Use of home and community-based services by elderly black and white females

The study purpose was to determine the impact of demographic, social, environmental, and health indicators on utilization of community-based services among black and white female elders. Existing data from a regional Area Agency on Aging was used and the sample (N = 1816) included low income and rural females. Races differed in use and services most frequently used were case management, outreach, congregate meal, and home delivered meals. Multiple linear and logistic regression indicated that age, payment source, income adequacy, residence, health conditions, sensory impairment, and function were associated with the number and types of services used, but these differed by race. Study findings have implications for health care providers, educators, policy makers, and planners.     

MEASURING QUALITY OF LIFE: ECONOMIC,SOCIAL, AND SUBJECTIVE INDICATORS

Thinkers have discussed the “good life” and the desirable society for millennia. In the last decades, scientists offered several alternative approaches to defining and measuring quality of life: social indicators such as health and levels of crime, subjective well-being measures (assessing people's evaluative reactions to their lives and societies), and economic indices. These alternative indicators assess three philosophical approaches to well-being that are based, respectively, on normative ideals, subjective experiences, and the ability to select goods and services that one desires. The strengths and weaknesses of the various approaches are reviewed. It is argued that social indicators and subjective well-being measures are necessary to evaluate a society, and add substantially to the regnant economic indicators that are now favored by policy makers. Each approach to measuring the quality of life contains information that is not contained in the other measures.     

Subjective Indicators in the Health Sector and Their Usefulness in Policy Making

A considerable literature produced in the field of social sciences focused in the last 20 years on the importance of subjective indicators of wellbeing as an element of great significance in the analysis of public policies and quality of services, in addition to objective indicators. The health sector is characterized by a particular propensity and special consideration of the role of patients and other persons involved in the care process (family, doctors, nurses, etc.), and therefore of subjective elements. Since the end of the 1980s several studies considered the incongruences between health demand and health service supply and introduced in the debate the need to produce better evaluation methodologies, based on the interaction between objective an subjective data. The consequence was that subjective assessment by users and operators is now an integral part of any health service evaluation activity. The paper shows the evolution of scientific approaches to health services assessment, and the nature of subjective indicators mostly utilized in recent Italian experiences. Special attention is dedicated to an interesting attempt to enlarge the evaluation approach, aim of which is to contribute to the assessment of the social impact of administrative actions and public services stimulating the contribution of social parties and independent experts and involving public authorities and policy-makers.     

Health Care Needs and Care Utilization Among Lesbian,Gay, Bisexual,and Transgender Populations in New Jersey

The purpose of this study was to explore prevalent health issues, perceived barriers to seeking health care, and utilization of health care among lesbian, gay, bisexual, and transgender (LGBT) populations in New Jersey. A cross-sectional online survey was administered to 438 self-identified LGBT people. Results identified health needs, which included management of chronic diseases, preventive care for risky behaviors, mental health issues, and issues related to interpersonal violence. Barriers to seeking health care included scarceness of health professionals competent in LGBT health, inadequate health insurance coverage and lack of personal finances, and widely dispersed LGBT inclusive practices making transportation difficult. There is a need for better preparation of health care professionals who care for LGBT patients, to strengthen social services to improve access and for better integration of medical and social services.     

老年人医疗保健支出水平及其影响因素分析——慢性病高发背景下的老年人医疗保健制度改革

选取年内绝对和相对医疗支出两个指标,采用Tobit模型,检验影响老年人医疗保健支出的因素。研究发现慢性病、收入、居住地、社会保障对老年人医疗保健支出的影响突出,其中慢性病的影响尤为显著,在此基础上提出调整城乡医疗资源配置结构,健全社会保障政策,在医疗保健制度中增加预防性保险与服务的政策性建议。     

Does Intergenerational Educational Mobility Shape the Well-Being of Young Europeans? Evidence from the European Social Survey

The level of accessibility to basic services is an important issue because it is closely related to social inclusion and social capital, key aspects of societal well-being. There is a large and growing literature on access to health care in an era of dwindling public resources due to recent economic downturns. Health care is an essential service, but it is not the only basic service. The literature on access to basic services including, but not limited to, health care is relatively small. The paper aims at contributing to the literature by providing a new index to measure and monitor household accessibility to basic services. A study of Italian regions is presented. It is shown that northern regions have more accessible basic services than central, southern and island regions. A longitudinal comparison has been performed. The results are very worrying because show that policy makers have failed in reducing regional (and in particular north–south) disparities in basic service accessibility. Measuring and monitoring the level of accessibility is central for an adequate provision of basic services and for exploring how the delivery of basic services in the most problematic regions can be improved.     

