How was patient empowerment portrayed in information leaflets describing the community pharmacy Medicines Use Review service in the UK?

Objective The Medicines Use Review (MUR) community pharmacy service was introduced in 2005 to enhance patient empowerment but the service has not been taken up as widely as expected. We investigated the depiction of the patient–pharmacist power relationship within MUR patient information leaflets. Methods We identified 11 MUR leaflets including the official Department of Health MUR booklet and through discourse analysis examined the way language and imagery had been used to symbolise and give meaning to the MUR service, especially the portrayal of the patient–pharmacist interactions and the implied power relations. Results A variety of terminology was used to describe the MUR, a service that aimed ultimately to produce more informed patients through the information imparted by knowledgeable, skilled pharmacists. Conclusion The educational role of the MUR overshadowed the intended patient empowerment that would take place with a true concordance-centred approach. Although patient empowerment was implied, this was within the boundaries of the biomedical model with the pharmacist as the expert provider of medicines information. Practice implications If patient empowerment is to be conveyed this needs to be communicated to patients through consistent use of language and imagery that portrays the inclusivity intended.

‘We are managing our own lives...’: life transitions and care in sibling-headed households affected by AIDS in Tanzania and Uganda

This paper explores the ways that young people express their agency and negotiate complex lifecourse transitions according to gender, age and inter- and intra-generational norms in sibling-headed households affected by AIDS in East Africa. Based on findings from a qualitative and participatory pilot study in Tanzania and Uganda, I examine young people's socio-spatial and temporal experiences of heading the household and caring for their siblings following their parent's/relative's death. Key dimensions of young people's caring pathways and life transitions are discussed: transitions into sibling care; the ways young people manage changing roles within the family; and the ways that young people are positioned and seek to position themselves within the community. The research reveals the relational and embodied nature of young people's life transitions over time and space. By living together independently, young people constantly reproduce and reconfigure gendered, inter- and intra-generational norms of ‘the family’, transgressing the boundaries of ‘childhood’, ‘youth’ and ‘adulthood’. Although young people take on ‘adult’ responsibilities and demonstrate their competencies in ‘managing their own lives’, this does not necessarily translate into more equal power relations with adults in the community. The research reveals the marginal ‘in-between’ place that young people occupy between local and global discourses of ‘childhood’ and ‘youth’ that construct them as ‘deviant’. Although young people adopt a range of strategies to resist marginalisation and harassment, I argue that constraints of poverty, unequal gender and generational power relations and the emotional impacts of sibling care, stigmatisation and exclusion can undermine their ability to exert agency and control over their sexual relationships, schooling, livelihood strategies and future lifecourse transitions.

Theorizing Literacy, Politics and Social Process: revisiting Maktab literacy in Rian in search of a paradigm

Literacy as a social practice is integrally linked with social, economic and political institutions and processes. As such, it has a material base which is fundamentally constituted in power relations. Literacy is therefore interwoven with the text and context of everyday living in which multi-levelled meanings are organically produced at both individual and societal level. This paper argues that if language thus mediates social reality, then it follows that literacy defined as a social practice cannot really be addressed as a reified, neutral activity but that it should take account of the social, cultural and political processes in which literacy practices are embedded. Drawing on the work of key writers within the field, the paper foregrounds the primary role of the state in defining the forms and levels of literacy required and made available at particular moments within society. In a case-study of the social construction of literacy meanings in pre-revolutionary Iran, it explores the view that the discourse about societal literacy levels has historically constituted a key terrain in which the struggle for control over meaning has taken place. This struggle, it is argued, sets the interests of the state to maintain ideological and political control over the production of knowledge within the culture and society over and against the needs identified by the individual for personal development, empowerment and liberation. In an overall sense, the paper examines existing theoretical perspectives on societal literacy programmes in terms of the scope that they provide for analyses that encompass the multi-levelled power relations that shape and influence dominant discourses on the relative value of literacy for both the individual and society

