Dissertations / Theses on the topic 'Equality – Health aspects – Germany'

Canada's health system is based on the firmly-held belief that the receipt of care should be based on need and not ability to pay. This thesis examines three aspects of this equity goal: provincial variations in equity in the receipt of care; the role of private prescription drug insurance in explaining inequity in the use of physician services; and the equity implications of subjective unmet need. Canada's provinces are responsible for planning and funding most publicly insured health services, hence there is variation in health system characteristics across the country. In the context of such variation, the first empirical analysis examines equity in the use of health services across the provinces. The analysis reveals some evidence of inequity in the likelihood of a GP visit, and the likelihood and number of specialist and dentist visits; some variations can also be found across the provinces. The second empirical analysis investigates the role of complementary insurance for prescription drugs in explaining inequity in the use of publicly-funded physician services. Due to the complementary relationship between prescription drugs and physician services, and the unequal distribution of private insurance coverage across income groups, inequity in physician utilisation partly can be explained by the interaction with insurance. The third empirical analysis assesses the equity implications of subjective unmet need. It finds that there are different utilisation patterns among the different types of unmet need, which raises methodological and conceptual challenges. The concluding chapter positions the three empirical studies within the broader policy context, offers an in-depth discussion of their methodological and policy implications, and proposes areas for future research.

Defence date: 13 April 2021
Examining Board: Professor Fabrizio Bernardi (European University Institute); Professor Juho Härkönen (European University Institute); Professor Anette Eva Fasang (Humboldt University Berlin); Professor Markus Jäntti (Stockholm University)
The intergenerational transmission of inequality is a research field that has sub-strands in several disciplines with findings that have consequences for the way we see and evaluate our society. Therefore, it is crucial to continuously update how we address questions in such an important research area. In this thesis, I study the importance of the family of origin for different areas of social inequality using a sibling design. I estimate the influence of the family on labor market success, partnership union formation, and occupational gender stratification in Germany using data from the German Socio-Economic Panel. The results show that the family plays a crucial role in the generations of social inequality over the life course. It affects the labor market attainment for different social origin groups and over and above a person's education, and it influences the timing of marriage, cohabitation, and living-apart-together unions. In addition, the gender composition of the sibling group creates inequality regarding occupational attainment within families. Thus, this thesis provides a comprehensive view of how the family of origin is relevant to several areas of social and economic life in Germany. It discusses the implications of using a comprehensive approach to the family for further research and policy.

Persons from the former USSR constitute a significant proportion of the migrant population in contemporary Germany. Current research on their health is scarce and carried out from a medical perspective, mostly focusing on health outcomes and patterns of healthcare utilisation. In contrast, this thesis is based on a sociological approach to health as a phenomenon embedded in a complex system of social stratification and cultural traditions. The research question of this thesis is about the relationship of identity to health beliefs and help-seeking practices, and they ways migration transforms ways people think of themselves and their health. To answer this question, qualitative research needs to establish migrants' own interpretations of health and illness in the biographical context. Setting out to identify and explain a variety of native conceptualisations of health, this thesis, on the one hand, seeks to establish differences between migrant and non-migrant population, and, on the other hand, to reflect on heterogeneity of health beliefs and help-seeking behaviours across different sub-groups of former Soviet citizens in Germany. In order to pursue these research objectives, comparative qualitative research design was employed, whereby different groups of migrant population were compared with each other and contrasted to native Germans. The empirical fieldwork was carried out in Berlin in 2009-2010, and included 35 semi-structured interviews (of which 8 were carried out with experts). This thesis suggests that health beliefs and help-seeking practices of migrants from the former USSR in Germany are highly heterogeneous. Attitudes to health make up components of diverse identities acquired in the sending country and that are transformed throughout the migratory processes. First, these findings argue against generalisations about 'fatalistic' health beliefs resulting from communist ideology, a stereotype appearing in some Western literatures. Second, this thesis draws attention to the effects of socialisation in the sending country on conceptualisations of health in the country of immigration, suggesting prospects for research in future migrant generations. And third, it demonstrates that folk conceptualisations of health are hugely heterogeneous, and diverge greatly from medical views of health as an absence of illness.

