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Sund, Erik Reidar. "Geographical and Social Inequalities in Health and Health Behaviour in the Nord-Trøndelag Health Study(HUNT)." Doctoral thesis, Norges teknisk-naturvitenskapelige universitet, Geografisk institutt, 2010. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-11283.
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Health and health behaviour varies both socially and geographically and individuals may experience different degrees of health according to their socioeconomic position and where they live. The fact that health varies geographically is usually given two interpretations. It may arise as a consequence of the composition of individuals according to sociodemographic markers. Alternatively, there may be features associated with the context in which they live that explains geographical health variation. Consequently, individuals’ health may be influenced by both individual factors and contextual factors. The overall aim of this thesis is to analyse whether geographical health variation is due to composition or features associated with context. Data from the Nord-Trøndelag Health Study (HUNT) in the county of Nord-Trøndelag, Norway, and the statistical technique of multilevel modelling were utilised to analyse these relationships at multiple geographical scales and also across non-geographical contexts. The overall finding is that geographical health variation in Nord-Trøndelag is rather small and that place makes little difference to the health of individuals. This applies both to the level of municipalities and wards/neighbourhoods. The importance of the family context was also explored, and it was found that health and health behaviour within families seemed to cluster. There was strong behavioural conformity in terms of smoking habits whereas body mass index was weakly to moderately dependent on the family context. The findings have some clear implications in terms of future disease prevention and health policy. First, targeted area based initiatives towards particular municipalities, or wards, is not warranted in this particular county. It is however difficult to generalise this particular finding across cultures and towards more urban areas, there may be societies where such initiatives may be of importance. Second, there are some clear indications that the family context is important for the health of individuals and this finding should be acknowledged in future research as well as in disease prevention and health policy.
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Davies, Michael. "The role of commonsense understandings in social inequalities in health : an investigation in the context of dental health /." Title page, contents and abstract only, 2000. http://web4.library.adelaide.edu.au/theses/09PH/09phd2565.pdf.
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Pons, i. Vigués Mariona. "Breast cancer screening: social inequalities by country of origin and social class and its impact on mortality." Doctoral thesis, Universitat Pompeu Fabra, 2010. http://hdl.handle.net/10803/31903.
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The general objective of this dissertation is to study breast cancer screening and specifically
social inequalities by social class and country of origin and its relationship with
decreasing mortality. Therefore, four different studies have been done: three with quantitative
methodology and one with qualitative. According to the quasi-experimental study, breast cancer
mortality decreased in Barcelona before the introduction of the population screening program, but
this reduction is more marked after its introduction. According to data from the Spanish National
Health Survey in 2006, there are inequalities in the rate of breast cancer screening according to
country of origin and social class. According to two studies conducted in Barcelona, immigrant
women from low-income countries are less aware, and hence do less, early detection practices,
as they have other priorities and perceive more barriers and taboos. Chinese women are the
immigrants who present more differences with native women, followed by Maghribian and
Philippine women. Place of origin, social class and migration process are key factors in
preventive practices. In conclusion, it is necessary to encourage access to preventive screening
practices for all women and also to undertake specific actions directed at the most vulnerable
groups, taking into account any socio-cultural factors that influence the use of preventive
practices.L’objectiu general d’aquesta tesi és estudiar el cribratge de càncer de mama i en concret les desigualtats socials per classe social i país d’origen, així com la seva relació amb la disminució de la mortalitat. En conseqüència, s’han realitzat quatre estudis diferents: tres de metodologia quantitativa i un de qualitativa. Segons l’estudi quasi-experimental, la mortalitat per càncer de mama a Barcelona disminueix des d’abans de la introducció del programa poblacional de cribatge, però aquesta reducció és més accentuada desprès de la seva introducció. En base a l’Enquesta Nacional de Salut de l’Estat Espanyol de l’any 2006, existeixen desigualtats en la realització de mamografies periòdiques segons país d’origen i classe social. Segons els dos estudis realitzats a Barcelona, les dones immigrades procedents de països de renda baixa coneixen i realitzen menys les pràctiques de detecció precoç, ja que tenen altres prioritats i perceben més barreres i tabús. Les dones xineses són les que presenten més diferències amb les dones autòctones, seguides de les magribines i les filipines. El lloc d’origen, la classe social i el procés migratori són factors claus en les practiques preventives. En conclusió, és necessari afavorir l’accés a les pràctiques preventives a totes les dones i també realitzar accions específiques dirigides als grups més vulnerables sense deixar de tenir en compte els factors socioculturals que influeixen en les pràctiques preventives de les dones.
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Ruiz, Muñoz Dolores 1978. "Socioeconomic inequalities in sexual and reproductives health in Spain." Doctoral thesis, Universitat Pompeu Fabra, 2013. http://hdl.handle.net/10803/131294.
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The general objective of this dissertation was to study the state of sexual and reproductive health of the Spanish population in reproductive age, especially focusing on individual and contextual socioeconomic inequalities.
Five different studies were designed to achieve this objective, one especially focused on the state of sexual health, three on the use of contraception and one on the practice of induced abortion, studying in each case the influence of socioeconomic factors.
Using sources of information such as the Fecundity Interview of 2006, the first National Sexual Health Survey of 2009 and the annual Register of Voluntary Interruption of Pregnancy, we were able to conduct multivariate regression studies, and when possible with a multilevel approach, to study socioeconomic inequalities in the different aspects related to sexual and reproductive health detailed.
The studies of this dissertation suggest that the general state of sexual and reproductive health of the Spanish population in reproductive age is quite good; nevertheless, individual and contextual socioeconomic inequalities are detected in almost all the aspects studied.El objetivo general de esta tesis fue estudiar el estado de salud sexual y reproductiva de la población española en edad reproductiva, centrándonos especialmente en las desigualdades socioeconómicas individuales y contextuales. Para alcanzar este objetivo se diseñaron cinco estudios diferentes, uno dedicado al estado de salud sexual, tres al uso de anticoncepción y el último a la práctica de aborto inducido, estudiando en cada caso la influencia de los factores socioeconómicos. Mediante el uso de fuentes de información como la Encuesta de Fecundidad de 2006, la primera Encuesta Nacional de Salud Sexual de 2009 y el Registro anual de Interrupciones Voluntarias del Embarazo, se realizaron estudios de regresión multivariados, con un enfoque multinivel cuando fue posible, para estudiar las desigualdades socioeconómicas en los diferentes aspectos relacionados con la salud sexual y reproductiva detallados. Los estudios de esta tesis sugieren que el estado general de salud sexual y reproductiva de la población española en edad reproductiva es bastante bueno; sin embargo, se detectan desigualdades socioeconómicas individuales y contextuales en la mayoría de los aspectos estudiados.
L’objectiu general d’aquesta tesi va ser estudiar l’estat de salut sexual i reproductiva de la població espanyola en edat reproductiva, centrant-nos especialment en les desigualtats socioeconòmiques individuals i contextuals. Per aconseguir aquest objectiu es van dissenyar cinc estudis diferents, un dedicat a l’estat de salut sexual, tres a l’ús d’anticoncepció i l’últim a la pràctica d’avortament induït, estudiant en cada cas la influència dels factors socioeconòmics. Mitjançant l’ús de fonts d’informació com l’Enquesta de Fecunditat de 2006, la primera Enquesta Nacional de Salut Sexual i Reproductiva de 2009 i el Registre anual d’Interrupcions Voluntàries de l’Embaràs, es van realitzar estudis de regressió multivariats, amb un enfocament multinivell quan va ser possible, per estudiar les desigualtats socioeconòmiques en els diferents aspectes relacionats amb la salut sexual i reproductiva detallats. Els estudis d’aquesta tesi suggereixen que l’estat de salut sexual i reproductiva de la població espanyola en edat reproductiva és bastant bo; tanmateix, es detecten desigualtats socioeconòmiques individuals i contextuals en la majoria dels aspectes estudiats.
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Schmitt, Natalie M., Jochen Schmitt, and Wilhelm Kirch. "Sozioökonomische Ungleichheiten in der Gesundheit und im Gesundheitsverhalten. Aktuelle Entwicklungen in Deutschland und Europa." Saechsische Landesbibliothek- Staats- und Universitaetsbibliothek Dresden, 2008. http://nbn-resolving.de/urn:nbn:de:bsz:14-ds-1226418554367-12486.
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Die Ergebnisse des Kinder- und Jugendgesundheitssurveys (KiGGS) enthüllen Unterschiede im Gesundheitsstatus und Gesundheitsverhalten in Deutschland je nach Einkommen, Bildungsstand und Berufswahl der Kinder und Jugendlichen selbst bzw. von deren Eltern. Besonders stark ausgeprägt sind die sozialen Unterschiede im Hinblick auf den allgemeinen Gesundheitszustand, psychische und Verhaltensauffälligkeiten sowie Übergewicht. Auch in allen anderen europäischen Staaten kumulieren Mortalität, Morbidität und verhaltensbedingte Risikofaktoren in den unteren sozioökonomischen Statusgruppen. In Europa differiert die Lebenserwartung bei Männern in höheren und niedrigeren sozialen Positionen durchschnittlich um fünf Jahre. Die Entwicklung von Strategien zur Bekämpfung sozialer Ungleichheiten in der Gesundheit ist eine der größten Herausforderungen unserer heutigen GesellschaftThe national representative survey on the health of children and adolescents in Germany (KiGGS) revealed social inequalities in health and health behaviour in Germany according to income, education and occupation of both the children and adolescents themselves and their parents. Social inequalities in general health status, psychological or behavioural disorders, and overweight seem to be most alarming. Mortality, morbidity and detrimental health behaviour accumulate in the subpopulation with a low socioeconomic position (SEP) across Europe. The average difference in life expectancy in European men with a high and low SEP is 5 years. The development of policies and strategies to tackle this important public health issue is a major present and future challenge
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Trujillo, Alemán Sara 1985. "Inequalities in health and health behaviours amongst couple and lone mothers : The influence of socioeconomic factors and social capital in Spain and Europe." Doctoral thesis, Universitat Pompeu Fabra, 2019. http://hdl.handle.net/10803/668326.
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This PhD research has three main aims: first, to design a conceptual framework for studying health inequalities amongst women who are mothers; secondly, to describe inequalities in health and health behaviours between couple and lone mothers in Spain; and lastly, to explore the relationship between social capital and lone mothers’ health in Europe. These objectives have been met through the publication of three papers, with data for Papers 2 and 3 drawn from the Spanish National Health Survey (waves 2003-2004 and 2011-2012) and the European Social Survey (2010), respectively. Paper 1 shows a conceptual framework that explains the processes and contexts that influence health inequalities amongst women who are mothers. Paper 2 points out that inequalities in health and health behaviours between couple and lone mothers exist in Spain amongst the manual social class, with lone mothers reporting worse health outcomes and health behaviours than couple mothers. However, changes in inequalities were not confirmed between 2003-2004 and 2011-2012. Findings of Paper 3 suggest a relationship between cognitive social capital and lone mothers’ health, although social capital does not seem to explain the cross-country variance observed in lone mother’s health across Europe.Esta tesis presenta tres objetivos: primero, diseñar un modelo conceptual para el estudio de desigualdades en salud entre mujeres que son madres; segundo, describir las desigualdades en salud y conductas relacionadas con la salud entre madres con y sin pareja en España; y, por último, explorar la relación entre el capital social y la salud de las madres sin pareja en Europa. Estos objetivos se alcanzaron mediante la publicación de tres artículos científicos, con datos para los Artículos 2 y 3 procedentes de la Encuesta Nacional de Salud de España (2003-2004 y 2011-2012) y de la Encuesta Social Europea (2010), respectivamente. El Artículo 1 presenta un modelo conceptual que describe los procesos y contextos que influyen en las desigualdades en salud entre mujeres que son madres. El Artículo 2 apunta que, en España, existen desigualdades entre madres con y sin pareja de la clase social manual, presentando las madres sin pareja peores resultados en salud y conductas relacionadas con la salud que las madres con pareja. Sin embargo, no se pudo confirmar la existencia de cambios en las desigualdades entre 2003-2004 y 2011-2012. El Artículo 3 sugiere que existe una relación entre el capital social cognitivo y la salud de las madres sin pareja, aunque no parece que el capital social explique la variabilidad observada en la salud de las madres sin pareja entre los países europeos.
