model shifted the gaze of health promotion from a deficit model of individual behaviour change to examining how health is created in social and institutional settings (Kickbusch, 1996). This gave rise to a healthy settings movement which started with healthy cities and soon expanded to healthy schools, hospitals, islands, markets, regional areas and universities (Baum, 2016). ...
A settings approach to health In this concept paper we apply the settings approach to health by exploring the potential to elevate the healthy university concept on the agenda of Divine Word University (DWU) in Madang, Papua New Guinea (PNG). We do this by explaining the application of a settings approach to DWU, illustrated by a combination of research and teaching strategies with the potential to reorient the university. A key theme of our paper is that a settings approach confers advantages upon a university by exploring new ways of thinking about its taken for granted assumptions, paradigms and structures.
... In recent times there has been much attention paid to translating evidence on SDH into policy to reduce health inequities in Australia [17,18]. However, there has been limited policy action in this area [5]. ...
... Subsequently, in the 2014 health budget there was a decrease in focus and funding in this area, including the cessation of the NPAPH [19]. This has been attributed to a neoliberal style government placing an emphasis on economics over social priorities [18]. Therefore, over the 10 years since our last study, the political landscape has changed in Australia, and there appears to be less political will to take action on the SDH. ...
... This method enables the researcher to conduct a systematic review of child and youth policies with a focus on the extent the SDH and health equity are addressed. The framework draws on seminal scholars from this area of scholarship including Baum [18], Dahlgren and Whitehead [22], and Carter [23] and allows the researcher to understand the status quo, or extent a set of policies addresses the SDH and health equity, at a particular point in time. The intention of the Fisher (2015) [21] framework is to provide 'an effective way to interrogate health policies on key points raised in recent literature about the translation of evidence on SDH into policy' (p.1). ...
Background
Children and youth are an important population group requiring specific policies to address their needs. In Australia, most children and youth are doing well, however, certain equity groups are not. To address child and youth health equity in policy, applying a social determinants of health approach is considered best practice. For over 10 years governments in Australia have been called upon to address the social determinants of health, however, there has been limited action. Health and education departments are typically most involved in policy development for children and youth. To date, there have been limited systematic analyses of Australian child and youth health policies, and selected education wellbeing policies, with a social determinants of health and health equity focus and this study aims to contribute to addressing this gap.
Methods
Policy analysis was conducted across 26 Australian child and youth health policies, and selected education wellbeing policies. We used an existing prior coding framework to understand the extent the social determinants of health and health equity were addressed. All policies were strategic level and only included if dated 2009 onwards.
Results
Across 26 selected policies only 10% of strategies addressed the social determinants of health, demonstrating a lack of policy action. However, there is relatively even focus on all developmental stages, and an increased focus on youth. Equity is acknowledged across most policies with some groups receiving more attention including Aboriginal and Torres Strait Islander children. The social determinants of health addressed, to some degree, include early childhood development, education, parental workplace conditions, healthy settings, and housing, those least mentioned include public transport and regulation.
Conclusion
This study demonstrates a lack of policy action on the social determinants of health within Australian child and youth health policy, and selected education wellbeing policies. Rather, the application of a siloed, and predominantly acute care approach. However, there is recognition of equity across all policies; an emphasis on housing as a determinant of health; and a link between health and education departments through education wellbeing policies, specifically addressing the issue of mental health.
... The two-phased approach, in which focus group discussions were conducted prior to the semi-structured interviews, was particularly fitting in respect the exploratory and sensitive nature of this research. The focus groups facilitated lively interaction between participants, and were an efficient way to capture multiple perspectives (Baum, 2008). This method was appropriate to establish broad priority themes, however, achieving depth of individual stories can be challenging within the group context (Baum, 2008). ...
... The focus groups facilitated lively interaction between participants, and were an efficient way to capture multiple perspectives (Baum, 2008). This method was appropriate to establish broad priority themes, however, achieving depth of individual stories can be challenging within the group context (Baum, 2008). 'Group think' is a further limitation of focus group discussions, in which participants may be reluctant to express perspectives and experiences that contrast with the majority of attendees (MacDougall & Baum, 1997). ...
... 'Group think' is a further limitation of focus group discussions, in which participants may be reluctant to express perspectives and experiences that contrast with the majority of attendees (MacDougall & Baum, 1997). Accordingly, Phase 2 complimented the focus group discussions by utilizing semi-structured interviews conducted in a private setting to explore the lived experiences of individual participants in greater depth and detail (Baum, 2008). This was particularly valuable for exploring subject areas of heightened sensitivity, such as relationships, sex, and cultural change. ...
Over the last two decades, Afghanistan has been a leading country of origin for asylum seekers and refugees arriving in Australia. It is widely recognized that humanitarian migrants experience poorer sexual and reproductive health than the broader population. In turn, a body of research has emerged exploring the sexual and reproductive health of the local Afghan community. However, this has predominantly focused on youth or perinatal experiences, and less attention has been given to the broader relational and social dimensions of sexuality. Accordingly, this research aimed to explore the perspectives and experiences of married Afghan women and men as they navigate and negotiate sex, sexuality, and intimate relationships following settlement in Melbourne, Australia. A total of 57 Afghan women and men participated in six focus group discussions and 20 semi-structured interviews. Male participants described the ways that having increased access to sex and sexually explicit materials in Australia is creating opportunities for them to establish more fulfilling sex lives. Many women also described a growing awareness of sexuality, although often expressed difficulty prioritizing and claiming more pleasurable sexual encounters for themselves. However, concerns about sexual freedom are also creating new challenges for the Afghan community living in Australia in relation to sex and relationships. For example, men expressed fears about women exercising sexual liberties outside of the home, and this appeared to place women’s everyday behavior under increased scrutiny. Women also voiced concerns about how easily men can access sex outside of marriage within Australia, and described how this amplified their sense of obligation to be sexually compliant and meet their husband’s desires. This study provides new insights into the ways that Afghan community members are moving between societies, and how their understandings of sexual participation, pleasure, desire, health, consent, and capacity for self-determination are being challenged, reshaped, and reconstructed throughout this process.
... The authors align with critical social scientists and public health scholars such as Lupton, Baum, and Nettleton, who view the diagnoses of states such as prediabetes as a social construction. [20][21][22][23] While numerical criteria are used to make the diagnosis, this categorisation tends to depict the cause of a disease as a failing of the individual's biology. Delivering the diagnosis in a medical setting implies that the individual is now on a trajectory to disease development, but will be able to control that progression through behaviour change. ...
... This individualist discourse of risk diminishes the condition's complexity and the role of the wider determinants of health in diabetes development. 23,24 These Table 1 Demographic and professional characteristics of study participants authors depict this type of health promotion as a form of medical surveillance. 20,21 Non-adherence to behaviour change with deviations outside defined 'normal ranges' may lead to victim-blaming, influencing how health messages are internalised by the individual. ...
... 20,21 Non-adherence to behaviour change with deviations outside defined 'normal ranges' may lead to victim-blaming, influencing how health messages are internalised by the individual. 23,25 Focusing on the individual downplays, intentionally or not, the role of social, economic, and political influences in disease development, and draws attention away from upstream disease prevention models. 23,26 Results ...
Background
Preventing type 2 diabetes is a national priority; one aspect is the identification and active management of prediabetes through lifestyle change.
Aim
To explore what primary care clinicians understood by ‘pre-diabetes’, how they communicated this diagnosis to people, how they delivered lifestyle advice and their views on barriers to lifestyle change.
Design & setting
Three focus groups were undertaken with 25 individuals from primary care teams (GPs, nurses, healthcare assistants) in a deprived and ethnically diverse part of London.
Method
Recordings were transcribed verbatim and analysed thematically before integrating social and behavioural science theories.
Results
Focus groups participants described four main influences on their management of prediabetes in the consultation: social determinants, clinical aspects of diagnosis and management, patient motivation and behaviour change, and long-term care. Since most felt unable to address social determinants such as poverty, discussions with patients tended to focus on attempts to change individual behaviours and achieve particular numerical targets, with limited attention to the social context in which behaviours would play out.
Conclusion
Type two diabetes prevention efforts in general practice may fail to do justice to the upstream causes of this disease. A narrow focus on numerical targets and decontextualized behaviours overlooks the social complexity of human behaviour and lifestyle choices. Within the consultation we recommend greater attention to discussing the social context and meaning of particular behaviours. Beyond the consultation, collaboration between primary care clinicians, public health and local governments is required to address community-level constraints to behaviour change.