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.

A number of theoretical explanations seek to describe the factors that have led to the position of the United States as the last industrialized Western nation without a universal health care program. Theories focus on institutional arrangement, historic precedent, and the influence of the private sector and market forces. This study explores another factor: the role of underlying social values. The research examines differences in values among ten European countries, the United States and Canada, and analyzes the associations between the values that have been seen to contribute the individualism-collectivism dynamic in the United States. The hypothesis that equality and generalized trust are positively associated with universalism is only partially true. Equality is positively associated (B = .301, p < .001), while generalized trust is negatively associated with universalism (B = -.052, p < .001). Not only do Americans show lower levels of support for income equality and universalism than Europeans, but the effect of being American holds even after controlling for socio-demographic and religious variables (B = .044, p < .01). When the model tests the association of equality and trust on universalism in each region, it explains approximately 17 percent of the variance of universalism for the United States, and approximately 13 percent in Europe and Canada.

This thesis presents an instrumental case study of a National Health Service (NHS) mental healthcare trust in relation to race related equality policy in the delivery of secondary mental healthcare in England. The study takes a constructionist ontological position, and an interpretivist epistemology. Semi-structured interviews were conducted with the 20 participants working at three different levels of the organisation. These include strategic leaders: Chief Executive Officer, Operational Director, Director of Nursing Quality and Patient Experiences, Director of Learning and Development, Head of Human Resources, Equality and Diversity Lead; service level middle managers: General Manager, Modern Matron, Team leader, Manager of the Recovery College; and frontline practitioners: clinical directors, psychiatrist, occupational therapist, staff nurses, community psychiatrist nurse, Recovery College instructor, all working in an adult mental healthcare setting of the organisation. Narrative interviews were also conducted with eight members of the Pakistani community living in the local service area to gain their perspectives on mental illnesses and mental health services. The study was conducted because national race equality policy expects NHS mental healthcare organisations to change their culture and deliver equitable, culturally appropriate and satisfactory mental health services to all members of society, including those who identify themselves as ‘BME’ groups. However, there is evidence in the policy and research literature of inequalities in mental healthcare experienced by service users who identify themselves as being from ‘BME’ groups in England. This study, therefore, explores how a NHS mental healthcare Trust is trying to bring about cultural changes in order to meet the expectations of policy as well as meeting the needs of service users of ethnic background. For example, on the organisational side, the study explored vision and strategy as well as interventions for bringing about organisational change and the views of the participants on this change. The views from the members of the Pakistani ethnic group highlight how mental illnesses are perceived and responded to within this ethnic group. Data obtained from the staff group were analysed using a thematic framework approach. Resultant themes include: interpretation of racial equality policy in the organisation; organisational vision and strategy for change; and the challenges, barriers and facilitators to achieving the stated vision on racial equality in the service provision, especially for people of Pakistani ethnic group. The analysis benefited from the organisational development literature in analysing the data. Data obtained from the members of the Pakistani community were analysed using a thematic narrative approach. This data reflected ways in which mental health/illness is perceived and responded to within this group including: the social identity claims that people of Pakistani ethnicity make when perceiving and responding to mental illnesses; the extent to which they associate themselves with western and/or eastern models of mental illnesses; and their identification as an ethnic group with diverse and multiple social identities. Social identity literature is used to analyse and interpret this data. The relationship between the organisational data and the ethnic group data is discussed, and a way forward is suggested for bringing about the expected cultural change to the organisation in order to meet the mental health needs of ‘BME’ groups in England. The instrumental organisational case study, along with perspectives of the service users, have served to underline the challenges for the organisation on a day-to-day basis as they attempt to meet the expectations of policy, as well as the views and expectations of people of Pakistani ethnicity.

