What kind of a problem is loneliness? Representations of connectedness and participation from a study of telepresence technologies in the UK.

Loneliness is represented in UK policy as a public health problem with consequences in terms of individual suffering, population burden and service use. However, loneliness is historically and culturally produced; manifestations of loneliness and social isolation also require social and cultural analysis. We explored meanings of loneliness and social isolation in the UK 2020-2022 and considered what the solutions of telepresence technologies reveal about the problems they are used to address. Through qualitative methods we traced the introduction and use of two telepresence technologies and representations of these, and other technologies, in policy and UK media. Our dataset comprises interviews, fieldnotes, policy documents, grey literature and newspaper articles. We found loneliness was represented as a problem of individual human connection and of collective participation in social life, with technology understood as having the potential to enhance and inhibit connections and participation. Technologically-mediated connections were frequently perceived as inferior to in-person contact, particularly in light of the enforced social isolation of the COVID-19 pandemic. We argue that addressing loneliness requires attending to other, related, health and social problems and introducing technological solutions requires integration into the complex social and organisational dynamics that shape technology adoption. We conclude that loneliness is primarily understood as a painful lack of co-presence, no longer regarded as simply a subjective experience, but as a social and policy problem demanding resolution.

'Ending AIDS' between comparison and commensuration and the role of global health indicators.

The use of targets and indicators in global health has become ubiquitous within global health and disease elimination programmes. The drive to 'end AIDS' has become a global flagship endeavour, including nation-states, donor organisations, NGOs, pharmaceutical companies, medical researchers, and activists. Almost synonymous with the campaign of ending AIDS is UNAIDS' 90-90-90 targets. Beyond indicators' role in neoliberal global health, an essential aspect of indicators and quantitative metrics is their ability to provide a basis for measurements and comparability across time and between different actors and entities. These processes are based on what has been called, commensuration, visual simplification, and serialisation. This article seeks to provide an account of how we can think about indicators in the drive to end AIDS as doing work that is contingent upon commensuration, simplification, and serialisation. The argument is that by attending to issues of commensuration, visual simplification, and serialisation we are better able to see how we risk erasing and foreclosing other forms of conceptualising what the end of AIDS could be. Logics of quantification risks erasing and foreclosing other qualitative aspects of the HIV epidemic as well as obscuring various epistemological tensions inherent in counting towards the end of AIDS.

Digital health and human rights of young adults in Ghana, Kenya and Vietnam: a qualitative participatory action research study.

INTRODUCTION: Digital health offers the potential to strengthen health systems in low- and middle-income countries. However, experts have warned about threats to human rights. METHODS: We used qualitative methods to investigate how young adults in Ghana, Kenya and Vietnam use their mobile phones to access online health information and peer support, and what they see as the effect on their human rights. We applied a transnational participatory action research approach. Global and national networks of people living with HIV, AIDS activists, young adults and human rights lawyers participated in study design, desk review, digital ethnography, focus group discussions, key informant interviews and qualitative analysis. RESULTS: We interviewed 174 young adults ages 18-30 in 24 focus groups in 7 cities in Ghana, Kenya and Vietnam, and held 36 key informant interviews with national and international stakeholders. Young adults reported predominantly using Google, social media and social chat groups for health information. They emphasised reliance on trusted peer networks, and the role of social media health champions. However, gender inequalities, class, education and geography create barriers to online access. Young adults also disclosed harms linked to seeking health information online. Some described anxiety about phone dependence and risk of surveillance. They called for a greater voice in digital governance. CONCLUSION: National health officials should invest in young adults' digital empowerment, and engage them in policy to address benefits and risks of digital health. Governments should cooperate to demand regulation of social media and web platforms to uphold the right to health.

Pandemic modelling and model citizens: Governing COVID-19 through predictive models, sovereignty and discipline.

Pandemic modelling functions as a means of producing evidence of potential events and as an instrument of intervention that Tim Rhodes and colleagues describe as entangling science into social practices, calculations into materializations, abstracts into effects and models into society. This article seeks to show how a model society evinced through mathematical models produces a model not only for society but also for citizens, showing them how to act in a certain model manner that prevents an anticipated pandemic future. To this end, we analyse political speeches by various Norwegian ministers to elucidate how various model-based COVID-19 responses enact a 'model citizen'. Theoretically, we combine Rhodes et al.'s arguments with Foucault's concepts of law, discipline and security, thus showing what a model society might imply for the model citizen. Finally, we conclude that although the model society is largely informed by epidemiological models and liberal biopolitics that typically place responsibility on individual subjects, sovereign state power remains manifestly present in the speeches' rhetoric.

Discipline for pleasure: a new governmentality of HIV prevention.

This article explores recent HIV prevention campaigns for pre-exposure prophylaxis (PrEP), focusing on how they integrate pleasure and desire in their calls for self-discipline through a continual use of pharmaceuticals. This emerging type of health promotion, here represented by ads promoting the preventive use of pharmaceuticals, no longer simply approaches target groups with demands to abstain from harmful substances or practices and thus control risks, but also includes messages that recognize individuals' habits, values, and their desires for pleasure. Drawing on Foucault's work concerning discipline and security, we suggest that a novel, permissive discipline is emerging in contemporary HIV prevention. Further guided by Barthes's theory of images, we analyse posters used in prevention campaigns, scrutinizing their culture-specific imagery and linguistic messages, i.e. how the words and images interact. We conclude that these campaigns introduce a new temporality of prevention, one centred on pleasure through the pre-emption and planning that PrEP enables.

