Class, Health, and Justice

Class inequalities in health are intuitively unjust. Although the link between social class and health status has been fully documented, the precise nature of the injustice has not been made clear. Four alternative views are presented, corresponding to four goals: (1) maximizing the sum total of health; (2) equalizing the health status of higher and lower social classes; (3) maximizing the health status of the lowest social class; and (4) maximizing the health status of the sickest individuals in society. The nature of the injustice is further obscured by several theoretical and empirical questions, like the degree and significance of personal responsibility for illness and the relation of the degree of economic inequality to sum total of health.     

Poverty,equity, human rights and health

Those concerned with poverty and health have sometimes viewed equity and human rights as abstract concepts with little practical application, and links between health, equity and human rights have not been examined systematically. Examination of the concepts of poverty, equity, and human rights in relation to health and to each other demonstrates that they are closely linked conceptually and operationally and that each provides valuable, unique guidance for health institutions' work. Equity and human rights perspectives can contribute concretely to health institutions' efforts to tackle poverty and health, and focusing on poverty is essential to operationalizing those commitments. Both equity and human rights principles dictate the necessity to strive for equal opportunity for health for groups of people who have suffered marginalization or discrimination. Health institutions can deal with poverty and health within a framework encompassing equity and human rights concerns in five general ways: (1) institutionalizing the systematic and routine application of equity and human rights perspectives to all health sector actions; (2) strengthening and extending the public health functions, other than health care, that create the conditions necessary for health; (3) implementing equitable health care financing, which should help reduce poverty while increasing access for the poor; (4) ensuring that health services respond effectively to the major causes of preventable ill-health among the poor and disadvantaged; and (5) monitoring, advocating and taking action to address the potential health equity and human rights implications of policies in all sectors affecting health, not only the health sector.     

Health insurance,endogenous medical progress,health expenditure growth,and welfare

We study the impact of health insurance expansion on medical spending, longevity and welfare in an OLG economy in which individuals purchase health care to lower mortality and medical progress is profit-driven. Three sectors are considered: final goods production; a health care sector, selling medical services to individuals; and an R&D sector, selling increasingly effective medical technology to the health care sector. We calibrate the model to the development of the US economy/health care system from 1965 to 2005 and study numerically the impact of the insurance expansion. We find that more extensive health insurance accounts for a large share of the rise in US health spending but also boosts the rate of medical progress. A welfare analysis shows that while the subsidization of health care through health insurance creates excessive health care spending, the gains in life expectancy brought about by induced medical progress more than compensate for this.     

完善主体优化资源：对公有医疗机构改革的思考

公有职机构数量较多，但布局不当，有些地方供大于求，人浮于事；有些地方机构较少，资源短缺。为了使公有医疗机构布局合理，发挥主导作用，必须进行改革。要调整机构，关停并转减一块；要精于机构，活化产权放一块；要优化机构，重点抓好保一块。有利于合理配置卫生资源；有利于集中财力保“主体”；有利于分流一部分人员但必须具备一定条件才能改革。要解放思想，更新观念；要政府重视，政策配套；要着眼整体，顾全大局。     

Stressed,anxious, and sick from the floods: A photovoice study of climate extremes,differentiated vulnerabilities,and health in Old Fadama,Accra, Ghana

Although there is a large and growing literature on anticipated climate change impacts on health, we know very little about the linkages between differentiated vulnerabilities to climate extremes and adverse physical and mental health outcomes. In this paper, we examine how recurrent flooding interacts with gendered vulnerability, social differentiation, and place-related historical and structural processes to produce unequal physical and mental health outcomes. We situated the study in Old Fadama, Ghana, using a Photovoice approach (n = 20) and theoretical concepts from political ecologies of health and feminist political ecology. Overall, the study revealed several adverse physical and mental health impacts of flooding, with vulnerability differentiated based particularly on gender and age, but also housing, class, and income. Our findings suggest the need for greater attentiveness to social differentiation in scholarship involving political ecologies of health. The paper builds on the health and place literature by linking the social and contextual to the medical.     