The objective of this study was to examine if intra-racial income inequality contributes to higher infant mortality rates (IMRs) for African-Americans. The conceptual framework for this study is derived from Richard Wilkinson's psychosocial environment interpretation of the income inequality and health link. The hypotheses examined were that race/ethnicity-specific IMRs are influenced by intra-race/ethnicity income inequality, and that these effects of income inequality on health are mediated by level of social mistrust and/or risk profile of the mother. Using state-level data from several sources, the 2000 National Center for Health Statistics Linked Birth Infant Death database, 2000 U.S. Census, and 2000 General Social Survey, a number of regression equations were estimated. Results indicated that the level of intra-racial/ethnic income inequality is a significant predictor of non-Hispanic Black IMRs, but not the IMRs of non-Hispanic Whites or Hispanics. Additionally, among Blacks, the effect of their intra-racial income inequality on their IMRs was found to be mediated by the risk profile of the mother, namely, the increased likelihood of smoking and/or drinking and/or less prenatal care by Black women during pregnancy. Implications of the findings are discussed.

Alors que les pays européens font face à des dépenses croissantes en matière de médicaments, la prise en charge d'un nouveau produit de santé par les financeurs publics apparaît comme un enjeu primordial dans le contrôle de ces dépenses. La plupart des pays, comme la France, utilisent alors des listes explicites définissant les produits pris en charge ou non pris en charge par le biais de financements publics. L'idée sous-jacente d'un tel procédé est de concentrer la prise en charge publique sur des produits dits « utiles », c'est-à-dire qui non seulement participent au traitement de pathologies jugées importantes, mais qui se montrent également efficaces et, le cas échéant, les moins onéreux. Si cette idée est simple, l'élaboration en pratique de telles listes reste complexe. La définition des critères adoptés pour déterminer les contours d'un panier de médicaments remboursables ainsi que les méthodes utilisées pour évaluer si un produit répond à ces critères, représentent des enjeux importants pour les décideurs publics et peuvent avoir des répercussions directes sur la qualité et les coûts des prescriptions médicamenteuses. Dans l'absolu, la décision de prendre en charge un médicament peut s'appuyer sur de nombreux critères : efficacité, rapport coût-efficacité, gravité de la pathologie, symptômes traités, impact sur les budgets consacrés à la santé, etc. De plus, les évaluations présentent toute une série de difficultés méthodologiques et techniques auxquelles viennent s'additionner le contexte politique et le pouvoir de négociation des laboratoires pharmaceutiques, qui influencent également les décisions de prise en charge. La présente étude s'organise autour de la présentation de la notion de médicament, des modalités de prise en charge de ces derniers et de la procédure de leur mise sur le marché sous un angle comparé entre le droit français et divers autres systèmes juridiques relevant du cadre communautaire. Une telle analyse soulève certaines interrogations dont la mise en cause du système actuel de régulation des médicaments. À travers ce travail de recherches, il est permis de constater plusieurs défaillances non seulement dans le mécanisme de régulation des dépenses, mais aussi dans le système de prise en charge lui-même. Si la question d'un réajustement de la politique de régulation des médicaments est alors au cœur du débat, des perspectives d'évolution se dessinent néanmoins
While the European countries face increasing spending regarding medicine, the coverage of a new product of health by the public financiers appears as an essential stake in the control of these spending. Most of the countries, as France, use then explicit lists defining products taken care or not taken care by means of public financing. The underlying idea of such a process is to concentrate the public coverage on "useful" said products, that is which not only participate in the treatment of pathologies considered important, but which show themselves also effective and, where necessary, the least expensive. If this idea is simple, the elaboration in practice of such lists remains complex. The definition of the criteria adopted to determine the outlines of a basket of refundable medicine as well as the methods used to estimate if a product answers these criteria, represent stakes important for the public decision-makers and can have direct repercussions on the quality and the costs of the medicinal prescriptions. Theoretically, the decision to take care of a medicine can lean on numerous criteria: efficiency, cost efficiency ratio, revolved by the pathology, the handled symptoms, the impact on the budgets dedicated to the health, etc. Furthermore, the evaluations present a whole series of methodological and technical difficulties to which come to add up the political context and the bargaining power of pharmaceutical companies, which also influence the decisions of care. The present study gets organized around the display of the notion of medicine, modalities of care of the latter and the procedure of their launch on the market under a compared angle enter the French and diverse law other legal systems being a matter of the community frame. Such an analysis lifts certain questioning of which the questioning of the current system of regulation of medicine. Through this research work, it is allowed to notice several failures not only in the mechanism of regulation of the spending, but also in the system of care itself. If the question of an adjustment of the policy of regulation of medicine is then at the heart of the debate, perspectives of evolution take shape nevertheless

