Advances in Applied Sociology
2013. Vol.3, No.1, 61-68
Published Online March 2013 in SciRes (
Copyright © 2013 SciRes. 61
Outside the Cage: Exploring Everyday Interactions between
Government Workers and Residents in a Place-Based
Health Initiative
Naomi Sunderland
School of Human Services and Social Work, Griffith Health Institute, Griffith University,
Meadowbrook, Australia
Received October 15th, 2012; revised November 20th, 2012; accepted November 30th, 2012
This paper presents an ethnographic case study of the daily lived experience of place by government
health and community workers in a place-based chronic disease initiative (PBI) located in a disadvan-
taged peri-urban area in Australia. The case study focused on the place at which the PBI staff members
interfaced with the community informally as opposed to the deliberate interactions described in the formal
community engagement strategy. Subtle social phenomena, such as social positioning and the contrasting
cultures of bureaucracy and community, generated outcomes that were the antithesis of those sought by
the PBI. If these characteristics of place are not attended to during the development of PBIs, we risk rec-
reating existing social divides and jeopardizing the potential of these initiatives to build community ca-
pacity. This case study provides an important conceptual-theoretical understanding of the place-based ap-
proach, which can augment existing empirical studies of place. The findings are also relevant for those
who are exploring the physical co-location of diverse professional groups in socially disadvantaged
neighbourhoods. It also exposes the inherent complexity of “place” and the futility of poorly designed
bureaucratic responses.
Keywords: Place-Based Initiative; Bureaucracy; Community; Culture; Habitus; Proximity; Ethnography;
Lived Experience
The district manager of the government health district is sit-
ting working in his office. He hears a commotion and yelling
from outside the eastern wall of his office which is made en-
tirely of glass and partially covered by blinds. He looks out to
see a man smashing his female companion’s head against a
brick wall on the walkway outside the office. The district man-
ager runs outside through the secured sliding glass doors of the
building to intervene. A female colleague who worked in the
office at the time said, “There was nothing else he could do!”
A female researcher and a female government employee are
walking to their car following a meeting at the government
office, which is located in the same building as several commu-
nity services (i.e., child protection, probation and parole, reha-
bilitation, and employment services). As they walk to their car,
they see a group of young men in “street” clothing leaning
against a brick wall talking. The young men do not look at the
women. They keep talking to each other as the women ap-
proach. The government employee says to the researcher,
“Should we cross the road, these guys might be chroming1”.
A female researcher, a government health promotion officer
and the PBI Manager are conducting formal interviews for a
team leader position in the PBI when a child screams. The
screaming continues and intensifies, “Daddy, Daddy, I don’t
want to go”. Looking out the boardroom window, the occupants
watch as a child safety worker carries the screaming child into
the office next d oor and locks th e security doors. Tw o other child
safety workers hold b ack the father who even tually throws up his
hands and walks away. The boardroom is silent for a few more
minutes, followed by some discussion about how this is a regular
occurrence. The interviews continued.
Program leaders and the Manager of a place-based health coa-
lition are having a formal monthly team meeting inside the go-
vernment build ing. The progra m leaders are all employees of th e
government health department. They are wearing semi-formal
corporate style clothing suitable for office work and public
meetings. The meeting room features a long boardroom table.
An eastern wall made entirely of glass overlooks a walkway that
circles the building and contains entrances to the various com-
munity services in the building. There is a commotion and
swearing outside the meeting room. The PBI Manager says,
“Are those unhappy people outside?” Another of the meeting
participants leans over and closes the blinds. Several of the
people outside stare into the meeting room as he closes the
Increasingly it is clear that people’s health and wellbeing is
determined not by individual actions alone but by complex
individual, social, political, economic, and environmental de-
terminants of health (CSDH, 2008; Marmot et al., 2010; Schulz
& Northbridge, 2004). Strategies for addressing these complex
“social determinants of health” (SDOH) have been recognised
internationally both as a way of preventing ill health in the
future and addressing pervasive health inequities between peo-
ple who experience positive social circumstances and those
1“Chroming ” is a colloquial term for sniffing substa n ces in ae r o so l cans.
who do not (CSDH, 2008; Marmot et al., 2010). Researchers
have shown that health advantage or disadvantage tends to
cluster in distinct geographical areas due to localised social and
environmental factors such as the affordability of housing and
other services such as transport; cultural, socio-economic, and
physical mobility; and the presence of supportive social net-
works and relationships (see for example, Baum & Palmer,
2002). As a result, policy makers have developed a string of
government funded “place-based” initiatives (PBIs) or “health
action zones” (see for example, Bradford, 2005) that are de-
signed to tackle place based SDOH. These PBIs attempt to
effect positive change across complex SDOH such as healthy
public policy, built environments, pollution, access to facilities
and services, income and employment, crime, and social in-
clusion (Schulz & Lempert, 2004; Schulz & Northbridge,
While there is growing support for PBIs internationally, there
is less acknowledgement of the inherent complexity of imple-
menting PBIs in neighbourhoods that experience significant
social and economic disadvantage and diversity. In particular,
there is little discussion of the challenging nature of place based
work for health promotion workers. The purpose of this article
is hence to examine the nature and reality of PBIs from the per-
spective of the health promotion workers who implement them.
