The health of the urban black in the South African context

The state of medicine in South Africa is a mixture of development and under-development. The Whites have the disease patterns typical of highly-industrialised western countries. By reason of their privileged position they have also abrogated to themselves most of the medical resources so that sophisticated health services for Whites can only exist at great cost to the Black population which bears the main burden of disease in the country. Infectious and epidemic diseases due to poor environmental conditions do not occur in the White population and they are also protected from most industrial accidents as they perform work which is largely supervisory, technical or professional. Among Blacks the major health problems relate to poverty, lack of adequate sanitation and water, over-crowded housing and the occupational hazards of low status workers poorly protected in many cases from industrial accidents. The high increase of infectious and epidemic diseases, particularly in the early years of life as well as tuberculosis are indicative of the difference between the two groups. During 1980 and again in 1981 there have been severe outbreaks of cholera among Black rural populations illustrating the failure of the society to provide its citizens with an unpolluted water supply, but this problem does not receive urgent attention in a country which instead pioneers new techniques in heart transplant surgery.However, the health problems of all Blacks in the Republic of South Africa are becoming differentiated today in terms of rural urban dichotomy. Because the modern sector of the economy needs permanently urbanised workers able to produce efficiently as well as reproduce themselves, some measure of attention has been given to the improvement of the environmental conditions and the health services of the worker in the city. This paper proposes that we consider the disease patterns and access to health care in South Africa in terms of three tiers of health with the Whites in the first tier, the urban Black population in the second tier and the rural Black in the third tier. this paper focuses on the position of the Blacks in the second tier and it shows that some of their most urgent health problems have received attention, yet in contrast with the Whites, in the first tier, glaring inequalities remain. But almost two-thirds of the Black population remains rural and the most signicant imbalance in terms of health is not being redressed.     

New-immigrant women in urban Canada: insights into occupation and sociocultural context

Recent statistics have shown that women from South Asia comprise one of the largest sub-groups of immigrants to enter Canada. The majority of this population has settled in the city of Toronto. As immigrants adapt to new physical, social, political, and economic environments in a new country, they are also subject to changes in occupational roles and expectations. Little research has been conducted with new immigrant women from South Asia from an occupational adjustment perspective in Canada. This qualitative study sought to understand the adjustment experiences of immigrant women from South Asia regarding the influence of a Canadian urban environment on their occupations. Twelve recently immigrated women from South Asia to Canada were interviewed about their experiences of living in the city of Toronto with respect to their adjustment to a new environment and engagement in new daily occupations. Using a modified grounded theory approach to analysis, results from the study revealed many challenges these women face and the major factors that aid in the adjustment process. A framework for understanding occupational adjustment in new immigrants is discussed with implications for occupational therapy theory and practice.     

Experiences of place attachment and mental wellbeing in the context of urban regeneration

Urban regeneration is an important policy focus across the European Union, with initiatives seeking to address inequalities in public health. Although theoretically such initiatives should produce benefits for mental wellbeing, this lacks strong supporting evidence. The current research addressed a prior overreliance on quantitative methods and underappreciation of the psychological significance of place, through the adoption of qualitative interviews with residents, as part of an independent review of a £650m regeneration project. Interpretative phenomenological analysis was utilised to explore the processes involved in residents' mental wellbeing and place attachment. Analysis developed three super-ordinate themes: ‘feelings of control’, ‘social and community relations’, and ‘understandings and definitions of place’. These highlight issues relating to physical health, social isolation, community cohesion, as well as the potential for regeneration activities to undermine various elements of the people-place relationship.     

Stress and diabetes in socioeconomic context: A qualitative study of urban Indians

Type 2 diabetes has escalated in urban India in the past two decades. Historically a disease of the affluent, recent epidemiological evidence indicates rising diabetes incidence and prevalence in urban India's middle class and working poor. Although there is substantial qualitative data about people with diabetes from high-income countries, scant resources provide insight into diabetes experiences among those in India, and lower-income groups specifically. In this article, we use individual-level analysis of illness narratives to understand how people experience and understand diabetes across income groups in Delhi, India. We conducted in-depth qualitative interviews and administered the Hopkins Symptoms Check-List (HSCL-25) to evaluate depression among 59 people with diabetes in northeast Delhi between December 2011 and February 2012. We analyzed their responses to: 1) what caused your diabetes?; 2) what do you find most stressful in your daily life?; and 3) where do you seek diabetes care? We found few people held diabetes beliefs that were congruent with socio-spiritual or biomedical explanatory models, and higher income participants commonly cited “tension” as a contributor to diabetes. Stress associated with children's futures, financial security, and family dynamics were most commonly reported, but how these subjective stresses were realized in people's lives varied across income groups. Depression was most common among the poorest income group (55%) but was also reported among middle- (38%) and high-income (29%) participants. One-quarter of respondents reported diabetes distress, but only those from the low-income community reported co-occurring depression and these respondents often revealed poor access to diabetes care. These data suggest that lower-income populations not only have higher rates of depression but also may be more likely to delay health care and therefore develop diabetes complications. This research has many implications for public health care in India as diabetes prevalence shifts to affect lower income groups who concurrently experience higher rates of depression and poorer access to medical care.     

