Strengthening health promotion practice: capacity development for a transdisciplinary field

The growing burden of non-communicable and newly emerging communicable diseases, multi-morbidity, increasing health inequalities, the health effects of climate change and natural disasters and the revolution in communication technology require a shift of focus towards more preventive, people-centred and community-based health services. This has implications for the health workforce, which needs to develop new capacities and skills, many of which are at the core of health promotion. Health promotion is thus being mainstreamed into modern public health. For health promotion, this offers both opportunities and challenges. A stronger focus on the enablers of health enhances the strategic importance of health promotion’s whole-of-society approach to health, showcases the achievements of health promotion with regard to core professional competencies, and helps build public health capacity with health promotion accents. On the other hand, mainstreaming health promotion can weaken its organizational capacity and visibility, and bears the risk of it being absorbed into a traditional public health discourse dominated by medical professions. To address these challenges and grasp the opportunities, it is essential for the health promotion workforce to position itself within the diversifying primary care and public health field. Taking the transdisciplinary status of health promotion and existing capacity development systems in primary and secondary prevention and health promotion as reference points, this paper considers the possibilities to integrate and implement health promotion capacities within and across disciplinary boundaries, arguing that the contribution of health promotion to public health development lies in the complementary nature of specialist and mainstreamed health promotion.

Normal Island: COVID-19, Border Control, and Viral Nationalism in UK Public Health Discourse

In this contribution, I present emergent analysis of a preoccupation with managing COVID-19 through border control, among non-Governmental public health actors and commentators. Through a reading of statements, tweets, and interviews from the ‘Independent Sage’ group – individually and collectively – I show how the language of border control, and of maintaining immunity within the national boundaries of the UK, has been a notable theme in the group’s analysis. To theorize this emphasis, I draw comparison with the phenomenon of ‘green nationalism’, in which the urgency of climate action has been turned to overtly nationalistic ends; I sketch the outlines of what I call ‘viral nationalism,’ a political ecology that understands the pandemic as an event occurring differentially between nation states, and thus sees pandemic management as, inter alia, a work of involuntary detention at securitized borders. I conclude with some general remarks on the relationship between public health, immunity, and national feeling in the UK.

Measles, Media and Memory: Journalism’s Role in Framing Collective Memory of Disease

Language used to describe measles in the press has altered significantly over the last sixty years, a shift that reflects changing perceptions of the disease within the medical community as well as broader changes in public health discourse. California, one of the most populous U.S. states and seat of the 2015 measles outbreak originating at Disneyland, presents an opportunity for observing these changes. This article offers a longitudinal case study of five decades of measles news coverage by the Los Angeles Times and the San Francisco Chronicle, which represented two of the largest news markets in California when the measles vaccine was released, in 1963, and during the 2015 outbreak. Measles reporting during this period displays patterns pointing to an active role for journalists in shaping public understanding of health and medical matters, especially as they recede from public memory, through the employment of available and circulating political and cultural frames. Moreover, journalistic frames in this period of reporting incorporated presentist descriptions of the disease, which imposed present values on the medical past, and which were constructed of decontextualized historical references that supported prevailing contemporary notions of the disease. Framing and the tendency toward presentism, in the context of shifting public health discourse, had the effect of communicating an increasingly severe sounding disease over time, and of shifting blame for that disease’s spread from nature to government to individuals. Journalistic framing and causal stories have much power to shape public understanding of medical matters as they recede from public memory.

War of conscience: antivaccination and the battle for medical freedom during World War I

The nineteenth century British antivaccination movement attracted popular and parliamentary support and ultimately saw the 1853 law which had made smallpox vaccination compulsory nullified by the 1898 ‘conscientious objector’ clause. In keeping with popular public health discourse of the time, the movement had employed rhetoric associated with sanitary science and liberalism. In the early twentieth century new discoveries in bacteriology were fuelling advances in vaccination and the medical establishment was increasingly pushing for public health to move towards more interventionist medical approaches. With the onset of war in 1914, the medical establishment hoped to persuade the government to introduce compulsory typhoid inoculation for soldiers. This article analyses antivaccination literature, mainstream newspapers and medical press along with parliamentary debates to examine how the British antivaccination movement engaged with this new threat of compulsion by expanding the rhetoric of ‘conscience’ and emphasising medical freedom while also asserting scientific critique concerning the effectiveness of vaccines and the new laboratory based diagnostic practices. In spite of ‘conscience’ fitting well with an emerging public health discourse of individual subjectivity, the mainstream press ridiculed the idea of working-class soldiers having a conscience, coalescing around the idea that ‘conscientious objection’ be reserved for spiritual, philosophical and educated men who objected to military service. Moreover, in spite of engaging in reasoned scientific critique, parliament and press consorted in the demarcation of scientific knowledge as exclusive to medical scientists, reflecting a growing allegiance between the state and the medical establishment during the war. Any scientific arguments critical of medical orthodoxy were subjugated, labelled as ‘crank’ or ‘faddist’ as well as unpatriotic. The antivaccination narratives around conscience contributed to or were part of an evolving discourse on consent and ethics in medicine. Potential parallels are drawn with current and likely future debates around vaccination and counterhegemonic scientific approaches.

"No Silver Bullet Solution": Cruel Optimism and Canada’s COVID-19 Public Health Messages

Science twines through many of the discussions related to hope for a return to normalcy within public discussions of COVID‑19. The framings of techno-scientific solutions for COVID‑19 are similar to those that are presented to address many societal problems. The messy scientific and regulatory underpinnings of this desired silver bullet rarely make it fully into view. Technoscientific-related hope and its associated affects can operate as a kind of “cruel optimism” (Berlant 2010, 2011). It can be an affective response to return to life as “normal” that is psychologically soothing, even as its enactment may replicate destructive social, political, and economic structures. Hope and technoscience thread throughout the interactions between journalists and health officials in the health press briefings in the first wave of the COVID‑19 pandemic. Technoscientific complexity that challenges the desire to return to normal is rarely brought up in Ontario and Nova Scotia public health briefings. But when it is, health officials in this zone of interaction balance explanations of scientific reality and caution, while attempting to not crush hope for a techno-scientifically mediated return to normal. As such, public health discourse obscures or tempers cruel optimism rather than directly confronting it.

Elijah's Nature

Existing scholarship struggles to theorize the relation between aesthetics, especially the aesthetics of catastrophe, and concerns with ecology and the environment. Mendelssohn's sacred oratorio Elijah premiered in 1846 at the birthplace of the steam engine in Birmingham, England. Commissioned by municipal reformers, Elijah constitutes a case study in disaster art. It was conceived as a vehicle for atmospheric repair, clean breathing, and moral healing for Black Country working populations. Its contexts include the development of biomedicine, public health discourse, and the history of air-purification systems, as well as the prophetic rhetoric of such firebrand modern Elijahs as the contemporaneous preacher-evangelist John Cumming. The popularity of the singing-class movement, moreover, aligns with the “great sanitary awakening” both because of its allegedly sanctifying spiritual potential, and because it was thought to fortify the lungs. Mendelssohn's oratorio was at once financed on the back of the profits of coal-fired energy systems and produced by well-meaning environmentalists to mitigate against the effects of heavy air pollution. The reception of the work is evidence of the extent to which the concerns of industry and the concerns of natural recovery co-constituted each other. Elijah deals in a cosmology—a way of narrating nature—that begins with the very real experience of ecological crisis. The endgame is to count the cost of a master narrative that sought natural recovery in an industrial enframement of global nature.