Tesis: "Environmental and social health inequalities"

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Brijbag, Brian S. "Southern Chivalry: Perception of Health & Environmental Justice in a Small Southern Neighborhood". Scholar Commons, 2015. http://scholarcommons.usf.edu/etd/5821.

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This paper analyzes heath risk and how it is communicated to, and understood within, a predominantly African American neighborhood in central Florida. Residents accuse the county department of public works of purposeful contamination and discrimination over a period of 30 years. I raise the questions of how risk is perceived and what roles race or class may play. I also developed a model for risk communication that includes all stakeholders. Finally, I expand the conversation of health disparities to include issues of widening gaps in perceptions of health. This was examined by looking at the following: 1. The lack of documentation into the subjectivity of the health risk assessment process - i.e. the critique of science 2. The differing modes for creating, communicating, and receiving risk in which the resident's perspective is not valued - i.e. the critique of power 3. The impact of race and class on furthering inequities and disparities in the environmental health risks message - i.e. the critique of policy. Underlining Key Factors: 1. The residents of Mitchell Heights (emic) perceive the contamination at the former Hernando County Department of Public Works site differently than the experts/officials (etic). 2. Race and class are factors in both the perception of risk and the communication of risk for the residents and the experts. 3. Policy concerning the determination and subsequent communication of risk is primarily concerning with the perspective of scientific data. Recommendations: 1. As it relates to assessing environmental risks, there needs to be a development of a more holistic set of methodologies that incorporate diverse perspectives in a bi-directional knowledge exchange. This should allow for acceptable risk to be understood as co-created through negotiation and compromise between the measured and lived experiences. Ethnographic methods should partner with epidemiology and environmental sciences. 2. Once these mixed-method, holistic methodologies are field-tested, they need to be adopted as formal procedure by agencies responsible for the analysis and communication of risks. Risk should include the technical and the relational. 3. Policymakers must widen their understanding of what constitutes "policy relevant knowledge." In addition, policies targeted at eliminating health disparities and inequalities need to value the broad differences the often exist in perceiving "health."

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2

Loh, Hui Yee. "The Contribution of the Neighbourhood Environment to the Relationship Between Neighbourhood Disadvantage and Physical Function Among Middle-Aged to Older Adults". Thesis, Australian Catholic University, 2018. https://acuresearchbank.acu.edu.au/download/f874dd1116560426fc11fffab625631c655ea1a636cb03fb913415437e2378c7/11526170/LOH_2018_The_contribution_of_the_neighbourhood_environment.pdf.

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Background With the continuing increases in life expectancies in developed countries, an important public health goal is to ensure successful ageing—morbidity compression, maintenance of physical functioning and active engagement in life. It is well established that the onset of physical function decline begins in mid-life, and functional capacity is critical to maintaining mobility, independence and quality of life. A growing body of literature has found that residents of more disadvantaged neighbourhoods have significantly poorer physical function, independent of individual-level factors. However, the mechanisms through which neighbourhood environments are associated with this relationship remain largely unknown. The overarching aim of this thesis was to investigate the contributions of the neighbourhood environment to the relationship between neighbourhood disadvantage and physical function among middle-aged to older adults: this was accomplished in three studies. First, I examined the relationship between neighbourhood disadvantage and physical function in the Australian context (Study One). Second, I investigated if this relationship is explained by neighbourhood-level perceptions of safety from crime and walking for recreation (Study Two). Third, I examined the contribution of neighbourhood walkability and walking for transport to the relationship between neighbourhood disadvantage and physical function (Study Three). Methods This program of research utilized secondary data from the How Areas in Brisbane Influence HealTh and AcTivity (HABITAT) study. HABITAT is a multilevel longitudinal study underpinned by a social ecological framework. It was conducted in Brisbane among adults aged 45-70 years living in 200 neighbourhoods. HABITAT commenced in 2007 and had subsequent data collection waves in 2009, 2011, 2013 and 2016. For this thesis, the 2013 data were utilised as physical function was first collected in 2013 (n= 6,520). The measure of neighbourhood disadvantage was derived from the Australian Bureau of Statistics’ (ABS) Index of Relative Socioeconomic Disadvantage (IRSD) scores. Physical function was measured using the Physical Function Scale (0 – 100), a component of the Short Form-36 Health Survey, with higher scores indicating better function. In Study Two, participants self-reported their perceptions of safety from crime using items from the Neighbourhood Environment Walkability Scale (NEWS) questionnaire, which were subsequently aggregated to the neighbourhood-level. Walking for recreation (minutes per week) was self-reported by participants. In Study Three, neighbourhood walkability measures (street connectivity, dwelling density and land use mix) was objectively measured and provided by the Brisbane City Council (the local government authority responsible for the jurisdiction covered by the HABITAT study). Walking for transport (minutes per week) was self-reported by participants. The data were analysed using multilevel regression models (linear, binomial or multinomial). In instances where multilevel categorical models are undertaken, Markov chain Monte Carlo (MCMC) simulation will be employed to estimate odds ratio and 95% credible intervals. All data were prepared in STATA SE 13 and analyses were conducted using MLwiN version 2.35. Results Findings from Study One found that residents of more disadvantaged neighbourhoods had significantly poorer physical function. These associations remained significant after adjustment for individual-level socioeconomic position (SEP). Moving forward from the descriptive findings, Study Two found that neighbourhood-level perceptions of safety from crime and walking for recreation partly explained (24% in men and 25% in women) neighbourhood differences in physical function. In Study Three, I found that neighbourhood walkability and walking for transport did not explain the relationship between neighbourhood disadvantage and physical function. Conclusion Given the growing proportion of the ageing population in Australia and the resultant increasing pressure on neighbourhood and city infrastructure in Australia, it is important to understand the contributions of the neighbourhood environment in the relationship between neighbourhood disadvantage and physical function. Despite the complexity in understanding neighbourhood socioeconomic differences in physical function, the findings of this thesis suggest that the neighbourhood in which we live is important to physical function. To reduce neighbourhood inequalities in physical function, attention needs to be given to improve the perceptions of safety from crime in more disadvantaged neighbourhoods to encourage more walking for recreation. Living in a walkable neighbourhood is important to support more walking for transport, but may not be sufficient to reduce neighbourhood inequalities in physical function. A multi-faceted intervention is needed to create a healthy, liveable and equitable community for successful ageing.

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Lalloué, Benoit. "Méthodes d'analyse de données et modèles bayésiens appliqués au contexte des inégalités socio-territoriales de santé et des expositions environnementales". Thesis, Université de Lorraine, 2013. http://www.theses.fr/2013LORR0205/document.

