Thursday, 13 August 2015

Project report update - discussion of theory

Classified as: theory, project update, reflective journal

The project report will include a largely descriptive component, which covers:
  • what the research involved, 
  • the development of the ISEPICH framework, 
  • what participants are doing to promote health, equity and environmental sustainability, 
  • what helps or challenges them in this work.
There will also be a more analytical component, which covers:
  • who said what, were there differences  between participants, why?
  • what are the underlying assumptions and ideas they are drawing on?
  • how does this relate to the context in which they are working and speaking?
  • what are the significant implications from this research so far?
It's not possible to make a hard distinction between description and analysis. For example, there are over 100,000 words in transcripts of interviews and group discussions, so just to make sense of that I have to summarise and select, which always involves analysis: what's relevant to the research questions, what are the key themes, and so on. However I think it's reasonable to make a distinction between mainly descriptive, where I am trying to portray what participants were doing and what they said, and mainly analytical, in which I look at differences and context and assumptions, and use theory to explore these.

Therefore at this point I want to be a bit more specific about the theory and methodology I am drawing on in this analysis.

Action research assumes that we all (once we get beyond very early life, anyway) have theories: ideas about the way the world works and why people do what they do. In an action research project such as this one, however, theories aren't necessarily fully articulated at the beginning. We develop a plan or idea for what we want to do, like the ISEPICH framework in the beginning of this project. The ISEPICH framework did draw on ideas and theories, both from the expert speakers at the first forum and from participants' own experience. The emphasis was not on using experts' theories to tell us what to do, but rather on using those theories, in conjunction with our own ideas and experience, to plan what we should do.

That is to say, theory in action research is grounded: it is not universal theory but rather particular theory about what will happen or should be done in a particular time and place.

Both the expert speakers at the first forum were health promotion experts, so the main theoretical approach they were drawing on was health promotion, as well as drawing on other theories and evidence about equity and climate change.  In devising the original project, I and the other people most involved were also drawing on integrated health promotion theory, particularly as expressed in the Department of Health Integrated Health Promotion Kit, and the Ottawa Charter. This is not to say, though, that all the participants in the project were drawing on the same theory. Most, I believe, shared a common ground of ideas about community development and social inclusion, but within that consensus, there may still have been some significant differences, particularly for the community members in ISEPICH.

The second stage of the research, talking with people in the three PCPs about what they had done and what helped or challenged them in this work, explored the 'action' of action research: this is the stage where theory is tested in practice. The theory that is being tested here is, at one level, the theory documented in the ISEPICH framework. However, the second stage of the research also involved people from other PCPs who hadn't been involved in developing the ISEPICH framework and were working with their own ideas and theories. The key common ground is the theory of integrated health promotion, as above. Beyond that, SGGPCP also have developed their own theory in Climate Change Adaptation: A Framework for Local Action. This was developed before this research project began and was clearly a very influential source for this research. Although it is expressed as being about adaptation, in fact it also addresses mitigation and provides a framework for health promotion drawing on the Ottawa Charter.

Part of the analysis therefore will be looking at those theories and how the findings of the research relate to them. When it comes to looking at context and assumptions, however, I will also draw on broader theories, which participants may or may not share or agree with. Specifically these are:
  • theories of culture and practice, particularly those that attempt to explain how people operate in 'everyday', taken-for-granted contexts
  • critical theory, particularly about the way that capitalist and neo-liberal societies work (these theories were alluded to, directly or indirectly, by participants at certain times)
  • feminist theory, particularly in regard to the tension between between hierarchical, competitive approaches and cooperative, egalitarian approaches, which I believe is a key underlying tension relevant to this research project.
I am currently working on a discussion of these fields of theory as they relate to the research project, and if I have time I will also try to summarise some of that here, before circulating the project report to participants.

I am also presenting on the research at the Population Health Congress in Hobart in September. The two presentations are a 15 minute presentation on 'Health promotion, equity, environmental sustainability and politics in Victoria, Australia'; and a poster presentation 'Ecofeminist theory can help us to counter the marginal political position of health promotion'. Both are on Tuesday 8th September.


Tuesday, 12 May 2015

Useful articles on co-benefits of addressing climate change, obesity and other public health issues

Classified as: very useful research

If you haven't already seen it, the following article is very relevant for those working in health promotion and is of general interest. As far as I know it's not available publicly,  but if you have access to a library you should be able to order a copy. I've included the abstract below.



Melanie Lowe ‘Obesity and climate change mitigation in Australia: overview and analysis of policies with co-benefits’ , Australian and New Zealand Journal of Public Health [Aust N Z J Public Health], ISSN: 1753-6405, 2014 Feb; Vol. 38 (1), pp. 19-24; Publisher: Wiley-Blackwell; PMID: 24494940

Abstract

Objective: To provide an overview of the shared structural causes of obesity and climate  change, and analyse policies that could be implemented in Australia to both equitably reduce obesity rates and contribute to mitigating climate change. 


