‘Give people work,and the blood pressure will sink’: lay engagement with cardiovascular risk factors in North Karelia in the 1970s

In high-income countries such as Finland, personal healthcare is organised around the management of lifestyle risks and minimisation of such risks forms a key part of public health policy. While the scientific development of the lifestyle risk model has been thoroughly studied, there has been less research on the history of popular experiences of the model. In this article, I examine lay people’s response to a pioneering heart disease prevention programme in north-eastern Finland in the 1970s, the North Karelia Project, which promoted the lifestyle risk model. I use archival data from early 1970s that recorded the project interactions with the local population and their reactions to the project. I show that although local residents in North Karelia responded positively to the project, they did not necessarily subscribe to its preventive and risk minimising objectives. In an area of limited health resources, the project provided local residents with access to medical expertise. Local reactions indicated a clash of a cultural notion of illness embedded in the social life-world of Karelians with a specific rationality of government emphasising individual responsibility vis-à-vis heart conditions. Local residents who were critical of the public health risk model tended to minimise the role of lifestyle risk factors in cardiovascular disease causation or subsumed these factors into a more encompassing explanation that stressed the effects of the on-going structural social change in the area, highlighting the sense of loss caused by the waning of traditional small farm existence and their anxiety about the resulting economic and social insecurity.     

Social inequities in cardiovascular disease risk factors in East and West Germany.

Social class related differences in prevalence of cardiovascular disease risk factors in Germany were investigated with special emphasis on comparisons between East and West Germany and on time trends. Databases for West Germany are the first and second National Health Survey (survey 1: N = 4794, survey 2: N = 5315), carried out in the framework of the German Cardiovascular Prevention Study, and for East Germany the first GDR-MONICA project (N = 6125). Different social class indices were applied to evaluate social inequities for hypertension, hypercholesterolemia, cigarette smoking, obesity and predicted cardiovascular disease mortality. As a main result, it was found that very similar patterns in the relation between social class characteristics and cardiovascular disease risk factor prevalence occurred for both parts of Germany. Social class gradients were strongest for obesity and weakest for hypercholesterolemia. Analysis of time trends for the period from 1984 to 1988 (for West Germany only) revealed an increase in social inequalities for hypertension in males and cigarette smoking in females. These findings point to the need to focus more on social disadvantaged segments in the population when community based health promotion and disease prevention programs are brought into action.     

Hope is a four‐letter word: riding the emotional rollercoaster of illness management

In this autoethnography, I explore the process and emotional experience of trying a new drug to improve my quality of life. In so doing, I synthesise personal history with extant research on chronic illness by analysing ways in which my experiences reflect and reject social norms. I also incorporate perspectives from research on aspirations and attainment, and the mental health consequences of cyclical disappointment. By weaving together lessons from each of these literatures, I articulate an integrative psychosocial understanding of the micro‐level processes and experiences involved in illness management as well as the ways that experiences of illness management may require integration of varied sociological insights concerning health. In closing, I draw out theoretical implications for understanding the integration and variation of insights from many areas of health research in the lived experiences of people with chronic conditions. A Virtual Abstract of this article can be seen at: https://youtu.be/5aoaWGItDgM     

The impact of maternal education on intrauterine growth: a comparison of former West and East Germany

BACKGROUND: Objective of this re-analysis of datasets from former East and West Germany was to examine the influence of maternal education on intrauterine growth in two different political and social systems. METHODS: Information on socio-demographic or lifestyle factors and pregnancy outcome was available for 3374 liveborn singletons from West Germany (1987/88) and 3070 from East Germany (1990/91). Multiple logistic regression was used to estimate the association between maternal education and the risk of delivering a small-for-gestational-age (SGA) newborn below the 10th percentile of birthweight. RESULTS: Women with the lowest education had a significantly elevated risk of SGA newborns compared to women with the highest education in West (odds ratio [OR] = 2.58, 95% CI : 1.17-5.67) and East Germany (OR = 2.77, 95% CI : 1.54- 5.00). The distribution of factors known to influence intrauterine growth varied with education in both states. After adjusting for these factors, women with the lowest educational level still had a higher risk of SGA birth: OR (West) = 2.02, 95% CI : 0.87-4.72; OR (East) = 1.95, 95% CI : 1.02-3.74. CONCLUSIONS: Our findings support the assumption that in former socialist countries health inequalities as a result of social inequalities existed.     

