Communication ethics in public health

As new diseases and medical conditions emerge, new community groups appear in the public health arena as consumer advocates or lobby groups seeking to affect policy or to represent ‘communities’ formed around these new diseases and conditions. The role of these groups in public health, their political status, and the extent to which they are actually representative are highly problematic for public health. These new constellations of social groups and activities challenge traditional ideas about public health decision-making and demand a rethinking of the constituency and limits of public health. Using discourse theory, symbolic interactionism, and ethological theory, the authors examine one case, exploring the perspectives of various communities on hepatitis C, and explore some issues that this raises for public health.

“Lay” theories of anorexia nervosa : a discourse analytic study

Previous studies on lay theories of anorexia nervosa have examined the ‘accuracy’ of lay knowledge, and the identification of factors by family and friends that would encourage early interventions (Huon, Brown, & Morris, 1988, 7, 239–252; Murray, Touyz, & Beumont, 1990, 9, 87–93). In contrast to these approaches, we examine lay theories of anorexia nervosa using a critical psychology perspective. We argue that the use of a discourse analysis methodology enables the examination of the construction of lay theories through dominant concepts and ideas. Ten semi-structured interviews with five women and five men aged between 15 and 25 years were carried out. Participants were asked questions about three main aspects of anorexia nervosa: aetiology, treatment and relationship to gender. Each interview was analysed in terms of the structure, function and variability of discourse. Three discourses: sociocultural, individual and femininity, are discussed in relation to the interview questions. We conclude that, in this study, lay theories of anorexia nervosa were structured through key discourses that maintained a separation between sociocultural aspects of anorexia nervosa and individual psychology. This separation exists in dominant psychomedical conceptualizations of anorexia nervosa, reinforcing the concept that it is a form of psychopathology.

Book review: Leaky Bodies and Boundaries. Feminism, Post-modernism and (Bio)ethics. Shildrick, M. (1997)

This thoughtful book is a much needed contribution to feminist ethics that is brimming with detailed and insightful analyses of the positioning of women in contemporary health care and particularly in relation to new reproductive technologies (NRTs). The clearly written and structured chapters provide accessible points to modern ethics, post-modernism, and feminist ethics. Margrit Shildrick takes on these areas with authority and vigour, building an argument for women to enter the relations of reproduction on terms more expressive of feminine desire...

Accounts of experiences of bulimia : a discourse analytic study.

Objectives: To identify the variety of versions of bulimia constructed by participants, to suggest functions and consequences of these constructions, and to examine the sociocultural ideologies evident in participants' discourse. Methods: Ten women and one man were interviewed about their experiences of bulimia. Transcribed interviews were analyzed using a discourse analytic approach. Results: Five dominant ways of talking about bulimia were identified: Individuals were constructed as victims of bulimia, women were constructed as victims of social stereotypes, bulimia was constructed as a damaging action one performs on oneself, bulimia was constructed as a personality trait of individuals, and bulimia was marginalized as abnormal and disgusting. Discussion: Sociocultural ideologies evident in participants' accounts included the valuing of individual will-power and self-mastery and the construction of a mind-body dichotomy entailing the need to control the latter. The analysis emphasizes the importance of considering the sociocultural context within which psychological problems occur.

Evaluation in health outcomes research : linking theories, methodologies and practice in health promotion.

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 methodologies 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 cultural, psychological, political and ideological problems and issues. The integration of methodologies of health promotion evaluation will inform further conceptualisation of the health outcomes approach with the differentiation 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 replacement of goals and targets with regional and locally based approaches. Rather, the future direction for health promotion evaluation needs to employ a framework that elaborates multiple methodologies and approaches necessary for establishing what relationships exist between morbidity, mortality, health advancement and equity.

Poststructuralism, qualitative methodology, and public health : research methods as a legitimization strategy for knowledge

The appearance of poststructuralism as a research methodology in public health literature raises questions about the history and purpose of this research. We examine (a) some aspects of the history of qualitative methods and their place within larger social and research domains, and (b) the purposes of a public health research that employs poststructuralist philosophy delineating the methodological issues that require consideration in positing a poststructural analysis. We argue against poststructuralism becoming a research methodology deployed to seize the pubic health debate, rather than being employed for its own particular critical strengths.

Hepatitis C and policy implementation : ethics as a dialogic process for resource allocation

Hepatitis C, which was first identified in 1988, has become an important issue for public health as epidemiological and clinical evidence has emerged. These disciplines have highlighted the extent of infection and its medical consequences. Now, governments at both the state and federal levels are sifting through this evidence and are attempting to create structures to deal with the problem of hepatitis C. These structures have generally taken the form of expert committees and working parties organised from established medical, scientific and public health bodies...

Qualitative analysis and eating disorders : Discourse analytic research on anorexia nervosa

The absence of qualitative analysis in mainstream research on eating disorders is discussed in the following article as being a weakness in developing theory and clinical practice. This article includes an analysis of interviews with British healthcare workers who manage anorexic patients. This analysis presents an example of qualitative methodology in the form of discourse analysis, which is argued to provide a systematic, yet flexible approach to research on eating disorders. The overwhelming prevalence of anorexia nervosa in women is specifically examined within the context of the identification of the "discourse of femininity. " The research findings are discussed in relation to the use of discursive practices that contribute to the maintenance and reproduction of clinical processes and their relative efficacy.

