Policy and practice: non‐governmental organisations and the health delivery system for displaced children in khartoum,Sudan

The civil war in Sudan and natural disasters have led to the displacement of many people of whom 2.2 million live in and around Khartoum, half of whom are under the age of 18. These children, living in barren, remote areas, must find ways to survive and meet their basic needs of food, shelter, health and education. This article focuses on the work of an international organisation working in health services for displaced people in one of the camps in Khartoum in order to argue the case for a rights‐based approach to health care, for separate provision of services to adolescent mothers, for education on sexual and reproductive health for children before they become sexually active, and for sexual and reproductive health services and education for adolescent boys and men. This article concentrates on health education, in particular sexual and reproductive rights and how gender‐based differences impact on the health and well‐being of children. By concentrating almost exclusively on pregnant and lactating women and children under five, the organisation may reduce the possibility of successful outcomes for women and may not contribute to the reduction of sexually transmitted diseases, early pregnancy and related morbidity and mortality. Copyright © 2009 John Wiley & Sons, Ltd.     

Did socioeconomic inequalities in morbidity and mortality change in the United States over the course of the twentieth century?

In this article we present two sets of empirical analyses that consider the extent to which socioeconomic gradients in self-assessed health and child mortality changed since the beginning of the twentieth century in the United States. This empirical issue has important and wide-ranging research and policy implications. In particular, our results speak to the value of considering the role of broader social, economic, and political inequalities in generating and maintaining socioeconomic disparities in morbidity and mortality. Despite dramatic declines in morbidity and mortality rates in the United States across the twentieth century, we find that socioeconomic-status gradients in morbidity and mortality declined only modestly (if at all) during that period.     

Osteoporosis: an invisible, undertreated, and neglected disease of elderly men

This article highlights a silent disease that threatens the health and vitality of older men. Among elderly men and women, osteoporosis is among one of the leading causes of morbidity and mortality in the United States. Once perceived as only a female dominated disease, osteoporosis is now known to be gender blind. The following discussion will review the epidemiology and pathology of osteoporosis, and identify the concerns raised for men, including neglect. Special management considerations for older men and recommendations for future research into this overlooked major health problem will be explored. Better understanding of how osteoporosis affects older men may help to encourage prevention strategies earlier in life, appropriate screening and monitoring, as well as more effective treatment later in life.     

The twain meet: empirical explanations of sex differences in health and mortality

Health statistics routinely show higher morbidity and health services use for women, while mortality rates are higher for men. This analysis empirically identifies reasons for women's poorer health. It is based on retrospective (interview) and prospective (health diaries) data from the Health In Detroit Study. Three kinds of risk factors, which may help explain females' excess, are considered: acquired risks, psychosocial aspects, and health-reporting behavior. Men and women differ markedly in acquired risks: smoking and job hazards are higher for men, but inactivity, nonemployment, stress, and many other factors are higher for women. Psychosocial aspects predispose women to more illness and health care. Women also had keener interest in the survey. When all of the risk factors are controlled, the morbidity gap narrows considerably. In fact, indicators of general and chronic health reverse to reveal higher morbidity for men. Similarly, females' excesses for therapeutic care (short- and long-term disability, medical visits, lay consultation, drug use) diminish when risks and morbidity level are controlled. They actually reverse to a male excess for disability and medical care. Though most of the unveiled male excesses are statistically nonsignificant, their pattern allows a reasonable interpretation. Our results are closely compatible with recent analyses of sex mortality differences in several California sites, which could not eliminate men's mortality excess by controlling for social factors. In conclusion, contemporary women's poorer health profile stems largely from their roles and stress (acquired risks), and to a smaller degree from their health attitudes. When social factors are taken into account, health data suggest a disadvantage for men, and mortality data maintain men's disadvantage. Do the reasons lie in biology?     

Health disparities in military veterans with PTSD: influential sociocultural factors

Health disparities based on sociocultural factors such as gender, race and ethnicity, socioeconomic status, culture, and access to health care can potentially complicate the early diagnosis and effective management of posttraumatic stress disorder (PTSD). Research indicates that among those individuals affected by health disparities, there is a greater burden of illness and disability, higher morbidity and mortality rates, and increased behavioral risk factors. The purpose of this article is to highlight the sociocultural factors that affect the development of PTSD and to publicize health disparities in military combat veterans.     

