Capitalism and the 'commercial determinants of health': A more-than-human micropolitics.

This paper argues that studies of the 'commercial determinants of health' (CDoH) need to acknowledge fully the part the capitalist mode of commodity production and exchange plays in producing negative health outcomes. This proposition is supported by recourse to a recent development in political economy that has established a more-than-human, relational and monist (or 'flat') ontology of capitalism, in place of the more conventional neo-Marxist perspective. This ontology reveals a dynamic to capitalism that operates beyond human intentionality, driven by the supply of, and demand for the capacities of commodities. This dynamic determines the production and consumption of all commodities, some among which (such as tobacco, alcohol and processed foods) contribute to ill-health. A case study of food consumption reveals how these supply and demand affects drive 'unhealthy' food choices by consumers. Ways to undermine this more-than-human dynamic are offered as an innovative approach to addressing the effects of commerce and capitalism upon health.

The critical (micro)political economy of health: A more-than-human approach.

The critical political economy of health offers different explanations for the social causes of health and the social factors determining the distribution of these causes. However, the relational, post-anthropocentric and monist ontology of the new materialisms overcomes this complexity, while retaining a critical focus. In this perspective, the social, economic and political relations of capitalism act upon bodies and other matter in everyday events, rather than as 'social structures'. Using a conceptual toolkit of 'affect', 'assemblage', 'capacity' and 'micropolitics', the paper asks the question: 'what does capitalism do?' The re-analysis of the social and economic relations of capitalism in terms of a production-assemblage and a market-assemblage reveals not only the workings of capitalist accumulation, but also how previously-unremarked more-than-human affects in these assemblages simultaneously produce uncertainty, waste and inequalities. This micropolitical economy of health is illustrated with examples from recent research, including a critical assessment of health inequalities during the Covid-19 pandemic.

Place, health and dis/advantage: A sociomaterial analysis.

The substantial literature on interactions between places/spaces and well-being/health often differentiate between physical and social aspects of geographical location. This paper sidesteps this dualism, instead considering places as sociomaterial assemblages of human and non-human materialities. It uses this posthuman and 'new materialist' perspective to explore how place-assemblages affect human capacities, in terms of both health and social dis/advantage. Based on secondary analysis of interview data on human/place interactions, it analyses the physical, sociocultural, psychological and emotional effects of place-assemblages, assessing how these produce opportunities for, and constraints upon human bodies. It than assesses how these emergent capacities affect both social dis/advantage and well-being. This analysis of how place-assemblages contribute positively or negatively to health and dis/advantage offers possibilities for further research and for social and public health policy.

Coronavirus, capitalism and a 'thousand tiny dis/advantages': a more-than-human analysis.

This paper establishes a relational, post-anthropocentric and materialist approach to the Covid-19 coronavirus pandemic. Analysis of the 'pandemic assemblage' reveals that the virus has subverted the social and economic relations of capitalism, enabling its global spread. This insight establishes a materialist framework for exploring socio-economic disparities in Covid-19 incidence and death rates, via a more-than-human and monist analysis of capitalist production and markets. Disparities derive from the 'thousand tiny dis/advantages' produced by people's daily interactions with human and non-human matter, making sense of the unequal occupational patterning of coronavirus incidence. This more-than-human approach supplies a critical alternative to the mainstream public health and scientific perspectives on the pandemic, with important implications for current and future policy to counter future microbiological outbreaks.

Re-assembling climate change policy: Materialism, posthumanism, and the policy assemblage.

