Towards a nuanced understanding of health‐supportive place using composite research methods

Chronic non‐communicable diseases comprise a major challenge for health in contemporary Australia and across the globe and, while various factors are at play, personal choices in behaviour and lifestyle are significant. The physical make‐up and ongoing management of the places where we live positively and negatively influences these lifestyle choices and subsequent health outcomes. However, responses—in research, policy, built environment design, construction, and management—frequently fail to recognise the intricacies of this people‐place‐behaviour nexus largely because those responses are highly focused and empirical. Rather, the health‐supportive environments needed to address the current chronic disease epidemic also require additional—networked, nuanced, and intuitive—understandings. Responding to that need, the study described in this paper took a comprehensive view of what constitutes a health‐supportive built environment. We detail the composite methods employed—built environment audits, interviews, and focus groups—all of which are available for use by others in similar situations. Then, using two case study examples, we reflect upon how our methodology revealed otherwise hidden aspects of the extent to which the study sites supported or hindered health‐supportive behaviours and responses. These results suggest intervention actions for policy makers and practitioners that will help them respond to the complex needs of communities in creating a health‐supportive environment.     

ON FUTURES AND ENDINGS: NARRATOLOGICAL REFLECTIONS ON CONTEMPORARY FORMS OF CRISES*

The article examines the changing relationship of the present to the future from a narratological perspective. It argues that three dominant narrative schemas structure the contemporary experiences of temporality in the Western social imaginary: the modern crisis narrative, the apocalyptic narrative, and the chronic crisis narrative. In its first part, the article shows how the modern sense of crisis, which emerged in the late eighteenth century, sedimented into a powerful narrative template by knitting together the past, the present, and the future into a unified plot. The second part focuses on the resurgence of apocalyptic stories in the Western social imaginary and humanities discourse. The final part highlights the special contribution of aesthetics of precariousness to the Western imaginary of time and temporality. It argues that the “chronic crisis narrative” deflates the teleological narrative arc of the modern crisis paradigm while also shunning the end-time discourse of the apocalyptic narrative.     

Sinus and meningeal vessel pattern changes induced by artificial cranial deformation: A pilot study

This study explores the changes in sinus and meningeal vessel patterns caused by various types of artificial cranial deformation. Endocranial casts were prepared from six crania exhibiting one of three types of deformation (lambdoid, parallelo-fronto-occipital and fronto-vertico-occipital), as well as from 15 undeformed crania. Vessel and sulcus patterns of each cranium were analysed and these patterns included depth of impressions, size and number of vessels, and directional pathways of vessels. Comparisons were made within and between the different deformation types. The results indicated that deformation has an effect upon the pattern, shape and depth of vessel impressions. Vessels tended to be flattened in the areas directly affected by cranial deformation, and there was often compensatory enlargement of other vessels. Further, three of the six artificially deformed crania exhibited enlarged occipital/marginal sinuses, suggesting that this trait is developmentally plastic and greatly influenced by environmental factors.     

Health status of the Venda,a post‐antibiotic community in rural South Africa

This paper examines the health status of a rural African community during the emergence of Westernisation. A total of 157 skeletons, which included 120 adults (55 males and 51 females), 37 juveniles, and 14 individuals of unknown age, were analysed. Date of death ranged from 1910 to 1999, with the majority of individuals (52%) being buried after 1960. The bones were examined for infectious diseases, trauma and degenerative changes. More than half of the individuals in the sample had no pathological lesions on their skeletal remains. No cribra orbitalia was present. One case of leprosy and three cases of osteomyelitis were recorded. The most common findings were osteophytes on the vertebral bodies (syndesmophytes) (17%) and osteoarthritis (7%). The low occurrence of chronic disease is unexpected given that malaria was endemic and intestinal worms were common. Explanations for these results include adequate intake of iron from dietary sources, death from acute infectious diseases, administration of antibiotics, and poor preservation of adult skeletal remains. Copyright © 2007 John Wiley & Sons, Ltd.     

Bridging the gap between forensic anthropology and osteoarchaeology—a case of vascular pathology

We report on two cases of similar bony lesions and emphasize the importance of cooperative work between forensic anthropology and forensic pathology. A fairly well preserved cadaver of an old woman was autopsied by a forensic team at the National Institute of Forensic Medicine in Portugal. Although age at death and sex were easily determined, there was insufficient other evidence for personal identification. However, the female revealed severe and extensive lesions in both lower legs and these were useful for determining personal identity. Here we describe the pathological findings, consistent with venous chronic insufficiency. The woman's family subsequently confirmed she suffered from this condition. Furthermore, they informed us of varicose ulcers, which also were suspected by the ties found, in both her legs, during autopsy. A long history of venous chronic insufficiency was subsequently found in her medical records. We compare these forensic findings to the bony pathologies of a male skeleton from the Coimbra Identified Skeletal Collection not previously diagnosed. We argue that these two cases represent the same pathological condition. Without the medical forensic work, the skeletal remains of the second case might not have been positively identified. The benefits of cooperative work between medical and anthropological forensic specialists are reinforced leading to resolution of otherwise unidentified skeletal pathological conditions. Copyright © 2004 John Wiley & Sons, Ltd.     

Unsafe drinking water quality in remote Western Australian Aboriginal communities

Chronic kidney disease (CKD) is important in the fields of public health and health geography because of its heavy burden on the health system and high cost of treatment in its advanced stages. The causes of CKD are associated with diabetes and hypertension, but in some parts of the world, the disease occurs in the absence of these factors. Researchers identify this condition as CKD of “unknown” causes (CKDu). CKDu is a multi‐factored health problem and one suspected causal factor is contaminated drinking water. The disease occurs globally but is found in particularly high concentrations among people of certain ethnic and disadvantaged social groups living in very different locations around the world. CKD has become endemic in Western Australia where hospital admissions for Aboriginal people requiring renal dialysis or treatment for diabetes are much higher than for the general population. The possible proportions of CKDu cases among the CKD patients are unknown. This study examines the drinking water quality among communities such as these. Water chemistry analysis in these areas indicates that the nitrate and uranium content greatly exceed officially recommended levels. Most of these communities rely on raw groundwater to supply their domestic needs, and it is very likely that the people are unwittingly ingesting high levels of nitrates and uranium, probably including uranyl nitrates. Very few such remote communities have access to treated drinking water, and cost‐effective water treatment systems are required to provide potable water at the local scale.     

Exploring the daily geographies of diverse men caregiving for family members with multiple chronic conditions

Within Canada, it has been estimated that almost half of all family, also known as informal, caregivers are now men. However, the contributions and experiences of these caregiver men have received relatively little attention, particularly from geographies of care and caregiving researchers. This analysis hopes to shed light on the unique, yet diverse, experiences of men caregiving for persons with multiple chronic conditions in Canada. Drawing on semi-structured interviews with nineteen men caregivers in two provinces of Canada, this analysis aims to explore how social and physical axes of difference shape men’s daily lived geographies when providing care. Our thematic findings reveal that caregiving is experienced by participants at the three scalar levels of the body, the home and the community. Our intersectional analysis reveals that at each scalar level, being a man was not the only variable shaping caregiving experiences. Rather, it was also age, physical capacity, culture, socio-economic status, marital status, housing status, social connectedness, relationship to the care recipient and care recipients’ physical and mental capacity that shaped experiences and meanings of place during the caregiving process. Accounting for this diversity at each scale, our findings point to the unique stresses and challenges experienced. We conclude by emphasizing the significance in acknowledging the diverse challenges that exist for all caregivers in order to inform comprehensive and inclusive social policy that ultimately will produce equitable caregiver supports.