Is the Education of Local Children Influenced by Living near a Refugee Camp? Evidence from Host Communities in Rwanda

This article studies the extent to which educational services and schooling outcomes of local children are influenced by the presence of a refugee camp in or near their community. Investigating Congolese refugees in Rwanda and relying on a mixed‐method approach, we examine schooling rates and access to school‐based feeding programmes in communities closer to and further away from three refugee camps. We conduct cohort analyses to compare the schooling outcomes of Rwandans residing at different distances from each of these camps. Our results highlight that children residing closer to the camps have better schooling outcomes and that locals residing closer to the camps have mostly positive views regarding the effects of refugees on local education. These results contribute to the literature on the effects of refugees on host communities and inform policy debates on how refugees need not be a “burden” if a long‐term vision shapes educational investments.     

Socioeconomic status,psychosocial factors and health in urban Guyana

Individuals of higher socioeconomic status live longer and enjoy better physical and mental health relative to individuals of lower social status. Socioeconomic status differences in health status persist over time. This paper examines the association between socioeconomic status, psychosocial factors, and health in Georgetown, Guyana. The major causes of death are cardiovascular and cerebrovascular disease; life expectancy at birth is 67.3 years for males and 72.3 years for females; and the infant mortality rate is 44 per 1000 live births. Data for the study were drawn from a probability sample of 654 adult residents of Georgetown. A significant inverse association was found between formal education and morbidity for four of the six measures of health status. The authors investigated the extent to which self-concept, health behaviors, stress, and social ties are linked to health status and socioeconomic status, and can explain socioeconomic status differences in health status. Psychosocial factors, especially the self-concept measures of self-esteem and mastery, were found to play a moderate role in accounting for educational differences in health status.     

Physical activity, genes, and lifetime predisposition to chronic disease

This mini-review summarizes the main associations between physical activity and chronic diseases and discusses the basic concepts related to the role of genetic factors in studies evaluating the effects of physical activity/exercise therapy on chronic disease prevention/treatment during the life course. Many observational cohort studies have shown that high physical activity during young adulthood or middle age is associated with reduced later life morbidity, mobility limitations and mortality. Physical activity or exercise therapy has a positive effect on health via many disease-specific mechanisms. The most consistent finding of the various randomized controlled studies conducted to date is that aerobic/functional capacity and/or muscle strength can be improved by exercise training among patients with different chronic diseases. Genes are known to play a role in chronic disease predisposition and to contribute to physical fitness levels, physical activity participation and ageing. Physical fitness, physical activity and health outcomes may be partly due to underlying genetic factors that have a favourable effect on all these traits (genetic pleiotropy). This means that in observational studies, the relationship between baseline activity and the later occurrence of diseases may not be interpreted entirely as causal. Increased knowledge on the role of nuclear genome, mitochondrial genome, epigenetics, telomeres and regulation of gene expression will increase our understanding of their relationships with physical activity and morbidity.     

‘The times,are they a‐changing?’ As the world enters a new millennium are we as paediatricians keeping up with the changing needs of children?

This paper describes changes that are occurring in paediatric practice in a variety of settings. The ‘new morbidity’ demands focused training of paediatricians of the twenty‐first century. Areas that include advocacy, public health, adolescence, chronic illness, health promotion, behavioural issues, parenting and family dynamics, social influences, health and social inequalities, managerial decision making and technological advances should be a part of paediatric training. These factors assume different importance in developing nations where priorities may be more focused on public health, nutrition and health promotion. Partnership with others who have children's interests at heart, for example mental health services, public health, social sciences, education and social services is imperative in planning service development informed by good information systems incorporating measures of mortality and morbidity. Copyright © 2000 John Wiley & Sons, Ltd.     

A Profile of Adolescent Health

SUMMARY

As the adolescent population living in this country undergoes dramatic demographic changes in the 21st Century, increasing both in numbers and ethnic/racial diversity, practitioners and policy makers need to understand the prevalence of and trends in adolescent risk-taking behaviors, morbidity and mortality. Significant disparities in health status exist by ethnicity/race and gender in areas including: unintentional injury, violence, mental health, substance use, sexual behavior, and disease prevention. The epidemiological profile can help mobilize communities to address adolescent health issues. Developing effective interventions will require an ecological approach that builds on adolescents' assets and takes into account the contexts in which they live.     

