Multiple socioeconomic circumstances and health : associations and explanations among Finnish and British public sector employees

Socioeconomic health inequalities have been widely documented, with a lower social position being associated with poorer physical and general health and higher mortality. For mental health the results have been more varied. However, the mechanisms by which the various dimensions of socioeconomic circumstances are associated with different domains of health are not yet fully understood. This is related to a lack of studies tackling the interrelations and pathways between multiple dimensions of socioeconomic circumstances and domains of health. In particular, evidence from comparative studies of populations from different national contexts that consider the complexity of the causes of socioeconomic health inequalities is needed. The aim of this study was to examine the associations of multiple socioeconomic circumstances with physical and mental health, more specifically physical functioning and common mental disorders. This was done in a comparative setting of two cohorts of white-collar public sector employees, one from Finland and one from Britain. The study also sought to find explanations for the observed associations between economic difficulties and health by analysing the contribution of health behaviours, living arrangements and work-family conflicts. The survey data were derived from the Finnish Helsinki Health Study baseline surveys in 2000-2002 among the City of Helsinki employees aged 40-60 years, and from the fifth phase of the London-based Whitehall II study (1997-9) which is a prospective study of civil servants aged 35-55 years at the time of recruitment. The data collection in the two countries was harmonised to safeguard maximal comparability. Physical functioning was measured with the Short Form (SF-36) physical component summary and common mental disorders with the General Health Questionnaire (GHQ-12). Socioeconomic circumstances were parental education, childhood economic difficulties, own education, occupational class, household income, housing tenure, and current economic difficulties. Further explanatory factors were health behaviours, living arrangements and work-family conflicts. The main statistical method used was logistic regression analysis. Analyses were conducted separately for the two sexes and two cohorts. Childhood and current economic difficulties were associated with poorer physical functioning and common mental disorders generally in both cohorts and sexes. Conventional dimensions of socioeconomic circumstances i.e. education, occupational class and income were associated with physical functioning and mediated each other’s effects, but in different ways in the two cohorts: education was more important in Helsinki and occupational class in London. The associations of economic difficulties with health were partly explained by work-family conflicts and other socioeconomic circumstances in both cohorts and sexes. In conclusion, this study on two country-specific cohorts confirms that different dimensions of socioeconomic circumstances are related but not interchangeable. They are also somewhat differently associated with physical and mental domains of health. In addition to conventionally measured dimensions of past and present socioeconomic circumstances, economic difficulties should be taken into account in studies and attempts to reduce health inequalities. Further explanatory factors, particularly conflicts between work and family, should also be considered when aiming to reduce inequalities and maintain the health of employees.

Ideological notions in public health care rationing : Case studies from Oregon, New Zealand and Finland

The purpose of this dissertation is to analyze and explicate the ideological content, which is often implicit, in the health care rationing discussion. The phrase "ideological content" refers to viewpoints and assumptions expressed in the rationing discussion that may be widespread and accepted, but without clear evidential support. The study method is philosophical text analysis. The study begins by exploring the literature from the 1970s that affects the present-day rationing discussion. Since ideological contents may have different emphases in realm of health care, three representative cases were studied. The first was a case study of the first and best-known rationing experiment in the American state of Oregon, namely, an experimental rationing plan within the public health program Medicaid, which is designed to provide care for the poor and underprivileged. The second was a study of the only national-level public priority setting that has been conducted in New Zealand. The third examined the Finnish Care Guarantee plan introduced in March 2005. The findings show that several problematic and scientifically mostly unproven concepts have remained largely uncontested in the debate about public health care rationing. Some of these notions already originated decades ago in studies that relied on outdated data or research paradigms. The problematic ideological contents have also been taken up from one publication into another, thereby affecting the rationing debate. The study suggests that before any new public health care rationing experiments are undertaken, these ideological factors should be properly examined, especially in order to avoid repetitious research and perhaps erroneous rationing decisions.