This thesis undertakes an in-depth examination of the power of human rights advocacy in combating women's vulnerability to HIV/AIDS. Focusing on sub-Saharan Africa, the thesis explores the gender discrimination that lies at the core of women's susceptibility to the virus. Culturally-imposed social roles are depicted as the fundamental cause of the violation of women's human rights, including their right to health. The objective of the thesis is to analyze the potential of using a human rights approach to address this issue. It adopts the assumption that "the mobilization of shame" triggered by civil society's actors can alter states' human rights practices. Looking at a specific type of actors, namely the transnational advocacy networks, the thesis concludes that "the human rights approach to HIV/AIDS" can be an efficient and effective strategy to pressurize governments to implement their international human rights obligations.

Defence date: 4 May 2017
Examining Board: Professor Hans-Peter Blossfled, European University Institute (Supervisor); Professor Fabrizio Bernardi, European University Institute; Professor Johan Mackenback, Erasmus Medical Centre, University of Rotterdam; Professor Johan Fritzell, CHESS, University of Stockholm
According to the cumulative (dis)advantage hypothesis, social disparities in health increase over the life course. Evidence on this hypothesis is largely limited to the U.S. context. The present dissertation draws on recent theoretical and methodological advances to test the cumulative (dis)advantage hypothesis in two other contexts – Sweden and West Germany. Three empirical studies examine the core association between socioeconomic position and health (a) from a life-course perspective considering individual change, (b) from a cohort perspective considering socio-historical change, and (c) from a comparative perspective considering cross-national differences. The analyses are based on large-scale longitudinal data from the Swedish Level of Living Survey, the German Socio-economic Panel Study, the Health and Retirement Study, and the Survey of Health, Ageing and Retirement in Europe. The key analytical constructs are education as a measure of socioeconomic position and self-rated health, mobility limitations, and chronic conditions as measures of health. The results show large differences within countries and between countries in the age patterns and cohort patterns of change in health inequality. In the U.S., educational gaps in health widen strongly over the life course, and this divergence intensifies across cohorts. In Sweden, health gaps are much smaller, widen only moderately with age, and remain stable across cohorts. In Germany, health gaps widen with age and across cohorts, but these patterns pertain only to men. Taken together, these findings show that health inequality across lives and cohorts is mitigated in Western European welfare states, which target social inequality in health-related resources. In the U.S. context, which is characterized by a lack of social security, unequal access to health care, and large social disparities in quality of living, health inequality increases across lives and cohorts.
Chapter 2 ‘Cumulative disadvantage in an egalitarian country? Socioeconomic Health Disparities over the Life Course in Sweden' of the PhD thesis draws upon an earlier version published as an article 'Cumulative advantage in an egalitarian country? : socioeconomic health disparities over the life course in Sweden' (2016) in the journal ‘Journal of health and social behavior’

Luo, Weixiang.
Thesis (Ph.D.)--Chinese University of Hong Kong, 2013.
Includes bibliographical references (leaves 90-105).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
Abstracts also in Chinese.