Residential mobility,socioeconomic context and body mass index in a cohort of urban South African adolescents

Adolescents who are changing residence, as well as their social and economic circumstances may experience lifestyle changes that have an effect on body composition outcomes such as undernutrition, overweight or obesity. This paper uses data from Birth to Twenty, a birth cohort of South African urban children, to determine the relationship between residential mobility and body mass index (BMI) amongst Black adolescents aged 15 (n=1613), and to examine the role of changes in household socioeconomic status (SES). The prevalence of overweight and obesity in the sample was 25% in females and 8% in males. Amongst the females, a strong positive association between residential mobility and BMI was observed for those who also experienced an increase in household SES between birth and 15 years (β=0.42, SE=0.13), while no effect was identified for males. The study shows the potential for environmental change and increased resources to influence the risk for obesity. It also highlights the value in considering the range of social environmental factors and changes across the early life course that might play a part in evolving nutritional patterns in urban transitioning environments.     

Modeling HPV vaccination scale-up among urban young men who have sex with men in the context of HIV

IntroductionYoung men who have sex with men (YMSM) are at high risk to contract human papillomavirus (HPV). While an effective vaccination exists, its use among YMSM is markedly lower compared to non-MSM and women. This study compares scaling up HPV vaccination in conjunction with other prevention strategies.MethodsAn agent-based model of urban YMSM (≤26 years of age) reflective of the demography of Philadelphia, PA, simulated for up to ten years of follow-up to examine anal and oral transmission of the HPV genotypes covered in the nonavalent (9v) vaccine: 6, 11, 16, 18, 31, 33, 45, 52, 58. Starting HPV prevalences ranged from a high of 18% (type 6) to a low of 6% (type 31); overall 65% of individuals carried any HPV genotype. Simulated levels of vaccination were ranged from 0% to 13% (present-day level), 25%, 50%, 80% (Healthy People 2020 target), and 100% in conjunction with condom use and HIV seroadaptive practices. The primary outcome was the relative reduction in HPV infection.ResultsCompared to present-day vaccination levels (13%), scaling-up vaccination led to expected declines in 10-year post-simulation HPV prevalence. Anal HPV (any 9v types) declined by 9%, 27%, 46%, and 58% at vaccination levels of 25%, 50%, 80%, and 100%, respectively. Similarly, oral HPV (any 9v types) declined by 11%, 33%, 57%, and 71% across the same levels of vaccine uptake. Comparing the prevention strategies, condoms blocked the greatest number of anal transmissions when vaccination was at or below present-day levels. For oral transmission, vaccination was superior to condom use at all levels of coverage.ConclusionsPublic health HPV preventions strategies should continue to emphasize the complementary roles of condoms and vaccination, especially for preventing oral infection. Improving vaccination coverage will ultimately have the greatest impact on reducing HPV infection among YMSM.     

Planning for National Disasters

THE four invited speakers were Dr. H. M. Archibald (Departmentof Health and Social Security), Dr. J. A. Bonnell (Central ElectricityGenerating Board), Dr. J. Sharp Grant (British Rail) and Dr.J. Graham Taylor (Air Corporation Joint Medical Service). Dr.Archibald stated that the policy of the Department of Healthand Social Security was to act in an advisory rather than executivecapacity. To that end advisory memoranda and recommendationsare produced, whilst relying on the local authority to takeexecutive control and to direct organisation and rescue operationsin a way which is most suitable to the local area. The planning for nuclear and radiological emergencies requiresthe co-operation of many other services near and around thesite to prevent and mitigate the dangers of nuclear fall-out.This was described by Dr. Bonnell, as well as plans for preventingand controlling the dangers which may occur during the transportof the nuclear materials.