The social life of natural experiments in epidemiology and public health.

Over the twentieth century, the concept of the natural experiment has become increasingly prominent across a variety of disciplines, albeit most consequentially in epidemiology and public health. Drawing on an analysis of the scientific and medical literature, we explore the social life of the natural experiment, tracing its changing use, meaning and uptake to better understand the work done by the concept. We demonstrate how the natural experiment became central to the identity of post-war epidemiology as the discipline professionalised, turned its attention to the prevention of chronic disease and took centre stage in the field of public health. We then turn to its growing significance amid the rise of evidence-based medicine, and the new meanings natural experiments came to take on in the context of concerns about policy and evidence. Finally, we turn to the newest iteration of the natural experiment in the COVID-19 era, which saw an explosion of studies drawing on the term, albeit in ways that reveal more about the underlying politics of health than the method itself. Throughout, we illustrate that the concept of the natural experiment has always been fundamentally social and political and tied to disciplinary claims-making about evidence and what should count as such.

The 'health workforce crisis' and 'the medical manpower problem': New term, old problems.

The recent, but overdue, publication of the NHS Long Term Workforce Plan marks a welcome investment in the future sustainability of the service. The Plan includes a near doubling of medical and nursing school places, a proposed shortening of medical degrees, growth in 'new roles' including associates and apprentices, reduced overseas recruitment of staff and efforts to boost productivity and retention. While the plan was greeted with enthusiasm by many, criticisms were also numerous. This short opinion piece does not aim to add to the critique, but instead presents an argument for why, in trying to understand the persistence of the 'health workforce crisis' across the world, we might usefully think back seven decades to international efforts to address the 'medical manpower problem'. Here, the manpower concept offers a hugely useful heuristic to think through the contours of time, space and resources that characterise(d) efforts to forecast and anticipate future health needs and, therefore, staff and resourcing. Geographers, I argue, should have far more to say about these conceptual continuities in modes and means of problematisation, as well as their consequences.

'We thank you for your sacrifice': Clinical vulnerability, shielding and biosociality in the UK's Covid-19 response.

The UK response to Covid-19 has been unusually complex in its ever-shifting classifications of clinical vulnerability. By May 2020, 2.2 million people had been identified as 'clinically extremely vulnerable' (CEV) and were asked to 'shield' at home for over four months. To adhere to this strict guidance, they were enfolded within the patchy infrastructure of the 'shielding programme'. However, membership of the 'shielded list' has changed-often without warning or explanation-through time and across space. Drawing on policy and evidentiary documents, government speeches, reports, press conferences and media analysis of Covid-19 coverage between March 2020 and April 1, 2021, this paper traces the shifting delineations of clinical vulnerability in the UK response across three lockdowns. It argues that the complexities and confusions generated by the transience of the CEV category have fed into forms of biosociality that have been as much about making practical sense of government guidance as a form of mutual support amid crisis. This uncertainty has not eased as restrictions have been relaxed and vaccines rolled out. Instead, tracing individual immune response has become a burgeoning industry as 'the shielded' navigate the uneasy demands of taking 'personal responsibility' rather than being protected by 'the rules'.

Humanitarian inversions: COVID-19 as crisis.

COVID-19 is a multi-spectral crisis that has added an acute layer over a panoply of complex emergencies across the world. In the process, it has not only exposed actually-existing emergencies, but also exacerbated them as the global gaze has turned inward. As a crisis, COVID-19 straddles and challenges the boundaries between humanitarianism, development and global health - the frames and categories through which emergencies are so often understood and intervened upon. Reflection on these fundamental categories is, we argue, an important geographical endeavour. Drawing on Geoffrey Bowker's analytical lens of the 'infrastructural inversion', we explore how humanitarianism has been upended by Covid-19 along two axes that are of core concern to geographers: (1) the spatial; and (2) the temporal. We first contextualise current debates on the humanitarian endeavour and its future within recent geographical research. We then set out the complex structure by which COVID-19 has been both imagined and intervened upon as a humanitarian emergency. In so doing, we then pave the way for a deeper empirical analysis of the spatial and temporal inversions that have been brought forth by COVID-19. The paper concludes by examining the conceptual value of the 'inversion' in developing geographical research agendas better attuned to the increasing porosity of humanitarianism, development and global health.

