France is overall a low endemic country for tuberculosis (TB); however, Seine-Saint-Denis-the poorest department of metropolitan France-has the highest incidence rate in the whole country, excluding overseas territories. At the national level, TB mainly concerns people coming from a country with a high endemicity of TB, people in conditions of absolute poverty, and people living in prison facilities. In this north-eastern Parisian suburb, we conducted qualitative research through a multi-sited ethnography in six university hospitals of the Assistance Publique - Hôpitaux de Paris (AP-HP), two inter-municipal hospital centres, and the Samusocial de Paris, Équipe Mobile de Lutte contre la Tuberculose, a mobile medico-social team dedicated to TB. This study examines the processes through which tuberculosis is experienced and interpreted by migrants undergoing treatment in these facilities. Drawing on 82 in-depth semi-structured interviews with people living with TB (65 men and 17 women, whose estimated mean length of residence in France was about 10 years), this study shows that persistent doubt about the biomedical diagnosis can coexist with almost complete adherence to treatment. While most participants follow the prescribed treatment, many do not fully recognise tuberculosis as an exhaustive explanation of their illness and construct aetiological interpretations anchored in the social, material, and institutional conditions of their lives in France, including the absence of stable work and housing, insecure residence status, and experiences of institutional disaffiliation accumulated over time. We define this specific configuration as semantic resistance: a situated and circumscribed form of agency exercised within the therapeutic relationship through the possibility of accepting treatment without necessarily relinquishing one's own interpretation of illness. These forms of resistance can be read as a denunciation and an unveiling of the social and existential conditions within which suffering is experienced.

Particularly in relatively well-funded healthcare systems, medicine increasingly seeks to detect disease before it causes symptoms. Early detection can prevent suffering and premature death, but it can also diagnose conditions that will never become harmful. Although the existence of overdiagnosis is supported by clinical and epidemiological literature, its implications for practice remain contested. This paper examines how clinicians and researchers decide what evidence of overdiagnosis should mean for good care and how they act on it (or not). Drawing on three years of ethnographic fieldwork at conferences and seminars on overdiagnosis and early detection in the UK and internationally, supplemented by formal interviews with attendees and many informal conversations, I examine how evidence about the benefits and harms of intervention is interpreted, debated and translated into practice. Using Barrett's oesophagus as a central case, I seek to make a conceptual contribution to the literature by identifying two overlapping ethical orientations found in these fields. An "ethics of doing" treats intervention as a responsible response to the possibility of future disease. An "ethics of restraint" treats limiting intervention as a way of protecting people from harms produced by diagnosis and treatment. These are not fixed positions held by opposing groups: the same people may move between them as they respond to different forms of risk, responsibility and uncertainty. I argue that evidence alone does not determine how evidence of overdiagnosis should be acted upon. The same uncertainty can support intervention, because clinicians cannot know in advance who will develop serious disease, or restraint, because they cannot know who will benefit from intervention. What is at stake is therefore not simply whether overdiagnosis exists, but how harms and responsibilities are understood. By treating overdiagnosis as an ethnographic problem, the paper shows how competing responses to early detection are made consequential in practice and produce divergent notions of care.

Brazil is aging rapidly, and deep social and territorial inequalities shape who can take part in the socially and culturally constituted forms of physical activity and leisure of later life (bodily practices). We asked how Brazil's aging policy documents frame active aging and access to these practices, and how they reproduce or challenge inequality. We analyzed 14 governmental, intergovernmental, and institutional documents published between 1994 and 2025, assembling and coding the corpus between January and June 2025. We combined reflexive thematic analysis with a critical, poststructural reading of policy discourse, guided by intersectional and decolonial perspectives. We identified four interconnected mechanisms: (1) under universalism and erasure, documents treat older adults as one neutral group; (2) under responsibilization and moralized autonomy, they ask people to manage their own aging even while naming structural conditions; (3) under territorialized implementation gaps, they leave pathways loosely specified across unequal municipalities; and (4) under metrics, recognition, and policy silence, they rarely disaggregate by race, gender, or territory, which limits what policy can see and address. Taken together, the findings suggest that universal rights-based commitments may leave intersecting inequities insufficiently addressed. Such commitments stay broad promises unless implementation and monitoring name the racialized, gendered, economic, and territorial conditions people live in. For critical gerontology and public health, the study shows how policy categories and silences shape who is recognized in later life, in Brazil and across Latin America and the wider Global South.