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Stringhini, Silvia. "Explaining social inequalities in mortality : evidence from the British Whitehall II and the French GAZEL studies." Phd thesis, Université Paris Sud - Paris XI, 2011. http://tel.archives-ouvertes.fr/tel-00681088.
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Les différences de morbidité et de mortalité entre les groupes socioéconomiques constituent un des résultatsle plus cohérent de la recherche épidémiologique. Cependant, les mécanismes qui sous-tendent cetteassociation demeurent encore mal compris. Les données de deux grandes cohortes européennes ont étéutilisées pour décrire l'ampleur des différences socioéconomiques de mortalité toutes causes et spécifique, etexaminer le rôle des comportements de santé et du soutien social dans ces inégalités. Les indicateurs de lasituation socioéconomique dans l'enfance se sont révélés liés à la mortalité à l'âge adulte, même si toutefoisles trois mesures examinées - position socioprofessionnelle du père, niveau d'études et taille - étaientdifféremment liées à la mortalité. Les indicateurs de la position socioéconomique à l'âge adulte, catégoriesocioprofessionnelle et revenu, étaient associés à la mortalité toutes causes et cardiovasculaire dans les deuxcohortes. Dans l'étude Whitehall II, les comportements de santé étaient socialement distribués etexpliquaient une grande partie des inégalités sociales de mortalité, en particulier lorsque les changementsdans ces comportements au cours du suivi étaient pris en compte. Les mêmes comportements expliquaienttrès peu les inégalités sociales de mortalité dans l'étude GAZEL, leur répartition sociale étant faible danscette cohorte. Parmi les mesures de soutien social considérées, le statut marital expliquait également unepartie du gradient socioéconomique de mortalité dans l'étude Whitehall II, mais pas dans GAZEL, tandis quele rôle de la participation sociale et du réseau social était négligeable dans les deux cohortes. Différentsmécanismes semblent jouer un rôle dans les inégalités sociales de santé dans ces deux pays européensvoisins. Cela implique que des recherches comparatives visant à comprendre les déterminants communs etspécifiques des différences sociales de santé sont nécessaires. D'autres recherches visant davantage lescauses fondamentales des inégalités sociales de santé sont également souhaitables.
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Forster, Martin. "Economics, inequalities in health and health-related behaviour." Thesis, University of York, 1997. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.245870.
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Bolam, Bruce Leslie. "Ideologies of health : towards a social psychology of health inequalities." Thesis, University of the West of England, Bristol, 2003. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.275831.
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This thesis works towards a social psychology of health inequalities in order to further understanding of the relations between structure and agency (re )producing these inequities. It does so by exploring the ideological construction of health and identities associated with the axes of inequality. Employing a material-discursive methodological standpoint to link work on inequality with that of 'lay health beliefs', it is argued that discourse is the semiotic moment of practices (re )producing health inequalities. Critical discourse analysis thereby provides a means to examine the ideological construction of health and identities associated with health inequalities. The interview and focus group methods used to generate text in interaction with a small, diverse sample of participants living in Bristol are described, paying particular attention to the reflexive issues embedded within the research process. F our competing ideologies within which health and illness were constructed as discursive objects are described: minimalism, associated with health as the absence of illness and medical ideology; psychological constructions of health as wellness or happiness relating to psychological ideology; lifestyle constructions of life ethics pertaining to health promotional ideology; and holism, the interdependency of mind, body and spirit, tied to alternative health ideology. The four interwoven health identities arising from these ideologies of health and respecting the key axes of inequalities in health, namely social class, gender, ethnicity and place, are considered. Resistance to class as prejudice is explored, alongside an examination the politics of class identity and a reading of working class and middle class health identities. Hegemonic gender identities of women as carers and men as uncaring, active agents are then examined. Ethnicity as health identity emerges as a site of solidarity and fragmentation closely linked to place via the concept of community. Finally, constructions of pollution, space and community provide a structural and spacial grounding to health identities associated with place. In conclusion, the usefulness of this social psychological analysis is evaluated in consideration of individualisation in ideologies of health, interpreted as 'internalised oppression', 'methodological product' and 'an assertion of agency' in the context of recent debate about identity in late modem society. In sum, the thesis both examines the social structuring of subjects and foregrounds the ethical and political dimensions of the ideologies of health within which inequalities research must recognise its' reflexive engagement
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Rueda, Pozo Silvia. "Social Inequalities in health among the elderly." Doctoral thesis, Universitat Pompeu Fabra, 2011. http://hdl.handle.net/10803/31877.
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Aquesta tesi analitza les desigualtats en salut entre les persones grans a través d’un marc
d’anàlisi on es combinen la posició socioeconòmica, el gènere, el desenvolupament
socioeconòmic regional i el suport social. Està formada per tres articles, cadascun d’ells
centrat en les diferents dimensions de les desigualtats socioeconòmiques en salut entre
les persones grans. Algunes de les troballes més importants han estat que les
desigualtats socioeconòmiques i de gènere persisteixen entre les persones grans; que les
dones presenten una pitjor salut que els homes; que l’impacte de les característiques
familiars en la salut de les persones grans varia per gènere i segons l’indicador de salut
analitzat; que el suport social constitueix un determinant important de l’estat de salut; i
que tot i que el grau de desenvolupament regional constitueix un determinant de l’estat
de salut, no està relacionat amb les desigualtats de gènere en salut.This dissertation analyses socio-economic inequalities in health among the elderly through a combined framework of socio-economic position, gender, regional socioeconomic development and social support. It is made up of three papers focusing on the different dimensions of socio-economic inequalities in health among the elderly. The most important findings are that socio-economic and gender inequalities in health persist in old age; that women present a poorer health status than men; that the impact of family characteristics on the health of older people differs by gender and the health indicator analysed; that social support constitutes an important determinant of health status; and that whereas regional socio-economic development constitutes a determinant of health status, it is not related to gender inequalities in health.
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Manneville, Florian. "Comportement alimentaire, activité physique, sédentarité et inégalités sociales de santé à l’adolescence." Thesis, Université de Lorraine, 2020. http://www.theses.fr/2020LORR0128.
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Contexte : A l’adolescence, plus le statut socioéconomique (SSE) des individus est élevé, meilleur est leur état de santé et traduit l’existence d’inégalités sociales de santé. Ces inégalités pourraient s’expliquer par une inégale répartition des modes de vie comme l’activité physique (AP), le comportement sédentaire (CS) et le comportement alimentaire (CA) en fonction du SSE des adolescents. Les liens entre les modes de vie et les inégalités sociales de santé sont encore mal connus à l’adolescence. Objectifs : Cette thèse visait à analyser les liens entre les modes de vie et les inégalités sociales de santé à l’adolescence à travers trois objectifs : 1) décrire les modes de vie et leurs répartitions en fonction du milieu social des adolescents, 2) évaluer l’efficacité d’une intervention de santé publique sur la réduction des inégalités sociales de santé à l’adolescence, 3) mesurer et quantifier les effets médiateurs des modes de vie sur les inégalités sociales de santé à l’adolescence. Méthodes : Pour répondre à ces objectifs, les données de deux essais de prévention du surpoids et de l’obésité à l’adolescence ont été utilisées : PRALIMAP (PRomotion de l’ALImentation et de l’Activité Physique) et PRALIMAP-INES (INEgalités de Santé). L’AP et le CS ont été mesurés en utilisant l’auto-questionnaire « International Physical Activity Questionnaire » et le CA avec un questionnaire de fréquence alimentaire. Le SSE a été défini à l’aide de l’Indice de Position Sociale des Elèves et du « Family Affluence Scale ». Les analyses statistiques réalisées comprenaient des modèles de régression linéaire, mixte et logistique et une analyse des transitions latentes. Résultats : Les adolescents de faibles SSE pratiquaient moins d’AP et avaient une alimentation moins équilibrée que ceux de SSE plus élevés. Globalement, le CS n’était pas associé au SSE des adolescents. Des inégalités sociales de corpulence et de qualité de vie ont été révélées. Il n’a pas été mis en évidence qu’une intervention universelle permettait de réduire les inégalités sociales de corpulence. Des effets médiateurs des comportements dans l’association entre le SSE et l’état de santé ont été suggérés. Conclusions : Ces résultats soulignent l’importance de la prise en compte le milieu social des adolescents pour réduire les inégalités sociales de santé à cette période de la vie. Les comportements apparaissent comme des leviers importants de réduction des inégalités sociales de santéBackground: During adolescence, the higher the socio-economic status (SES), the better the health status is and reflects the existence of social inequalities in health. These inequalities could be explained by the unequal distribution of lifestyles such as physical activity (PA), sedentary behaviour (SB) and dietary behaviour (DB) according to adolescents’ SES. The associations between lifestyles and social inequalities in health are unclear among adolescents. Objectives: This thesis aimed to analyze the associations between lifestyles and social inequalities in health during adolescence through three objectives: 1) to describe lifestyles and their distribution according to adolescents’ SES, 2) to evaluate the effectiveness of a public health intervention on the reduction of social inequalities in health among adolescents, and 3) to measure and quantify the mediating effects of lifestyles on social inequalities in health among adolescents. Methods: To address these objectives, data from two trials aimed at preventing overweight and obesity among adolescents were used: PRALIMAP (PRomotion de l’ALImentation et de l’Activité Physique) and PRALIMAP-INES (PRALIMAP-INEgalités de Santé). PA, SB were measured using the International Physical Activity Questionnaire and DB using a food frequency questionnaire. SES was defined using the Social Position Index of Students and the Family Affluence Scale. Statistical analyses included linear, mixed and logistic regression models and an analysis of latent transitions. Results: Low SES adolescents had lower levels of PA and less adapted DB than high SES ones. Overall, DB was not associated with adolescents’ SES. Social inequalities in weight and quality of life were highlighted. There was no evidence that a universal intervention could reduce social inequalities in weight. Mediating effects of behaviours in the association between SES and health status were suggested. Conclusions: These results underline the importance of taking SES into account in order to reduce social inequalities in health among adolescents. Behaviours appear to be important levers to reduce social inequalities in health
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GYASI, Razak Mohammed. "Ageing, health and health-seeking behaviour in Ghana." Digital Commons @ Lingnan University, 2018. https://commons.ln.edu.hk/otd/41.
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Rapid ageing of populations globally following reductions in fertility and mortality rates has become one of the most significant demographic features in recent decades. As a low- and middle-income country, Ghana has one of the largest and fastest growing older populations in sub-Saharan Africa, where ageing often occurs ahead of socioeconomic development and provision of health and social care services. Older persons in these contexts often face greater health challenges and various life circumstances including role loss, retirement, irregular incomes and widowhood, which can increase their demand for both formal and informal support. This thesis addresses the effects of the socio-political structure, informal social support and micro-level factors on health and health-seeking behaviour among community-dwelling older persons in Ghana. The theoretical perspectives draw on political economy of ageing, social convoy theory and Andersen5s behavioural model. Using multi-stage stratified cluster cross-sectional survey data of older cohorts (N= 1,200) aged 50 years and older, multivariate generalised Poisson and logit regression models estimated the associations among variables and interaction terms. Although Ghana’s national health insurance scheme (NHIS) enrollment was significantly associated with increased log count of healthcare use (β = 0.237), the relationship was largely a function of health status. Moreover, the NHIS was related with improved time from onset of illness to healthcare use (β = 1.347). However, even with NHIS enrollment, the intermediate (OR = 1.468) and richer groups (OR = 2.149) had higher odds of seeking healthcare compared with the poor. In addition, features of meaningful informal social support including contacts with family and friends, social participation and remittances significantly improved psychological wellbeing and health services utilisation. Somewhat counter-intuitively, spousal cohabitation was associated with decreased health services use (OR = 0.999). Whilst self-rated health revealed a strong positive association with functional status of older persons (fair SRH: β = 1.346; poor SRH: β = 2.422), the relationship differed by gender and also was moderated by marital status for women but not men. The employed and urban residents somewhat surprisingly had lower odds of formal healthcare use. The findings support the hypotheses that interactive impacts of aspects of structural and functional social support and removal of catastrophic healthcare costs are particularly important in older persons’ psychological health and health service utilisation. Nevertheless, Ghana’s NHIS currently apparently lacks the capacity to improve equitable attendance at health facility between poor and non-poor. In contributing to the public health and social policy discourse, this study proposes that, whilst policies to ensure improved health status of older people are recommended, multidimensional social support and NHIS policy should be properly resourced and strengthened so they may act as critical tools for improving health and health services utilization of this marginalized and vulnerable older people in Ghana. Moreover, policies targeting and addressing economic empowerment including universal social pensions and welfare payments should be initiated and maintained to complement the NHIS for older people. The achievement of age-relevant policies and Universal Health Coverage (UCH) as advocated by WHO could be enhanced by adopting some of these suggestions.