National and international policy-makers have addressed threats to environmental sustainability from climate change and other environmental degradation for over 30 years. However, it is questionable whether current policies are socially, politically, economically, and scientifically capable of adequately resolving these threats to the planet and living organisms. In this paper we theorize and develop the concept of a "policy assemblage" from within a new materialist ontology, to interrogate critically four policy perspectives on climate change: "liberal environmentalism"; the United Nations policy statements on sustainable development; "green capitalism" (also known as "climate capitalism") and finally "no-growth economics." A materialist analysis of interactions between climate change and policies enables us to establish what each policy can do, what it ignores or omits, and consequently its adequacy to address environmental sustainability in the face of climate change. None, we conclude, is adequate or appropriate to address climate change successfully. We then use this conceptual tool to establish a "posthuman" policy on climate change. Humans, from this perspective, are part of the environment, not separate from or in opposition to it, but possess unique capacities that we suggest are now necessary to address climate change. This ontology supplies the starting point from which to establish sociologically a scientifically, socially, and politically adequate posthuman climate change policy. We offer suggestions for the constituent elements of such a policy.

Social structures, power and resistance in monist sociology: (New) materialist insights.

Though mainstream sociological theory has been founded within dualisms such as structure/agency, nature/culture, and mind/matter, a thread within sociology dating back to Spencer and Tarde favoured a monist ontology that cut across such dualistic categories. This thread has been reinvigorated by recent developments in social theory, including the new materialisms, posthumanism and affect theories. Here we assess what a monist or 'flat' ontology means for sociological understanding of key concepts such as structures and systems, power and resistance. We examine two monistic sociologies: Bruno Latour's 'sociology of associations' and DeLanda's ontology of assemblages. Understandings of social processes in terms of structures, systems or mechanisms are replaced with a focus upon the micropolitics of events and interactions. Power is a flux of forces or 'affects' fully immanent within events, while resistance is similarly an affective flow in events producing micropolitical effects contrary to power or control.

Personal health technologies, micropolitics and resistance: A new materialist analysis.

Personal health technologies are near-body devices or applications designed for use by a single individual, principally outside healthcare facilities. They enable users to monitor physiological processes or body activity, are frequently communication-enabled and sometimes also intervene therapeutically. This article explores a range of personal health technologies, from blood pressure or blood glucose monitors purchased in pharmacies and fitness monitors such as Fitbit and Nike+ Fuelband to drug pumps and implantable medical devices. It applies a new materialist analysis, first reverse engineering a range of personal health technologies to explore their micropolitics and then forward engineering personal health technologies to meet, variously, public health, corporate, patient and resisting-citizen agendas. This article concludes with a critical discussion of personal health technologies and the possibilities of designing devices and apps that might foster subversive micropolitics and encourage collective and resisting 'citizen health'.

Health sociology from post-structuralism to the new materialisms.

The article reviews the impact of post-structuralism and postmodern social theory upon health sociology during the past 20 years. It then addresses the emergence of new materialist perspectives, which to an extent build upon insights of post-structuralist concerning power, but mark a turn away from a textual or linguistic focus to address the range of materialities that affect health, illness and health care. I conclude by assessing the impact of these movements for health sociology.

Emotions, affects and the production of social life.

While many aspects of social life possess an emotional component, sociology needs to explore explicitly the part emotions play in producing the social world and human history. This paper turns away from individualistic and anthropocentric emphases upon the experience of feelings and emotions, attending instead to an exploration of flows of 'affect' (meaning simply a capacity to affect or be affected) between bodies, things, social institutions and abstractions. It establishes a materialist sociology of affects that acknowledges emotions as a part, but only a part, of a more generalized affective flow that produces bodies and the social world. From this perspective, emotions are not a peculiarly remarkable outcome of the confluence of biology and culture, but part of a continuum of affectivity that links human bodies to their physical and social environment. This enhances sociological understanding of the part emotions play in shaping actions and capacities in many settings of sociological concern.

Creativity and health: an anti-humanist reflection.

Many studies suggest that health benefits from engaging with the creative arts, but explanations of the association remain tenuous. This article explores both creativity and health from an anti-humanist perspective and develops a Deleuze-inspired analysis to supply the theoretical framework for creativity and health. In this view, creativity is an active, experimenting flow within a network or assemblage of bodies, things, ideas and institutions, while health is understood as the capacity of a body to affect and be affected by this assemblage. It is consequently unsurprising that there is a relationship between creative activity and health. This analysis is used to explore how creative production and reception can affect health, and to assess the implications for sociology and for arts in health-care practice.