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Cette thèse a pour but d'améliorer les connaissances concernant les techniques d'analyse de données et certains modèles bayésiens dans le domaine de l'étude des inégalités sociales et environnementales de santé. À l'échelle géographique de l'IRIS sur les agglomérations de Paris, Marseille, Lyon et Lille, l'événement sanitaire étudié est la mortalité infantile dont on cherchera à expliquer le risque avec des données socio-économiques issues du recensement et des expositions environnementales comme la pollution de l'air, les niveaux de bruit et la proximité aux industries polluantes, au trafic automobile ou aux espaces verts. Deux volets principaux composent cette thèse. Le volet analyse de données détaille la mise au point d'une procédure de création d'indices socio-économiques multidimensionnels et la conception d'un package R l'implémentant, puis la création d'un indice de multi-expositions environnementales. Pour cela, on utilise des techniques d'analyse de données pour synthétiser l'information et fournir des indicateurs composites utilisables directement par les décideurs publics ou dans le cadre d'études épidémiologiques. Le second volet concerne les modèles bayésiens et explique le modèle « BYM ». Celui-ci permet de prendre en compte les aspects spatiaux des données et est mis en oeuvre pour estimer le risque de mortalité infantile. Dans les deux cas, les méthodes sont présentées et différents résultats de leur utilisation dans le contexte ci-dessus exposés. On montre notamment l'intérêt de la procédure de création d'indices socio-économiques et de multi-expositions, ainsi que l'existence d'inégalités sociales de mortalité infantile dans les agglomérations étudiées
The purpose of this thesis is to improve the knowledge about and apply data mining techniques and some Bayesian model in the field of social and environmental health inequalities. On the neighborhood scale on the Paris, Marseille, Lyon and Lille metropolitan areas, the health event studied is infant mortality. We try to explain its risk with socio-economic data retrieved from the national census and environmental exposures such as air pollution, noise, proximity to traffic, green spaces and industries. The thesis is composed of two parts. The data mining part details the development of a procedure of creation of multidimensional socio-economic indices and of an R package that implements it, followed by the creation of a cumulative exposure index. In this part, data mining techniques are used to synthesize information and provide composite indicators amenable for direct usage by stakeholders or in the framework of epidemiological studies. The second part is about Bayesian models. It explains the "BYM" model. This model allows to take into account the spatial dimension of the data when estimating mortality risks. In both cases, the methods are exposed and several results of their usage in the above-mentioned context are presented. We also show the value of the socio-economic index procedure, as well as the existence of social inequalities of infant mortality in the studied metropolitan areas

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Lutters, Marie-Claire. "Explaining the Occupational Class Gradient in Health Among Swedish Employees: Physical and Psychosocial Work-Related Stressors". Thesis, Stockholms universitet, Institutionen för folkhälsovetenskap, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-157309.

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The work environment constitutes a key social determinant of health, yet previous research is relatively limited vis-à-vis the contribution of both physical and psychosocial work-related stressors on occupational class differences in health among Swedish employees. This study used cross-sectional data from the Swedish Level of Living Survey 2010 to assess the mediating effect of physical and psychosocial work-related stressors to occupational class differences in physical and mental ill health in Sweden. Disparities between gender were also considered. A sub-sample of 2,624 full- and part-time employed individuals aged 18-65 was analysed using logistic regression. Employees who belonged to higher occupational classes had a lower risk of physical ill health compared to employees from lower occupational classes when age, gender and part-time work is accounted for – but there was no evidence of an occupational class gradient in mental ill health. Similar results were observed among men and women. In line with previous research, differential exposure to physical work-related stressors explained most of the occupational class gradient in physical ill health, yet certain psychosocial work-related stressors were also influential. Future research should further examine what other work-related factors – or social determinants of health – can help explain the association between occupational class and mental health.

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5

Letellier, Noémie. "Déterminants sociaux et professionnels de la cognition". Thesis, Montpellier, 2019. http://www.theses.fr/2019MONTT044.

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Le vieillissement cognitif est un processus lent et progressif influencé par de nombreux facteurs individuels mais aussi contextuels, dont les conditions de travail et les caractéristiques de l’environnement résidentiel. Cependant, l’impact de ces expositions environnementales sur la cognition reste largement sous-étudié. L'objectif principal de cette thèse est d’étudier le rôle des déterminants sociaux et professionnels dans la cognition en population générale, en France. La mise en place en 2012 de la cohorte Constances permet d'étudier cette problématique de façon transversale sur une population âgée de 45 à 70 ans (~70 000 participants), la cohorte 3C (9 294 participants) quant à elle, nous permet d’analyser sous l’angle social une population âgée de plus de 65 ans suivie depuis les années 2000. Nous avons montré dans ces deux populations différentes, un effet des caractéristiques socioéconomiques du lieu de résidence sur le niveau de performances cognitives et le risque de démence, indépendamment du niveau socioéconomique individuel et de nombreuses autres caractéristiques individuelles. Dans Constances, nous avons observé que les performances cognitives sont précocement associées à une exposition professionnelle aux produits chimiques (solvants et formaldéhyde), indépendamment des caractéristiques individuelles et des facteurs de pénibilité au travail. Ces résultats suggèrent que les environnements dans lesquels nous vivons, l'environnement socio-économique et/ou l'environnement de travail, ont un impact sur le niveau de performances cognitives et la survenue de démence, et peuvent être source d’inégalités sociales de santé dans le domaine du vieillissement cognitif
Cognitive aging is a slow and progressive process influenced by many individual and contextual factors, including working conditions and residential environment characteristics. However, the impact of these environmental exposures on cognition remains largely under-studied. The main objective of this thesis is to study the role of social and occupational determinants on cognition, in the general French population. The implementation in 2012 of the Constances cohort allows us to study this issue on a population aged 45 to 70 years (~70,000 participants) in cross-sectional, while the 3C cohort (9,294 participants) allows us to analyze from a social perspective a population aged over 65 years followed since the 2000s. We have observed in these two different populations, an effect of socio-economic characteristics living environment on cognitive performances and risk of dementia, independently of individual socio-economic level and many other individual characteristics. In Constances, we have shown that cognitive performances is early associated with occupational exposure to chemicals (solvents and formaldehyde), regardless of individual characteristics and working conditions. These results suggest that living environments, socio-economic and/or work environment, have an impact on cognitive performances level and dementia, and can be a source of social health inequalities in cognitive aging

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Bouhadj, Laakri. "Développement d'outils de gestion pour la prise en compte des enjeux de santé dans les opérations d'aménagement urbain : atténuation des vulnérabilités et renforcement de la résilience des systèmes territoriaux". Electronic Thesis or Diss., Université de Lille (2022-....), 2023. http://www.theses.fr/2023ULILS046.