Rethinking equal access: Agency,quality, and norms

Abstract

In 2005 the Global Health Council convened healthcare providers, community organizers, policymakers and researchers at Health Systems: Putting Pieces Together to discuss health from a systems perspective. Its report and others have established healthcare access and quality as two of the most important issues in health policy today. Still, there is little agreement about what equal access and quality mean for health system development. At the philosophical level, few have sought to understand why differences in healthcare quality are morally so troubling. While there has been considerable work in medical ethics on equal access, these efforts have neglected health agency (individuals’ ability to work toward health goals they value) and health norms, both of which influence individuals’ ability to be healthy. This paper argues for rethinking equal access in terms of an alternative ethical aim: to ensure the social conditions in which all individuals have the capability to be healthy. This perspective requires that we examine injustices not just by the level of healthcare resources, but by the: (1) quality of those resources and their capacity to enable effective health functioning; (2) extent to which society supports health agency so that individuals can convert healthcare resources into health functioning; and (3) nature of health norms, which affect individuals’ efforts to achieve functioning.     

Urbanization,urbanicity, and health

A majority of the world's population will live in urban areas by 2007. The most rapidly urbanizing cities are in less-wealthy nations, and the pace of growth varies among regions. There are few data linking features of cities to the health of populations. We suggest a framework to guide inquiry into features of the urban environment that affect health and well-being. We consider two key dimensions: urbanization and urbanicity. Urbanization refers to change in size, density, and heterogeneity of cities. Urbanicity refers to the impact of living in urban areas at a given time. A review of the published literature suggests that most of the important factors that affect health can be considered within three broad themes: the social environment, the physical environment, and access to health and social services. The development of urban health as a discipline will need to draw on the strengths of diverse academic areas of study (e.g., ecology, epidemiology, sociology). Cross-national research may provide insights about the key features of cities and how urbanization influences population health.     

Administrators,health service providers,and consumers perspectives of functions of district health‐care systems in Oromia region,Ethiopia: A qualitative study

The practice of functions of district health‐care systems in Ethiopia is not clear. The aim of this study was to investigate the perspectives of administrators, health service providers, and health‐care consumers regarding functions of district health‐care systems as currently practiced. Grounded theory approach was applied using interviews and desk review of documents. This study was set up in Oromia National Regional State, Ethiopia. Inductive analysis of interviews was done. Interviews and document reviews were mirrored. Eleven functions of district health‐care systems emerged in this study organized by level with relationships and commonality of few activities. The 11 functions of district health‐care systems were creating capacity of health centers and health professionals for the provision of health care; creating access for the provision of health care; ensuring equitable access to health care; regulation of private health‐care providers; disaster preparedness; monitoring risk factors and diseases in the district; provision of health promotive, preventive, and curative health care for communicable diseases and maternal health conditions; monitoring intermediate outcomes of care; developing capacity of health post and villagers toward demand creation for health care; provision of maternal and child health services; and helping health posts in reaching mothers and sick individuals.     

Predicting Health Care Utilization in Marginalized Populations: Black,Female, Street-Based Sex Workers

BackgroundPatterns of social and structural factors experienced by vulnerable populations may negatively affect willingness and ability to seek out health care services, and ultimately, their health.MethodsThe outcome variable was utilization of health care services in the previous 12 months. Using Andersen's Behavioral Model for Vulnerable Populations, we examined self-reported data on utilization of health care services among a sample of 546 Black, street-based, female sex workers in Miami, Florida. To evaluate the impact of each domain of the model on predicting health care utilization, domains were included in the logistic regression analysis by blocks using the traditional variables first and then adding the vulnerable domain variables.FindingsThe most consistent variables predicting health care utilization were having a regular source of care and self-rated health. The model that included only enabling variables was the most efficient model in predicting health care utilization.ConclusionsAny type of resource, link, or connection to or with an institution, or any consistent point of care, contributes significantly to health care utilization behaviors. A consistent and reliable source for health care may increase health care utilization and subsequently decrease health disparities among vulnerable and marginalized populations, as well as contribute to public health efforts that encourage preventive health.     

Health care practices,problems, and needs of young adult women

A study of 308 midwestern college women was undertaken to ascertain their health care practices, problems, and needs. Specific areas investigated were smoking, alcohol consumption, and drug use; gynecologic health practices and problems; nutrition, exercise, and coping strategies; and physical illness and disabilities. The majority of young women in this study appeared to be in good health. Although there were few negative health factors, those factors identified have significance for long‐term health. Problems were identified in the areas of nutrition, gynecologic health practices, and coping strategies. This survey pointed out the need for further study of practices that influence the health of young women.     

