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The Emergence of Critical Health Psychology Can It Contribute to Promoting Public Health?

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Abstract

The purpose of this article is twofold: first to provide an overview of the emergence of critical health psychology for those working in the related social and health sciences and as a review of its major developments for health psychology; and second to discuss critically the potential for critical health psychology to contribute to promoting public health with specific reference to the directives espoused by Prilleltensky (2003) and Murray and Campbell (2003). The identification of three philosophical phases of the emergence of critical health psychology is used to examine the directions of the field and the challenges facing critical health psychology in order to contribute to public and global health.

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... Davies (2021) described psychology as a study that deals with the mental processes and mind especially concerning behaviour. Hepworth (2006) has stressed the importance of health psychology in determining the public health status for any given society. Psychology helps to learn about why people behave the way they do and how that behaviour can be modified to benefit their overall health and that of society. ...
... Psychology Davies (2021) described psychology as a study that deals with the mental processes and mind especially in relation to behaviour. Hepworth (2006) has stressed the importance of health psychology in determining the public health status for any given society. Psychology helps to learn about why people behave the way they do and how that behaviour can be modified to benefit their overall health and that of the The provision and management of any country's healthcare system will depend on both financial and human resources so economics will help the policymakers to make the appropriate choices that will produce the best outcome and good value for money. ...
Research
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This work is a capstone project that used narrative literature review to look at the impact of COVID19 on the nursing staff working within the United Kingdom's hospitals.
... CHP 'is concerned with the analysis of social structures and of the social, economic and political issues that produce health, illness, and health care' (Marks, 2004: 79–80). Of interest for the current study are trends which Hepworth (2006) believes are of significant import for critical and mainstream health psychologist alike. These trends include aspects of contemporary western life such as individualism which 'reinforces a focus on modifiable " lifestyle " factors rather than structural determinants of health [and] ... changing relationships between global corporations, governments and affected populations' (Hepworth, 2006: 339). ...
... Of interest for the current study are trends which Hepworth (2006) believes are of significant import for critical and mainstream health psychologist alike. These trends include aspects of contemporary western life such as individualism which 'reinforces a focus on modifiable " lifestyle " factors rather than structural determinants of health [and] ... changing relationships between global corporations, governments and affected populations' (Hepworth, 2006: 339). While the current study employed a CHP lens, this is not to exclude other perspectives within clinical, public health and community health psychology (see Marks, 2002). ...
Article
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The emphasis on body weight and the terms 'fat', 'overweight' and 'obese' are increasingly political in public health promotion. The UK government's 2009-2011 social marketing campaign, Change4Life explicitly avoids the term 'obesity' and imagery that connotes it, despite the emphasis on obesity in the preceding research, policy and strategy. Using a critical health psychology perspective, this research explores the tensions arising from the omission of 'obesity' in the Change4Life campaign. We argue the justifications for omitting obesity are at times contrary to evidence that informed the campaign. Considerations are offered for the construction of future health promotion campaigns.
... In the interest of contributing to the ongoing debate about the philosophy, scope, values and methodologies of health psychology (Crossley, 2000a; Hepworth, 2006; Marks, 2002; Murray & Campbell, 2003; Prilleltensky, 2003), this article introduces a pragmatist philosophical perspective. Pragmatism, we shall argue, avoids the problems of realism and relativism and enables both critique and action. ...
... Such questioning has been complemented by alternative positive programmes of research, including the development of qualitative research methods (Camic, Rhodes & Yardley, 2003a), and research interests in other knowledges, such as community and service user perspectives (Foster, 2007; Fryer & Fagan, 2003). However, the constructionist perspective has itself been subjected to critique (Murray & Campbell, 2003; Hepworth, 2006). Two major charges are of particular relevance here. ...
Article
The multiplicity of forms of health-related knowledge, including biomedical knowledge, lay knowledge and critical constructionist knowledge, raises challenges for health researchers. On one hand, there is a demand for a pluralist acceptance of the variety of health-related knowledge. On the other, the need to improve health calls for action, and thus for choices between opposing forms of knowledge. The present article proposes a pragmatist approach to this epistemological problem. According to pragmatism, knowledge is a tool for action and as such it should be evaluated according to whether it serves our desired interests. We identify implications for research methodology and the choice of research goals.
... I am a health psychologist-what has all this got to do with me? In a recent open-peer commentary in the Journal of Health Psychology, Hepworth (2006) discussed the emergence of critical health psychology and how it can contribute to the promotion of public health. Critical health psychology (CHP) is one of the four evolving approaches within health psychology that is concerned with 'the analysis of how power, economics and macro-social processes influence health, health care, and social issues, and the study of the implications for the theory and praxis of health work' (Marks, 2002, p. 12). ...
... Recent discussions within the critical health psychology literature called to widen the scope of health psychology to encompass micro to macro levels of intervention (Vinck, Oldenburg, & von Lengerke, 2004); to adopt a pluralistic approach that utilizes ESTACIO: HUMAN EXPLOITATION IS NOT A JOKE multiple theoretical perspectives, research strategies, skills and competencies (Marks, 2006); to avoid methodolatry (Chamberlain, 2000); to bring issues of power and social injustice to the fore (Campbell & Murray, 2004;Marks, 1996Marks, , 2002Marks, , 2008Prilleltensky & Prilleltensky, 2003); and to act and utilize our theories and methods to help improve the health of the world's marginalized and dispossessed (Murray & Campbell, 2003). With ethics at its core, CHP can bring promising contributions in understanding health inequities and social injustice and its impact on health and well-being (Hepworth, 2006). ...
Article
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In a previous article, I called for an open discussion and debate on health psychology perspectives on social and political issues relevant to health, in particular the issue concerning racism and the media (Estacio, 2009). In this article, I raise three topics for discussion which the controversial BBC 'Harry and Paul' sketch (un)intentionally exposed to the public domain: (1) racist humour, the media and health; (2) human rights abuses against domestic workers; and (3) third world poverty and labour migration. Its implications on health psychology theory, research and practice are also explored.