... For example, internationally, life expectancy increases across the social gradient, with low income countries experiencing lower life expectancy than medium and high income countries. Infant mortality rates decline, the greater the income of the country [4]. Within Australia, there are clear correlations between socioeconomic disadvantage and poor health, on various indicators such as premature mortality and chronic disease prevalence, among others [5]. ...
... The ideological position that individuals are responsible for their health (victim blaming), that was apparent in a few PHNs, ignores the underlying social, cultural and economic factors that hinder behaviour change [4]. It also provides governments of such neoliberal persuasion with justification for abrogating responsibility to mitigate such factors through regulation, or fund medical services for consequent illness [31]. ...
Background
Meso-level, regional primary health care organisations such as Australia’s Primary Health Networks (PHNs) are well placed to address health inequities through comprehensive primary health care approaches. This study aimed to examine the equity actions of PHNs and identify factors that hinder or enable the equity-orientation of PHNs’ activities.
Methods
Analysis of all 31 PHNs’ public planning documents. Case studies with a sample of five PHNs, drawing on 29 original interviews with key stakeholders, secondary analysis of 38 prior interviews, and analysis of 30 internal planning guidance documents. This study employed an existing framework to examine equity actions.
Results
PHNs displayed clear intentions and goals for health equity and collected considerable evidence of health inequities. However, their planned activities were largely restricted to individualistic clinical and behavioural approaches, with little to facilitate access to other health and social services, or act on the broader social determinants of health. PHNs’ equity-oriented planning was enabled by organisational values for equity, evidence of local health inequities, and engagement with local stakeholders. Equity-oriented planning was hindered by federal government constraints and lack of equity-oriented prompts in the planning process.
Conclusions
PHNs’ equity actions were limited. To optimise regional planning for health equity, primary health care organisations need autonomy and scope to act on the ‘upstream’ factors that contribute to local health issues. They also need sufficient time and resources for robust, systematic planning processes that incorporate mechanisms such as procedure guides and tools/templates, to capitalise on their local evidence to address health inequities. Organisations should engage meaningfully with local communities and service providers, to ensure approaches are equity sensitive and appropriately targeted.
... The WHO Healthy Cities model is a recognised approach to strengthening community participation (WHO, 1999); however, when following the framework in real life, the goals of the model, namely intersectoral approaches, community participation and placing health issues on the urban agenda, have not been easily achieved or have had limitations (Baum, 2008;Harphan et al., 2001;Strobl and Bruce, 2000;Low in Chu and Simpson, 1994). ...
... This work emerges from a doctoral study exploring community participation in MPHP in Queensland. In-depth interviews and case studies are recognised methods of qualitative data collection in the public health research field (Baum, 2008) and these were the methods of choice for this study. ...
Municipal public health planning (MPHP) endeavours to enhance community participation in public health decision making. A study of community participation of municipal public health planning projects in Queensland, Australia highlights that while community participation is an important element of the planning, the focus is also on developing mechanisms to ensure intersectoral collaborations and placing public health issues on the agenda of decision makers. With modest funding and the breadth of these focuses, MPHP is limited in directly supporting disadvantaged groups in the community to engage in participatory activities. The challenge can be to engage all the relative perspectives of the community, particularly if it is typical of a group to demonstrate nonparticipation in whole of community group activities. Success in the area of engaging with target groups was found by having the time and project staff to identify and access an advocate or advocacy forum to represent a voice for the group. This highlights the importance of representative and advocacy roles in the community.
... Through critical reflection, practitioners increase their consciousness about the dominant values and principles of health promotion programs, and the implications for whom they are intended (22)(23)(24)(25). Health promotion practitioners are encouraged to engage in critical reflection at individual and team levels as a mechanism for enhancing the quality of practice (44)(45)(46). Johnson and MacDougall describe critical reflection as an active process that requires practitioners to: ...
... Key elements of critical reflection include questioning underlying assumptions, a social focus as distinct from an individual focus, the analysis of power relations, and emancipation (46). Critical reflection assists practitioners to better understand and learn about their health promotion practice, and to change, enhance or transform their practice in the future (44)(45)(46)(47)(48)(49). Practice elements might include the philosophical approach, values and principles, theory and models used (46,50), all of which underpin . ...
Background
The origins of health promotion are based in critical practice; however, health promotion practice is still dominated by selective biomedical and behavioral approaches, which are insufficient to reduce health inequities resulting from the inequitable distribution of structural and systemic privilege and power. The Red Lotus Critical Health Promotion Model (RLCHPM), developed to enhance critical practice, includes values and principles that practitioners can use to critically reflect on health promotion practice. Existing quality assessment tools focus primarily on technical aspects of practice rather than the underpinning values and principles. The aim of this project was to develop a quality assessment tool to support critical reflection using the values and principles of critical health promotion. The purpose of the tool is to support the reorientation of health promotion practice toward a more critical approach.
Research design
We used Critical Systems Heuristics as the theoretical framework to develop the quality assessment tool. First, we refined the values and principles in the RLCHPM, then created critical reflective questions, refined the response categories, and added a scoring system.
Results
The Quality Assessment Tool for Critical Health Promotion Practice (QATCHEPP) includes 10 values and associated principles. Each value is a critical health promotion concept, and its associated principle provides a description of how the value is enacted in professional practice. QATCHEPP includes a set of three reflective questions for each value and associated principle. For each question, users score the practice as strongly, somewhat, or minimally/not at all reflective of critical health promotion practice. A percentage summary score is generated with 85% or above indicative of strongly critical practice, 50% ≤ 84% is somewhat critical practice, and < 50% minimally or does not reflect critical practice.
Conclusion
QATCHEPP provides theory-based heuristic support for practitioners to use critical reflection to assess the extent to which practice aligns with critical health promotion. QATCHEPP can be used as part of the Red Lotus Critical Promotion Model or as an independent quality assessment tool to support the orientation of health promotion toward critical practice. This is essential to ensure that health promotion practice contributes to enhancing health equity.
... Research on gender disparities in mental health has shown significant correlations with gender inequalities [123]. Gender inequality refers to circumstances where individuals are consistently given different opportunities as a consequence of inequitable (avoidable and unfair) attitudes, perceptions, and social or cultural norms about gender [124][125][126]. It can be present in terms of health, employment, wealth, status and power [124][125][126]. ...
... Gender inequality refers to circumstances where individuals are consistently given different opportunities as a consequence of inequitable (avoidable and unfair) attitudes, perceptions, and social or cultural norms about gender [124][125][126]. It can be present in terms of health, employment, wealth, status and power [124][125][126]. Examples of gender inequality include lower income for similar work [126][127][128][129]; higher levels of unpaid/carer work [128]; lower rates of schooling and secure employment [127,[129][130][131]; increased stress [132]; less opportunity Table 1 Potential health impacts of lockdown policies Health impacts may be direct (D) or indirect (I), short-term (ST) or long-term (LT) for representation in high-level jobs [126][127][128][129]; and increased risk and exposure to sexual assault, intimate partner abuse, and gender-based violence [133,134]. ...
Background:
Since March 2020, when the COVID19 pandemic hit Australia, Victoria has been in lockdown six times for 264 days, making it the world's longest cumulative locked-down city. This Health Impact Assessment evaluated gender disparities, especially women's mental health, represented by increased levels of psychological distress during the lockdowns.
Methods:
A desk-based, retrospective Health Impact Assessment was undertaken to explore the health impacts of the lockdown public health directive with an equity focus, on the Victorian population, through reviewing available qualitative and quantitative published studies and grey literature.
Results:
Findings from the assessment suggest the lockdown policies generated and perpetuated avoidable inequities harming mental health demonstrated through increased psychological distress, particularly for women, through psychosocial determinants.
Conclusion:
Ongoing research is needed to elucidate these inequities further. Governments implementing policies to suppress and mitigate COVID19 need to consider how to reduce harmful consequences of these strategies to avoid further generating inequities towards vulnerable groups within the population and increasing inequalities in the broader society.
... Hence, programs targeting problematic AOD use alone are unlikely to lead to substantial reductions in criminal convictions (de Andrade et al., 2018). Instead, programs that attempt to modify risk factors and encourage protective factors associated with AOD misuse (Baum, 2015;Jackson Pulver et al., 2019), many of which are also associated with criminal behaviour, are more likely to reduce future involvement in crime. ...
... This is likely due to a range of complex and intersecting factors, including negative neocolonial impacts and trauma (Cunneen, 2008), greater exposure to adversity (Weatherburn, Snowball, & Hunter, 2006), targeted policing practices (Sentas & Pandolfini, 2017), harsher sentences (Thorburn & Weatherburn, 2018), and lower likelihood of diversion (Papalia et al., 2019). In addition, a failure to address the social determinants of health and well-being is well accepted as a factor in both problematic AOD use and crime among young people from more disadvantaged backgrounds, including Aboriginal young people (Baum, 2015;Jackson Pulver et al., 2019). Our finding that PALM treatment was associated with fewer criminal convictions for those in the high incline conviction trajectory highlights the potential value of therapeutic community treatment approaches to reduce the overrepresentation of Aboriginal and/or Torres Strait Islander young people in the criminal justice system. ...