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Kenyon, Anna. "The built environment, walking and health inequalities in urban Scotland." Thesis, University of Edinburgh, 2018. http://hdl.handle.net/1842/29551.
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Background: Many adults do not take recommended amounts of physical activity (PA). This is associated with adverse health outcomes such as obesity, overweight, diabetes and heart disease. Moreover, physical inactivity is socially patterned. People with lower socioeconomic status or who live in more deprived areas do less PA which may in turn contribute to inequalities in health outcomes. Identifying the causes and possible pathways for increasing PA and addressing health inequalities is a pressing national and international priority. There is increasing evidence that features of the built environment (BE) can support physical activities such as walking. The built environment may also ameliorate health inequalities by providing a supportive context for walking across diverse sections of the population. However, there is little evidence relating to the UK and Scottish context or about inequalities in these associations for different groups such as people with different demographic characteristics or people living in areas with different levels of deprivation. This study aimed to fill this knowledge gap, examining associations between built environments and walking in urban Scotland. It considered individual and spatial inequalities in these relationships. Methods: This study had a quantitative cross-sectional design. Geographical Information Systems (GIS) was used to create neighbourhood level BE measures of Area Walking Potential (AWP) across urban Scotland. These were destination accessibility, street connectivity, residential density and walkability (a composite measure of the former three measures). An examination of the distribution of AWP across Scotland and in relation to area deprivation was made. The measures were then appended to individual level walking data for adults aged 19+ years from the 2010 Scottish Health Survey. Regression analysis tested for associations between the AWP measures with four different walking outcomes: any walking, frequency of walking, achieving 30 minutes of walking per day and total minutes walked in the previous week. Individual and area level confounders were controlled for. Associations were examined using two sizes of neighbourhood area: 500m and 1000m zones around residential centres. Interactions with individual demographic, socioeconomic, household characteristics and area deprivation were evaluated. Results: There was modest evidence of positive associations between AWP and walking. After controlling for covariates, destination accessibility showed the strongest associations with frequency of walking. There were limited associations for street connectivity and walkability and no associations between residential density and walking. Positive associations remained for some groups less likely to walk, such as older adults. However, there were also interaction effects showing inequalities in associations between AWP and walking. In particular, people with lower educational attainment were less influenced by AWP. The spatial analysis showed areas with lowest deprivation had lowest AWP although people in more deprived areas walked less overall. Conclusions: There is some evidence that the BE supports some types of walking in Scotland. The BE may also enhance walking opportunities for certain groups who generally walk less, and therefore could potentially reduce inequalities in health outcomes. However, the socioeconomic inequalities in outcomes suggest multifaceted approaches to increasing walking are more likely to reach all sections of the population. The evidence that there are geographic inequalities in levels of AWP can be used to inform geographically targeted interventions aimed at improving walking environments. This research has generated original evidence in the Scottish context, highlighting the importance of context specific research.
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Llop, Gironés Alba 1987. "Social determinants of health and the health system of Mozambique : Towards a comprehensive analysis of health inequalities." Doctoral thesis, Universitat Pompeu Fabra, 2018. http://hdl.handle.net/10803/665400.
Full textAbstract:
The present thesis aims to give a critical overview of the health care and health
inequalities for the Mozambican case. The thesis is divided into four articles, two of them
are quantitative articles analysing data from the Mozambican household budget survey,
while the other two articles employ different methodologies: a systematic review and data
source mapping. Findings show that in Mozambique, despite the overall health status has
improved over time, women, children, elders and the population living in rural areas of
the country are left behind in the progress to attain better health. Structural factors are the
major drivers of health inequalities and people’s access to basic services and material
conditions, although crucial, are not the main causes of health inequalities in
Mozambique. Another key finding is that a comprehensive view of the health system
based in primary health care is fundamental for addressing health care inequalities. In
Sub-Saharan Africa, the access to and quality of primary health care is mainly determined
by the social position, rather than by the need, and health care inequalities persist over
time. These results allow drawing conclusions for the improvement of the equity in the
access to quality care in Mozambique. In the country, 70% of Mozambicans use
healthcare services when having a health need, and despite there are no differences in the
direct payments for the public sector visits, significant socio-economic and geographical
inequalities were found for women and men in the access to and quality of care received.
Finally, this thesis highlights the important information gaps that exists in the national
health information system to monitor health equity in MozambiqueAquesta tesi té com a objectiu oferir una visió crítica de les desigualtats sanitàries i de salut per al cas de Moçambic. La tesi es divideix en quatre articles, dos d'ells són articles quantitatius que analitzen dades de l'enquesta sobre el pressupost familiar de Moçambic, mentre que els altres dos articles fan servir diferents metodologies: una revisió sistemàtica i un mapeig de fonts de dades. Els resultats mostren que a Moçambic, malgrat que l'estat general de salut ha millorat amb el temps, les dones, els nens, els ancians i la població que viu a les zones rurals del país es queden enrere en el progrés per aconseguir una millor salut. Els factors estructurals són els principals impulsors de les desigualtats en salut i l'accés als serveis bàsics i les condicions materials, tot i que són crucials, no són les principals causes de les desigualtats en salut a Moçambic. Una altra troballa clau és que una visió integral del sistema de salut basada en l'atenció primària de salut és fonamental per abordar les desigualtats en l'atenció de la salut. A l'Àfrica Subsahariana, l'accés i la qualitat de l'atenció primària de salut es determina principalment per la posició social, més que per la necessitat, i les desigualtats en l'atenció de la salut persisteixen al llarg del temps. Aquests resultats permeten extreure conclusions per a la millora de l'equitat en l'accés a l'atenció de qualitat a Moçambic. Al país, el 70% dels moçambiquesos fan servir els serveis de salut quan tenen una necessitat i, tot i que no hi ha diferències en els pagaments directes per a les visites al sector públic, es van trobar desigualtats socioeconòmiques i geogràfiques significatives per a les dones i els homes en l'accés i la qualitat de l'atenció rebuda. Finalment, aquesta tesi ressalta importants llacunes d'informació que hi ha en el sistema nacional d'informació de salut per a l'avaluació de l'equitat en salut a Moçambic
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Crawford, Natasha. "The social determinants of health : an empirical analysis of ethnic and spatial inequalities in health." Thesis, University of Essex, 2017. http://repository.essex.ac.uk/20449/.
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This thesis consists of three self-contained research articles that empirically examine the ethnic and spatial patterning of health outcomes in England today. Health is defined here as a multidimensional concept encompassing physical and mental health and wellbeing, in line with the Public Health White Paper ‘Healthy Lives, Healthy People’ (HM Government, 2010). Each chapter utilises data from Understanding Society, a nationally representative panel study, which provides detailed information about the social and economic situations of people living in the UK.
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Benova, L. "Bad behaviour or 'poor' behaviour? : mechanisms underlying socio-economic inequalities in maternal and child health-seeking in Egypt." Thesis, London School of Hygiene and Tropical Medicine (University of London), 2015. http://researchonline.lshtm.ac.uk/2212898/.
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Background: Health-seeking behaviour is a key contributor to the widespread and unfair inequalities in health outcomes related to socio-economic position. This thesis compared the levels and determinants of maternal and child health-seeking between a national sample and the rural poor in Egypt, and examined whether existing inequalities could be explained by socio-cultural characteristics or ability to afford care. Methods: This quantitative analysis relied on two datasets: the Egypt Demographic and Health Survey from 2008 and a 2010/11 survey of households below the poverty line in rural Upper Egypt. Latent variables capturing several dimensions of socio-economic position were constructed and used in multivariable regression models to predict several dimensions of maternal (antenatal and delivery care) and child (diarrhoea and acute respiratory infection) health-seeking. Results: Latent constructs capturing socio-cultural and economic resources were identified in both datasets. Two further dimensions of socio-economic position in the Upper Egypt sample included dwelling quality and woman’s status. DHS analysis showed that sociocultural and economic capital were independently positively associated with seeking antenatal and delivery care among women, and with seeking timely and private child illness treatment. Free-of-charge public maternal care was not effectively targeted to poorest women. Poor households in Upper Egypt showed lower maternal healthseeking levels than nationally; both socio-cultural and economic resourcefulness positively predicted maternal health-seeking, dwelling quality was positively associated with private provider use, while women’s status was not associated with any dimension of maternal health-seeking behaviour. Conclusion: A better understanding of perceived and objective quality of care in both public and private sectors is required to reduce existing inequalities in the coverage of essential maternal and child health interventions. Improvement in free public care targeting is required to prevent catastrophically high expenditures for basic care among poor households.
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Asogwa, Celestine Emeka. "Poverty and sickness: The correlation of social inequalities and poor health." Thesis, Boston College, 2015. http://hdl.handle.net/2345/bc-ir:105002.
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Lajtai, Laszlo. "Multilingualism, social inequalities, and mental health : an anthropological study in Mauritius." Thesis, University of Edinburgh, 2015. http://hdl.handle.net/1842/14189.
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This thesis analyses two different features of Mauritian society in relation to multilingualism. The first is how multilingualism appears in everyday Mauritian life. The second is how it influences mental health provision in this country. The sociolinguistics of Mauritius has drawn the attention of many linguists in the past (Baker 1972; Stein 1982; Rajah- Carrim 2004; Biltoo 2004; Atchia-Emmerich 2005; Thomson 2008), but linguists tend to have quite different views on Mauritian languages than many Mauritians themselves. Language shifts and diverse language games in the Wittgensteinian sense are commonplace in Mauritius, and have been in the focus of linguistic and anthropological interest (Rajah-Carrim 2004 and Eisenlohr 2007), but this is the first research so far about the situation in the clinical arena. Sociolinguistic studies tend to revolve only around a few other domains of language; in particular, there is great attention on proper language use – or the lack of it – in education, which diverts attention away from equally important domains of social life. Little has been published and is known about mental health, the state of psychology and psychiatry in Mauritius and its relationship with language use. This work demonstrates that mental health can provide a new viewpoint to understand complex social processes in Mauritius. People dealing with mental health problems come across certain, dedicated social institutions that reflect, represent and form an important part of the wider society. This encounter is to a great extent verbal; therefore, the use of language or languages here can serve as an object of observation for the researcher. The agency of the social actors in question – patients, relatives and staff members in selected settings – manifests largely in speaking, including sometimes a choice of available languages and language variations. This choice is influenced by the pragmatism of the ‘problem’ that brings the patient to those institutions but also simultaneously determined by the dynamic complexity of sociohistorical and economic circumstances. It is surprising for many policy makers and theorists that social suffering has not lessened in recent decades in spite of global technological advancements and increased democracy. This thesis demonstrates through ethnographic examples that existing provisions (particularly in biomedicine) that have been created to attend to problems of mental health may operate contrary to the principle of help. In the case of Mauritius, this distress is significantly due to postcolonial inequities and elite rivalries that are in significant measure associated with the use of postcolonial languages. Biomedical institutions and particularly the encounters among social actors in biomedical institutions, which are not isolated or independent from the prevailing social context, can contribute to the reproduction of social suffering.
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Carlisle, Sandra. "Tackling health inequalities in a social inclusion partnership : a case study." Thesis, University of Edinburgh, 2002. http://hdl.handle.net/1842/23288.
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Morrison, Esteve Joana 1977. "Policies, health plans and interventions to adress social inequalities in health in Europe: a qualitativ perspective." Doctoral thesis, Universitat Pompeu Fabra, 2015. http://hdl.handle.net/10803/298725.