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La conception de nos villes et régions est déterminante pour notre santé et bien-être. Elle impacte notamment la qualité de notre cadre de vie, de l'air que nous respirons, de l'eau que nous buvons, notre accès aux espaces verts, aux services de santé et aux opportunités d'emplois (OMS & ONU, 2021). En effet, notre santé est influencée par de nombreux facteurs qui dépassent le simple domaine de la pathologie. L'enjeu de cette thèse est de développer un outil d'aide à la décision dont les acteurs locaux pourront se saisir pour une meilleure prise en compte de la santé dans les plans, documents et projets d'urbanisme et d'aménagement.Le premier objectif de la thèse est de caractériser les Inégalités Environnementales et Sociales de Santé (IESS) à l'échelle infra-communale sur le périmètre du Schéma de Cohérence Territoriale (SCoT) de la Métropole Européenne de Lille (MEL). Une revue de la littérature ainsi que des ateliers thématiques avec des acteurs locaux et régionaux ont été organisés et un cadre méthodologique a été proposé pour la construction d'indices composites spatialisés de vulnérabilité et de résilience. De plus, une méthodologie d'analyse des profils des catégories de territoires, résultant de l'interprétation conjointe des deux indices, a été développée.Le second objectif est d'accompagner et de favoriser la prise en compte des enjeux de santé dans les projets d'aménagement urbain en proposant une approche expérimentale appliquée sur deux projets d'aménagement. L'analyse approfondie des enjeux de santé environnementale dans les deux quartiers, ainsi que la contribution du groupe de travail composé des deux équipes de projet et les observations sur le terrain, ont permis de mieux comprendre les facteurs de vulnérabilité et de résilience présents dans ces quartiers. Cela a également permis d'évaluer l'impact du projet d'aménagement sur ces quartiers et de proposer une modélisation théorique des perspectives d'amélioration pour les deux propositions d'aménagement.Les résultats obtenus mettent en évidence l'importance de prendre en compte non seulement les facteurs de vulnérabilité et de résilience des territoires dans l'analyse de IESS, mais également la dimension spatiale. La division du SCoT en zones homogènes faciliterait la compréhension de la dynamique des IESS à une échelle fine. L'exploitation des indices composites à l'échelle d'un projet d'aménagement met en évidence la question de la transversalité et de l'impact de toutes les dimensions impliquées. À cette échelle, les indices composites permettent d'avoir une vision globale des enjeux au sein d'un quartier, ils soulèvent également les limites des politiques d'aménagement pour la réduction des IESS
The design of our cities and regions is crucial for our health and well-being. It notably impacts the quality of our living environment, the air we breathe, the water we drink, our access to green spaces, healthcare services, and employment opportunities (OMS & ONU, 2021). Indeed, our health are influenced by numerous factors that go beyond the scope of pathology alone. The focus of this thesis is to develop a decision support tool that local actors can use to better consider health in urban planning and development plans, documents, and projects.The first objective of the thesis is to characterize the environmental and social health inequalities (ESHI) at the sub-municipal level within the perimeter of the European metropolis of Lille's Territorial Coherence Scheme. A literature review and thematic workshops involving local and regional stakeholders were organized, and a methodological framework was proposed for constructing spatialized composite indices of vulnerability and resilience. Furthermore, a methodology for analyzing the profiles of territory categories resulting from the joint interpretation of the two indices was developed.The second objective is to support and promote the consideration of health issues in urban development projects by proposing an experimental approach applied to two development projects. The in-depth analysis of environmental health issues in the two neighborhoods, along with the contribution of the working group composed of the two project teams and field observations, helped to better understand the factors of vulnerability and resilience present in these neighborhoods. It also enabled the evaluation of the impact of the development project on these neighborhoods and the proposal of a theoretical modeling of improvement prospects for the two development proposals.The obtained results highlight the importance of considering not only the vulnerability and resilience factors of territories but also the spatial dimension. Dividing the European metropolis of Lille's Territorial Coherence Scheme into homogeneous zones would facilitate understanding the dynamics of ESHI at a fine scale. The use of composite indices at the scale of a development project brings to light the issue of transversality and the impact of all involved dimensions. At this scale, composite indices provide an overall vision of the issues within a neighborhood, they also reveal the limitations of development policies for reducing ESHI

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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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8

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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Solé, Juvés Meritxell. "Working conditions and health: Evidence on inequalities in Spain". Doctoral thesis, Universitat de Barcelona, 2014. http://hdl.handle.net/10803/145835.

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This thesis is concerned with the relationship between disability and working conditions. In the first two chapters we investigate how past and current working conditions, in conjunction with other socio-demographic variables, contribute to disability. We focus on differences by migrant status (first chapter) and by period or cohort (second chapter) specifically, by comparing successive cohorts of young people aged 25 to 34. In the third chapter we take up the opposite perspective and we analyse the effect of permanent disability on the working life of the individual. The main result of the first chapter is that migrant status – with differences among regions of origin – significantly affects both disability and the probability of being employed in a high-risk occupation. In spite of immigrants’ working conditions being objectively worse, they exhibit lower probability of becoming disabled than natives because the impact of such conditions on disability is much smaller in their case. Our results also suggest that not only the risks of illness and injury, widely recognized, involve higher rates of disability. Unskilled labour and employment instability are also associated with increased risks of disability and its impact is greatest among later-born cohorts, as the second chapter reveals. Attending to differences by cohort, job insecurity has a significant and huge impact on disability for all birth cohorts. By contrast, the effect of temporary employment “per se” is controversial without considering other factors, like the changes in Employment Protection Legislation motivated by the labour market reforms of the last two decades. Finally, the results of the third chapter show that only 10% of disabled people remain in the labour market after the occurrence of the disability. The potential disincentives to employment are controversial. While it is true that higher disability pensions are associated with lower probabilities of employment, it is also observed that, in general, wages and income decreases as a result of a disability, being the decision of remaining out of the labour market not entirely attributable to the worker and his pension level. Conversely, it is plausible that the alleged disincentives to employment come too, and largely, from the labour market. The wage gap between workers with and without IP are high and significant, and only in part can be explained by differences in productivity, so that the unexplained difference could be attributed to discrimination in the labour market against people with disability. The data sets employed in the three chapters have been elaborated from the Continuous Sample of Working Lives, known as the MCVL in Spanish (from "Muestra Continua de Vidas Laborales"), a Spanish administrative data set containing work histories of workers and pensioners available since 2004.
Esta tesis se ocupa de la relación entre incapacidad permanente y condiciones de trabajo. En los dos primeros capítulos se investiga cómo las condiciones de trabajo, junto con otras variables sociodemográficas, contribuyen a la discapacidad. Nos centramos en diferencias asociadas a la condición de inmigrante (primer capítulo) y por periodo o cohorte (segundo capítulo), mediante la comparación de sucesivas cohortes de jóvenes entre 25 y 34 años de edad. En el tercer capítulo tomamos la perspectiva opuesta y analizamos el efecto de la incapacidad permanente en la vida laboral del individuo. Los resultados del primer capítulo indican que la condición de migrante - con diferencias por región de origen - tiene efectos significativos en la discapacidad y la probabilidad de estar empleado en una ocupación de alto riesgo. A pesar de que las condiciones de trabajo de los inmigrantes son objetivamente peores, presentan menor probabilidad de quedar discapacitados que los nativos. Nuestros resultados también sugieren que no sólo los riesgos de accidente y enfermedad profesional, ampliamente reconocidos, se asocian con probabilidades elevadas de discapacidad. Los trabajos poco cualificados y la inestabilidad en el empleo también se asocian con un mayor riesgo de discapacidad. En el segundo capítulo se muestra que el impacto de la inestabilidad laboral es mayor entre las cohortes de jóvenes actuales, si se comparan con los jóvenes en los años 80. Por último, los resultados del tercer capítulo muestran que sólo cerca del 10 % de las personas con discapacidad siguen trabajando después de la aparición de ésta. La brecha salarial entre trabajadores con y sin discapacidad es importante y significativa, y cerca del 30% de esta diferencia se atribuiría a discriminación de las personas con discapacidad. Nuestros resultados apuntan a que los efectos de esta discriminación en el empleo de las personas con discapacidad serían importantes, en particular para los hombres. Los conjuntos de datos utilizados en los tres capítulos se han elaborado a partir de la Muestra Continua de Vidas Laborales (MCVL), un conjunto de datos administrativos que contiene las historias laborales de los trabajadores y pensionistas desde 2004 .

