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Julie Spray

Working at the nexus of medical anthropology and the anthropology of childhood, this article challenges three assumptions often embedded in child health policy: (1) children are the passive recipients of healthcare; (2) children’s knowledge of illness and their body can be assumed based on adult understandings; and (3) children’s healthcare can be isolated from their social relations. I explore these themes through the case study of a 2011 New Zealand government initiative to reduce the rates of rheumatic fever affecting low-income Māori and Pasifika children. Drawing on fieldwork with around 80 children at an Auckland primary school, I show how the ‘sore throat’ programme does not merely treat streptococcus A infections, but plays an active role in constituting children’s experiences and understandings of their bodies and illness, and in shaping healthcare practices in ways unintended by policy-makers.

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Confronting Collaboration

Dilemmas in an Ethnographic Study of Health Policy Makers

Serena Heckler and Andrew Russell

In this article we report on collaborative, ethnographic research investigating the first regional tobacco control office in the U.K. and some of the dilemmas it poses. The ideal of collaboration is fully realisable in this setting, where the participants are both eager and qualified to contribute meaningfully to the project. However, the fulfilment of such an ideal poses its own problems. For example, the educational level and professional expertise of some participants allows them to fully engage with the theoretical framework to the extent that they could, if allowed, rewrite manuscripts. Other issues are more subtle, such as how to establish appropriate boundaries between the researcher and the tobacco control office staff. We suggest that the collaborative research model presupposes differentials of power, education and culture between researchers and participants that do not necessarily apply in the case of research in such settings. Where these differentials are lacking, the field is open for dominant participants to assume `undue influence' over the research project. To prevent this, we have reinstated boundaries between object and subject that were originally dissolved as part of the collaborative model. As a result, our project is maintaining a delicate balance between the conflicting aims of objectivity and collaboration.

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Reproductive Governance in the New Europe

Competing Visions of Morality, Sovereignty and Supranational Policy

Joanna Mishtal

While the European Union currently lacks a mandate to govern reproductive health services and policies, reproductive governance is increasingly debated both at the EU and the nation-state levels. The EU has taken formal positions to promote access to comprehensive reproductive health services. In tension with the EU's position is the Vatican, which promotes the use of conscientious objection to decline the provision of certain health services. Currently, the use of conscientious objection is mostly unregulated, prompting debates about supranational regulation at the Parliamentary Assembly of the Council of Europe (PACE) meeting in Paris in 2010. This article uses the lens of the PACE meeting debate to consider the cultural, historical and political specificities and agendas that give shape to competing arguments about rights, health and state sovereignty. I argue that political rationalities directed towards reproduction locally and the supranational rights debates work synergistically to paralyse European reproductive health policymaking.

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Echoes of austerity

Policy, temporality, and public health in South Africa

Theodore Powers

South Africa’s post-apartheid era has been marked by the continuation of racialized socioeconomic inequality, a social situation produced by earlier periods of settlement, colonization, and apartheid. While the ruling African National Congress has pursued a transformative political agenda, it has done so within the confines of neoliberal macroeconomic policy, including a period of fiscal austerity, which has had limited impact on poverty and inequality. Here, I explore how policy principles associated with austerity travel across time, space, and the levels of the state in South Africa, eventually manifesting in a public health policy that produced cuts to public health services. In assessing these sociopolitical dynamics, I utilize policy process as a chronotope to unify diverse experiences of temporality relative to austerity-inspired public health policy.

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Social Quality and Modern Public Health

Developing a Framework for the Twenty-First Century

Paul Ward

The central focus of this special issue of the European Journal of Social Quality is exploring and understanding the utility, relevance and operationalisation of the Theory of Social Quality for public health policy and practice. In keeping with the aim of this special issue, the authors work with the Theory of Social Quality and make attempts to ground it in the reality of public health practice and policy. However, the Editorial Board stress that in the future papers will be published which discuss, critique and provide counter-arguments to this theory, in the hope of providing extra theoretical and empirical depth. In so doing, we intend to develop the journal as a place for critical debate and discussion.

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Operationalizing the Theory of Social Quality

Theoretical and Experiential Reflections from the Development and Implementation of a Public Health Programme in the UK

Paul Ward, Paul Redgrave and Cathy Read

The main purpose of this short paper is to provide reflections on the potential to operationalise the Theory of Social Quality within public health and also on its utility for both public health policy and practice. In addition, we outline the inter-relationships between the theory of social quality and other areas of social theory and social policy. We do not attempt to provide a wide ranging or in-depth critique of social quality as it applies across the board in public health. Rather, we wish to provide an outline of a public health programme (or set of integrated interventions) which is currently running in a location in the UK (called Fit for the Future), and show how the different domains inherent within social quality may be operationalised.

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Edwin Cameron

Judge Edwin Cameron (South African Supreme Court of Appeal) makes a plea for a radical change of approach and of formal health policy in relation to HIV/AIDS in South Africa. Cameron delivered this lecture at the University of KwaZulu-Natal Forum on 4 May 2006 as part of the Ronald Louw Memorial Campaign, 'Get Tested, Get Treated'. Ronald Louw was a Professor of Law at the University of KwaZulu-Natal, an AIDS treatment activist and co-founder of the Durban Gay and Lesbian Community Centre. He died of AIDS in 2005. Cameron, who was appointed by Nelson Mandela to the high court in 1994, is a high profile AIDS activist and gay rights advocate. He has written about the experience of his decision to make public his own HIV positive status in the book, Witness to AIDS (Tafelberg).

