'Staying in the lane' of public health? Boundary-work in the roles of state health officials and experts in COVID-19 policymaking.

The state-level COVID-19 response in the United States necessitated collaboration between governor' offices, health departments and numerous other departments and outside experts. To gain insight into how health officials and experts contributed to advising on COVID-19 policies, we conducted semi-structured interviews with 25 individuals with a health specialisation who were involved in COVID-19 policymaking, taking place between February and December 2022. We found two diverging understandings of the role of health officials and experts in COVID-19 policymaking: the role of 'staying in the lane' of public health in terms of the information that they collected, their advocacy for policies and their area of expertise and the role of engaging in the balancing of multiple considerations, such as public health, feasibility and competing objectives (such as the economy) in the crafting of pandemic policy. We draw on the concept of boundary-work to examine how these roles were constructed. We conclude by considering the appropriateness as well as the ethical implications of these two approaches to public health policymaking.

A Social and Ethical Framework for Providing Health Information Obtained from Combining Genetics and Fitness Tracking Data.

In this paper we explore a new technological intersection in the "big data revolution": the integration of two forms of data, genetic data and fitness tracking data. For example, a small number of direct-to-consumer (DTC) genetic testing companies have recently begun offering customers the ability to link their fitness tracking data with their genetic profile to get personalized diet and exercise recommendations. In this paper we put forward four ethical considerations that should inform potential uses of this health information. Those considerations are: the heightened risks to privacy resulting from combining sensitive data sets; the poor quality of health information that is possible at present in the realm of precision DTC genomics; the limited usefulness of the recommendations; and finally, the cultural assumptions about health and personal responsibility that are embedded within fitness genetic testing and fitness tracking. To conclude, we offer some guidance on how the benefits and risks of returning this type of health information can be weighed.

"Lives versus livelihoods": Conflict and coherence between policy objectives in the COVID-19 pandemic.

Many policies were put in place during the COVID-19 pandemic in the United States to manage the negative impact of the coronavirus. Limiting severe illness and death was one important objective of these policies, but it is widely acknowledged by public health ethicists that pandemic policies needed to consider other factors. Drawing on semi-structured interviews with 38 people across 17 states who participated in the state-level COVID-19 pandemic policy process, we examine how those actors recounted their engagement with four different objectives over the course of the pandemic: protecting public health with respect to COVID-19 (which we refer to as pathogen-focused disease prevention), protecting the economy, promoting the public's broader health and wellbeing, and preserving and restoring individual freedoms. We describe the different ways that pathogen-focused disease prevention was thought to have conflicted with, or to have been coherent with, the other three policy objectives over the course of the pandemic. In tracing the shifting relationships between objectives, we highlight four reasons put forward by the participants for why policy changes occurred throughout the pandemic: a change on the part of decisionmaker(s) regarding the perceived acceptability of the negative effects of a policy on one or more policy objectives; a change in the epistemic context; a change in the 'tools in the toolbox'; and a change in the public's attitudes that affected the feasibility of a policy. We conclude by considering the ethical implications of the shifting relationships that were described between objectives over the course of the pandemic.

Lessons from sustainability of Play Streets in the United States.

Communities around the world lack safe places for children to play and be physically active. One solution to this issue is Play Streets, which involves the temporary closure of streets for several hours to create a safe space for active play and physical activity. While the benefits of these programs are greater when they are recurring over many years, there is a dearth of literature regarding how to successfully sustain Play Streets. To understand how Play Streets can be sustained in the long term, we conducted semi-structured interviews with 24 Play Streets organizers representing 22 Play Streets programs across the United States. Four recurring sustainability challenges were highlighted from the thematic analysis: 1) securing and sustaining funding, 2) managing community and city resistance to street closures, 3) navigating government bureaucracy, and 4) retaining interest amongst organizers and volunteers. With each challenge, we describe how Play Streets organizers navigated those challenges, with a goal of generating recommendations for those wishing to sustain Play Streets programs in the long term.

Assembling the 'Fitbit subject': A Foucauldian-sociomaterialist examination of social class, gender and self-surveillance on Fitbit community message boards.

The rise of fitness-tracking devices such as the Fitbit in personal health and wellness is emblematic of the use of data-gathering health and fitness technologies by institutions to create a surveillance regime. Using postings on Fitbit community message boards and the theoretical frames of Michel Foucault and sociomaterialist scholars, the goal of this article is to analyse the experiences of those who choose to self-track using a Fitbit and the constellation of barriers and facilitators (human and non-human) related to social class and gender that enable and constrain one's ability to use a Fitbit as intended. First, we examine the social class assumptions of Fitbit as a risk management tool in the workplace, illustrating what elements must come together - both human and non-human - to create an environment that enables walking throughout the workday to combat the risks of sedentary work. Second, we explore the ways that Fitbit users 'confessed' to their past inactivity and how gendered home labour differently enables and constrains some of the users' abilities to act on their confessions. Ultimately, one's ability to engage in the idealized use of the Fitbit in the minds of its users, or what we term the 'Fitbit subject assemblage', is structured by numerous material and social factors that must be taken into account when examining the mechanics of power in fitness tracking.

Promoting Prenatal Exercise From a Sociocultural and Life-Course Perspective: An "Embodied" Conceptual Framework.

PURPOSE: Prenatal exercise is a health behavior that is receiving growing attention amid concern that women in Western societies are gaining excess weight during pregnancy and contributing to future obesity in both the mother and child. In this article, we draw on insights from the fields of social epidemiology and social theory of the body to examine existing prenatal exercise interventions and to propose a multidimensional framework intended to guide future theorizing and intervention design. METHOD: A scoping review of existing prenatal exercise programs and interventions focused on controlling gestational weight gain was conducted. Articles published prior to January 2017 were obtained from PubMed and CINAHL, and relevant articles were identified (n = 62) using specified inclusion and exclusion criteria. Identified articles were further analyzed to classify the level(s) of the socioecological model targeted in the intervention or program. RESULTS: The majority of existing interventions target intrapersonal factors during pregnancy and do not attend to the role that cumulative exposure of social and structural disadvantage over the lifetime-not just during the prenatal period-plays in shaping health outcomes. In response, a multidimensional framework is proposed that includes key concepts that facilitate a life-course perspective, as well as attention to the integration of biological and social factors as they relate to health and health-related behaviors. CONCLUSION: Efforts to promote prenatal exercise and to improve maternal and infant health should attend to how systemic inequality impacts women's health.