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Las ciudades están densamente pobladas y ofrecen una diversidad cultural, religiosa, étnica, y de costumbres. Suele estar dividida por demarcaciones socioeconómicas. Las desigualdades en el desarrollo infantil temprano son de gran preocupación. El objetivo de esta disertación es describir políticas, planes de salud e intervenciones para abordar las desigualdades sociales en salud y desarrollo temprano infantil en países europeos durante 2010-2013. La tesis se llevó a cabo utilizando métodos de investigación cualitativa y una revisión sistemática. Los resultados sugieren la importancia de poner más esfuerzos en proveer a los responsables de políticas con información necesaria de salud y sus determinantes sociales. Es necesario asegurar que los objetivos de las desigualdades en salud sean incluidos en la agenda política. Estos deberían tener en cuenta la naturaleza multidisciplinaria y multisectorial de reducir las desigualdades en salud. Proveer el acceso a un abanico amplio de servicios universalmente proporcionales durante la edad temprana de calidad, es importante.Cities are densely populated and offer a diversity of cultural backgrounds, religions, ethnicity and customs, frequently divided by socio-economic demarcations. Inequalities in early child development within cities are of great concern. The objective of this dissertation is to describe policies, health plans and interventions to address social inequalities in health and early child development in European countries during 2010-2013. This thesis was carried out using qualitative research methods and a systematic review. Findings suggest the importance of placing more effort on providing policymakers with available information on health and its social determinants. It is necessary to ensure that health inequality aims are included in the political agenda. These should take into account the multidisciplinary and multisectoral nature of tackling health inequalities. Providing access to a comprehensive range of quality universally proportionate services during children’s early years is important
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Krokstad, Steinar. "Socioeconomic inequalities in health and disability. : Social epidemiology in the Nord-Trøndelag health study (HUNT), Norway." Doctoral thesis, Norwegian University of Science and Technology, Faculty of Medicine, 2004. http://urn.kb.se/resolve?urn=urn:nbn:no:ntnu:diva-325.
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Socioeconomic inequalities in health and disability are found in all countries where social gradients have been studied. Despite rapid economic growth and expanding health care systems, aiming at providing services to people according to need rather than according to wealth, persistent and even widening health inequalities are found in Europe after the second World War.
In this research project we wanted to establish a method for measuring socioeconomic status based on occupational groups and education in the HUNT Study, thereby providing tools for research in social medicine. A social gradient scale based on the occupational grouping from the HUNT study questionnaires had not been established. When this study was planned however, educational level, which might serve as a proxy for socioeconomic status, had been monitored in both HUNT I and HUNT II.
Disability pension has been a central element in social security legislation in Norway, established as a universal right for all citizens in 1967. This public income-maintenance program protects workers in case of disability, and comprises both universal and earningrelated programs. The main eligibility criterion has been permanent impaired earning ability by at least 50 % for reasons of illness or disease, injury or disability. Despite objective health improvement in the population the last decades, incidence of disability pension has increased.
In epidemiology, socioeconomic status is not only an important variable in itself. It is also a confounder that should be taken into consideration in discussing almost all causal relationships. Thus, in population based health studies, measures of socio-economic status are essential. Occupation, education and income together determine the socioeconomic status of a person. However, these factors are sufficiently distinct to require that they should also be studied separately in relation to health. To study them separately is often preferable since this can suggest hypotheses on causal relationships between exposure and disease.
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Espinel, Flores Verónica 1979. "Socioeconomic inequalities in teenage motherhood in Ecuador : #NiñasNoMadres." Doctoral thesis, Universitat Pompeu Fabra, 2020. http://hdl.handle.net/10803/668760.
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This PhD dissertation analyses the socioeconomic inequalities in teenage motherhood considering its influencing factors and social determinants. This doctoral thesis is structured in four research papers. In paper I, we analysed how factors related to the first heterosexual experience and sexual education are associated to socioeconomic inequalities in teenage motherhood. We observed that the most important factors influencing the relationship between higher socioeconomic status and teenage motherhood were those related to the first experience of heterosexual intercourse. Paper II analysed the trends in socioeconomic inequalities in teenage motherhood and in the factors related to the first heterosexual intercourse. This study revealed that - in the past 14 years - there has been no changes in the disadvantageous socioeconomic conditions of teenage mothers and in the adverse characteristics of the first experience of heterosexual intercourse in Ecuador. Paper III described the construction of a deprivation index for the study of geographical inequalities in health in Ecuador. This ecological study showed a geographical pattern in which cantons inhabited by historically oppressed ethnic groups have the highest deprivation scores. Paper IV analysed geographical and social inequalities in adolescent birth rates (ABR) in Ecuador. This study showed a geographical pattern of high ABR in cantons from the Coastal and Amazonic region. Furthermore, a strong association was observed between high ABR and cantons with high deprivation, ethnic historical oppression and gender inequality.Esta tesis doctoral analiza las desigualdades socioeconómicas en la maternidad adolescente en Ecuador teniendo en cuenta los factores psicosociales y determinantes sociales que la influyen. Esta tesis se estructura en cuatro trabajos de investigación. En el artículo I, se analiza la influencia de los factores relacionados con la primera experiencia de relaciones heterosexuales y la educación sexual en las desigualdades socioeconómicas en la maternidad adolescente. A partir de este análisis observamos que los factores más importantes que influyen en la relación entre el estatus socioeconómico y la maternidad adolescente fueron los relacionados con la primera experiencia de relaciones sexuales heterosexuales. En el artículo II se analizan las tendencias de las desigualdades socioeconómicas en la maternidad adolescente y los factores relacionados con las primeras relaciones heterosexuales. Este estudio reveló que en los últimos 14 años no ha habido cambios en Ecuador en las condiciones socioeconómicas desventajosas de las madres adolescentes y en las características adversas de la primera experiencia de relaciones sexuales heterosexuales. En el documento III se describe la construcción de un índice de privación para el estudio de las desigualdades geográficas en salud en el Ecuador. Este estudio mostró un patrón geográfico de privación en los cantones habitados por grupos étnicos históricamente oprimidos. En el documento IV se analizan las desigualdades geográficas y sociales en la tasa de fertilidad adolescente (TFA) en Ecuador. Este estudio mostró un patrón geográfico de altas TFA en los cantones de la región costera y amazónica. Además, se observó una fuerte asociación entre la privación, la histórica opresión étnica y la desigualdad de género y la elevada TFA en cantones del país.
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Hong, Jihyung. "Socio-economic inequalities in mental health and their determinants in South Korea." Thesis, London School of Economics and Political Science (University of London), 2012. http://etheses.lse.ac.uk/494/.
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Suicide rates in South Korea (hereafter ‘Korea’) have seen a sharp upward trend over the past decade, and now stand amongst the highest in OECD countries. This raises urgent policy concerns about population mental health and its socioeconomic determinants, an area that is still poorly understood in Korea. This thesis sets out to investigate socio-economic inequalities in the domain of mental health, particularly for depression and suicidal behaviour, in contemporary Korea. The thesis first evaluates the extent of income-related inequality in the prevalence of depression, suicidal ideation and suicide attempts in Korea and tracks their changes over a 10-year period (1998-2007) in the aftermath of the 1997/98 economic crisis. Based on four waves of the Korea National Health and Nutrition Examination Survey (KHANES) data, concentration indices reveal a growing trend of pro-rich inequalities in all three outcomes over this period. To understand the potential impact of the observed widening income inequality, the next empirical investigation examines whether income inequality has a detrimental effect on mental health that is independent of a person’s absolute level of income. Due to the paucity of time series data, the analysis focuses on an association between regional-level income inequality and mental health, using the 2005 KHANES data. The results provide little evidence to support the link between the two at regional level. The thesis pays special attention to suicide mortality rates given their disconcerting trend in contemporary Korea. Using mortality data for 2004-2006, the third empirical investigation first elucidates the spatial patterns of suicide rates, highlighting substantial geographical variations across 250 districts. The results of a spatial lag model suggest that area deprivation has an important role in shaping the geographical distribution of suicide, particularly for men. The final empirical investigation sets out to understand the suicide trend in Korea in the context of other Asian countries (Hong Kong, Japan, Singapore, and Taiwan), using both panel data and country-specific time-series analyses (1980-2009). Despite similarities in geography and culture, the suicide phenomenon is unique to Korea, particularly for the elderly. The overall findings suggest that low levels of social integration and economic adversity may in part explain the atypical suicide trend in Korea.
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Parkinson, Clive. "Social justice, inequalities, the arts and public health : weapons of mass happiness?" Thesis, Manchester Metropolitan University, 2018. http://e-space.mmu.ac.uk/621436/.
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This thesis draws together nine publications spanning the period between 2007 and 2018. They have been selected to reflect a specific aspect of my research trajectory, its contribution to the field of arts and health, and its future direction, demonstrating its application to international policy and practice, whilst placing it within a space that is critical of its own community of interest. The research is informed by the cultural and political landscape of ‘austerity’ in the UK. It questions the dominance of neoliberal policies and culture and how these influence the arts and health field, and positions itself outside the bio-medical discourse. Whilst questioning notions of ‘gold standards’ in research and evaluation, the argument made, is for an arts-led field in the pursuit of social justice and health equity, rather than one understood through the language of pathology and sickness. Through an artist led perspective, this thesis amplifies and builds on the thinking of those concerned with inequalities, (Marmot, 2010; Wilkinson and Pickett, 2009/2011) drawing on the work of contemporary theorists and academics across allied disciplines, taking into account the current policy context for arts and health in the UK. It suggests that whilst there is evidence (Gordon-Nesbitt, 2015) that the arts might mitigate against some of the factors that influence health and wellbeing, by being framed and understood in predominantly bio-medical ways, the arts are at risk of becoming a reductivist cost-effective tool, rather than a liberating force for social change.
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Schooling, Catherine Mary. "Health behaviour in a social and temporal context." Thesis, University College London (University of London), 2001. http://discovery.ucl.ac.uk/1350107/.
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Smoking, alcohol consumption, diet and exercise are sources of risk for many chronic diseases and the need to change unhealthy behaviours is now a key aspect of health promotion policies. Interventions to change adult behaviours have been unsuccessful despite, or perhaps because of, rather dramatic secular changes. Health behaviour is usually understood in terms of three different motivating forces for action, which can be categorised as individual utility, social structure and agency (i.e. engagement in a specific social and temporal context). The first two of these have been relatively well studied. The role of individual utility has been explored using a variety of expectancy-value models that relate individual psychological attributes (attitudes, beliefs and suchlike) to health behaviour. The role of social structure has been explored by studying how behaviour varies with economic circumstances (such as income or tenure) and social relationships (such as family and neighbourhood). Less well studied has been the role of agency. This thesis develops Giddens's concept of self-identity and Simmel's ideas on fashion, to provide an operationalisation of agency. The concept of image is used to link the individual's presentation of self and the appearance of an activity, in terms of underlying attributes such as conformity, gender-identity, sociability and asceticism. Considerations of image provide a potential explanation as to why some people might be more attracted to one activity than another. The concept of status seeking is used to explore why some people are motivated to follow new trends more quickly than others. This operationalisation of the role of agency in health behaviour is tested by exploring the relationship between all these potential motivating forces (individual utility, social structure and agency) and the initiation of and change in 4 specific health behaviours (smoking, drinking, diet and exercise), using data from the 1946 national birth cohort. The 1946 cohort provides a unique opportunity to explore these relationships because it provides the historical specificity necessary to delineate the changing public image of these health behaviours. It covers a period (1946-1989) during which advice about and the public image of the 4 health behaviours changed considerably, and it has data on the cohort's health habits and self images. Results indicate that people's views of themselves in relation to public images do indeed relate to these 4 health behaviours along with the other motivating forces. Understanding how all these motivating forces operate offers the possibility of predicting future behaviour and designing strategies to promote healthy choices.
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Högberg, Björn. "Ageing, health inequalities and welfare state regimes – a multilevel analysis." Thesis, Umeå universitet, Sociologiska institutionen, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-100401.