城乡差异、就医惯性与老年人卫生服务利用

现有对城乡老年人卫生服务利用不公平的研究多忽略了长期的城乡差异所导致的隐性的农村老年人就医惯性的存在。本研究在控制了收入、医疗保障和就医可及性等因素的条件下,发现就医惯性的存在;并运用集中指数分解法发现,卫生服务的利用存在不公平,偏向于富人,而就医惯性在两种卫生服务利用中的贡献度分别为12%和5%。这种城乡固定差异造成了农村老年人在身体健康、心理健康和自我照料能力上都显著地低于城市老年人。     

Residential independence among older persons: community and individual factors

The objective of this study is to evaluate an expanded version of the resource model of living arrangements among older persons. This expanded model includes community-level measures of geriatric health services and housing market conditions. We employ the first two waves of the National Survey of Families and Households to test static and longitudinal fixed effects models of residential living arrangements. We find that residing in areas with higher levels of geriatric health care services increases the likelihood of residential independence, net of other contextual factors and individual characteristics. Our results show that housing market conditions are not related to levels of or changes in residential independence when control variables are included in the models. The results for the individual-level resource variables show that persons with greater economic resources, more children, and better functional status are better able to maintain independence and are less likely to die or live in a nursing home. This study shows the utility of expanding on micro-level approaches to understanding community living arrangements among older persons. Future investigations should include measures of the policy environment, transportation constraints and opportunities, and a more complete array of indicators of health and social services oriented toward helping elderly persons maintain their independence.     

Son preference, use of maternal health care, and infant mortality in rural China, 1989-2000

This study assesses the effects of socio-economic conditions and the interaction between son preference and China's one-child family planning policy on the use of maternal health care services and their effects on infant mortality in rural China, using nationally representative data from the 2001 National Family Planning and Reproductive Health Survey. The results show that while the use of maternal health care services has continued to increase over time, large gaps still exist in the use of these services and in infant survival by mother's education, community income, and parity. Further improvements in the reproductive health of all women and in infant survival will require effective reduction of the obstacles to the use of maternal health care among those women in rural China who are less educated, poor, and of higher parity.     

Toward sociomedical health indicators

The various forms of mortality data and biomedical measures of morbidity have become inadequate measures of the level of health in economically developed countries. Measures of functional physical capacity have some advantages but do not reflect physical impairment. Current attempts to develop sociomedical health indicators include: measures of social disability; typologies of presenting symptoms, which have been used to estimate probable needs for care; measures which focus on behavioral expressions of sickness; research based on operational definitions of ‘positive mental health’, ‘happiness’ and perceived quality of life; assessments of met and unmet needs for health care, which are measures of social capacity to care for the sick. Sociomedical indicators reflect both objective conditions and social values. They are policy-oriented, serving as mobilizing agents for sociopolitical pressures concerned with raising the overall level of health of the population.     

Accessibility of health and human services for the HIV-infected

Most research on services for the HIV/AIDS population has focused on primary medical care or on service brokering by advocacy groups. Little research data exist on the extent to which services of programs that do not specialize in HIV/AIDS clients are available to these individuals who often have multiple and multi-dimensional problems. The reported research examines selected data from a sample of 236 medical, behavioral health and social service programs in Miami-Dade County, Florida. A constructed measure of involvement in services for HIV/AIDS clients, pertinent provider program and client characteristics are examined in the context of geo-distributed data on reported AIDS cases and census data. In logistic regression analyses, two aspects of race/– the population in the zip code area served by the program, and the clients or patients seen in the program – were significant in predicting program under-response, defined as level of response relative to cumulative reported AIDS cases from the program's zip code area. The analysis is briefly discussed regarding its relevance and methodological generalizability for HIV/AIDS and related public health policy and applied purposes.     

Social Monitoring and Reporting: A Success Story in Applied Research on Social Indicators and Quality of Life

From its beginnings research on social indicators was not primarily considered as pure, but rather applied research in terms of the regular monitoring of and reporting on quality of life. Thus, the successes—but eventually also failures—of social indicators research may first of all be visible in its most important field of application. Social monitoring and reporting activities, which can be traced back to the early 1970s provide quantitative information and empirically based analytical knowledge on well-being and progress in a single society or groups of societies to be used for different purposes, including policy making. Providing an overview over the variety of social monitoring and reporting projects emerging from social indicators research is supposed to be important with a view to form a more solid fundament for present and future discourses and initiatives in the field of measuring and monitoring well-being and progress. The article looks back to this field of applied social indicators research and—with a focus on Europe—identifies patterns and recent trends in this sort of activities. By looking forward, it finally discusses selected issues that are considered to be crucial for further improvements in this field.     