Performance as social practice

Starting point for these outputs is a large scale research project in collaboration with the Zurich University for the Arts and the Kunstmuseum Thun, looking at a redefinition of Social Sculpture (Joseph Beuys/ Bazon Brock, 1970) as a functional device re-deployed to expand the art discourse into a societal discourse. Although Beuys‘ version of a social sculpture involved notions of abstruse mysticism and reformulations of a national identity these were never-the less part of a social transformation that shifted and re-arranged power relations. Following Laclau and Mouffe in their contention that democray is a fundamentally antagonistic process and contesting Grant Kester’s understanding of a ethically based relational practice, this work is alignes itself with Hirschhorn’s claim to an aesthetic practice within communities, following the possibility to view a socially based practice from both ends of the ethics debate, whereby ethical aspects fuels the aethetic to “create situations that are beautiful because they are ethical and shocking because they are ethical, thus in turn aesthetic because they are ethical” (O’Donnell). This project sets out to engage in activities which interact with surrounding communities and evoce new imaginations of site, thereby understanding site as a catalysts for subjective emergences. Performance is tested as a site for social practice. Archival research into local audio/visual resources, such as the Swiss Radio Archive, the Swiss Military Film Archives and zoological film archives of the Basel Zoo, was instrumental to the navigation of this work, under theme of crisis, catastrophy, landscape, fallout, in order to create a visual language for an active performance site. Commissioned by the Kunstmuseum Thun in collaboration with the University for the Arts in Zurich as part of a year long exhibition programme, (other artists are Jeanne Van Heeswijk (NL) and San Keller (CH), ) this project brings together a series of different works in a new performace installation. The performance process includes a performance workshop with 30 school children from local Swiss schools and their teachers, which was conducted publicly in the museum spaces. It enabled the children to engage with an unexpected set of tribal and animalistic behaviours, looking at situations of flight and rescue, resulting in a large performance choreography orchestration without an apparent conductor, it includes a collaboration with renowned Swiss zoologist, Prof Klaus Zuberbühler(University of St Andrews) and the Colonal General Haldimann commander of the military base in Thun. The installation included 2 static video images, shot in an around spectacular local cave site (Beatus Caves) including 3 children. The project will culminate in an edited edition of the Oncurating Journal, (issue no, tbc, in 2012) including interviews and essays from project collaborators. (Army Commander General, Thun, Jörg Hess, performance script, Timothy Long, and others)

Reframing 'crisis' in fair trade coffee production: trajectories of agrarian change in Nicaragua

A focus on crisis provides a methodological window to understand how agrarian change shapes producer engagement in fair trade. This orientation challenges a seperation between the market and development, situating fair trade within global processes that incorporate agrarian histories of social change and conflict. Reframing crisis as a condition of agrarian life, rather than emphasizing its cyclical manifestation within the global economy, reveals how market-driven development encompasses the material conditions of peoples' existence in ambiguous and contradictory ways. Drawing on the case of coffee production in Nicaragua, experiences of crisis demonstrate that greater attention needs to be paid to the socioeconomic and political dimensions of development within regional commodity assemblages to address entrenched power relations and unequal access to land and resources. This questions moral certainties when examining the paradox of working in and against the market, and suggests that a better understanding of specific trajectories of development could improve fair trade's objective of enhancing producer livelihoods.

Tactical ethics: how the discourses of fairtrade and black economic empowerment change and interact in wine networks from South Africa to the UK.

This paper explores the spaces and power relations of ethical foodscapes. Ethics can offer a commodity a valuable unique selling point in a competitive marketplace but managing the changeable and multiple motivations for stakeholder participation throughout the commodity chain in order to utilise this opportunity is a complex negotiation. Through exploring the spaces and relations within three South African– UK ethical wine networks, the discursive tactics used to sustain these are uncovered. The discourses of Fairtrade, Black Economic Empowerment and organics are highly adaptive, interacting with each other in such a way as to always be contextually appealing. This ‘tactical mutability’ is combined with ‘scales of knowing’, which, this paper argues, are essential for network durability. ‘Scales of knowing’ refers to the recognition by stakeholders of the potential for different articulations of a discourse within the network, which combines with ‘tactical mutability’ to allow for a scalar, contextual and ’knowing’ (im)mutability to ensure the discourse’s continued appeal. However, even when one discourse is the ‘lead’ it always folds within it linkages to other ethical discourses at work, suggesting that ethical practice is mutually supportive discursively. This means that at the producer end ethical interactions may offer more capacity to enact genuine transformation than the solo operations of a discourse.