... Recent contributions to this journal have criticized this model for propagating an individualistic account of health and illness that deflects attention away from the socioeconomic and political context (e.g. Campbell & Murray, 2004;Hepworth, 2006). This shortcoming is particularly serious when one considers health and illness in African settings, which are consistently rated among the least healthy in the world (see United Nations Office of the High Representative for the Least Developed Countries, 2006). ...
... By directing attention to the impact of these beliefs and associated consumption patterns on health in African settings, the present analysis resonates with recent critiques of mainstream health psychology as an overly individualist enterprise that ignores the broader geopolitical context of health and illness (e.g. Campbell & Murray, 2004;Hepworth, 2006). A cultural analysis emphasizes that public health and community development require not only programs that educate people in African settings about health behaviors, but also programs that educate people in 'developed' societies about the potential effects of their behaviors (including patterns of consumption) on health and community development in African worlds. ...
Article
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African settings provide an important context in which to examine the relationship between cultural beliefs and health. First, research in African settings helps illuminate the sociocultural grounding of health and illness: the idea that beliefs play a constitutive role in the experience of distress. Second, research in African settings helps to illuminate the cultural grounding of health sciences: the idea that theory and practice reflect particular constructions of reality. We examine these ideas in the context of three research examples: the prominent experience of personal enemies; epidemic outbreaks of genital-shrinking panic; and fears about sabotage of vaccines in immunization campaigns.
... Instead, an illness is a construct, imbued with historical and social conditions, even if founded on physiological processes. Hepworth (2006) identifies three philosophical engagements central to critical health psychology; (1) a rejection of reification, (2) an engagement with the thorny issues of consensuality and subjectivism, and (3) a concern with justice and fairness. In addition there are more specific issues, such as the medicalisation of normal life events; the political use of health conditions to subjugate certain citizens; racism and sexism masquerading as health science; and the broader issue of power utilised by certain groups. ...
... A central and pressing question in critical health psychology has been how, and to what extent, social action is its goal (see Hepworth, 2006). Concerns about the relevance and purpose of psychological knowledge are hardly new among critically-minded scholars. ...
Chapter
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An important area within applied social psychology is the health and wellbeing of individuals, communities, and societies and how this is related to broader social, cultural, and global contexts. Drawing on the insights and methods of social psychology, critical health psychology works to interrogate these relationships to improve health and wellbeing outcomes. In this way, it extends beyond the more conventional approaches to physical health and wellbeing found in traditional health psychology (Horrocks and Johnson, 2012). Critical health psychologists are interested in advancing new psychological understandings of health and illness. Like applied social psychologists, they are also committed to finding ways to contribute to the transformation of an unhealthy world (Murray and Poland, 2006). These two features delineate the 'critical' in critical health psychology. Taking such an approach to health psychology, therefore, means opening one's eyes to new ways of seeing health-related issues (Lyons and Chamberlain, 2017).
... The studies blended culturally sensitive (mainly mixed qualitative) research with an explicit concern for the development of practical interventions and policy and attention to the challenges of health systems and health policy implementation in Ghana (e.g. de-Graft Aikins, 2002, 2003, 2005, 2006, de-Graft Aikins et al., 2012, 2015Osafo et al., 2011;Teye-Kwadjo et al., 2013). Seven studies were drawn from doctoral theses (de-Graft Aikins, 2005; Osafo, 2012) and a master's thesis (Teye-Kwadjo, 2011) that were conceptually informed by critical (health) psychology. ...
Article
This article presents a historical overview of psychology applied to health and health psychology in Ghana. A brief history of health, illness and healthcare in Ghana is introduced. Then, the history of psychology in Ghana is presented, with signposts of the major turns in the field in relation to psychology and other disciplines applied to health and the emergence of health psychology as a sub-field. Selected health psychology studies are reviewed to highlight ideological trends in the field. Finally, future prospects are considered in terms of how the sub-field can transition into an established critical field with unique contributions to make to global health psychology.
... We would argue that in order to develop sexual health psychology, the sexual and Towards a psychology of sexual health 750162H PQ0010.1177/1359105317750162Journal of Health PsychologyEditorial editorial2018 Editorial reproductive health of individuals cannot be properly understood in isolation from the socio-political contexts in which people are embedded. Furthermore, so as not to perpetuate dominant models, reproduce inequalities and power relations or to reify oppressive theories (Hepworth, 2006), a pluralist approach is required. A psychology of sexual health must encourage a diversity of analytic foci and an inclusive approach to both methods and theory. ...
... In responding to these areas, critical health psychologists remind us not to re-invent the wheel; instead to work collaboratively across disciplines that already incorporate similar themes and values (Hepworth, 2006). ...
Article
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This paper outlines the beginning of a movement that seeks to explore new ways of framing how we educate, practice and research in dietetics i.e. the professional discipline of nutrition. The 'critical' in Critical Dietetics refers to critical social theory, a paradigm adopted by many disciplines in order to expand traditional theoretical frameworks beyond conventional ways of thought and practice. Beginning with the historical context of dietetics, this paper explicates the relevance of critical theory to our work in dietetics. Next, we provide examples of other health-related disciplines (i.e. gerontology, psychology, nursing, psychiatry) that have adopted a critical perspective. Finally, we discuss what we see as the key areas of this theoretical framework and what implications the framework would have for dietetic education, practice and research. We expect this discussion paper to outline a movement that will spark novel ways of approaching the complex social, political, and cultural issues encountered in dietetics.
... The relevance of IP to health psychology may be understood in light of the wide margin of affinity between IP and critical health psychology (Hepworth, 2006;Bolam & Chamberlain, 2003), which is a subdiscipline in health psychology, characterized by a profound dissatisfaction with the positivist assumptions of much of mainstream psychology and its ignorance of broader social and political issues, and by an abiding interest in alternative theories and methods in the investigation of health and illness. Both disciplines are sensitive to the question of justice. ...