... However, the focus has been on better coordination and integration among health care sectors to manage specific chronic diseases [27]. It has become evident that to provide public health services that improve population health, the scope of integrated care needs to be expanded to bridge the gaps not only within the health system, but also between the various sectors of health and social systems [22,[28][29][30][31][32]. ...
... Kodner and Spreeuwenberg [43] argue that previous integrated care efforts have failed to achieve change at the service delivery level because there have been top-down approaches, even though the bottom-up approach has been highlighted as crucial for a public health approach [31,32] to enhance local leadership, citizens' participation and local community action. Our results indicate that health care policies seem to have failed to promote good relationships and trust-building between care stakeholders and alignment across organizations and providers in Southern Denmark. ...
Health care systems are increasingly complex, and evidence shows poor coordination of care within and between providers, as well as at the interface between different levels of care. The purpose of this study is to explore users’ and providers’ (stakeholders’) perspectives of integrated care in Denmark. We conducted qualitative interviews with 19 providers and 18 users that were analysed through inductive content analysis. Providers’ and stakeholders’ perceived deficits in system-level factors, lack of organizational culture, weaknesses in communication, a need for a shift towards considering equity in access to health services and focus on person-centeredness. Fundamental changes suggested by participants were better sharing of information and knowledge, focus on stronger trust building, efforts in making communication more effective, and changes in incentive structure. Users perceived poor navigation in the health care system, frustration when they experienced that the services were not based on their needs and lack of support for improving their health literacy. The study showed health care weaknesses in improving user involvement in decision-making, enhancing the user–provider relationship, coordination, and access to services. Public health within integrated care requires policies and management practices that promote system awareness, relationship-building and information-sharing and provides incentive structures that support integration.
... At the 2006 Census, out of a population of 20 million, 4.75 million or approximately 24% were born overseas, higher than most Western countries. 2,3 Furthermore, over 50% of these were born in a non-English speaking countries 4 . Australia is one of the countries that accepts immigrants under the United Nations High Commissioner for Refugee program. ...
... The 'healthy immigrant effect', suggests that immigrants are healthier than native born residents due to the selectivity of immigration process (health screening prior to migration, education level, language proficiency and age), healthier behaviour of immigrants prior to migration, and immigrant self-selection whereby the healthiest and wealthiest individuals are the most likely to migrate. 4,24 However, it needs to be noted that some NSEO patients would have entered Australia under humanitarian visas and may have experienced the ill-effects of the conditions in refugees' camps thus arriving with existing health problems. These patients could be more vulnerable to illness and may attend EDs with advanced illness. ...
Aim: The aim of this pilot study is to describe the use of an Emergency Department (ED) at a large metropolitan teaching hospital by patients who speak English or other languages at home. Methods: All data were retrieved from the Emergency Department Information System (EDIS) of this tertiary teaching hospital in Brisbane. Patients were divided into two groups based on the language spoken at home: patients who speak English only at home (SEO) and patients who do not speak English only or speak other language at home (NSEO). Modes of arrival, length of ED stay and the proportion of hospital admission were compared among the two groups of patients by using SPSS V18 software. Results: A total of 69,494 patients visited this hospital ED in 2009 with 67,727 (97.5%) being in the SEO group and 1,281 (1.80%) in the NSEO group. The proportion of ambulance utilisation in arrival mode was significantly higher among SEO 23,172 (34.2%) than NSEO 397 (31.0%), p <0.05. The NSEO patients had longer length of stay in the ED (M = 337.21, SD = 285.9) compared to SEO patients (M= 290.9, SD = 266.8), with 46.3 minutes (95%CI 62.1, 30.5, p <0.001) difference. The admission to the hospital among NSEO was 402 (31.9%) higher than SEO 17,652 (26.6%), p <0.001. Conclusion: The lower utilisation rates of ambulance services, longer length of ED stay and higher hospital admission rates in NSEO patients compared to SEO patients are consistent with other international studies and may be due to the language barriers. The number of immigrants is increasing around the globe. It was estimated at 191 million in 2005, with 60% of these migrating from developing countries to developed countries. 1 Australia is not isolated from this phenomenon. Its population has grown rapidly as a result of immigration over the past five decades, increasing the cultural and linguistic diversity of the country. At the 2006 Census, out of a population of 20 million, 4.75 million or approximately 24% were born overseas, higher than most Western countries. 2, 3 Furthermore, over 50% of these were born in a non-English speaking countries 4. Australia is one of the countries that accepts immigrants under the United Nations High Commissioner for Refugee program. Each year, 13,000 immigrants under refugees status are resettled in Australia it the second largest intake worldwide, in proportion to its population. 5 Since 2001, the greatest number of immigrants has been from sub-Saharan African and Asian origins. 2, 6 There is increasing evidence of poorer health status and high prevalence of a range of health problems among recently arrived immigrants with refugee status in Australia. This population is also more likely to have low socioeconomic status including low education level and poor English proficiency. 7 The recent increase in the number of disadvantaged immigrants to Australia represents a particular challenge for the healthcare system. The equitable provision of access to health care service to all those in need, irrespective of their language, ethnicities and social characteristics, is one of the central value within the Australian health care system. A number of international studies have demonstrated inequities in health among immigrants in developed nations as a result of financial, language and cultural barriers. 6, 8, 9 These studies have shown that language and cultural barriers are associated with longer visit time and less frequent visits to healthcare facilities, inadequate assessment, less understanding and misunderstanding of treatment, more laboratory tests, less follow up, lack of access to day surgery, less use of cancer screening service, higher readmission rates, more use of ED services, less satisfaction and poor health outcomes. 6, 9 These studies were suggesting that immigrants tend to use ED service for non-urgent conditions at the expense of primary health care services. 9, 10 Immigrants are seeking treatment in EDs for diverse reasons, for example emergency services are almost free in most developed countries, do not require papers which might be an obstacle for illegal immigrants, can be obtained at any time without prior appointment and require less administration steps to access which reduce language, cultural and legal barriers. 11, 12 ED usage for non-urgent care is more costly than visits to primary health care clinics. 13-15 Moreover, utilisation of ED for non-urgent conditions can be serious, as it results in prolonged length of stay and increased wait time which together reduce quality of care provided and lead to increased probability of complications for urgent conditions. 16 Also, research has shown that it adds to increased patient dissatisfaction and an increase in the number of patients who leave before being seen. 17 ED visits among the general population has been rising in many
... Complex factors such as emotional state, community environment, and personal preferences can also significantly contribute to health behaviours [253, ] [363]. This is consistent with research on the impact of social determinants on our health [463]. Given that health literacy can be utilised to overcome one's social determinants and support positive health outcomes, there is a need to promote health literacy development through education. ...
... Two studies reported that stories were central to developing children's health literacy [396,4037]. This supports previous findings, given that storytelling is established as an effective pedagogical approach [530] and used for centuries by First Nations people to communicate on cultural, spiritual, emotional, mental, and social health [463]. Stories allow the listener or reader an opportunity to have an experience vicariously and can thus help children to understand the world around them. ...
Despite international recognition that developing health literacy in childhood is critically important, little is known about how best to do so. This paper reports a systematised review of research literature in which six electronic databases were searched for articles that considered how children develop health literacy. Results were screened and sorted, and full-text screening was carried out by independent reviewers. Findings suggest that childhood is an optimal time to promote health literacy, that primary schools are ideal settings in which to support health literacy development, and that six core characteristics of health literacy education promote health literacy development: collaboration, contextualisation, accessibility, autonomy, reflectiveness, and continuity. Consideration of these characteristics could inform the development and implementation of future health literacy interventions.
... The publication of the biopsychosocial model of the determinants of disease by Engel [25], and its subsequent evolution alongside contemporaneous work in the 'new public health' [26] and modern epidemiology by Rothman [27] (amongst others), highlighted that in real-world settings, multi-causality in the development of health and disease outcomes is the norm, rather than the exception. Recognition that complex interactions among multiple factors that may vary over time [28] was a feature of the aetiology of many diseases and health conditions (e.g. ...