Living “In-between”—Vietnamese Canadian Women's Experiences: Implications for Health Care Practice

Intercultural living—a living that dwells “in-between” spaces of cultures—how it is conceptualized and what its lived experiences might mean, can give the direction for how we ought to care for one another. Drawing from my research with Vietnamese Canadian women, I argue that many immigrant women live and practice health care in “in-between” spaces, spaces that belong neither to East nor to West. Thus, supporting immigrant women's health care practices requires the removal of social ideologies that set apart the West and the “Other.” To provide equal and quality health care, caring should occur within in-between spaces, spaces that belong to both those who provide and those who receive health care services.     

Living "in-between"--Vietnamese Canadian women's experiences: implications for health care practice

Intercultural living-a living that dwells "in-between" spaces of cultures-how it is conceptualized and what its lived experiences might mean, can give the direction for how we ought to care for one another. Drawing from my research with Vietnamese Canadian women, I argue that many immigrant women live and practice health care in "in-between" spaces, spaces that belong neither to East nor to West. Thus, supporting immigrant women's health care practices requires the removal of social ideologies that set apart the West and the "Other." To provide equal and quality health care, caring should occur within in-between spaces, spaces that belong to both those who provide and those who receive health care services.     

WOMEN'S POSTNATAL EXPERIENCE FOLLOWING A MEDICALLY COMPLICATED PREGNANCY

Within the social science literature on reproduction, relatively little attention has been paid to the areas of major illness during pregnancy and postnatal physical health. In this paper I present the results of a qualitative study of the postnatal health experiences of 15 women who had suffered a serious illness during pregnancy, the onset of which either predated or developed during pregnancy. Recently delivered women with continuing health problems face additional difficulties at a time when they are recovering from the physical and psychological processes of birth and are adjusting to the care of the new baby or grieving a loss. A few women in this study had experienced health problems that were resolved at or soon after the birth. Those with continuing or chronic illness described attempts to regain normality that involved both restoring bodily health and reestablishing their control over symptoms of the illness. Professional help with this process was often reported to be limited.     

Women's postnatal experience following a medically complicated pregnancy

Within the social science literature on reproduction, relatively little attention has been paid to the areas of major illness during pregnancy and postnatal physical health. In this paper I present the results of a qualitative study of the postnatal health experiences of 15 women who had suffered a serious illness during pregnancy, the onset of which either predated or developed during pregnancy. Recently delivered women with continuing health problems face additional difficulties at a time when they are recovering from the physical and psychological processes of birth and are adjusting to the care of the new baby or grieving a loss. A few women in this study had experienced health problems that were resolved at or soon after the birth. Those with continuing or chronic illness described attempts to regain normality that involved both restoring bodily health and reestablishing their control over symptoms of the illness. Professional help with this process was often reported to be limited.     

Environmental and social determinants of human risk during a West Nile virus outbreak in the greater Chicago area, 2002

Background  

The outbreak of West Nile Virus (WNV) in and around Chicago in 2002 included over 680 cases of human illness caused by the virus within this region. The notable clustering of the cases in two well-defined areas suggests the existence of specific environmental and social factors that increase the risk for WNV infection and/or illness in these locations. This investigation sought to create an empirically based model to account for these factors and to assess their importance in explaining the possible processes that may have led to this pattern.     

Television illness depictions, identity, and social experience: responses to multiple sclerosis on The West Wing among people with MS

This project contributes to our understanding of how audiences interpret televised depictions of illness by investigating responses to the depiction of multiple sclerosis (MS) on the television drama The West Wing from 1999 to 2002. The study employs qualitative methods, including a focus group, individual interviews, and the collection of electronic message board posts to investigate how people with MS interpret the dramatization of the illness. Findings are analyzed in terms of respondents' perceptions of (a) the portrayal of the physical disease, (b) the portrayal of the social dimensions of MS, and (c) the impact of this portrayal for themselves and others with the disease. The study found that participants engaged in self-comparisons with the depiction of MS within the program. These comparisons resulted in a range of reactions from individuals varying in relation with their multiple physical and social experiences with the illness. Thus, illness experience adds complexity to judgments about accuracy, meaning, and outcomes related to health depictions. Participants expressed a desire to see more symptoms depicted, and they noted concern about the identities communicated to the public about people with MS and its influence on their daily, lived experience.     