Barriers to Knowledge Production, Knowledge Translation, and Urban Health Policy Change: Ideological, Economic, and Political Considerations

In this paper, we consider social forces that affect the processes of both knowledge production and knowledge translation in relation to urban health research. First, we briefly review our conceptual model, derived from a social-conflict framework, to outline how unequal power relations and health inequalities are causally linked. Second, we critically discuss ideological, political, and economic barriers that exist within academia that affect knowledge production related to urban health and health inequalities. Third, we broaden the scope of our analysis to examine how the ideological, political, and economic environment beyond the academy creates barriers to health equity policy making. We conclude with some key questions about the role that knowledge translation can possibly play in light of these constraints on research and policy for urban health.     

Health, mental health, substance use, and service utilization among rural and urban incarcerated women.

Incarcerated women commonly report health, mental health, and substance use problems, yet there is limited research on service utilization before incarceration, particularly among women from urban and rural areas. This study includes a stratified random sample of 100 rural and urban incarcerated women to profile the health, mental health, substance use, and service utilization; examine the relationship between the number of self-reported problems and service utilization; and examine self-reported health and mental health problems in prison as associated with preincarceration health-related problems and community service utilization. Study findings suggest that health and mental health problems and substance use do not differ significantly among rural and urban women prisoners. However, there are differences in service utilization -- particularly behavioral health services including mental health and substance abuse services; urban women report more service utilization. In addition, rural women who reported using needed community services before prison also reported fewer health problems in prison. Implications for correctional and community treatment opportunities in rural and urban areas are discussed.     

Hunting for health,well-being,and quality of life

Health, well-being, quality of life, and lifestyle are central concepts within health science, although generally accepted definitions are still lacking. Lifestyle can either be seen as an independent variable and the cause of unhealthy behaviour or as a dependent variable, which is affected by conditions in the society. In the first case, the attention is directed on each individual case: maintaining or improving health requires changes in lifestyle and living habits. In this perspective, diet and physical activity are important features for health promotion. In the second case the attention is rather directed on structural conditions in society, for example the food industry, the lunches for children at school, and the “fast food” industry should be influenced to protect human health. The structural perspective has, so far, received restricted impact when it concerns prevention and promotion of health. Processes of individualisation in the society have to an increasing extent viewed health as an affair for the individual. The benefits of physical activity, healthy food and beverage, social support, and joy are documented scientifically. In general, the trend towards increasing responsibility for one''s lifestyle and health is positive, but might reinforce the inequality in health. With an even harder climate in society there might be a risk that individual health projects undermine the solidarity and the will to accept costs for medical treatment and care for people who risk their health through an unhealthy and risk-taking lifestyle. However, we argue that peoples’ well-being and quality of life presupposes a society that stands up for all people.     

Health Literacy,Cognitive Ability,and Functional Health Status among Older Adults

Objective

To investigate whether previously noted associations between health literacy and functional health status might be explained by cognitive function.

Data Sources/Study Setting

Health Literacy and Cognition in Older Adults (“LitCog,” prospective study funded by National Institute on Aging). Data presented are from interviews conducted among 784 adults, ages 55–74 years receiving care at an academic general medicine clinic or one of four federally qualified health centers in Chicago from 2008 to 2010.

Study Design

Study participants completed structured, in-person interviews administered by trained research assistants.

Data Collection

Health literacy was measured using the Test of Functional Health Literacy in Adults, Rapid Estimate of Adult Literacy in Medicine, and Newest Vital Sign. Cognitive function was assessed using measures of long-term and working memory, processing speed, reasoning, and verbal ability. Functional health was assessed with SF-36 physical health summary scale and Patient Reported Outcomes Measurement Information System short form subscales for depression and anxiety.

Principal Findings

All health literacy measures were significantly correlated with all cognitive domains. In multivariable analyses, inadequate health literacy was associated with worse physical health and more depressive symptoms. After adjusting for cognitive abilities, associations between health literacy, physical health, and depressive symptoms were attenuated and no longer significant.