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Carrillo, Alvarez Elena. "Empirical approach to the effect of social capital on the lifestyle, eating habits and weight status of a sample of Catalan adolescents. A specific focus on the family environment in different socioeconomic contexts". Doctoral thesis, Universitat Ramon Llull, 2016. http://hdl.handle.net/10803/352222.

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El capital social, definit com els recursos als quals es té accés gràcies a la participació en grups o xarxes, ha estat reconegut com un determinant social de la salut. No obstant, el seu efecte ha estat poc investigat en relació a l’obesitat i les conductes de salut relacionades en població adolescent. Els mecanismes a través dels quals el capital social influencia diferents aspectes de la salut no estan suficientment descrits. A més, un espai poc explorat en l’estudi del capital social és el context familiar. L’objectiu general d’aquesta tesi doctoral és, doncs, investigar l’efecte del capital social en l’estil de vida, hàbits alimentaris i estatus ponderal d’una mostra d’adolescents catalans de diferents contextos socioeconòmics, amb un focus específic en l’entorn familiar. Els resultats indiquen que els diferents constructes del capital social actuen de manera separada i ens han permès caracteritzar alguns dels diversos mecanismes a través dels quals influeixen en l’estil de vida i conductes de salut en adolescents. Així mateix, en el marc d’aquesta recerca, alts nivells de capital social familiar són el factor més protector vers als indicadors de salut estudiats, i la seva influencia preval sobre el nivell socioeconòmic com a principal predictor social de salut en el nostre estudi. Investigacions futures haurien de contribuir a redefinir el paper del capital social en diferents àmbits, especialment el familiar, com a determinant social de la salut en els adolescents i en relació a altres determinants de la salut.
El capital social, definido como los recursos a los cuales se tiene acceso gracias a la participación en grupos o redes, ha sido reconocido como un determinante social de la salud. Sin embargo, su efecto ha sido poco investigado en relación a la obesidad y las conductas de salud relacionadas en población adolescente. Los mecanismos a través de los cuales el capital social influencia diferentes aspectos de la salud no están suficientemente descritos. Además, un espacio poco explorado en el estudio del capital social es el contexto familiar. El objetivo general de esta tesis doctoral es, pues, investigar el efecto del capital social en el estilo de vida, hábitos alimentarios y el estado ponderal de una muestra de adolescentes catalanes de diferentes contextos socioeconómicos, con un foco específico en el entorno familiar. Los resultados indican que los diferentes constructos del capital social actúan de forma separada y nos han permitido caracterizar alguno de los diversos mecanismos a través de los cuales influyen en el estilo de vida y conductas de salud en adolescentes. Así mismo, en el marco de esta investigación. Altos niveles de capital social familiar son el factor más protector hacia los indicadores de estudiados, y su influencia prevalece sobre el nivel socioeconómico como principal predictor social de salud en nuestro estudio. Investigaciones futuras deberían contribuir a redefinir el papel del capital social en diferentes ámbitos, especialmente el familiar, como determinante social de la salud en los adolescentes y en relación a otros determinantes de la salud.
Social capital, described as the resources that can be accessed thanks to the membership in groups or networks, has been recognized as social determinant of health. However, its effect has been little investigated in relation to obesity and its health related behaviors and in adolescent population. The pathways through which it influences different health outcomes are not sufficiently described. Furthermore, one glaring gap in the social capital related literature is the family domain. Thus, the overall aim of this dissertation is to investigate the effect of social capital on the lifestyle, eating habits and weight status of a sample of Catalan adolescents from different socioeconomic context, with a specific focus on the family environment. Results show that the different constructs of social capital act separately and have allowed to characterize some of the several mechanisms through which they influence lifestyle and health behaviors in adolescents. In the framework of this research, higher levels of social capital in the family domain are the most protective factor for the health outcomes included in this investigation, and its influence on health outplace socioeconomic status as the main social predictor of health in our study. Further research should contribute to refine the role of social capital in different domains, especially the family context, as a social determinant of health in adolescents and in relation to other determinants of health.

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11

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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12

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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13

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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14

Dhesi, Surindar. "Exploring how Health and Wellbeing Boards are tackling health inequalities with particular reference to the role of environmental health". Thesis, University of Manchester, 2014. https://www.research.manchester.ac.uk/portal/en/theses/exploring-how-health-and-wellbeing-boards-are-tackling-health-inequalities-with-particular-reference-to-the-role-of-environmental-health(da084261-1937-4da4-94a8-4d10f1d69ffb).html.