The association between mistreatment of women during childbirth and postnatal maternal and child health care: Findings from “Birth in Brazil”

BackgroundThe mistreatment of women during pregnancy, childbirth, and the puerperium is a global public health problem besides being a violation of human rights. However, research exploring the consequences of mistreatment of women and newborns is scarce.QuestionTo shed light on this issue, we investigated the association between the mistreatment of women during childbirth and the subsequent use of postnatal health services by women and their newborns.MethodsWe used data from the study “Birth in Brazil”, a national hospital-based survey of puerperal women and their newborns, carried out in 2011/2012. This analysis involved 19,644 women. Mistreatment was a latent variable composed of seven indicators. We assessed the attendance of women and newborns to a review consultation following birth, and the timing of this appointment. We applied multigroup structural equation modeling (based on childbirth payment source) and considered separate analysis for women (vaginal births and0 caesarean-sections) and newborns.FindingsWe found a causal association between mistreatment during childbirth and decreased and/or delayed use of postnatal health services, for both women and their newborns. These results also revealed that women who use the public sector are affected more than those who pay for private healthcare.ConclusionMistreatment during childbirth has broader implications than “maternal mental health”, and it would be useful to understand that experience of care has vast implications for families. In Brazil, the mistreatment must be mitigated via the implementation of public policy. This is part of the path to dignified and respectful childbirth care for all women.     

Social Health Indicators and Economic Growth: Evidence from East Asia and Pacific,Middle East and North Africa,South Asia,and Sub-Saharan Africa

The objective of this study is to empirically investigate a two-way statistical relationship between the social health indicators and economic growth in the context of four major regions of the world i.e., East Asia and Pacific, Middle East and North Africa (MENA), South Asia and Sub-Saharan Africa. To recognize the relationship between the two variables, a time series, co-integration and Granger causality tests have been employed. Aggregate secondary data pertaining to these four regions from 1975 to 2011 on economic growth and social health indicators i.e., infant mortality, child abuse, child poverty, unemployment, weekly wages, health insurance coverage, teenage suicide, teenage drug abuse, high school dropouts, poverty, out-of-pocket health costs, homicides, alcohol related traffic fatalities, food insecurity, income inequality, HIV/AIDS, tuberculosis, basic health units and rural health centers has been used for analysis. This study evaluates four alternative but equally plausible hypotheses, each with different policy implications. These are: (1) social health indicators Granger cause economic growth, (2) economic growth Granger cause social health indicators (the conventional view), (3) There is a bi-directional causality between the two variables and (4) Both variables are causality independent (although highly correlated). The empirical results only moderately support the conventional view that economic growth has significant long run casual effect on social health indicators in East Asia and Pacific, MENA, South Asia and Sub-Saharan Africa. The present study find evident of unidirectional causality running towards economic growth to social health indicators, although, there are some bidirectional causality also exists between the variables. The percentage of unidirectional causality between economic growth and social health indicators is larger than bidirectional or neutrality hypothesis.     

Not on their own again: psychological, social, and health characteristics of custodial African American grandmothers

The article presents social and health indicators of depression among custodial African American grandmothers. Using a cross-sectional design, a sample of 99 custodial African American grandmothers caring for one or more grandchildren was included in the analysis. The results indicated that approximately 20% of custodial African American grandmothers were depressed. Depressed grandmothers were more likely to report having all ten chronic physical health conditions listed in the study. One additional chronic condition increased the probability of depression by 68%. Old age, more social support, and caring for older children were associated with low levels of depression. The proliferation of grandchildren being raised by African American grandmothers suggests the need for more research, policy, and programmatic interventions.     

CONSTRUCTING A HEALTH AND SOCIAL INDICATOR FRAMEWORK FOR INDIGENOUS COMMUNITY HEALTH RESEARCH

Health and social indicators that capture the distinct historical, social, and cultural contexts of Indigenous communities can play an important role in informing the planning and delivery of community interventions. There is currently considerable interest in cataloguing and vetting meaningful community-level health and social indicators that could be applied to research and health promotion activities in Indigenous communities in Australia, Canada, and New Zealand, inclusive of conventional indicators as well as measures developed specifically for use in or with Indigenous communities. To avoid haphazard selection of indicators, and to assure the comprehensiveness and relevance of any given set of indicators, a framework that can accommodate and conceptually classify indicators representing a full range of domains is required. We report here on the development of a conceptual framework, by which Indigenous community indicators, and more general community-level social indicators, can be sorted, catalogued, and systematically classified within four hierarchical levels. The indicator framework was developed across Canada, Australia and New Zealand in consultation with academic researchers and Indigenous community stakeholders, building from established health and social indicator systems. The Indigenous indicator framework permits Indigenous communities, public health researchers, and funding agencies to compare and select the most appropriate indicators for application in specific contexts from the multitude of existing indicators.     