Methods: Informed by the political economy of health theoretical framework, a review was conducted of the literature on the shared causes of, and solutions to, obesity and climate change. Policies with potential co-benefits for climate change and obesity were then analysed based upon their feasibility and capacity to reduce greenhouse gas emissions and equitably  reduce obesity rates in Australia.


Results: Policies with potential co-benefits fit within three broad categories: those to replace  car use with low-emissions, active modes of transport; those to improve diets and reduce  emissions from the food system; and macro-level economic policies to reduce the over-consumption of food and fossil fuel energy.


Conclusion: Given the complex causes of both problems, it is argued that a full spectrum of complementary strategies across different sectors should be utilised.


Implications: Such an approach would have significant public health, social and environmental benefits.


Key words: obesity, climate change, political economy of health, policy analysis, co-benefits

People working in PCP health promotion are likely to be aware of this I should think. I had seen it myself before, but came across it again recently and thought how practically useful it is, for example for those who are funded to work on obesity related projects but would also like to have an environmental focus in their work. 

If you have been able to make use of this evidence in your work, I'd be really interested to hear about it. You can respond in the comments below or by contacting me direct on my email (see side panel).

Here's another relevant article, from Canada. I'll probably come across more as I work through the review I'm doing, so it may be worth checking back if you are interested in this topic.



Cheng JJ  & Berry P ‘Health co-benefits and risks of public health adaptation strategies to climate change: a review of current literature’  International Journal Of Public Health [Int J Public Health] 2013 Apr; Vol. 58 (2), pp. 305-11.



Abstract:

Objectives: Many public health adaptation strategies have been identified in response to climate change. This report reviews current literature on health co-benefits and risks of these strategies to gain a better understanding of how they may affect health.

Methods: A literature review was conducted electronically using English language literature from January 2000 to March 2012. Of 812 articles identified, 22 peer-reviewed articles that directly addressed health co-benefits or risks of adaptation were included in the review.
Results: The co-benefits and risks identified in the literature most commonly relate to improvements in health associated with adaptation actions that affect social capital and urban design. Health co-benefits of improvements in social capital have positive influences on mental health, independently of other determinants. Risks included reinforcing existing misconceptions regarding health. Health co-benefits of urban design strategies included reduced obesity, cardiovascular disease and improved mental health through increased physical activity, cooling spaces (e.g., shaded areas), and social connectivity. Risks included pollen allergies with increased urban green space, and adverse health effects from heat events through the use of air conditioning.
Conclusions: Due to the current limited understanding of the full impacts of the wide range of existing climate change adaptation strategies, further research should focus on both unintended positive and negative consequences of public health adaptation.
  
A more policy-related discussion with a focus on non-communicable disease. There is a useful grid of expected co-benefits in the article:


Friel S, Bowen K, Campbell-Lendrum D, Frumkin H, McMichael AJ and  Rasanathan K ‘Climate change, noncommunicable diseases, and development: the relationships and common policy opportunities’ Annual Review Of Public Health [Annu Rev Public Health] 2011; Vol. 32, pp. 133-47


Abstract:

The rapid growth in noncommunicable diseases (NCDs), including injury and poor mental health, in low- and middle-income countries and the widening social gradients in NCDs within most countries worldwide pose major challenges to health and social systems and to development more generally. As Earth's surface temperature rises, a consequence of human-induced climate change, incidences of severe heat waves, droughts, storms, and floods will increase and become more severe. These changes will bring heightened risks to human survival and will likely exacerbate the incidence of some NCDs, including cardiovascular disease, some cancers, respiratory health, mental disorders, injuries, and malnutrition. These two great and urgent contemporary human challenges-to improve global health, especially the control of NCDs, and to protect people from the effects of climate change-would benefit from alignment of their policy agendas, offering synergistic opportunities to improve population and planetary health. Well-designed climate change policy can reduce the incidence of major NCDs in local populations.

Sunday, 12 April 2015

Taking a stand against the glorification of war

Classified as: reflections, feminist theory

I haven't been writing much on the blog lately, but I want to take a stand on an issue that's bothering me a lot: the glorification of war in the lead-up to Anzac Day this year.

I have nothing against people who want to honour the dead, but what we are seeing is glorification of war, and it seems almost ubiquitous. Perhaps I am more aware of it than many because my tram or bike commute takes me past the Shrine of Remembrance, but the ABC is also full of it.

There seems to be no place for those who question war. The only event which questions it that I'm aware of is a reading of The One Day of the Year on 24 April, by the Independent Theatre in Adelaide (which my niece is acting in). Other than that I'm just seeing unquestioning glorification.

So this is to register my protest. Armed violence and war are not simply 'natural' to human beings and they are not the best or only way to resolve conflict. Many of my parents' generation (who were involved in World War Two) seemed to think that the lesson from war was that we should try to seek peace, but that lesson seems to have been lost in Australia.

Tomorrow I will try to put up some broader historical information about violent conflict from the readings I have been doing about patriarchy.