To do this, I present an ethnographic case study of interesting
and unexpected social interactions and boundaries between go-
vernment PBI workers and local community members at a gov-
ernment service building in a peri-urban PBI targeting chronic
disease in Australia. I draw on a range of theoretical concepts
from existing literature to aid in interpreting the phenomena
encountered during the case study that may in turn usefully
inform future PBIs (Farmer, Munoz, & Threlkeld, 2012: p.
In parallel with international PBI policies and investments,
researchers across the fields of social geography, urban and
community studies, sociology of health, and health promotion
have developed innovative theory and methods to examine the
deterministic relationship between place and health (see for
example, Brodsky, 1996; Carpiano, Kelly, Easterbrook, & Par-
sons, 2011; Caughy, O’Campo, & Patterson, 2001). Farmer and
colleagues (2012) for example, adopted social geography the-
ory to emphasise the heterogeneity and dynamism of places that
health planners and researchers often label using misleading
static and homogenising categories such as “peri-urban”, “re-
gional”, and “remote”. Farmer et al. (2012) argue instead for a
dynamic conception of place and health that understands
“place” as the crossing in time and space of various forces and
flows (including people, economic opportunities, natural re-
sources, social assets, politics, cultural mix, infrastructure and
history), and so as defined not only by the local but also by
relatedness to other places.
Such a conception of place and health is obviously amenable
to the complex SDOH view of health in international policy.
Following Massey (2005), Farmer et al., (2012) further empha-
sise the “throwntogetherness” of place that “unites a host of
human and nonhuman features in time” including “people and
health services, and also family, work and social networks, lo-
cal and distant community and business organisations, govern-
ment, policy and regulatory arrangements” (p. 187).
Broader literature on space and place emphasises that people
participate in places and spaces for different reasons and with
differing levels of familiarity and connection (Tuan, 1977: p. 6).
Likewise, the social relations that comprise places “are never
still; they are inherently dynamic” (Massey, 1999: p. 2). As
such, people may have both complex and ambivalent feelings
about place (Tuan, 2005: p. 7). In shaping and being shaped by
our experiences, places become interwoven with individual and
collective identity and belongingness where “people collective-
ly imbue physical space with meaning that transforms it into a
socially and emotionally significant location—a “place” (Hochs-
child Jr., 2010: p. 622). Likewise, place identities are created
and recreated through “meaningful social interaction and inter-
connectedness at the locale” (Hochschild Jr., 2010: p. 622).
“Cultures of place” then are not universally shared experiences
for all people who frequent a place but, rather, general patterns
of relating and experience that lead to shared meaning making
(Martin, 2002: p. 112).
Despite the “throwntogetherness” of place, place participants
produce and reproduce known expectations for experience
within that place and “observable social orders” for specific
activities such as how to line up for buses or wait for appoint-
ments (Sharrock, 1995; McHoul, 2009: p. 18). Health research-
ers have also identified that class related SDOH cluster within
specific geographic areas and places. Singh-Manoux and Mar-
mot (2005), for example, identified intergenerational class so-
cialisation and resulting “habitus” and social positioning as key
SDOH that determine health outcomes across many generations
of families. Singh-Manoux and Marmot (2005) applied Bour-
dieu’s theory of habitus to explain the way that “social struc-
tures, through the processes of socialization, come to be em-
bodied as schemes of perception that enable individuals to live
their lives, leading societies to reproduce existing social struc-
tures” (Bourdieu, 1984; Singh-Manoux & Marmot, 2005: p.
2129). They contend, as a result, that “norms on healthy be-
haviour” are conditioned through socio-economic contexts
throughout our life course (Singh-Manoux & Marmot, 2005: p.
2129). The social environment is hence paramount in defining
and perpetuating class-related health behaviours, attitudes, and
beliefs that are available to individuals. In order to “belong” to
a certain social class and related social places, then, individuals
exhibit—both consciously and unconsciously—the material
cues (such as dress and habits) and dispositions that identify
them as part of the relevant social group (see also Weyers,
Dragano, Richter, & Bosma, 2010).
Health researchers have sought to document the complexity
of place and health outlined above using a range of innovative
methods including: geographical information systems mapping
of relevant SDOH and health outcomes statistics ( see Dennis Jr.,
Gaulocher, Carpiano, & Brown, 2009; Gudes, Kendall, Yigit-
canlar, Pathak, & Baum, 2010); systematic observational stud-
ies that document physical environments (see Caughy et al.,
2001; Cohen et al., 2000; Craddock, 2000; Raudenbush &
Sampson, 1999); narrative studies of place based experience of
health and wellbeing (see Dennis Jr. et al., 2009; Parry, Mathers,
Laburn-Peart, Orford, & Dalton, 2007); and ethnographic stud-
ies of the lived experience of local SDOH (see Burbank, 2011;
Schulz & Lempert, 2004; Sunderland, Bristed, Gudes, Boddy,
& Da Silva, 2012). Despite the significant above mentioned
advances, current literature under-represents one of the key fac-
tors that influences how a PBI is enacted: namely the prepar-
edness or otherwise of health workers to operate collaboratively
Copyright © 2013 SciRes.
and in situ with the communities that experience significant
disadvantage (see Broadhead & Fox, 1990: p. 323; Moore,
2009). PBIs typically involve the generation of a partnership or
coalition among providers in the government, non-government,
local council authority, and community sectors. Although this
connection to local organisations is a defining feature of PBIs
(i.e. based in and with place as opposed to being imposed upon
place), the connection to the local community can often be li-
mited to formal (i.e. deliberate and controlled) bureaucratic
modes of engagement. As shown in this study, this focus on
formal partnerships leaves an intensely under-recognised spec-
trum of informal and incidental engagement that occurs con-
tinuously as a result of the physical proximity of PBI workers
to their local comm un ities.
