Saturday, 17 December 2016

Conferences 1

Classified as: reflections

I'm updating this blog with bits and pieces from conferences I have attended.
At present I'm working on the mobile so formatting will be basic till I have access to a computer again and can update.
Here is a communique from the population health congress in Adelaide 2012

here is the text:

Population Health Congress Communique

The undersigned Australian and Australasian population health associations - and 1150 delegates from over 20 countries - met in Adelaide on 10-12 September 2012 to take stock of the achievements of public health in Australasia, and agree on priority areas for future action. We affirm our commitment to improving the health and wellbeing of the Australian and New Zealand populations through collective action in relation to:

1. Social determinants of health and addressing inequities
  • Reducing health inequities within and between populations.
  • Progressing an agenda for ‘Health in All’ policies, recognising that health outcomes are impacted by a range of public policies across government portfolio areas, including taxation.
  • Progressing cross-portfolio and cross-sectoral efforts to ‘Close the Gap’ in life expectancy and health outcomes for Aboriginal and Torres Strait Islander peoples.

2. Loss of public health workforce and community based services
  • Highlighting the impact of recent cuts to public health workforce and infrastructure within jurisdictions, recognising that cuts to public health services impact heavily on marginalised and disadvantaged communities. We call for the reversal of these cuts.
  • Demonstrating the cost effectiveness of expenditure on health promotion and disease prevention programs, consistent with the recommendations of the National Preventative Health Taskforce.
  • Ensuring expansion of resources for health promotion and population health, and effective inclusion of health promotion/ population health into Medicare Locals.
  • Working collectively to strengthen the workforce voice.

3. Global health, climate change and economics
  • Addressing Trade Agreements and Health – the potential impact of trade agreements in undermining public health policy within Australia and the region. For instance, the capacity for the current Trans-Pacific Partnership Agreement discussions to impact on plain packaging legislation and access to medicines under the Pharmaceutical Benefits Scheme.
  • Progressing World Health Organisation reform - increasing involvement of Australian public health organisations in global public health efforts and issues.
  • Calling for urgent and immediate social, economic and environmental policy action to achieve a just and sustainable society as the greatest health priority this century.
  • Illustrating the linkage with local level environment issues, such as the water supply and health impacts of coal seam gas in Australia.
  • Remaining actively engaged in the Climate and Health Alliance (CAHA).

Collectively, our associations share common ideals to reduce the burden of disease through processes that protect the population, prevent disease and promote individual and collective health and well being. Through the use of evidence, our associations strive to influence public policy that creates, supports and sustains healthy environments and social conditions. We share a common belief that government support and community mobilisation are needed to effect change in policy and practice through multisectoral and interdisciplinary collaboration.
We agree in principle to reconvene a Congress in three or four years’ time to review our progress in achieving collective action on the above points and to bring together population health researchers, policy makers and program practitioners once again to share their experiences and knowledge in improving the health of our populations.
The Presidents of the Public Health Association of Australia, the Australian Health Promotion Association, the Australasian Faculty of Public Health Medicine, and the Australasian Epidemiological Association are committed to collective action in relation to each of the above.

Saturday, 27 August 2016

The joy of commuting by bike

(Updated) For a long time now I've meant to do a blog post about the joys of commuting by bike, and this post by John Davidson at ClimatePlus has inspired me to do it. Brian Bahnisch, who runs the blog, and John in his occasional posts, always have lots of good practical information.

John highlighted some interesting information showing that the majority of commutes in Brisbane are not to the CBD - apparently only ten percent are, while two thirds are within " 'normal area of residence' ", which I guess means fairly close to home.

I'm not sure if the same is true in Melbourne (I haven't yet found comparable info) - possibly not quite as much, because Melbourne is a larger city, but still it makes me question the way I think about promoting PT and active transport.

In Melbourne, as in Brisbane, PT is best for going into or across the CBD, and not very good for lateral journeys (although in the inner city there is a lot of under-utilised capacity on buses). But if many of the commutes are quite short, that would seem like an opportunity to promote active transport.

As John points out, there are barriers, including safety (not enough safe bike routes) and the "arriving hot and sweaty" problem, plus of course time and convenience. "Arriving hot and sweaty" is probably  more of a problem in Brisbane than Melbourne because of warmer weather and more hills, but it is still a problem here.

Things that can be done include: more safe bike routes, safe walking routes for children and people with disabilities, showering facilities at work and 'traffic calming' measures, amongst others.

We can also promote the health benefits of active transport (including that you don't get quite so "hot and sweaty" as you get fitter), and my personal favourite, that walking and cycling take you through lovely areas where cars can't go!