From evidence-based to sustainable healthcare: Cochrane revisited.

Evidence-based healthcare is the prevailing model for healthcare services. In Cochrane's seminal thinking, political context was included with the purpose of promoting healthcare equity. However, the subsequent evidence-based healthcare models marginalized political context. In this paper, we argue that current models of evidence-based healthcare fail to respond to emerging healthcare challenges. We claim that reintegration of political context is crucial to make healthcare sustainable. Global communities are anticipating ecological crises with immense repercussions for healthcare. This prospect illustrates that healthcare models failing to integrate political context also risk neglecting some of the most relevant healthcare issues of our time.

The necropolitics of COVID-19: Race, class and slow death in an ongoing pandemic.

Achille Mbembe states that 'the ultimate expression of sovereignty resides, to a large degree, in the power and the capacity to dictate who may live and who must die […]. To exercise sovereignty is to exercise control over mortality and to define life as the deployment and manifestation of power' (Mbembe, 2003. Necropolitics. Public Culture, 15(1), 11-40. https://doi.org/10.1215/08992363-15-1-11). For Mbembe a key question is 'under what practical conditions is the right to kill, to allow to live, or to expose to death exercised?' (Mbembe, 2003. Necropolitics. Public Culture, 15(1), 11-40. https://doi.org/10.1215/08992363-15-1-11). This article will map the necropolitical underpinnings of racial and class-based health disparities and vulnerabilities in the current COVID-19 pandemic. The article will directly engage with the question of 'under what practical conditions are the right to expose to death' unfolding in the current COVID-19 pandemic. Drawing on news media representations and public health data in the UK and the U.S, the article will provide a disciplinary conjecture arguing for the importance of looking at what I call a 'state of acceptance' plays into the necropolitical dynamics of the COVID-19 pandemic.

Putting the NHS England on trial: uncertainty-as-power, evidence and the controversy of PrEP in England.

Pre-exposure prophylaxis (PrEP) (Truvada) is a medication which if taken correctly is almost entirely effective in preventing HIV infection. In regions and countries where it has been widely taken up, HIV seroconversion rates have significantly decreased. Alongside testing and treatment, it offers the very real prospect of ending HIV infections. However, in England, commissioning it has (and still is) a controversial process, where NHS England has repeatedly raised supposed 'uncertainties', first legal and then scientific. The same has not happened in Scotland, where PrEP was commissioned to anyone who needed it in April 2017. This article presents a close reading of the IMPACT trial protocol, which we conclude cannot answer the questions it sets out to answer. We then suggest that the uncertainties the trial claims to address are in fact a tool of power which is deployed to strategically ration healthcare; introduce uncertainty about commissioning PrEP; and shift the boundary between individual responsibilities and state responsibilities for public health and HIV prevention. We conclude that all the above constitute an unethical use of clinical trial rhetoric, systematically discriminate against minority and vulnerable groups, and ration healthcare for those who most need it. As such, we call on all academics, clinicians and activists to resist further unethical misuses of clinical trial rhetoric.

Expanding the knowledge translation metaphor.

BACKGROUND: Knowledge translation (KT) is a buzzword in modern medical science. However, there has been little theoretical reflection on translation as a process of meaning production in KT. In this paper, we argue that KT will benefit from the incorporation of a more theoretical notion of translation as an entangled material, textual and cultural process. DISCUSSION: We discuss and challenge fundamental assumptions in KT, drawing on theories of translation from the human sciences. We show that the current construal of KT as separate from and secondary to the original scientific message is close to the now deeply compromised literary view of translation as the simple act of copying the original. Inspired by recent theories of translation, we claim that KT can be more adequately understood in terms of a 'double supplement' - on the one hand, KT offers new approaches to the communication of scientific knowledge to different groups in the healthcare system with the aim of supplementing a lack of knowledge among clinicians (and patients). On the other, it demonstrates that a textual and cultural supplement, namely a concern with target audiences (clinicians and patients), is inevitable in the creation of an 'autonomous' science. Hence, the division between science and its translation is unproductive and impossible to maintain. We discuss some possible implications of our suggested shift in concept by drawing on pharmaceutical interventions for the prevention of HIV as a case. We argue that such interventions are based on a supplementary and paradoxical relation to the target audiences, both presupposing and denying their existence. More sophisticated theories of translation can lay the foundation for an expanded model of KT that incorporates a more adequate and reflective description of the interdependency of scientific, cultural, textual and material practices.

Who cares? The lost legacy of Archie Cochrane.

Over the last 20 years, the evidence-based medicine (EBM) movement has sought to develop standardised approaches to patient treatment by drawing on research results from randomised controlled trials (RCTs). The Cochrane Collaboration and its eponym, Archie Cochrane, have become symbols of this development, and Cochrane's book Effectiveness and Efficiency from 1972 is often referred to as the first sketch of what was to become EBM. In this article, we claim that this construction of EBM's historical roots is based on a selective reading of Cochrane's text. Through a close reading of this text, we show that the principal aim of modern EBM, namely to warrant clinical decisions based on evidence drawn from RCTs, is not part of Cochrane's original project. He had more modest ambitions for what RCTs can accomplish, and, more importantly, he was more concerned with care and equality than are his followers in the EBM movement. We try to reconstruct some of Cochrane's lost legacy and to articulate some of the important silences in Effectiveness and Efficiency From these clues it might be possible, we argue, to remodel EBM in a broader, more pluralistic, more democratic and less authoritarian manner.