Nick Higginbotham

Solastalgia: The Distress Caused by Environmental Change

Objective: Solastalgia is a new concept developed to give greater meaning and clarity to environmentally induced distress. As opposed to nostalgia – the melancholia or homesickness experienced by individuals when separated from a loved home – solastalgia is the distress that is produced by environmental change impacting on people while they are directly connected to their home environment. The paper will focus on two contexts where collaborative research teams have found solastalgia to be evident: the experiences of persistent drought in rural NSW and the impact of large-scale open-cut coal mining on individuals in the Upper Hunter Valley of NSW. In both cases, people exposed to environmental change experienced negative affect that is exacerbated by a sense of powerlessness or lack of control over the unfolding change process. Methods: Qualitative (interviews and focus groups) and quantitative (community-based surveys) research has been conducted on the lived experience of drought and mining, and the findings relevant to solastalgia are presented. Results: The authors are exploring the potential uses and applications of the concept of solastalgia for understanding the psychological impact of the increasing incidence of environmental change worldwide. Conclusions: Worldwide, there is an increase in ecosystem distress syndromes matched by a corresponding increase in human distress syndromes. The specific role played by global-scale environmental challenges to ‘sense of place’ and identity will be explored in the future development of the concept of solastalgia.

Complexity and Human Health: The Case for a Transdisciplinary Paradigm

Transdisciplinary thinking is an emerging philosophy underpinning health social science. We advance a definition of transdisciplinary thinking and link it with complexity theory. Complexity theorys concern with non-linear relationships, interactive causality and emergent properties of systems compels researchers to adopt a transdisciplinary perspective. We construct a generic framework for analyzing health processes from diverse disciplines and apply it to coronary heart disease in the Australian Coalfields. Insights from this analysis support our argument that transdisciplinary thinking maximizes understanding of the complexity of human health.

Environmental change and human health in Upper Hunter communities of New South Wales, Australia

This article presents the theory and method informing an ongoing study of environmental change and human distress in the Upper Hunter Valley of New South Wales (NSW), Australia. The nature of environmental change in the Upper Hunter landscape over the past two centuries is first described, followed by the preliminary results of a long-term study that aims to investigate the nature of residents’ understanding of, and responses to, environmental change. Data from in-depth interviews found that the transformation of the environment from mining and power station activities was associated with significant expressions of distress linked to negative changes to interviewees’ sense of place, well-being, and control. A new concept, “solastalgia,” is introduced to help explain the relationship between ecosystem health, human health, and powerlessness. We claim that solastalgia, as opposed to nostalgia, is a type of homesickness (distress) that one gets when one is still “at home.” Future research will aim to validate a questionnaire to test the hypothesis that environmental distress is associated with levels of depression, quality of life, and rates of stress-related disease, as well as activism and environmental rehabilitation.

Designing the Home Falls and Accidents Screening Tool (HOME FAST): Selecting the Items

The Home Falls and Accidents Screening Tool (HOME FAST) was developed as a screening instrument for use in a community preventive care trial for older people. This paper describes the first stage of the development of this screening tool. The objectives of the study were (i) to review existing home safety measures, (ii) to field test an instrument containing a pool of home safety items with the goal of identifying those hazards associated with falls in the home and (iii) to select the items for inclusion in a 25-item tool using an expert panel. The field testing took place in a rural area of Australia, where the pooled checklist was used to evaluate hazards within the homes of 83 older people. No individual hazards were associated with the risk of falls at home and, although participants who had experienced falls had a higher mean number of home hazards (mean = 13.7, SD 8.2), the differences between fallers and non-fallers was not significant. Items relevant to a rural population were indicated through field testing. Further psychometric testing of the HOME FAST and a meaningful method of scoring the checklist are now warranted.

Association between availability of non-prescription beta 2 agonist inhalers and undertreatment of asthma.