Paperbark and pinard: A historical account of maternity care in one remote Australian Aboriginal town

Background and aimMaternity care in remote areas of the Australian Northern Territory is restricted to antenatal and postnatal care only, with women routinely evacuated to give birth in hospital. Using one remote Aboriginal community as a case study, our aim with this research was to document and explore the major changes to the provision of remote maternity care over the period spanning pre-European colonisation to 1996.MethodsOur research methods included historical ethnographic fieldwork (2007–2013); interviews with Aboriginal women, Aboriginal health workers, religious and non-religious non-Aboriginal health workers and past residents; and archival review of historical documents.FindingsWe identified four distinct eras of maternity care. Maternity care staffed by nuns who were trained in nursing and midwifery serviced childbirth in the local community. Support for community childbirth was incrementally withdrawn over a period, until the government eventually assumed responsibility for all health care.ConclusionsThe introduction of Western maternity care colonised Aboriginal birth practices and midwifery practice. Historical population statistics suggest that access to local Western maternity care may have contributed to a significant population increase. Despite population growth and higher demand for maternity services, local maternity services declined significantly. The rationale for removing childbirth services from the community was never explicitly addressed in any known written policy directive. Declining maternity services led to the de-skilling of many Aboriginal health workers and the significant community loss of future career pathways for Aboriginal midwives. This has contributed to the current status quo, with very few female Aboriginal health workers actively providing remote maternity care.     

How do health professionals support pregnant and young mothers in the community? A selective review of the research literature

BackgroundThe cultural phenomenon of “teenage pregnancy and motherhood” has been socially constructed and (mis)represented in social and health care discourses for several decades. Despite a growing body of qualitative research that presents an alternative and positive view of young motherhood, there remains a significant gap between pregnant and young women's experience of young motherhood and current global health and social policy that directs service delivery and practice.AimThis paper aims to heighten awareness of how a negative social construction of young motherhood influences global health and social policy that directs current community health models of practice and care for young mothers in the community.DiscussionThere is clear evidence on the vital role social support plays in young women's experience of pregnancy and motherhood, particularly in forming a positive motherhood identity. This discussion paper calls us to start open and honest dialogue on how we may begin to re-vision the ‘deficit view’ of young motherhood in order to address this contradiction between research evidence, policy discourse and current practice and service provision. Qualitative research that privileges young women's voices by considering the multidimensional experiences of young motherhood is an important step towards moving away from universally prescribed interventions to a non-standard approach that fosters relational and responsive relationships with young mothers that includes addressing the immediate needs of young mothers at the particular time.     

Not on Their Own Again: Psychological,Social, and Health Characteristics of Custodial African American Grandmothers

SUMMARY

The article presents social and health indicators of depression among custodial African American grandmothers. Using a cross-sectional design, a sample of 99 custodial African American grandmothers caring for one or more grandchildren was included in the analysis. The results indicated that approximately 20% of custodial African American grandmothers were depressed. Depressed grandmothers were more likely to report having all ten chronic physical health conditions listed in the study. One additional chronic condition increased the probability of depression by 68%. Old age, more social support, and caring for older children were associated with low levels of depression. The proliferation of grandchildren being raised by African American grandmothers suggests the need for more research, policy, and programmatic interventions.     

Family policy in 1990-1994

The nature and goals of family policy in Poland are discussed in the larger context of social policy and economic change, which reflects the transition to a market economy. The aim of family policy is to bring about a proper system of relationships between state and family, which allows for the performance of basic functions related to child rearing and satisfaction of basic needs. The roles of both governmental and nongovernmental organizations are considered important, although not actualized, in the implementation of family policy. Family policy involves laws regulating the conditions of welfare benefits in terms of prerequisites, amount of financial grants, services, and allowances such as food, clothing, or fuel. Financial resources may be received directly or indirectly by families. During 1990-94 major changes in family policy came about due to the transition to a market economy and were applied to social security benefits, work benefits, disability pensions, and health insurance. Changes were made in education, health care, and housing. A comprehensive model was never developed, in which negative effects of changes could be improved upon. Changes put greater emphasis on state and territorial governments to provide social welfare benefits, including social security benefits. Social welfare benefits were set at the lowest level of social security benefits. Economic changes have led to greater unemployment, housing difficulties, inflation, lower quality services, and a decline in the standard of living and security. The Central Statistical Office determined that over 56% of families in 1993 were affected by poverty conditions, which reduced expenditures on food and other needs. The proportion of the population recognized as poor increased during 1990-93 from 16.6% to 22.5% among workers, from 9.7% to 17.3% among farm tenants, from 23.9% to 36.6% among the self-employed, and from 30.4% to 40.6% among the aged and disabled. World Bank estimates showed that 15% of the total population were identified as poor. During this period, however, old-age pensions and the lowest salaries increased. The author concludes that policies must use general concepts that are comprehensive and that current economic trends should increase family income.