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Health and Wellbeing Boards (HWBs) are new local government (LG) sub-committees tasked with assessing local health and social care needs, and developing strategies for promoting integration and tackling health inequalities; yet they have no statutory authority to compel action. This research explored how they approached tackling health inequalities, focussing on the role of environmental health (EH), the LG public health occupation, in the pre-shadow and shadow stages and as they went live in April 2013. Four case study sites (based around individual HWBs) were purposively sampled to ensure that a variety of HWBs were included, including unitary and two-tier authorities and urban, suburban and rural areas. Data collection at each case study site included semi-structured interviews, observation of HWB meetings, and documentary analysis and extended for 18 months from early 2012. In addition, EH practitioners and managers were interviewed from each of the English regions to provide a wider context. The data was analysed thematically both inductively and deductively using Atlas.ti. and conclusions drawn. HWBs were varied in their structures, practices and intentions and some changed considerably during the research, as would be expected at a time of new policy development and implementation. There was evident commitment and enthusiasm from HWB members to improve the health of local populations. However it is unclear what ‘success’ will be or how it will be measured and attributed to the work of the HWB, and there were some tensions between the various parties involved. There was an espoused commitment to the principles of Marmot, in particular to children, however much of the focus during HWB meetings was on integrating health and social care. Taking action on many of the social determinants of health is outside the core sphere of HWB control, however they did not generally appear to be utilising some of the readily available tools, such as EH work to improve local living and working conditions. EH was found to be largely ‘invisible’ within its own public health community and does not have a tradition of evidence based practice needed to secure funding in the new system. This, along with the decline of the regulatory role, has led to a period of reflection and adaptation. The research findings are linked by the policy approaches of ‘doodle’ and localism, including the shrinking of the state, and in particular the retreat of statutory and regulatory roles and the introduction of overt political values in policy making; shifting the focus to relationships, partnership-building, integration and the impact of individuals. The contexts in which the research has taken place, both at local and national levels, including financial austerity, major health restructuring, and high national and local expectations are all significant factors which have shaped the findings.

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15

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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16

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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17

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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18

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.

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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 Mozambique
Aquesta 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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19

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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20

Sheriff, Shiraz. "Exploring the socio-environmental context in the prevalence and management of asthma at Scottish General Practices". Thesis, University of Dundee, 2016. https://discovery.dundee.ac.uk/en/studentTheses/a2bf7f0b-c376-45bf-9dcf-5e54c661a54f.

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Worldwide, asthma is a chronic condition which is prevalent and neglected and Scotland has a high prevalence of asthma compared to the rest of the world. In their report on the global burden of asthma, the Global Initiative for Asthma (GINA) Program ranks Scotland as having the highest asthma prevalence in the world, with almost one in every five people affected and 6.3 % of the population in Scotland are seeking treatment at General Practices. The aetiology of asthma is complex and it remains a persistent and chronic problem affecting many people, and prevention and treatment are not working. This thesis makes a unique contribution utlising an interdisciplinary approach from Geography and Public Health to explore the nature and role of the socio-environmental context in relation to the prevalence and management of asthma at Scottish General Practices located in areas of dissimilar deprivation levels. The key focus of the research is the way that health professionals (and related stakeholders) understand the factors that shape the causation and prevalence of asthma (including social and environmental contexts), and how this in turn shapes their management of the condition in their practice. Aim: The overall aim of this research is identify, understand and interpret the nature and role of the socio-environmental context in relation to asthma prevalence and management at the Scottish primary care setting. Methods: The research employed quantitative analysis of a secondary dataset on asthma and a case study analysis of two General Practices located in areas of dissimilar deprivation levels in Scotland. Practices were selected after quantitative data analysis comparing the deprivation scores (SIMD) against crude prevalence rates of asthma. The case study employed in-depth semi-structured interviews with stakeholders involved in asthma care. The results of the study contributed to the understanding of what a conventional deprivation measure does/ does not reveal about asthma–place contexts. It also gave insights on how health professionals perceived their area, patient population and how they integrated these perceptions it into their practice as their understanding or lack of understanding or their inability to act upon their understanding on the importance of the socio-environmental context was one of key factors that shape their management of asthma. The study concluded imparting policy implications and renewed approaches to asthma care and management practices within the Health Services.

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21

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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22

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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23

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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24

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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25

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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27

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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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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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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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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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.
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32

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.
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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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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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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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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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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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39

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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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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Jutz, Regina [Verfasser] y 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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CONSOLAZIO, DAVID. "Social and Spatial Inequalities in Health in Milan: the Case of Type 2 Diabetes Mellitus". Doctoral thesis, Università degli Studi di Milano-Bicocca, 2020. http://hdl.handle.net/10281/263136.

