A comparison of stream biological responses to discharge from wastewater treatment plants in high and low population density areas

The ultimate purpose of this study was to identify broad relationships that may have relevance for the risk assessment of chemicals and materials that are discharged to receiving streams via municipal wastewater treatment plant (WWTP) effluents (e.g., consumer product ingredients). The effects of municipal wastewaters occurring in high population density (>500 persons per square mile, urban) and low population density (<500 persons per square mile, rural) environments were determined via analysis of biological, habitat, and water chemistry data collected both immediately upstream and downstream of 221 WWTPs in Ohio, USA. Several biological and chemistry indicators demonstrated poorer water quality in urban areas compared to rural areas. After considering the effect of river size, adverse effects downstream of WWTPs for both fish and macroinvertebrate communities were clearly identified for only urban areas. These data indicate that WWTP potency may be greater in urban areas compared to rural areas.     

Social participation and health in a community rich in stock of social capital

In Finland, members of the Swedish-speaking minority, many of whom live in the province of Ostrobothnia, intermingle with the Finnish-speaking majority. Although the two language communities are quite similar to each other in most societal respects, including socioeconomic status, education and use of health services, significant disparities have been reported in the morbidity, disability and mortality between the Swedish-speaking minority and the Finnish-speaking majority. Since the population genetic, ecological and socioeconomic circumstances are equal, Swedish speakers' longer active life is difficult to explain by conventional health-related risk factors. A great deal of health inequality (between the language groups) seems to derive from uneven distribution of social capital, i.e. the Swedish-speaking community holds a higher amount of social capital that is associated with their well-being and health. Factor analysis revealed four patterns of social capital measures, i.e. voluntary associational activity, friendship network, religious involvement and hobby club activity, of which associational activity, friendship network and religious involvement were significantly associated with good self-rated health. Also, trustful friendship network, hobby club activity and religious involvement as well as avoidance of intoxication-prone drinking behavior were significantly more frequent among the individuals of the Swedish-speaking community. We suggest that health promotion should seek ways of working which would encourage social participation.     

Individual-level relationships between social capital and self-rated health in a bilingual community

BACKGROUND. Previous register studies have shown that mortality rates and disability pension statistics favor Swedish-speakers when compared to their Finnish-speaking neighbors in the same bilingual region in Finland. The purpose of the present questionnaire survey was to determine whether the Swedish-speaking community has more social capital and if the social capital is associated with health at the individual level. METHODS. The study population consisted of randomly selected samples of Finnish-speakers (N 1,000, response rate 66%) and Swedish-speakers (N 1,000, response rate 63%) representing all adults living in bilingual Ostrobothnian municipalities (75,000 Finnish-speakers and 78,000 Swedish-speakers). To inquire into social capital and health indicators, a bilingual questionnaire was composed to cover variables and indicators of sociodemography, health status, health behavior, and social capital (interpersonal trust and civic engagement). Data were analyzed with multiple logistic regression for two binary outcome variables: language group (Finnish vs Swedish) and self-rated health (good vs almost good/fair/poor/bad). RESULTS. When health-related variables (urban residence, migration, age, BMI, household income, smoking, singing in a choir, membership in any voluntary association, participation in community events, and long-term diseases) were controlled for, the Finnish-speakers were more often migrated (P = 0.0001) and mistrusting (P = 0.0001) and less active in community events (P = 0.0016) and in singing in a choir (P = 0.02) than the Swedish-speakers. After controlling for language and the above-mentioned health-related variables, the number of auxiliary (willing to help) friends (P = 0.001), mistrust (P = 0.037), and membership in any religious association (P = 0.0096) were significantly and independently associated with good self-rated health in the whole sample. CONCLUSIONS. The Swedish-speaking community seems to hold a fair quantity of social capital, which is associated with good health. Since the ecological and socioeconomic circumstances are equal for both language communities, a great deal of health inequality can be explained by differences in social capital.     