Chapter
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Indigenous psychology (IP) shares with critical health psychology a discontent with mainstream psychology and the endeavor to offer alternative formulations of health and illness. As an alternative to the individualistic framework of health in mainstream psychology, we propose a model of the self as a multilayered concentric system. For illustration, we present a variety of indigenous traditions, with special focus on the health-related beliefs and practices in India. Implications of this alternative model of culture and self for the assessment, diagnosis, and treatment of mental disorders are explored. Relevance of this framework to health psychology is discussed, with special focus on the DSM-V controversy, A. E. Kazdin's call for health reform, and visions of hybridization in the global community.
... Critical health psychology, an approach aiming to generate alternative theories (Marks, 2002(Marks, , 2004(Marks, , 2006 was the subject of an article by Hepworth (2006). Hepworth identified three philosophical phases in critical health psychology's role in contributing to public and global health: rejection of reification (past), consensuality and subjectivism (present), and justice and fairness (future). ...
Chapter
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“No man is an island, entire of itself; every man is a piece of the continent” (John Donne). This overview of health psychology gives an account of health in the context of society and culture. A multidimensional definition is helpful in conceptualizing the “continent” of health. Each person has a unique makeup of age, sex, and hereditary factors. Each person's health is a multidimensional state of balance with physical, mental, psychosocial, educational, economic, cultural, and spiritual aspects. The principle of compensation enables any one element that is relatively strong to compensate for a relative lack in another element. Thus a balance between the different dimensions is as important as strength in any particular set of these. The cult of individualism spawned the questionable construct of the “anything in moderation” responsible consumer. Alternative theories and approaches must be tried to enable faster results and more efficient use of assets and resources than was possible in the campaign to reduce smoking. The endemic toxicity of the physical and social environment is extended to all of the major determinants of health and well-being, including obesity, sexual health, and stress. Qualitative, community, and critical perspectives are offering alternative methods for research and intervention. Conceptual clarification to radically alter current theories and methods with large-scale evaluation studies is needed. Health psychology can contribute toward health improvements in the context of the sociopolitical struggles of yesterday, today, and tomorrow.Keywords:health psychology;multidimensional theory of health;principle of compensation;individualist paradigm;responsible consumer;community paradigm;the qualitative turn;social justice
... Moreover, critical perspectives view health and illness as inseparable from relations of class, ethnicity, gender and sexuality (Murray, 2004;Hepworth, 2006). For instance, feminism has proved a profitable lens through which critical health psychologists have sought to understand issues of health, power and inequality (Travis, Gressley and Crumpler, 1991;Wilkinson, 2004). ...
Thesis
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This copy of the thesis has been supplied on condition that anyone who consults it is understood to recognise that its copyright rests with its author and that no quotation from the thesis and no information derived from it may be published without proper acknowledgement.
... The analysis was informed by a critical health psychology perspective which understands illness behaviour within social, political and cultural contexts which not only influence health and illness, but systems of health care [21][22][23]. We drew on Wilkinson and Marmot's 'key facts' model to situate participants' experiences within structures which both place individuals at risk and shape health actions, including: stressful life circumstances, influence of early life, social exclusion, unemployment, addiction, food, opportunities for healthy lifestyle and access to services [16]. ...
Article
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Background Tuberculosis awareness, grounded in social cognition models of health care seeking behaviour, relies on the ability of individuals to recognise symptoms, assess their risk and access health care (passive case finding). There is scant published research into the health actions of ‘hard-to-reach’ groups with tuberculosis, who represent approximately 17% of the London TB caseload. This study aimed to analyse patients’ knowledge of tuberculosis, their experiences of symptoms and their health care seeking behaviours. Methods Qualitative interviews were conducted with 17 participants, predominantly homeless and attending a major tuberculosis centre in London, UK. Most had complex medical and social needs including drug and alcohol use or immigration problems affecting entitlement to social welfare. Analytical frameworks aimed to reflect the role of broader social structures in shaping individual health actions. Results Although participants demonstrated some knowledge of tuberculosis their awareness of personal risk was low. Symptoms commonly associated with tuberculosis were either not recognised or were attributed to other causes for which participants would not ordinarily seek health care. Many accessed health care by chance and, for some, for health concerns other than tuberculosis. Conclusions Health education, based on increasing awareness of symptoms, may play a limited role in tuberculosis care for populations with complex health and social needs. The findings support the intensification of outreach initiatives to identify groups at risk of tuberculosis and the development of structured care pathways which support people into prompt diagnosis and treatment.
... The February issue of The Psychologist contained a plea from the director of public health in Hertfordshire for health psychologists to take more of a prominent role in public health, suggesting that there is a need for psychological as well as biomedical interventions to combat the public health challenges facing us, and that there is 'much untapped potential ' (McManus, 2014). Previous calls from around the world for greater engagement of psychologists in public health have pointed out the potential of our discipline for empowering both practitioners and the public but only if we take seriously the structural determinants of health and leave behind some of our focus on the individual (Hepworth, 2006). Our opinion is that if we are committed to improving public health, health psychologists must move on from the development of small-scale, programmatic interventions to becoming more involved in designing, delivering, monitoring and evaluating population-level, sustainable, cost-effective interventions, of which workforce training in behaviour change skills is one obvious example. ...
Article
Changes in human behaviour are at the heart of any response to the current epidemic of chronic disease. Health psychologists are in a unique position to address these major public health challenges, but need to focus efforts on maximising the scale of our impact. Training frontline health and social care practitioners of every type to deliver evidence-based behaviour change support to patients and clients is an approach with great potential in this regard.