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La presente tesi di dottorato si propone di indagare lo stato delle disuguaglianze di salute nella città di Milano. Si parla di disuguaglianze di salute in presenza di differenze negli stati di salute delle persone all’interno di una popolazione, o tra gruppi di individui, quando queste sono attribuibili alle condizioni socioeconomiche delle persone, in virtù dell’iniqua distribuzione di risorse sociali, economiche, culturali e relazionali che consentono a ciascuno di raggiungere il proprio potenziale di salute. In aggiunta, il raggiungimento di uno stato di salute ottimale può essere influenzato anche dalle caratteristiche materiali e psicosociali del contesto di residenza, esponendo coloro che vivono in contesti svantaggiati a maggiori rischi per la loro. Muovendo dai presupposti teorici e concettuali della Fundamental Causes Theory e dall’approccio alla salute basato sui determinanti sociali questo lavoro si pone l’obiettivo di fornire una mappatura della distribuzione delle condizioni di salute all’interno del territorio milanese, contribuendo altresì al dibattito circa la presenza di neighbourhood effects sulla salute. Il lavoro svolto si basa sull’utilizzo di un approccio interdisciplinare, nel quale si fa ricorso a metodi e strumenti di tipo sociologico, epidemiologico, e geografico. Uno studio dettagliato della distribuzione sociale e territoriale di una patologia nei diversi quartieri della città è ad oggi assente, abbiamo dunque deciso di concentrarci sul Diabete Mellito di Tipo 2 alla luce della sua tipica associazione sia con le condizioni socioeconomiche individuali che con le caratteristiche dell’ambiente di vita. Facendo ricorso all’utilizzo inedito di dati amministrativi del sistema sanitario forniti dall’Unità di Epidemiologia dell’Agenzia di Tutela della Salute della Città Metropolitana di Milano, in combinazione con i dati provenienti dall’ultimo censimento della popolazione italiana, abbiamo condotto uno studio caso-controllo multilivello, con l’obiettivo di esaminare l’impatto relativo delle condizioni socioeconomiche individuali e del quartiere di residenza sul rischio di sviluppare la patologia in esame. I risultati hanno confermato la presenza di un gradiente sociale nella patologia, con una più alta prevalenza rintracciabile nelle persone con titolo di studio più basso. È stata inoltre riscontrata un’eterogeneità nella distribuzione territoriale della patologia, la quale non viene tuttavia spiegata unicamente dalle condizioni socioeconomiche individuali: l’associazione tra condizioni socioeconomiche del quartiere di residenza e rischio di sviluppo del Diabete Mellito di Tipo 2 risulta infatti essere statisticamente significativa anche controllando per le variabili individuali, suggerendo un ruolo del contesto di residenza nel plasmare l’esposizione al rischio indipendentemente dalla concentrazione di individui con caratteristiche simili nelle stesse aree. In linea con la letteratura di riferimento, è stato riscontrato che le caratteristiche individuali giocano un ruolo predominate nel determinare l’esposizione, ciononostante il quartiere dove le persone vivono esercita un effetto non trascurabile sulla salute e necessita di essere tenuto in considerazione nello sviluppo di politiche volte a contrastare l’incidenza della patologia e a ridurre le disuguaglianze sociali connaturate alla sua insorgenza. Pur essendo parzialmente in grado di mitigare le disparità in ambito di gestione della patologia e qualità delle cure, è evidente che il sistema sanitario da solo non può essere in grado di porre rimedio alle disuguaglianze sociali esistenti nel Diabete Mellito di Tipo 2, evidenziando il bisogno di interventi più ampi capaci di agire sulla struttura che contribuisce a generare e perpetuare le disuguaglianze sociali e territoriali in relazione alla patologia.
This PhD dissertation is aimed at studying health inequalities in the Italian city of Milan. Health inequalities can be defined as differences in people’s health across the population and between population groups, which are attributable to individuals’ socioeconomic status as a consequence of the uneven distribution of social, economic, cultural, and relational resources that enable people to reach their health potential (Sarti et al., 2011). Moreover, people’s health may also be affected by psychosocial and physical characteristics of the local environment in which they live, so that those living in disadvantaged areas may be at a higher risk of being subjected to worse health conditions (Macintyre and Ellaway, 2000; 2003). Moving from the theoretical and conceptual foundations of the Fundamental Causes Theory (Link and Phelan 1995; Phelan et al., 2010) and the Social Determinants of Health approach ( Solar and Irwin, 2010; Wilkinson and Marmot, 2003) this work intends to provide both an accurate mapping of the distribution of health conditions within the Milanese territory – and its association with individual and contextual socioeconomic status – and to contribute to the debate on the presence of neighbourhood effects on health (Diez-Roux, 2004; Galster, 2012). We thus relied on an interdisciplinary approach, making use of tools and methods from sociology, epidemiology, and geography. A fine-grained study of disease distribution among the neighbourhoods of the city of Milan was missing, and we opted to focus on Type 2 Diabetes Mellitus in light of its typical association with both individual socioeconomic conditions (Agardh et al., 2011) and environmental characteristics (Den Braver et al., 2018). Relying on the unprecedented use of administrative healthcare data provided by the Epidemiology Unit of the Health Protection Agency of the Metropolitan City of Milan, linked with data from the most recent Italian census, we performed a multilevel case-control study, aimed at assessing the relative impact of individual and neighbourhood socioeconomic status on the risk of developing the disease. Our results confirmed the presence of a social gradient in the distribution of the disease, with an increasing prevalence in correspondence with lower educational attainment. Moreover, we found evidence of a spatial heterogeneity in the distribution of the disease, which was not entirely explained by individual socioeconomic status: the association between neighbourhood socioeconomic status and the risk of developing Type 2 Diabetes Mellitus remained statistically significant even after accounting for individual-level variables, suggesting a role of the context in shaping risk exposure independently of the clustering of individuals with similar characteristics in the same areas. In line with the existing literature, we found that individual characteristics still play a major role in explaining risk exposure, but also that the context where people live has a non-negligible effect and should be encompassed in the design of policies aimed at tackling the disease and reducing social inequalities at its onset. Despite playing a role in mitigating disparities in relation to disease management and quality of care, there is evidence that the healthcare system alone is not able to effectively tackle existing inequalities, and that broader actions intervening in the structure that contribute to the generation and perpetuation of social and spatial inequalities are needed.

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Huda, Tanvir Mahmudul. "Social determinants of inequalities in child mortality, child under-nutrition and maternal health services in Bangladesh". Thesis, The University of Sydney, 2017. http://hdl.handle.net/2123/18145.

