Body weight management and dilemmas of health responsibility for vulnerable groups in the changing Danish welfare state: a comparative case analysis

[Theoretical and practical challenges of proportionate universalism: a reviewAnálise dos desafios teóricos e práticos de universalismo proporcional]

OBJECTIVE

In 2010, the principle of proportionate universalism (PU) has been proposed as a solution to reduce health inequalities. It had a great resonance but does not seem to have been widely applied and no guidelines exist on how to implement it. The two specific objectives of this scoping review were: (1) to describe the theoretical context in which PU was established, (2) to describe how researchers apply PU and related methodological issues.

METHODS

We searched for all articles published until 6th of February 2020, mentioning "Proportionate Universalism" or its synonyms "Targeted universalism" OR "Progressive Universalism" as a topic in all Web of Science databases.

RESULTS

This review of 55 articles allowed us a global vision around the question of PU regarding its theoretical foundations and practical implementation. PU principle is rooted in the social theories of universalism and targeting. It proposes to link these two aspects in order to achieve an effective reduction of health inequalities. Regarding practical implementation, PU interventions were rare and led to different interpretations. There are still many methodological and ethical challenges regarding conception and evaluation of PU interventions, including how to apply proportionality, and identification of needs.

CONCLUSION

This review mapped available scientific literature on PU and its related concepts. PU principle originates from social theories. As highlighted by authors who implemented PU interventions, application raises many challenges from design to evaluation. Analysis of PU applications provided in this review answered to some of them but remaining methodological challenges could be addressed in further research.

Right by your side? - the relational scope of health and wellbeing as congruence, complement and coincidence

Purpose: Although the relation between health and well-being is deemed conceptually important, it is diverse and intractable. The aim of this small-scale study is to reveal different possible relations of the concepts of health and well-being, interrelation of these relations and consequences of implied normative expectations in the relations.

Method: Primary data originate from course literature in Swedish health education. Additional data included scientific articles and website content (collected from WHO and via Google) and were analysed with objective hermeneutics.

Results: Congruent, complementary and coincident relations were found. In congruence, health and well-being are synonyms. Complement relations contain: “quality” with well-being as overall aim, “plurality” with health as umbrella term, “well-being as positive health”, “enhancement” with health and well-being potentially boosting each other and “subjectivity/objectivity” with objective health complemented by subjective well-being. In coincidence, health and well-being are counter-intuitively regarded unlinked, which may challenge expectations concerning health promotive activities. Independent and affiliated relations were identified.

Conclusion: In congruence and complement, health and well-being are mostly aligned whereas in coincidence, their quality may be decoupled. In the discursive climate of second modernity, the relation of health and well-being tends to conflict and ambiguous coincidence, demanding ambiguity tolerance as key skill.

Hybridity and change in cooking skills in everyday life: Conceptual contributions from a study of cooking with meal-box schemes

In a sizeable amount of public health and nutrition food research there seems to be an assumption that there has been a decline in cooking and cooking skills alongside an increase in the consumption of convenience-based meals. However, existing empirical sociological research on food in everyday life does not tend to support this picture. Instead, cooking and cooking skills in current everyday life are characterized by hybridity and change, rather than mere decline. Thus, it is necessary to draw upon an understanding of cooking skills that takes this empirically based understanding of cooking skills into account. In the article, four elements of skillfulness in cooking are suggested that can improve the analytical understanding of cooking skills in all kinds of food research. The four suggested cooking skills elements are the following: Balancing rules and improvisation; handling planning and organizing flexibly; assembling meals from different sources; and handling normative food issues. The analysis and conceptual suggestions of the article is based upon an empirical qualitative study of use of meal-box schemes in Denmark, and is informed by a practice theoretical perspective.

Linking socioeconomic disadvantage to healthiness of food practices: Can a practice-theoretical perspective sharpen everyday life analysis?

Food is one of the key themes in public health policy and debates over inequalities in health. In this article, we argue that more research is needed to understand how socioeconomic disadvantage is translated into low degrees of healthiness. We suggest that everyday life analysis may be sharpened by way of drawing upon a practice-theoretical perspective on the mundane processes involved in this translation. We base our suggestion on a small review of three strands in the literature on social inequality, food and health, namely public health research, lifestyle analysis and everyday life studies, and we take our analytical starting point in the latter. In the article, we argue that a practice-theoretical perspective may enable research in social disadvantage and healthiness of food that describes and interprets variants in the conditioned agency, which cuts cross the multiplicity of different practices that make-up people's daily lives. Finally, we suggest that a stronger focus on social interaction and social hierarchy would adapt a practice-theoretical perspective further to empirical analysis in the field of food, health and socioeconomic disadvantage.

Theoretical and practical challenges of proportionate universalism: a review

OBJECTIVE

In 2010, the principle of proportionate universalism (PU) has been proposed as a solution to reduce health inequalities. It had a great resonance but does not seem to have been widely applied and no guidelines exist on how to implement it.The two specific objectives of this scoping review were: (1) to describe the theoretical context in which PU was established, (2) to describe how researchers apply PU and related methodological issues.

METHODS

We searched for all articles published until 6th of February 2020, mentioning "Proportionate Universalism" or its synonyms "Targeted universalism" OR "Progressive Universalism" as a topic in all Web of Science databases.

RESULTS

This review of 55 articles allowed us a global vision around the question of PU regarding its theoretical foundations and practical implementation. PU principle is rooted in the social theories of universalism and targeting. It proposes to link these two aspects in order to achieve an effective reduction of health inequalities. Regarding practical implementation, PU interventions were rare and led to different interpretations. There are still many methodological and ethical challenges regarding conception and evaluation of PU interventions, including how to apply proportionality, and identification of needs.

CONCLUSION

This review mapped available scientific literature on PU and its related concepts. PU principle originates from social theories. As highlighted by authors who implemented PU interventions, application raises many challenges from design to evaluation. Analysis of PU applications provided in this review answered to some of them but remaining methodological challenges could be addressed in further research.

Unruly bodies: resistance, (in)action and hysteresis in a public health intervention

Schools have long been sites of public health intervention on the bodies of children. Increasingly, these interventions also act on the bodies of educators. Our case study is an intervention focused on the future health of children’s bodies (‘The Daily Mile’), which, we argue, also resulted in the surveillance of educators’ bodies. We draw on Bourdieu’s concept of hysteresis to explore how those bodies can become ‘unruly’ during implementation, in both resisting and being positioned as reluctant. Hysteresis, an under-utilised Bourdieusian concept, proved useful for exploring embodiment at a point when there were mismatches between habitus and the changing field of primary education. We show how the non-participation of some actors (e.g. teachers) was positioned as part of a broader resistance to health as a dominant value, whereas non-participation of less-privileged social actors (e.g. Teaching Assistants) was problematised in different ways. We argue that attending to moments of hysteresis, in which the changing symbolic values of physical capital become explicit, surfaces not just how dominant discourses (e.g. healthism) become reproduced in fields, but also how they change and are resisted, and with what effects.