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.

Trust in Institutions, Not in Political Leaders, Determines Covid-19 Public Health Compliance in Societies across the Globe

A core assumption often heard in public health discourse is that increasing trust in national political leaders is essential for securing public health compliance during crises like the Covid-19 pandemic (2019-ongoing). However, studies of national government trust typically are too coarse-grained to differentiate between the trust in institutions versus more interpersonal trust in political leaders. Here, we present multiscale trust measurements for twelve countries and territories across the West, Oceania and East Asia. These trust results are used to identify which specific domains of government and social trust were most crucial for securing public health compliance (frequency of mask wearing and social distancing), and understanding the reasons for following the health measures (belief in effectiveness of public health measures). Our cross-cultural survey-based analysis (12 countries/territories, N=3369 subjects) reveals that higher trust in national and local public health institutions were a universally consistent predictor of public health compliance, while trust in national political leaders was actually not predictive of compliance across cultures and geographical regions. Institutional trust was mediated by multiple types of transparency, including providing rationale, securing public feedback, and honestly expressing uncertainty. These measures of transparency in public health communications, in turn, influence the public’s compliance behavior and beliefs. In total, these results highlight the importance of distinguishing between components of government trust, to better understand which entities the public give the most attention to during crises. Our findings may contribute to better planning and improvement of society-level cooperation, especially under highly uncertain disaster contexts.

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.

Mental health under occupation: an analysis of the de-politicization of the mental health discourse in Palestine and a call for a human rights approach

Purpose This study aims to look at the effects of the Israeli occupation on the mental health of Palestinians and examine the link between political oppression and the occurrence of mental health disorders. It argues that, as human rights violations in Palestine are connected to psychological distress, the root causes of social suffering need to be considered in order not to pathologize Palestinians. The purpose of this paper lies in connecting the mental health discourse with a human rights approach to better understand this connection within the context of political violence. Design/methodology/approach The paper presents the viewpoint and perspectives of the authors on significant mental health issues in Palestine. The methodology is based on a literature review of the de-politicization of the mental health discourse and on the theoretical framework of a human rights approach. At the base of this discourse lies the demand for social justice and professional solidarity. Findings The study highlights that to truly understand social suffering in Palestine, it needs to be related to the prevalence of human rights violations, which in turn have a conceivable impact on the mental health well-being of individuals. It advocates for a shift from a de-contextualized, de-politicized and individualistic approach to mental health to acknowledging the importance of the social and political context in which trauma develops. It further illustrates how the adaptation of a human rights approach can strengthen demands of social justice and oppose the victimization of Palestinians. Originality/value The value of the works lies in putting the prevalence of mental health disorders in Palestine in relation to human rights violations as a consequence of the ongoing Israeli occupation and in highlighting the role that international organizations play in the de-politicization of the mental health discourse.

Multimorbidity among People Experiencing Homelessness—Insights from Primary Care Data

Background: Although the poor health of people experiencing homelessness is increasingly recognised in health discourse, there is a dearth of research that has quantified the nature and magnitude of chronic health issues and morbidity among people experiencing homelessness, particularly in the Australian context. Methods: Analysis of the medical records of 2068 “active” patients registered with a specialist homeless health service in Perth, Western Australia as of 31 December 2019. Results: Overall, 67.8% of patients had at least one chronic physical health condition, 67.5% had at least one mental health condition, and 61.6% had at least one alcohol or other drug (AOD) use disorder. Nearly half (47.8%) had a dual diagnosis of mental health and AOD use issues, and over a third (38.1%) were tri-morbid (mental health, AOD and physical health condition). Three-quarters (74.9%) were multimorbid or had at least two long-term conditions (LTCs), and on average, each patient had 3.3 LTCs. Conclusions: The study findings have substantial implications from both a health risk and healthcare treatment perspective for people experiencing homeless. The pervasiveness of preventable health conditions among people experiencing homelessness also highlights the imperative to improve the accessibility of public health programs and screening to reduce their morbidity and premature mortality.