Case Study
Given the nature of place outlined above, PBIs are inherently
complex social interventions. As Massey (2005), indicated, cul-
tures of place encompass various cultures of ethnicity, organi-
sations, families, language groups, and professions that are
“thrown together” in space and time. This case study occurred
as part of my research with a complex PBI targeting chronic di-
sease prevention in an intensely diverse health service district
in Australia. The PBI district is classed as experiencing signifi-
cant “socioeconomic disadvantage” (ABS, 2006) and residents
experience complex interlocking SDOH such as low income,
unemployment, crime, violence, and relatively high incidence
of preventable chronic disease. It is one of the most culturally
and linguistically diverse health service districts in its state and
is known to function as a first “port” for refugees and migrants
to Australia (ABS, 2006). The Australian Bureau of Statistics
attributes net migration into the area to the availability of rela-
tively low or unskilled employment in the area, low income
housing, and pre-existing culturally and linguistically diverse
communities in the district (ABS, 2006). I was part of an inter-
disciplinary research team that worked with the PBI team as
collaborators over a period of four years. Our research was
funded by a combination of Griffith University and Australian
Research Council (ARC) funding.
The venue for this particular case study was the PBI central
administration office and the community services building
within which it is located. It was a venue worthy of study for at
least two main reasons. First, it was chosen by the founding
employees of the PBI so they could be located in close physical
proximity to the “community” with which they would be work-
ing. They made this decision in an attempt to break down per-
ceived divisions and tensions between the central funding
agency for the PBI (a state government health department), and
local non-government health and community service providers
who were voluntary partners in the PBI. Second, the venue is
worthy of study because of the significantly personal (private
and potentially sensitive) nature of the services that are pro-
vided to community members in the building and the resulting
culture that surrounds them. In addition to the PBI central ad-
ministration office, the building houses: Adult Mental Health
Services; Legal Aid; Probation and Parole; Employment ser-
vices; Hearing services and equipment providers; Child safety
services; Indigenous youth employment services; and State
multicultural services.
I was initially invited to observe regular PBI team meetings
at the case study venue to document knowledge sharing across
the PBI’s teams and networks as part of the broader ARC and
Griffith University funded research. This included a focus on
how the PBI engaged with local communities. This case study
of the PBI office building emerged somewhat unexpectedly
from my observations of these meetings after I observed sig-
nificant “insider-outsider” incidents and dynamics—such as
those described in the preface to this paper—between PBI team
members and local community members at the case study ve-
nue. Case study participants hence opportunistically included
the three male and five female state government health depart-
ment employees who participated in the observed meetings and
who were located in the central PBI administration office (n=8).
These participants were not engaged in direct service provision
and did not have direct professional contact with local commu-
nity residents as part of their daily tasks. Their contact with ex-
ternal parties was almost solely comprised of contact with other
service providers in the district. Hence their only regular con-
tact with community members was through daily incidental in-
teractions at the case study ven ue.
The overarching aim of this case study was to document and
interpret government health workers’ daily lived experiences of
implementing a PBI in a known area of socio-economic disad-
vantage. In particular, I wanted to explore the PBI office build-
ing as an interface between PBI workers and local community
members. The case study method aligned with interpretive
approaches to research which frame both the building itself and
the social relationships enacted within it as meaningful discur-
sive resources upon which human agents both draw and con-
tribute to in making sense of their experience s (Pink, 2007a). Al l
elements of the social interaction can be seen as active and
dynamic “meaning-making” resources including, for example,
signs, documents, clothing, hairstyles, facial features, expressions,
language, and general demeanour (see Goffman, 1959). Pink’s
(2007a, 2007b) visual ethn ography informed data collection, em-
phasizing the role of visual data in creating durable representa-
tions of the meaning-making resources present at a given time
in a given social space. This method was ideal for investigating
the ways in which built environments interacted with social
relationships to create and recreate shared meaning and experi-
I initially conducted data collection during my observation of
monthly PBI team meetings over a period of 12 months be-
tween 2008 and 2009 (approximately 24 hours of meeting ob-
servation in total). Once I observed an initial “insider-outsider”
dynamic between PBI staff and community members outside
the building during team meetings, I began to conduct additio-
nal unstructured observations and interviews with meeting par-
ticipants opportunistically before or after meetings to ask them
about the dynamics I was observing. I was already in a routine
of taking semi-structured field notes during and after every
meeting I observed and extended this for the purposes of the
case study. I routinely shared my notes with the Chair of the
meeting via email to gather her feedback on my observations
and provide insider knowledge and explanations wherever she
saw fit. If the Chair responded to my observations via email, I
copied and pasted her response into my original observations
document and referred to them as part of my ongoing collection
Copyright © 2013 SciRes. 63
of research data. I also began to take a small camera with me to
meetings and took random photographs of public spaces in and
around the building to create a “personal record of spatial and
social relationships” (Knoblauch, Baer, Laurier, Petschke, &
Schnettler, 2008). I later took additional purposive photographs
that expressed particular observed patterns of interaction or
meaning making.