Determining whether repetitive head impacts (RHI) cause the development of chronic traumatic encephalopathy (CTE)-neuropathological change (NC) and whether pathological changes cause clinical syndromes are topics of considerable interest to the global sports medicine community. In 2022, an article was published that used the Bradford Hill criteria to evaluate the claim that RHI cause CTE. The publication garnered international media attention and has since been promoted as definitive proof that causality has been established. Our counterpoint presents an appraisal of the published article in terms of the claims made and the scientific literature used in developing those claims. We conclude that the evidence provided does not justify the causal claims. We discuss how causes are conceptualised in modern epidemiology and highlight shortcomings in the current definitions and measurement of exposures (RHI) and outcomes (CTE). We address the Bradford Hill arguments that are used as evidence in the original review and conclude that assertions of causality having been established are premature. Members of the scientific community must be cautious of making causal claims until the proposed exposures and outcomes are well defined and consistently measured, and findings from appropriately designed studies have been published. Evaluating and reflecting on the quality of research is a crucial step in providing accurate evidence-based information to the public.
Graphical abstract
... Our review identified seventeen (35.42%) peer-reviewed journal articles that discussed primary and secondary prevention interventions. Primary prevention interventions focused on addressing the root causes of GBV to prevent violence from occurring; secondary interventions involved early intervention and measures to identify and respond to GBV incidents promptly [74]. ...
Background
Women in low- and middle-income countries (LMICs) are primary producers of subsistence food and significant contributors to the agricultural economy. Gender Based Violence (GBV) adversely impacts their capacity to contribute and sustain their families and undermines social, economic, and human capital. Addressing GBV, therefore, is critical to creating safe and inclusive environments for women as primary producers to participate fully in rural communities. The aim of this scoping review is to explore the existing evidence on GBV in the context of women primary producers in LMICs to inform research gaps and priorities.
Methods
A scoping review was conducted using PubMed, Web of Science, Ebscohost and Google Scholar using keywords related to GBV and women producers in LMICs. Peer-reviewed journal articles published between January 2012 and June 2022 were included in the review. Duplicates were removed, titles and abstracts were screened, and characteristics and main results of included studies were recorded in a data charting form. A total of 579 records were identified, of which 49 studies were eligible for inclusion in this study.
Results
Five major themes were identified from our analysis: (1) extent and nature of GBV, (2) the impact of GBV on agricultural/primary production livelihood activities, (3) sociocultural beliefs, practices, and attitudes, (4) aggravating or protective factors, and (5) GBV interventions. Addressing GBV in agriculture requires inclusive research approaches and targeted interventions to empower women producers, promote gender equality, enhance agricultural productivity, and contribute to broader societal development. Despite attempts by researchers to delve into this issue, the pervasive under-reporting of GBV remains a challenge. The true extent and nature of GBV perpetrated against women is far from fully understood in this context.
Conclusion
Despite the significant challenges posed by GBV to the health, economy and livelihoods of women primary producers in LMICs, there is a paucity in the current state of knowledge. To make meaningful progress, more research is required to understand the relationship between GBV and agricultural settings, and to gain nuanced insight into the nature and impact of GBV on women primary producers in different regions and contexts.
... While the public health evidence for immunisation is unequivocal [13,17], it is important to consider the impacts of mandates, including their unintended consequences. Although mandates are generally supported in Australia, debates around collective benefits versus individual choice highlight the need for ongoing evaluation [18][19][20]. ...
Background
Mandates provide a relatively cost-effective strategy to increase vaccinate rates. Since 2014, five Australian states have implemented No Jab No Play (NJPlay) policies that require children to be fully immunised to attend early childhood education and childcare services. In Western Australia, where this study was conducted, NJNPlay legislation was enacted in 2019. While most Australian families support vaccine mandates, there are a range of complexities and unintended consequences for some families. This research explores the impact on families of the NJNPlay legislation in Western Australia (WA).
Methods
This mixed-methods study used an online parent/carer survey (n = 261) representing 427 children and in-depth interviews (n = 18) to investigate: (1) the influence of the NJNPlay legislation on decision to vaccinate; and (2) the financial and emotional impacts of NJNPlay legislation. Descriptive and bivariate tests were used to analyse the survey data and open-ended questions and interviews were analysed using reflexive thematic analysis to capture the experience and the reality of participants.
Results
Approximately 60% of parents intended to vaccinate their child. Parents who had decided not to vaccinate their child/ren were significantly more likely to experience financial [p < 0.001] and emotional impacts [p < 0.001], compared to those who chose to vaccinate because of the mandate. Qualitative data were divided with around half of participants supporting childhood immunisation and NJNPlay with others discussing concerns. The themes (a) belief in the importance of vaccination and ease of access, (b) individual and community protection, and (c) vaccine effectiveness, safety and alternatives help understand how parents’ beliefs and access may influence vaccination uptake. Unintended impacts of NJNPlay included: (a) lack of choice, pressure and coercion to vaccinate; (b) policy and community level stigma and discrimination; (c) financial and career impacts; and (d) loss of education opportunities.
Conclusions
Parents appreciation of funded immunisation programs and mandates which enhance individual and community protection was evident. However for others unintended consequences of the mandate resulted in significant social, emotional, financial and educational impacts. Long-term evidence highlights the positive impact of immunisation programs. Opinions of impacted families should be considered to alleviate mental health stressors.
... Rehabilitation has become an area of fundamental interest because of increased survival after even severe injuries and because it enhances the quality of life of individuals affected, as well as reducing healthcare costs [3,4]. Discourses on rehabilitation, including how health and disability are understood, individually and socially, have changed during recent decades [5][6][7][8][9]. As a result of these changes, the conceptualisation of rehabilitation has shifted from primarily medically oriented care to holistic, socially oriented care that includes biological, psychological and social factors [10,11]. ...
Background
Rehabilitation is considered paramount for enhancing quality of life and reducing healthcare costs. As a result of healthcare reforms, Norwegian municipalities have been given greater responsibility for allocating rehabilitation services following discharge from hospital. Individual decision letters serve as the basis for implementing services and they have been described as information labels on the services provided by the municipality. They play an important role in planning and implementing the services in collaboration with the individual applicants. Research indicates that the implementation of policies may lead to unintended consequences, as individuals receiving municipal services perceive them as fragmented. This perception is characterised by limited user involvement and a high focus on body functions. The aim of this study was to examine how municipal decision letters about service allocation incorporate the recommendations made in the official national guideline and reflect a holistic approach to rehabilitation, coordination and user involvement for individuals with comprehensive needs.
Methods
The decision letters of ten individuals with moderate to severe brain injury allocating rehabilitation services in two municipalities were examined. It was assessed whether the content was in accordance with the authorities’ recommendations, and a discourse analysis was conducted using four tools adapted from an established integrated approach.
Results
The letters primarily contained standard texts concerning legal and administrative regulations. They were predominantly in line with the official guideline to municipal service allocation. From a rehabilitation perspective, the focus was mainly on medically oriented care, scarcely referring to psychosocial needs, activity, and participation. The intended user involvement seemed to vary between active and passive status, while the coordination of services was given limited attention.
Conclusions
The written decision letters did fulfil legal and administrative recommendations for service allocation. However, they did not fulfil their potential to serve as a means of conveying rehabilitation issues, such as specification of the allocated services, a holistic approach to health, coordination, or the involvement of users in decision processes. These elements must be incorporated throughout the allocation process if the policies are to be implemented as intended. Findings can have international relevance for discussions between clinicians and policy makers.
... This study was a qualitative research with case study approach. The case study is a practical exploration inspect existing phenomenon of the actual life issues (Baum, 2008). Boundaries between phenomenon and context are not clearly (Yin, 2003, p.23). ...
Introduction: Partnership is a key in the implementation of Healthy Cities at various countries. However, studies in this field are still very limited, especially in the context of local government such as Makassar. Indonesia. This study aims to identify the achievement and typology of partnership between central government, provincial and municipal towards the implementation of the Healthy Cities in Makassar, Indonesia. Methods: This research was a qualitative research with a a case study approach and analysed in thematic analysis. Informants were 25 people of decision makers in the implementation of Healthy Cities at all levels: Central government (Healthy Cities' staff of the Ministry of Home Affairs and the Ministry of Health), provincial and city level: Healthy City Forum and Advisor. The Healthy City Forum members were from the community level and the Healthy City Advisory members were from the government elements, for example Regional Planning and Development Board, Health Office, Tourism Office, Social Affairs. This research also conducted a Focus Group Discussion to the members of Healthy City Forum, and government document review. Results: This research identified that implementation of Healthy City in Makassar runs gradually and continously improve up to the highest level of the Healthy Cities Award of Indonesia: Swasti Saba Wistara. The central government has more function in providing policy while the provincial level is expected to provide facilities and can become bridging from the central government to strenghten the application of Healthy City in Makassar. The core of Healthy Cities is at the Makassar government along with other stakeholders. Conclusion: This research needs to quicken the birth of a presidential decree on the Implementation of the Healthy District/Cities in Indonesia that have a strong tie to the relevant ministries and can provide leverage to the districts / cities in Indonesia. This study can be used as consideration for local government in Indonesia, especially for the Forum and the Healthy Cities Advisor for the implementation of the Healthy Cities which is more clean, safe, comfortable and healthy.