Occupying the margins: Labour integration and social exclusion in artisanal mining in Tanzania

This article examines the marginal position of artisanal miners in sub-Saharan Africa, and considers how they are incorporated into mineral sector change in the context of institutional and legal integration. Taking the case of diamond and gold mining in Tanzania, the concept of social exclusion is used to explore the consequences of marginalization on people's access to mineral resources and ability to make a living from artisanal mining. Because existing inequalities and forms of discrimination are ignored by the Tanzanian state, the institutionalization of mineral titles conceals social and power relations that perpetuate highly unequal access to resources. The article highlights the complexity of these processes, and shows that while legal integration can benefit certain wealthier categories of people, who fit into the model of an 'entrepreneurial small-scale miner', for others adverse incorporation contributes to socio-economic dependence, exploitation and insecurity. For the issue of marginality to be addressed within integration processes, the existence of local forms of organization, institutions and relationships, which underpin inequalities and discrimination, need to be recognized.

Cashew cultivation, access to land and food security in Brong-Ahafo Region, Ghana: Preventing the intergenerational transmission of poverty

This research aimed to investigate the implications of changing agricultural land use from food production towards increased cashew cultivation for food security and poverty alleviation in Jaman North District, Brong-Ahafo Region of Ghana. Based on qualitative, participatory research with a total of 60 participants, the research found that increased cashew production had led to improvements in living standards for many farmers and their children over recent years. Global demand for cashew is projected to continue to grow rapidly in the immediate future and cashew-growing areas of Ghana are well placed to respond to this demand. Cashew farmers however were subject to price fluctuations in the value of Raw Cashew Nuts (RCN) due to unequal power relations with intermediaries and export buyer companies and global markets, in addition to other vulnerabilities that constrained the quality and quantity of cashew and food crops they could produce. The expansion of cashew plantations was leading to pressure on the remaining family lands available for food crop production, which community members feared could potentially compromise the food security of rural communities and the land inheritance of future generations.

Are we there yet? Exploring empowerment at the microscale in the South African wine industry

Empowerment is a standard but ambiguous element of development rhetoric and so, through the socially complex and contested terrain of South Africa, this paper explores its potential to contribute to inclusive development. Investigating micro-level engagements with the national strategy of Broad-Based Black Economic Empowerment (B-BBEE) in the South African wine industry highlights the limitations, but also potential, of this single domain approach. However, latent paternalism, entrenched interests and a ‘dislocated blackness’ maintain a complex racial politics that shapes both power relations and the opportunities for transformation within the industry. Nonetheless, while B-BBEE may not, in reality, be broad-based its manifestations are contributing to challenging racist structures and normalising changing attitudes. This paper concludes that, to be transformative, empowerment needs to be re-embedded within South Africa as a multi-scalar, multi-dimensional dialogue and, despite the continuation of structural constraints, positions the local as a critical scale at which to initiate broader social change.

Struggles over family land? Tree crops, land and labour in Ghana's Brong-Ahafo region

Agricultural land use in much of Brong-Ahafo region, Ghana has been shifting from the production of food crops towards increased cashew nut cultivation in recent years. This article explores everyday, less visible, gendered and generational struggles over family farms in West Africa, based on qualitative, participatory research in a rural community that is becoming increasingly integrated into the global capitalist system. As a tree crop, cashew was regarded as an individual man's property to be passed on to his wife and children rather than to extended family members, which differed from the communal land tenure arrangements governing food crop cultivation. The tendency for land, cash crops and income to be controlled by men, despite women's and young people's significant labour contributions to family farms, and for women to rely on food crop production for their main source of income and for household food security, means that women and girls are more likely to lose out when cashew plantations are expanded to the detriment of land for food crops. Intergenerational tensions emerged when young people felt that their parents and elders were neglecting their views and concerns. The research provides important insights into gendered and generational power relations regarding land access, property rights and intra-household decision-making processes. Greater dialogue between genders and generations may help to tackle unequal power relations and lead to shared decision-making processes that build the resilience of rural communities.