I adopted a theory-driven approach to interpret the phenom-
ena I observed during the case study. This consisted of me at-
tempting to explain the phenomena using theoretical concepts
from the existing literature and then coding observation notes
and photographs in reference t o these concepts (see for example,
Carpiano et al., 2011; Ryan & Bernard, 2003; Singh-Manoux &
Marmot, 2005; Snow, Morrill, & Anderson, 2003). I then ap-
plied a series of more structured analysis questions during this
process including: What is observable about social interactions
within this place? Do the photographs support, contradict or
complement the perspectives observed in meetings? Can these
patterns be explained using any thematic concepts (i.e. theore-
tical concepts that are applicable to observed phenomena)?
Based on the outcomes of this questioning, I identified the key
“thematic concepts” (i.e. the most frequently coded) that could
be used to describe and interpret the observed social phenom-
ena at the case study venue. I discuss these key thematic con-
cepts in the following section.
Three concepts from the existing literature effectively de-
scribe the insider-outsider dynamics I observed at the PBI of-
fice building. These include: 1) cultures of bureaucracy and
community ; 2) habi tus a nd socia l positioning; and 3) proximity.
In particular, I found that these concepts described both the
social boundaries I observed between PBI workers and local
community members at the case study venue and the broader
dynamics—such as proximity—that PBI workers experience in
significantly disadvantaged areas. I discuss the case study out-
comes in reference to these conc epts below.
Contrasting C ul tures o f Bureaucracy and
The first observable boundary that divided those inside and
outside the window at the PBI building was the contradiction
between the cultures of bureaucracy and community and re-
sulting “insider-outsider” demarcations of space in the building.
Scribner and colleagues (1999) usefully described this pheno-
… it is useful to view community and bureaucracy as occu-
pying opposite ends of the organizational spectrum. Within the
Gemeinschaft/Gesellschaft theoretical framework (14), “com-
munity (Gemeinschaft) may be experienced through kinship,
through living in the same neighborhood, or through gathering
with others in community of the mind” (15)… In contrast to
relationships experienced in community settings, Gesellschaft-
type relationships are often contractual in nature, serve to achi-
eve some goal or benefit, and are representative of relationships
formed within bureaucratic organizations (Scribner et al., 1999:
p. 135).
The symbolic features “inside” the PBI office were typical of
bureaucracy and government within Australia (for example:
office furniture, filing cabinets, desks, chairs, computers and
partitions). The physical parts of the PBI office that were most
visible to the outside world were the secure doors, warning
signs, and meeting rooms or offices located on the walkway
(see photographs). When community members looked through
the glass, they saw a group of professional people in profes-
sional clothing engaged in discussions around a boardroom
table, or sitting at a computer desk. The relationships commu-
nity members witnessed inside the office were not of a social
nature, although these may of course have been present. Rather,
the relationships were systems-oriented, work-related, contrac-
tual in nature, largely conducted between the hours of 8 am to 5
pm from Monday to Friday.
By contrast, the symbolic features of the “outside” world
were those of the local community or, at least, those sub-groups
of local community that attended the building on a regular basis.
The relationships among people who grouped together outside
were those of friendship and family, in all their positive and ne-
gative forms, that were not limited to business hours and work-
ing days. They were relationships of place and kinship that en-
dure and find their home in the geographic locations mapped by
the PBI strategic documents. Although the PBI was designed to
be finite in its duration and presence, these community rela-
tionships went on indefinitely. People from outside were not
welcome in the PBI office unless they had an appointment to
participate in some aspect of the administration of the PBI,
which was rare.
The cultural cues for maintaining an insider-outsider culture
at the building were clear. The sign shown in Image D” hangs
on the secure sliding doors into the PBI office and Image E
hangs on the main public entrance to the building as well as on
the toilet doors prohibiting members of the public from using
the public toilets allegedly due to previous “vandalism”. A for-
mal letter from the building owner hangs on the toilet doors jus-
tifying and notifying of a decision not to allow public access to
the toilets. All doors to the toilets and offices are protected by
coded locks with passwords or buzzers that allow acceptable
visitors to gain admission with approval from the PBI recap-
tionist. Although there are necessary safety and security justifi-
cations for restricting access to the building, these precautions
reinforce the culture of place that keeps insiders and outsiders
apart. The signs are notable because they are a powerful cue to
all people entering the building that: 1) there have been some
problems associated with people using the building as a public
space; 2) that [some] people who frequent the building are the
kind of people who vandalize public toilets; and 3) [some] peo-
ple inside want to keep other people out.
A more complex history of the toilets at the building emer-
ged through an informal interview with one of the team mem-
bers. The team member stated that the “real” reason for secur-
ing the public toilets was because a community member had
committed suicide in the toilets. The team member had per-
formed cardio-pulmonary resuscitation on the community
member with another colleague from the PBI office. The team
member said that because the PBI office was labelled as a state
health department office, the security officer had turned to the
PBI for assistance when the community member was found
unresponsive in the toilets. Others in the PBI office were pre-
sent in the toilets and surrounding hallway until the ambulance
arrived. A male team member i ndependently reported t he same
incident, but added that it had happened within the first two
weeks of the PBI moving into the building “just before Christ-
Copyright © 2013 SciRes.
mas”. The male participant said he had a feeling of “woah what
a way to start” following the incident.
