Journal of Critical Public Health

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The Journal of Critical Public Health (JCPH) is devoted to disseminating critically engaged research in public health, health promotion & related fields. Diamond Open Access. journalhosting.ucalgary.ca/index.php/jcph/

The World Health Organization (WHO)’s proposal for a Pandemic Agreement, released in April 2024, at first blush, seems laudable (WHO 2024a). The failure of governments to coordinate a response to COVID-19, as implored by the WHO and the United Nations (UN) at the beginning of the pandemic, underlines the urgent need for reform in the global governance of pandemics. This editorial considers: how has the Agreement progressed to date? And will it adequately prepare societies to tackle future pandemics?

With the purposes of identifying the underlying challenges of global and public health governance of outbreaks, this paper explores three key themes that emerged in response to the 2022 mpox epidemic: the belated change of disease nomenclature from monkeypox to mpox; the classification of mpox as a sexually transmitted infection (STI); and the unpreparedness of health agencies to vaccinate impacted populations. The paper makes the case that, because of the global and public health tensions arising from racialized nomenclatures, sexualized classifications, biosecuritized borders, and monopolized vaccines, national and international agencies failed in providing an adequate and comprehensive response to the latest mpox pandemic, which contributed further to the pathologization of already vulnerable and stigmatized population groups.

Racialised social inequalities were exposed and exacerbated during the COVID-19 pandemic. The methods health researchers employ in designing and conducting research can replicate the same inequalities, with important implications for the creation of new knowledge. In this paper, we retrospectively and critically analyse the thinking and methods we employed during two qualitative studies about the diverse experiences of people and families during the COVID-19 pandemic in the UK. Set within a wider literature on engaging with race and ethnicity in health research, we present an analysis based on reflexive accounts and testimonies from researchers, and close-up examinations of different stages of the research. By illustrating these ideological, practical and interactional components of research, including some uncomfortable reflections, we hope to encourage more open conversations among researchers and research funders. Through this process, we can strengthen efforts that dismantle unhelpful historical research orthodoxies and move towards re-formulating ways of research practice that are more explicitly anti-racist and inclusive.

While critical scholarship has demonstrated the harmful effects of austerity on public mental health, relatively little attention has been paid to austerity’s impacts on health services themselves. In response, this paper develops a descriptive analysis of mental health spending and provision in England during the austerity period, from 2009–10 to 2019–20. It examines spending patterns at the national and local level, highlighting a major growth in funding that has been overlooked by prior studies. Then it interrogates national trends in mental health provisioning, utilisation and treatment. The paper argues that austerity has divergent impacts on localities which are best understood as multiple localised austerities. Meanwhile, the overall mental health service landscape under austerity is characterised by three trends, all of which have the potential to harm public health. Inpatient services are utilising more coercion; community services are increasingly conditionalised; and a significant population – too ill for work but judged too healthy for treatment – has been abandoned by services. For critical scholars and practitioners of public health, these findings highlight the complexity of the political, economic and institutional dynamics which distribute spending cuts and therefore mediate austerity’s effects on health.

Scotland experiences higher mortality rates and larger health inequalities than other high-income countries, including the wider UK. The predominantly epidemiological evidence-base identifies deprivation, inequalities in wealth, deindustrialization, health behaviours and housing as important factors, while excess mortality has been attributed to a ‘political attack’ on the Scottish population in the late twentieth century. This paper synthesises 48 studies offering lay perspectives on the factors shaping health in Scotland, identified via systematic searches. The findings demonstrate that people with lived experience of disadvantage have a good understanding of the social determinants of health inequalities. We also identify five ways in which Scotland’s disadvantaged communities experience a sense of ‘attack’: the structural violence of poverty; disadvantageous national policies; ‘street level bureaucrats’ gatekeeping welfare support; local profiteers (e.g., unresponsive landlords); and interpersonal violence. We argue that these findings provide support for the ‘political attack’ hypothesis and that they suggest research and policy needs to better grapple with the depth of poverty, the intersectional nature of inequalities and the roles that history, narratives, crime, violence and policy implementation each play in shaping Scotland’s health outcomes. We call for research and policy responses that ground both diagnosis and future prescriptions in the experiential knowledge of those most negatively impacted.