Discipline of Public Health

Controlling dengue fever in Australia and internationally, relies heavily upon the actions of residents as well as community education and awareness of the risks. Although it has been well established in medical anthropology that the success of health interventions is highly dependent upon a clear grasp of lay knowledge of disease, limited attention has been given to lay understandings of dengue fever and its vectors in the extant literature. We begin addressing this hiatus through an examination of north Queensland residents’ knowledge of the breeding habitats of Aedes aegypti mosquitoes. Building on the insights of earlier social research, we use factor analysis to examine the results of a series of randomly selected telephone surveys and compare responses over time and between cities.Our analysis confirms that many people assume that Ae. aegypti is ubiquitous in the landscape, that it lives and breeds not only around the home, but also in a variety of geographical spaces located beyond the suburban ‘backyard’, and beyond the control of local residents. Lay understandings appear to be placing people at risk from dengue, influencing the mosquito management practices of local residents and acting as a source of resistance to public health messages that focus on individual responsibility. A way forward through the provision of new information that challenges key assumptions is provided in the discussion. We argue that rather than dismissing lay understandings as ignorance, strategies, practices and policy based on a detailed understanding of this knowledge will mean that practitioners are better able to address these assumptions and will likely be more effective at educating the public of the risks posed by dengue.Medical anthropology has established that health interventions based on a limited awareness of lay understandings of disease will likely fail. We explore this with regard to dengue fever in Australia.

Mosquito-borne diseases such as dengue fever, chikungunya or malaria affect millions of people each year and control solutions are urgently needed. An international research program is currently being developed that relies on the introduction of the bacterial endosymbiont Wolbachia pipientis into Aedes aegypti to control dengue transmission. In order to prepare for open-field testing releases of Wolbachia-infected mosquitoes, an intensive social research and community engagement program was undertaken in Cairns, Northern Australia. The most common concern expressed by the diverse range of community members and stakeholders surveyed was the necessity of assuring the safety of the proposed approach for humans, animals and the environment. To address these concerns a series of safety experiments were undertaken. We report in this paper on the experimental data obtained, discuss the limitations of experimental risk assessment and focus on the necessity of including community concerns in scientific research.

In recent decades overnutrition and obesity have been presented as a looming threat to the health and wellbeing of children and infants, most notably in western industrialised societies. However, this threat is not simply limited to ‘children’ who are ‘over fed’ by their ‘parents’. Increasingly, maternal overweight and obesity are said to inhibit conception, cause recurrent miscarriage, pose a serious threat to the development and health of the foetus and have long-term implications for the future wellbeing of the child. Parental responsibility looms large in these discourses, in which women in particular are held responsible for the future (fat free) health of their offspring from the womb to the tomb. In this article, it is argued that core assumptions at the heart of obesity science have been taken up uncritically in medical arenas focused on conception, pregnancy and reproduction and that this is providing new opportunities for the surveillance, regulation and disciplining of ‘threatening’ (fat) female bodies. It is shown that although all women of a reproductive age are being brought under the gaze of this deeply punitive medico-moral discourse, it is the bodies, lives and bedrooms of marginalised women that are singled out as posing the greatest ‘risk’ to their offspring and then targeted for even greater degrees of health/State intervention and surveillance.

Over the past few decades, three issues have emerged as threats to the health of infants and children in western, industrialised countries: the developmental impact of alcohol use in pregnancy (Foetal Alcohol Spectrum Disorder, or FASD), children’s exposure to second-hand smoke in the home, and childhood overnutrition and obesity. The definitive role of drinking during pregnancy, exposure to second-hand smoke and overnutrition on negative health outcomes in infants and children remains the subject of considerable debate. Nevertheless, all three issues have been medicalised and criminalised: framed as looming health emergencies that require immediate intervention and, increasingly, legislation. However, it is our contention that the alarm these health ‘threats’ currently generate has many of the characteristics of a moral panic. In this paper we unpack the discourses surrounding these three issues, and explore the common focus on maternal responsibility and the ways in which these movements serve to covertly marginalise and stigmatise particular groups of women.

