Submited on: 07 Mar 2011 06:51:06 AM GMT
Published on: 07 Mar 2011 06:19:51 PM GMT
 

1 Is the subject of the article within the scope of the subject category? Yes
2 Are the interpretations / conclusions sound and justified by the data? Partly
3 Is this a new and original contribution? Yes
4 Does this paper exemplify an awareness of other research on the topic? Yes
5 Are structure and length satisfactory? Yes
6 Can you suggest brief additions or amendments or an introductory statement that will increase the value of this paper for an international audience? No
7 Can you suggest any reductions in the paper, or deletions of parts? No
8 Is the quality of the diction satisfactory? Yes
9 Are the illustrations and tables necessary and acceptable? Yes
10 Are the references adequate and are they all necessary? Yes
11 Are the keywords and abstract or summary informative? Yes
  • Other Comments:

    This paper is concerned with both the lack of headway in the health of populations around socially complex health issues, and with the lack of influence the health of the population has on all public affairs.  A New Public Health agenda is promoted, although not explicitly, that moves population health research and policy away from the dominance of the biomedical paradigm that focuses on physical disease and constructs health as the absence of disease, and towards the social paradigm in which health is constructed as a complex product of environmental and social factors. A growing concern in the health field to counter social trends that are harmful to health is acknowledged in the paper but this concern is noted as not yet affecting the ‘dominant scientific and political perspectives on population health’.   The main strengths of the paper lie in the detailed exposure of the inadequacy of the current concept of health restricted as it is by the orthodox use of the biomedical paradigm, however the method suggested to shift towards the use of the social paradigm is problematic.

     

    In particular, the paper calls for research within the discipline of population health that exposes the cultural values of materialism and individualism as important cultural determinants of health.  I argue that the academic discipline of population health that specialises in research on the biomedical, social, and cultural determinants of health, carries out this research within a highly influential and under-explored political context.  Although the paper is entitled, the science and politics of population health, it under-explores this political context of the discipline and this is critical to the paper’s central argument.

     

    The political context of population health is a tangle of past and present interests, power relations, and values including; a biomedically dominated past, disease and risk-specific researchers and academic institutions, and a growing funding pressure to create policy-relevant research for a policy context that constructs a dichotomy between science and values, and focuses on specific diseases and risk factors rather than the social or cultural determinants of health.   Operating within this political context, population health as a discipline strives to produce value-neutral, empirical or interpretive science fit for use within biomedically-biased, individual-focused policy frameworks.  When the research is not shaped to the framework, at times, the policy makers will shape the research, for example, through cherry picking from a range of mainly social solutions, to find those that focus on individual behaviour. 

     

    It is within this context that research on cultural determinants such as time pressure or parenting strategies are studied as value-neutral factors that produce value-neutral empirical and interpretive scientific research that strives to be policy-relevant. Such research does not shy away from the complexity of social health problems, it rides the edge of what is valid or useable within the political context of both research and policy, and acts to promote the new public health agenda by calling attention to the importance of sociocultural and environmental factors and contexts.   Such research by its presence in public health literature and forums chips away at the policy framework even when it is ignored within the development of specific policy initiatives.  Currently such research is under-supported by the dearth of open and critical accounts of the political context in which research and policy are formed. 

     

    In the political context of the discipline of population health and within determinants of health research, cultural factors such as time pressure are framed as distal but measureable factors but cultural values are deemed less measureable and more distal.  I would also argue that cultural values are too obviously value-laden to be safely and validly measured and explained within determinants of health research.  This is not to say these concepts cannot be scientifically studied using rigorous methods, but that critical analyses that openly explore the political nature and context of such values would be essential to empower any explanatory account.  I argue that such research belongs outside determinants of health research and probably outside the discipline of population health itself. 

     

    When the political context of the discipline of population health is explored, it is no longer surprising that, as the author and others have noted, culture and values are often only briefly noted as determinants in population health strategic documents, but not further examined.   To move the policy framework toward the use of social, cultural and environmental explanations, the current need is for inter-disciplinary research – population health with political science, sociology, policy studies among other disciplines – to critically explore the political context of both research and policy including values, interests and power relations.  Such research would not be policy relevant, but policy-framework challenging and would be a better bet to move the new Public Health agenda forward and reap some of the positive consequences the author has outlined.