Unravelling the maze : Hepatitis C, psychosocial factors and access to antiviral therapy

In this paper we present an examination of the literature on the psychosocial aspects of hepatitis C (HCV), and ask what are the implications for patients and clinicians regarding access to treatment? Hepatitis C (HCV) is a blood-borne communicable disease that was identified in 1988. In Australia, an estimated 217,000 people live with HCV. The virus causes serious liver inflammation, can lead to liver cirrhosis and a small percentage of sufferers will develop hepatocellular carcinoma. Reports about the psychosocial aspects of HCV appeared from around 1994 indicating a similar set of societal responses to people with HIV; stigmatisation and discrimination. A number of calls were made for the establishment of counselling and support services to address the specific mental health needs of people with HCV. We conducted a systematic review of the literature between 2002-2012 about the psychosocial aspects of HCV and its relationship to access to treatment and identified a number of key issues that suggest the anticipated progress in this area has not been made. The majority of people with HCV already experience marginalisation, and the diagnosis of HCV further compounds their marginalisation through stigma and discrimination and complicates clinical decision-making around treatment. We conclude that the need for mental health services that are capable of addressing the complexities of the psychosocial aspects of HCV remains. Concomitantly, primary care clinicians require greater clarity and consistency about the clinical guidelines for HCV to meet the increasing expectations on them to deliver comprehensive patient management within primary care. (248 words)

Aliens, borders and social citizens : Health and community services for trafficked women

Australian policy makers recognise women who are trafficked to Australia (and these are largely for the purposes of sexual exploitation) primarily as victims of crime. The main public mechanism by which the "problem" of trafficked people in Australia is managed is the criminal law. At the same time, however, as a signatory to the UN Protocol on Trafficking and the Declaration of Human Rights, the Australian Government also recognises the rights of women trafficked to Australia to access health and community services in the wake of the health damage and trauma they often incur as a consequence of their experience. Current evidence suggests that trafficked women in Australia face considerable barriers in being able to avail themselves of such a right and of the services that accompany it. This paper explores the tensions posed by Australian policy and service approaches to trafficked women in light of the concept of social citizenship and the ways in which it is mediated in the Australian context by national border protection policy.

College, shared house, or home? The impact of living situation on university students’ drinking

University students are recognised as a heavy drinking group who are at risk of both short and long term harms from their alcohol consumption. This paper explores the social dynamics of drinking and the key differences between three core groups of university students – those who live at home, those living in college and those who live independently. We draw on a large scale survey of Australian university students on alcohol consumption and harm minimisation and extensive qualitative individual and focus group interviews with university students in Victoria, New South Wales and Queensland. Our data suggests that living at home supports safer drinking in comparison to the less regulated college context or living independently in shared households.

International trends in early childhood education for sustainability

Early childhood education for sustainability (ECEfS) is an emerging field within education – a synthesis of early childhood education and education for sustainability. As a distinct field of educational inquiry and practice, it is less than 20 years old in Australia. My personal story is one that emerged from teaching Aboriginal children in an Indigenous community. These experiences made me question the marginalization of Indigenous peoples in Australian society, the colonizing impacts of education, gave me deeper understandings of human-environment interactions, and the effects of poverty and powerlessness on options for Indigenous people in Australia and elsewhere where people and their lands have been exploited. These experiences saw me return to university to undertake a degree in environmental studies to help me better understand the nexus between society, environment and economy. Hence my background in education for sustainability comes as much from the social sciences as from the biological/ecological sciences and shapes my orientation to my work in ECEFS...

People with ID as active participants in nursing research : a literature review.

Aim: The movement from a medical model of disability to a more social model implies an imperative to include the views of people with ID in research regarding their care. Contemporary quality processes in improving care require consumer involvement at many levels and in doing so have shown better outcomes. A New Zealand research study is being undertaken utilizing focus groups with people with ID to understand their experiences during a psychiatric inpatient admission. The primary focus of this presentation will concern the literature review, undertaken as part of the study, of research in which people with ID have participated. Method: The literature review was conducted using a variety of electronic databases and search terms to identify studies with people with ID as active participants. Results: Only a few studies have been undertaken with people with ID as participants. While these studies demonstrate numerous benefits in including the voice of the person with ID this still remains absent from much of the research discourse. Conclusion: It is accepted and indeed advocated that people with ID have the same rights as others in regard to choosing whether or not they wish to participate in research. High response rates in the few identified studies indicated that people with ID are eager to be consulted. It is recommended that the unique needs of people with ID be taken into account in the research evidence base for future services.

Regulating the coal industry : striking a balance between commercial and public interests - a Queensland case study

The coal industry in Queensland operates in a very complex regulatory environment with a matrix of Federal and State laws covering the environment, health and safety, taxation and royalties, tenure, and development approvals. The Queensland Government in 2012 recognised the validity of certain industry concerns and passed two Acts being the Environmental Protection (Greentape Reduction) Amendment Act 2012 (the Greentape Act) and the Mines Legislation (Streamlining) Amendment Act 2012 (the Streamlining Act). Other changes are foreshadowed in relation to overlapping tenure and in the development of common resources legislation. Accordingly there is a great level of activity and change that has occurred or which is on the horizon. This article focuses upon these regulatory changes and foreshadows other areas requiring consideration. It commences with a consideration of the changes that have already occurred, examines those regulatory amendments that are on the drawing board and concludes with suggestions as to further interventions and amendments that have the potential to enhance the efficiency and effectiveness of the legislative framework in which coal mining is conducted.