So here are some photos from my bike commute to Monash campus at The Alfred, where we do have showering facilities (shout out to Population Health and Health Promotion at The Alfred) - as my commute is 17km, I appreciate the showers, especially in summer!

Blogger has put the photos in reverse order and it would be a lot of work to change them - so the ride to work is from the bottom to the top of the photos.

Parks are wonderful!

Wednesday, 17 August 2016

Reflections on a visit to the Wimmera

Classified as: Reflective journal, participant reflections, history and discourse, observations
Edited and updated 22 August for the reasons outlined in the section on ethical considerations at the end of this post.
Beautiful 'reflections' on the roadside verge
On 9th August
I went to Wimmera PCP for my final presentation and feedback session. It was a really good visit that has inspired a lot of ideas for me.

Bruno Latour, in 'Writing Down Risky Accounts' (2005) says that social life is always complex and "messy" and that a good report should be able to elicit “networks of actors” and capture “energy, movement and specificity”.

I think this blog has captured some of the 'messiness' of social life and social research, but I don't think this (or my other notebooks or journals) has entirely captured the complexity, and the interconnections.  So, as this is likely my last formal meeting with research participants before I finish my thesis, I would like to try a pictorial essay to capture some of the complexity of colour, movement, networks and  connections.

I will possibly try to do something similar for the two previous feedback sessions, but as they are a while ago, I won't be able to capture so much.

In this essay, I am drawing on my notes and observations from the meeting. The essay thus uses information provided by participants at the meeting, but I haven't included information that could identify individuals, and any mistakes or misrepresentations are my responsibility. There is a discussion of ethical considerations at the end of the post. I'm using photos I took after the meeting, and some publicly available images. In this writing I am drawing on knowledge from my previous studies in history and on general sources such as Wikipedia, so this essay should be seen only as a 'think piece' at present. It is also a draft for some further writing I will be doing in the thesis, where it will be fully referenced.

Where we met in Horsham (image from Google*)
I gave the presentation at the meeting of the Health Promotion Network. There were eight people present and two linked in by videolink. All were women. (There had also been two men present, but they had to leave before my presentation).

 After the presentation, people talked about the challenges of health promotion, such as engaging 'hard to reach groups'. They also talked about community gardens, including this one:

Community garden in Warracknabeal

Other gardens in the area include a school garden and a community garden at Horsham North, and another that involved members of the local Karen community. The gardens have had different levels of success. People in disadvantaged areas may be reluctant to get involved. On the other hand, a network member commented about how people from the Karen community are very actively involved in their local garden and use the vegetables, and how mainstream Australian culture seems wasteful by contrast.

At the Warracknabeal garden, organisers have been making soup and giving it to local people. The community garden is in a central spot in the town, which probably makes it easier to engage people. There are some very engaged community members, one of whom also got some local youth involved recently.  Similarly, some of the teachers at Horsham North Primary School are active in the school garden.

There was some other interesting public information that I became aware of as a result of attending the meeting. The regional Office of Health is planning a 'Prevention Exchange' forum in the area. NAIDOC week had recently been held in Horsham, with a range of activities.

Image reproduced from the Horsham Rural City Facebook page

I was also interested to learn that lentils are an important crop grown in this region.

As Latour might say, the diversity of topics discussed in most meetings illustrate some of the apparent "messiness" of social life. Latour is not using "messiness" in a pejorative sense (and I do not mean it in that way) but in the sense that when researchers try to record complexity it sometimes seems 'messy', because there is so much going on in most social situations.  Underneath the variety of topics I've referred to here there are important themes, illustrating how social determinants, ecology, culture, everyday life and health connect, and are shaped by history. Below are some photos from my visit, and some history, exploring some of these themes further.

Bush near Horsham after the rain
Often along the roadsides in regional areas, there are revegetated areas of natural bush, or remnant bushland that has not been cleared.

For contemporary Australians, even city dwellers, just by stopping beside the road as we drive from place, we can imagine something of what the land was like when Indigenous people lived here, before the white invasion.

No doubt it was different in Indigenous times when areas may have been regularly cleared by 'fire stick farming', but we can get some sense of  the past.

The current day Wimmera and surrounding areas were home to the Wotjobaluk, Jaadwa, Jadawadjali, Japagulk and Wergaia peoples. They obtained their food, building materials and other resources from the indigenous plants and animals of the land and had done so for thousands of years.