Community Development's Role in Cardiovascular Disease Prevention Projects for African Americans

The study investigates the use of community development strategies to address the problem of high morbidity and mortality rates among African Americans in eight Michigan communities. The findings indicate a shift from a traditional medical paradigm, one-to-one doctor–patient approach, to a social behavioral paradigm that incorporates community development approaches, such as technical assistance and self help approaches. This fosters lifestyle changes that are needed to impact the cardiovascular disease-related morbidity and mortality statistics. In addition, the research links the findings of the use of community development approaches to community capacity building. This study concludes that applying community development approaches can serve as the catalyst to planned change as it relates to health empowerment, which in turn will help disenfranchised groups of people to become more empowered in making other significant changes in their communities.     

Early childbearing, marital status, and women's health and mortality after age 50

This article examines the relationship between a woman's childbearing history and her later health and mortality, with primary focus on whether the association between them is due to early and later socioeconomic status. Data are drawn from the Health and Retirement Study birth cohort of 1931-1941. Results indicate that, conditional on reaching midlife and controlling for early and later socioeconomic status, a first birth before age 20 is associated with a higher hazard of dying. In addition, having an early birth is associated with a higher prevalence of reported heart disease, lung disease, and cancer in 1994. Being unmarried at the time of the first birth is associated with earlier mortality, but this association disappears when midlife socioeconomic status is controlled. The number of children ever born does not significantly affect mortality but is associated with prevalence of diabetes.     

The Indochinese Refugees

Cambodian, Laotian and Vietnamese refugees who have come to North American host countries via the South Asian camps have been exposed to many potentially traumatic events and have been submitted to an alienating migration process. A comprehensive analysis of their experience both in refugee camps and North American host countries is facilitated by the use of various stress theories. The stressors of change, acculturation, bereavement and trauma are identified with regard to the migration process of the Indochinese refugees as well as to the pre- and post-migration period. Some implications for practice in social, physical and mental health settings are underlined: in particular a sensitivity to the meaning of physical illness within this population, to the cultural reticence towards mental health consultation, to the possibility of longterm vulnerability to post-traumatic stress disorders and to increasing value conflicts within the family. Intervention experiences both in the South Asian refugee camps and in North American host countries suggests the importance of traditional healers and natural support networks.     

Socioeconomic status, smoking, and health: a test of competing theories of cumulative advantage

Although both low socioeconomic status and cigarette smoking increase health problems and mortality, their possible combined or interactive influence is less clear On one hand, the health of low status groups may be harmed least by unhealthy behavior such as smoking because, given the substantial health risks produced by limited resources, they have less to lose from damaging lifestyles. On the other hand, the health of low status groups may be harmed most by smoking because lifestyle choices exacerbate the health problems created by deprived material conditions. Alternatively, the harm of low status and smoking may accumulate additively rather than multiplicatively. We test these arguments with data from the 1990 U.S. National Health Interview Survey, and with measures of morbidity and mortality. For ascribed statuses such as gender, race, and ethnicity, and for the outcome measure of mortality, the results favor the additive argument, whereas for achieved status and morbidity, the results support the vulnerability hypothesis--that smoking inflicts greater harm among disadvantaged groups.     

Aging,Health, and Social Policy:

Seven major turning points in the evolution of U.S. aging policy are identified and reviewed: (1) the Social Security Act (2) the Great Society (3) the federalization of Old Age Assistance (4) the enactment of comprehensive social services (5) Social Security improvements (6) New Federalism, and (7) medical cost-containment policies under Medicare and Medicaid. In the 1980s, significant and growing problems of uninsurance and underinsurance for health care have re-emerged. Simultaneously, state Medicaid programs are characterized by their increasing variation and inequities, while there has been a decline in access for the poor. The future of aging policy will be decided in the context of four socio-demographic realities: (1) population aging (2) trends in mortality and morbidity (3) the relationship between income and health, and (4) aging as a woman's issue. The article concludes with a call for a recommitment to the public interest and to public solutions which affirm that health care is an inalienable right.     