Increasingly, qualitative health researchers might consider using social media to facilitate communication with participants. Ambiguity surrounding the potential risks intrinsic to social media could hinder ethical conduct and discourage use of this innovative method. We used some core principles of traditional human research ethics, that is, respect, integrity, and beneficence, to design our photo elicitation research that explored the social influences of drinking alcohol among 34 underage women in metropolitan South Australia. Facebook aided our communication with participants, including correspondence ranging from recruitment to feeding back results and sharing research data. This article outlines the ethical issues we encountered when using Facebook to interact with participants and provides guidance to researchers planning to incorporate social media as a tool in their qualitative studies. In particular, we raise the issues of privacy and confidentiality as contemporary risks associated with research using social media.

Objective Self-management of type 1 diabetes over a lifetime is complex and challenging even in the best of circumstances, and the social environment can be a powerful determinant of health behaviours and outcomes. The aim of this study was to identify how social determinants of health can impact on the capacity of young people to manage their glycaemic control.
Methods The findings emerged from a constructivist grounded theory approach through an in-depth examination of life course events that were recounted through qualitative interviews. The rich descriptive detail obtained from this enquiry locates common expe- riences and the context in which concordance with therapies occurs and health behaviours develop.
Results This qualitative study of young people with type 1 diabe- tes who have developed end-stage renal disease demonstrates that there are many factors beyond individual control that can contrib- ute to health outcomes. The social determinants of childhood envi- ronment, education, socio-economic status, gender and the culture of public health can contribute to disengagement from treatment regimens and the health-care system and to the development of microvascular complications at a comparatively young age.
Conclusion These findings challenge the assumptions of health-care practitioners about individual responsibility and highlight the importance of considering how social determinants can shape lives, behaviours and health.

Abstract Previous research on remote nineteenth-and early twentieth-century Indigenous missions in northern and central Australia point to their often tenuous existence and the complex nature of engagements between Christian Missionaries and Indigenous people. This paper explores the contribution and significance of Indigenous production of wild foods in the context of one such settlement located at Weipa on Cape York Peninsula, north eastern Australia. It is premised on the assertion that investigation of the economies of these often remote settlements has the potential to reveal much about the character of cross-cultural engagements within the context of early mission settlements. Many remote missions had a far from secure economic basis and were sometimes unable to produce the consistent food supplies that were central to their proselytizing efforts. In this paper it is suggested that Indigenous-produced wild foods were of significant importance to the mission on a day-to-day basis in terms of their dietary contribution (particularly in terms of protein sources) and were also important to Indigenous people from a social and cultural perspective. We develop this argument through the case study of culturally modified trees that resulted from the collection of wild honey.

Abstract
Background: The Wolbachia strategy aims to manipulate mosquito populations to make them incapable of transmitting dengue viruses between people. To test its efficacy, this strategy requires field trials. Public consultation and engagement are recognized as critical to the future success of these programs, but questions remain regarding how to proceed. This paper reports on a case study where social research was used to design a community engagement framework for a new dengue control method, at a potential release site in central Vietnam.
Methodology/Principal Findings: The approach described here, draws on an anthropological methodology and uses both qualitative and quantitative methods to design an engagement framework tailored to the concerns, expectations, and socio-political setting of a potential trial release site for Wolbachia-infected Aedes aegypti mosquitoes. The process, research activities, key findings and how these were responded to are described. Safety of the method to humans and the environment was the most common and significant concern, followed by efficacy and impact on local lives. Residents expected to be fully informed and engaged about the science, the project, its safety, the release and who would be responsible should something go wrong. They desired a level of engagement that included regular updates and authorization from government and at least one member of every household at the release site.
Conclusions/Significance: Results demonstrate that social research can provide important and reliable insights into public concerns and expectations at a potential release site, as well as guidance on how these might be addressed. Findings support the argument that using research to develop more targeted, engagement frameworks can lead to more sensitive, thorough, culturally comprehensible and therefore ethical consultation processes. This approach has now been used successfully to seek public input and eventually support for releases Wolbachia-infected mosquitoes, in two different international settings - Australia and Vietnam.