The link between foreign aid, public investment and economic growth

Länsimaat ovat rahoittaneet kehitysyhteistyöhankkeita jo lähes kuuden vuosikymmenen ajan, mutta kehitysavun tehokkuudesta ei olla edelleenkään päästy yksimielisyyteen. Yksi avunantajamaiden tapa vaikuttaa kehitysavun tehokkuuteen, eli avun vaikutukseen vastaanottajamaan taloudellisen kasvun kiihdyttäjänä, on sitoa ne julkisen sektorin infrastruktuurihankkeisiin. Joissain tapauksissa tämä vaikuttaa avun vastaanottajan käytökseen ja asenteisiin kehitysapua kohtaan. Tutkielmassa käsitellään kehitysavun tehokkuutta tilanteessa, jossa se on sidottu julkisen sektorin investointeihin kehitysmaassa. Tutkimus pohjaa Kalaitzidakisin ja Kalyvitisin (2008) malliin, jossa osa kehitysmaan julkisen talouden investoinneista rahoitetaan kehitysavulla. Seuraavaksi tarkastellaan ylijäämää tavoittelevan käyttäytymisen (rent- seeking) vaikutusta kehitysavun tehokkuuteen pohjaten Economidesin, Kalyvitisin ja Philippopoulosin (2008) malliin. Tutkielmassa referoidaan lisäksi tutkimuskysymystä sivuavia empiirisiä tutkimuksia, esitellään aluksi tavallisimmat kehitysyhteistyön muodot, sekä esitellään talousteoreettisia näkökulmia kehitysyhteistyön tehokkuuden määrittelylle. Tutkielma perustuu puhtaasti teoreettisiin malleihin ja niissä sovelletut menetelmät ovat matemaattisia. Tutkielmassa käsitellään ensin tapaus, jossa kehitysyhteistyöllä rahoitetaan julkisen sektorin investointihankkeita. Jossain tapauksissa kehitysavun kasvu lasku siirtää vastaanottajamaan kulutusta julkisista investoinneista kulutukseen, jolloin kehitysyhteistyövaroin osittain rahoitettujen hankkeiden koko pienenee, ja suhteellinen tehokkuus laskee. Seuraavaksi tarkastellaan tilannetta, jossa kehitysyhteistyövaroista vain osa päätyy hankkeen rahoittamiseen, ja todetaan, että kehitysavun tehokkuus ja vaikutus maan kansantulon kasvuun vähenee talouden toimijoiden ylijäämää tavoittelevan käyttäytymisen (mukaan lukien korruptio) myötä entisestään. Tämän tutkimuksen perusteella voidaan todeta, että kehitysapu vaikuttaa kehittyvän maan talouden kasvuun tapauksessa, jossa julkisia infrastruktuurihankkeita rahoitetaan osittain maan omin verovaroin ja osittain kehitysyhteistyövaroin. Ylijäämää tavoitteleva käyttäytyminen vaikuttaa kehitysavun tehokkuuteen negatiivistesti vähentäen kehitysavun positiivisia kasvuvaikutuksia.

Social dynamics for sustainable food systems : Actors' orientations towards sustainability in primary production and public consumption

The modern food system and sustainable development form a conceptual combination that suggests sustainability deficits in environmental impacts and nutritional status of western populations. This study explores actors orientations towards sustainability by probing into social dynamics for sustainability within primary production and public consumption. If actors within these two worlds were to express converging orientations for sustainability, the system dynamics of the market would enable more sustainable growth in terms of production dictated by consumption. The study is based on a constructivist research approach with qualitative text analyses. The findings were validated by internal and external food system actors and are suggested to represent current social dynamics within Finnish food system. The key findings included primary producers social skilfulness, which enabled networking with other actors in very different paths of life, learning in order to promote one s trade, and trusting reflectively in partners in order to expand business. These activities extended the supply chain in a spiral fashion by horizontal and vertical forward integration, until large retailers were met for negotiations on a more equal basis. This mode of chain level coordination, typically building around the core of social and partnership relations, was coined as a socially overlaid network, and seen as sustainable coordination mode for endogenous growth. The caterers exhibited more or less committed professional identity for sustainability within their reach. The facilitating approaches for professional identities dealt successfully with local and organic food in addition to domestic food, and also imported food. The co-operation with supply chains created innovative solutions and savings for the business parties to be shared. There were also more complicated identities as juggling, critical and delimited approaches for sustainability, with less productive efforts due to restrictions such as absence of organisational sustainability strategy, weak presence of local and organic suppliers, limited understanding about sustainability and no organisational resources for informed choices for sustainability. The convergence between producers and caterers existed to an extent allowing suggestion that increased clarity about sustainable consumption and production by actors could be constructed using advanced tools. The study looks for introduction of more profound environmental and socio-economic knowledge through participatory research with supply chain actors. Learning in the workplace about food system reality in terms of supply chain co-operation may prove to be a change engine that leads to advanced network operations and a more sustainable food system.

Public opinion on useful languages in Europe

This article analyses the results of five Eurobarometer surveys (of 1995, 1997, 1998, 2000 and 2005) designed to measure which languages Europeans consider most useful to know. Most Europeans are of the opinion that English is the most useful, followed by French and German. During the last decade the popularity of French and German as useful languages has been decreasing significantly, while English has remained universally favoured as the most useful language. French and German have lost their popularity especially among those who do not speak them as a foreign language. On the other hand, Spanish, Russian and other languages (often these include languages of neighbouring countries, minority languages or a second official language of the country in question) have kept and even increased their former level of popularity. Opinions about useful languages vary according to a respondent’s knowledge of languages, education and profession. This article analyses these differences and discusses their impact on the study of foreign languages and the future of the practice of foreign languages in Europe.