The US has seen an alarming rise in overdose mortality among people experiencing homelessness and incarceration. Drug overdose and homelessness are dual crises that disproportionately impact Black, Hispanic, and American Indian/Alaska Native communities due to historic and ongoing structural racism. Our objective was to better understand the intersection of substance use, homelessness, and criminal-legal involvement among these populations to inform harm reduction and policy. We completed in-depth semi-structured interviews with racially minoritized people who use drugs (PWUD) in Michigan, New Jersey, and Wisconsin. This analysis focused on 54 participants currently or previously experiencing homelessness. We conducted a thematic analysis informed by the risk environment framework, which considers structural factors related to substance use. Participants identified a cyclical relationship between homelessness and substance use that was highly influenced by the policy risk environment. Substance use was shaped by the risk environment of homelessness, and untreated substance use led to homelessness. This synergy was exacerbated by criminal-legal involvement, including incarceration without treatment and exclusion from resources based on criminal histories. Participants described experiences living in racially segregated neighborhoods, which were important potential access-points for social services. Participants also noted the need for housing and treatment outside of the environments where their substance use and homelessness began. Our study describes risk environments that contribute to cyclical substance use, homelessness, and criminal-legal involvement among racially minoritized PWUD. To address overdose trends, it is imperative to expand equitable access to harm reduction and housing and reform criminal-legal policies surrounding substance use and unsheltered living.

Resilience is often framed within neoliberal health discourses as an individual capacity for adaptation, obscuring how the ability to endure illness is socially organised. This article reconceptualises resilience as a biographically embedded social practice through a study of older and emerging older adults living with Long COVID, an uncertain chronic health condition that unsettles everyday life and expectations of ageing. Drawing on longitudinal qualitative data from a UK study comprising three phases of 23 interviews (2021-2023), this article presents four illustrative cases of participants aged over 50. Rather than a static attribute, resilience was a dynamic and often painful process in which participants situated the present in relation to past experiences and (un)imagined futures, while seeking to maintain a coherent sense of self amid disruption. This work was enacted through everyday practices such as adjusting routines, renegotiating roles and seeking recognition in healthcare and social relationships. These efforts were enabled or constrained by social conditions, including institutional acknowledgement, material resources and normative expectations of ageing, sometimes leading resilience to be performed rather than authentically experienced. A central finding is that resilience involved learning to live with ambiguity. An uncertain prognosis disrupted biographical continuity and required continual recalibration of temporal horizons, often producing experiences of accelerated or disjunct ageing. Resilience therefore emerged not as recovery but as the socially mediated maintenance of a liveable biography. Recognising resilience as social practice foregrounds the need to reorganise the institutional and relational conditions that make endurance possible.

Studies of cancer survivorship and social media have treated survivors as audiences of online cancer content, examining how cancer survivors receive support and information from what others post. This study, in contrast, shifts attention from the consumption of online cancer content to its creation. In this article, we employed a theory-led phenomenological approach to examine how creating cancer content on social media did not merely represent survivorship, but - in participants' accounts - substantially transformed their embodied experience of illness. Drawing on interviews conducted between January and May 2026 with 18 cancer content creators in the United States and Europe, findings revealed three ways participants described content creation as reshaping how they lived with cancer. 1) Becoming recognizable showed how participants described their own public cancer brands as becoming part of their self-understanding. 2) Becoming believable showed how participants - who reported that followers doubted whether they really had cancer - came to experience visible bodily changes and clinical spaces as evidence that could prove their illness was real. 3) Becoming valuable revealed how participants perceived suffering and medical crisis as drawing greater audience attention than recovery - creating a paradox in their experience of healing. Namely, as participants recovered and audience attention appeared to decline, some participants came to feel less valuable. Building on these findings, this study demonstrates that social media is not only a repository of cancer information, but a lived cancer environment in which survivorship itself takes shape.