Conclusions

Cognitive function explains a significant proportion of the associations between health literacy, physical health, and depression among older adults. Interventions to reduce literacy disparities in health care should minimize the cognitive burden in behaviors patients must adopt to manage personal health.     

Psychological Culture, Physical Health, and Subjective Well-being

This article investigates the role of psychological culture in influencing health by examining the relationship between cultural discrepancies and physical health and subjective well-being. Participants completed a large battery of tests assessing their individual, psychological culture; perceptions of the larger, ecological culture; coping strategies; emotion and mood states; physical health and subjective well-being. Cultural discrepancies were operationalized as the difference between ratings of psychological and ecological culture. Regression analyses indicated that cultural discrepancies were associated with greater coping strategy usage which, in turn, was associated with anxiety and depression. These emotions were then predictive of both physical health and psychological well-being. These findings suggest that this approach is promising, and may open the door to other studies that operationalize culture on the individual level, forcing us to consider psychological culture and cultural discrepancies in our theoretical models of culture and health.     

供方需方第三方

分析了体制因素对共需双方的影响。指出，供需双方都呼唤第三方从体制改革入手，为供方和需方共同提供适宜的环境。第三方找基本职责调供需关系，其中构建起把供需利用统一起来的体制尤为重要。卫生行政部门应该承担第三方的职责，而医疗保险制度的构建与运行是第三方必须牢牢抓住的龙头。     

Gender, self-reported health, and health-related lifestyles in Poland

Little is known about gender differences in the health of individuals in the former Eastern Europe. Determinants of health and health-related lifestyles may operate differently there than in the West. Data from the 1994 Polish General Social Survey (PGSS) are used to estimate structural and psychosocial effects on self-reported health, risk behaviors, and social participation for women and men. Employment improves the chance of better health for men, whereas marital happiness increases the probability of better health for women; smoking declines with education among men but not among women; and excessive drinking increases for unhappily married men. Religiosity protects the health of both women and men. This research sheds light on the possible sources of gender differences in health in Poland.     

Public health, populations, and lethal ingestion

BackgroundIn 2008 the American Public Health Association endorsed lethal ingestion as a public health policy as part of “Patients' Rights to Self-Determination at the End of Life.” Although rhetoric framing physician-assisted suicide (PAS) invokes individual autonomy, public health's focus is populations. Even regarding treatment refusal, its logic and coercive power (e.g., quarantine) subordinate autonomy to population interests. Research indicates health practitioners and disciplines that are closer to persons with terminal conditions oppose more PAS than those having little contact: specifically, public health associations are more willing to authorize life-ending means than disciplines directly caring for the dying. Why is that the case and with what consequences for populations and public health?MethodsContextual analysis of semantics; policy submissions; standards; statutory and regulatory documents; related economic, equity, and demographic discourses is employed; and, finally, scenarios offered of the future.ResultsNotwithstanding rhetoric invoking autonomy, public health's population orientation is reflected in population health measures (e.g., aggregated DALYs, QALYs) that intimate why public health might endorse availing life-ending means. Current associated statutes, regulations, terminology, and data practices compromise public health and semantic integrity (e.g., the falsification of death certificates) and inadequately address population vulnerabilities. In recent policy processes, evidence of patient and system vulnerabilities has not been given due weight while future-oriented scenarios suggest autonomy-based rationales will increasingly yield to population-driven rationales, increasing risk of private and public forms of domination and vulnerabilities at life's end.ConclusionPublic health should address institutionalized violations of data integrity and patient vulnerabilities, while rescinding policy supporting the institutionalization of lethal means.     

Perceived problem solving, stress, and health among college students

OBJECTIVE: To study the relationships among perceived problem solving, stress, and physical health. METHODS: The Perceived Stress Questionnaire (PSQ), Personal Problem solving Inventory (PSI), and a stress-related physical health symptoms checklist were used to measure perceived stress, problem solving, and health among undergraduate college students (N = 232). RESULTS: Perceived problem-solving ability predicted self-reported physical health symptoms (R2 = .12; P < .001) and perceived stress (R2 = .19; P < .001). CONCLUSION: Perceived problem solving was a stronger predictor of physical health and perceived stress than were physical activity, alcohol consumption, or social support. Implications for college health promotion are discussed.