... critical health psychologists are arguing for a repositioning of the field within the macrosocial , economic, and political context of health and health care (Marks, 2002). Appeals for greater practice and action orientation are at the forefront of recent discussions, with increasing emphasis on " the structural determinants of health, the impact of poverty on human health, and ethics in the context of a just society " (Hepworth, 2006 p. 334). ...
Article
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Acknowledgements: We would like to acknowledge the Popular Education for People's Empowerment (PEPE), the Development Action for Grassroots Learning (DANGLE), the Barangay Bodega Council, and the National Commission on Indigenous Peoples (NCIP) for their valuable contributions in this project. We dedicate this article to the Ayta community in Floridablanca whose appeals for social justice have long been ignored. Abstract This article presents an example of a collaborative effort involving health psychologists, NGOs, and the local government that aims to understand health, material deprivation, and social inequity in an indigenous community in Floridablanca, Philippines. It adapts a participatory action research approach and uses literacy and empowerment to address emerging issues.
... As a student, I was greatly influenced by the widespread 'calls to action' within the critical health psychology literature (e.g. Hepworth, 2006;Marks, 1996;2002;Murray & Campbell, 2003;Murray & Poland, 2006). These calls encouraged the field to act and to utilise academic theories and methods to help improve the health of marginalized and dispossessed communities. ...
Article
The value of community-based research as a useful mechanism for social change is gaining recognition in the psychological literature. While this kind of work has the potential to impact upon the lives of individuals and communities we engage with, it can also leave researchers facilitating the process with a lasting impression on both their academic and personal lives. This article is a case-based reflection on the dilemmas surrounding community-based research and how it can impact upon the experiences of both the community and the researchers facilitating the project. This case study is based upon the author’s experiences of facilitating a participatory action research (PAR) project with a small indigenous community in the Philippines. Written more than five years since the project commenced, some of the challenges encountered are presented and reflected upon. This includes the dynamic nature of PAR, inter-organisational conflicts, and lack of personal distance in action research. Sensitive issues specific to this case study are also discussed, i.e. land-grabbing and violence against indigenous communities. Reflections are contextualized within discussions from various academic orientations within the psychological and social science literature, including community and critical psychology, Sikolohiyang Pilipino, and human rights.
... Propositions such as those put forward in The Lancet about physical activity provide a significant moment to examine 'a whole complex of knowledges' (Foucault, 1994, p. 220). In examining the text of various Lancet articles, we are also guided by critical health psychology (Hepworth, 2006) and an adapted policy-as-discourse perspective (Bacchi, 2000), both of which interrogate the construction processes and outcomes in the realm of public policy. While The Lancet is not official public policy, we consider its global reputation sufficient to warrant its 'official' pronouncements of pandemics as authoritative. ...
Article
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In July 2012, The Lancet announced a pandemic of physical inactivity and a global call to action to effect change. The worldwide pandemic is said to be claiming millions of lives every year. Asserting that physical inactivity is pandemic is an important moment. Given the purported scale and significance of physical inactivity around the world, this research examines how the pandemic is rhetorically constructed and how various solutions are proposed. We apply a governmentality perspective to examine the continuity, coherence and appropriateness of ideas about physical activity. The analysis demonstrates that within The Lancet, there is disunity about what is known about physical activity, problematic claims of ‘abnormality’ and contradictions in the proposed deployment of a systems approach to solve the problem. The article concludes by suggesting that as knowledge produced about physical activity grows, scholars need to beware of nostalgic conceptions of physical activity, account for the immense diversity of lived experiences which do not abide by idealistic recommendations and consider more rigorously contentious claims about physical activity programme effects.
... By understanding more about these dynamics, one can begin to either support or question the impact of such interventions in the lives of citizens. In examining the ideas emanating from DTM, this research is also guided by recent work in critical health psychology (Hepworth, 2006) and an adapted policy-as-discourse perspective (Bacchi, 2000), both of which interrogate the production processes of policy documents. While DTM is not official policy, given the range of organisations which contributed to its formulation, it is considered to be of significant importance in the discursive creation of a public health policy problem and solution. ...
Article
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Objectives: Physical inactivity is a major public health concern. At a population level, it is increasingly perceived to be a social problem which is global and multidimensional, and which requires attention by a diverse range of state, private and civil society organisations. Given the increasing attention to physical in/activity by a range of interest groups, this paper explores the political dynamics that are present within physical activity promotion discourse. Specifically, the paper examines the political dynamics associated with a recent physical activity lobby document entitled Designed To Move (DTM). DTM was written and produced by a variety of corporate, government, and health promotion organisations. Method and analysis: This paper uses a critical policy framework to analyse the justifications for, and suggested techniques of, physical activity promotion. It examines the explicit and more subtle reasons used to justify physical activity recommendations, how causes of physical inactivity are conveyed, and who is identified as able to fix the problem. Conclusions: While DTM appears to be a positive and inspirational call to action, several aspects of the document are problematic. Significantly, older adults receive scant attention in DTM, and are therefore removed from being potentially important agents in the proposed solution. DTM also frames the workplace milieu in a way that promotes ‘productivity’ and business ‘fortune’ above concern for and consideration of employees’ material conditions of existence. The paper concludes by encouraging health researchers, physical activity students and health promoters to look behind and beyond assumptions about the causes of, and solutions to, physical inactivity.
... Community health psychology interventions focus on improving health-related relationships at interpersonal, group, community and societal levels (Francescato and Bruna, 2010), and as these relationships often underlie cases of patient neglect, it appears highly relevant (Reader and Gillespie, 2013). Furthermore, the field of community health psychology can be developed through its application to new 'concrete' problems relating to public health and society (Cornish, 2009;Hepworth, 2006;Murray et al., 2004). In this article, we review the concept of patient neglect and consider it from a community health psychology perspective (through a symbolic, material and relational framework: Campbell and Cornish, 2012). ...
