This paper explores different conceptual and policy spaces of wellbeing. The increasing use of wellbeing in contemporary health debates affords geographers of health new arena in which to explore the processes that promote, remedy or regenerate health and ill‐health. The paper first critically reviews the theoretical approaches and challenges for operationalizing the concept of wellbeing in both research and policy. We then present a framework of the spaces of wellbeing to provoke discussion and research amongst geographers of health. The paper concludes with proposals for future research orientations.

Despite multiple axes of variation in defining wellbeing, the paper argues for the dominance of a ‘components approach’ in current research and practice. This approach builds on a well-established tradition within the social sciences of attending to categories whether for their identification, their value or their meanings and political resonance. The paper critiques the components approach and explores how to move beyond it towards conceptually integrating the various categories and dimensions through a relational and situated account of wellbeing. Drawing on more fluid social sciences, wellbeing is framed as an effect, dependent on the mobilisation of resources from everyday encounters with complex assemblages of people, things and places. Through such a framing, wellbeing can be conceived of as stable and amenable to change, as individual and collective and as subjective and objective. Policy interventions then need to attend to the relationalities of particular social and spatial contexts.

This study identified patient and operative risk factors for anastomotic leak on a national scale. It also demonstrates that these patients have increased morbidity and 30-day mortality rates, experience multiple readmissions to the hospital, and have a higher likelihood of requiring further operative intervention.

Objective Prognostic and predictive enrichment strategies are fundamental tools of precision medicine. Identifying children with septic shock who may benefit from corticosteroids remains a challenge. We combined prognostic and predictive strategies to identify a pediatric septic shock subgroup responsive to corticosteroids. Design We conducted a secondary analysis of 288 previously published pediatric subjects with septic shock. For prognostic enrichment, each study subject was assigned a baseline mortality probability using the pediatric sepsis biomarker risk model (PERSEVERE). For predictive enrichment, each study subject was allocated to one of two septic shock endotypes, based on a 100-gene signature reflecting adaptive immunity and glucocorticoid receptor signaling. The primary study endpoint was complicated course, defined as the persistence of two or more organ failures at day seven of septic shock or 28-day mortality. We used logistic regression to test for an association between corticosteroids and complicated course, within endotype. Measurements and Main Results Among endotype B subjects at intermediate to high PERSEVERE-based risk of mortality, corticosteroids were independently associated with more than a ten-fold reduction in the risk of a complicated course (R.R. 0.09, 95% CI: 0.01 to 0.54; p = 0.007). Conclusions A combination of prognostic and predictive strategies based on serum protein and mRNA biomarkers can identify a subgroup of children with septic shock who may be more likely to benefit from corticosteroids. Prospective validation of these strategies and the existence of this subgroup are warranted.

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Care -concept, emotion, practice, politics, moral exhortation -is a starting point for critical geographies that cut across diverse fields of interest. Whilst, conventionally, care remains predominantly associated with systems of social support and health care, intellectual engagements with feminist theory, moral geographies, post-colonial theory and reflections on academic practice have all mobilised explorations of care as a central focus. Care, it seems, affords geographers a richness of possibilities through which to critically engage with a range of politically charged discourses. The papers in this special issue focus on critically engaging the trajectory of public discourse which increasingly privileges embodied individuals as primary sites for agency, responsibility and wellbeing as expressed through a logic of autonomy and choice (Mol, 2006). This trajectory is often exclusively attributed to the emergence of a dominant neoliberal politics (Miller and Rose, 2008) but it has diverse roots, some of much longer duration, including classical liberalism and conservative politics (Staeheli and Brown, 2003), but also in working class solidarity and resistance in the face of imposed values (Fox and Smith, 2011). Within this trajectory, new technologies, whether biomedical or discursive, appear to afford new possibilities for self-actualisation but must also intersect with the histories of existing material, moral and ideological landscapes. This intersection of landscapes, which allows for inequality and exclusion coupled with a trajectory that privileges a logic of individual autonomy and choice, may erode even the most limited and bounded spaces for care.Several special issues in geography focussed on care precede this collection. The first two came out in 2003 and were both situated within debates on health and social welfare politics (Conradson, 2003a;Staeheli and Brown, 2003). Three recent collections demonstrate growing interest in care, published in rapid succession over the last three years. Two couple the practices and values of care with responsibility in a globalised and postcolonial geography and reflect an expansion of concerns with care into domains beyond conventional spaces of welfare policy (Raghuram et al., 2009;McEwan and Goodman, 2010). The most recent collection revisits health care to engage with new sites and debates, particularly those related to the production of health (Boyer, 2011).Geographical research on care has been characterised as constituting two strands distinguished by scale. First, care of bodies, premised on proximity, emotional attachment or practical need (Conradson, 2003a;Milligan and Wiles, 2010), reflects Conradson's definition of care as 'physical and emotional labour ' (2003a: 451). Secondly, researchers question why and how we might care about embodied experiences and destinies unfolding beyond the immediate spaces and times of our daily lives

Intervention to enhance wellbeing through participation in the creative arts has a transformative potential, but the spatialities to this are poorly theorised. The paper examines arts-based interventions in two primary schools in which small groups of children are taken out of their everyday classrooms to participate in weekly sessions. The paper argues that such intervention is usefully seen as a practice of liminality, a distinct time and space that needs careful management to realise a transformative potential. Such management involves negotiating multiple sources of tension to balance different modes of power, forms of art practices and permeability of the liminal time-space.

This paper explores the ways in which community wellbeing is, and could be, related to individual subjective wellbeing by mapping current practice, teasing out the assumptions underlying a dominant approach and flagging neglected issues. The notion of community is widely understood as about something more than the sum of the parts. Capturing subjective aspects of local life that are not simply individual but reflect the ways in which people feel and are well together is a challenging undertaking. Most existing frameworks for assessing community wellbeing are premised on a theory of the self as an autonomous, rational and independently acting or feeling individual, and the primary interest is on how community aspects of life impact on individual subjective wellbeing. This dominant approach consistently neglects spatial and social inequalities, multiple settings and scales and temporal choices and legacies, all of which constitute important political dimensions to community wellbeing. Social theories of the self as relational put relations as prior to subjectivity and as such afford ways to conceptualise community wellbeing in terms of being well together. A relational approach can also offer routes to tackling the complex interactions of inequality, scale and time. Such an approach is not, however, easily translated into quantitative measures or simple policy interventions. The approach taken to community wellbeing is not a technological issue but a political choice.