Public health and social policies are often debated, designed, and adopted without implementation, sustainability, or equity in mind, which can generate profound uncertainty about how to equitably deliver them initially and over time. Although sustainability and equity considerations are sometimes considered in post-hoc policy analysis and evaluation, little is known about how to plan for and track planned and unplanned adaptations to policy implementation, as well as the ways that key sustainability factors and strategies can relate to the equitable delivery or relative effectiveness of policies on the ground and in community settings. The purpose of this dissertation was to explore the long-term sustainability and equity of tobacco control policies and programs in New York City to understand and contextualize their limited reach and impact on persistent smoking and tobacco-related health disparities in underserved Asian American communities. The specific aims were to: 1) conceptually specify an operational definition of policy sustainability and its key dimensions, including health equity, and to refine this using a mixed methods single case study of tobacco policies in New York City; 2) use the case study approach to describe the extent to which tobacco policies have been sustained and adapted in New York City; and 3) to use the case study to identify key multi-level factors that influence the long-term sustainability and equity of tobacco policies in New York City. Using a single, in-depth, convergent-parallel mixed methods case study design, data were collected, analyzed, and integrated across five key primary and secondary sources: 1) Policymaking documents – text of key tobacco bills and statutes, as well as transcripts from when they were first proposed, amended, debated, and adopted; 2) Local newspaper coverage – articles from a database of 29 major newspapers in New York State on the policies and their impacts on communities and businesses over time; 3) Key informant interviews – conducted with community members and community leaders at local health and advocacy organizations in New York City that primarily serve Asian American and immigrant communities (n = 21); 4) Direct observation periods – conducted within and around the health and advocacy organizations, as well as in majority Asian neighborhoods and Asian ethnic enclaves (n = 15); and 5) the New York City Community Health Survey (2012-2017) – conducted annually by the New York City Department of Health and Mental Hygiene. The integrated study findings point to the importance of understanding policy sustainability not as a static end goal, but rather as a dynamic set of processes and outcomes that impact health and health equity. Findings from this case study clustered across three key themes: 1) since the initial adoption of comprehensive local tobacco control measures in New York City in 2002, broad “one-size-fits-all” approaches to policy implementation and monitoring have been sustained, which have had and continue to have limited reach and impact within underserved Asian American and immigrant communities; 2) two delayed adaptation efforts were made by policymakers during the sustainability phase, one in 2012 and another in 2018, were intended to improve on prior uneven implementation to better reach Chinese-speaking communities, with the 2018 adaptation demonstrating significant improvements from the 2012 effort; and 3) community-based organizations have played a direct role in functioning not just as key stakeholders but also as key implementers to ensure that tobacco and other health policies are reaching communities that the designated or official implementers cannot reach. This suggests the need for further study of unofficial implementers in implementation science – those who have not been formally designated as the ones responsible for ensuring that implementation takes place, but are still delivering implementation strategies to ensure adoption, integration, and sustainment. Overall, this case study points to the potential for policy sustainability research to advance health equity by identifying factors and mechanisms that can be improved to maximize and sustain the equitable reach and impact of social and public health policies. By focusing on dynamic contextual factors and sustainability as a set of processes and outcomes, the findings from this case study raise critical questions about the criteria typically used to evaluate whether policy interventions are deemed evidence-based and effective by asking: 1) effective for whom?; 2) based on what evidence?; and 3) what happens as dynamic populations and contexts change over time? These questions highlight how the tobacco control success story was largely constructed around broad population-wide implementation and benefits, while overlooking underserved Asian American communities who continue to disproportionately bear the brunt of smoking and tobacco-related health disparities in New York City.