Article
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Despite the technological and organisational advances of 21st century health-care systems, care scandals and burgeoning complaints from patients have raised concerns about patient neglect in hospitals. This article reviews the concept of patient neglect and the role of community health psychology in understanding its occurrence. Patient neglect has previously been conceptualised as a problem associated with hospital staff attitudes and behaviours, with regulation and training cited as solutions. Yet, a community health psychology perspective shows that the wider symbolic, material and relational aspects of care are crucial for understanding why patient neglect occurs and for outlining new solutions to augment existing interventions.
... In this special issue, we focus more narrowly and specifically on the articulation of CHP as part and parcel of the western academic canon of critical social psychology, aired in earlier editorials (Marks, 1996(Marks, , 2002 and special issues of JHP (Campbell and Murray, 2004;De-Graft Aikins and Marks, 2007;Murray and Marks, 2010). This canon aligns itself with left-wing political interests in challenging the social inequalities that undermine the health of those who suffer from multiple and interlocking forms of economic, political and symbolic marginalisation (Estacio, 2009;Hepworth 2006;Hodgetts and Chamberlain 2006;Kulkarni, 2013;Ng, 2010;Ratna and Rifkin, 2007;Stephens, 2010). ...
Article
This special issue celebrates and maps out the 'coming of age' of community health psychology, demonstrating its confident and productive expansion beyond its roots in the theory and practice of small-scale collective action in local settings. Articles demonstrate the field's engagement with the growing complexity of local and global inequalities, contemporary forms of collective social protest and developments in critical social science. These open up novel problem spaces for the application and extension of its theories and methods, deepening our understandings of power, identity, community, knowledge and social change - in the context of evolving understandings of the spatial, embodied, relational, collaborative and historical dimensions of health.
... Resonating with the topic of the next section, another problem with the biomedical model is that its internal gaze and atomistic focus obscure structural, socioeconomic, and geopolitical forces associated with socio-ecological variation in health and disease (see Mirowsky & Ross, 2003; Williams & Collins, 1995). Regardless of individual scientists' intentions, an atomistic focus on physiological processes constitutes a politically consequential "intentional world" that, by ignoring structural determinants of ill health (e.g., malnutrition and poverty), contributes to the reproduction of disease and discomfort in marginalized spaces (see Hepworth, 2006). From this perspective, an adequate health science requires greater attention to the structures of mindin-context that influence not only the experience of health and illness, but also the study of health and illness (see Adams & Salter, 2007). ...
... Hepworth suggests this focus can problematize some of the dominant themes in recent health promotion discourse including 'a focus on modifiable "lifestyle" factors rather than structural determinants of health [and] . . . changing relationships between global corporations, governments and affected populations' [21]. Therefore, this study takes into account aspects of contemporary health promotion including debates around individualism, personal responsibility and structural factors. ...
Article
This article examines how important decisions about health can alter between public health policy formulation and eventual marketing implementation. Specifically, the article traces the development and production of a major United Kingdom social marketing campaign named Change4Life, and examines how ideas about the causes of and solutions to the obesity epidemic are produced in differing ways throughout the health promotion process. This study examines a variety of United Kingdom health research, policy, marketing strategy and marketing messages between 2008 and 2011. This research demonstrates that claims about causality oscillate and alter throughout the research, policy and Change4Life marketing process. These oscillations are problematic, since the Department of Health described the original consumer research as 'critical'. Given both the importance of the health issues being addressed and the amount of funding dedicated to Change4Life, that 'critical' research was directly contradicted in the campaign requires urgent review. To conclude, the article discusses the utility of social marketing when considering causal claims in health promotion.
... The conclusion that she provides is one that most, if not all, critical health psychologists would share, in that critical health psychology should look to facilitate social action on the side of those whose health and well-being are adversely affected by the inequalities of the social processes that are operating. Arguably, only by doing so, can critical health psychology as a pluralistic approach contribute meaningfully to the promotion of public health for those on the receiving end of social injustices, as proposed by Hepworth (2006). ...
Article
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Estacio argues for critical health psychology to take action to address three issues raised (unintentionally) in the 'Harry and Paul' sketch broadcast on British television. It is suggested that, although attempting humour, the sketch offensively reflected and reproduced patterns of social injustice that are far from funny. We argue here that micro-level analysis of the interactional elements of the sketch provides an understanding of how in everyday contexts Filipino workers are constructed in socially unjust terms and of how abuse can be justified. Such an understanding can allow critical health psychology to make a distinctive contribution to these topics.
... An approach aiming to generate alternative theories, 'critical health psychology', was the subject of a recent open peer commentary article by Hepworth (2006). This article provoked a mixture of positive and negative reactions from international commentators. ...
Article
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Theories generate questions, which in turn generate findings, which in turn generate articles. Theories in health psychology have successfully generated research activity but with inconclusive results. Avenues for more fruitful exploration are described. One of these suggests that health psychology will alter its focus from the study of what is (description) to the study of what might be (explanation), from what individuals do and say (behaviour) to what that behaviour means (contextuality), from ;social cognitions' (box ticks) to personal subjectivities (mental experience), from the status quo (demographics) to social injustice (structures of power and inequality).