... The ideological position that individuals are responsible for their health (victim blaming), that was apparent in a few PHNs, ignores the underlying social, cultural and economic factors that hinder behaviour change (24). It also provides governments of such neoliberal persuasion with justi cation for abrogating responsibility to mitigate such factors through regulation, or fund medical services for consequent illness (25). ...
Background
Meso-level, regional primary health care organisations such as Australia’s Primary Health Networks (PHNs) are well placed to address health inequities through comprehensive primary health care approaches. This study aimed to examine the equity actions of PHNs and identify factors that hinder or enable the equity-orientation of PHNs’ activities.
Methods
Analysis of all 31 PHNs’ public planning documents, case study interviews with a sample of five PHNs’ stakeholders, and analysis of internal planning guidance documents, employing an existing framework to examine equity actions.
Results
PHNs displayed clear intentions and goals for health equity and collected considerable evidence of health inequities. However, their planned activities were largely restricted to individualistic clinical and behavioural approaches, with little to facilitate access to other health and social services, or act on the broader social determinants of health. PHNs’ equity-oriented planning was enabled by organisational values for equity, evidence of local health inequities, and engagement with local stakeholders. Equity-oriented planning was hindered by federal government constraints and lack of equity-oriented planning process mechanisms.
Conclusions
PHNs’ equity actions were limited. They need greater autonomy and systematic planning mechanisms to capitalise on their local evidence and connections to address health inequities.
... 22 Recently, the document analysis method has been used frequently in research on health policies. [23][24][25] Document Analysis Document analysis is a qualitative analysis method used to rigorously and systematically analyze the content of written documents. Like other methods used in qualitative research, a document analysis requires examining and interpreting data to make sense of them, building an understanding of the topic, and developing empirical knowledge. ...
Objective:
A substantial amount of work addressing strategies on how to respond to the coronavirus disease (COVID-19) crisis already exists. However, there is simply not enough evidence to support a systematic and all-encompassing approach. This study aims to systematically review and present the roadmap of Turkiye’s response to COVID-19.
Methods:
This study is based on a thematic content analysis of official policy documents to present the roadmap in Turkiye’s fight against COVID-19. The analysis included 46 press releases accessed from the Ministry of Health’s website. The coding structure was created by the researchers based on the literature. Documents were analyzed by dividing them into 3 periods: the panic period, the controlled normalization period, and the normalization period. Each document was sub-coded under the main themes of “concerns” and “strategies” and interpreted by comparing them with each other.
Results:
The study results show that different categories and coding structures were formed between periods. Some categories that emerged under the theme of concerns were “vaccine concerns” and “social concerns.” Similarly, some categories that appeared under the theme of strategies were “vaccine strategies,” “monitoring and surveillance strategies,” and “intervention strategies.”
Conclusion:
The results provide policy-makers with an appropriate conceptual framework to deal with the pandemic crisis that may be encountered in the future.
... Technological innovations and medical discoveries are crucial, but they are only a part of our response to keeping communities healthy and well. Understanding how the environment impacts human health-both positively and negatively-is now an established interdisciplinary area of scholarship and practice [23,24], which brings public health [25], town planning [26], and urban design [27] together, alongside the legacy framework of the WHO Healthy Cities. Post COVID health-supportive environments will continue to progress in response to readjustments in work patterns, commuter travel behaviour, and the extent to which communities inhabit local environments. ...
Urban planning has long pursued the improvement of health and wellbeing through the rapidly evolving scholarship and practice of health-supportive environments, underpinned by the seminal World Health Organization’s Healthy Cities Framework. Although a much more recent development, technology has been informing urban planning, as well as advancing healthcare and personal wellbeing monitoring and assessment. Known as the Smart City movement, it has much to offer regarding life in towns and cities, as well as how they are managed, maintained, and developed. There is also a growing appreciation of the potential for smart city technology to enhance human and environmental health in the context of urban planning and public place making. This has been reinforced by the COVID-19 pandemic with its reawakening of community interest in health and wellbeing, including mental illness, a greater awareness of the importance of local environments, and an explosion of technological knowhow in the embrace of remote working, online shopping, and education. Using the example of the authors’ “Smart Social Spaces” project, this entry discusses the potential benefits of an evolving integrative concept called “Smart Healthy Social Spaces”. The aim is to support community wellbeing as part of everyday living, especially associated with social connection, in densely populated and culturally diverse urban environments, where locally situated public spaces are increasingly important for all citizens.
... What is striking about the commission's reports is the emphasis on environmental factors in preventing chronic disease; these are far more of a focus than "lifestyle" in its behavioral formulation. This challenges the widespread view that there was a straigh tforward shift from an emphasis on lifestyle risk factors in the 1950s to a "new" public health focusing on the social determinants of health in the 1970s (e.g., Baum 2008). At the very least, it suggests that conceptions of lifestyle in the fi eld of public health have changed over the past half century; after all, lifestyle is ultimately a mixture of both behavior and environment. ...
... Enabling factors for effective community engagement include governance, leadership, decision-making, communication, collaboration and partnership and resources [12]. The benefits of intersectoral collaboration and partnership between government services, non-government organisations and the local community have been well documented in health promotion [13][14][15]. Ongoing partnerships ensure that community priorities and values continue to shape services and systems [10]. ...
Meeting the health needs of migrant and refugee communities is crucial to successful settlement and integration. These communities are often under-served by mental health services. Previous research has demonstrated the effectiveness of a group mindfulness-based intervention tailored for Arabic and Bangla speakers living in Sydney, Australia. This study aimed to explore community partner perspectives on the program’s impact, contributing factors and sustainability, and to elicit suggestions for future development. Data were collected via semi-structured telephone interviews with a purposively selected sample of 16 informants. Thematic analysis was conducted using the Rigorous and Accelerated Data Reduction (RADaR) technique. Community partners welcomed the emphasis on promoting wellbeing and reported that the community-based in-language intervention, in both face-to-face and online formats, overcame many of the barriers to timely mental health care for culturally and linguistically diverse (CALD) communities, with a beneficial impact on group participants, program providers, partner organisations and the broader community. Positive outcomes led to stronger community engagement and demand for more programs. For group mental health programs, both trust and safety are necessary. Relationships must be nurtured, diversity within CALD communities recognised, and projects adequately resourced to ensure partner organisations are not overburdened.
... Even though the topic of prevention was already of importance for society's approach to health in the 18th and 19th centuries, it is now acquiring even more prominent significance (Leanza 2017). The Ottawa Charter adopted by the WHO in 1986 finally marks the transition from the "old" to the "new" public health (Petersen and Lupton 1996;Rosenbrock 2001;Baum 2016). The focus is no longer on the spread of infectious and viral diseases, but on the increase in chronic diseases such as diabetes, obesity, or cardiovascular diseases. ...
... Immunisation is considered one of the most successful and cost-effective public health interventions to prevent infectious disease and protect public health and well-being [1]. Globally, childhood immunisation programs have led to a decline in disease transmission rates [2] and have provided the advantage of community-level protection or herd immunity in addition to individual level protection [3]. ...
Australia has a long history of population-based immunisation programs including legislations. This paper reports on a review of evaluations of the impact of the federal No Jab No Pay (NJNPay) and state implemented No Jab No Play (NJNPlay) legislations on childhood immunisation coverage and related parental attitudes. Five databases were searched for peer-review papers (Medline (Ovid); Scopus; PsycInfo; ProQuest; and CINAHL). Additional searches were conducted in Google Scholar and Informit (Australian databases) for grey literature. Studies were included if they evaluated the impact of the Australian NJNPay and/or NJNPlay legislations. Ten evaluations were included: nine peer-review studies and one government report. Two studies specifically evaluated NJNPlay, five evaluated NJNPay, and three evaluated both legislations. Findings show small but gradual and significant increases in full coverage and increases in catch-up vaccination after the implementation of the legislations. Full coverage was lowest for lower and higher socio-economic groups. Mandates are influential in encouraging vaccination; however, inequities may exist for lower income families who are reliant on financial incentives and the need to enrol their children in early childhood centres. Vaccine refusal and hesitancy was more evident among higher income parents while practical barriers were more likely to impact lower income families. Interventions to address access and vaccine hesitancy will support these legislations.