Socioeconomic inequalities are a substantial problem in relation to Australia's biggest killer and area of health expenditure, coronary heart disease (CHD). They have been well documented for mortality, but little is known about whether they are due to differing chances of having a major coronary event (the event rate) or of dying when one occurs (the case-fatality rate). Nor does very much detail exist on whether these inequalities have changed over time. This study aims to fill these gaps, and also to examine the role the health care system plays in generating inequalities by analysing inequalities in the use of relevant services, and whether levels of use match levels of need for these services. A large, national dataset was constructed. It contains information on all major coronary events (essentially heart attacks) in Australia over a period of 10 years, 1996-2005, both fatal and non-fatal. Similarly, all 'services' provided for up to 10 years in the form of cholesterol-lowering medications (statins), a diagnostic procedure (angiography) and two types of revascularisation (coronary artery bypass grafts (CABGs) and percutaneous coronary interventions (PCls)) are included. In addition, a measure of need for services was developed. The dataset was then linked to census information on the socioeconomic characteristics of small areas to enable analysis of differences in outcomes and services across socioeconomic groups. The majority of the analysis was carried out using negative binomial regression to derive relative and absolute measures of inequality, including in particular the relative index of inequality and the slope index of inequality. The study clearly shows that nearly all of the socioeconomic inequality in CHD mortality in Australia comes from event rates rather than case-fatality rates. This indicates that the health care system's efforts to reduce these inequalities need to focus on preventing major coronary events, including by encouraging improvements in behavioural risk factors for them and treating risk factors when present (such as with medications), diagnosing problems early, and using surgery and other procedures (such as CABGs and PCls). Differential access to emergency care appears not to contribute to these inequalities. Time series analysis shows that inequalities in event rates have been increasing in relative terms, and even in absolute terms for males. Analysis of the use of statins, angiography and revascularisations shows substantial inequity -that is, use relative to need is much higher among the most well-off compared with the least well-off. The former are over twice as likely as the latter to receive these services for a given level of need. The largest inequities were found for the newer service (PCl rather than CABG) and for care provided earlier in the disease process (through medications and angiography). The study also shows that differential use of private health care plays a significant role in this inequity, and rural or remote locations play a smaller role. This study clearly demonstrates that socioeconomic inequalities in CHD are a major problem in Australia, and the gap is widening-improvements over time are benefiting the most well-off more than the least well-off. Inequalities largely derive from differential chances of having a major coronary event, rather than of dying when one occurs. The health care system appears to also contribute to the inequalities, and therefore has the potential to help reduce them by becoming more equitable.

Prior 1994 South Africa had a fragmented health system designed along racial lines. One system was highly resourced and benefitted the few and the other was under-resourced and was for the black majority. Attempts to deal with these disparities did not fully address the inequities. The objective of the NHI is to address the inequalities by ensuring that all South African have access to affordable, quality healthcare services regardless of their socio-economic status. The majority of the participants do not understand the meaning and the implications of the national health insurance. Among the health professionals that were interviewed, there were no consultations before the implementation of the NHI. The health economists verbalized that it will be too expensive as the majority of citizens do not pay taxes. More roadshows need to be done to make communities aware of the planned strategy which will benefit all.
Health Studies

In many cultures and religions of the world the belief in transcendental realities, like God, the Devil and other benevolent and malevolent spirits are widespread. These realities are constructed in different ways, depending upon context. In light of the development Western industrial societies have undergone, it follows that the belief in transcendental realities may have given way to beliefs that are steeped more, in empiricism. However, understanding the belief in transcendental realities seems to be gaining renewed interest in various social science disciplines in light of the fact that claims of experiences of spirit possession are escalating. The implication this understanding has on the treatment a patient receives is likely to depend upon the training of the practitioner consulted. It follows that the experiences of patients who believe they are possessed by a spirit is as equally important to practitioners of psychology as it is to theologians. Psychologists would likely ascribe a spirit possession to a psychological experience; while theologians will attest to the presence of a spiritual illness. This project focussed on Free Church pastors in Germany and their perceptions of spirit possession and mental illness. To explore Free Church pastors understanding of spirit possession and mental illness is critical in light of the overlap of symptoms. Misdiagnosis may result in a client receiving treatment which may not be appropriate. Interviews with Free Church pastors were conducted. The results were analysed and 4 themes were identified. Based on these interviews conclusions could be drawn which ultimately made it clear that the German free church pastors’ theological training needs to be supplemented in the area of psychology and that the pastors are unable to cope in the area of ‘spirit possession or mental illness’
Psychology
D.Litt. et Phil. (Psychology)