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The paper studies class inequalities in health over the ageing process in a comparative perspective. It investigates if health inequalities among the elderly vary between European welfare state regimes, and if this variation is age-dependent. Previous comparative research on health inequalities have largely failed to take age and ageing into account, and have not investigated whether cross-country variation in health inequalities might differ for different age categories. Since the elderly belong to the demographic category most dependent on welfare policies, an ageing perspective is warranted. The study combines fives data rounds (2002 to 2010) from the European Social Survey. Multilevel techniques are used, and the analysis is stratified by age, comparing the 50-64 year olds with those aged 65-80 years. Health is measured by self-assessed general health and disability status. Two results stand out. First, class differences in health are strongly reduced or vanish completely for the 65-80 year olds in the Social democratic welfare states, while they remain stable or are in some cases even intensified in almost all other welfare states. Second, the cross-country variation in health inequalities is much larger for the oldest (aged 65-80 years) than is the case for the 50-64 year olds. It is concluded that welfare policies seem to influence the magnitude of health inequalities, and that the importance of welfare state context is greater for the elderly, who are more fragile and more reliant on welfare policies such as public pensions and elderly care.
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Córdoba, Doña Juan Antonio. "Withstanding austerity : economic crisis and health inequalities in Spain." Doctoral thesis, Umeå universitet, Epidemiologi och global hälsa, 2017. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-130950.
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Background: Along with the austerity measures introduced in many countries, the economic crisis affecting Europe since 2008 seems to have impacted many aspects of the health of the Spanish population and has had a negative effect on the provision health services. An increasing body of knowledge has shown a clear impact of the current crisis on suicidal behaviour and mental health, and a less consistent effect on physical health and access to healthcare. However, little is known about the impact of the crisis on social inequalities in health and healthcare access, an area on which the present study seeks to shed light in the context of Spain, and specifically Andalusia, a region hit very hard by the crisis. Objective: To study the impact of the economic crisis starting in 2008 on health, health inequalities and health service utilisation in Spain and Andalusia and the roles of socio-demographic factors in these associations. Methods: Death rates were analysed to study the annual percent change in overall and cause-specific mortality in Spain between 1999 and 2011, and the Longitudinal Database of the Andalusian Population was used to study educational inequalities in overall mortality from 2002 to 2010 (study 1). To calculate suicide attempt rates, information from 2003 to 2012 on 11,494 men and 12,886 women provided by the Health Emergencies Public Enterprise Information System in Andalusia was utilised. The association between unemployment and suicide attempts was studied through linear regression models (study 2). Two waves of the Andalusian Health Survey (2007 and 2011–12) provided data for the third and fourth studies of this thesis. Educational and employment status inequalities in poor mental health in relation with the crisis were analysed through Poisson regression models (study 3). The change in inequalities (pre-crisis–crisis) in health care utilisation outcomes (general practitioner, specialist, hospitalisation and emergency attendance) was measured by the change in horizontal inequality indices. A decomposition analysis of change in inequality between periods was performed using the Oaxaca approach (study 4). Results: Study 1: Overall mortality in Spain decreased steadily during the period, with annual percent changes of -2.44% in men and -2.20% in women. An increase in educational inequality in mortality was observed in men in Andalusia. In women, the inequalities instead remained stable. Suicide mortality showed a downward trend in both sexes in Spain. Study 2: A sharp increase in suicide attempts in Andalusia was detected after the onset of the crisis in both sexes, with adults aged 35 to 54 years being the most affected. Suicide attempts were associated with unemployment rates only in men. Study 3: Poor mental health increased in working individuals with secondary and primary studies during the crisis compared to the pre-crisis period, while it decreased in the university study group. However, in unemployed individuals poor mental health increased only in the secondary studies group. Financial strain could partly explain the crisis effect on mental health among the unemployed. Study 4: Horizontal inequality in utilisation changed to a greater equality or a more pro-poor inequality in both sexes. In the decomposition analysis, socioeconomic position and health status showed greater contributions to the changes in inequalities. Conclusion: This thesis illustrates the complexity of the influences of the current economic crisis on health inequalities in a Southern European region. Specifically, no noticeable effects of the crisis on overall and suicide mortality were detected; instead, increasing educational inequalities in mortality in men and a large increase in suicide attempts in middle aged men and women were observed. The deterioration in poor mental health was mainly detected in those of intermediate educational level. Economic conditions such as unemployment and financial strain proved to be relevant. Finally, in the light of no increased inequalities in healthcare utilisation, the universal coverage health system seems to buffer the deleterious effect of the crisis and austerity policies in this context.
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Kniess, Johannes. "Justice in health : social and global." Thesis, University of Oxford, 2017. https://ora.ox.ac.uk/objects/uuid:c1b36ded-85da-4888-91ce-83c164252f93.
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Within and across all societies, some people live longer and healthier lives than others. Although many of us intuitively think of health as a very important good, general theories of justice have hitherto paid little attention to its distribution. This is a thesis about what we owe to one another, as a matter of justice, in view of our unequal levels of health. The first part of the thesis addresses the problem of social justice in health. I argue that the basic institutional framework of society must be arranged so as to ensure an egalitarian distribution of the 'social bases of health,' that is, the socioeconomic conditions that shape our opportunities for a healthy life. Inequalities in health, including those caused by differences in individual lifestyles, are only fair when people have been given fair opportunities. This egalitarian approach to the social bases of health must be complemented by a sufficientarian concern for meeting all basic health needs, regardless of whether these originate in unfair social arrangements. The second part of the thesis takes up the problem of global justice in health. Although I argue against the idea that domestic principles of justice can be simply replicated on a global scale, I emphasise the fact that there are a number of international institutions and practices that shape people's opportunities for health. One of these is the state system - the division of the world into sovereign states - which I argue grounds the idea of the human right to health. I also examine two more specific examples of global practices that contribute to global inequalities in health, namely global trade in tobacco and the global labour market for healthcare workers. Both of these, I suggest, must be restricted in light of their impact on health levels worldwide.
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Powell, Katie. "A sociological analysis of an area-based health initiative : a vehicle for social change?" Thesis, University of Chester, 2012. http://hdl.handle.net/10034/620351.
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This thesis explores the implementation of an area-based health improvement initiative in the north west of England called Target Wellbeing. In the decades before Target Wellbeing was commissioned in 2007, health inequalities between people living in different areas of the UK had been widening. ABIs were identified by the Labour Government as a key tool for improving the health and wellbeing of residents in areas of socio-economic disadvantage and addressing inequalities in health. ABIs such as this have been well evaluated but there remains no firm evidence about the ability of such initiatives to improve health or to reduce health inequalities. In addition to the problems associated with evaluation, the processes through which ABIs might be used to influence change are not well understood and the value of using area-based services to improve health has been taken for granted. There is little understanding about the processes through which service provider partnerships might develop and limited knowledge about the processes through which residents might develop relations with providers. The key aim of this research was to examine the social processes through which ABIs develop over time. Using a case study approach, the research examined one Target Wellbeing programme as a social figuration of interdependent people. Ethnographic methods, including documentary analysis, non-participant observation and interviews, were used to explore the processes and networks that mediated the planned public health development. The study also drew on relevant quantitative data to describe changes over time. Ideas from figurational sociology were used as sensitising concepts in the development of a substantive theory about the processes through which ABIs develop. The study developed theoretical insight into processes of joint working that helps to explain why, in the context in which services are commissioned and performance managed, provider co-ordination is unlikely to be implemented as planned. It also provided a more sociologically adequate account of the ways in which relations between residents and providers were influenced by the history of relations in the town. Changes to residents’ relations with other residents and providers in the town influenced a greater sense of control over their circumstances. These findings demonstrate that, in relation to public health policy and practice, ABIs might more usefully be conceptualised as a series of interrelated processes that might be used to establish the preconditions for influencing change among residents. However, the study showed that interventions targeted at a small part of much wider networks of interconnected people are unlikely to influence sustained changes for residents in deprived areas.
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Carney, Caroline. "Social patterning in biomarkers of health : an analysis of health inequalities using 'Understanding Society: the UK Household Longitudinal Study'." Thesis, University of Essex, 2017. http://repository.essex.ac.uk/20623/.
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Health inequalities are known to be prevalent in Britain. Though testing hypothesised pathways between socio-economic position and biological markers of health, this thesis aims to improve understanding of how socio-economic inequality becomes health inequality and how physiology is affected by socio-economic position. Using Understanding Society data, access is gained to a range of biomarkers collected cross-sectionally from an adult age range. Methods such as regressions, decompositions and mixed-models are used to identify mediators of SEP’s association with grip strength, self-reported type two diabetes, glycated haemoglobin and lung function. The mediators explored are material deprivation and exposures, psychosocial stress and health behaviours. Using retrospective socio-economic position measures, consideration is paid to the timing of disadvantage, while the wide age range enables identification of when inequalities emerge. Disadvantaged socio-economic position in childhood and adulthood were negatively associated with grip strength, though the gradient does not emerge until mid-adulthood. Health behaviours only slightly mediated this association and childhood socio-economic position continued to be important in adulthood. Support was found for mediation of socio-economic position’s association with self-reported type two diabetes, but not with glycated haemoglobin. The mediation was mainly via obesity with no significant mediation through material deprivation, psychosocial stress or health behaviours. Inequalities in lung function were observable at all adult ages and appeared to worsen with increasing age. Material exposures and health behaviours mediated this. Childhood socio-economic position was important in adulthood and moderated the effect of some exposures and health behaviours. This thesis finds that early disadvantage can have lasting effects. The lack of support for mediation in some outcomes suggests the need to address social inequalities directly, while the identification of mediating mechanisms in other outcomes indicates ways to alleviate these processes.
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Hedegaard, Joel. "The production and maintenance of inequalities in health care : A communicative perspective." Doctoral thesis, Högskolan för lärande och kommunikation, Högskolan i Jönköping, HLK, Livslångt lärande/Encell, 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:hj:diva-24380.
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The Swedish health care system does not offer care on equal terms for all its end-users. Discrimination toward patients can take the form substandard communication toward women or foreign born patients. Discrimination is also embedded in the organizational context. Health care is under pressure to increase efficiency and quality of care at the same time. There is a risk that demands for equality will be pushed aside. This thesis aims to contribute to our understanding of how discrimination is expressed in interpersonal- and organizational communication within health care, and highlight educational implications for health care practices. This thesis is comprised of three empirical studies and one conceptual study. In the first study, critical discourse analysis (CDA) is used to categorize gender patterns in communication between health care workers and patients, and finds that both patients and health care workers reproduced the gender order. Open questions created a setting less prone to be limited by gender stereotypes. In the second study, CDA is used and complemented with Linell’s dialogic perspective in order to explore whether patients who were native speakers of Swedish were constructed differently than those who were not, in patient-physician consultations. Findings indicated that the non-native speakers actually were model, participative patients according to patient-centered care. Notwithstanding this they were met by argumentation, whereas the more amenable native patients were met by accommodating responses. In the third study, qualitative content analysis is used to analyze how health care workers talked about patients in their absence. The results revealed that communication about patients who were perceived as not acting according to socially accepted gender norms contained negative and disparaging statements. The final study focused on Clinical Microsystems, a New Public Management-based model for multi-professional collaboration and improvement of health care delivery. Drawing on theories of New Public Management, gender, and organizational control, this study argues that the construction of innovative and flexible health care workers risks reproducing the gender order. The thesis concludes that gender and ethnic stereotypes are reproduced in health care communication, and that an efficiency-inspired organizational and institutional discourse may be an impediment to equal care. This calls for focus on learning about communication for prospective and existing health care workers in a multicultural health care context.
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Diaz, Martinez Elisa. "Does social class explain health inequalities? : a study of Great Britain and Spain." Thesis, University of Oxford, 2004. http://ora.ox.ac.uk/objects/uuid:ca53a88e-0459-47d0-b13a-2525745d0d6a.