Epidemic confusions: On irony and decolonisation in global health.

The movement to decolonise global health is gathering pace. In its concern with the fundamental, distal causes of inequality and its call for social justice, the decolonisation movement forces us to question how global health works, for whom, where it is located, its funding practices, power asymmetries, cultures of collaboration and publication. This paper uses a new book by Harvard-based physician-anthropologist Eugene T. Richardson, Epidemic Illusions, as a point of departure for a broader analysis of the nature of global health knowledge, science, authorship, research and practice. Written in a 'carnivalesque' style, the book proceeds through a series of 'ironic (re)descriptions' to argue that global public health is an 'apparatus of coloniality'. In so doing, the book is generative of four ironic turns that we explore through the themes of guilt, humility, privilege and ambiguity. In locating these ironic turns within the broader landscape of global health, we reflect on whether the means of such a book achieve the ends of decolonisation.

Unequal ecosystems of global health authorial expertise: Decolonising noncommunicable disease.

The decolonisation agenda is gathering momentum in global health. Within this movement, one domain of analysis has been the ways in which the geographies of scholarly knowledge production (re)produce the inequities of coloniality. Drawing on the example of noncommunicable diseases (NCDs), here we deviate from this and instead examine the authorship of the key global documents that were used to ignite and mobilise the NCD advocacy agenda from 2000 to 2020. In doing so, we reflect on the changing ecosystems of authorial expertise. It shows that while the geographic distribution of expertise has broadened over time, the NCD domain remains a fairly tight and circumscribed network. Importantly this research also shows the complexities of ascribing location to expertise, a finding that speaks back to the decolonisation debate.

On the Perils of Universal and Product-Led Thinking Comment on "How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention".

Lencucha and Thow's paper offers an important addition and corrective to the burgeoning body of work in public health on the 'commercial determinants of health' in the context of non-communicable diseases (NCDs). Rather than tracing the origins of incoherence across policy sectors to the nefarious actions of industry, they argue that we need to be better attuned to the neoliberal ideologies that underpin these policies. In this commentary I explore two aspects of their argument that I find to be problematic: First, the suggestion that neoliberalism itself has some kind of deterministic or explanatory capacity across vastly different social, spatial, economic and political contexts. Second, I explore their concept of 'product-based NCD risk,' a perspective that disembodies and detaches risk from the social and structural conditions of their making.

The optics of noncommunicable diseases: from lifestyle to environmental toxicity.

Until recently, the noncommunicable disease (NCD) category was composed of four chronic diseases (cancer, cardiovascular disease, diabetes and chronic respiratory disease) and four shared, 'modifiable' behavioural risk factors (smoking, diet, physical activity and alcohol). In late 2018, the NCD category was expanded to include mental health as an additional disease outcome and air pollution as an explicit environmental risk factor. The newly-expanded NCD category connects behavioural and environmental readings of risk and shifts attention from individual acts of consumption to unequal and inescapable conditions of environmental exposure. It thus renders the increasing 'toxicity' of everyday life amid ubiquitous environmental contamination a new conceptual and empirical concern for NCD research. It also, as this paper explores, signals a new 'optics' of a much-maligned disease category. This is particularly significant as chronic disease research has long been siloed between public and environmental health, with each discipline operationalising the notion of the 'environment' as a source of disease causation in contrasting ways. Given this, this paper is positioned as a significant contribution to both research on NCDs and environmental risk, bringing these interdisciplinary domains into a new critical conversation around the concept of toxicity.

Growing old in New Towns: A call for research on health and ageing in planned urban environments.

This paper focuses on the planning of New Towns in the UK in order to explore what the design and planning of urban spaces can tell us about which populations and their health matter and are prioritized, at different points in time. We concentrate on how ageing was conceptualized, and what this tells us about how ageing societies and bodies are accounted for and understood. Through the dynamic evolution of people and place, we can also come to see that what was once viewed as health promoting can become entangled with the causes of ill health. We recommend further multidisciplinary research into the planning of future cities and urban environments.

Geographic charisma and the potential energy of Ebola.

