In the context of the high-profile controversy that has unfolded in the UK around the measles, mumps and rubella (MMR) vaccine and its possible adverse effects, this paper explores how parents in Brighton, southern England, are thinking about MMR for their own children. Research focusing on parents' engagement with MMR has been dominated by analysis of the proximate influences on their choices, and in particular scientific and media information, which have led health policy to focus on information and education campaigns. This paper reports ethnographic work including narratives by mothers in Brighton. Our work questions such reasoning in showing how wider personal and social issues shape parents' immunisation actions. The narratives by mothers show how practices around MMR are shaped by personal histories, by birth experiences and related feelings of control, by family health histories, by their readings of their child's health and particular strengths and vulnerabilities, by particular engagements with health services, by processes building or undermining confidence, and by friendships and conversations with others, which are themselves shaped by wider social differences and transformations. Although many see vaccination as a personal decision which must respond to the particularities of a child's immune system, 'MMR talk', which affirms these conceptualisations, has become a social phenomenon in itself. These perspectives suggest ways in which people's engagements with MMR reflect wider changes in their relations with science and the state. r

Summary Objectives: (1) To explore the social and cultural influences, and health beliefs associated with low uptake of MMR (measles, mumps and rubella vaccine). (2) To describe and explore the prevalence of health beliefs associated with noncompliance with MMR, with a view to improving the personal relevance and impact of information for parents, in the context of persisting low uptake following public controversy. Methods: We undertook a survey of mothers' experiences of and attitudes to the MMR, developed through ethnographic study, which was linked to maternal and child information on the Child Health Database in Brighton, England. Results: Mothers interpret MMR risk through concepts of child health embedded in family health history, with a majority both of compliers and non-compliers holding that each child's immune system is unique. Cultural 'risk factors' for non-compliance relate strongly to the use of complementary healthcare, such as homeopathy, with evidence that rejection of vitamin K is associated with MMR non-compliance. Forty per cent, both of compliers and non-compliers, did not consider the possible benefits to other children of MMR. Conclusions: These findings have paradoxical and challenging consequences for the promotion of immunization in the policy context of increasing emphasis on healthy choices. They demonstrate the need for immunization information that acknowledges and addresses lay concepts of immunity.

Bilateral health system development in Tonga is implicated in a misrepresentation of 'traditional' healing that has serious implications for the provision of health care. It has strengthened the tendency to homogenise and stereotype a diverse body of healers in counter distinction with biomedicine. The diversity of and syncretism in non-biomedical local healing practice is little appreciated in policy debates. Addressing the epistemological, social and linguistic context of syncretism in terms sensitive to healers' concerns and conceptualisations is vital to build on the pre-existing collaborations between health professionals and a diverse body of healers in a country that has experienced a marked shift from communicable to noncommunicable disorders. This paper examines the diversity and syncretism of five of the most popular 'spirit' healers in Vava'u, Tonga in terms suggested by healers themselves using the Tongan concept and value of tauhi vaha'a (to evoke and intensify relatedness) as an analytic tool. The creativity implied in healers' socially constitutive use of language with ancestors, relatives, patients, churches and the hospital questions the value of any notion of traditionality and suggests considerable grounds for collaboration.

The Global Mental Health (GMH) movement has raised questions of the translatability of psychiatric concepts and the challenges of community engagement. In Tonga, the local psychiatrist Dr Puloka successfully established a publicly accessible psychiatry that has improved admission rates for serious mental illnesses and addressed some of the stigma attached to diagnosis. On the basis of historical analysis and ethnographic fieldwork with healers, doctors, and patients since 1998, this article offers an ethnographic contextualization of the development and reception of Puloka's three key interventions during the 1990s: (a) collaboration with traditional healers; (b) translation of psychiatric diagnoses into local cultural concepts; and (c) encouraging freedom of movement and legal appeal to involuntary admission. Dr Puloka's use of medical anthropological and transcultural psychiatry research informed a community-engaged brokerage between the implications of psychiatric nosologies and local needs that can address some of the challenges of the Global Mental Health movement.

This article argues for a shift from an evaluation of the efficacy of "traditional medicine" to an analysis of the influence of notions of efficacy on health seeking and health outcomes. Studies on the therapeutic value of traditional medicine tend to focus on countering or engaging with biomedical models to explain the process and efficacy of healing. Less examined is how efficacy is evaluated by traditional healers and patients themselves. Ethnographic research focused on health seeking and language use in Tonga reveals a diversity of claims of efficacy that relate to the social and epistemological positions of healers, health workers, and patients. Using the celebrated case of a man who was cured by a healer after the hospital could do no more for him facilitates greater epistemological dialogue and poses a challenge to the current efficacy consensuses in medical anthropology and Tonga.