Stephanie A. Alexander

Playing for health? Revisiting health promotion to examine the emerging public health position on children's play

Concerns over dwindling play opportunities for children have recently become a preoccupation for health promotion in western industrialized countries. The emerging discussions of play seem to be shaped by the urgency to address the childrens obesity epidemic and by societal concerns around risk. Accordingly, the promotion of play from within the field appears to have adopted the following principles: (i) particular forms of play are critical for increasing childrens levels of physical activity; and (ii) play should be limited to activities that are not risky. In this article, we argue that these emerging principles may begin to re-shape childrens play: play is predominantly instrumentalized as a means to promote childrens physical health, which may result in a reduction of possibilities for children to play freely and a restriction of the kinds of play designated as appropriate for physical health. We argue that within this context some of the social and emotional elements of health and well-being that children gain through diverse forms of playing are neglected. This has implications for health promotion because it suggests a narrowing of the conception of health that was originally advocated for within the field. Additionally, this reveals a curious paradox; despite the urgency to promote physical activity through play, this position may limit the range of opportunities for children to freely engage in play, in effect reducing their activity levels. We propose an example that promotes play for children and better aligns with the conception of health as outlined in the Ottawa Charter.

Tobacco control and the inequitable socio-economic distribution of smoking: smokers’ discourses and implications for tobacco control

Warning: this article contains strong language. This paper focuses on the ways in which social context structures smokers’ views of, and reactions to, tobacco control. This exploratory study examined the interactions between tobacco control and smokers’ social contexts and how this may be contributing to inequalities in smoking. We found in our sample that higher socio-economic status (SES) smokers are more likely to positively respond and adapt to tobacco control messages and policies, viewing them for their future health betterment. Lower SES smokers in our study, on the other hand, are in conflict with tobacco control and feel intransigent with regard to the effects that tobacco control is having on their smoking. A better understanding of how social context structures peoples perceptions of tobacco control may help us to understand why social inequalities in smoking are deepening, and potentially what can be done better in tobacco control to decrease them.

‘You have to do 60 minutes of physical activity per day … I saw it on TV’: Children's constructions of play in the context of Canadian public health discourse of playing for health.

Public health institutions in many industrialised countries have been launching calls to address childhood obesity. As part of these efforts, Canadian physical activity campaigns have recently introduced childrens play as a critical component of obesity prevention strategies. We consider this approach problematic as it may reshape the meanings and affective experiences of play for children. Drawing on the analytical concept of biopedagogies, we place Canadian public health discourse on play in dialogue with childrens constructions of play to examine first, how play is promoted within obesity prevention strategies and second, whether children take up this public health discourse. Our findings suggest that: (i) the public health discourse on active play is taken up and reproduced by some children. However, for other children sedentary play is important for their social and emotional wellbeing; (ii) while active play is deemed to be a solution to the risk of obesity, it also embodies contradictions over risk in play, which children have to negotiate. We argue that the active play discourse, which valorises some representations of play (that is, active) while obscuring others (that is, sedentary), is reshaping meanings of play for children, and that this may have unintended consequences for childrens wellbeing.

Problematizing “Play-for-Health” Discourses Through Children’s Photo-Elicited Narratives

There are growing concerns in many industrialized Western societies about declining opportunities for children to play, and fears that this will have adverse health consequences for them. Informed by anti-obesity efforts, public health institutions have recently begun to advance active forms of play as a way of improving children’s physical health; however, promoting play for physical health might reshape meanings of play for children. We conducted photography and interview sessions with 25 Canadian children aged 7 to 11 years to examine their representations of play. Our findings suggest that for children, (a) play is an end in itself, (b) play involves but is more than active play, (c) there is ambivalence about scheduled play, and (d) risk is considered a pleasurable component of play. These findings point to a dissonance between children’s play promoted for physical health and the meaning of play for children as emotionally contingent, intrinsically motivated, and purposeless.

I’m a young student, I’m a girl … and for some reason they are hard on me for smoking: The role of gender and social context for smoking behaviour

Despite considerable population declines, smoking has become increasingly socially stratified, a trend that emerges as salient when examining smoking according to gender. However, there is a dearth of comparative research with regard to smoking inequalities among men and women. The goal of this exploratory study was to examine how three elements of the social context (identity, body, agency) are gendered and the way in which they differentially shape mens and womens smoking practices. In-depth qualitative interviews were conducted with 23 adult smokers living in Toronto and Montréal, Canada stratified by socio-economic position and gender. Our results show that: (1) women express considerable dissonance between gender identities and smoking behaviour, whereas mens gender identities seem to reinforce smoking behaviour; (2) womens smoking was tied to gendered representations of the body, with the fear of weight gain factoring into their smoking maintenance, whereas concern about the body was absent among men; (3) women suggested wanting, but not having agency over their smoking behaviour while men suggested having agency but little urgency to quit smoking. Our exploratory study points to the possibility that gender remains important for shaping smoking practices among adult smokers and that smoking among some women may be characterised by a greater sense of dissonance and tension than among some men. Addressing gender inequalities in the health discourse surrounding smoking may help reduce the current gender disparities in smoking patterns.

The heterogeneity of vulnerability in public health: a heat wave action plan as a case study

Abstract The concept of vulnerability is frequently used in public health policies to develop tailored interventions or dedicate proportionately more resources to certain sub-populations. However, once segments of the population are identified as vulnerable, they are rarely consulted regarding whether this label is acceptable before instituting interventions. Instead, it is implicitly assumed that the targeted individuals identify themselves as vulnerable and experience an unambiguous and consistent need for public health assistance. In this paper, using public health interventions during heat waves as a case study, we question such assumptions. A qualitative study was conducted in Montreal, Canada involving two focus groups among populations specifically targeted by the heat action plan as vulnerable: one composed of individuals diagnosed with schizophrenia, and one composed of individuals who have alcohol or drug addictions. Findings revealed significant heterogeneity in the definition and experience of vulnerability as it is used in the context of a heat action plan in Montreal. We found differences between the two focus groups in several areas including sources of information they had access to within the heat action plan measures and their perspectives regarding the appropriateness of specific measures in the heat action plan. We then observed differences within each of the focus groups in several areas including their social networks relationships. The concept of vulnerability is often used in public health policies. Yet, while this concept may be convenient for shaping policies to reduce inequalities in health, the heterogeneity of populations defined as vulnerable should not be underestimated.