... From the perspective of public health, food equity has been recognised as being both desirable and achievable (Pollard et al., 2016;Baum, 2008) and should therefore be one of the basic objectives of social and economic policy. Some problems associated with chronic hunger including undernutrition, malnutrition and ultimately increased mortality, all have direct impacts on the health outcomes of the population, leading to a loss in human capital and productivity, and eventually to a reduction in the pace of economic growth. ...
Lockdowns were used as a tool to avoid excessive social contact and thus limit the spread of Covid-19. However, the true welfare effects of this policy action are still being determined. This paper studies the impact of these lockdowns on the food security outcomes of households in Uganda using a dynamic probit model. We find that the most consequential determinant of whether a household’s food security was severely impacted by the lockdown was the initial status of whether a family was food insecure to begin with. Also, an increase in a household’s economic resources (log consumption per person) significantly influences a reduction in the probability of being severely food insecure. Over time, this creates a wedge of greater inequality between the food security of households who were initially food secure and those who were not. This is despite the use of government cash transfers which have turned out to be ineffective.
Highlights
A dynamic probit model is used to assess the influence Covid lockdowns have had on food security
Households who were initially severely food insecure experienced greater levels of food insecurity post-lockdown, than those who were not.
Increased command of economic resources reduces the probability of severe food security
Contemporaneous government transfers have not made a significant impact on reducing the probability of severe food insecurity
... This study also found that maternal health knowledge of husbands was inadequate as the average score before health education for both groups was only around 30. Consequently, husbands' interest and involvement in maternal health programs would likely be negative (5). This study also showed that almost all respondents had irregular jobs as farmers, motorcycle taxi drivers, and builders. ...
Background: Partnership with local head villages to deliver maternal and child health (MCH) education is considered necessary, as the availability of health professional is limited in rural remote area. While the head villages could be viewed as credible, they have rarely been involved as a health communicator in their villages. Objective: This study aimed to analyze the difference of the knowledge level of the heads of family (husband) after attending MCH education delivered by the head village and midwife. Methods: The research method applied was quasi experiment with non-equivalent control design conducted in two remote villages in Timor Tengah Selatan District. The population was all heads of the family (husband) living in two selected villages, with a total of 920. The sample of 60 men was selected purposively. The experiment and control group consisted of 25 and 35 men, respectively. Data were analyzed using t-test dependent and t-test independent. Results: The result showed that 1. Both MCH education delivered by the head village and midwife increased the level of knowledge of husband with the value of (ρ) 0,00 <(ɑ) 0,05; 2. The head village and midwife were equally effective as communicators in increasing the knowledge level of husbands about MCH with the value of (ρ) 0,245 >ɑ (0,05). Conclusion: Both the village head and the midwife can be educators in increasing the knowledge of MCH among husbands. Thus, the village head could also be empowered as an alternative MCH communicator.
... Public health is concerned with supporting communities to make health-promoting decisions, to prevent and protect them against illnesses (Baum, 2015). Health promotion is a component of public health and can be defined as 'the process of enabling people to increase control over, and to improve, their health' (World Health Organization (WHO), 2022: 1). ...
An imperative exists to promote health literacy (HL) development in today's young people. Included in curricula worldwide, health literacy has been recognised as a social determinant in its own right, which has the potential to redress inequity and positively impact health and educational outcomes. While it has been shown that schools provide an ideal setting to support HL development, available evidence suggests that health may be undertaught in primary schools, and further resources are required to support educators' inclusion of HL in their lessons. The aims of this paper were to (1) highlight the ethical imperative to promote HL through schools and (2) provide an ethical evaluation of an existing HL intervention. Spike's (2018) four principles for public health ethics were employed as a framework for evaluating a program's ethical status and suitability in the school setting. In this paper, one program, HealthLit4Kids, is evaluated according to Spike's framework, and shown to be an ethically acceptable approach to foster HL in young people. These results model how other HL programs may be evaluated and offer critical insights concerning how HL could be promoted in an ethically acceptable manner in the classroom.
... Observations run continuously throughout the project. We will make use of a semi-structured template that will be filled out by the researcher and that contains the following variables: (1) information about the setting, (2) enumeration and description of the participants, (3) ...
Background/Objectives
Compassionate Cities are social ecology approaches that apply a set of actions, targeting a broad range of stakeholders, with the intention of renormalising caring, dying, loss and grieving in everyday life. While several initiatives have been described in the literature, a rigorous evaluation of their processes and outcomes is lacking. This article describes the protocol for a mixed-methods study to evaluate the development process and the outcomes of two Compassionate Cities in Flanders, Belgium.
Methods and Analysis
We will use a convergent multiphase mixed-methods design, in which a combination of qualitative and quantitative data collection methods will be triangulated in the data analysis stage to capture both development processes and outcomes. Our design includes a quasi-experimental component of a quantitative outcome evaluation in both Compassionate Cities and two comparable control cities with no formal Compassionate City programme. Both Compassionate Cities will be co-created in collaboration with local stakeholders. A critical realism lens will be applied to understand how and why certain processes manifest themselves.
Discussion
The creation of Compassionate Cities implies high levels of complexity, adaptivity, unpredictability and uncertainty. This requires various data collection methods that can be applied flexibly. A researcher taking on the role of active participant in the project’s development has several advantages, such as access to scholarly information. Reflexivity in this role is paramount to questioning where the ownership of the project lies. By applying a critical realism lens, we remain cautious about our interpretations, and we test the homogeneity of our findings through other forms of data collection.
Conclusion
This is the first published study protocol to describe both a process and outcome evaluation of a Compassionate City project. By transparently describing our aims and data collection methods, we try to maximise information exchange among researchers and to inform others who desire to implement and evaluate their own initiatives.
... For this reason, the population for the study was students of the University of Education, Winneba. While there are no closely defined rules for sample size (Baum, 2000), sampling in qualitative research usually relies on small numbers to study in-depth and in detail (Miles & Huberman, 1994). Per this position, the considered sample was five (5) students who were found to be using identifiable landmarks on campus (Students' Centre, University Bookshop, Jophus Anamoah-Mensah Conference Centre, Faculty Block, John Agyekum Kufuor Building) as places to take photographs. ...
Picture taking seems no longer predominantly an act of memory intended to safeguard the heritage of a family's pictorial portal. However, it is increasingly becoming a tool for an individual's identity formation and communication. Self-identity construction is an integral component of society, including human interactions, interpersonal connections, relationships, and strong attachment stamps. This expressively incorporates the entirety
of one's thoughts and emotions, creating this visual representation of themselves. The study aims to find out how today's youth use photography as a tool in the identity construction of the self. The research adopted the qualitative approach and exploratory research design for the study. However, the interpretivism approach was adopted to
provide novel insight into the study. It was revealed from the analyses that perspectives of the youth on photography trends have lots of insights, and digital photography has been the activator of these trends. The paper concludes that photography may represent a true reflection of reality and, in some cases, memory. However, photography trends have come to a point where reflection goes beyond the limit by providing the youth the option to enhance and reconstruct their appearance through photo editing. It also concludes that photography has become a new tool that enables individuals to control the outcome of images. Special emphasis is placed on the youth because they are more exposed to the technological know-how of some of these photographic tools that construct identity through an improved photography trend.
... Comprehensive primary health care (CPHC) is an approach to health care provision and health promotion underpinned by a social view of health, community participation, empowerment, social justice, equity, and action on social determinants of health. 1,2 Soon after this approach was the subject of international accord in the Alma Ata declaration, 1 a "selective" primary health care approach was proposed, which had a narrower focus on the technical treatment and prevention of certain diseases. 3 There has been an ongoing tension between these comprehensive and selective visions in the implementation of primary health care globally, ever since they were presented in the 1970s. ...
... A mounting compendium of scientific proof has over the years documented the link between low housing quality and poor health, both locally and globally [1,2] and these have been identified to have a deleterious effect on health, and according to Moloughney [3] scientific proof connected to housing of poor quality and ill health has been perhaps the most documented. ...
Despite the mounting compendium of scientific evidence that has clearly documented the link between poor housing quality and health both locally and globally, poor housing quality has continued to be a significant concern in public health, especially in rural and sub-rural areas of emerging nations like Nigeria, where there is slight or no knowledge about the public health consequences of poor housing quality. As a result, the object of this work is to observe the housing quality and the perceived health impacts in Ijebu Ode, Nigeria. The work adopted a descriptive but cross-sectional approach, and data was obtained from four hundred (400) systemically sampled households through structured questionnaires, and analysed descriptively using a statistical tool for social scientists. According to the findings, a significant number of the residents 51.5% had no water in their houses, 44% had two windows in the room; out of which only 32% had windows on the two walls of the room, and 33% of the homes were overcrowded with over two people in a room. The findings further revealed that the vast majority of residents reported having cases of malaria with 67.5%, and cases of typhoid and cough with 15.5% and 4.5%, respectively. Consequently, the study has hitherto concluded that housing quality in Ijebu Ode is poor, which is a major predictor of the perceived health effects experienced by the residents.