Update 20 April 2015
One of the necessary conditions for the glorification of war is the normalisation of war: the acceptance that war is a normal part of human existence and history. In addition, there is usually an assumption that 'our' side was justified in going into the war because the other side 'started' it, that is, that violence is the only, or at least the acceptable, response to violence.

In the case of the Anzac legend, the second assumption isn't part of the legend. There doesn't seem to be much concern or belief about whether the the First World War was justified (unlike say, the Second World War) and the Anzac battle at Gallipoli is widely accepted to have been a misguided battle. Rather, the glorification rests on a belief that Australia 'proved itself' as a nation by proving that it could fight in a war. Thus war is seen as not only normal, but heroic, regardless of cause or justification.

Contrary to this is the evidence provided by some archeologists and historians, including feminist historians, that war is not normal in a longer view.^ There is evidence that at certain times and places in history, such as the Neolithic era in the fertile parts of central Asia and Southern Europe, or in Minoan Crete, there were societies that were relatively peaceful and egalitarian, and did not make war.

The very first "pre-requisite" for health mentioned in the Ottawa Charter is peace, yet I don't often seem to hear health promoters speaking out on this issue. Indeed health promotion students are sometimes taught that the Charter is an 'utopian' document rather than something we can realistically aspire towards. Yet how much of that is because of this belief - not justified by history - that war is inevitable and normal? I would like to see more health promoters engaging with this question.

^ Key references
Riane Eisler The chalice and the blade : our history, our future 1987
Gerda Lerner The creation of patriarchy 1986


Additional works of interest:
Henryd Delcore 'New Reflections on Old Questions in the Anthropology of Gender' Reviews in Anthropology 36(2) 2007 (Discussion of some southeast Asian societies)
Cheryl Johnson-Odim 'Actions louder than words' in Sue Morgan (ed) The feminist history reader 2006 (first published in Pierson and Chaudhuri Nation, Empire, Colony 1998) (Discussion of some African societies)
Iam Armit 'Violence and society in the deep human past' British Journal of Criminology 51(3) 2011 (Discussion of early Europe)
Ian Hodder 'Women and Men at Çatalhöyük' Scientific American 290 (1) 2004 (Popular article on recent excavations at Çatalhöyük, post Lerner. Questions ubiquity of goddess worship as suggested by Lerner and Eisler, but acknowledges that neolithic society at Çatalhöyük appears to have been relatively egalitarian and peaceful)


Wednesday, 11 February 2015

Greetings for 2015 from the researcher as a tortoise!

Classified as: project update, reflections, discourse, beautiful world


Giant tortoise - from Wikipedia
Greetings to all research participants and any other interested readers for 2015. I hope you had a great break and celebrated the summer solstice.

I haven't updated the blog for some time because I'm making slow progress at present and, yep, I did have a bit of a holiday.

Back at work now. Research things I have been doing:
  • drafting a report to research participants on project findings and implications, for feedback
  • rewriting an article about climate change denial (been doing this forever so it seems)
  • writing a short report about PCP strategic priorities in 2009-12 and 2013-17
  • reading eco-feminist theory

Hoping to get the report out to research participants within the next couple of months - so I'd better get on with it. Anyway we all know the old parable about tortoises and hares I guess (hope it's true).

In the meantime, hasn't Australian politics been interesting? We live in interesting times. Yes we all have our views on particular politicians, but isn't the basic issue that many of us (hopefully the majority) want a fairer Australia?

This article by David Marr seems to cover it pretty well: 'Abbott has failed to make the one promise that could save him: to be fair'.

Interested to hear your views on this. I know commenting on blogger is hard, but it can be done! Or you can email me on valerie.kay@monash.edu if you can't comment here.


Tuesday, 11 November 2014

Project update - project report now early next year

Classified as: project update

I had planned to send a project report to all participants in October, with a survey for final comments. However it now looks as though I won't be able to do that until early next year.

So this is just a brief update, explaining the delay. It's mainly because I have been working on two tasks: one, finishing an article on climate change denial (based on a literature review) that I hope to publish; the second, a review of Primary Care Partnership (PCP) strategic plans that I'm currently working on.

While this research is on three PCPs specifically, it's valuable to put their work in the context of what all PCPs in Victoria are doing. I began looking  at the PCP strategic plans particularly for a guest presentation I did recently for Masters of Public Health students in the 'Climate Change and Public Health' unit at Monash. I am now reviewing the plans systematically to see how many PCPs are, or were, addressing climate change and equity in their strategic priorities in 2013-17 and 2009-12.

It's been a time consuming business getting all the plans from the PCPs (the 2013-17 plans no longer appear to be published on the Department of Health website as the 2009-12 plans were) and going through them all. I hope to finish it in the next week or so, and then send my preliminary conclusions out to all the PCPs for checking. When that is completed I will return to finalising the research report for those who have been involved directly in the project.

I probably won't finish the report until December, and then I have to apply to the Ethics Committee for approval of the final survey, so I don't expect that to be completed until early next year. My apologies for this delay, but I think having the information about all the PCP plans, for context, will add value to the research.