Alcohol misuse among mid- and later-life adults is a growing public health concern. Early life adversity (e.g., abuse, poverty) is a well-established risk factor for alcohol misuse in midlife and beyond. Neighborhood environments may also influence alcohol use and shape the extent to which early adversity contributes to misuse later in life, yet little is known about these relationships among midlife and older adults. Using a cross-sectional sample of 9759 adults aged 51+ from the Health and Retirement Study and a series of multilevel mixed effects logistic regression models, this study examined whether adult residential characteristics moderate the associations between three domains of childhood adversity and two problematic drinking outcomes (heavy episodic drinking and hazardous drinking). Findings showed that exposure to two or more risky parental (e.g., abuse) or any adolescent (e.g., trouble with police) behaviors increased the odds of hazardous drinking, while exposure to multiple childhood socioeconomic disadvantages (e.g., poor family finances) was associated with lower odds of hazardous drinking. Among residential characteristics, neighborhood social ties were associated with higher odds of both heavy episodic and hazardous drinking. Neighborhood affluence, however, was a protective factor for problematic drinking. Significant cross-level interactions indicated that residential context modifies associations between early life adversity and alcohol misuse. Notably, neighborhood social ties amplified the probability of heavy episodic drinking among individuals with childhood socioeconomic disadvantage. These findings highlight the complex and context-dependent nature of alcohol misuse risk in mid- and older-adulthood, and that residential characteristics may function as both protective and risk-enhancing factors.

Health services generate substantial greenhouse gas emissions and contribute to climate change, which is expected to increase pressure on those services. In response, health services have committed to reducing their emissions through net zero policies. Successful implementation of these policies depends on public support, yet little is known about public preferences for net zero policies for health services. This paper uses a discrete choice experiment fielded in February-April 2024 among 2050 adults (1018 in England and 1032 in Scotland) to elicit public preferences for net zero policies within the context of a publicly funded healthcare service. We find that respondents in England and Scotland are broadly supportive of net zero policies (net zero plans are chosen 88-93% of tasks), but support decreases if policies are financed by increased taxation (net zero plans are chosen in 76-79% of tasks). We find an average willingness to pay of £340-£358 per year, with significant preference heterogeneity across respondents based on income. 3-12% of respondents do not support any net zero policies and, based on debrief open-ended questions, most of them do not consider reducing greenhouse gas emissions a priority for the health service. Our results provide new and timely information about public preferences and trade-offs for net zero policies within health services. These results can inform net zero health and care policies that have public support.

Public health emergencies confront officials with the challenge of communicating guidance that evolves as scientific evidence and institutional recommendations change. Although institutional trust is associated with adherence to public health measures, less is known about the interpretive and communicative work through which public officials seek to make changing guidance understandable, legitimate, and credible. Drawing on a comparative qualitative study of Brazil and Japan, this article examines trust-building communication among public officials involved in implementation, coordination, and policy oversight. The study is based on 122 semi-structured interviews and a 239-document corpus covering 2020-2022. Using abductive comparative analysis, we identify Public Health Sensegiving as the process through which officials interpret evolving scientific and institutional guidance and translate it into public-facing explanations. Empirical episodes show a recurrent sequence in which officials interpret ambiguous guidance, communicate workable explanations, and refine them in response to citizen questions. Four practices constitute this process: explaining and translating guidance, contextualizing risk and uncertainty, legitimizing recommendations, and encouraging voluntary cooperation. Comparisons within and across countries show that competing messages increased the need for reconciliation, whereas more consistent messaging allowed greater emphasis on continuity and shared responsibility. These differences reflect contextual communicative demands rather than fixed national types. Rather than demonstrating changes in citizens' trust or behaviour, the findings identify how officials perform trust-building communicative work under uncertainty and highlight interpretive capacity as a public health preparedness capability.

Technology is increasingly seen as a viable option for 'solving' future (and present) crises of healthcare labour through the automation or augmentation of human labour. Exoskeletons are wearable robotic suits designed to augment care workers' strength and endurance and to protect them from injury. We frame our analysis of them within two impulses in feminist science studies: that care work reorients how technoscience is approached and assessed, and that technology demands careful attention to its entanglements with gendered and racialized labour and with militarization. Drawing on interviews with the designers of occupational exoskeletons, we first present their claims about the ways in which exoskeletons are a form of care for the bodies of healthcare workers; a means towards race and gender workplace equity; and a vehicle for revaluing care work. We then question these technoliberal claims, voicing concerns that exoskeletons can be a means of surveilling workers' bodies for the purpose of increasing productivity; potentially creating humanoid robots to replace them; extending life spans of work; and the hardening national borders against immigrant care workers. These speculations set an agenda for further localised study. We call for more grounded assessments of technoscience to understand what new care technologies are doing in the world and how these 'creeping' technologies may unsettle the relationship between care and technology. 23 semi-structured qualitative interviews were conducted in person and online from the United Kingdom and Canada between 2021 and 2026 with 13 exoskeleton companies and industry experts based in 8 countries. Observation and interviews were also conducted in person at 3 industry trade exhibitions.