Narrating Sustainability in Canadian Health Care Reform Discourse

In Canada, as in other industrialized welfare states, definitions of health system sustainability reflect different goals and correspondingly diverse ways of understanding exactly what is to be sustained and how. In this article, we report on results from a survey of documents and groups involved in and/or concerned about sustainability of the healthcare system. We identify four broad narratives of sustainability in Canadian healthcare reform discourse, and explore what these different sustainability narratives tell us about the character and contours of these often‐fractious debates. We argue that sustainability itself may not be a paradigm shift, as has been suggested, but a plot device that helps to steer the story in a particular direction, ‘black‐boxing’ certain aspects of context and emphasizing others.     

Couple Longevity in the Era of Same‐Sex Marriage in the United States

The author used a new longitudinal data set, the How Couples Meet and Stay Together surveys (N = 3,009), to generate the first nationally representative comparison of same‐sex couple stability and heterosexual couple stability in the United States. He measured the association between marriage (by several definitions of marriage) and couple longevity for same‐sex couples in the United States. Reports of same‐sex relationship instability in the past were due in part to the low rate of marriages among same‐sex couples. After controlling for marriage and marriage‐like commitments, the break‐up rate for same‐sex couples was comparable to (and not statistically distinguishable from) the break‐up rate for heterosexual couples. The results revealed that same‐sex couples who had a marriage‐like commitment had stable unions regardless of government recognition. A variety of predictors of relationship dissolution for heterosexual and for same‐sex couples are explored.     

Quantifying Economic Dependency

In this paper we compare several types of economic dependency ratios for a selection of European countries. These dependency ratios take into account not only the demographic structure of the population, but also the differences in age-specific economic behaviour such as labour market activity, income and consumption as well as age-specific public transfers. In selected simulations where we combine patterns of age-specific economic behaviour and transfers with population projections, we show that in all countries population ageing would lead to a pronounced increase in dependency ratios if present age-specific patterns were not to change. Our analysis of cross-country differences in economic dependency demonstrates that these differences are driven by both differences in age-specific economic behaviour and in the age composition of the populations. The choice of which dependency ratio to use in a specific policy context is determined by the nature of the question to be answered. The comparison of our various dependency ratios across countries gives insights into which strategies might be effective in mitigating the expected increase in economic dependency due to demographic change.     

Assessing Participation and Effectiveness of the Peer-Led Approach in Youth Sexual Health Education: Systematic Review and Meta-Analysis in More Developed Countries

Sexual health education for young people is crucial not only for development of norms but also for protection against vulnerabilities during this stage in life. Although several systematic reviews have examined the effectiveness of peer-led sex education, none have focused on the extent of peer participation. The purpose of this review was to evaluate peer-led sexual health education interventions in more developed countries (MDCs). Electronic and manual searches across five social science, education, and medical databases were conducted. Fifteen articles were selected in total. Most (10 of 15) studies gave low or no responsibility to peers. The majority of articles found improvements in sexual health knowledge (13 of 14) and attitudes (11 of 15) at postintervention stages. Two studies showed improved self-efficacy, and three showed behavioral changes. A preliminary synthesis of effectiveness and level of participation was done. Meta-analysis revealed a large effect on knowledge change (Hedges’ g = 0.84, 95% confidence interval [CI]: 0.43 to 1.25) and a medium effect on attitude change (Hedges’ g = 0.49, 95% CI: 0.19 to 0.80). Peer-led interventions could be a powerful tool. This review shows that this approach is effective in changing knowledge and attitudes but not behaviors. Further research and action are needed to understand optimal implementation.