... The World Health Organization (WHO) famously defined "health" as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity (World Health Organization, 2001a). Since the Declaration of Alma-Ata in 1978 and the Ottawa Charter for Health Promotion in 1986, health promotion is an emerging field of action considered in the late 1990s as the "new" public health (Baum, 1998(Baum, , 2016. The WHO also defined "mental health" as a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community (World Health Organization, 2001b); reinforcing that there is no health without mental health and mental health is more than the absence of mental illness. ...
Topic:
The concept of mental health literacy (MHL) was defined as the knowledge and beliefs about mental disorders that help in their recognition, management, or prevention. The complexity of interventions to promote adolescents' MHL requires that they be investigated through a process of development, feasibility/piloting, evaluation, and implementation, according to Medical Research Council (MRC) Framework.
Purpose:
This article aimed to identify the theory that supports the development of a psychoeducational intervention to promote adolescents' MHL in schools, possibly to be developed by mental health and psychiatric nurses.
Sources used:
Journal articles, books, reports, and regulations.
Conclusions:
This theory allows us to design a psychoeducational intervention to promote adolescents' MHL in schools and supports the subsequent phases of the MRC Framework.
... New public health approaches emphasize a pursuit of equity and access (Baum, 2016). They work based on the assumption that social and environmental factors are responsible for adverse population health outcomes and they emphasize primary care as a driver for health promotion. ...
This chapter explores the challenges and complexities of public health palliative care research. The rapid development of public health palliative care research over the last decades foretells a whole new domain of research and policy in end of life care. This chapter reviews what the public health approach to palliative care entails and suggests appropriate research designs that can be used to develop and evaluate public health palliative care studies. Furthermore, it provides an overview of how observational, experimental, and change-oriented designs have been used in public health palliative care research. Finally, it explores what complexity means in public health palliative care research and what particular sources of complexity one may encounter in the research experience.
... The advisory group decided the first author would undertake all data collection activities and supported a participatory action research methodology to uphold a shared and respectful relationship between community and research stakeholders, and to meet cultural protocols (Kendall et al. 2011). The rigour of participatory action research lies in its attention to community control, cultural appropriateness and pragmatic outcomes (Baum 2008). The project proceeded with approval of the Human Research Ethics Committee (Tasmania) Network. ...
Background:
The impact of colonisation, dispossession and marginalisation on the health of Aboriginal and/or Torres Strait Islander peoples (hereafter respectfully referred to as Aboriginal people) is well documented. Aboriginal people continue to practice traditional healing, and in recent years have initiated numerous community-based healing programs around Australia. The Closing the Gap policy has also resulted in numerous community health programs. Despite these program and policy responses, Aboriginal people continue to experience persistent health disparities. The role of Aboriginal Elders in shaping Aboriginal health has yet to be a focus of research attention. This paper reports on a study that examined the contributions of Elders to the healing of Aboriginal people in a remote Tasmanian community.
Methods:
Our co-designed participatory action research methodology was undertaken with eight community Elders.
Results:
Analysis of qualitative data derived through interviews and yarning circle discussions revealed an emerging theme of community healing; with Elders undertaking a suite of therapeutic practices, and promoting cultural values to strengthen Aboriginal identity, community cohesion and connections to Country. The Elders identified healing as an essential process in response to intergenerational trauma, racism and marginalisation.
Conclusions:
The findings inform policy stakeholders to consider the wisdom and voice of Elders in addressing Aboriginal community healing.
... The Queensland project aligned with psychologist Urie Bronfenbrenner's (1981Bronfenbrenner's ( , 2005 ecological systems theory approach to understanding environmental influences on how children grow and develop. This approach opens up the possibility of greater recognition of the powerful effects socio-economic differences and resulting inequities can have on health and wellbeing in childhood and through to adulthood (Viner et al. 2012;Baum 2008). ...
This report outlines the findings of research into the operation of the reunification specialist model within the foster care program from the perspectives of foster carers and program staff.
The study, co-designed by researchers and NGO staff, was intended to produce independent recommendations for improving service delivery and outcomes for carers and children in the reunification specialist model. The first stage of the project was a review of prior research on out of home care settings for children in Australia and internationally.
This study addresses a gap in the existing research, which includes limited data on the perceptions of foster carers and staff involved in reunification specialist models. The findings highlight the distinctive nature of fostering as part of reunification specialist models. Foster carers’ role in such programs is more complex, more relational and sometimes more ambiguous than that of foster carers with long-term placements. Notwithstanding these demands, the findings indicate strong support for the family reunification model among foster carers and staff, whilst acknowledging that reunification is not always the best outcome in individual
circumstances.
... As políticas públicas saudáveis cobrem uma gama de atividades que permeiam diferentes sectores, incluindo habitação, transporte e emprego, e envolvem uma ampla gama de grupos, incluindo consumidores, serviços governamentais, organizações não governamentais, grupos de pressão e o sector comercial (Baum, 2008). Uma política pública saudável pode-se sobrepor à política social, pois inclui aspetos da economia, da sociedade e da política, da seguridade social e da promoção da saúde e da educação (Dixey et al., 2013). ...
O Guia de bolso para a promoção da saúde foi escrito para ser uma companhia
de grande valor para os profissionais de saúde, os estudantes e todos os que par�tilhem paixão pela promoção da saúde. Acima de tudo, foi escrito para cultivar
nos profissionais que diariamente se esforçam para desenvolver programas de
promoção da saúde, por vezes sem uma fonte de recursos adequada, o melhor
das suas capacidades. A ideia para o guia de bolso veio das minhas próprias
experiências com profissionais de campo internacionais e a sua necessidade de
um livro que apresentasse apenas os aspetos essenciais da promoção da saúde na
prática clínica.
Population health is profoundly affected by the liveability of the urban environments where people live. In Australia today most people live in suburbs which fall well short of the form and function required for liveability, which is adversely affecting population health and health equity. We produced the Healthy Urban Neighbourhood Transition Tool (HUNTT) to analyze the existing liveability strengths and weaknesses of neighbourhoods with the objective of assessing their potential for, and pathways required, for a liveability transition. This paper presents a summary of the findings of the application of the HUNTT in 22 suburbs of Adelaide, South Australia, looking at the liveability determinant of walkability. The study showed that there were walkability strengths and weaknesses in all surveyed suburbs, and weaknesses tended to proliferate more in middle and all outer suburbs and those with lower median incomes. It also showed that a walkability transition is possible in all the suburbs surveyed. However, it would require coordination between multiple stakeholders, government regulatory changes and intervention, and significant public funding.
This work involved investigating bacterial pollution of medical wastes produced by shredder autoclave at some local hospitals in Iraq. A modulation has been introduced to ensure sterilization performance through the use of Ultraviolet light on the hazardous wastes after being processed by shredder autoclave with different retention times at optical density of 270 nm in order to control the full killing of all kind of microbial life according to the environmental limits. The bacteria recovered from the wastes were identified through routine microscopically and biochemical tests and the results revealed the following species: Acinetobacter baumanii, Bacillus cereus, Clostridium difficilie, Escherichia coli, Klebsiella pneumonia, Proteus mirabilis, Pseudomonas aeruginosa and Staphylococcus aureus. The results showed ability of these bacteria to re-generate in the produced solid medical wastes within the periods of 72 hours that reaches up to 20 cell / ml, while the use of UV light in a retention time of 15 min. was able to destroy all bacterial growth in the same period of 72 hours.
Background:
Many anti-stigma programs for healthcare workers already exist however there is less research on the effectiveness of training in skills for health professionals to counter stigma and its impacts on patients.
Aims:
The objective of this study was to examine the theory base, content, delivery, and outcomes of interventions for healthcare professionals which aim to equip them with knowledge and skills to aid patients to mitigate stigma and discrimination and their health impacts.
Methods:
Five electronic databases and grey literature were searched. Data were screened by two independent reviewers, conflicts were discussed. Quality appraisal was realized using the ICROMS tool. A narrative synthesis was carried out.
Results:
The final number of studies was 41. In terms of theory base, there are three strands - responsibility as part of the professional role, correction of wrongful practices, and collaboration with local communities. Content focusses either on specific groups experiencing health-related stigma or health advocacy in general.
