‘Live Beautiful,Live Well’ (‘Vivir Bonito,Vivir Bien’) in Nicaragua: Environmental health citizenship in a post-neoliberal context

ABSTRACT

The concepts Vivir Bien and Buen Vivir, often translated as ‘living well’ or ‘collective well-being,’ are central to contemporary social medicine reforms in Latin America. Owing to increasing social inequalities, notably in the public healthcare sector, Vivir Bien has regional significance as it redefines the neoliberal development goals from economic improvement to so-called post-neoliberal social goals of harmonious co-existence between society and the physical environment. To examine how this abstract concept is conceptualised, is incorporated into, and shapes state-sponsored public health strategies, I analyze the ‘Vivir Limpio, Vivir Sano, Vivir Bonito, Vivir Bien?…?!’ (‘Live Clean, Live Healthy, Live Beautiful, Live Well?…?!’) national campaign in Nicaragua that began in 2013. The campaign promotes normative socio-political ideals around environmental health citizenship, including the adoption of indigenous grammars and solidarity. However, analyses of dozens of interviews and 143 household surveys in four historically impoverished, untidy, and unhygienic communities suggest that the campaign’s discourses do not resonate with citizens or their socio-economic contexts. In highlighting discrepancies between state-sponsored normative sociopolitical ideals and citizens’ lived realities and perspectives, this paper introduces the term ‘post-neoliberal citizenship’ to reflect contemporary – and changing – conceptualizations of health, wellbeing, and citizenship in post-neoliberal Latin America.     

Community action for health in socioeconomically deprived neighbourhoods in Barcelona: Evaluating its effects on health and social class health inequalities

BackgroundThe aim of this study was to analyse trends in several health-related indicators in socioeconomically deprived neighbourhoods in Barcelona with strong community action for health (CA), and compare them to neighbourhoods without such community action. A secondary goal was to analyse trends in socioeconomic inequalities in health in both types of neighbourhood.MethodsWe performed a quasi-experimental pre-post study using data from the Barcelona Health Surveys of 2001 and 2011. Our dependent variables were self-perceived health, mental health, previous drug use, and smoking cessation. We used Poisson regression with robust variance to calculate prevalence ratios (PR) and 95% Confidence Intervals (95% CI).ResultsThe percentage of men who had ever used drugs decreased over time in neighbourhoods with strong CA (PR = 0.48; 95% CI:0.25–0.92, from 2001 to 2011), but not in neighbourhoods without CA (PR = 1.02; 95% CI:0.74–1.40). However, the prevalence of poor mental health among men increased more in neighbourhoods with strong CA than in neighbourhoods without CA (p-value = 0.025). Among women, social class inequalities in poor mental health and smoking cessation decreased over time in neighbourhoods with strong CA but not in neighbourhoods without CA.ConclusionsOur study shows promising results regarding the effect of community action on health, particularly in terms of inequalities. Our results highlight the importance of allocating resources to implement and continuously evaluate CA initiatives.     

Between diverging discourses of the child: juveniles’ self-construction in coercive residential care

Based on a qualitative study, this article explores how Norwegian juveniles construct themselves through stories of everyday life in coercive residential care and how this is related to diverging discourses of the child’s status in society. The findings reveal two dominant positions of identification—the autonomy position and the responsibility position—which are discussed as made possible by the child-as-citizen discourse. The article argues that juveniles self-constructions primarily contrast but also are intervened with the dominant discourse of the vulnerable child in social work. The article concludes that recognising juveniles’ in residential care as citizens implies a critical evaluation of practices inherent in the discourse of the vulnerable child.     