Habitus and Social Positioning
A second significant boundary between insiders and outsid-
ers was habitus and social positioning. Habitus refers to the
way in which a person’s (or group’s) access to social, economic,
cultural, and other forms of capital are inscribed upon them in
discernable ways (Bourdieu, 1990). According to Bourdieu, the
social, political, economic, and cultural spaces of our present
and past are evident the dispositions we display. Social posi-
tioning relates to social dynamics that reach beyond place.
Lindemann’s (2007) concept of social positioning further iden-
tified the categories of social stratification that are inscribed
upon us, namely, “age, gender, ethnicity, education, status on
the labour market and income”. These categories all affect a
person’s perceived and lived position in social hierarchy. She
argued that income, for instance, determines an individual’s
perceived sense of their position in social hierarchies. In her
words, “[t]he subjective social position depends not only on the
objective characteristics but also on how people experience
society, the way they perceive their position in comparison with
others, and what they imagine their position would be in future”
(Lindemann, 2007: p. 54).
Although it is obvious that the people working in the PBI of-
fice were diverse in terms of their own experiences and origins,
it was also clear that those outside the window differed substan-
tially from those inside. The people inside the PBI office inhab-
ited different social, political, economic, and cultural spaces to the
people outside the office. There was little observable about the
culture of the place that would allow either the insiders or out-
siders to develop more than cursory impressions of one other.
As Goffman (1959) observed, when thinking about social po-
sitioning as a barrier to engagement and understanding, it is
important to recognize that it is intertwined with stereotypes
and lived experience—both positive and negative. If proximal
engagement between people does not occur in a PBI setting,
there is nothing to challenge the stereotypes that social posi-
tioning conjures. For example, when a community member
punched the window of the meeting room, it provoked in-
tensely negative engagement from the meeting participants.
Neither those outside nor those inside moved any closer toward
an appreciation of the other as a result of this interaction, or any
other interactions. Hence, there is no conciliatory social or mo-
ral engagement despite the close physical proximity. The po-
tential for social positioning to produce stereotyped and distant
interactions was further evidenced when a female PBI em-
ployee came upon the group of young men talking and leaning
against the fence. Her reaction was unexpectedly one of fear
which prompted her to cross the street. She invoked a stereo-
type that the young men were chroming and would be danger-
ous, even though there was no indication to support this view.
The suicide incident in the PBI building’s toilets was a pow-
erful and intense ex ample of the ext reme proxi mity be twee n the
government employees and community members in this venue.
In this case, the team member who provided assistance to the
community member had extensive clinical experience via which
she could interpret and manage the experience. For most gov-
ernment employees engaged in bureaucratic work, the require-
ment to provide medical attention would be highly unusual and
stressful. Team members who did not have clinical back-
grounds also attended the scene but were unable to assist. With-
in the first two weeks of commencement, this incident was a di-
rect and confronting example of the challenges that were faced
by the communities at the centre of the PBI and the degree to
which PBI team members would potentially be engaged in
those challenges.
Other incidents and experiences reported by team members
shaped their experiences of place in the PBI. For instance, team
members reported during informal interviews that the health
department had arranged for them to have physical self-defense
training so they could disarm a threatening person if they
moved into the building. Several building-wide “lock-downs”
had occurred in response to threats of violence made toward
child protection workers housed in the building. A bullet hole
was once found in the window of the PBI meeting room and
there had been several “ram raids2” on the building. Most sig-
nificantly, there had been a murder around the corner from the
building. An armed security officer patrolled the main public
entrance to the building at all times. There was a secure area
under the building used to transport children and others safely
to and from the building without the need to interact with
members of the public. After hearing about the range of inci-
dents that occurred in the PBI building, and seeing the range of
bureaucratic steps taken in response to those incidents, it be-
came clearer how an inside-outside culture had developed. It
also raised my awareness of the complex and often contradic-
tory interplay between physical and moral proximity between
staff and community members in PBIs. In short, physical pro-
ximity did not appear to invoke moral proximity (i.e. an appre-
ciation of the “other”). In the above examples it appeared, rather,
to create the opposite effect of creating moral distance and even
Although it was often not acknowledged by the PBI team
members themselves as meaningful or significant, I observed
that the PBI team was constantly interacting with community
members in informal and incidental ways within the shared
spaces of the building (e.g. walkway) and via the permeable
interface of the office windows. This was largely due to the
physical layout of the building. The Eastern-facing walls of the
office were made of glass, covered by blinds that were kept
partially or fully open. The office was on the first floor of the
building which featured a wrap-around walkway providing
access to two public entrances. There was a relatively high
amount of pedestrian traffic on the walkway consisting of com-
munity membe rs who were accessing the range of services pro-
vided in the building as well as friends and family members
who accompanied them. Almost every desk within the office
had a view of the outside walkway. Community members often
congregated in small groups on the walkway to wait for friends
or family or appointments. There were smoking areas on the
footpaths that surrounded the building.
