Kia Ditlevsen

Body weight management and dilemmas of health responsibility for vulnerable groups in the changing Danish welfare state: a comparative case analysis

Abstract This article explores how health responsibility in relation to body weight management is institutionally enacted in three welfare institutions in the interplay between traditional ‘social interventionist’ welfare and ‘non-interfering’ neoliberal ideology. The analysis asks how citizens of non-Western origin at different life stages are positioned within, and navigate, opposing ideological value systems, and adapt to, or resist, institutionally constructed ‘health subjectivities’. The cross-case analysis shows that as people grow older, the institutional requirement to adapt to neoliberal norms of individual responsibility increases, but that in all three settings health responsibility is ambiguously distributed and enacted among welfare state agencies and citizens, and that this renders children, youths and parents vulnerable in different ways. We identify how marginalised citizens are constituted by, but also resist, neoliberal health promotion policies as welfare policy moves away from universalism and towards targeting in Denmark, which appears to increase health inequalities along socio-economic and ethnic lines.

Setting limits in uneasy times – healthy diets in underprivileged families

Purpose The purpose of this paper is to provide knowledge on barriers to preventive action on early childhood overweight in non-western migrant families. It investigates the underlying understandings of the parental role in relation to weight control present in health-care professionals and in families. Design/methodology/approach The study is based on qualitative interviews with parents who are engaged in interventions aimed at helping them and their children to adopt a healthier life style, and on interviews with health-care professionals. Findings This study shows that the participating parents, all low SES and living under different forms of insecurity, perceived their parental task for the present as creating well-being for their children, and they were, therefore, reluctant to enforce dietary changes. The health-care professionals, in contrast, considered the need for change through a perspective on future risks. Research limitations/implications The results are based on a rather small sample and the link between insecurity, family dynamics and health practice needs further research. Originality/value The participating parents represented a group that is rarely included in scientific research and the study, therefore, contributes valuable knowledge on health behavior in ethnic minority families. The empirical analysis provides new insights for health professionals regarding the suitability of the universal model of parental feeding styles. It illuminates the implications of implicitly applying this model in health interventions which involve vulnerable categories of parents such as refugees to western societies.

From policy to reality: early overweight, structural barriers, and the allocation of responsibility in the Danish health care system

Abstract This qualitative study explores the structural barriers to preventive interventions targeting childhood obesity in the Danish health care system. Based on interviews with relevant health care professionals, the paper reports on the problems which are experienced by general practitioners and health visitors and which complicate implementation of the policies of the Danish health authorities. Findings show that the current system is not well equipped to treat early overweight. A gap in primary preventive health care for children at age 3–5, indistinct lines of responsibility, inadequate cooperation, and lack of resources together make it difficult for health care professionals to initiate interventions and reach the children in need of support. By analyzing the policy implementation process in a theoretical framework that discloses the discursive allocation of responsibilities, the study is able to provide a deeper description and analysis of the problem. The study makes it clear how preventive health care for overweight children rests on the negotiation of formal and performed responsibilities among health practitioners within a framework of scarce resources and communication deficit.

Recruitment of ethnic minorities for public health research: An interpretive synthesis of experiences from six interlinked Danish studies:

Aims: This paper examines the importance of recruitment site in relation to the recruitment of ethnic minorities into health research. It presents a synthesis of experiences drawn from six interlinked Danish studies which applied different methods and used healthcare facilities and educational settings as sites for recruitment. Methods: Inspired by interpretive reviewing, data on recruitment methods from the different studies were synthesized with a focus on the various levels of recruitment success achieved. This involved an iterative process of comparison, analysis and discussion of experiences among the researchers involved. Results: Success in recruitment seemed to depend partly on recruitment site. Using healthcare facilities as the recruitment site and healthcare professionals as gatekeepers was less efficient than using schools and employees from educational institutions. Successful study designs also depended on the possibility of singling out specific locations with a high proportion of the relevant ethnic minority target population. Conclusions: The findings, though based on a small number of cases, indicate that health professionals and healthcare institutions, despite their interest in high-quality health research into all population groups, fail to facilitate research access to some of the most disadvantaged groups, who need to be included in order to understand the mechanisms behind health disparities. This happens despite the genuine wish of many healthcare professionals to help facilitate such research. In this way, the findings indirectly emphasize the specific challenge of accessing more vulnerable and sick groups in research studies.

Resignation, goal orientation or cultural essentialism? Health care practitioners’ approaches to interventions on childhood obesity

ABSTRACT This qualitative study investigates health care practitioners’ approaches to early childhood obesity in Denmark and their view on their own ability to initiate processes of change in affected families, and it asks the overall question of whether perceived barriers become real through practitioners’ reluctance to intervene in families labelled as ´problematic’. The paper identifies three approaches in the practitioners’ narratives: the socially oriented, the individually oriented, and the mixed. The individually oriented approach was based on a logic resembling individualistic explanatory models of behaviour change, and was related to a positive perspective on their own ability to move families towards healthier habits by health care practitioners. The socially oriented approach borrowed elements from a sociological perspective, which seemed to lead to resigned pessimism in the face of the complexity of the problem of childhood overweight and a reluctance to address early childhood overweight in some families. In practitioners of all three types, widespread cultural essentialism was found. Non-western, ethnic minority background was seen as determining family habits and making preventive action especially difficult. Based on this, the current paper discusses whether individual actions and choices are being ascribed too much explanatory power, and the health systems biased perceptions too little.