Welfare state and infant mortality

This article seeks to understand the effects of welfare-state spending on infant mortality rates. Infant mortality was chosen for its importance as a social indicator and its putative sensitivity to state action over a short time span. Country fixed-effects models are used to determine that public health spending does have a significant impact in lowering infant mortality rates, net of other factors, such as economic development, and that this effect is cumulative over a five-year time span. A net effect of health spending is also found, even when controlling for the level of spending in the year after which the outcome is measured (to account for spurious effects or reverse causation). State spending effects infant mortality both through social mechanisms and through medical ones. This article also shows that the impact of state spending may vary by the institutional structure of the welfare state. Finally, this study tests for structural breaks in the relationship between health spending and infant mortality and finds none over this time period.     

Older Hispanic Women and Breast Cancer Screening: Do Cultural Factors Matter?

High morbidity and mortality cancer rates among older minority adults underscores the importance of identifying and addressing health disparities related to age and cultural factors that may influence participation in cancer screening and early detection of disease. Disparities for Hispanic women exist in part due to behavior, including lower participation in cancer screenings. Using data from the 2008 wave of the Health and Retirement Study, this study investigated the relationships among cultural factors, time orientation, and uncertainty avoidance among Hispanic women. Results indicate that time orientation and uncertainty avoidance predicted older Hispanic women’s participation in breast cancer screening services.     

BLACK-WHITE DIFFERENCES IN HEALTH AND MORTALITY:

An important segment of social science research focuses on differences in health and mortality between the African American and non-Hispanic white populations in the United States. This article begins by documenting some of the current health and mortality differences. I then review and critique the three major theoretical approaches that are most often used to explain such differences: racial genetic, cultural/behavioral, and socioeconomic. Finally, I present an alternative conceptual framework for the study of black-white differences in health and mortality. This reorientation of the importance of race for health and mortality moves beyond narrow genetic, cultural/behavioral, or socioeconomic representations to include, most importantly, multiple forms of racism as crucial sociological determinants of health and mortality differentials. Key sets of intervening, or proximate, variables are also identified to specify the process by which the health and mortality differentials are created. While no single future study may encompass all of the factors highlighted in the proposed framework, data collection and research efforts in this area can be guided by a model that organizes into a relatively parsimonious framework the seemingly endless number of factors involved in the creation of such differences.     

Constructing autonomy: the significance of architecture in creating and manifesting autonomy in protest camps

ABSTRACT

This study examines how autonomy in protest camps is enabled by and manifested through architecture. Although the importance of space for the struggles for autonomy in protest camps has been recognized in recent research, their architecture has not been widely examined in this respect. This study uses empirical data collected from four different protest camps during 2015–2017 to examine the role of architecture for the struggles for autonomy. The study found that architecture is essential in creating protest camps’ autonomy from the status quo. Furthermore, the results suggest that protesters engage especially with Do-It-Yourself -architecture to organize their lifeworlds in a way that allows, enforces, and reflects their alternative societal structures and practices, thus also enforcing their autonomy as a prefigurative praxis. Overall, the findings of this research suggest that architecture plays a significant role in both creating and manifesting autonomy in protest camps, thus adding architecture as a significant element to be analyzed in protest camps and expanding the existing field of research.     

Troubling stories of the end of occupy: Feminist narratives of betrayal at occupy Glasgow

This article offers a feminist take on the question of why Occupy camps closed down, in the form of a narrative analysis of interviews from participants in Occupy Glasgow. In response to the emergence of an activist discourse emphasising the role of external forces in camp closure and the existence of a longer-term legacy in terms of individual and community politicisation, I build here on feminist interventions that point instead to serious internal problems within the camps and thus to a more limited legacy. Interrogating the plotting, characterisation and denouement of interviewee narratives, I show that feminist participants in Occupy Glasgow characterise the trajectory of the camp as a tragedy, attribute responsibility for the camp’s demise to co-campers and sometimes to themselves, and present the outcome of Occupy Glasgow as limited, and in some cases even traumatic. This raises serious questions about the culmination and outcomes of Occupy in Glasgow and more generally, and indicates the extent of the hard work remaining if future mobilisation against neoliberal austerity is to be more inclusive and sustainable. The article closes by considering the theoretical implications for the wider question of why movements come to an end.