Protective behaviours among young African American women with non-monogamous sexual partners

In the USA, partner non-monogamy is reported to be more common among African American women than White women and may contribute to African American women’s increased risk for HIV and other sexually transmitted infections (STIs). Few studies have explicitly and comprehensively described the protective behaviours that African American women employ with non-monogamous partners to reduce their HIV risk. We conducted interviews to examine protective behaviours among 11 African American women aged 18–24 years who perceived that a partner in the preceding 12 months had another sex partner. Participants described three types of partnerships with 29 non-monogamous men; these partnerships clustered into three categories. Narrative analysis revealed an overall paucity of protective behaviours with non-monogamous partners. Protective behaviours (i.e. communication and condom use) were informed by partnership type, rather than perceptions of non-monogamy. There were few instances in which partner non-monogamy motivated women to terminate sex partnerships. Rather, these decisions were often motivated by changes in other relationship dynamics. To address HIV/STI risk related to partner non-monogamy, HIV prevention strategies for young African American women should emphasise the importance of condom use in all non-marital partnership types. Interventions where testing is available may be effective for women who frequently test for HIV/STIs but do not use condoms.     

Parenting children with neurodevelopmental disorders and/or behaviour problems

Background Parenting behaviours influence child well‐being and development. However, much of the research on parenting behaviours and their correlates has focused on caregivers of healthy, typically developing children. Relatively less is known about the parenting behaviours of caregivers of children with chronic health conditions. Objective To examine and compare three parenting behaviours (positive interactions, consistency and ineffective parenting) among caregivers of children with neurodevelopmental disorders and/or externalizing behaviour problems, before and after accounting for child and family socio‐demographic characteristics. Methods Participants (n= 14 226) were drawn from the National Longitudinal Survey of Children and Youth, a long‐term study of Canadian children that follows their development and well‐being from birth to early adulthood. Children (and their caregivers) were divided into four groups according to the presence of a neurodevelopmental disorder (NDD; n= 815), the presence of an externalizing behaviour problem (EBP; n= 1322), the presence of both conditions (BOTH; n= 452) or neither of these conditions (NEITHER; n= 11 376). Results Caregivers of children in the NEITHER group reported significantly higher positive interaction scores and lower ineffective parenting behaviours than caregivers of children in any of the other three groups. Caregivers of children in the EBP and BOTH groups reported similar levels of consistency, but significantly lower levels than caregivers of NDD or NEITHER children. These associations largely remained after accounting for child and family socio‐demographic characteristics, with two exceptions: caregivers' reports of positive interactions were no longer significantly associated with child's NDD and BOTH conditions. Conclusions Parenting children with multiple health conditions can be associated with less positive, less consistent and more ineffective parenting behaviours. Understanding the factors that are associated with the challenges of caring for these children may require additional research attention.     

The ‘healthy brothel’: The context of clinical services for sex workers in Hillbrow,South Africa

Conventional health services often present barriers to sex workers seeking health care resulting in untreated sexually transmitted infections (STI) and increased risk of HIV infection. A brothel‐based clinic was established to provide STI treatment for sex workers who worked in the inner city suburb of Hillbrow, South Africa. Qualitative research demonstrated that the clinic was acceptable to women in terms of service quality, accessibility, and efficacy, and positively influenced health‐seeking behaviours, health awareness, and condom use. The intervention also transformed the image of the hotels from sites of ‘dirt and disease’ into ‘healthy brothels’. The paper concludes that clinical services offered on site are a viable alternative to the provision of conventional clinical services.

Résumé

Les travailleuses du sexe en recherche de soins sont souvent confrontées à certains obstacles dans les services de soins conventionnels. Il en résulte des infections sexuellement transmissibles (IST) non traitées et une augmentation des risques de contamination par le VIH. Un centre de soins a été installé dans un bordel de la banlieue déshéritée de Hillbrow en Afrique du Sud, pour dispenser des traitements des IST aux travailleuses du sexe exerçant localement. Une étude qualitative a démontré que ce centre était acceptable aux yeux de ces femmes, en termes de qualité des services, d'accessibilité et d'efficacité, et qu'il influait positivement sur les comportements de recherche de soins, la sensibilisation à la santé et l'usage du préservatif. L'intervention a aussi transformé l'image de ces lieux «sales et remplis de maladies» en celle de «bordels sains». L'article conclut que les services de soins sur sites sont une alternative viable aux services de soins conventionnels.