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Ana B. Amaya, Stephen Kingah and Philippe De Lombaerde

English abstract: Health governance has become multi-layered as the combined result of decentralization, regional integration and the emergence of new actors nationally and internationally. Whereas this has enhanced the installed capacity for health response worldwide, this complexity also poses serious challenges for health governance, health diplomacy and health policy-making. This article focuses on one of these challenges, namely the organization of statistical information flows at and between governance levels, and the emerging role that regional organizations play therein. Regional to national-level data flows are analyzed with the use of two case studies focusing on UNASUR (Bolivia and Paraguay) and SADC (Swaziland and Zambia). The results of the analysis lead to several policy recommendations at the regional and national levels.

Spanish abstract: La gobernanza de la salud se ha convertido en una gobernanza multi-nivel, resultado de la descentralización, integración regional y aparición de nuevos actores nacionales e internacionales. Aunque esto ha mejorado la capacidad de respuesta en materia de salud mundialmente, esta complejidad plantea desafíos para la gobernanza de la salud, diplomacia en salud y elaboración de políticas. Este artículo se centra en uno de estos retos: la organización de flujos de información estadística en y entre los niveles de gobernanza, y el papel emergente de las organizaciones regionales en este ámbito. Se analizan los flujos de datos entre regiones y países mediante dos estudios de casos en UNASUR (Bolivia y Paraguay) y SADC (Suazilandia y Zambia). Los resultados del análisis arrojan recomendaciones de política regional y nacional.

French abstract: La gouvernance en matière de santé est devenue multi-niveaux comme résultat combiné de la décentralisation, de l’intégration régionale et de l’émergence de nouveaux acteurs nationaux et internationaux. Bien que cela ait renforcé la capacité d’intervention sanitaire dans le monde entier, cette complexité pose également de sérieux défi s pour la gouvernance de la santé, la diplomatie et l’élaboration des politiques. L’article se concentre sur l’un de ces défi s, à savoir l’organisation des flux d’informations statistiques à l’intérieur et entre les niveaux de gouvernance, et sur le rôle émergent des organisations régionales. Les flux de données régionales et nationales sont analysés à l’aide de deux études de cas portant sur l’UNASUR (Bolivie et Paraguay) et la SADC (Swaziland et Zambie). Les résultats de l’analyse ont conduit à plusieurs recommandations de politiques.

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Solange Ngo Yebga

*Full article is in French

English abstract: The notion of civil society became popular and generalized in Africa during the 1990s, through the initiatives of international bodies like the World Bank and agencies for international development. In Cameroon, the economic recession caused by the deterioration of exchange rates and falling prices of agricultural raw materials (coffee, cocoa, and co on) has favored the emergence of these actors alongside the state in managing and improving the living conditions of those urban populations. In the field of reproductive health, civil society, through associations, is pursuing public orientation through services of education, promotion, and diffusion. Observing the Association for the Struggle against Violence against Women (ALFV in French) ALFV and Women, Health, and Development in Sub-Saharan Africa (FESADE in French) shows how a health policy is operationalized via endogenous initiatives. This research, which is mainly empirical, was conducted between 2006 and 2009 with institutional health managers and managers of associative structures in Yaoundé and throughout Cameroon.

Spanish abstract: La noción de sociedad civil se populariza y vulgariza en África hacia los años 90 bajo la iniciativa de instancias internacionales como el Banco Mundial y las agencias de desarrollo. En Camerún, la recesión económica debida a la caída de las tasas de cambio y a la baja en las materias primas agrícolas (café, cacao, algodón) favoreció la emergencia de dicha sociedad paralelamente al Estado en la gestión y mejoramiento de las condiciones de vida de las poblaciones urbanas. Por ejemplo, en el campo de la salud reproductiva, la sociedad civil, en la forma de asociaciones, lleva a cabo acciones públicas a través de los servicios de educación, promoción y difusión. La observación de los ejemplos de la Asociación para la Lucha contra la Violencia contra la Mujer (ALVF en francés) y de Mujer, Salud y Desarrollo en el África subsahariana (FESADE en francés) permite ver cómo se operativiza una política de salud a través de iniciativas endógenas. Esta investigación esencialmente empírica fue desarrollada entre 2006 y 2009 con los responsables institucionales de salud y con los responsables de las estructuras asociativas de Yaoundé y Camerún.

French abstract: La notion de société civile se popularise et se vulgarise en Afrique vers les années 90 à l'initiative d'instances internationales comme la Banque mondiale et des agences d'aide au développement. Au Cameroun, la récession économique due à la détérioration des termes de l'échange et à la chute des prix des matières premières agricoles (café, cacao, coton) a favorisé l'émergence de cet intervenant aux côtés de l'Etat dans la gestion et l'amélioration des conditions de vie des populations urbaines. Dans le domaine de la santé reproductive, la société civile, sous la forme d'associations par exemple, poursuit les orientations publiques à travers des services d'éducation, de promotion et de diffusion. En observant les exemples de l'ALVF et de la FESADE, nous étudions comment s'opérationnalise une politique de santé à travers des initiatives endogènes. Ce e recherche, essentiellement empirique, a été menée entre 2006 et 2009 auprès de responsables institutionnels de santé et de responsables des structures associatives à Yaoundé et dans d'autres villes du Cameroun.