Article
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The treatment of cardiovascular disease (CVD) is managed inadequately globally. Theoretically informed frameworks have the potential to account for the multiple elements which constitute the CVD patient pathway, and capture their inter-relationships and processes of change. However, a review and critique of such frameworks is currently lacking. This systematic review aims to identify and critically assess frameworks of access to and utilisation of care which capture the pathways of patients diagnosed with one or more CVDs. The specific objectives are to (1) review how existing frameworks have been used and adapted to capture CVD patient pathways and (2) draw on elements of Strong Structuration Theory to critically appraise them, in terms of their ability to capture the dynamics of the patient journey and the factors that influence it. Five bibliographic databases were searched in January 2019. We included qualitative and quantitative studies containing frameworks used to capture the patient pathway of individuals with CVD, encompassing symptoms, diagnosis, treatment and long-term management. Data on patient behaviour and structural factors were interpreted according to elements of Strong Structuration Theory to assess frameworks on their ability to capture a holistic patient journey. The search yielded 15 articles. The majority were quantitative and all focused on management of CVDs, primarily hypertension. Commonly used frameworks included the common-sense self-regulation model, transtheoretical model and theory of planned behaviour. A critique drawing on elements of Strong Structuration Theory revealed these frameworks narrowly focused on patient attributes (patient beliefs/attitudes) and resulting patient action, but neglected external structures that interacted with these to produce particular outcomes, which results in an individualistic and linear view of the patient pathway. We suggest that a framework informed by Strong Structuration Theory is sufficiently flexible to examine the patient pathway, while avoiding a strict linear view facilitated by other frameworks.
Chapter
Health and well-being are significant aspects of human existence. Issues related to health have been changing over time in several respects. While infectious diseases were earlier considered as the cause for ill health, in recent times, health problems are related to degenerative diseases brought about by unhealthy lifestyle practices. Lack of adequate sleep and exercise, consumption of alcohol and wrong eating habits are factors which are increasingly affecting causes of mortality. Hence, attention is now paid to the presence of positive well-being and not merely the absence of disease. The significance of educating people about health practices is being globally realized. Health-related interventions are diverse, often targeting behaviour change which has the potential to substantially transform the position of public health. A multipronged approach to intervention at individual and community levels is warranted.
Chapter
Health psychology is concerned with applying psychological knowledge to all aspects of physical health and illness. Traditionally dominated by positivist approaches, in recent years critical perspectives have been increasingly employed. These focus on understandings of health and illness as socially, culturally, politically and historically situated and contributing to enhanced health and well-being. Critical health psychology approaches are sensitive to issues of power and benefit from theoretical and methodological pluralism. Key areas in critical health psychology include exploring people’s experiences of health and illness; working with people in marginalised or vulnerable groups to provide insights; achieving change and social justice in communities through interventions and activism; engaging with arts-based approaches to researching health and illness; examining how health is understood in everyday life; and highlighting how the physical, psychosocial and economic environments in which we live dramatically influence our health.
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Feminist psychology and health psychology both coalesced into organized fields of scientific study and clinical practice in the 1970s. However, there has been relatively little integration of the two fields. In this chapter, the authors consider why it can be difficult to conduct feminist research in health psychology and teach health psychology from a feminist perspective. Reasons include changing perspectives on “feminists” and “feminism” and differences in philosophical approaches (e.g., medicalization, research methods) that can be difficult to reconcile. The authors also discuss strategies they have employed in their careers as feminist psychologists with strong interests in health psychology.
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Health education is largely informed by psychological theories and practices that pursue reductionist views of people learning. However, critical attention is moving to understand health in ways that reconsider relationships to context and the forms of life within which everyday living takes place. This shift is apparent in theoretical developments from health literacy to critical health literacies. The discussion herein presents an introduction to critical health literacies focusing on potential contributions critically oriented psychologies offer this work. Research is introduced from critical health psychology, critical educational psychology and critical community psychology to engage psychological phenomena as jointly constituted via embodied, discursive and relational means. Subsequently, it is argued, by re-evaluating understanding in this way, a prospective kind of psychosocial theory is elucidated capable of promoting and sustaining health inclusive education.
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There is scant qualitative research into the experiences of tuberculosis (TB) treatment in urban risk groups with complex health and social needs in the UK. This study aimed to describe the social context of adherence to treatment in marginalized groups attending a major TB centre in London. A qualitative cross-sectional study was performed using semi-structured interviews with patients receiving treatment for TB. Analytical frameworks aimed to reflect the role of broader social structures in shaping individual health actions. There were 17 participants; the majority were homeless and had complex medical and social needs, including drug and alcohol use or immigration problems affecting entitlement to social welfare. Participants rarely actively chose not to take their medication, but described a number of social and institutional barriers to adherence and their need for practical support. Many struggled with the physical aspects of taking medication and the side effects. Participants receiving directly observed therapy (DOT) reported both positive and negative experiences, reflecting the type of DOT provider and culture of the organization. There is a need for integrated care across drug, alcohol, HIV, and homeless services in order to address the complex clinical co-morbidities and social needs that impact on the patient's ability to sustain a course of treatment. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.
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While interdisciplinary knowledge is critical to moving beyond categorical ways of knowing, this comes with its own set of pedagogical challenges. We contend that acknowledging existing knowledge hierarchies and epistemological differences, recognizing the ideological baggage that students' bring to the classroom in terms of their understandings of health, embracing intellectual uncertainty, and encouraging learning-as-witnessing, are fundamental to fostering an interdisciplinary pedagogy that opens up a space for dialogue between psychology and sociology. We draw on the case of obesity and physical inactivity in the Canadian context as an exemplar of a kinesiology dilemma in which both psychology and sociology have important, albeit different, roles to play. We suggest that the anxiety provoked by such an approach is not only necessary but productive to forge an intellectual space where psychologists and sociologists may better hear one another.
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It can be argued that young people are one of the least empowered and listened to groups in our community. Their voices are rarely heard in a meaningful way that is not tokenistic, and they have very little control or opportunities to make decisions, even over matters that directly affect them. In the institution of education where they spend large portions of their lives, young people are by far the majority group and yet are controlled and dominated most of the time. Our control as adults over young people needs exploration and action, but it also has implications for carrying out research. As community psychologists who wish to improve the well being of communities, we need to change the way we think and act towards young people in order to contest rather than collude with negative dominant beliefs.
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There is no question that health psychology needs to be more involved with matters concerning health inequalities and the social injustices associated with media racism, and racism in general. It is recognized that our discipline has the potential to develop and carry out research that can make valuable contributions to address such issues. Reflecting and discussing these matters were useful in this respect, however, the recommendations raised here need to be put into practice for real progress to be made. Engaging with society itself is also crucial.
