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Welcome. at Maastricht University. ‘Where are the fat people in public health?’ How to engage with users and non-users in public health? Klasien Horstman Caphri 2 April 2012. Tensions public health-user centeredness Public health is offered by public institutions to healthy citizens

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  1. Welcome at Maastricht University

  2. ‘Where are the fat people in public health?’ How to engage with users and non-users in public health? Klasien Horstman Caphri 2 April 2012

  3. Tensions public health-user centeredness • Public health is offered by public institutions to healthy citizens • Targeting the public/society (not individuals) • Assumption non-users must be transformed into users of top down interventions • Context: gap life worlds ph/LSES – them and us; distrust state • Result: crisis in authority/trust

  4. Meaning of user centeredness: strategy of risk governance/management of post modern democracies - ‘users’ should play a role in the production of knowledge, in the design, the development, the implementation and evaluation of public health programmes and technologies - users to be considered experts, embodying knowledge - institutions and users interact, co-produce each other - user centeredness results in more socially robust and authoritative public health institutions

  5. Public health & user centeredness - Tradition of moral paternalism (top down ph) • Replaced by expert (EBM) driven paternalism (top down ph) • Undercurrent of participative community based ph since 1970’s (participative research) • Currently: hesitating turn in public health towards users, communities, neighborhoods, voice, dialogue, ‘the other’.

  6. Two models of user centeredness Instrumental. Dialogue, listening, motivating etc. is considered as instrumental for successful implementing expert based interventions. Sticking to the own ph agenda. Intrinsically. Learning from users because of the added value of their knowledge and willingness to change the ph agenda based on users feed back. In practice – the instrumental model dominates, many experiences of users/non users not taken seriously as such.

  7. Example: National Vaccination Programme RIVM - on the one hand interested in perspectives of people with respect to vaccination ( many questionnaires, interviews, focus groups) - on the other hand no structural voice channels from local practices through regional physicians etc. to the RIVM, and turning away (in many respects) from non-users and non-standard users. Evading non users = missing insight in practices of non-users (which is a main task of the RIVM!).

  8. Questions • How to engage users and their social embeddings in public health? • How does the rather individualistic notion of user/citizens relate to socially embedded practices of users (culture of class; notion of community?) • How to organize voice in all phases of public health (research, design, development, implementation etc.) and how to learn from this? • How to balance the many different user perspectives? • How to balance epidemiology and users; statistics and life stories; the mean and the particular? • How to relate user centeredness and professional authority? • How to prevent that now, instead of ebm, user centeredness becomes the new standard and ideology?

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