     

    Bacchi, C. (2009). Analysing Policy: What's the problem represented to be? Sydney, Pearson Australia. Broom, D. (2008). "Hazardous good intentions? Unintended consequences of the project of prevention." Health Sociology Review 17(2): 129-140. Judge, K. (2008). "Politics and health: policy design and implementation are even more neglected than political values?" European Journal of Public Health 18(4): 355-356. Lin, V. and S. Fawkes (2007). "Health promotion in Australia: twenty years on from the Ottawa Charter." Promotion & Education 14: 203-208. Navarro, V. (2008). "Politics and health: a neglected area of research: A scarcity of studies." European Journal of Public Health 18(4): 354-356.

  • Competing interests:
    -
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    I am a PhD candidate, and have been reading on the prevention of chronic disease for two years and have around 6 years of full time equivalent experience in health policy and administration.

  • How to cite:  Kinmonth H A.The Science and Politics of Population Health: Giving Health a Greater Role in Public Policy[Review of the article 'The Science and Politics of Population Health: Giving Health a Greater Role in Public Policy ' by Eckersley R].WebmedCentral 2011;2(9):WMCRW00949
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1 Is the subject of the article within the scope of the subject category? Yes
2 Are the interpretations / conclusions sound and justified by the data? Yes
3 Is this a new and original contribution? Yes
4 Does this paper exemplify an awareness of other research on the topic? Yes
5 Are structure and length satisfactory? Yes
6 Can you suggest brief additions or amendments or an introductory statement that will increase the value of this paper for an international audience? Yes
7 Can you suggest any reductions in the paper, or deletions of parts? No
8 Is the quality of the diction satisfactory? Yes
9 Are the illustrations and tables necessary and acceptable? Yes
10 Are the references adequate and are they all necessary? Yes
11 Are the keywords and abstract or summary informative? Yes
  • Other Comments:

    This thoughtful and insightful article draws on a diverse range of theoretical and policy literatures to present a compelling case for a broader framing and understanding of the scope of population health concerns and drivers.

     

    The article begins by arguing that, health policy and practice paradigms, service delivery and funding models remain dominated by a relatively narrow focus on physical health outcomes.  This is despite an extensive body of evidence pointing to the significant contribution of mental health challenges to the global burden of disease.  Recent political debates in Australia about the difficulty of securing adequate funding for mental health programs are only one of many examples of the ways in which this unhelpful distinction between physical and mental health is continuing to inform and drive policy priorities and resource allocation decisions.  This section of the article might be further strengthened by a brief exploration of the importance of a focus on the promotion of ‘mental health’ as well as the prevention of ‘mental illness’, along with related debates about the value of employing alternative conceptual discourses such as ‘emotional wellbeing’.

     

    The article also correctly notes the tendency for even the more progressive conceptualizations of population health to focus primarily on socio-economic determinants, with considerably less attention paid to environmental and cultural relationships and trends. The rapidly expanding evidence pointing to the profound implications of climate change for population health outcomes provides one of many potentially strong arguments for supporting the author’s view that environmental and ecological determinants should be included in the brief for future research programs and reports on global population health trends and determinants. The case for work which deepens understanding of the health implications of the ongoing centrality of materialist and individualist cultural values and assumptions is also extremely strong.  On this issue it may also be worth bearing in mind and reflecting on the diverse – and contested - range of meanings attached to the term ‘culture’. 

     

    A particular strength of the article is the author’s commitment to draw out and explore the implications of these reflections for the challenges and issues facing young people – as well as for the important work underway in many settings to develop and implement new and broader measures of wellbeing and ‘progress’. 

     

    This is a wide ranging and valuable contribution to the rapidly growing literature exploring the policy implications of an alternative political paradigm based on social and ecological wellbeing and sustainability.  The article raises a host of challenging and complex questions which merit further consideration and debate.