Kaupapa Maori Action Research to improve heart disease services in Aotearoa,New Zealand

Action Research can be a powerful tool for change and improvement in health services for indigenous people when utilised within an appropriate framework. The project Maori Utilisation & Experience of Ischaemic Heart Disease Management illustrates this convergence in its use of Kaupapa Maori Action Research methods in its efforts to improve the health and well-being of Maori within the northern region of Aotearoa/New Zealand. We outline the research processes and outcomes obtained through the application of ‘by Maori for Maori’ approaches to understanding Maori pathways and barriers to care for ischaemic heart disease. Maori understandings of their illness and experiences of treatment, and healthcare providers' perspectives on care of Maori with ischaemic heart disease, were combined into Maori-led actions to improve service provision. The paper examines critical factors in an action research approach to health service innovations and implications for efforts to reduce entrenched health disparities.     

"What's wrong with me?": cervical cancer in Venezuela--living in the borderlands of health, disease, and illness

Social scientists concerned with studying the social and cultural meaning of illness problematize the relationship between disease and illness, noting that illness can exist without disease-abnormal physical changes in the body. What has received less attention is the existence of disease-made visible through technological advances-in the absence of illness. Cervical cancer (or the more ambiguous cervical abnormalities) is an example of a disease that is largely symptomless in its early stages and can occur in the absence of illness. In this paper I explore how women seek to understand and negotiate cervical cancer in the context of their everyday lives, as they are confronted with seemingly disparate and contradictory physical and psychological states of well-being, sickness, and disease. This experience is what I call living on the borderlands of health, disease, and illness, where all of these states are experienced concurrently and boundaries between them blur. Through observations of patient-doctor interactions, ethnographic interviews with doctors and women seeking treatment for cervical cancer and pre-cancerous abnormalities, I analyze how women try to understand their medical experience. And they do so with the added challenge of little information being shared with them by the doctors who treat them. While patients do not ask many questions of their doctors, this does not mean that women are disinterested in their health. In fact, they develop strategies for eliciting clinical information about their medical conditions and actively seek to make sense of their experiences. By problematizing the concepts of health, disease, and illness, and avoiding the tendency to see these as distinct and contradictory phenomenon, we can gain a better understanding of their interrelatedness, and how people negotiate this borderland.     

The NSW Social Determinants of Health Action Group: influencing the social determinants of health

There is robust evidence demonstrating that social determinants have far greater influence upon health and the incidence of illness than conventional biomedical and behavioural risk factors, but the public discourse on health and disease remains focused on lifestyle approaches to disease prevention.     

Self rating of health is associated with stressful life events, social support and residency in East and West Berlin shortly after the fall of the wall

STUDY OBJECTIVE: To compare the health status and factors influencing the health of populations that had previously lived under different political systems. DESIGN: Cross sectional health and social survey using postal interviews. The relation between self reported health and psychosocial factors (stressful life events, social support, education, health promoting life style and health endangering behaviour) was investigated. To determine East-West differences a logistic regression model including interaction terms was fitted. SETTING: East and West Berlin shortly after reunification 1991. PARTICIPANTS: Representative sample of 4430 Berlin residents aged 18 years and over (response rate 63%). RESULTS: Of all respondents, 15.4% rated their health as unsatisfactory. Residents of East Berlin rated their health more frequently as unsatisfactory than residents of West Berlin (Or(age adjusted)= 1.29, 95%CI 1.08, 1.52), these differences occurred predominantly in the over 60 years age group. Logistic regression showed significant independent effects of stressful life events, social support, education, and health promoting life style on self rated health. The effects of education and health promoting life style were observed to be more pronounced in the western part of Berlin. Old age and female sex showed a stronger association with unsatisfactory health status in the eastern part of Berlin. CONCLUSIONS: For subjects aged over 60 years there was evidence that living in the former East Berlin had an adverse effect on health compared with West Berlin. The impact of education and a health promoting lifestyle on self rated health seemed to be weaker in a former socialist society compared with that of a Western democracy. This study supports an "additive model" rather than a "buffering model" in explaining the effects of psychosocial factors on health.     