As a result of the physical layout of the building, the com-
munity member s, who were by all acc ounts the raison dêtre of
the PBI, were literally just outside the window. Introna (2001)
observed that proximity to others in geographical and social
space brings an unavoidable obligation to respond to them in
2Slang term used to denote the process of breaking into a building with a
motor vehic le.
Copyright © 2013 SciRes. 65
a moral way (see Introna, 2002, 2001; Levinas, 1998; Silver-
stone, 2003). Introna (2002) argued that our moral obligation to
others becomes most visible and strongest when we come “face
to a face” with another person in our physical and social set-
tings (i.e., we are allowed to see that individual for who he or
she is, in all of his or her vulnerability and humanness). In con-
trast, the further away we are from another person in physical
and social proximity, the easier it is to ignore that person or
people. Despite this “natural” obligation to others, I observed
that there were many aspects of social life (e.g. stereotypes and
prejudice) that prevented PBI workers and commu nity membe rs
from coming “face to a face” wi th each other. During meetings,
for example, significant social boundaries had been constructed
to divide those inside the window from those outside. The only
observed acknowledgement of the community members was
negative verbal and non-verbal responses to perceived “antiso-
cial” behaviors (e.g., swearing, shouting, physical violence, a
community member punching the meeting room window).
Through the artificial barriers created by the ability to close the
blinds, the labelling of behavior and the solidarity of the “in-
siders”, potential for mutual engagement and naturalistic under-
standing of local community based on physical proximity in
place was lost.
Photographic observation of place—selected images
Image A. Main entrance to community services building in
which PBI central administration office is located.
This image shows the main entrance to the PBI administra-
tion building which also houses several other community ser-
vices including: probation and parole; child protective services;
and employment services. The building itself is set high off the
street. An armed security guard stands just inside the sliding
glass windows at the top of these stairs. The windows display a
number of A4 laminated warning signs to members of the pub-
lic including Image “E” which advises community members
that there is no access to toilets in the building due to vandalism.
The image also shows community members sitting on the walls
waiting which is typical of this venue.
Image B. Walkway and meeting area outside PBI office.
This image shows the walkway that surrounds the building
and its proximity to the PBI offices. PBI staff members’ desks
are located against or facing the windows shown in this image.
Groups of community members frequently congregate along
these walkways while they wait for appointments. There are no
waiting areas inside the building and only those with appoint-
ments are allowed inside. The meeting room pictured from
inside the building in Image “C” overlooks this walkway just
around the corner from where this image was taken. The bike
pictured in Image “F” was located on the walkway during a
subsequent photo-observation data collection.
Image C. PBI meeting room overlooking walkway. Bullet
hole was found in this window.
This image shows the meeting room where program leader
meetings were observed for 12 consecutive months in year one
and the final quarter of years 2 - 3. The walkway outside is
clearly visible through the windows and sound is audible
through the glass from outside. During an unstructured inter-
view, one participant told me that a bullet hole was found in
this window during the early period of the PBI. This is also the
window that a community member punched during one of the
observed meetings. PBI staff can close off the view to outside
by closing the blinds on the windows. It was notable that the
blinds were kept open during meetings until the incidents re-
ported in this paper occurred (e.g. community member punch-
ing window, verbal arguments outside, and so on).
Image D. “This is not a clinic” Sign displayed on secure
sliding glass doors that lead into PBI office.
This sign is displayed on the sliding glass doors leading into
the PBI office (Image “B”) as another artefact of the insider-
outsider culture that exists at the PBI building. The statement
that “no bags or money are kept on these premises” infers that
those outside looking in may be interested in knowing this fact
(i.e. interested in stealing). Also the statement “this is not a cli-
nic” indicates that because the government health department
logo is displayed on the sign outside the PBI offices that some
community member may have, or may be expected to have
mistaken, the office for a medical clinic. Overall the message of
this sign can be interpreted as “keep out” and “we are not here
to help you”.
Image E. “Due to constant vandalism there is “No” public
toilets available in this building” Sign displayed on main en-
trance to building.
Copyright © 2013 SciRes.
This sign was located at the top of the stairs pictured in Im-
age “A”. The sign is accompanied by a formal dated business
letter from the building manager advising that toilet access is no
longer available due to “repeated” acts of vandalism including
“removal of toilet seats”. The nearest toilets at Station Road
were a considerable distance away. The building manager’s
prohibiting community access to the toilets then appeared to me
as quite an extreme measure. The bureaucratic and authoritative
tone of the letter was distinct and clearly positioned the build-
ing as being in control of those who are embedded in a formal
bureaucratic way of operating. This is reinforced in the sign
pictured above which refers in a general way to “constant van-
Image F. “Which Bank? They’re all bastards!” Sticker on
bike parked on walkway outside PBI offices.
This bike is an example of the discursive resources on offer
to both insiders and outsiders at the PBI building (i.e. “us ver-
sus them”). The “which bank?” sticker is an intertextual refer-
ence to an advertising campaign run by the Commonwealth
Bank of Australia throughout the 1990s-2000s which posed the
question “which bank?” to which people would enthusiastically
answer “the Commonwealth Bank!”. The alternate answer on
this bike of “they’re all bastards” echoed the almost stereotypi-
cal hostility that existed between some community members
outside the PBI windows and those inside. It appeared that
community members automatically identified PBI workers as
“them”. Note the spelling errors in the graffiti on the bike (“to
rite” instead of “too right”).