Bibliography: leaves 203-219.
219 leaves : ill. ; 30 cm.
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Concerned with the contribution of commonsense understandings of disease to social differentials in health outcomes. Argues that understandings in part reflect the social circumstances of an individual and mediate preventive activities and use of services, thereby influencing health outcomes. These are examined using the specific health outcomes of tooth loss and tooth decay.
Thesis (Ph.D.)--University of Adelaide, Dept. of Public Health, 2000

Bibliography: leaves 203-219.
219 leaves : ill. ; 30 cm.
Concerned with the contribution of commonsense understandings of disease to social differentials in health outcomes. Argues that understandings in part reflect the social circumstances of an individual and mediate preventive activities and use of services, thereby influencing health outcomes. These are examined using the specific health outcomes of tooth loss and tooth decay.
Thesis (Ph.D.)--University of Adelaide, Dept. of Public Health, 2000

In recent years, studies have linked various structural and environmental factors to disproportionately increased rates of morbidity, mortality, and adverse health outcomes in low-income racial and ethnic minority neighborhoods. Among the adverse health outcomes, is the constraint on the ability to access and afford a healthy diet. While local food systems play a significant role in influencing urban health and well-being outcomes, they also present an opportunity to develop community-based assets and resilience. By identifying limitations and successes in current food system literature and practice, this report examines how a more comprehensive approach to equitable community health and wellness can be achieved and sustained. Effective disparity reduction relies on cross-sectoral partnerships that not only promote food equity, but also provide participatory social, economic, and educational opportunities to marginalized communities.
text

Inequalities in levels of health between regions within a country are frequently regarded as a problem. Zimbabwe is characterised by poor and unequal conditions of health (both the state of people’s health and health services). The health system of the country shows severe spatial inequalities that are manifested at provincial, district and even local levels. This research therefore examines and analyses the spatial inequalities and temporal variation of health conditions in Zimbabwe. Composite indices were used to determine the people’s state of health in Zimbabwe. Administrative districts were ranked according to the level of people’s state of health. Cluster analysis was also performed to demarcate administrative districts according the level of health service provision. Districts with minimum difference were demarcated in a single cluster. Clusters were delineated using data on patterns of diseases and health and such clusters were used to demarcate the country’s spatial health system according to the Adapted Epidemiological Transition Model. This was used to evaluate the applicability of the model to Zimbabwe. It emerged from the research that generally the country’s health conditions are poor and the health system is characterised by severe spatial inequalities. Some districts are experiencing poor health service provision and serious health challenges and are still in the age of pestilence and famine but others have good health service provision as well as highly developed health conditions and are in the age degenerative diseases of the epidemiological transition model. It further emerged that the country’s health has been evolving with signs of improvement since the 1990s. Recommendations were made regarding possible adjustment to previous strategies and policies used in Zimbabwe, for the development of the health system of the country. New strategies were also recommended for the improvement of the health system of the country. Some proposals are made for further research on the spatial development of health in the country.
Geography
D. Litt et. Phil. (Geography)

Text in English
South Africa is currently in the process health care reform as the Government has undertaken the task of providing universal health care to all South Africans through the implementation of the National Health Insurance Scheme (NHI). This study took an in-depth look at the history and progression of the post-1994 South African health care policy, and applied the Power Resources Theory to the political economy of the current health care reform process in South Africa. Through a comparative study of the pivotal elements in the phases of health reform in Canada and Sweden this study drew lessons for the design and implementation of universal public health care provision in South Africa. This study found that a strong culture of care, strong political will, active civil society participation and a focus on equality as opposed to poverty in the creation of policy is essential to a successful implementation of universal health care.
Sociology
M.A. (Sociology)

Text in English
South Africa is currently in the process health care reform as the Government has undertaken the task of providing universal health care to all South Africans through the implementation of the National Health Insurance Scheme (NHI). This study took an in-depth look at the history and progression of the post-1994 South African health care policy, and applied the Power Resources Theory to the political economy of the current health care reform process in South Africa. Through a comparative study of the pivotal elements in the phases of health reform in Canada and Sweden this study drew lessons for the design and implementation of universal public health care provision in South Africa. This study found that a strong culture of care, strong political will, active civil society participation and a focus on equality as opposed to poverty in the creation of policy is essential to a successful implementation of universal health care.
Sociology
M.A. (Sociology)

