Health, inequality and poverty

In this unfinished rough powerpoint for a series of lectures I explore why the United States is markedly different from other representative democracies and welfare states.  I trace the tradition of using a combination of bribery and corruption of the Congress and Judiciary, and violence and racist terror as a means of marginalizing organized labour and frustrating democratic control.  I explore how the contemporary crisis of social inequality, political corruption and racist authoritarian government long predates Trump, first emerging after Reconstruction in the Kleptocracy of the Gilded Age, receding somewhat under Roosevelt's leadership and with the Bretton Woods consensus, only to re-emerge with the Reagan revolution and the political triumph of the racist reaction to the Civil Rights and Feminist Movements, and the radicalism of the 1960s.  On the foreign policy side, the resurgent power of the oligarchy within the country and the brutal repression of the poor and marginalization of labour and the voices of the black radical tradition, symbolized by the ruins of Detroit and the South Bronx, would be matched by the consolidation of the policies of the so-called Washington Consensus.  This policy approach, enforced by the IMF, World Bank, and American military force and paramilitary violence, is often sold as Globalization, critiqued as Neo-liberalism, but might more accurately be described as a return to racist colonialism of the filibusters, Teddy Roosevelt, and Woodrow Wilson.  The talk, which is intended to engage non-academic audiences and avoid jargon and theory, ought to be read in conjunction with Richard Iton's Solidarity Blues, and WIlkinson and Pickett's The Spirit Level.

Multidisciplinary teams (MDTs) are conventionally recommended in mental health
care literature as an important way to offer holistic treatment provision to patients. This
study aims to explore multidisciplinary teamwork in contemporary mental health
settings, particularly what aids and hinders the process of multidisciplinary teamworking,
and the social work contribution in such teams. In order to attain an in-depth
exploration of these phenomena, a single case study design was employed. Within this
design, data were generated through semi-structured interviews and structured
observation of a mental health MDT in Ireland. These data were analysed using
interpretative phenomenological analysis. The research highlights how the concept of
mental illness is contested within this MDT, with the medical model dominant within
an environment of fluid working arrangements. Professional role blurring and
stereotyping were found to impact the division of labour on this team, with role
negotiation found to be an integral part of retaining a professional’s practice identity.
This research raises concerns for social work’s capacity to function within mental
health MDTs in Ireland, and highlights ways in which social work educators might
respond in order to empower Irish social workers to meet the challenges of mental
health multidisciplinary teamworking.

Desde mediados del siglo XX las condiciones de salud presentaron un panorama divergente, en el que se experimentó el incremento de la esperanza de vida y en contraste, la persistente insatisfacción de las necesidades básicas con efectos en las tasas de morbilidad y mortalidad. Pobreza y salud componen una asociación de tipo bidireccional : la pobreza da paso a la mala salud y la mala salud perpetúa la pobreza. En este capítulo se observan las correlaciones de cinco enfermedades características de la pobreza distribuidas en México.

(with Chhea, C. and Warren, N.)  A decade after health sector reform, public health services in rural Cambodia remain under-utilised for multiple reasons related to financial, structural and personnel factors. Ineffectiveness of rural public health services has led to a significant increase in private providers, often the same people who staff public facilities. Public health clinics are often portrayed as low quality, with long waiting times and unexpected costs; in contrast, private clinics are seen to provide more convenient health care. Several strategies, including contract management and health equity funds, have been introduced to improve public sector performance and encourage utilization; these efforts are ongoing. However, the feasibility of these strategies remains in question, particularly in terms of cost-effectiveness and sustainability.

Methods: In this article the strategies of and barriers met by health workers who remain in rural areas and deliver public health services are elucidated. Ethnographic research conducted in 2008 with health providers involved in treating tuberculosis patients in Kampong Speu Province, Cambodia is drawn on. Participants were recruited from the provincial health department, provincial hospital and four health centres. Data collection involved in-depth interviews, participation in meetings and workshops aimed at health workers, and observation of daily activities at the health facilities. Data were transcribed verbatim, imported into NVivo software (www.qsrinternational.com) for management, and analysed using a grounded theory approach.

Results: Primary healthcare service delivery in rural Cambodia was reliant on the retention of mid-level of health staff, primarily midwives and nurses. Its performance was influenced by institutional characteristics relating to the structure of the health system. Personal factors were impacted on by these structural issues and affected the performance of health staff. Institutional factors worked against the provision of high-quality public health services, and included the fragmentation of service delivery and structure, limited capacity and shortage of high-qualified health staff, competition with the private sector, and shortage of medical supplies. These factors all de-motivated health staff, and undermined their performance in public service positions. Personal factors were paramount for staff retention. These included: optimism and appreciation of work responsibilities and position, the personal ability to cope with financial barriers, and institutional benefits such as opportunities for professional development, job security, financial opportunities (via performance-based allowances), and status in society. Individual financial coping strategies were the dominant factor underlying retention, but alone were often de-motivating: clients were diverted from the public services, which led to distrust, and thus undermined the capacity of public system. There was significant interaction between institutional and personal factors, which impacted on the effectiveness of health staff retention in rural areas. Health workers tended to remain in their government positions for prolonged periods of time because they experienced personal rewards. At the same time, however, their job performance in the public health services were hindered by challenges related to the institutional factors.