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Depending on which kind of philosophy of science we espouse, health psychology can be a relatively concrete or relatively abstract activity. Estacio, I suggest, prioritizes the concrete, by foregrounding real social phenomena. I argue that prioritizing the concrete has two particular benefits: it increases the social relevance of health psychology, and it increases the validity of our analyses, by ensuring that they are close to reality. To further the pursuit of the concrete, I suggest that critical health psychology is in particular need of exemplars of critical health psychology in action, rather than reflexive commentary on critical health psychology itself.
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The BBC comedy show ;Harry and Paul' sparked media controversy in the UK and around the world for inciting stereotyped racial discrimination, vulgarity and violation of human rights when it portrayed a Filipino domestic worker as a sex toy in Episode 4 of the series. This incident raises the issue concerning the media's role in framing social issues and how it affects the wider determinants of health. There is a need for health psychology as an academic discipline to engage more in these issues. The Journal of Health Psychology provides a unique platform for discussion and debate of perspectives on racism, the media and health.
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Behaviour oriented health promotion has often relied on over-simplistic and over-deterministic models in which action emanates from individuals, not the social or economic structures they inhabit. Mainstream health psychology models are allied with official health ideology and policy, stressing self-control, self-regulation and responsible (low-cost) health citizenship. Discussion of psycho-political validity and of the use of a wider community of meanings and theories is welcome and moves beyond narrow disciplinary concerns by developing epistemological self-critique. Reflection and critique of psychology and its uses in public health is needed for theoretical and morally reasons and points to inseparability of psychology and politics.
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Homelessness can be seen as a challenge for health psychology in research and practice on several levels: analysing the risks of becoming homeless; the living conditions of being homeless and their impact on health risks and problems; homeless youth as a specific phenomenon; health problems in the context of homelessness; service utilization and barriers and effects of interventions in the context of homelessness. With these levels, a framework is outlined for the contributions to this Special Issue. In the end, homelessness is discussed as an issue for prevention in three respects for a comprehensive approach in health psychology.
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Community health psychology is concerned with the theory and method of working with communities to combat disease and to promote health. This introductory article outlines key assumptions and debates underlying this area of research and practice—in the interests of framing the papers in this special edition of the Journal of Health Psychology. Attention is given to the value of emphasizing the community level of analysis and action; the role of collective action in improving health; psycho-social mediatiors between community participation and health; and the potential role of partnerships in creating 'healthy communities'. A distinction is made between 'accommodationist' and 'critical' perspectives, and the authors consider whether or not significant social change can come from community-level action.
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This book constitutes a valuable resource for postgraduate students and researchers. Most.... of the chapters succeed in providing a clear and comprehensive introduction to the various approaches and/or methods, thus enabling the reader to make an informed decision about whether or not they wish to pursue the topic further. The book as a whole is also very well referenced and this makes it a source of essential information for students and researchers with an interest in qualitative health psychology'-Health Psychology Update This book explains the role of qualitative research within health psychology. Theories and methods from a qualitative perspective are highly varied but, in general, differ from the positivist approach which is concerned with quantifying the individual risk factors presumed to cause health and illness behaviour. This book shows clearly how a qualitative approach offers a better understanding of the experience of illness while locating it in its broader social context. Providing a detailed examination of these issues, the book is organized into three sections-the first considers some of the main theoretical perspectives underlying qualitative research in health psychology including discourse analysis and narrative as well as the social context and embodiment of health and illness; the second examines some of the practical issues involved in conducting qualitative research with different populations, such as children and the terminally ill; and the final section considers a range of analytic issues and specific analytic approaches such as grounded theory and action research, and the evaluation of qualitative methods.
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In Health Psychology in Context it was argued that, if we are to make any sense of it, the subject matter of health psychology must be understood in the context of social, political and economic forces. That theme is continued here with a brief examination of how freedom, responsibility and power enter into the generation of conflicts, including the recent outbreak of war. The interplay of commercial and state interests in academic and health research settings is then discussed. The assumptions, values and meanings of work in health psychology are examined in that light. These are divided between four evolving approaches in health psychology: clinical, public, community and critical health psychology. A framework is presented for positioning these approaches within a system for the production of health and social care.
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This article explores the possible contributions of a psychology of liberation for the practice of health psychology. It explores alternative psychological 'practices', for example participatory action research, with groups historically marginalized from access to power and resources. Selected lenses for crafting a liberatory psychology include: discourse of human rights and mental health; cultural and constructivist psychological theory; and reflexivity. Specific examples from the author's work with Mayan women in rural Guatemala in the context of ongoing war and subsequent efforts at peace building are discussed to clarify possible contributions of psychologists committed to accompanying local communities in creating more just futures. Selected challenges and contradictions encountered in this work are discussed.
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Health and illness in contemporary psychology are remarkably undertheorized, with the consequence that implicit definitions of these topics are unquestionably imported into health psychology. Largely inspired and oriented to the medical system, health psychology is often subservient to biomedically inspired theory or directed to solving the problems of the health care system, not those of its patients or those who might ultimately benefit from health knowledge. Qualitative approaches have attempted to reintroduce the voice of the patient/sufferer/individual back into health psychology but without adequate theoretical integration this work has been marginalized and ignored by mainstream health psychology in the service of medical modelling. The point is not to develop a health psychology as an exclusive disciplinary enclave but rather to open up the possibilities of a responsible knowing. Using Kathryn Addelson's work on professional knowing I argue that the collective activity that constitutes health psychology can be made more explicit not only by devising reflexive theories and practices but by focusing on what the outcomes of that activity might be. Functional theories of health and illness, on the other hand, obscure our epistemological and moral commitments.