Chronic illness, expert patients and care transition

During the last century demographic and epidemiological transitions have had a radical impact upon health and health service provision. A considerable body of research on the sociological aspects of living with chronic illness has accumulated. Debate has focused on how social environments shape disability-related experiences, and the extent to which individual responses define health outcomes. Through the establishment of the Expert Patients Programme (EPP) in 2001, the Department of Health has sought to enhance NHS patients' self-management capacities. This paper discusses three areas relevant to this: the policy formation process leading up to the EPP's present stage of development; the evidence base supporting claims made for its effectiveness; and the significance of psychological concepts such as self-efficacy in approaches to improving public health. The conclusion discusses NHS developments in primary care and public involvement in health and healthcare, and the implications that initiatives such as the EPP carry for the future. It is argued that to facilitate a constructive process of 'care transition' in response to epidemiological and allied change, awareness of cognitive/psychological factors involved in illness behaviours should not draw attention away from the social determinants and contexts of health.     

Cause-specific hospital admission and mortality among working men: association with socioeconomic circumstances in childhood and adult life, and the mediating role of daily stress

BACKGROUND: The aim of this study was to investigate the association of childhood and adulthood social class with the occurrence of specific diseases, including those not associated with a high mortality rate, and to investigate daily stress as the mechanism for that part of any association which cannot be accounted for by established risk factors. METHODS: This was a prospective cohort study with 25 years of follow-up for cause-specific morbidity and mortality. A total of 5577 Scottish men were recruited from 27 workplaces in the West of Scotland. Childhood social class was determined from the occupation held by the individual's father, and adulthood social class from the individual's occupation at enrolment. Daily stress was measured at enrolment using the Reeder Stress Inventory. RESULTS: Health differentials were found for cardiovascular diseases, lung cancer, peptic ulcer, asthma, accidents and violence, alcohol-related diseases, and perhaps psychiatric illness. Adulthood circumstances were associated with the incidence of most diseases in adulthood, the exception being stroke, which was strongly associated with less privileged circumstances in childhood. Both childhood and adulthood circumstances contributed to the incidence of coronary heart disease. Daily stress did not underlie any of these associations once the influence of established risk factors had been taken into account. CONCLUSIONS: Socioeconomic circumstances in childhood and adulthood both contribute to health differentials in adulthood, the relative contributions depending upon the particular disease. Where known risk factors explained only part of the excess of a disease among individuals raised or living in less-privileged circumstances, there was no evidence to suggest that daily stress was the reason for the unexplained excess.     

Implementing a Community Intervention Program for Health Promotion

ABSTRACT

High rates of cardiovascular disease (CVD) among low income African American and Latinos are well documented. While health promotion interventions leading to personal behavior change are known to reduce CVD in white, middle class, more educated populations, these approaches have not been widely tested in poor, minority ethnic communities. This paper describes a community intervention program to reduce cardiovascular disease risk factors in East Harlem, a low income New York City community in Manhattan, whose population is 53% Latino and 39% African American. This primary prevention model seeks to change attitudes, norms and values regarding behaviors that contribute to chronic disease within a defined population through initiating changes in the social, educational, cultural and physical environment. Environmental and organizational conditions that predict successful outcomes for the model and strategies, methods and skills, borrowed from social work and other behavioral sciences to implement and institutionalize community wide lifestyle changes, are highlighted.     

Individual risk factors, health behaviour and mortality developments in Germany from 1984 to 1998

The aim of the study is to investigate the contribution by the risk factors smoking, overweight, high blood pressure, physical inactivity and regular alcohol consumption to the total mortality development of the general population in Germany. Data are a mortality follow-up conducted by the Federal Institute for Population Research during 1984 - 1998 in West Germany and 1991-1998 in East Germany. 8474 persons participated at baseline in West Germany in the age group 31-69 years, and 1546 persons participated at baseline in East Germany in the age-group 40-79 years. The vital status in the year 1998 could be determined in West Germany for 86.5% and in East Germany for 97.0%. In the observation period 1986-1998 for West Germany 17.2% of the males died and 8.6% of the females. In East Germany between 1991-1998 9.6% of the males died and 6.7% of the females. The statistical analysis, based on the Cox regression showed for West Germany except for overweight in males throughout a significant contribution of the risk factor load on total mortality. The highest relative risks were found for strong smokers (males: RR = 3.47, p < 0.001, females: RR = 3.62, p < 0.001). The relative mortality risk for persons with three and more risk factors yielded in males 4.88 (p < 0.001) and in females 5.05 (p < 0.001). These findings clearly demonstrate that already a few risk markers of the individual health behaviour have a strong impact on the total mortality development in Germany. The mortality risk is about five times higher for persons with three and more risk factors. This indicates the need for preventive measures targeting high-risk population groups.