The Ebola virus is unparalleled in its charismatic ability to ignite fear, anxiety and disgust at a scale grossly disproportionate to the number of lives it claims. As an archetypal 'Emerging Infectious Disease' (EID), this designation and the politics that have encircled it have provided Ebola with a conceptual space in which epidemiology and geography to splice together in the genesis and maintenance of its charismatic valence. Even before the West African outbreak of 2013-2016, Ebola was an 'exceptional' and 'master status' disease around which media attention mobilised to an unparalleled degree and effect. This paper argues that even if never directly conceptualised as such, Ebola is uniquely charismatic among EIDs and, more, this charisma can be understood geographically. To do so, the paper proceeds in three parts to explore how Ebola's geographic charisma emerges from: (i) it being fixed 'in place' as something innately African; (ii) fears about the virus moving 'out of place' and (iii) its 'potential energy' or the persistent unease generated by the uncertainty of when and where the virus's potential geographies will become actual.

The Binds of Global Health Partnership: Working out Working Together in Sierra Leone.

Global health partnerships (GHPs) are the conceptual cousin of partnerships in the development sphere. Since their emergence in the 1990s, the GHP mode of working and funding has mainly been applied to single-disease, vertical interventions. However, GHPs are increasingly being used to enact Health Systems Strengthening and to address the global health worker shortage. In contrast to other critical explorations of GHPs, we explore in this article how the fact, act, and aspiration of binding different actors together around the ideology and modes of partnership working produces the perpetual state of being in a bind. This is an original analytical framework drawing on research in Sierra Leone and London. We offer new insights into the ways in which GHPs function and are experienced, showing that along with the successes of partnership work, such arrangements are often and unavoidably tense, uncomfortable, and a source of frustration and angst.

The strategic geographies of global health partnerships.

Global health partnerships have been hailed as a means of addressing the global health worker shortage, bringing forth health systems strengthening and, therefore, the universal health coverage aspirations of the Sustainable Development Goals. In contrast to other critical engagements with partnerships which have tended to focus on experiences and effects of these partnerships in situ; this paper draws on the example of the UK to explore how partnership working and development agendas have become entwined. Moreover, this entwinement has ensured that GHPs are far from the "global" endeavour that might be expected of global health and instead exhibit geographies that are far more representative of the geopolitics of overseas development assistance than biomedical need.

Global Health, Geographical Contingency, and Contingent Geographies.

Health geography has emerged from under the "shadow of the medical" to become one of the most vibrant of all the subdisciplines. Yet, this success has also meant that health research has become increasingly siloed within this subdisciplinary domain. As this article explores, this represents a potential lost opportunity with regard to the study of global health, which has instead come to be dominated by anthropology and political science. Chief among the former's concerns are exploring the gap between the programmatic intentions of global health and the unintended or unanticipated consequences of their deployment. This article asserts that recent work on contingency within geography offers significant conceptual potential for examining this gap. It therefore uses the example of alcohol taxation in Botswana, an emergent global health target and tool, to explore how geographical contingency and the emergent, contingent geographies that result might help counter the prevailing tendency for geography to be side-stepped within critical studies of global health. At the very least, then, this intervention aims to encourage reflection by geographers on how to make explicit the all-too-often implicit links between their research and global health debates located outside the discipline.

La geografía de la salud ha emergido desde la "sombra de la geografía médica" para convertirse en una de las subdisciplinas más dinámicas. Sin embargo, este éxito ha significado también que la investigación sobre la salud crecientemente se haya enclaustrado dentro de este dominio subdisciplinario. Como lo explora este artículo, esto representa una potencial pérdida de oportunidad en lo que concierne al estudio de la salud global, que alternativamente ha llegado a caer dentro del dominio de la antropología y la ciencia política. Importante entre las preocupaciones de la primera son la exploración de la brecha entre las intenciones programáticas de la salud global y las consecuencias no intencionales o imprevistas de su despliegue. Este artículo sostiene que el trabajo reciente sobre contingencia dentro de la geografía presenta un significativo potencial conceptual para el examen de esa brecha. Este utiliza por lo eso el ejemplo de la tributación del alcohol en Botsuana, un propósito global emergente de la salud y herramienta para explorar de qué manera la contingencia geográfica y las geografías emergentes y contingentes que resultan podrían ayudar a contrarrestar la tendencia prevaleciente en geografía de ser soslayada dentro de los estudios críticos de la salud global. Como mínimo, entonces, esta intervención apunta a estimular la reflexión de los geógrafos sobre cómo hacer explícitos los más que frecuentes enlaces implícitos entre su investigación y los debates globales sobre salud ubicados fuera de la disciplina.