Raindrops in the bush

Some of the foodstuffs included animals such as kangaroos and emus, fish and eels, but they also had a wide variety of plant foods. Tuberous plants were a key source of vegetable food, including the Yam Daisy, one of the key food sources in this area. Women gathered it using their digging sticks, but also leaving enough in the ground to ensure they grew again next season.

Murnong or Yam Daisy (photo: A J Brown for VRO)

Small plants on the roadside verge near Horsham
Wattle on the road near Horsham

Wattleseed was also an important food source for Indigenous peoples. Many wattles have edible seeds, although we don't know now the full range of which seeds are edible and which are not.

Cleared and cultivated paddock near Horsham
When white people came to this area, first as large scale squatters and then as smaller scale settlers, they cleared the land and introduced imported animals such as sheep and cattle, and started broadscale farming of crops for trade and cash, rather than for local subsistence.

The dispossession of Indigenous people was also a violent process. There were numerous massacres in the present day Wimmera area. Historically this was an invasion by a white society hierarchically structured by class and gender, ruled largely by white men largely from middle or upper class backgrounds. Closer settlement and soldier settlement later allowed people from working class backgrounds to gain some land, but it was still a hierarchical and patriarchal society, in which the production of cash crops or livestock for capitalist trade and export formed the economic basis, and people aimed for individual ownership of land and acquisition of resources.

This was in contrast to Indigenous society, which was generally egalitarian in sharing ownership of food and resources, and in which people were seen to have shared responsibilities to the land rather than individual rights to profit from it. 

White people rationalised the dispossession of Indigenous peoples by saying that they were 'cultivating' the land and making better use of it than Indigenous peoples had, however industrial scale farming has major ecological impacts. These impacts are not just the dispossession and destruction of people and other species, but also the impacts on soil fertility and the high levels of carbon emissions associated with current industrial farming.

Industrial scale farming requires structures of machinery production, storage and transport, illustrated by these pictures of grain silos and fuel tankers in Horsham.

 One of the final consumer products of farming within a capitalist industrial society is of course fast food! Horsham has its share of fast food outlets, so a farmer who has spent the day on the tractor working to produce a cash crop of lentils, or wheat, or other foods, could then drive in to town to buy a hamburger.

So on the one hand, here is industrialised capitalist society which has become dominant in Australia over the last 230 years since the white invasion began. Cash crops of grain or legumes, and livestock, are grown on broadscale farms and transported over long distances to be sold to companies which package them or transform them into consumer goods such as hamburgers (or lentil burgers!), to be sold in supermarkets and fast food outlets.  Correspondingly, cars, farm machinery, fuel and fertilisers are imported, or manufactured elsewhere in Australia, and transported over the same long distances to the farms.

Historically, this has replaced a society in which people walked over the land that gave them nearly everything they needed (there was some long distance trade in Indigenous societies). Indigenous societies had shared ownership of land, were relatively egalitarian and, although they affected the landscape, for example through the use of fire, lived sustainably for thousands of years. Industrial capitalist societies produce vast amounts of comforts and consumer goods, but are deeply unequal, and in their present form, ecologically unsustainable.

Health promotion network members can be seen as located at the intersection of these differing social forms. The network includes Indigenous organisations and Indigenous members as well as members of the farming families and the regional township populations created by white industrial society. Network members look after the health and wellbeing of local people. They work to make their local community more inclusive, bringing people together around projects such as community gardens, which encourage healthier and more sustainable ways of eating and living.

But great unresolved issues still underly this work. These issues can be represented through looking at food and transport: can we continue with societies that are based on individual ownership, profit and inequality, and which are making us unhealthy, through sedentary lifestyles and fast food production, and putting our ecology at risk, through carbon emissions and destruction of local environments and species? Or can we learn from societies that were based on principles of communal ownership, respect for land and sharing of resources, but to many people now would be almost unthinkable as a way to live? Local health promotion workers are doing great work within these contested fields, but my contention is that health promotion as a discipline has to engage more directly with these questions about what kind of society we want, and how we can live in ways that are fairer and more sustainable, but potentially involve huge disruption to taken-for-granted social and economic arrangements?

Finally though, the combination of cleared land and natural landscapes is sometimes very beautiful.

Ethical considerations: This part of the project has been approved by the Monash Ethics committee on the understanding that participants are providing information anonymously and discussion is not being taped. I gave participants a project information sheet but they did not sign individual consent forms for individual information to be used. Therefore I can only report my observations in a general way, rather than in a way that links information to individuals. The participants of course know who they are and probably can remember who said what, but I can't record or report anything that would indicate that. In fact, even if new participants had signed consent forms, as previous participants did, the forms would have specified that information would not be reported in a way that could be linked to a particular individual.   I am not able to say, for example, that 'a health promotion worker from a community health service in xx municipality said such and such', because that could potentially identify somebody, even though I did not use their name.