Conclusions: The interaction between institutional factors and personal factors was crucial for effectiveness of health staff retention in rural Cambodia. Efforts aimed at ensuring quality of care and encouraging health staff retention should attempt to remove the institutional barriers that discourage the use of rural public health services.

This encyclopedia entry introduces the concept of reproductive health and rights. The article discusses the history of institutionalization of the concept, it's conceptualization, current world status on reproductive health and rights, and the relation between reproductive health and rights and poverty.

Health for urban poor is made unaffordable by poor policies and lack of vision for health of the nation. Severe illness or hospitalization is a great economic shock for the marginal communities. Poverty and ill health forma a vicious cycle that it never allows a poor man to be healthy. It is for governments to develop policies and systems to provide access of health care for all. Public - Private - Partnership (PPP) is one of the methods/models by which the health can be made available to the public by overcoming the limitations of the state.  As a result of privatization, neglect and corruption the public (government) health systems are ruining and private share in the health care is growing very rapidly in India. Though the PPP model of development was initially used in only huge infrastructural projects, gradually it also evaded into service sector. There are few best practices in PPP modeled health care , as well as there are ill methods by which the public money is exploited by deserting the government health systems. While explaining the need for PPP model in urban health; this paper highlights the pros and cons of each PPP method. And also indicates the precautions to be taken for optimizing the benefit to the public. (This paper was presented in a state level seminar  on Urban Health Management in Dr. MCRHRD at Hyderabad.)

Should we grant a fresh start to those who come to regret their past lifestyle choices? A negative response to this question can be located in the luck egalitarian literature. As a responsibility-sensitive theory of justice, luck egalitarianism considers it just that people’s relative positions reflect their past choices, including those they regret. In a recent article, Vansteenkiste, Devooght and Schokkaert argue against the luck egalitarian view, maintaining instead that those who regret their past choices in health are disadvantaged in a relevant way and should receive compensation. Employing the ideal that people should be made equal as measured by equivalent resources they purport to show the fairness of such an arrangement through a hypothetical scenario. Relaxing the implicit assumptions of this scenario brings forth several unattractive consequences of the fresh start idea. The main problem is that in striving to ensure that people’s past choices do not affect their own opportunities, the authors must accept that these choices put heavy strains on the opportunities available to other people. Furthermore, the luck egalitarian position is more compelling than they admit.

The health of a community can be seen in the health of its individual members as it relates to the environment. The built environment, through opportunity for physical activity and availability of resources, strongly affects the health of the individual in mapping the options residents have for making healthful choices. The social environment is the result of individual interactions that serve to reinforce social norms and resist behaviors out of the norm. Research shows low socioeconomic status impedes the ability of the individual to make healthy choices, and curtail the development of the community resulting in negative health outcomes on a community level.

Background: Studies of weight and health-related quality of life (HRQOL) generally focus on white populations. This analysis examines the association between clinical weight categories and physical HRQOL in five racial= ethnic groups of older women and determines the extent to which emotional=psychological (social support, caregiver burden) and physical health (diabetes, osteoarthritis) factors modify this relationship. Methods: The cross-sectional analysis, completed in 2007, used baseline data from postmenopausal women enrolled in the Women's Health Initiative (WHI) during the 5-year recruitment period (1993)(1994)(1995)(1996)(1997)(1998). Results: Of 161,393 women, 83% were non-Hispanic white, 9% were African American, 4% were Hispanic= Latina, 3% were Asian=Pacific Islander, and <1% were American Indian=Alaska Native. Obesity (body mass index [BMI] !30 kg=m 2 ) was most common in non-Asian minority groups. Regression modeling showed higher odds of poor physical HRQOL with increasing weight category in all groups. In the total sample, these odds were at least 6 times as high in women with class 3 obesity as in women of normal weight and were only mildly attenuated after the analysis adjusted for emotional=psychological factors. Further adjustment for physical health factors made odds ratio (OR) estimates drop from 2.36 to 1.59 for class 1 obesity and from 6.96 to 3.71 for class 3 obesity. This pattern generally persisted within each racial=ethnic group. Conclusions: Heavier weight negatively affects physical HRQOL in postmenopausal women across diverse racial=ethnic backgrounds. Weight-relevant physical health factors have a greater impact on this weight-HRQOL association than do emotional=psychological factors.