This empirical and theological research investigates the self-conception of the east-german women in the Brethren Movement, in order to discover by which role model they predominantly orientated themselves. Therefore women were interviewed, who are – on one hand – socialised in the Brethren Movement, and on the other hand have partly realized the GDR role model through working in a typically male business and/or in a leading position. It was possible to describe in that study three contrasting typologies. On that foundation, thesis and conclusions were drawn for the development of identity and the operation of the church. This project wants to make a contribution to the investigation of the –almost untouched academically – field of the women in the Brethren Movement. At the same time it should serve as an historical example in how the church dealt with changing role models.
In dieser Forschungsarbeit wird das Selbstverständnis der ostdeutschen Frauen in der Brüderbewegung empirisch-theologisch untersucht, um herauszufinden, an welchem der beiden divergierenden Rollenbilder (DDR-Gesellschaft oder Brüderbewegung) sich diese Frauen stärker orientieren. Dazu wurden Frauen interviewt, die einerseits in der Brüderbewegung sozialisiert sind, und andererseits durch ihre Berufstätigkeit in einem männertypischen Beruf und/oder in Leitungspositionen das DDR-Rollenbild teilweise umgesetzt haben. Im Verlauf dieser Studie ließen sich drei kontrastierende Typologien von Selbstbildern erkennen. Auf dieser Grundlage wurden Schlussfolgerungen und Thesen über die Identitätsfindung der Frauen und ihre gelebte Gemeindepraxis gezogen. Mit der Betrachtung der Frauen in den Brüdergemeinden will diese qualitative Studie einen Beitrag dazu leisten, neue Erkenntnisse aus einem wissenschaftlich bisher kaum erforschten Gebiet zu gewinnen. Gleichzeitig soll die vorliegende Studie anhand dieses historischen Beispiels den Umgang einer Gemeinde mit sich verändernden Rollenbildern zeigen.
Christian Spirituality, Church History and Missiology
M. Th. (Missiology)

This empirical and theological research investigates the self-conception of the east-german women in the Brethren Movement, in order to discover by which role model they predominantly orientated themselves. Therefore women were interviewed, who are – on one hand – socialised in the Brethren Movement, and on the other hand have partly realized the GDR role model through working in a typically male business and/or in a leading position. It was possible to describe in that study three contrasting typologies. On that foundation, thesis and conclusions were drawn for the development of identity and the operation of the church. This project wants to make a contribution to the investigation of the –almost untouched academically – field of the women in the Brethren Movement. At the same time it should serve as an historical example in how the church dealt with changing role models.
In dieser Forschungsarbeit wird das Selbstverständnis der ostdeutschen Frauen in der Brüderbewegung empirisch-theologisch untersucht, um herauszufinden, an welchem der beiden divergierenden Rollenbilder (DDR-Gesellschaft oder Brüderbewegung) sich diese Frauen stärker orientieren. Dazu wurden Frauen interviewt, die einerseits in der Brüderbewegung sozialisiert sind, und andererseits durch ihre Berufstätigkeit in einem männertypischen Beruf und/oder in Leitungspositionen das DDR-Rollenbild teilweise umgesetzt haben. Im Verlauf dieser Studie ließen sich drei kontrastierende Typologien von Selbstbildern erkennen. Auf dieser Grundlage wurden Schlussfolgerungen und Thesen über die Identitätsfindung der Frauen und ihre gelebte Gemeindepraxis gezogen. Mit der Betrachtung der Frauen in den Brüdergemeinden will diese qualitative Studie einen Beitrag dazu leisten, neue Erkenntnisse aus einem wissenschaftlich bisher kaum erforschten Gebiet zu gewinnen. Gleichzeitig soll die vorliegende Studie anhand dieses historischen Beispiels den Umgang einer Gemeinde mit sich verändernden Rollenbildern zeigen.
Christian Spirituality, Church History and Missiology
M. Th. (Missiology)