Mitigating social and health inequities: community participation and Chagas disease in rural Argentina

Chagas disease (CD) causes 12,500 deaths annually in Latin America. As a neglected disease primarily associated with poverty, it is a major driver of health inequity. Argentina's efforts to control vector transmission have been unsuccessful. Using new survey data (n=400 households), we compare the social patterning of the burden of CD by examining socio-demographic predictors of self-reported CD and the presence of vinchucas in two areas of rural northern Argentina known to have experienced different interventions in surveillance and control. Our analyses suggest that Avellaneda, an area known for horizontal intervention strategies which nurture community participation is quite distinct from Silipica, an area which has experienced a vertical intervention strategy since 1990. Avellaneda has higher level of self-reported Chagas infection and lower level of vinchuca presence; Silipica has pronounced and statistically significant differences patterned by the head of household's level of educational attainment. A greater awareness of the disease and its transmission, along with community mobilisation and spraying, may bring about more self-reported CD and less vinchuca presence in Avellaneda than in Silipica. This suggests that strategies based on community participation may be effective in reducing the social patterning of the burden of disease, even in poor places.     

An alternative approach to social capital: exploring the linkage between health consciousness and community participation

In recent years, social capital has received a great deal of attention in health communication. The fundamental premise behind the increased attention to social capital is the positive health outcome of social capital. Social capital is treated as an antecedent to health. Building on recent research that points out the role of trait-level variables in the production of social capital, this article examines the role of health consciousness in the production of social capital. The central idea here is that health conscious individuals choose to participate in their communities because of the positive health benefits of such participation.     

A comparative study of two mental health services: relationships between popular participation and social representations related to the right to health

The present paper originated from a qualitative study that analyzed social representations related to the right to health, expressed by users of two types of mental health services, one with participation by users and families and the other without such participation. The aim was to analyze such representations not only in relation to the awareness of the right to health, but also concerning associated factors, such as: popular participation; illness; public health care; perception of social intervention capacity; and concepts concerning the state. Social representations of the right to health involve expectations that the health system and the state meet their roles of ensuring care and support. Users of the mental health service without user/family participation tended to be more resigned and pessimistic. The group with participation views the service it has built as having characteristics denied by the official system and view advocacy as a possible alternative focus for forming new social representations.     

The reform process and social participation in health in Latin America

Currently, many countries throughout the world are reforming their health services. Even though these reforms differ according to the country's characteristics, they share many policies, one of which is the promotion of social participation in health-related matters. This policy, however, is not new in the field of health service organization. Throughout the last century, individual or collective collaboration between the population and health services has been promoted by several philosophies and concepts with different aims: from the search for collaboration with the general public to broaden public health system coverage to the promotion of the creation of mechanisms that would allow society to exercise control over these services' performance. Nevertheless, for the public to be involved with these services, several factors concerning both the services themselves and the population, need to converge. Although the theoretical frameworks that have encouraged social participation throughout the history of the development of health systems differ considerably, their practical implementation shares many common elements in all periods, from participation as a means of obtaining certain objectives to being an end in itself, as a democratic process. This can also be applied to the current promotion of social participation policies in the context of health care reforms, which are analyzed using Colombia and Brazil as examples.     

Multicultural social policy and community participation in health: new opportunities and challenges for indigenous people

Community participation in local health has assumed a central role in the reforms of public healthcare, being increasingly associated with the issue of decentralization of the health system. The aim of this paper is to raise questions regarding the structural approaches to multicultural social policy in Chile and to analyze the results of its implementation. The article analyzes the case study of Makewe Hospital, one of the pioneering experiences of intercultural health initiative in Chile. The Makewe Hospital, which involves the indigenous community of the Mapuche, provides interesting insights to understand the dynamics of multicultural social policy and presents an example of a successful initiative that has succeeded in involving local communities in multicultural health policy. This case study discusses the effectiveness of grassroots participation in multicultural healthcare provision and presents the main strengths and challenges for the replicability of this experience in other settings.     