OBJECTIVE--To determine whether the availability of beta 2 agonist inhalers without prescription leads to undertreatment of asthma. DESIGN--Cross sectional study of adequacy of treatment in asthmatic subjects who purchased beta 2 agonist inhalers and subjects who obtained inhalers by prescription. SETTING--Community pharmacies in New South Wales, Australia. SUBJECTS--403 eligible consecutive asthmatic subjects aged 13 to 55 purchasing salbutamol metered dose inhalers over the counter or by prescription; 197 attended for follow up and spirometry and 139 returned 14 day symptom, peak flow, and medication diaries. MAIN OUTCOME MEASURES--Severity of asthma assessed on frequency of day time and night time wheezing, frequency of inhaler use, and peak expiratory flow rates. Adequacy of treatment according to published guidelines. RESULTS--Of the 139 patients who completed the diary 83, (60%) purchased their inhalers without prescription and 83 were undertreated. The characteristics of patients in the prescription and purchasing groups were similar. Multiple logistic regression analysis identified use of non-prescribed salbutamol as being associated with a 2.9-fold increase in the odds of undertreatment (95% confidence interval 1.3 to 6.8). Smoking increased the odds of undertreatment (3.3, 1.2 to 9.5) and use of a peak flow meter reduced the odds (0.11, 0.04 to 0.34). Adjustment for frequency of consultation made use of non-prescription salbutamol insignificant (1.4, 0.55 to 3.8). Attitudes to services provided by doctors and pharmacists were favourable and not associated with undertreatment. CONCLUSION--Over the counter purchase of salbutamol is associated with infrequent consultation with doctors and undertreatment of asthma.

International consultation and the homogenization of psychiatry in Southeast Asia

The nature of psychiatric care varies little among the capital cities of Southeast Asia. Differences that may exist are of degrees along a common dimension. Colonial forces from the past and contemporary diffusion of modern psychiatry have produced this remarkably uniform pattern of thought and treatment across divergent national and cultural boundaries. Our paper analyzes the homogenization of psychiatry in Southeast Asia in three ways. First, we examine international mental health education, consultation and collaboration as interlocking mechanisms for the transfer of psychiatric technology. Second, the indirect and undesirable consequences of the diffusion of psychiatric knowledge and practice are analyzed. Third, we pose recommendations for countering these unanticipated consequences through evaluation research, ethical guidelines, and educational and intervention practices that strengthen indigenous healing resources.

Men’s Perceived Health Needs

Cross-sectional survey data describing health priorities and needs perceived by men and women living in Newcastle, Australia are compared and contrasted with national health policies. The highest prevalence of felt needs for men were stress (13 percent), cost of medical care (10 percent) and money problems (9 percent); while stress (16 percent), overweight (16 percent) and money problems (15 percent) were highest for women. These contrast with the 2000 National Health Priorities of cancer, mental health, injury, cardiovascular health, diabetes and asthma. We conclude that men’s perceived unmet health needs are similar to those of women; while sharing some commonalities, they also differ from health professional priorities. Incorporating felt needs into health service planning and delivery is a critical unmet challenge for government planners.

A Prospective Community-Based Study of Falls among Older People in Australia: Frequency, Circumstances, and Consequences

Falls among the population of older people are a major international public health concern. Few prospective studies have been conducted in Australia with a healthy, rural and urban community sample that measure a broad range of health-related potential risk factors for falls. This study aims to identify the nature and circumstances of falls experienced by people aged 70 years and older, and explores any health and environmental variables associated with falls over a 6-month period. A total of 264 participants kept calendars and recorded information about falls. Health status measures were taken prior to the study period. Falls occurred mainly during mobility and housework activities causing a wide range of minor but notable injuries, and were associated with psychosocial factors as well as medical risk factors. The need for occupational therapists to develop specific programs for healthy older people living in the community is identified, as well as the need for cross-national falls research.

Critical appraisal checklist for qualitative research studies

The ability to critically appraise literature is an essential skill for clinicians adopting a population perspective. Conventions exist for reporting and evaluating the quality of quantitative and epidemiological research. The same traditions do not exist in qualitative research for a number of reasons including the number of theories under which this type of research can be conducted and the subsequent incompatibility of indicators of quality. This paper presents a 10-point checklist for assessing the quality of qualitative research in clinical epidemiological studies. We aim to provide a framework for critical appraisal as well as offer direction for qualitative researchers in designing and publishing their work.

THE SOCIAL SCIENCE CONTRIBUTION TO PHARMACOEPIDEMIOLOGY

An understanding of the inappropriate use of pharmaceuticals (the prescribing of unnecessary or ineffective medications, and non-compliance by consumers) can be furthered by considering the psychological, social and cultural contexts in which medicines are used. The consumers are influenced by their beliefs about benefits, safety and cost; opinions of their social group; and emotions associated with taking the medication itself. Similar considerations apply to the prescribers or dispensers of the drugs, who are also influenced by the marketing and regulatory practices of their countries. A model of drug use which takes these factors into account can suggest various strategies to increase optimal pharmaceutical utilization. To date, these efforts have focused almost exclusively on the prescriber or manufacturer, and have had limited success. However, other, more effective techniques exist, which can modify the behavior of both of these groups, and of the consumers. A strategy of research in this area is outlined.