Gendered struggles over land: shifting inheritance practices among the Serer in rural Senegal

Although women's land rights are often affirmed unequivocally in constitutions and international human rights conventions in many African countries, customary practices usually prevail on the ground and often deny women's land inheritance. Yet land inheritance often goes unnoticed in wider policy and development initiatives to promote women's equal access to land. This paper draws on feminist ethnographic research among the Serer ethnic group in two contrasting rural communities in Senegal. Through analysis of land governance, power relations and 'technologies of the self', this article shows how land inheritance rights are contingent on the specific effects of intersectionality in particular places. The contradictions of legal pluralism, greater adherence to Islam and decentralisation led to greater application of patrilineal inheritance practices. Gender, religion and ethnicity intersected with individuals' marital position, status, generation and socio-ecological change to constrain land inheritance rights for women, particularly daughters, and widows who had been in polygamous unions and who remarried. Although some women were aware that they were legally entitled to inherit a share of the land, they tended not to 'demand their rights'. In participatory workshops, micro-scale shifts in women's and men's positionings reveal a recognition of the gender discriminatory nature of customary and Islamic law and a desire to 'change with the times'. While the effects of 'reverse' discourses are ambiguous and potentially reinforce prevailing patriarchal power regimes, 'counter' discourses, which emerged in participatory spaces, may challenge customary practices and move closer to a rights-based approach to gender equality and women's land inheritance.

The calculative turn in land value capture: lessons from the English planning system

For over three decades, negotiated planning obligations have been the primary form of land value capture in England. Diffusing and evolving over the last decade, a significant policy innovation has been the use of financial calculations to estimate the extent to which policies on planning obligations for actual, proposed development projects and in plan making affect the financial viability of development. This paper assesses the extent to which the use of financial appraisals has provided a robust, just and practical procedure to support land value capture. It is concluded that development viability appraisals are saturated with intrinsic uncertainty and that land value capture that is based on such calculations is, to some extent, capricious. In addition, clear incentives for developers and land owners to bias viability calculations, the economic dependence of many viability consultants on developers and land owners, a lack of transparency, contested or ambiguous guidance and the opportunities created by input uncertainty for bias are further failings. It is argued that how viability calculations are applied has been, is being and will continue to be shaped by power relations.

Environmentalities of urban climate governance in Maputo, Mozambique

Interest in the role that cities can play in climate change as sites of transformation has increased but research has been limited in its practical applications and there has been limited consideration of how policies and technologies play out. These challenges necessitate a re-thinking of existing notions of urban governance in order to account for the practices that emerge from governments and a plethora of other actors in the context of uncertainty. We understand these practices to constitute adaptive governance, underpinned by social learning guiding the actions of the multiplicity of actors. The aim here is to unpack how social learning for adaptive governance requires attention to competing understandings of risk and identity, and the multiplicity of mechanisms in which change occurs or is blocked in urban climate governance. We adopt a novel lens of 'environmentalities' which allows us to assess the historical and institutional context and power relations in the informal settlements of Maputo, Mozambique. Our findings highlight how environmental identities around urban adaptation to climate change are constituted in the social and physical divisions between the formal and informal settlements, whilst existing knowledge models prioritise dominant economic and political interests and lead to the construction of new environmental subjects. While the findings of this study are contextually distinct, the generalizable lessons are that governance of urban adaptation occurs and is solidified within a complex multiplicity of socioecological relations.

Strong armies, slow adaptation: civil-military relations and diffusion of military power

Why are some states more willing to adopt military innovations than others? Why, for example, were the great powers of Europe able to successfully reform their military practices to better adapt to and participate in the so-called military revolution of the sixteenth and seventeenth centuries while their most important extra-European competitor, the Ottoman Empire, failed to do so? This puzzle is best explained by two factors: civil-military relations and historical timing. In the Ottoman Empire, the emergence of an institutionally strong and internally cohesive army during the early stages of state formation—in the late fourteenth century—equipped the military with substantial bargaining powers. In contrast, the great powers of Europe drew heavily on private providers of military power during the military revolution and developed similar armies only by the second half of the seventeenth century, limiting the bargaining leverage of European militaries over their rulers. In essence, the Ottoman standing army was able to block reform efforts that it believed challenged its parochial interests. Absent a similar institutional challenge, European rulers initiated military reforms and motivated officers and military entrepreneurs to participate in the ongoing military revolution.