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The main research questions examined in this thesis concern the extent to which social class influence individuals' health, and how and whether individuals' occupation, education and lifestyles mediate between class and health. The conclusions drawn from the analysis of these empirical questions cast further light on the widening health inequalities seen in developed societies in recent decades. In particular, this research suggests that, employment conditions as well as educational levels are variables that need to be taken into account when planning policies aimed at tackling differences in health outcomes. Lifestyle variables, on the other hand, would appear to be almost irrelevant when explaining why the members of the more privileged social classes not only live longer than those in other classes, but also enjoy significantly better health over the course of their lives. In trying to understand the association between class and health, I define a theoretical framework that specifies the mechanisms through which class is linked to health. Social structure influences health by distributing certain factors such as material resources or some health-related behaviour that ultimately result in individuals having different living conditions. Educational attainment also affects the way these resources are employed and, therefore, lifestyles. A fundamental element of a social class is occupation: individuals' employment and working conditions also affect their health. Furthermore, the nature of a social structure has an effect on health at the aggregate level of analysis since social policies are partly the result of the structure of class interests. Four mechanisms are specified in order to systematically test this theoretical framework. Mechanisms (2) and (3), those that relate class and health through education and lifestyle lie at the heart of the empirical analysis. This analysis employs individual-level data drawn from health surveys carried out during the first half of the 1990s in the two countries selected for the analysis, United Kingdom and Spain. These countries are treated as contexts in which to test the theoretical explanation. The main results of the analysis reveal the importance of social class in determining health outcomes. Indeed, individuals from different classes enjoy distinct degrees of health. Specifically, individuals in the most privileged class categories have persistently better health than those in the other class categories. Differences exist in terms of both objective and subjective or self-perceived health. Moving on from observation to explanation, the analysis suggests that the distribution of certain resources across classes accounts for some of the variance in health outcomes. Hence, education is identified as a significant variable to comprehend part of the health inequalities in developed societies. Lifestyle, on the other hand, does not appear relevant in accounting for health outcomes. The small differences found between the United Kingdom and Spain in the mechanisms that link class and health suggest that the process through which class affects health is essentially similar in developed societies.
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Davis, Owen. "Exploring the links between cash benefits policies and social inequalities in mental health." Thesis, University of Kent, 2018. https://kar.kent.ac.uk/67121/.
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This thesis examines the impact of policies which provide cash support for unemployed and workless persons on social inequalities in mental health. It contributes to a body of literature which has tended to assume that more generous cash benefits will reduce health gaps between advantaged and less advantaged groups. It notes that while there is some empirical support for this proposition, the evidence remains inconclusive. The thesis addresses this research problem by examining how cash benefits influence health inequalities. It defines three cash benefits 'design features' - generosity, activation and conditionality - and explores empirical connections with health inequalities through specific 'causal pathways'. Chapter Four focuses on one causal pathway - the influence of cash benefits via social stress. Operationalising cash benefits policies in terms of 'welfare regimes', it explores evidence from the Survey of Health, Ageing and Retirement in Europe for a relationship between welfare regimes and inequalities in depressive symptoms. It finds evidence that the Scandinavian regime has the least inequalities in depressive symptoms, suggesting that cash benefits generosity remains an important buffer for stress among disadvantaged groups. Chapter Five uses two more precise measures of cash benefits policies: passive and active labour market spending. Combining expenditure data from the OECD with individual-level data from the European Social Survey it uses regression and mediation analyses to explore a range of causal pathways from these policies to health inequalities. It finds some evidence that active labour market policies reduce inequalities in depressive symptoms by improving employment outcomes, while generous cash benefits may improve mental health during unemployment. Chapter Six develops the approach yet further, by looking at conditionality requirements attached to receipt of benefits as well as generosity and activation. Focusing on sanctions and work requirements linked with receipt of Temporary Assistance for Needy Families policies in the United States, it looks at how variations across states in conditionality practices matter for health inequalities. There are indications that stringent conditionality may increase inequalities in mental health, although it is unclear why this is.
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Lin, Shih-Chi. "Socioeconomic Inequalities in Health under Marketization and Community Context: Evidence from China." Thesis, University of Oregon, 2017. http://hdl.handle.net/1794/22737.
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This dissertation examines China’s market reforms over the last few decades, and their implications for (re)shaping socioeconomic inequalities in health. Specifically, I study the effect of marketization and related structural changes at community level on individual health outcomes. The first part of this dissertation revisits the market transition theory of Nee (1989), using individual health status as the outcome variable to assess Nee’s theory. Using multiple waves of a longitudinal survey from 1991 to 2006, I compare temporal changes in the role of human capital, political capital, and state policy in determining health under marketization. In partial support of the market transition theory, the empirical results show that the significance of human capital for health increases with marketization, while the return to political capital and one’s household registration status diminishes with a growing market. Additionally, I distinguish between marketization effects on community level, and different aspects of community context in shaping the SES-health link. I find that the level of urbanization and available resources within each community exert influences on self-rated health and change the relative importance of individual socioeconomic conditions in shaping health. Overall, this study provides new longitudinal evidence from China to support the notion that health is influenced by dynamic processes moderated by the structural changes as well as the social stratification system. I discuss the findings in the context of China’s market reform, fundamental causes theory, and socio-ecological perspectives, highlighting that health is determined by a nexus of life experiences and social environment that impact individuals at different levels.10000-01-01
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Kamal, Noreen. "Designing online social networks to motivate health behaviour change." Thesis, University of British Columbia, 2013. http://hdl.handle.net/2429/45242.
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Eating nutritious foods and being more physically active prevents significant illnesses such as cardiac disease, stroke, and diabetes. However, leading a healthy lifestyle remains elusive and obesity continues to increase in North America. We investigate how online social networks (OSN) can change health behaviour by blending theories from health behaviour and participation in OSNs, which allow us to design and evaluate an OSN through a user-centred design (UCD) process.
We begin this research by reviewing existing theoretical models to obtain the determining factors for participation in OSNs and changing personal health behaviour. Through this review, we develop a conceptual framework, Appeal Belonging Commitment (ABC) Framework, which provides individual determinants (Appeal), social determinants (Belonging), and temporal consideration (Commitment) for participation in OSNs for health behaviour change.
The ABC Framework is used in a UCD process to develop an OSN called VivoSpace. The framework is then utilized to evaluate each design to determine if VivoSpace is able to change the determinants for health behaviour change. The UCD process begins with an initial user inquiry using questionnaires to validate the determinants from the framework (n=104). These results are used to develop a paper prototype of VivoSpace, which is evaluated through interviews (N=11). These results are used to design a medium fidelity prototype for VivoSpace, which is tested in a laboratory through both direct and indirect methods (n=36).
The final iteration of VivoSpace is a high fidelity prototype, which is evaluated in a field experiment with clinical and non-clinical participants from Canada and USA (n=32). The results reveal positive changes for the participants associated with a clinic in self-efficacy for eating healthy food and leading an active lifestyle, attitudes towards healthy behaviour, and in the stages of change for health behaviour. These results are further validated by evaluating changes in health behaviour, which reveal a positive change for the clinical group in physical activity and an increase in patient activation. The evaluation of the high fidelity prototype allow for a final iteration of the ABC Framework, and the development of design principles for an OSN for positive health behaviour change.
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Hoffman, Steven Justin. "Evaluating Strategies for Achieving Global Collective Action on Transnational Health Threats and Social Inequalities." Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:23845489.
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This dissertation presents three studies that evaluate different strategies for addressing transnational health threats and social inequalities that depend upon or would benefit from global collective action. Each draws upon different academic disciplines, methods and epistemological traditions.
Chapter 1 assesses the role of international law in addressing global health challenges, specifically examining when, how and why global health treaties may be helpful. Evidence from 90 quantitative impact evaluations of past treaties was synthesized to uncover what impact can be expected from global health treaties, and based on these results, an analytic framework was developed to help determine when proposals for new global health treaties have reasonable prospects for yielding net positive effects. Findings from the evidence synthesis suggest that treaties consistently succeed in shaping economic matters and consistently fail in achieving social progress. There are three differences between these domains which point to design characteristics that new global health treaties can incorporate to achieve positive impact: 1) incentives for those with power to act upon them; 2) institutions designed to bring edicts into effect; and 3) interests advocating for their negotiation, adoption, ratification and domestic implementation. The chapter concludes by presenting an analytic framework and four criteria for determining which proposals for new global health treaties should be pursued. First, there must be a significant transnational dimension to the problem being addressed. Second, the goals should justify the coercive nature of treaties. Third, proposed global health treaties should have a reasonable chance of achieving benefits. Fourth, treaties should be the best commitment mechanism among the many competing alternatives. Applying this analytic framework to nine recent calls for new global health treaties reveals that none fully meet the four criteria. This finding suggests that efforts aiming to better utilize or revise existing international instruments may be more productive than advocating for new treaties. The one exception is the additional transnational health threat of antimicrobial resistance, which probably meets all four criteria.
Chapter 2 builds on this work by evaluating a broad range of opportunities for working towards global collective action on antimicrobial resistance. Access to antimicrobials and the sustainability of their effectiveness are undermined by deep-seated failures in both global governance and global markets. These failures can be conceptualized as political economy challenges unique to each antimicrobial policy goal, including global commons dilemmas, negative externalities, unrealized positive externalities, coordination issues and free-rider problems. Many actors, instruments and initiatives that form part of the global antimicrobial regime are addressing these challenges, yet they are insufficiently coordinated, compliant, led or financed. Taking an evidence-based approach to global strategy reveals at least ten options for promoting collective action on antimicrobial access, conservation and innovation, including those that involve building institutions, crafting incentives and mobilizing interests. While no single option is individually sufficient to tackle all political economy challenges facing the global antimicrobial regime, the most promising options seem to be monitored milestones (institution), an inter-agency task force (institution), a global pooled fund (incentive) and a special representative (interest mobilizer), perhaps with an international antimicrobial treaty driving forward their implementation. Whichever are chosen, this chapter argues that their real-world impact will depend on strong accountability relationships and robust accountability mechanisms that facilitate transparency, oversight, complaint, and enforcement. Such relationships and mechanisms, if designed properly, can promote compliance and help bring about the changes that the negotiators of any new international agreement on antimicrobial resistance will likely be aspiring to achieve. Progress should be possible if only we find the right mix of options matched with the right forum and accountability mechanisms, and if we make this grand bargain politically possible by ensuring it simultaneously addresses all three imperatives for antimicrobials – namely access, conservation and innovation.
Chapter 3 takes this dissertation beyond traditional Westphalian notions of collective action by exploring whether new disruptive technologies like cheap supercomputers, open-access statistical software, and canned packages for machine learning can theoretically provide the same global regulatory effects on health matters as state-negotiated international agreements. This kind of “techno-regulation” may be especially helpful for issues and areas of activity that are hard to control or where governments cannot reach. One example is news media coverage of health issues, which is currently far from optimal – especially during crises like pandemics – and which may be difficult to regulate through traditional strategies given constitutional freedoms of expression and the press. But techno-regulating news media coverage might be possible if there was a feasible way of automatically measuring desirable attributes of news records in real-time and disseminating the results widely, thereby incentivizing news media organizations to compete for better scores and reputational advantage. As a first move, this third chapter presents a relatively simple maximum entropy machine-learning model that automatically quantifies the relevance, scientific quality and sensationalism of news media records, and validates the model on a corpus of 163,433 news records mentioning the recent SARS and H1N1 pandemics. This involved optimizing retrieval of relevant news records, using specially tailored tools for scoring these qualities on a randomly sampled training set of 500 news records, processing the training set into a document-term matrix, utilizing a maximum entropy model for inductive machine learning to identify relationships that distinguish differently scored news records, computationally applying these relationships to classify other news records, and validating the model using a test set that compares computer and human judgments. Estimates of overall scientific quality and sensationalism based on the 500 human-scored news records were 3.17 (“potentially important but not critical shortcomings”) and 1.81 (“not too much sensationalizing”) out of 5, respectively, and updated by the computer model to 3.32 and 1.73 out of 5 after including information from 10,000 records. This confirms that news media coverage of pandemic outbreaks is far from perfect, especially its scientific quality if not also its sensationalism. The accuracy of computer scoring of individual news records for relevance, quality and sensationalism was 86%, 65% and 73%, respectively. The chapter concludes by arguing that these findings demonstrate how automated methods can evaluate news records faster, cheaper and possibly better than humans – suggesting that techno-regulating health news coverage is feasible – and that the specific procedure implemented in this study can at the very least identify subsets of news records that are far more likely to have particular scientific and discursive qualities.
Prospects for achieving global collective action on transnational health threats and social inequalities would be improved if greater efforts were taken to systematically take stock of the full-range of strategies available and to scientifically evaluate their potential effectiveness. This dissertation presents three studies that do so, which together showcase the diversity of approaches that can be mustered in pursuit of this goal.Health Policy
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Drakou, Ismini. "Inequalities and inequity in utilisation of health care among the older people in Greece." Thesis, London School of Economics and Political Science (University of London), 2015. http://etheses.lse.ac.uk/3462/.