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Introduction: In recent years the idea of inequality has been revitalised in the global discourse of development. Despite experiencing significant achievements in addressing the Millennium Development Goal, the fight against inequality remained an unfinished agenda. Disparities in child and maternal health & nutrition exist in almost every low and middle-income country. The global community is increasingly recognising the fact that while a country may be on track to achieve specific targets, the situation concerning some subgroups of the population may remain the same or even worsen over time. To address inequalities within a country, it is thus critical to understand the determinants of inequalities. Social determinants of health, which denote the economic and social conditions and their distribution among the population, have significant influences on individual health conditions. To reduce inequalities in maternal and child health and undernutrition in Bangladesh, it is thus imperative we take proper action on the social determinants of health. But the foremost task is to understand the specific role of social determinants of inequalities in the health and nutrition of the mother and the child. Objectives: Overall the research aims to examine the role of social determinants of health in explaining the inequalities in child health, child under-nutrition and maternal health services in Bangladesh. The specific objectives are to examine the role of social determinants in explaining the inequalities in childhood mortality, childhood malnutrition and maternal health services in Bangladesh. The research also aims to assess the feasibility of monitoring social determinants of health in Bangladesh and testing innovative approached to address inequality in child undernutrition. Methods: Data for Chapter 3, 4, 5 and 6, data were derived from Bangladesh Demographic and Health Surveys, while data for Chapter 7 and 8 were derived from Bangladesh Maternal Mortality and Health Care Survey 2010. Multilevel logistic regression analysis was used in Chapters 3 and 8. The study used decomposition of concentration index method to assess the contribution of social-determinants to the inequality in Chapters 4, 5, 6 and 7. The study also used horizontal inequity index (HII) to measure the horizontal inequity. For measuring the feasibility of monitoring social determinants of health and testing of a mobile-based integrated package to improve maternal and child nutrition among low-income families, the study undertook a mixed method approach. Results: Chapter 3 reported the current situation of universal health coverage in Bangladesh based on priority indicators from a suggested UHC framework. For several priority public-health interventions, the country has reached relatively high levels of coverage with greater equity. For example, Bangladesh has achieved high vaccine coverage while reducing disparities significantly between different wealth quintiles. The primary treatment coverage for diarrhoea and acute respiratory infections (ARI) has also improved. In 2011 81% of under-five children with diarrhoea were treated with ORS. Among children with ARI, 35% were taken to a health facility or a health care provider, and 71% received an antibiotic. Bangladesh’s progress with interventions to combat malnutrition has been mixed. According to the latest DHS, 90% of children are breastfed until the age two years and 64% of children less than age 6 months are exclusively breastfed. However, a mere 21% of children age 6-23 months are appropriately fed based on recommended infant and young child feeding practices. The country has done less well with specific interventions that require relatively higher clinical care, For example, the rate of delivery assisted by skilled birth attendants is only 32%. Chapter 4 examined the mortality differentials in children of different age groups by key social determinants of health (SDH). Our study reported that the mother’s age, parental education, the mother’s autonomy to make decisions about matters linked to the health of her child, the household socio-economic conditions, the geographical region of residence, and the condition of the roads were significantly associated with higher risks of neonatal, infant, and under-five mortality in Bangladesh. Chapter 5 measured the extent of socioeconomic‐related inequalities in childhood stunting and identified the key social determinants that potentially explain these inequalities in Bangladesh. The study reported significant inequality in stunting prevalence in Bangladesh. The negative concentration index of stunting indicated that stunting was more concentrated among the poor than among the well‐off. Our results suggest that inequalities in stunting increased between 2004 and 2014. Household economic status, maternal and paternal education, the health‐seeking behaviour of the mothers, sanitation, fertility, and maternal stature were the significant contributors to the disparity in stunting prevalence in Bangladesh. Chapters 6, 7 and 8 examined the inequities in access to maternal health services (facility delivery and caesarean section) and identified the key social determinants that can potentially explain such inequities. Chapter 6 reported that the use of caesarean sections for delivery is mainly driven by the social determinants of health. Household economic status; women’s education, and neighbourhood prevalence of caesarean sections contributed the most to this socioeconomic inequality. Chapter 7 reported that facility delivery in Bangladesh Nepal and Pakistan is driven mostly by the social determinants of health rather than individual health risks. Household socioeconomic condition, parental education, place of residence and parity emerged as the most critical factors. Chapter 8 reported that there is a substantial amount of variation at the community level in the use of facility delivery services. Among the community level factors place of residence, low concentration of poverty in the community, the high concentration of use of antenatal care services in the community, the high concentration of media exposure and high concentration of educated women in the community were found to be significantly associated with facility delivery. Among other individual and household level factors maternal age, educational status of the mother, religion, parity, delivery complications, individual exposure to media, individual access to antenatal care and household socioeconomic status showed strong association with facility delivery. Chapter 9 reported the relevance of a set of indicators of social determinants of health in tracking progress in universal health coverage and population health in Bangladesh and three other countries. For most countries, monitoring is possible. However, a qualitative assessment showed that technical feasibility, reliability, and validity varied across indicators and countries. Producing understandable and useful information proved challenging, and particularly so in translating indicator definitions and data into meaningful lay and managerial narratives, and efficiently communicating links to health and ways in which the information could improve decision-making. Chapter 10 tested an intervention package of voice messaging, direct counselling through mobile phones and an unconditional cash transfer for changing perceptions on nutrition during pregnancy and first year of the child’s life. The study aims to assess the feasibility and acceptability of an integrated package of nutrition counselling, and unconditional cash transfers all on a mobile platform for changing perceptions on nutrition during pregnancy and the first year of the child’s life. The study was a mixed method pilot study with 340 women. The women were either pregnant or lactating. The intervention consisted of an unconditional cash transfer combined with nutrition counselling both delivered on a mobile platform. The participants received BDT 787 per month and a mobile phone. The nutrition messages were delivered by a voice messaging service. Additional nutrition counselling were provided by a nutrition counsellor from a call centre. The poor rural women were interested both in voice messages and direct counselling. Most women reported that they had no problem in operating the mobile phones and listen to the voice messages. There were also able to interact freely with the counsellor. Charging of the mobile handsets posed some challenges. No significant barriers were identified with the use of mobile banking for cash transfers. Regarding the use of cash, our study reported that one of the highest priorities for low-income families was purchasing food. Chapter 11 describes the study protocol of a cluster randomised controlled trial that aims to assess the impact of a cash and nutrition counselling based interventions, randomised among villages with an objective of improving the nutritional status of children less than two years of age to reduce stunting. The proposed trial will provide high-level evidence of the efficacy and cost-effectiveness of a behaviour change communication intervention combined with unconditional cash transfers in reducing child undernutrition in rural Bangladesh. This trial of an innovative approach to enhancing the impact of cash transfers on child nutrition will be a leading study to guide future policies about how to reduce inequalities in child undernutrition in low income and food insecure populations. Conclusions: Health equity is considered as a critical component of progressive achievement of universal health coverage as part of the Sustainable Development Goals (SDG 3). The results of the research presented in this thesis demonstrate the importance of reducing the inequalities in social determinants of health to reduce socioeconomic inequalities in health and nutrition outcomes. There is no simple solution to tackle inequalities in the social determinants of health. The mechanisms producing social hierarchy are different in different settings so there is no strategy that will be effective for every socio-political context. It is now well established that contextual factors that produce the social hierarchy or social stratification are within people’s control. There are evidence-based actions that can address the determinants of health inequities adequately, and such steps are politically achievable. Policymakers should not limit their focus towards intermediary determinants but also try to tackle the underlying structural determinants of health inequalities. A coordinated multi-sectoral approach will be needed to combat the inequalities in the social determinant of health.

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46

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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MATOS, Inês Ferreira Pita de Campos. "The relationship between context and health inequalities: Europe and Portugal as case studies". Doctoral thesis, Instituto de Higiene e medicina Tropical, 2018. http://hdl.handle.net/10362/50901.