Promoting the European Union : Attitudinal stance adjectives in three genres of EU communication to the public

Målet för Pro Gradu-avhandlingen är att undersöka hur Europeiska unionen (EU) marknadsförs genom användningen av värderande adjektiv i tre genrer av skriftlig kommunikation från EU till medlemsstaternas medborgare. Undersökningen är inriktad på tre forskningsfrågor: hur marknadsföringen av EU syns i användningen av värderande adjektiv i de tre genrerna, vilka de centrala skillnaderna mellan de tre genrerna är gällande användningen av värderande adjektiv, samt på vilket sätt texterna uppfyller sitt kommunikativa syfte, nämligen att informera allmänheten om EU:s verksamhet och marknadsföra EU som en giltig och handlingskraftig union. Den teoretiska ramen för undersökningen grundar sig på genreanalys, kommunikationsteori och teorier om hur författarens värdering (stance) syns i texter. Skillnaden mellan genre, texttyp och register diskuteras, och teoridelen redogör även för begreppet diskurssamfund, dvs. den grupp personer som i ett yrkesmässigt eller institutionellt sammanhang producerar och använder sig av en genre enligt dess kommunikativa konventioner. Materialet behandlas även utgående från Egon Werlichs indelning av texttyper i deskriptiva, narrativa, expositära, argumentativa och instruktiva texter. Materialet består av tre delar som representerar var sin genre: informationsbroschyrer, pressmeddelanden och den Allmänna rapporten om Europeiska unionens verksamhet, som utges av EU varje år. Storleken på varje del av materialet varierar mellan 20 000 - 30 000 ord. Materialet har valts på basis av de teman texterna behandlar, och kriterierna för urvalet är bl.a. att texterna behandlar ämnen som har anknytning till medborgarnas vardag, att de är riktade till allmänheten, och att de finns tillgängliga på Internet. Undersökningen är genomförd som en kvalitativ genreanalys. Materialet analyseras först utgående från kontexten och det samhälleliga sammanhanget enligt Vijay K. Bhatias metodik för analys av obekanta genrer. Det kommunikativa syftet, författaren och den tilltänkta läsarkretsen, dvs. målgruppen för kommunikationen, fastställs. Värderande adjektiv som uttrycker författarens hållning har plockats ur texten manuellt och med hjälp av konkordansprogrammet AntConc, och placerats i 16 kategorier enligt de värden de uttrycker. Varje genre analyseras sedan språkligt med utgångspunkt i adjektivlistorna, varefter resultaten jämförs med varandra. Undersökningen visar att pressmeddelandena innehåller det största antalet värderande adjektiv, medan informationsbroschyrerna innehåller det minsta antalet värderande adjektiv. Den Allmänna rapporten om Europeiska unionens verksamhet innehåller delar med tätt förekommande värderande adjektiv, i synnerhet i stycken som behandlar mer kontroversiella ämnen. I alla tre genrer sammanfaller ett högt antal värderande adjektiv med argumentativ text, och argumentativ text förekommer främst då ämnet som diskuteras rör sig på en mer abstrakt nivå, t.ex. om EU:s värderingar och grundläggande principer, eller då texten behandlar sådan politik som delar allmänhetens uppfattning. För EU utgör alla tre genrer viktiga kanaler för kommunikationen till medlemsstaternas medborgare, och EU kan genom sitt informationsmaterial och sina officiella publikationer informera om, förklara och marknadsföra sin verksamhet på ett sätt som avser att upprätthålla och förbättra EU:s image. Utarbetandet av lämpliga texter är ändå krävande på grund av den heterogena målgruppen, och det är en utmaning i sig att få fram rätt budskap bland det stora utbudet information som finns tillgängligt på Internet.

Rhetoric and public speech in English republicanism, 1642-1681

The study analyses the ambivalent relationship republicanism, as a form of self-government free from domination, had with the ideal of participatory oratory and non-dominated speech on the one hand, and with the danger of unhindered demagogy and its possibly fatal consequences to that form of government on the other. Although previous scholarship has delved deeply into republicanism as well as into rhetoric and public speech, the interplay between those aspects has only gathered scattered interest, and there has been no systematic study considering the variety of republican approaches to rhetoric and public speech in 17th-century England. The rare attempts to do so have been studies in English literature, and they have not analysed the political philosophy of republicanism, as the focus has been on republicanism as a literary culture. This study connects the fields of political theory, political history as well as literature in order to make a multidisciplinary contribution to intellectual history. The study shows that, within the tradition of classical republicanism, individual authors could make different choices when addressing the problematic topics of public speech and rhetoric, and the variety of their conclusions often set the authors against each other, resulting in the development of their theories through internal debates within the republican tradition. The authors under study were chosen to reflect this variety and the connections between them: the similarities between James Harrington and John Streater, and between John Milton and John Hall of Durham are shown, as well the controversies between Harrington and Milton, and Streater and Hall, respectively. In addition, by analysing the writings of Marchamont Nedham the study will show that the choices were not limited to more, or less, democratic brands of republicanism. Most significantly, the study provides a thorough analysis of the political philosophies behind the various brands of republicanism, in addition to describing them. By means of this analysis, the study shows that previous attempts to assess the role of free speech and public debate, through the lenses of modern, rights-based liberal political theory have resulted in an inappropriate framework for understanding early modern English republicanism. By approaching the topics through concepts used by the republicans legitimate authority, leadership by oratory, and republican freedom and through the frames of reference available and familiar to them roles of education and institutions the study presents a thorough and systematic analysis of the role and function of rhetoric and public speech in English republicanism. The findings of this analysis have significant consequences to our current understanding of the history and development of republican political theory, and, more generally, of the connections between democratic theory and free speech.