A qualitative investigation of lived experiences of long-term health condition management with people who are food insecure.

BACKGROUND: As more people are living with one or more chronic health conditions, supporting patients to become activated, self-managers of their conditions has become a key health policy focus both in the UK and internationally. There is also growing evidence in the UK that those with long term health conditions have an increased risk of being food insecure. While international evidence indicates that food insecurity adversely affects individual's health condition management capability, little is known about how those so affected manage their condition(s) in this context. An investigation of lived experience of health condition management was undertaken with food insecure people living in north east Scotland. The study aimed to explore the challenges facing food insecure people in terms of, i. their self-care condition management practices, and ii. disclosing and discussing the experience of managing their condition with a health care professional, and iii. Notions of the support they might wish to receive from them. METHODS: Twenty in-depth interviews were conducted with individuals attending a food bank and food pantry in north east Scotland. Interview audio recordings were fully transcribed and thematically analysed. RESULTS: Individuals reporting multiple physical and mental health conditions, took part in the study. Four main themes were identified i.e.: 1. food practices, trade-offs and compromises, that relate to economic constraints and lack of choice; 2. illness experiences and food as they relate to physical and mental ill-health; 3. (in) visibility of participants' economic vulnerability within health care consultations; and 4. perceptions and expectations of the health care system. CONCLUSIONS: This study, the first of its kind in the UK, indicated that participants' health condition management aspirations were undermined by the experience of food insecurity, and that their health care consultations in were, on the whole, devoid of discussions of those challenges. As such, the study indicated practical and ethical implications for health care policy, practice and research associated with the risk of intervention-generated health inequalities that were suggested by this study. Better understanding is needed about the impact of household food insecurity on existing ill health, wellbeing and health care use across the UK.

Landscape and well-being: A conceptual framework and an example.

This article explores why landscape is a crucial element in researching the relationship between environment and well-being. The main point we make is that human social agents are embedded in particular landscapes, and it is in landscapes that environmental changes are experienced, which can have implications for well-being. We draw from a variety of perspectives on landscape that understands a fundamental creative relation between humans and landscape and recent developments in neo-materialism theorising. Landscape is understood here as an assemblage of different forms of matter, animate and inanimate objects, as well as symbolic and cultural processes. A case study is also presented to indicate how landscape can be studied in relation to environment and change. Using the conceptual ideas laid out in the first section of the article, we analyse landscape, environment and well-being in Xuan Thuy National Park in North Vietnam. The area is part of a precarious coastal region where extreme weather events have impacted on the well-being of both humans and other matter. This article concludes with suggestions on the use of this landscape approach in researching environment and well-being.

Forgetting and remembering alienation theory.

Alienation theory has acted as the stimulus for a great deal of research and writing in the history of sociology. It has formed the basis of many sociological "classics" focused on the workplace and the experiences of workers, and has also been mobilized to chart wider social malaise and individual troubles. Alienation theory usage has, however, declined significantly since its heyday of the 1960s and 1970s. Here, the reasons why alienation theory was "forgotten" and what can be gained by "remembering" alienation theory are explored. to realize this ambition this article proceeds by (1) briefly visiting differing definitions of alienation theory, before charting its high point, and the various debates and tensions of the time, during the 1960s and 1970s; (2) analysing the reasons why alienation theory fell from grace from the 1980s onwards; (3) elaborating how and why alienation theory is still relevant for sociology and the wider social sciences today.

What can alienation theory contribute to an understanding of social inequalities in health?

This article examines both the contribution and the limitations of research that has sought to develop a causal understanding of the psychosocial dimension of inequalities in health. The article seeks to revive interest in Marx's theory of alienation in developing the case for an alternative materialist conceptualization that is able to postulate the pathways from alienation as a psychosocial generative structure to social inequalities in health outcomes within late modern societies.