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Thirty years have passed and five major reforms have followed since the establishment of the Greek National Health System (NHS) in 1983 on universal coverage as an elementary policy goal, and the Greek NHS is still insufficient with regard to organisation, coverage, funding and delivering health services. The primary objective of the thesis is to employ quantitative empirical methods to explore some key aspects of equity in the receipt of health care in Greece among the older population via two nationwide and one urban setting datasets. This thesis comprises three essays which shed light on the equity issue before and after NHS major reforms of 2001-4 and 2005-7. The findings of this thesis suggest that inequalities in health care exist mainly for the probability of specialist and dentist private visits. Income- related inequalities are less apparent in probability of inpatient admissions and probability of outpatient visits, favoring the less advantaged. Income itself is not the only contributor. The findings indicate intra and interregional inequalities in most of health care services use except for probability of GP visits, favoring residents of thinly-populated areas. Compared to Athens region, regional disparities-inequalities are not apparent for inpatient care, as well. Furthermore, the findings suggest that even though we signify territorial disparities in the probability of specialist visit favoring the better off, once the positive contacts of specialist visits are included, the elderly have equal probability to make a specialist private visit, irrespective of their income and their region of residence. In addition, this thesis finds that inequalities are apparent among the Social health insurance funds (SHIFs) in use of most health care types, except the probability of inpatient admissions. Non Noble Farmers OGA SHIF - who tends to be less advantaged - has a more pronounced pro poor contribution to overall inequity in the probability of specialist private visit than the Noble SHIFs, revealing an unfair relationship. This thesis also finds that OOP expenses constitute a significant financial burden to inpatient and outpatient care. There is a regressive trend in OOP amount for inpatient admission in terms of ability to pay and region of residence favoring residents of thinly-populated areas and Central Greece region- who tend to be less advantaged. For outpatient care, there is a progressive trend in OOP amount in terms of ability to pay, SHIF coverage and region of residence. The thesis provides useful tools for understanding and measuring inequalities in the use of health care among the older population, who are the most constant consumers of health services. It urges policy makers to review the governance of primary health care by setting conditions and implements measures for improving efficiency, unifying SHIFunds, eliminating geographical inequalities and control the role of OOP expenses as significant barriers to access health care, especially during the current period of economic crisis.
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Mamani-Ortiz, Yercin. "Cardiovascular risk factors in Cochabamba, Bolivia : estimating its distribution and assessing social inequalities." Licentiate thesis, Umeå universitet, Institutionen för epidemiologi och global hälsa, 2019. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-164923.
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Background: The increase in the prevalence of cardiovascular risk factors (CVRFs) is considered one of the most important public health problems worldwide and especially in Latin American (LA) countries. Although the systematic surveillance of chronic diseases and their risk factors has been recommended, Bolivia has not yet implemented a national strategy to collect and monitor CVRF information. Evidence from previous studies in Bolivia and other Latin American countries has suggested that CVRFs affect women more than men and mestizos more than indigenous people. However, a more accurate and comprehensive picture of the CVRF situation and how ethnicity and gender intersect to affect CVRFs is dearly needed to support the development of health policies to improve population health and reduce inequalities. Objective: to estimate the distribution of CVRFs and to examine intersectional in equalities in Cochabamba – Bolivia in order to provide useful information for public health practice and decision making. The specific objectives are: i) to estimate the prevalence of preventable risk factors associated with CVDs and ii) to assess and explain obesity inequalities in the intersectional spaces of ethnicity and gender. Methods: The data collection procedure was based on the Pan-American version (V2.0) of the WHO STEPS approach adapted to the Bolivian context. Between 2015 and 2016, 10,754 individuals aged over 18 years old were surveyed. The two first stages of the STEPS approach were conducted: a) Step 1 consisted of the application of a questionnaire to collect demographic and lifestyle data; b) Step 2 involved taking measurements of height, weight, blood pressure, and waist circumference of the participants. To achieve objective 1, the prevalence of relevant behavioural risk factors and anthropometric measures were calculated, and then odds ratios/prevalence ratios were estimated for each CVRF, both with crude and adjusted regression models. Regarding objective 2, an intersectionality approach based on the method suggested by Jackson et al. (67) was used to analyse the ethnic and gender inequalities in obesity. Gender and ethnicity information were combined to form four mutually exclusive intersectional positions: i) the dually disadvantaged group of indigenous women; ii) the dually advantaged group of mestizo men; and the singly disadvantaged groups of iii) indigenous men and iv) mestizo women. Joint and excess intersectional disparities in abdominal obesity were estimated as absolute prevalence differences between binary groups, using binomial regression models. The Oaxaca-Blinder decomposition was applied to estimate the contributions of explanatory factors underlying the observed intersectional disparities. Main findings: Our findings revealed that Cochabamba had a high prevalence of CVRFs, with significant variations among the different socio-demographic groups. Indigenous populations and those living in the Andean region showed, in general, a lower prevalence for most of the risk factors evaluated. The prevalence of behavioural risk factors were: current smoking (11.6%); current alcohol consumption (42.76%); low consumption of fruits and vegetables (76.73%); and low level of physical activity (64.77%). The prevalence of metabolic risk factors evaluated were: being overweight (35.84%); obesity (20.49%); abdominal obesity (54.13%); and raised blood pressure (17.5%). It is important to highlight that 40.7% of participants had four or more CVRFs simultaneously. Dually and singly disadvantaged groups (indigenous women, indigenous men, and mestizo women) were less obese than the dually advantaged group (mestizomen). The joint disparity showed that the obesity prevalence was 7.26 percentage points higher in the doubly advantaged mestizo men (MM) than in the doubly disadvantaged indigenous women (IW). Mestizo men (MM) had an obesity prevalence of 4.30 percentage points higher than mestizo women (MW) and 9.18 percentage points higher than indigenous men (IM). The resulting excess intersectional disparity was 6.22 percentage points, representing -86 percentage points of the joint disparity. The lower prevalence of obesity in the doubly disadvantaged group of indigenous women (7.26 percentage points) was mainly due to ethnic differences alone. However, they had higher obesity than expected when considering both genders alone and ethnicity alone. Health behaviours were important factors in explaining the intersectional inequalities, while differences in socioeconomic and demographic factors played less important roles. Conclusion: The prevalence of all CVRFs in Cochabamba was high, and nearly two-thirds of the population reported two or more risk factors simultaneously. The intersectional disparities illustrate that abdominal obesity is not distributed according to expected patterns of structural disadvantages in the intersectional spaces of ethnicity and gender in Bolivia. A high social advantage was related to higher rates of abdominal obesity, with health behaviours as the most important factors explaining the observed inequalities. The information generated by this study provides evidence for health policymakers at the regional level and a baseline data for department-wide action plans to carry out specific interventionsin the population and on individual levels.
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Tigova, Olena. "Income-related inequalities in self-raported health across 29 European countries : Findings from the European Social Survey." Thesis, Stockholms universitet, Centrum för forskning om ojämlikhet i hälsa (CHESS), 2014. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-104779.
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Background: The degree of health variation among social groups is an important indicator of population health and the efficiency of economic and social systems. Previous studies revealed existence of health inequalities across Europe, however recent studies on the contribution of income to such inequalities are scarce. Aim: To investigate differences in self-reported health between the lowest and the highest income groups across Europe. Method: Data from the European Social Survey for 29 countries were examined. The absolute inequalities were calculated as differences in age-adjusted prevalence of poor self-reported health between the lowest and the highest income quintiles. The relative inequalities were measured by odds ratios for reporting poor health in the lowest income group compared to the highest one. Results: Income-related health inequalities were found in all countries. Larger relative inequalities among men were observed in Greece, Kosovo, Ireland, Israel, Iceland, and Slovenia; among women – in Lithuania, Denmark, Norway, Portugal, Cyprus, and Czech Republic. Conslusions: In Europe, income-related health inequalities persist, however, their degree varies across countries. Gender differences in income-related inequalities were observed within certain countries. For a comprehensive description of health situation in a country assessing both the prevalence of poor health and the inequality level is crucial.
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Darlington, Frances. "Ethnic inequalities in health : understanding the nexus between migration, deprivation change and social mobility." Thesis, University of Leeds, 2015. http://etheses.whiterose.ac.uk/12108/.
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Ethnic inequalities in health, although widely observed, are not fully understood. Explanations for these inequalities are often overtaken by discussions of social inequalities in health or dismissed as the inevitable consequence of genetic and cultural differences determining health differences between ethnic groups. However, as society is becoming increasingly ethnically diverse, determining the nature of ethnic inequalities in health is ever more important, as is research evaluating whether and how health gradients are changing over time. This thesis addresses these gaps in knowledge, examining the nature of ethnic inequalities in health and evaluating whether theories of selective sorting can help explain changing health gradients in the overall population or by ethnic group in England. Selective sorting is the process whereby differently healthy groups are sorted into different area types or social classes through migration, deprivation change and social mobility. Given the contrasting socioeconomic, spatial and health experiences of different ethnic groups in England it is likely that selective sorting may operate differently for different ethnic groups. Using a variety of statistical methods, this thesis analyses data from the Health Surveys for England between 1998 and 2011, and the 1991, 2001 and 2011 Samples of Anonymised Records and ONS Longitudinal Study. This thesis notably finds that ethnic inequalities in health are better explained by socioeconomic and broad spatial difference than inherent features of different ethnic groups. However, an ethnic penalty may be operating which interacts with the already disadvantaged circumstances of certain ethnic groups further limiting their chances of good health. Transition between area types and social classes can contribute to widening health gradients for the overall population and by ethnic group. However, probability of transitioning varies between ethnic groups, with certain groups less likely to move away from areas becoming more deprived. This may further exacerbate existing health gradients.
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Craig, Pauline M. "An exploration of primary care policy and practice for reducing inequalities in mental health." Thesis, Connect to e-thesis, 2008. http://theses.gla.ac.uk/287/.
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Thesis (Ph.D.) - University of Glasgow, 2007.Ph.D. thesis submitted to the Faculty of Medicine, Public Health and Community-Based Sciences, 2007. Includes bibliographical references. Print version also available.
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Mylonopoulou, V. (Vasiliki). "MAD:designing social comparison features in health behaviour change technological interventions." Doctoral thesis, Oulun yliopisto, 2019. http://urn.fi/urn:isbn:9789526222851.