PBIs are complex endeavours because they join in collabora-
tion those who live in and care about the place experiencing the
intervention and those who do not. The social spaces within a
place that are claimed by a PBI can be close, local, and familiar
to some and distant, professionalised, and work-oriented to
others. This means that participants’ experience, use, and valu-
ing of place and the PBI in general are inherently different even
though all parties might be united under a common social aim
or vision. Great degrees of variability, ambivalence, and ambi-
guity toward place can thus exist within a PBI.
This case study provided insight into the capacity of PBI
staff members to connect with and understand local places and
the people who inhabit them. Rather than promoting in-place
engagement, the co-location of PBI staff members in this com-
munity service building [re]produced a defensive insider-out-
sider culture that limited opportunities for informal and inci-
dental knowledge sharing. The culture at the building also pre-
cluded opportunities for PBI staff to move beyond their bu-
reaucratic roles by reinforcing existing social boundaries and
deflecting attention and appreciation away from the particular-
ity of the immediate community in which they were embedded.
These observations could be applied to the more appropriate
and sustainable development of PBI interventions in future.
Although this study focused on the patterns of experience
(i.e., culture) in a specific place (i.e., the PBI building), they are
not likely to be contained to this venue. Rather, the dynamics
revealed in this case study could potentially apply in any setting
where professional workers who are embedded in cultures of
bureaucracy meet local residents who are embedded in cultures
of community, pa rticularly when they also herald from substan-
tially different social contexts and backgrounds. Indeed, a sig-
nificant finding of the case study was that fundamental pre-
existing social stratifications between “insiders” and “outsid-
ers” were recreated (and in fact exacerbated) through the me-
dium of this administration building. Ironically, the result of
placing the PBI within the local community was the antithesis
of the community engagement intentions of the PBI staff. The
study has indicated the need for future research on PBIs to ex-
plore the role played by the concepts identified through this
case study. Specifically, it is necessary for PBI organizers to
more critically explore the place at which they intersect with
the community, seeking and managing instances of insider-out-
sider cultures and divides created by social positioning. These
concepts are likely to apply to all services placed in areas that
are experiencing significant social disadvantage.
I would like to acknowledge the generous and insightful con-
tributions of all participants and colleagues in the research. I
would also like to acknowledge and thank Heidi Muenchberger
and Elizabeth Kendall for editing and additional examples, and
Stephanie Prout and Courtney Wright for editorial support.
Australian Bureau of Statistics (ABS) (2006). Census of population and
housing. Australian Bureau of Statistics.
Baum, F., & Palmer, C. (2002). “Opportunity structures”: Urban land-
scape, social capital and health promotion in Australia. Health Pro-
motion International, 17, 351-361. doi:10.1093/heapro/17.4.351
Bourdieu, P. (1990). The logic of practice. Stanford, CA: Stanford Uni-
versity Press.
Bradford, N. (2005). Place-based public policy: Towards a new urban
and community agenda for Canada research. Ottawa, ON: Canadian
Policy Research Networks.
Broadhead, R. S., & Fox, K. J. (1990). Takin’ it to the streets: AIDS
outreach as ethnography. Journal of Contemporary Ethnography, 19,
322-348. doi:10.1177/089124190019003004
Brodsky, A. E. (1996). Resilient single mothers in risky neighborhoods:
Negative psychological sense of community. Journal of Community
Psychology, 24, 347-363.
Copyright © 2013 SciRes. 67
Copyright © 2013 SciRes.
Burbank, V. K. (2011). An ethnography of stress: The social determi-
nants of health in Aboriginal Australia (culture, mind and society se-
ries). New York, NY: Palgrave Macmillan.
Carpiano, R. M., Kelly, B. C., Easterbrook, A., & Parson, J. T. (2011).
Community and drug use among gay men: The role of neighbor-
hoods and networks. Journal of Health & Social Behavior, 52, 74-90.
Caughy, M. O., O’Campo, P. J., & Patterson, J. (2001). A brief obser-
vational measure for urban neighbourhoods. Health & Place, 7, 225-
236. doi:10.1016/S1353-8292(01)00012-0
Cohen, D., Spear, S., Scribner, R., Kissinger, P., Mason, K., & Wildgen,
J. (2000). Broken windows and the risk of gonorrhoea. American
Journal of Public Heal t h , 90, 230-236. doi:10.2105/AJPH.90.2.230
Commission on Social Determinants of Health (CSDH) (2008). Closing
the gap in a generation: Health equity through action on the social
determinants of health. Final Report of the Commission on the Social
Determinants of Health. Geneva: World Health Organization.
Craddock, S. (2000). Disease, social identity and risk: Rethinking the
geography of AIDS. Transactions of the Institute of British Geogra-
phers, 25, 153-168. doi:10.1111/j.0020-2754.2000.00153.x
Dennis Jr., S. F., Gaulocher, S., Carpiano, R. M., & Brown, D. (2009).
Participatory photo mapping (PPM): Exploring an integrated method
for health and place research with young people. Health & Place, 15,
466-473. doi:10.1016/j.healthplace.2008.08.004
Farmer, J., Munoz, S. A., & Threlkeld, G. (2012). Theory in rural
health. Australian Journal of Rural Health, 20, 185-189.