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This Final Report of the European Federation of Professional Psychologists' Associations (EFPPA) Task Force on Health Psychology defines the nature and scope of health psychology and its possible future development to the year 2000 and beyond. Training needs and objectives are specified for professional health psychologists working in Europe. Practical and policy implications of medical progress and societal changes are discussed. The future development of health psychology as a profession depends on putting theory and policy into practice through the implementation of high quality training. Currently there are relatively few European countries where this has yet happened. Training programmes need to be introduced in all European countries within the framework of each member- country's national laws, regulations and practices.
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Over 25 years there has been a remarkable growth of theoretical and empirical studies in health psychology. Its theoretical underpinnings have been largely derivative, its focus primarily clinical, and its subject, the individual. Relatively little attention has been paid to the cultural, sociopolitical and economic conditions which set the context for individual health experience and behaviour. Theories which do not reflect the complex interaction of these variables are unlikely to provide a satisfactory account of individual health. Multidisciplinary efforts are needed at a community level to provide effective interventions which are relevant to the exposure groups being targeted. Health psychology needs measures which are valid and relevant to the general population regardless of culture, gender, social class or age. Putting health psychology into its cultural, sociopolitical and community context is a major priority for future development.
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The field of critical psychology is exerting an influence in the way various sub-disciplines within psychology operate. In this article we use a critical psychology framework to review the field of health psychology. Through the use of values, assumptions and practices we review progress in health psychology and offer recommendations for aligning contemporary practices with current thinking in critical psychology. We discuss typical expectations, critical formulations and critical practice for interventions with individuals, groups and communities along these dimensions.
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The topic of the body is now firmly on the agenda for psychology, as it has been for sociology for some time. What contribution will health psychology make to this debate? This article argues that the biomedical view of the physical body is inappropriate for a psychology addressing the key concerns of suffering and healing. Instead, health psychology needs to theorize what it means to be embodied in the context of illness and of health care. To do this requires investigation of the practical relationships between staff and patients as well as of experiences of sufferers. By reflecting critically upon the relationship between clinical practice and the conceptualization of the body, a health psychology embracing the idea of embodiment becomes possible.
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Health psychology generally prioritizes scientific method as its means of enquiry, and positivism as its theoretical foundation. In the broader domain of social psychology, however, we are now seeing the emergence of a new paradigm, 'critical social psychology', which draws extensively upon postmodern theorizing, and, in particular, discursive methods of analysis and inquiry. In this article, I describe what is meant by critical social psychology, how it differs from the mainstream, and examine some of its implications for health psychology. My aim is to open up debate between mainstream and critical approaches. In adopting an explicit challenge to the way health psychology is currently conceived, it invites dialogue over the methods, theorization and practical applications of our discipline.
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Book reviews: Marks, D.F. (ed) The Health Psychology Reader
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SUMMARY Health outcomes research has developed as a means of evaluating the effectiveness of health care interventions and as an approach to informing resource allocation. The use of a health outcomes approach in health promotion has made increasing demands on evaluation methodolo- gies to demonstrate program effectiveness. However, criticism of the contribution of health promotion to outcomes research has made several assumptions about the use of qualitative methodologies and the content of program objectives largely derived from a biomedical approach. In contrast to the measurement of biomedical interventions in clinical health care, health promotion practice involves social phenomena, wide-reaching cul- tural, psychological, political and ideological problems and issues. The integration of methodologies of health promotion evaluation will inform further conceptualisa- tion of the health outcomes approach with the differen- tiation of three types of outcomes: health development outcomes; social health outcomes; and biomedical health outcomes. It is concluded that this differentiation moves away from dualist concepts that advocate the replace- ment of goals and targets with regional and locally based approaches. Rather, the future direction for health pro- motion evaluation needs to employ a framework that elaborates multiple methodologies and approaches neces- sary for establishing what relationships exist between morbidity, mortality, health advancement and equity.
Article
Developments over the past decade in psychology, in medicine, in funding institutions such as the National Institutes of Health, and in industry make clear that the rapidly growing areas of behavioral medicine and behavioral health are presenting psychology and its sister professions with new opportunities for training, research, and practice. Specific developments within psychology leading to the establishment of the American Psychological Association's Division 38 (Health Psychology) are traced. Also traced are activities on the national level that have led to the development of organizations with a more interdisciplinary focus. Despite a modicum of overselling in some quarters, behavioral health and health psychology appear to be ideas whose time has come. (40 ref)
Article
This qualitative study of women with non-insulin dependent diabetes mellitus (NIDDM) examined constructions of their diabetes management and socio-familial relationships as potential sources of support. Semi-structured interview data was collected from 16 women. The transcripts were analysed with the aim of examining the ways in which gender relations structured women's accounts of health-related behaviours. Women talked about themselves as wives, mothers, being pregnant and parenting, and friends of other women in ways that demonstrated how caring for others impeded their capacity to care for themselves. Meeting the food preferences of husbands and dietary requirements of diabetic husbands were dominant themes in women's accounts of marriage, and in various ways women justified their husbands' lack of support. Furthermore, the care of others during pregnancy and parenting was also an obstacle to women caring for themselves. An awareness of the gender politics inherent within social and family contexts is crucial to improving the effectiveness of medical advice for diabetes management.
Article
Increasingly, the development of public health infrastructures requires psychology to reevaluate its contribution to public health at local, national and global levels. Already familiar to some psychologists, particularly those in community psychology and health promotion, the expansion of public health has implications for psychology in terms of knowledge/practice and working differently in multidisciplinary settings. In this article, I provide a critical overview of the implications of the historical and international development of health psychology and the changing nature of public health to strengthen the establishment of public health psychology. A conceptual and practical framework is proposed in which public health psychology theory, methods and practice are considered as well as its relevance to the health social sciences more generally.
Critical health psychology needs psychopolitical validity
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Prilleltensky, I. (2003). Critical health psychology needs psychopolitical validity. Health Psychology Update, 12(3), 2–11.
Health psychology 2000: The development of professional health psychology
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