Access to health care in urban areas of developing societies

Emphasis on rural health problems has led to a relative neglect of urban health issues in developing societies. Yet the fact that a large proportion of the limited financial and human resources is allocated to urban health care makes it imperative for researchers and health planners to evaluate the effectiveness of the urban health care system. This paper examines data on health care utilization from a sample survey of 1500 households conducted in three areas of Accra, Ghana in 1982. The factors that influence the use of three types of health care services (clinics, drug vendors, and traditional healers) are examined. Suggestions are made for increasing the effectiveness of the health care system in Accra, with the aim of making medical care more accessible to all families.     

Medical tourism in the backcountry: alternative health and healing in the Arkansas Ozarks

Tourists travel to Arkansas' mountain regions to experience, appreciate, and consume multiple aspects of otherness, including sacred sites and pristine and authentic peoples and environments. A largely unexplored aspect of this consumption of authenticity is alternative medicine, provided to tourists and day travelers in search of physical and emotional restoration. Traditional forms of medicine are deeply rooted in women's social roles as community healers in the region and are perpetuated in part because of the lack of readily accessible forms of so-called modern medicine. Contemporary medical tourism in Arkansas has promoted access to folk health systems, preserving them by incorporating them into tourists' health care services, and also has attracted new and dynamic alternative medical practices while encouraging the transformation of existing forms of traditional medicine. Ultimately, the blend of alternative, folk, and conventional medicine in the Arkansas highlands is evidence of globalizing forces at work in a regional culture. It also serves to highlight a renewed appreciation for the historic continuity and the efficacy of traditional knowledge in the upper South.     

The consequences of acculturation to service delivery and research with Hispanic families

The experience of working with Hispanic children and their parents is compared with the existing professional literature. Although the literature acknowledges partially the importance of acculturation, the consequences of acculturation to service delivery and working with Hispanics as research subjects are seldom addressed. These consequences are demonstrated in four areas: as a cause of family problems, in the attitudes of Hispanics toward speaking Spanish and English, in the status of folk healers in the Hispanic community, and in attitudes toward the delivery of human services. The failure to take into account the consequences of acculturation can contribute to the further underutilization of mental health services by Hispanic families.The research described in this article was funded by a grant from the Blowitz-Ridgeway Foundation.Special thanks to Laura L. Schmidt, M.A., Research Associate, and to Dora Maya, Ph.D., Program Director, VIVA Family Center, Children's Home and Aid Society of Illinois.     

冷战后埃及青年问题初探

2011年埃及政治变局凸显了当代埃及青年问题的严重性,并引起了世界各国的广泛关注。冷战后埃及青年问题主要表现在以下3个方面:教育不公平现象普遍,青年失业率居高不下;青年成家困难,住房问题难以解决;青年性健康及吸食毒品问题令人担忧。青年问题不仅影响到埃及经济的持续发展与外交政策的制定,而且关系着埃及社会的稳定,并不自觉地推动了埃及政局的变革。通过对埃及青年问题进行审视发现其实质上是埃及人口问题的衍生品,而且青年问题已成为一个全球性问题,因而需要各国携手合作,共同应对。     

Child abuse and neglect in Cambodian refugee families: characteristics and implications for practice

This study examines the characteristics and patterns of child maltreatment among Cambodian refugee families in Los Angeles and assesses the implications for child welfare practice with Cambodian refugee families. Data were extracted from 243 active Cambodian case files maintained by the Los Angeles County Department of Children and Family Services (LAC-DCFS). Some of the major findings include (1) Cambodian child maltreatment cases were most frequently reported to the LAC-DCFS among various Asian Pacific ethnic groups; (2) Cambodian refugee families were more likely to be charged with neglect, while their Asian Pacific counterparts were more likely charged with physical abuse; (3) the circumstances under which maltreatment occurred most frequently were parental substance abuse and mental illness; and (4) while fathers who maltreated their child were likely to use alcohol, mothers were also more likely to have a mental health problem such as depression. This study suggests the importance of collaboration between Child Protective Service agencies, substance abuse programs, traditional healers, mental health services, and other social service agencies for effective child abuse prevention and intervention efforts.     

Health Services Utilization Among Graduate Students: Patterns of Use,Access, and Satisfaction

Abstract

Utilization of health services by graduate students has been a neglected area of college health research. This paper describes the access problems and utilization patterns of a systematic random sample of the graduate student population at the University of Mississippi.

Survey methodology was used to assess sociodemographic, health status, and attitudinal characteristics of the study sample. In addition to type and number of visits for various health services, other utilization-related items included access to and satisfaction with care, and information received about these health services.