Delivering shiatsu in a primary care setting: benefits and challenges.

AIM: To pilot the delivery of shiatsu in primary care and investigate the non-clinical impact on the general practice, its patients and staff. DESIGN: Ten patients, referred by four GPs, were each offered six shiatsu treatments with a qualified practitioner. SETTING: An inner-city general practice in Sheffield, England. METHODS: 36 semi-structured interviews, evaluated with Interpretative Phenomenological Analysis and practitioner research including a reflective journal. FINDINGS: GPs welcomed having more options of care, especially for patients with complex, chronic symptoms, and patients appreciated the increased time and holistic, patient-centred approach during shiatsu consultations. Participants claimed the clinic increased equality of access to complementary medicine, improved perceptions of the general practice, reduced consultation and prescription rates, enhanced GP-patient relationships and the working practices of the GPs and shiatsu practitioner. CONCLUSION: The study successfully integrated a shiatsu clinic into a general practice and offers a model for future research on complementary medicine in primary care.

Pharma in the bedroom . . . and the kitchen. . . . The pharmaceuticalisation of daily life.

This paper examines the consequences of a new emphasis on lifestyle in the production, marketing and consumption of pharmaceuticals. Over the past decade, a range of medicines have become available that address aspects of lifestyle, while others have been the subject of lifestyle marketing. We argue, with recourse to a broad literature from the social sciences, economics and health services research and from our study of pharmaceutical consumption, that two processes can be discerned. First, there is a domestication of pharmaceutical consumption, with drugs available via home computers, and marketing of pharmaceuticals that focuses upon private or personal conditions and addresses domestic activities such as sex and cooking. Secondly, there is a pharmaceuticalisation of everyday life as the pharmaceutical industry introduces profitable medicines for a range of daily activities and pharmaceuticals come to be seen by consumers as a 'magic bullet' to resolve problems of daily life. We suggest that the pharmaceuticalisation of daily life links the economics and politics of pharmaceutical production to the private lives of citizens.

What governs governance, and how does it evolve? The sociology of governance-in-action.

Governance addresses a wide range of issues including social, economic and political continuity, security and integrity, individual and collective safety and the liberty and rights to self-actualization of citizens. Questions to be answered include how governance can be achieved and sustained within a social context imbued with cultural values and in which power is distributed unevenly and dynamically, and how governance impacts on individuals and institutions. Drawing on Gramscian notions of hegemony and consent, and recent political science literatures on regulation and meta-regulation, this paper develops a sociological model of governance that emphasizes a dynamic and responsive governance in action. Empirical data from a study of pharmaceutical governance is used to show how multiple institutions and actors are involved in sustaining effective governance. The model addresses issues of how governance is sustained in the face of change, why governance of practices varies from setting to setting, and how governance is achieved without legislation.

What are health identities and how may we study them?

This paper draws together findings from studies of health and identity to develop a model of health identities, based upon Deleuze and Guattari's approach to understanding the relationship between self, body and society. The model is used to inform a methodology for the empirical study of identities in relation to health and the body. Using a sample interview transcript, the methodology of analysis is demonstrated. The application of the model and the methodology for studying health identities are discussed.

The contribution of children to informal care: a Delphi study.

Sociological studies of informal care have documented the contributions of adults, both female and male, however, the contributions of children to care-giving has been relatively under-researched. This paper reports data from a Delphi study of eduction and welfare professionals with experience of children with care responsibilities in their family homes. According to these professionals, children are involved in a range of care activities, and often there is a strong emotional component to this care-giving. It is argued that research into informal care needs to recognize the contributions made by children, and that the emotional content of such care-giving is crucial in understanding the character of such care relations.