Clearly this means that this report - and anything I publish on the research - can't always include the 'specificity' of actors that Latour is referring to above, and indeed academic writing can be a bit boring partly for this very reason. More broadly, ethical processes that have often been designed particularly to protect participants from certain kinds of risks in medical research - such as invasive procedures, or the publication of personal health information - can in some ways conflict with other ethical considerations in community based participatory research. For example, the requirement that research participants are anonymous while I, as the researcher, am named, carries a risk that I will be seen as the 'author' of all the ideas in this project, whereas clearly many of the ideas come from participants.

Community based participatory research is of its nature a shared project, but formal academic processes and ethical requirements carry a risk that the academic researcher is privileged.  I have done a lot of work on this project and put a lot of thought into it, and I expect and hope to get credit for this. I think, however, there also need to be processes, including ethics processes, to ensure that research participants, as well as academic researchers, are acknowledged as 'authors' of the knowledge created by research. I'm not sure how to do this, but maybe there could be a form of report or article which gives research participants, if they wish, the opportunity to state who they are and how they have contributed to the research. Again, I'm not sure which journals would (or do) publish such articles but it is worth thinking further about.

I rewrote this post on 22 August because I felt that I had gone a bit beyond where I should have in using some information from the meeting that was not directly related to my presentation, and that in using Latour's word "messiness" it might have sounded as if I was suggesting the meeting was 'messy' when that was not what I intended! Some of the risks of participant action research are illustrated here, I guess.


* acknowledged according to Google permissions

Monday, 8 August 2016

"nothing begins when it begins and nothing's over when it's over" - progress report

I've presented on the research project to people in ISEPICH and SGPCP earlier this year and am presenting to Wimmera PCP this week. This is the final stage of the research and I'm trying to get some feedback from participants (or their colleagues) on the findings of the project and the implications of those findings before I finish writing up my thesis.

It is difficult because most people involved have limited time and it is hard to condense the findings and implications down to a 15 minute presentation, and hard for people to give feedback within those constraints too. However I think it is grounding the research - even recognising those difficulties grounds it.  Hopefully the results of this project will feed into ongoing policy and development in health promotion and public health. It's all an ongoing project and this research is just one small part of it.

 "nothing begins when it begins and nothing's over when it's over"
(Margaret Atwood, The Robber Bride)

Here's the presentation. Some the slides are a bit hard to read, I can't make them any larger on Blogger, but if you click on individual slides they will come up more clearly.

Saturday, 30 July 2016

Hows, whys and Ecofeminism

Classified as: theory, reflections

I've been writing my theoretical and methodological chapters and trying to make sense of the fields of theory I've used in developing the research and analysing the findings. These are: health promotion theory, political economy (largely based on Marxist and neomarxist theory), theories of discourse and practice (sometimes called cultural theory, to distinguish them from the economism and structuralism of Marxist theory in particular, I think), ecohealth and ecofeminist theories.

One of the things I have to explain is how I moved from beginning the research with a personal belief in feminism but not a strong over-arching feminist approach, to the current position where I now see Ecofeminism as the strongest explanatory framework for the research findings.

The simple answer is this: there have been over 100 people involved in this research project now, including about 40 as research participants (I will try to include a table with specific figures next week). The overwhelming majority have been female, particularly when you analyse down to 'those employed in the health and community sector' and then 'those who are research participants'.

You can explain the 'how' of this quite easily: women are over-represented in the caring professions and women are somewhat more 'pro-environment' than men, therefore more women are involved in the research. But the 'why' is deeper, and involves asking about things that are generally taken for granted, such as why 'caring' (both paid and unpaid) in this society is predominantly done by women.

For that, I have turned to history and feminist theory, and finally to Ecofeminism, to understand that our public discourse is dominated by exchange, trade, competition, money and hierarchy but is built on a taken-for-granted realm of subsistence, cooperation, everyday life, care and nurturance and 'nature' or the ecologically given.

As I've noted before, in recent history dominant knowledge was patriarchal, created by ruling class white men. Within that knowledge, women, 'inferior races', peasants or working class people and the natural world, were the given - that which constituted, or produced, the natural and human 'resources' that could be traded or fought over (summarised so clearly by Weber, as discussed here).

I have become increasingly impatient with social theory that doesn't deal with gender (as so much of it doesn't). I think that only by understanding this patriarchal world that has created our current reality, can we move on from it - but so many people seem reluctant to do so (partly because it's still all around us, of course!).