The results indicated that graduate students and their dependents were reliant to a large degree on local health care. Inadequacy of information was viewed as a major problem relating to access. Satisfaction with care appeared to be a function of the quality of care received.     

HMOs and the Future of Student Mental Health Services

Abstract

The health maintenance organization (HMO) is likely to have a prominent position under national health insurance, which will have a strong systematizing effect on the nation's health services. Over the past two years the University of Massachusetts mental health services have provided benefits at both the university and a private medical group practice. Experience has shown that a university which already provides broad services to a large student population can extend itself to the university community including its faculty and staff. Several advantages of this development, as well as some significant problems, are discussed. As the HMO grew and quality services were established, it became feasible for the private medical group to develop its own mental health component. Based on this and other experiences in mental health delivery systems, certain conclusions are drawn about the ways universities can develop HMOs and some recommendations are made for national mental health planning.     

Assessing the Effects of the Physical,Psychological, and Social Dimensions of Health on the Use of Health Services*

In this paper we examine two major assumptions inherent in the literature relating health status to the use of health services: (1) that each of the three dimensions of health (i.e., the physical, the psychological, and the social) has an equal impact on the use of health services; and (2) that the effects of these three dimensions of health are manifest in an additive rather than in an interactive fashion. To test these assumptions, multiple regression analyses are performed using a modified version of the generic model of access to medical care in order to predict eight different types of health services utilization. The results compel us to accept the additivity assumption, while rejecting the equality assumption. Moreover, contrary to Mechanic's assertion, psychological health was found to have the least impact of any of the three dimensions of health on the use of health services. We then discuss two possible explanations (i.e., differences in the populations studied and the measurement of the independent variables) that might account for the disparity between Mechanic's and our own findings. Although further study is needed before any firm conclusions may be drawn, the evidence suggests that Mechanic's findings may be specific to the HMO populations that he sampled.     

Mental health and the aging: A review of the literature for clinical social workers

This article is a review of the literature on recent trends in mental health services to the elderly. The focus is on clinical services to elderly living outside of mental hospitals but includes services to residents of community nursing homes and homes for the aged. It is concluded that there is currently a non-system of services failing to meet present mental health needs. Current restrictive government reimbursement policies and national health insurance proposals are focused on treatment for acute episodic illness. This orientation does not permit a broader preventive perspective or a comprehensive mental health care approach.     

'E-health': the internet and the transformation of patients into consumers and producers of health knowledge

This article analyses the use and production of health information on the Internet. The paper will show that users of health services have also become significant providers of health information and advice. This analysis is based on two studies. The first involved a qualitative study of households that used home computers to find health information on the Internet. The second piece of research involved the examination of home pages that contained accounts of ill health and an e-mailed questionnaire to home page authors. Drawing upon this research the consumption of health information is examined and related to how users make discussions about their health. This is followed by an analysis of the provision of health information on home pages. It is shown that these include web sites that provide simple accounts of an individual illness as well as sites that advocate a particular approach to health or offer services and products. The interweaving of personal experience with advice is considered and linked to debates about the quality of health information on the Internet and the reconfiguration of 'expertise'.     

中产阶级与埃及政局变化

本文认为,2011年埃及变局主要归因于中产阶级的民生问题。萨达特—穆巴拉克的政策以及各种外力导致了埃及社会结构的扭曲,引发中产阶级的政治地位下降、经济能力减弱、生活困难加剧,使中产阶级由社会的引领者变为政权的抗争者,最终颠覆了穆巴拉克政权。本文分析了中产阶级与这一社会变化之间的逻辑关系后强调,2011年埃及变局将有利于中产阶级的重新崛起与社会结构的合理发展。     

‘I Will Not Leave My Baby Behind’: A Cook Island Māori Family's Experience of New Zealand Māori Traditional Healing

Traditional healers in many parts of the world have used family focused understandings and interventions well before the emergence of western family therapy theory and practice. This paper gives a detailed account of New Zealand Māori traditional healing work with a Cook Island Māori family in which the eldest daughter was in considerable distress as were her family, who believed that she had become maki tūpāpaku (possessed). This account is told from the perspectives of the child psychiatrist, the traditional healer and the mother of the family. While the intervention bears a superficial resemblance to western family therapy approaches, the theoretical foundation reflects the traditional healer's New Zealand Māori world views in which spiritual understandings are paramount, and concepts of mana, tapu and mauri ¹ guide him in the family healing process. The single session described here can be viewed as an indigenous family therapy intervention involving six generations of family members, both living and deceased, in the one room. Conclusions: Indigenous communities have called for traditional healers to be employed alongside child mental health workers and family therapists who work with their communities. Close and sincere collaboration between an indigenous traditional healer and a health professional can offer a family in distress healing possibilities that may not be available to them in conventional child mental health or other family therapy settings.     