Goffman, E. (1959). Presentation of self in everyday life. New York,
NY: Doubleday Anchor Books.
Gudes, O., Kendall, E., Yigitcanlar, T., Pathak, V., & Baum, S. (2010).
Rethinking health planning: A framework for organising information
to underpin collaborative health planning. Health Information Man-
agement Journal, 39, 18-29.
Hochschild Jr., T. R. (2010). “Our club”: Place-work and the negotia-
tion of collective belongingness. Journal of Contemporary Ethnog-
raphy, 39, 619-645. doi:10.1177/0891241610378857
Introna, L. D. (2002). The (im)possibility of ethics in the information
age. Information and Organisation, 12, 71-84.
Introna, L. D. (2001). Virtuality and morality: On (not) being disturbed
by the other. Philosophy in the Contemporary World, 8, 11-19.
Knoblauch, H., Baer, A., Laurier, E., Petschke, S., & Schnettler, B.
(2008). Visual analysis. New developments in the interpretative ana-
lysis of video and photography. Forum: Qualitative Social Research,
Levinas, E. (1998). Otherwise than being: Or beyond essence. Pitts-
burgh: Duquesne Univer si t y Press.
Lindemann, K. (2007). The impact of objective characteristics on sub-
jective social position. TRAMES Journal of the Humanities and So-
cial Sciences, 11, 54-68.
McHoul, A. (2009). What are we doing when we analyse conversation?
Australian Journal o f Co mm uni ca ti on, 36, 15-21.
Marmot, M. G., Allen, J., Goldblatt, P., Boyce, T., McNeish, D., Grady,
M., & Geddes, I. (2010). Fair society, healthy lives. Strategic review
of health inequalities in England post-2010. London: University Col-
lege London.
Massey, D. B. (2005). For space. London: SAGE.
Massey, D. B. (1999). Space, place, and gender. Minneapolis, MN:
University of Minnesota Press.
Martin, J. (2002). Organisational culture: Mapping the terrain. Thou-
sand Oaks, CA: Sage Publications.
Moore, D. (2009). Workers, “clients” and the struggle over needs: Un-
derstanding encounters between service providers and injecting drug
users in an Australian city. Social Science & Medicine, 68, 1161-
1168. doi:10.1016/j.socscimed.2008.12.015
Parry, J., Mathers, J., Laburn-Peart, C., Orford, J., & Dalton, S. (2007).
Improving health in deprived communities: What can residents teach
us? Critical Public Healt h , 1 7 , 123-136.
Pink, S. (2007a). Doing visual ethnography: Images, media and repre-
sentation in research (2nd ed.). The Hague: Mouton.
Pink, S. (2007b). Sensing cittàslow: Slow living and the constitution of
the sensory city. Sense and Society, 2, 59- 77.
Raudenbush, S. W., & Sampson, R. J. (1999). Ecometrics: Toward a
science of assessment ecological settings, with application to the sys-
tematic social observation of neighborhoods. Sociological Method-
ology, 29, 1-41. doi:10.1111/0081-1750.00059
Ryan, G. W., & Bernard, H. R. (2003). Techniques to identify themes.
Field Methods, 15, 85-109. doi:10.1177/1525822X02239569
Schulz, A. J., & Lempert, L. B. (2004). Being part of the world: Detroit
women’s perceptions of health and the social environment. Journal
of Contemporary Ethnogra ph y, 33, 437-465.
Schulz, A., & Northridge, M. E. (2004). Social determinants of health:
Implications for environmental health promotion. Health Education
& Behavior, 31, 455-471. doi:10.1177/1090198104265598
Scribner, J. P., Cockrell, K. S., Cockrell, D. H., & Valentine, J. W.
(1999). Creating professional communities in schools through orga-
nizational learning: An evaluation of a school improvement process.
Educational Administration Quarterly, 35, 130-160.
Silverstone, R. (2003). Proper distance: Towards an ethics for cyber-
space. In G. Liestol, A. Morrison, & T. Rasmussen (Eds.), Digital
media revisited: Theoretical and conceptual innovations in digital
domains (pp. 469-490). Cambridge, MA: MIT Press.
Singh-Manoux, A., & Marmot, M. (2005). Role of socialization in ex-
plaining social inequalities in health. Social Science & Medicine, 60,
2129-2133. doi:10.1016/j.socscimed.2004.08.070
Snow, D. A., Morrill, C., & Anderson, L. (2003). Elaborating analytic
ethnography: Linking fieldwork and theory. Ethnography, 4, 181-
200. doi:10.1177/14661381030042002
Sunderland, N., Bristed, H., Gudes, O., Boddy, J., & Da Silva, M.
(2012). What does it feel like to live here? Exploring sensory ethno-
graphy as a methodology for investigating social determinants of
health. Health & Place, 18, 1056-1067.
Tuan, Y. (2005). Space and place: The perspective of experience. Min-
neapolis, MN: University of Minn esota Press.
Weyers, S., Dragano, N., Richter, M., & Bosma, H. (2010). How does
socio economic position link to health behaviour? Sociological path-
ways and perspectives for health promotion. Global Health Promo-
tion, 17, 25-33.