Consequences of criminalisation: the Dutch khat market before and after the ban

Abstract

Aims: To evaluate the consequences of criminalising khat, with a focus on the changes in law enforcement and the use, availability, price and quality of khat in the Netherlands. Methods: Mixed methods, including law enforcement data, expert interviews, focus group interviews with members of the Somali community, and a survey among 168 current (last month) khat users. Findings: Soon after the law changed (early in 2013), and khat had become an illicit drug, much of the khat imported from Africa was confiscated at Schiphol International Airport and users found it more difficult to obtain fresh khat leaves. About two years after the ban had been implemented, the price of fresh khat at user level had increased tenfold on average, and much of it was of poorer quality (e.g. sold in dried or powdered form). Conclusion: Criminalisation of khat in the Netherlands had substantial consequences for the khat market, predominantly because the ban was actively enforced at a crucial stage in the distribution chain (transcontinental import by air) and there was a lack of alternative transportation routes that could supply users with fresh khat. It is highly likely that the total number of Somali khat users in the Netherlands dropped, but that the proportion of dependent and poor, “problem users” increased.     

Adolescence as a gateway to adult health outcomes

Adolescence has long been regarded as a transition from childhood to adulthood. More recently it is become a concern of those wishing to avoid adverse health outcomes during middle and late adulthood. Most of this effort has been focused on behavioural risk factors such as tobacco and excessive alcohol use, physical exercise habits, dietary habits, as well as sexual and injury-related behaviours. The concern is that these habits are established during adolescence, continue into adulthood, and come to constitute ongoing risk factors for adverse health outcomes during middle and late adulthood. There is good reason to criticize this approach. These behaviours are themselves shaped by adolescents’ living and working conditions and even then constitute a small proportion of the variance predicting adverse health outcomes during adulthood. More complex models of how adolescence serves as a gateway to adult health outcomes are presented. These are the socio-environmental, public policy, and political economy approaches. The argument is made that adolescence is a period during which public policy plays an especially important role in predicting future health outcomes. Yet, these public policies influence health all across the life span with adolescence providing only one of many important periods during which public policy shapes health prospects during middle and later adulthood. Ultimately one should consider a range of approaches ranging from the behavioural to the political to examine how adolescence serves as a gateway towards future adult prospects. An Adolescent Gateway Towards Adult Health Model is provided to assist in this process.     

Operational research leading to rapid national policy change: tuberculosis-diabetes collaboration in India

In 2011, bi-directional screening for tuberculosis (TB) and diabetes mellitus (DM) was recommended by the World Health Organization (WHO), although how best to implement the activity was not clear. In India, with early engagement of national programme managers and all important stakeholders, a countrywide, multicentre operational research (OR) project was designed in October 2011 and completed in 2012. The results led to a rapid national policy decision to routinely screen all TB patients for DM in September 2012. The process, experience and enablers of implementing this unique and successful collaborative model of operational research are presented.     

Comparison of Turkish Disability Policy,the United Nations Convention on the Rights of Persons with Disabilities,and the core concepts of U.S. disability policy

This article compares Turkey's Constitution and its Disabled Persons Act with the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) and the core concepts of United States (U.S.) disability policy. Conclusions are that Turkey's Constitution and statutes are remarkably congruent with the UNCRPD and the core concepts. They are not, however, identical. This fact suggests that Turkey can still improve its statutes to reflect more closely the UNCRPD and core concepts. The review of these policy documents suggests that there are other steps Turkey can take to improve disability policy and its implementation. They are to amend Turkey's laws, determine the status of individuals and families affected by disability, and pursue vigorous implementation of their rights.     

EEPP: Conclusions,Implications and Future Directions

Early childhood is an important time for the promotion of healthy development and the prevention of mental disorders in adult life. In the context of the need to understand and design universally accessible promotional and preventative services for children, the European Early Promotion Project (EEPP) was developed as an innovative service implemented and evaluated in five European countries. Previous chapters in this special issue have detailed the components of the project, its outcomes for the primary health care professionals (PHCPs) and the families who were involved, and an evaluation of the costs. Here we draw together the major findings, assess the success of the project and discuss its contribution to the field of primary prevention.     

Physician Training:

The authors surveyed former medical resident physicians who participated in long-term home health care program services during training. Forty-four physicians who had served in a home visit program were surveyed after an average of ten years since completion of medical training (range: 1 to 18 years). The majority of the 43 respondents (56%) make house calls in their current medical practices and most of the 36 now involved in medical house staff training (83%) incorporate their home care experience into their teaching today. Working at a home health care program can have educational value for medical residents, influence later practice, and result in personal and professional rewards.     

El impacto de la crisis en la relación entre vivienda y salud. Políticas de buenas prácticas para reducir las desigualdades en salud asociadas con las condiciones de vivienda

Housing conditions can impact on physical and mental health through 4 interrelated dimensions: 1) the home (the emotional housing conditions), 2) the physical housing conditions, and 3) the physical environment, and 4) the social (community) environment of the neighborhood where the house is located. In Spain, the use of the construction market as an engine for economic growth and the promotion of private property as the main type of housing tenure has led to the use of housing as a speculative good instead of its being considered a first-necessity good. While Spain is the Organisation for Economic Co-operation and Development (OECD) country with the largest housing stock per inhabitant, this stock is highly underutilized, thus excluding the most deprived sector of the population from access to housing. The impact of the current economic crisis on housing has mainly been due to a reduction in household income, which has increased the number of families or persons struggling to cover their housing costs or being evicted. Evidence indicates that this type of problem has a negative impact on health, especially on mental health, but financial problems also make it difficult to meet other basic needs such as eating. There are several instruments to reduce the impact of the economic crisis, such as debt financing or deed of assignment in payment. In the long-term, the creation of a social housing stock should be promoted, as well as rental assistance mechanisms.