     

     

     

     

  • Competing interests:
    No
  • Invited by the author to review this article? :
    Yes
  • Have you previously published on this or a similar topic?:
    Yes
  • References:
    Wiseman, J. and Edwards, T. ?Climate change, resilience and transformation: Challenges and opportunities for local communities?, in I. Weissbecker (ed.) Climate Change and Human Wellbeing: Global Challenges and Opportunities, Springer, NY, July 2011. Wiseman J. and Nolan T. 2008. ?Climate transformation: the next revolution in public health?? Journal of Public Health. 30 (4): 362-363. Bourke, S., Blashki, G., Fritze, J. and Wiseman, J. ?Hope, despair and transformation: climate change and the promotion of mental health ad wellbeing?, International Journal of Mental Health Systems, 2: 13, 2008 Brasher, K. and Wiseman, J. ?Community Wellbeing in an unwell world?, Journal of Public Health Policy, Vo. 29, No. 3, 2008, pp. 353-365 McMahon, J., Wiseman, J. and Zubrick, S. ?Individual, organisational and community level indicators of mental health and wellbeing?, Health Promotion Journal of Australia, December 2007 Wiseman, J. ?Growing Victoria Together?: The challenges of integrating social, economic and environmental policy directions at State and regional levels in A. Rainnie and M. Grobbelaar. eds New Regionalism in Australia', Ashgate, London, 2005
  • Experience and credentials in the specific area of science:

     John Wiseman is a Professorial Fellow with the Melbourne Sustainable Society Institute, University of Melbourne.

    John has worked in a wide range of public sector, academic and community sector settings including as Director of the McCaughey Centre, VicHEalth Centre for the Promotion of Mental Health and Community Wellbeing, School of Population Health, University of Melbourne (2006-2010); Professor of Public Policy, Victoria University (2003-2006); and Assistant Director, Policy Development and Research, Victorian Department of Premier and Cabinet (2000-2003).

     

  • How to cite:  Wiseman J . The Science and Politics of Population Health: Giving Health a Greater Role in Public Policy[Review of the article 'The Science and Politics of Population Health: Giving Health a Greater Role in Public Policy ' by Eckersley R].WebmedCentral 2011;2(7):WMCRW00859
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1 Is the subject of the article within the scope of the subject category? Yes
2 Are the interpretations / conclusions sound and justified by the data? Yes
3 Is this a new and original contribution? Yes
4 Does this paper exemplify an awareness of other research on the topic? Yes
5 Are structure and length satisfactory? Yes
6 Can you suggest brief additions or amendments or an introductory statement that will increase the value of this paper for an international audience? No
7 Can you suggest any reductions in the paper, or deletions of parts? No
8 Is the quality of the diction satisfactory? Yes
9 Are the illustrations and tables necessary and acceptable? Yes
10 Are the references adequate and are they all necessary? Yes
11 Are the keywords and abstract or summary informative? Yes
  • Other Comments:

    I have only favourable comments to make on this valuable paper, the publication of which I entirely endorse.  Eckersley’s arguments about the need for population health approaches to be re-thought are cogently argued. He effectively challenges some of the dominant orthodoxies which actually hinder broader understandings of what creates and damages health and wellbeing, so this article needs to reach the public health community. He convincingly explains the relevance of mental health and illness to population health and the problems with current (socio-economic) conceptualisations of the social determinants of health.  His explanation of how and why epidemiology currently fails to grasp the importance of 'culture' is particularly timely.  Few in public health truly understand the distinction between social structure and culture, so the influence of the latter tends to be profoundly under-estimated.  Importantly for an international readership, he explains the relevance of the contemporary 'dis-eases' of affluent Western societies to the developing world. He is to be congratulated, I believe, on this important and well-written paper.