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As desigualdades socioeconómicas na saúde têm sido observadas há séculos por todo o mundo. Décadas de investigação identificaram múltiplos fatores que determinam estas desigualdades, como educação ou emprego. Recentemente, o foco da investigação sobre desigualdades em saúde mudou de determinantes individuais para determinantes contextuais, como as características físicas e sociais do ambiente. No entanto, a investigação sobre os determinantes contextuais depara-se com a ausência de uma base teórica sobre como estes determinantes influenciam a saúde. Portugal, sendo um dos países Europeus mais desiguais, tanto em rendimento como em saúde, é um caso de estudo interessante para o estudo das desigualdades em saúde. Esta tese procura contribuir para a compreensão do impacto dos determinantes contextuais na saúde e na sua distribuição, utilizando Portugal e a Europa como casos de estudo. Para cumprir este objetivo, foram selecionados três determinantes contextuais – capital social, regimes de bem-estar e alterações macroeconómicas – e os seus efeitos sobre a saúde e sobre as desigualdades em saúde foram explorados. Fora utilizados dados transversais do European Social Survey para analisar a associação entre capital social e saúde auto-declarada em países Europeus entre 2002 e 2012. A mesma base de dados foi utilizada para analisar a associação entre a mobilidade social e saúde auto-declarada em seis tipos de regimes de bem-estar Europeus. Estas análises utilizaram regressões logísticas multinível. Para analisar evidência sobre desigualdades socioeconómicas na saúde em Portugal depois de 2000 foi efetuada uma revisão sistemática da literatura. Dados transversais do European Union Survey on Income and Living Conditions foram utilizados para analisar alterações da desigualdade nas limitações em saúde em Portugal entre 2004 e 2014, tendo em conta as alterações macroeconómicas no País. Nesta análise, foram utilizados o índice de concentração e regressões logísticas múltiplas. O capital social contextual estava associado com pior saúde auto-declarada em indivíduos com pouca confiança interpessoal, influenciando assim a distribuição da saúde. Regimes de bem-estar Europeus estavam associados com a magnitude do impacto da mobilidade social na saúde. A revisão sistemática mostrou que o estudo dos determinantes contextuais em Portugal ainda é incomum. Alterações macroeconómicas em Portugal influenciaram a saúde e a sua distribuição na última década. Com base nestes resultados, foi delineado um quadro conceptual sobre a influência do contexto na saúde da população e na sua distribuição. O quadro conceptual distingue claramente entre um mecanismo que influencia a saúde da população e outro que influencia a sua distribuição. Este quadro pode ser utilizado como base de análises futuras para clarificar os mecanismos pelos quais o contexto influencia a saúde e as desigualdades em saúde. Pode também apoiar decisões sobre políticas que procurem influenciar a saúde da população e reduzir as desigualdades em saúde. Apesar das suas limitações, este trabalho produz evidência sobre os determinantes socioeconómicos da saúde em Portugal e sobre o impacto que o contexto pode ter nestes determinantes e nas desigualdades em saúde. O quadro conceptual proposto poderá avançar o debate sobre a influência do contexto na saúde e na sua distribuição.
Socioeconomic inequalities in health have been observed for centuries throughout the world. Decades of research have identified multiple factors that determine these inequalities, such as education or employment. More recently, the focus of research in health inequalities shifted from individual to contextual determinants, such as physical and social characteristics of the environment. However, research on contextual determinants has been undermined by the absence of a theoretical basis to explain how these determinants influence health outcomes. Portugal is an interesting case study as it is one of the most unequal European countries both in income and health inequality, with limited academic and political attention to the topic. This dissertation aims to contribute to the understanding of how contextual characteristics can impact population health and health distribution, using Portugal and Europe as case studies. To achieve its aim, this research selected three contextual determinants – social capital, welfare regimes, and macroeconomic changes – and explored their effect on health and health inequalities. Cross-sectional data from the European Social Survey was used to analyse how social capital was associated with self-assessed health in European countries between 2002 and 2012. The same database was used to analyse the association between social mobility and self-assessed health in six welfare regime types in Europe. These analyses used multilevel logistic regressions. A systematic review of the literature was done to collect and analyse evidence about socioeconomic health inequalities in Portugal after 2000. Cross-sectional data from the European Union Survey on Income and Living Conditions was used to analyse how inequalities in health limitations changed in Portugal between 2004 and 2014, in light of important macroeconomic changes in the country. For this analysis, the concentration index was calculated and a multiple logistic regression model was run for each year. Contextual social capital was found to have an effect on individuals with low interpersonal trust, thus influencing health distribution. Welfare regime types were associated with the magnitude of the impact of social mobility on health. The systematic review showed that the study of contextual determinants of health inequalities is still uncommon in Portugal. Finally, important contextual changes in Portugal over the last decade seem to have influenced health and its distribution in the country. Drawing on the findings from these analyses, a conceptual framework was outlined, summarising how context influences population health and health distribution. The framework draws a clear distinction between a mechanism that leads to changes in population health, and another mechanism that leads to changes in health distribution. This framework can be used as a basis for future empirical research, helping clarify the mechanisms by which context influences health and health inequalities. It can also support policies seeking to influence population health and health inequalities. Despite its limitations, this work provides evidence on the social determinants of health in Portugal and on the impact that contextual characteristics can have on these determinants and on health inequalities. The proposed conceptual framework will hopefully further the debate on how context can influence population health and health distribution.

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48

Karban, Kate E. "On the Edge: Power and Partnership in Social Work". Thesis, University of Bradford, 2016. http://hdl.handle.net/10454/17402.

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This submission for the award of PhD by Published Work includes a range of single, joint and multiple-authored publications that were published between 2005 and 2016. The publications cover a range of issues relevant to social work with a particular emphasis on mental health and health inequalities. The statement provides an underpinning conceptual framework that demonstrates interwoven themes of power, partnership and marginality. These are explored in relation to the published work, demonstrating an original and coherent contribution to the social work knowledge and practice base. The discussion draws on a reflexive journey through social work practice, education and research. The conclusion proposes that considerations of power and partnership are crucial elements of the potential for creative work ‘on the margins’.

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Dang, Rui [Verfasser], Thomas K. [Gutachter] Bauer y Hendrik [Gutachter] Schmitz. "Empirical essays on social interactions and health inequalities / Rui Dang. Gutachter: Thomas K. Bauer ; Hendrik Schmitz". Bochum : Ruhr-Universität Bochum, 2016. http://d-nb.info/1109051670/34.

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Evans, Clare Rosenfeld. "Innovative Approaches to Investigating Social Determinants of Health - Social Networks, Environmental Effects and Intersectionality". Thesis, Harvard University, 2015. http://nrs.harvard.edu/urn-3:HUL.InstRepos:23205168.

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Contexts are important social determinants of individual health trajectories and population level patterns of health disparities. This dissertation examines three types of contexts—social networks, physical environments, and social positions—using innovative quantitative approaches. Chapter 1 examines the intersectional social positions created by interlocking social identities—race/ethnicity, sex, income, education, and age—and their relationship to health disparities in the obesity epidemic. We outline an innovative analytic approach to evaluating intersectionality using multilevel models. After adjustment for the contributions of the main effects, a large intersectional effect remains. While clear social patterning emerges, interactions are not necessarily patterned according to ‘multiple jeopardy’ and ‘multiplicative benefit’ as might have been expected. These findings reveal the complex social patterning of the obesity epidemic, and challenge us to consider possible refinements to intersectionality theory. Chapter 2 evaluates whether U.S. adolescent social networks are segregated by family income level. Network segregation or integration may affect adolescent health trajectories through a variety of pathways, yet the extent to which networks are socioeconomically segregated is poorly understood. We approach the evaluation of income segregation through a novel lens by explicitly considering three scales of analysis within social networks: the network community level, the dyadic level, and a level in between. We find evidence of income segregation at all three levels, though this segregation is neither extreme nor universal. Family income appears to be a socially salient factor in the structure of adolescent social networks. In Chapter 3, three contexts of relevance to the adolescent obesity epidemic—schools, neighborhoods, and social networks—are examined simultaneously. Using a novel combination of social network community detection and cross-classified multilevel modeling, we compare the contributions of each of these contexts to the total variation in adolescent body mass index. After adjusting for relevant covariates, we find that the school-level and neighborhood-level contributions to the variance are modest compared with the network community-level. These results are robust to multiple sensitivity tests. This study highlights the salience of adolescent social networks and indicates that they may be a promising context to address in the design of health promotion programs.

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Tesis sobre el tema "Environmental and social health inequalities"

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