Social participation and community orientation in health services

The community participation in the health systems is a concept that develops from the health policy proposals that have led the World Health Organization and that they highlight the fundamental role of health promotion and of primary care to answer to the health challenges from the middle of the XXth century. Its development has encountered big obstacles that have become major from the increasing trend of introduction of healthcare marketing. This explains partly its scanty advance in the developed countries, though there exist very interesting experiences that are based especially on the effort of professionals and social organizations. The fundamental dilemma is one in the option among the assumption of the role like consumers or clients that it supports a relation subordinated of the patients with a major dependence of the consumption, or on the contrary to give voice and vote for the citizens incorporating them into the productive process and turning them into producers of health. There are analyzed also the existing practices of community participation in Spain and offers are realized for its impulse and development.     

Access to health care and community social capital

OBJECTIVE: To test the hypothesis that variation in reported access to health care is positively related to the level of social capital present in a community. DATA SOURCES: The 1996 Household Survey of the Community Tracking Study, drawn from 22 metropolitan statistical areas across the United States (n = 19,672). Additional data for the 22 communities are from a 1996 multicity broadcast media marketing database, including key social capital indicators, the 1997 National Profile of Local Health Departments survey, and Interstudy, American Hospital Association, and American Medical Association sources. STUDY DESIGN: The design is cross-sectional. Self-reported access to care problems is the dependent variable. Independent variables include individual sociodemographic variables, community-level health sector variables, and social capital variables. DATA COLLECTION/EXTRACTION METHODS: Data are merged from the various sources and weighted to be population representative and are analyzed using hierarchical categorical modeling. PRINCIPAL FINDINGS: Persons who live in metropolitan statistical areas featuring higher levels of social capital report fewer problems accessing health care. A higher HMO penetration rate in a metropolitan statistical area was also associated with fewer access problems. Other health sector variables were not related to health care access. CONCLUSIONS: The results observed for 22 major U.S. cities are consistent with the hypothesis that community social capital enables better access to care, perhaps through improving community accountability mechanisms.     

Perceptions of community participation and health gain in a community project for the South Asian population: a qualitative study

BACKGROUND: The new public health rejects old individualist attempts at improving health and embraces community-based approaches in reducing health inequalities. Primary Care Trusts in England face the challenge of converting community participation in health into reality. This study explores differences in perception of participation between lay and professional stakeholders of a community health project for a South Asian population in Greater Manchester. METHODS: In-depth interviews and focus groups were used to explore the views of professional and lay stakeholders. All data were audio-taped, transcribed and analysed for emerging themes using a qualitative framework. RESULTS: Professionals talked of working in partnership with the community but lay stakeholders did not feel that they had control over the project. There were problems in engaging the community and local health professionals in the project. Lack of cultural awareness hampered participation in the project. There was agreement that the project improved the self-confidence of participants and created a more informed population. However, there was little support for claims of improvements in social cohesion and changes in lifestyle directly as a result of the project. CONCLUSION: Converting the rhetoric of community participation in health into reality is a greater challenge than was envisaged by policy makers. Marginalized communities may not be willing participants and issues of language and cultural sensitivity are important. Project outcomes need to be agreed to ensure projects are evaluated appropriately. Projects with South Asian communities should not be seen to be dealing with all 'ethnic health' issues without addressing changes in statutory organizations and other wider social determinants of health.     

社会组织参与卫生政策过程的思考

社会组织是政党和政府以外的民间性组织,一般具有非政治性、非营利性、自发性等特点。在本文所关注的广西壮族自治区内的三个与妇女健康相关的政策个案中,不同层级、不同类别的社会组织都参与其中并发挥了重要作用。社会组织在人力资源、技术能力、投入热情等方面的优势是其得以参与并发挥作用的基础,而政府与社会组织之间的平等和信任关系则是维系这种参与的关键。今后政府应为社会组织提供更好的参与空间和平台,发挥其自身优势,在一个多元治理体系下形成政府和社会组织的良性互动,进而有效的推动政策目标的实现。