Conclusions:
Findings suggest programs should link definitions of stigma to the role of the professional. They should be developed following a situational analysis and include people with lived experience. Training should use interactive delivery methods. Evaluation should include follow-up times that allow examination of behavioural change. PROSPERO, ID: CRD42020212527.
Objectives: This paper attempts to explain the term inequity in public health based on The Rainbow Model introduced by Dahlgreen & Whitehead (1991) and The Social determinant of Health (SDH) framework of the Commision of Social Determinants of Health). Methods: The author applied a narrative review and examined 29 relevant English literatures and found two themes. Results: First, Explanation of The Rainbow Model’ introduced by Dahlgreen & Whitehead (1991) and The SDH framework of the Commision of Social Determinants of Health. Second, the perspective of traditional public health emphasizes the proximal determinants while New Public health emphasis on intermediate determinants and distal determinants. Conclusions: Therefore, as a public health professional need to consider about proximal, intermediate and distal determinant of public health issue.
This article addresses citizens’ psychological health disparities in pandemic-stricken Japan from the perspective of positive psychology with a collective/political perspective. Our analysis of three internet surveys in 2020 and 2021 in Japan indicates most people’s well-being declined continuously during this period, while some people’s well-being increased. As previous studies of health inequality proved about physical health, the objective income/assets level has influenced psychological inequality. This paper demonstrated this relation in Japan, although it is often mentioned as an egalitarian country with comparatively better health conditions. Moreover, psychological levels and changes have been associated with biological, natural environmental, cultural, and social factors. Social factors include economic, societal-community, and political factors, such as income/assets, stratification, general trust, and fairness/justice. Accordingly, multi-dimensional disparities are related to psychological health disparity; tackling the disparities along the multi-layered strata is desirable. Furthermore, subjective perception of fairness/justice is significantly associated with the level of psychological health and mitigating its decrease. Thus, fairness and justice are found to be dynamic and protective factors against the decline of psychological health. While relatively little literature on health inequality analyzes fairness/justice philosophically, this paper highlights these together with income/assets by clarifying the significance of multi-dimensional factors: natural environmental, cultural, socioeconomic, and political.
The Constitution of Papua New Guinea reflected the hopes of an emerging postcolonial state and was intended to enable the country to develop in a way that was self-determining and self-orienting. It reflected what was loosely called the “Melanesian Way”—sometimes an empty cliché, sometimes a romantic allusion, and occasionally a glimmer of an alternative. Communities were to drive economic development in ways that reflected “small-scale artisan, service and business activity.” Development was to be built on the peoples’ skills and resources. This was part of an explicit concern to mitigate the risk that the wrong kind of economic development could encourage “dependence on imported skills and resources,” undermine Papua New Guinea’s “self-reliance and self-respect,” or promote dependency on donor countries. The framers of the Constitution could not have been more prescient about the dangers. Many of the problems they identified have been realized—some tragically, some as farcical reruns of earlier tragedies, and some as manageable problems endemic to any development process. In response, this book focuses on ways of supporting and building the base-level foundations for enhancing the resilience and vibrancy of communities under threat.2 In effect, we wanted to rewrite the mainstream development literature by emphasizing the possibilities for revitalizing nonformal economies, restructuring health practices, and providing alternative pathways to community development through informal learning. One of the core strategies suggested by the research involves drawing on the existing strengths of communities and working in partnership with government and civil society organizations to create networks of community learning centers.
An international effort to restore contaminated areas across the Great Lakes has been underway for over 50 years. Although experts have increasingly recognized the inherent connections between ecological conditions and community level benefits, Great Lakes community revitalization continues to be a broad and complex topic, lacking a comprehensive definition. The purpose of this study was to generate a testable “AOC-Revitalization Framework” for linking remediation and restoration success, represented by Beneficial Use Impairment (BUI) removal in U.S. Great Lakes Areas of Concern (AOC), to community revitalization. Using directed content analysis, we conducted a literature review and identified 433 potential revitalization metrics and indicators and grouped them into 15 broader community revitalization attributes to develop the following definition of Great Lakes community revitalization: “locally driven community resurgence resulting in resilient and equitable enhancements to social, economic, and environmental community structures.” We surveyed experts within the Great Lakes AOC program on the likelihood remediation and restoration success, would positively impact revitalization attributes. Focus groups triangulated survey results. Results identified BUI removal was expected to positively affect revitalization, but the type of revitalization outcome was based on the BUI being removed. The AOC-Revitalization Framework is the first to empirically outline these possible linkages, providing a clear testable structure for future research; it can be used to better understand how environmental improvements are or are not leading to community revitalization and more accurately identify components of revitalization impacted, thus supporting more equitable representation, communication, and measurement of the relationship.
Low‐dose computed tomography lung cancer screening has mortality benefits. Yet, uptake has been low. To inform strategies to better deliver and promote screening, in 2018, we interviewed 27 long‐term smokers immediately following lung cancer screening in Australia, prior to receiving scan results. Existing lung screening studies employ the Health Belief Model. Reflecting growing acknowledgement of the centrality of emotions to screening uptake, we draw on psychological and sociological theories on emotions to thematically and abductively analyse the emotional dimensions of lung cancer screening, with implications for screening promotion and delivery. As smokers, interviewees described feeling stigmatised, with female participants internalising and male participants resisting stigma. Guilt and fear related to lung cancer were described as screening motivators. The screening itself elicited mild positive emotions. Notably, interviewees expressed gratitude for the care implicitly shown through lung screening to smokers. More than individual risk assessment, findings suggest lung screening campaigns should prioritise emotions. Peer workers have been found to increase cancer screening uptake in marginalised communities, however the risk to confidentiality—especially for female smokers—limits its feasibility in lung cancer screening. Instead, we suggest involving peer consultants in developing targeted screening strategies that foreground emotions. Furthermore, findings suggest prioritising humanistic care in lung screening delivery. Such an approach may be especially important for smokers from low socioeconomic backgrounds, who perceive lung cancer screening and smoking as sources of stigma and face a higher risk of dying from lung cancer and lower engagement with screening.
Issue addressed:
There is a need for culturally appropriate methods in the implementation and evaluation of Aboriginal and Torres Strait Islander health programs. A group of Indigenous and non-Indigenous practitioners culturally adapted and applied the Tri-Ethnic Research Centre's Community Readiness Tool (CRT) to evaluate change in community readiness and reflect on its appropriateness.
Methods:
Aboriginal community-controlled health service staff informed the cultural adaptation of the standard CRT. The adapted CRT was then used at baseline and 12-month follow-up in three remote communities in the Cape York region, Queensland, Australia. Program implementation occurred within a pilot project aiming to influence availability of drinking water and sugary drinks.
Results:
The adapted CRT was found to be feasible and useful. Overall mean readiness scores increased in two communities, with no change in the third community. CRT interview data were used to develop community action plans with key stakeholders that were tailored to communities' stage of readiness. Considerations for future application of the CRT were the importance of having a pre-defined issue, time and resource-intensiveness of the process, and need to review appropriateness prior to implementation in other regions.
Conclusion:
The adapted CRT was valuable for evaluating the project and co-designing strategies with stakeholders, and holds potential for further applications in health promotion in remote Aboriginal and Torres Strait Islander communities. SO WHAT?: This project identified benefits of CRT application not reported elsewhere. The adapted CRT adds a practical method to the toolkits of health promotors and evaluators for working in partnership with Aboriginal and Torres Strait Islander communities to address priority concerns. This article is protected by copyright. All rights reserved.
Issue addressed:
The use of old-style, top-down health education and awareness programmes in Aotearoa New Zealand, which adopt a single issue-based approach to health promotion, primarily ignores a broad approach to social determinants of health, as well as indigenous Māori understandings of well-being.
Methods:
This paper draws on the indigenous framework Te Pae Māhutonga as a guide for presenting narratives collated from members of a waka ama rōpū (group) who were interviewed about the social, cultural, and health benefits of waka ama.
Results:
This waka ama case study is an exemplar of community led health promotion within an indigenous context, where Māori values and practices, such as whanaungatanga (process of forming and maintaining relationships), manaakitanga (generosity and caring for others), and kaitiakitanga (guardianship), are foundational. The findings highlight the multiple benefits of engagement in waka ama and illustrate effective techniques for enhancing wellbeing within local communities.
Conclusions:
At a time when Aotearoa New Zealand is seeing a decreasing trend in physical activity levels and an increase in mental health challenges, waka ama provides us with an exemplar of ways to increase health and wellbeing within our communities SO WHAT?: The findings of this research contribute to the evidence base of effective indigenous health promotion, bridging the gap between academia and local community action. To better recognise, comprehend, and improve indigenous health and wellbeing, we argue that active participation of people in the community is required to achieve long-term and revolutionary change.
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