The post-2015 landscape: vested interests, corporate social responsibility and public health advocacy.

This paper explores the tensions between UN calls for private sector engagement in the post-2015 landscape and public health opposition to those 'harm industries' that are 'corporate vectors of disease' for the mounting global non-communicable disease burden. The UN's support for public-private partnership has provided industries with 'vested interests' in the propagation of unhealthy behaviours with new opportunities for the strategic alignment of their corporate social responsibility (CSR) endeavours with the post-2015 sustainable development agenda. This has galvanised public health advocates to place pressure on the World Health Organisation to formalise their ambiguous stance towards private sector involvement in public policy formation and the resultant 'conflicts of interest'. This paper critically examines the 'gathering storm' between this 'anti-corporate movement' and the alcohol industry in the increasingly politicised domain of CSR. Drawing on the example of SABMiller's Tavern Intervention Program, the paper argues that CSR represents a profound threat to the sanctity and moral authority of the public health worldview. Questions therefore need to be asked about whether the public health-led path of industry non-association will necessarily result in health improvements or just a further retrenchment of the ideological faultlines explored in the paper.

The politics of non-communicable diseases in the global South.

In this paper, we explore the emergence of non-communicable diseases (NCDs) as an object of political concern in and for countries of the global South. While epidemiologists and public health practitioners and scholars have long expressed concern with the changing global distribution of the burden of NCDs, it is only in more recent years that the aetiology, politics and consequences of these shifts have become an object of critical social scientific enquiry. These shifts mark the starting point for this special issue on 'The Politics of NCDs in the Global South' and act as the basis for new, critical interventions in how we understand NCDs. In this paper, we aim not only to introduce and contextualise the six contributions that form this special issue, but also to identify and explore three themes - problematisation, care and culture - that index the main areas of analytical and empirical concern that have motivated analyses of NCDs in the global South and are central to critical engagement with their political contours.

Alcohol control in the news: the politics of media representations of alcohol policy in South Africa.

Media coverage of the "problems" associated with alcohol is widespread in countries of the global North and now, increasingly, in those of the global South. However, despite this mounting ubiquity, there have been very few analyses either of newspaper coverage of alcohol or of media coverage of alcohol policy, especially outside Europe and North America. This article argues that given international concern with the long-term health, economic, social, and developmental consequences of risky drinking in the global South, an exploration of newspaper coverage of nascent alcohol policy in such a context is both timely and valuable. Indeed, such analyses bring to the fore the deeply contextual and contingent nature of alcohol's problematization in politics, policy, and public life. To examine these assertions, we explore the "attention allocation" processes of two South African alcohol control policies--the Western Cape Liquor Bill and the city of Cape Town's liquor bylaws--in two regional English-language newspapers between 2007 and 2011. In so doing, the article highlights the particularities of the political valence of alcohol in the South African context. Furthermore, it also draws out the tensions between alcohol as a source of livelihoods in a context of endemic unemployment and chronic poverty and alcohol as a causal factor in poverty, crime, violence, and social disintegration. In contrast to media coverage of alcohol policy in Europe and North America, this analysis of the South African press suggests that liquor consumption is far less likely to be framed as an express health risk, forcing us to question how preventative policy efforts should best proceed.

Shifting blame/selling health: corporate social responsibility in the age of obesity.

This paper examines how and why health has become a Corporate Social Responsibility (CSR) strategy for the global food and drink industry (FDI) in the context of current governmental and public calls to address mounting obesity rates. It argues that, despite the current prominence of health within CSR, there has not been a reciprocal interest by those adopting sociological approaches to the study of health and illness in the implications of this strategic uptake of health or in the viability and legitimacy of the state's own public health role. This omission is addressed through an empirical exploration of three contentions: first, that health and wellbeing may be used to secure brand value and consumer goodwill at a time when mounting obesity rates demand new levels of accountability from the FDI. Secondly, that the food industry, through CSR, may promote a narrow epidemiological understanding of obesity, shifting blame from 'foods' to 'diet' and from 'diet' to 'sedentarism'. Thirdly, that CSR reporting and its associated practices have enabled the food industry to assume some responsibility for obesity prevention, thereby problematising the state's role in addressing its own 'public health' crisis.