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Abstract Health behaviour change is challenging and is addressed by the international community. Many people try to effect change for a healthier lifestyle, but they find it difficult to sustain their new habits. Today, technological applications support people who want to change their behaviour, oftentimes by utilising social influence: The influence of others on one’s behaviour. Social influence consists of different aspects, the particularities of which are often neglected in design. This thesis focusses on the design of the social comparison aspect of social influence. Social comparison psychology supports the view that when facing a lack of objective measurements, people tend to compare themselves to others who are similar to them for self-evaluation, self-enhancement, self-prediction, and coping. In psychology, social comparison theory has shown great potential in the aforementioned areas as well as challenges regarding its application. In the design of technology, social comparison theory has been utilised but lacks extensive exploration. In this thesis, four perspectives are considered to better understand social comparison in design: Existing designs, designers’ perspective, healthcare professionals’ perspective, and user research for social comparison. The four perspectives are explored using qualitative methodologies and through design science research. The knowledge took the form of a Multiple-perspective Approach Design (MAD) for social comparison features in technology that supports health behaviour change. MAD aims to support designers when working with social comparison in health behaviour change, by presenting social comparison potentials and challenges informed by the different perspectives. MAD builds upon the knowledge transferred from the field of psychology regarding social comparison and on the research conducted to understand the four perspectives of social comparisonTiivistelmä Terveyskäyttäytymisen muutos on haastavaa ja sitä käsittelee kansainvälinen yhteisö. Monet ihmiset yrittävät tehdä muutoksia kohti terveellisempiä elämäntapoja, mutta heidän on vaikea ylläpitää uusia tapojaan. Tänä päivänä teknologiset sovellukset tukevat ihmisiä, jotka haluavat muuttaa käyttäytymistään, usein hyödyntämällä sosiaalista vaikutusta: toisten vaikutusta omaan käyttäytymiseen. Sosiaalinen vaikutus koostuu erilaisista näkökulmista, joiden erityispiirteitä on usein laiminlyöty suunnittelussa. Tässä opinnäytetyössä keskitytään sosiaalisen vertailun näkökulman suunnitteluun sosiaalisessa vaikutuksessa. Sosiaalisen vertailun psykologia tukee näkemystä siitä, että objektiivisten mittausten puuttuessa, ihmiset pyrkivät vertaamaan itseään muihin, jotka ovat samankaltaisia, itsearvioinnin, itsensä vahvistamisen, itsearvioinnin ja selviytymisen kannalta. Psykologiassa sosiaalisen vertailun teoria on osoittanut potentiaalinsa edellä mainituilla aloilla, mutta sen soveltamiseen liittyy haasteita. Sosiaalisen vertailun teoriaa on hyödynnetty teknologian suunnittelussa, mutta laaja-alaisempi tutkimus aiheesta on puutteellista. Tässä opinnäytetyössä tarkastellaan neljää näkökulmaa ymmärtämään paremmin sosiaalista vertailua suunnittelussa: Olemassa olevat mallit, suunnittelijoiden näkökulma, terveydenhuollon ammattilaisten näkökulma ja käyttäjätutkimus sosiaaliseen vertailuun. Näitä neljää näkökulmaa tutkitaan käyttämällä laadullisia tutkimusmenetelmiä ja suunnittelutieteellistä tutkimusta. Kerätyn tiedon perusteella muodostettiin monia toimijoita tarkasteleva lähestymistapa suunnitteluun (MAD), joka koskee sosiaalisen vertailun ominaisuuksia teknologiassa, joka tukee terveyskäyttäytymisen muutosta. MAD pyrkii tukemaan suunnittelijoita, jotka työskentelevät sosiaalisen vertailun parissa terveyskäyttäytymisen muutoksessa, esittämällä sosiaalisen vertailun mahdollisuuksia ja haasteita, joita on kerätty eri näkökulmista. MAD perustuu psykologian alalta kerättyyn tietämykseen sosiaalista vertailusta ja toteutettuun tutkimukseen, joka on tehty sosiaalisen vertailun neljän näkökulman ymmärtämiseksi
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Fors, Stefan. "Blood on the tracks : Life-course perspectives on health inequalities in later life." Doctoral thesis, Stockholms universitet, Institutionen för socialt arbete - Socialhögskolan, 2010. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-38848.
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The overall aim of the thesis was to explore social inequalities in: a) mortality during mid-life, b) health in later life, and c) old-age mortality, from a life-course perspective. The studies are based on longitudinal Swedish survey and registry data. The results from Study I showed substantial inequalities in health, based on social class and gender, among older adults (aged 55+). Moreover, the magnitude of these inequalities did not change during the period 1991-2002. The results from Study II revealed social inequalities in cognitive functioning among the oldest old (aged 77+). Social turbulence and social class during childhood, education and social class in adulthood were all independently associated with level of cognitive functioning in later life. In Study III, social inequalities in mortality during mid-life (i.e., between ages 25 and 69) were explored. The results showed that childhood living conditions were associated with marital status and social class in adulthood and that, in turn, these conditions were associated with mid-life mortality. Thus, the results suggested that childhood disadvantage may serve as a stepping stone to a hazardous life-course trajectory. Study IV explored the association between income in mid-life, income during retirement and old-age mortality (i.e., mortality during retirement). The results showed that both income during mid-life and income during retirement were associated with old-age mortality. Mutually adjusted models showed that income in mid-life was more important for women’s mortality and that income during retirement was more important for men’s. Thus, the results of the present thesis suggest that there are substantial social inequalities in the likelihood of reaching old age, as well as in health and mortality among older adults. These inequalities are shaped by differential exposures throughout the life-course that affect health in later life both through direct effects and through processes of accumulation.At the time of the doctoral defense, the following papers were unpublished and had a status as follows: Paper 3: Manuscript. Paper 4: Manuscript.
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Tanner, Susan J. "Social representations of cancer and their role in health promotion." Thesis, University of Surrey, 1997. http://epubs.surrey.ac.uk/771378/.
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This thesis examines the potential of the Social Representation (SR) approach as an alternative to the traditional social cognition approach adopted in the study of cancer-related thought and behaviour. The traditional approach is critically examined. The main motivation for this thesis concerned the non-compliance of cancer-related health behaviour despite the huge investment into health promotion campaigns. Given the lack of any methodological orthodoxy for the study of SRs the core aim of the thesis was to explore the methodology appropriate for SR analysis in the area of cancer. In recognition of the complex nature of SRs a multi-method approach was adopted in which four different methods were evaluated. As the basis of this research Qualitative methods (Chapter 4) were used to explore the underlying rationale of the representations of cancer, and to inform the design of more quantitative instruments. Next an idiographic approach (Multiple Card Sort Procedure) (Chapter 5) was employed to examine the cognitive component of the SRs of cancer. The affective elements making up the SRs of cancer along with the cultural elements were then explored using a Metaphor Procedure (Chapter 6). The fourth method, a self-report Questionnaire (Chapter 7) was used to examine the attitudes, knowledge and emotional cognitions making up the SRs of cancer. An attempt was also made to identify shared representations using each of the methods employed using analytic procedures consistent with the data collected. Thus a qualitative analysis was carried out on the qualitative data, a scaling analysis on the idiographic data. Both the metaphor and the questionnaire data were analysed using a cluster analytic methodology (Fife-Schaw, 1993). Each method proved to have strengths and weaknesses. The questionnaire approach for example proved to be the most useful in examining the relationship between the representations of cancer and health behaviour, but the constraints of this method were shown by the idiographic technique. This work provided a foundation for the second part of the thesis. Using a questionnaire format (Chapter 8) the measurement tool for the SRs of cancer was refined on a sample of 510 respondents. Five factors were identified, IIInesslRestriction, Challenge, Symptom Focus, Cancer Control and Emotional Aspects. When operationalised into scales these factors proved to be highly reliable with values in excess of 0.75 making them sound measurement tools. Using a cluster - discriminant technique three shared representations of cancer were identified, an Ambivalent representation, a Positive Control representation and an Illness representation which proved to be differentially related to health behaviour. The positive orientation is an interesting one because it receives less documentation within the cancer literature. The research suggests that social cognition models are failing to fully account for the variance in health behaviour for a number of reasons. Perhaps most important is the insufficient attention paid to emotionally arousing qualities of cancer and the role played by socio-cultural factors. Lifestyle approaches, experience of cancer, and dominant conceptualisations in the media seem to be influencing the representations of cancer held. The role of individual differences within the formulation of SRs was then examined (see Chapter 8). The findings suggest that SRs are a product of both the social environment and individual psychological differences. Cancer-related thought and behaviour then may vary according to the social context as well as individual traits. The implication for health educators is that they cannot rely upon a superordinate representational 'norm' but must look at the mores and mileu of the target group in question.
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McElhinney, Evelyn. "Living in 3D social virtual worlds and the influence of health literacy, health behaviour and wellbeing." Thesis, Glasgow Caledonian University, 2015. https://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.743881.
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Jutz, Regina [Verfasser], and Christof [Akademischer Betreuer] Wolf. "The impact of social policies on health inequalities in Europe / Regina Jutz ; Betreuer: Christof Wolf." Mannheim : Universitätsbibliothek Mannheim, 2019. http://d-nb.info/1192215672/34.
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Lacey, Elizabeth Ann. "Health inequalities after a heart attack : the influence of social variables on perceptions of recovery." Thesis, University of York, 2000. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.313875.
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Campbell, Malcolm H. "Exploring the social and spatial inequalities of ill-health in Scotland : a spatial microsimulation approach." Thesis, University of Sheffield, 2011. http://etheses.whiterose.ac.uk/1942/.
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The main purpose of this thesis is to explore social and spatial inequalities of ill-health in Scotland using a spatial microsimulation modelling approach. The complex questions of what socio-economic or geographical factors may influence the health of individuals are explored in this PhD, using a variety of statistical methods. Using data from the Scottish Health Survey and the UK Census of Population a Spatial Microsimulation model was designed and constructed to undertake this task. The Spatial Microsimulation Model developed allowed the exploration of simulated health and socio-economic data at small area (micro) level as well as modelling of `what-if' policy scenarios. The study is focused on Scotland. The Research begins with a general introduction to what the areas of study will be, with a series of substantive research questions being forwarded for examination. The literature relevant to the field of study is then carefully critiqued and examined to ensure the originality of this research and the gaps which exist in the field of health inequalities research. An examination of the data and methods used as well as the more technical details of Microsimulation modelling are also discussed at chapter length which forms the basis for proceeding with the research questions. The complex task of building a Spatial Microsimulation Model, the challenges involved and the inner workings of the model are discussed along with methods to assess the accuracy of the model. The subsequent chapters then focus on the results of the analysis performed. These chapters deal with the research questions posed at the beginning as well as the `what-if' policy scenarios. The study then concludes with directions for future research as well as some key points that have been drawn out over the course of the three year PhD project.
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Furler, John. "Chronicity and character : patient centredness and health inequalities in general practice diabetes care /." Connect to thesis, 2006. http://repository.unimelb.edu.au/10187/52.
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This study explores the experiences of General Practitioners (GPs) and patients in the management of type 2 diabetes in contemporary Australia. I focus on the way the socioeconomic position of patients is a factor in that experience as my underlying interest is in exploring how health inequalities are understood, approached and handled in general practice. The study is thus a practical and grounded exploration of a widely debated theoretical issue in the study of social life, namely the relationship between the micro day-to-day interactions and events in the lives of individuals and the broad macro structure of society and the position of the individual within that. There is now wide acceptance and evidence that people’s social and economic circumstances impact on their health status and their experiences in the health system. However, there is considerable debate about the role played by primary medical care. Nevertheless, better theoretical understanding of the importance of psychosocial processes in generating social inequalities in health suggests medical care may well be important, as such processes are crucial in the care of chronic illnesses such as diabetes which are now such a large part of general practice work. I approach this study through an exploration of patient centred clinical practice. Patient centredness is a pragmatic, idealised prescriptive framework for clinical practice, particularly general practice. Patient centredness developed in part in response to critiques of biomedicine, and is premised on a notion of a more equal relationship between GP and patient, and one that places importance on the context of patients’ lives. It contains an implicit promise that it will help GP and patient engage with and confront social disadvantage.
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Venkatapuram, Sridhar. "Health and justice : the capability to be healthy." Thesis, University of Cambridge, 2009. https://www.repository.cam.ac.uk/handle/1810/224951.
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This is an inter-disciplinary argument for a moral entitlement to a capability to be healthy. Motivated by the goal to make a human right to health intelligible and justifiable, the thesis extends the capability approach, advocated by Amartya Sen and Martha Nussbaum, to the theory and practice of the human health sciences. Moral claims related to human health are considered at the level of ethical theory, or a level of abstraction where principles of social justice that determine the purpose, form, and scope of basic social institutions are proposed, evaluated, and justified. The argument includes 1) a conception of health as capability, 2) a theory of causation and distribution of health capability as well as 3) an argument for the moral entitlement to a sufficient and equitable capability to be healthy grounded in the respect for human dignity. Moreover, the entitlement to the capability to be healthy is defended against alternative ethical approaches that focus on welfare or resources in evaluating and satisfying health claims. In specific, it is argued that human health is best understood as a capability to be healthy - a meta-capability to achieve a cluster of basic and inter-related capabilities and functionings. Such a cluster of capabilities and functionings is in line with Martha Nussbaum's central human capabilities. A theory of causation and distribution of health capability is put forward that integrates the 'classic' biomedical factors of disease (genetic endowment, exposure to hazardous materials, behaviour), social determinants of disease, and Drèze and Sen's econometric analysis of the causation and distribution of acute and endemic malnutrition. Furthermore, the argument critiques Norman Daniels's revised Rawlsian theory of health justice, and advocates for the capability approach to recognize group capabilities in light of 'population health' phenomena. Lastly, the thesis also argues that a coherent, capability conception of health as a species-wide conception will tend to make any theory of justice recognizing health claims a cosmopolitan theory of justice.