The impact of migrants' remittances on the Egyptian economy

"The main objective of this paper is to evaluate the impact of the large remittances made by Egyptian migrants to their home country on the Egyptian economy. In order to study this impact, we use the implications of the standard Keynesian model. We estimated the structural equations of the model using annual data for the Egyptian economy over the period from 1970 to 1984.... The results suggest that remittances have had a strong positive impact on GNP in Egypt." The authors note that remittances especially affect private consumption spending. Policy implications concerning labor migration are discussed. (SUMMARY IN FRE AND SPA)     

Rethinking resistance under authoritarianism: civil society and non-contentious forms of contestation in post-uprisings Egypt

ABSTRACT

In 2018 President Abdel Fattah al-Sisi secured a second presidential term in a constrained political environment exacerbated by his control over the media, prosecution of journalists and activists, and his crackdown on civil society. As a result of such resilient authoritarianism, the optimism that once defined the Egyptian uprisings has turned into cynicism. This article contributes to the literature surrounding civil society and resistance in authoritarian contexts by offering an examination of the interplay between authoritarian tendencies and their resistance in post-uprisings Egypt. I argue that we should view al-Sisi’s regime as representing an authoritarian system that is not absolute, despite its soft and hard repressive methods, but one that still offers limited space for civil society organizations (CSOs) to function. This limited space importantly comprises covert resistance methods which can offer Egyptian CSOs opportunities to resist the state’s legal and extra-legal restrictions. The resistance methods considered in this article need to be understood in Gramscian terms as they encompass the limited means available by which CSOs can negotiate the terrain of hegemonic contestation under the existing authoritarian context. Given al-Sisi’s re-election and the sustained crackdown on Egyptian civil society, the need to analyse such forms of resistance is pertinent.     

Health and the household

We underscore the close link between the economics of the household and health economics in a framework in which consumers produce their fundamental objects of choice. Health is produced with inputs of market goods and services and the own time of the consumer. Health is demanded not only because it is an argument in the utility function but also because it determines the amount of time available for market and nonmarket production. The latter motive points to health capital as one component of the stock of human capital. The economics of the household has much to say about the determinants of investment in this type of capital. The five health economics papers in this issue of Review of Economics of the Household are connected by an emphasis on the role of time in the production of two aspects of health: obesity and the general health of elderly persons.      

Perceptions of geography students in the USA and Egypt on global issues

The study aimed to compare the perceptions of Egyptian and US students on global issues. The authors developed a survey of global issues and administered it to sample of 321 Geography students in the USA and Egypt. The survey tapped five issues: global citizenship, cultural diversity, global conflicts, nuclear arms race, and global warming. The results showed that there were significant differences in Egyptian and US students’ perception of each of the global issues.     

Institutional contexts and mortality: the case of Peru

Increasingly, attention is being given to institutional contexts to explain differential demographic and health outcomes. Regional inequality in terms of economic development, social institutions, and health services leads to regional disparities in health outcomes, especially infant mortality. The author uses linked data from population and economic censuses, government agencies, and health surveys on 24 Peruvian provinces to explore how differential economic development and institutional contexts influence health outcomes. Regional inequities based on rural population, subsistence activity, women's illiteracy, monthly income, gross domestic product, medical care, and health facilities are compared, with a cluster analysis identifying institutional contexts which have internal similarities. These contexts are able to discriminate differences in infant mortality. The analysis demonstrates that infant mortality in Peru varies systematically with social, economic, and medical contexts. Economic development, income and subsistence levels, women's literacy, and the amount of medical care and public health services influence health outcomes. It is clear that understanding such regional inequities can help explain disparities in health outcomes.     

The Health Status of Elderly People and the New Direction of Health Services

The projected increase of people in Japan aged 75 years and older in the years to come implies the increase of the disabled elderly. Thus, the core of societal preparation for the aging of the population is generally considered to be the expansion of services for the disabled elderly. However, gerontological studies on the health status of the elderly conducted in Japan show that the prevalence of disability is quite low and even decreasing. Relative to the services for the disabled elderly, preventive services for the healthy elderly have long been overlooked. In 1994, the Metropolitan Tokyo Government organized a task force to develop a new health education program as the preventive health service for the healthy urban elderly. A preliminary plan outlining the health education program consisting of propagation with a booklet, on-the-job training of practitioners, and development of new curricula and teaching materials was proposed by the authors for discussion within the task force. Although the inquiry has just begun and the plan is still nascent, it seems adequate to fit the needs for preventive health services in the near future.