Resumen

Los servicios tradicionales de la salud muchas veces ponen trabas a las trabajadoras sexuales que piden ayuda médica lo que implica que no se traten las infecciones de transmisión sexual y aumente el riesgo de infección del VIH. En un centro de un suburbio de la ciudad de Hillbrow, en Sudáfrica, se creó una clínica dentro de un burdel para ofrecer tratamiento contra las enfermedades de transmisión sexual a las trabajadoras sexuales. En un estudio cualitativo se demostró que la clínica era aceptable para las mujeres en lo referente a calidad de servicios, accesibilidad y eficacia y además influenciaba positivamente en actitudes tales como pedir ayuda médica, interesarse por la salud y usar preservativos. Esta intervención también transformó la imagen de los hoteles que pasaron de ser sitios “sucios y con riesgo de enfermedades” a “burdeles sanos”. Terminamos el artículo defendiendo que los servicios clínicos ofrecidos en estos lugares son una alternativa viable a los servicios clínicos convencionales.     

Who you know, where you live: social capital, neighbourhood and health

This article examines the degree to which relationships between social capital and health are embedded in local geographical contexts and influenced by demographic factors, socio-economic status, health behaviours and coping skills. Using data from a telephone survey of a random sample of adults (N=1504 respondents, response rate=60%), the article determines if relationships between involvement in voluntary associations and various measures of individual health are associated with neighbourhood of residence in the mid-sized city of Hamilton, Canada. Associational involvement and overweight status (assessed by body-mass score) were weakly but significantly related after controlling for the other variables; involvement had relationships with self-rated health and emotional distress before but not after controlling for socio-economic status, health behaviours and coping skills. Relationships between neighbourhood of residence and two health outcomes, self-rated health and overweight status, were statistically significant before and after controlling for the other characteristics of respondents; neighbourhood of residence was not a significant predictor of number of chronic conditions and emotional distress in multivariate models. The neighbourhood and associational involvement relationships with health were not dependent upon one another, suggesting that neighbourhood of residence did not help to explain the positive health effects of this particular measure of social capital.     

Parental rearing behaviours and eating disorders: the moderating role of core beliefs

OBJECTIVE: Core beliefs have been shown to mediate between eating psychopathology and dysfunctional parent-daughter interactions. However, the possible moderating role of core beliefs has been neglected. This study aimed to explore the hypothesis that core beliefs serve as moderator variables in the relationship between recalled parental rearing behaviours and eating psychopathology. METHOD: Sixty-six women with a current eating disorder completed self-report measures of parental rearing behaviours, core beliefs, and eating psychopathology. RESULTS: Three core beliefs were found to moderate the relationship between paternal rejection and aspects of eating psychopathology. The predictive validity of paternal rejection on aspects of eating symptomatology was found to decrease as dysfunctional core beliefs increased. DISCUSSION: When levels of social isolation, vulnerability to harm, and self-sacrifice core beliefs were high, recalled parental relationships were no longer relevant to current eating psychopathology. The findings provide further evidence that core beliefs are important factors in eating disorder psychopathology and may be clinically useful in identifying targets for treatment.     

Implications of attachment style for patterns of health and illness

There is substantial evidence that health status and health outcomes are related to the availability and quality of personal relationships. The proposition that attachment relationships in childhood and adolescence have health-related implications fits within this research tradition, and has guided recent attempts to develop models linking attachment style with emotional regulation, coping mechanisms, and illness behaviours. The present paper discusses these theoretical models, together with relevant empirical findings. It is argued that measures of attachment security are related to symptom-reporting, health-care utilization, and restriction of normal activities, and that these links can be explained, in part, by individual differences in emotional and behavioural responses to stress. It is further noted that researchers have proposed physiological and biochemical pathways which may explain some of the effects of attachment style on physical health. The quality of parent-child attachment also predicts family responses to children's illness, as reflected in parents' visitation rates and in family participation in studies of health and illness. The implications of the findings for research and for practice in the health professions are briefly discussed.