  • Competing interests:
    No
  • Invited by the author to review this article? :
    Yes
  • Have you previously published on this or a similar topic?:
    Yes
  • References:
    Hanlon P, Carlisle S, Hannah M, Reilly D and Lyon A (2011) Making the case for a ?fifth wave? in Public Health. Public Health, 125(1): 30-36. doi: 10.1016/j.puhe.2010.09.004 Hanlon, P and Carlisle, S (2010) Re-orienting public health: rhetoric, challenges and possibilities for sustainability. Critical Public Health, 20: 3, 299-309. doi: 10.1080/09581596.2010.482581 Hanlon P, Carlisle S, Reilly D, Lyon A, Hannah M (2010) Enabling well-being in a time of radical change: Integrative public health for the 21st century. Public Health; 124: 305-312. doi:10.1016/j.puhe.2010.03.014 Carlisle S, Henderson G and Hanlon P (2009) ?Wellbeing?: a collateral casualty of modernity? Social Science & Medicine, 69; 1556-1560. Hanlon P and Carlisle S (2009) ?Is Modern Culture bad for our well-being?? Global Health Promotion, 16(4): 27?34. doi: 10.1177/1757975909348113 Hanlon P and Carlisle S (2008) Do we face a third revolution in human history? If so, how will Public Health respond? Journal of Public Health, 30(4) 355-361. Carlisle S and Hanlon P (2008) ?Wellbeing? as a focus for public health? A critique and defence. Critical Public Health, 18(3); 263-70. Hanlon P and Carlisle S (2008) What can the emerging science of well-being tell psychiatry? (And why might psychiatry listen?) Journal of Advances in Psychiatric Treatment, 14: 312-319. Carlisle S, Hanlon P and Hannah M (2008) Status, taste and distinction in consumer culture: acknowledging the symbolic dimensions of inequality. Public Health, 122, 631-637. Carlisle S and Hanlon P (2007) Well-being and consumer culture: a different kind of public health problem? Health Promotion International, 22(3) pp 261-268. Carlisle S and Hanlon P (2007) The complex territory of well-being: contestable evidence, contentious theories and speculative conclusions. Journal of Public Mental Health 6(2) 8-13.
  • Experience and credentials in the specific area of science:

    My colleagues and I have been engaged in studying the relationship between positive mental health, well-being and 'modern' culture for several years. We have published widely on these issues, and their relationship to contemporary public health.

  • How to cite:  Carlisle S .The Science and Politics of Population Health: Giving Health a Greater Role in Public Policy[Review of the article 'The Science and Politics of Population Health: Giving Health a Greater Role in Public Policy ' by Eckersley R].WebmedCentral 2011;2(3):WMCRW00614
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1 Is the subject of the article within the scope of the subject category? Yes
2 Are the interpretations / conclusions sound and justified by the data? Yes
3 Is this a new and original contribution? Yes
4 Does this paper exemplify an awareness of other research on the topic? Yes
5 Are structure and length satisfactory? Yes
6 Can you suggest brief additions or amendments or an introductory statement that will increase the value of this paper for an international audience? Yes
7 Can you suggest any reductions in the paper, or deletions of parts? No
8 Is the quality of the diction satisfactory? Yes
9 Are the illustrations and tables necessary and acceptable? Yes
10 Are the references adequate and are they all necessary? Yes
11 Are the keywords and abstract or summary informative? Yes
  • Other Comments:

    Thanks for sending this paper for review,I found it very strongly structures paper with sound background knowledge,good discussin and conclusion.

    I agree with the author about his statment "This paper seeks to change this situation. In essence, it argues that a broad view of population health and its social determinants – socio-economic, cultural and environmental - challenges the legitimacy of the dominant worldview or paradigm of material progress, and supports the alternative, sustainable development. The contest between the two models, or narratives, of progress has been framed largely in economic and environmental terms, and the social dimension has been neglected. Population-health research can help to correct this distortion."

    The references are relevant an dup to the mark.I congratulate the author for publishing such a good article.

  • Competing interests:
    NIL
  • Invited by the author to review this article? :
    No
  • Have you previously published on this or a similar topic?:
    No
  • References:
    None
  • Experience and credentials in the specific area of science:

    10 years

  • How to cite:  Gilani S A.The Science and Politics of Population Health: Giving Health a Greater Role in Public Policy[Review of the article 'The Science and Politics of Population Health: Giving Health a Greater Role in Public Policy ' by Eckersley R].WebmedCentral 2011;2(3):WMCRW00587
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