Inequalities in cardiovascular disease mortality : the role of behavioural, physiological and social risk factors

Background While the relationship between socio-economic disadvantage and cardiovascular disease (CVD) is well established, the role that traditional cardiovascular risk factors play in this association remains unclear. The authors examined the association between education attainment and CVD mortality and the extent to which behavioural, social and physiological factors explained this relationship.

Methods Adults (n=38 355) aged 40–69 years living in Melbourne, Australia were recruited in 1990–1994. Subjects with baseline CVD risk factor data ascertained through questionnaire and physical measurement were followed for an average of 9.4 years with CVD deaths verified by review of medical records and autopsy reports.

Results CVD mortality was higher for those with primary education only, compared with those who had completed tertiary education, with an HR of 1.66 (95% CI 1.10 to 2.49) after adjustment for age, country of birth and gender. Those from the lowest educated group had a more adverse cardiovascular risk factor profile compared with the highest educated group, and adjustment for these risk factors reduced the HR to 1.18 (95% CI 0.78 to 1.77). In analysis of individual risk factors, smoking and waist circumference explained most of the difference in CVD mortality between the highest and lowest education groups.

Conclusions Most of the excess CVD mortality in lower socio-economic groups can be explained by known risk factors, particularly smoking and overweight. While targeting cardiovascular risk factors should not divert efforts from addressing the underlying determinants of health inequalities, it is essential that known risk factors are addressed effectively among lower socio-economic groups.

The geopolitical economy of social policy in the Philippines: securitisation, emerging powers and multilateral policies

Recent geopolitical and economic changes have altered global social policy formation. Bretton Woods multilateral development agencies (MDAs) have selectively incorporated ideas that have emerged from developing country states and decision makers. Recent years have witnessed an increased acceptance of social transfers as part of renewed efforts at poverty alleviation policies based on social risk management. There has been an instance in the use and promotion of conditional cash transfer (CCT) policies by MDAs. One case is the Philippines. CCTs were a product of the emergence of a neostructuralist welfare regime (understood as an ideal type) in Latin America. There was an attempt to reconcile neoliberal strategies of development with aspirations for guaranteed minimum incomes. The Bretton Woods and regional development bank MDAs have facilitated the adoption of CCTs in other developing country contexts. In the Philippines, a combination of actions by national political actors and MDAs resulted in the implementation of a securitised and compliance-focused version of CCTs derived from the Colombian security state. Although poor households welcome income assistance, CCTs have acted to enforce further state monitoring without altering the national-based political and economic processes that replicate poverty.

Exporting social policy from Latin America to the Philippines: Securitisation, neoliberalism and multilateral mediation of poverty policies

Recent years have seen an increased acceptance of social transfers as part of renewed efforts at poverty alleviation policies based on social risk management. There has been an instance in the use and promotion of conditional cash transfer (CCT) policies by multilateral development agencies (MDAs). One case is the Philippines. The ideational basis of CCTs can be traced to the influence of neostructuralism in Latin America. One facet of this was an attempt to reconcile neoliberal strategies of development with aspirations for guaranteed minimum incomes. The adoption of CCTs was mediated by MDA s that further reduced the modest concessions to poor people's rights implicit in Latin American programs. The Philippines demonstrates that MDAs have promoted a more heavily securitised and compliance-focused versions of CCTs that was derived the Colombian security state. Although small grants are welcomed by poor households, they have acted to further enforce state control while maintaining a neoliberal policy focus.

A risk worth taking: perceived risk as moderator of satisfaction, loyalty, and willingness-to-pay premium price

This research investigates the moderating role of perceived risk in the relationship between satisfaction, loyalty, and willingness to pay premium price (WTP). A total of 364 respondents were recruited from Amazon's Mechanical Turk panel. Financial, social, performance, and psychological risks have significant negative effects on the relationship between satisfaction and WTP, whereas only financial risks have significant negative effects on the relationship between loyalty and WTP. Using moderated mediation analysis, we found that the mediating effects of loyalty diminish significantly in high social risk conditions and diminish completely in high financial risk conditions.

The care crunch: changing work, families and welfare in Australia

Structural shifts in labour markets and in households are impacting on the capacity of households and families to deal with risk. In Australia the post-Federation and post-war social settlement, based on the gendered assumptions underpinning the male breadwinner/female carer model, is no longer viable in an era of increasingly precarious employment, diverse family forms and deepening inequalities. Labour market and industrial relations changes, when combined with major demographic shifts such as divorce and population ageing, and increasing expectations for community care are contributing to a 'care crunch'. The article canvasses the challenge of developing a social risk protection framework that balances caring, work and quality of life.

Many routes lead to Rome : potential causes for the multi-route migration system of Red Knots, Calidris canutus islandica

Migrants, such as birds or representatives of other taxa, usually make use of several stopover sites to cover the distance between their site of origin and destination. Potentially, multiple routes exist, but often little is known about the causes and consequences of alternative migration routes. Apart from their geographical distribution, the suitability of potential sites might play an important role in the animals’ decisions for a particular itinerary. We used an optimal-migration model to test three nonmutually exclusive hypotheses leading to variations in the spring migration routes of a subspecies of Red Knot, Calidris canutus islandica, which migrates from wintering grounds in Western Europe to breeding grounds in Greenland and the Canadian Arctic: the breeding location hypothesis, the energy budget hypothesis, and the predation risk hypothesis. Varying only breeding location, the model predicted that birds breeding in the Canadian Arctic and on West Greenland stop over on Iceland, whereas birds breeding in East and Northeast Greenland migrate via northern Norway, a prediction that is supported by empirical findings. Energy budgets on stopover sites had a strong influence on the choice of route and staging times. Varying foraging-intensity and mass-dependent predation risk prompted the birds to use less risky sites, if possible. The effect of simultaneous changes in the energy budget and predation risk strongly depended on the site where these occurred. Our findings provide potential explanations for the observations that C. canutus islandica uses a diverse array of migration routes. Scrutinizing the three alternative driving forces for the choice of migratory routes awaits further, specific data collection in rapidly developing fields of research (e.g., predation risk assessment, GPS tracking). Generally, the type of modeling presented here may not only highlight alternative explanations, but also direct follow-up empirical research.

Sex-linked neuroanatomical basis of human altruistic cooperativeness

Human altruistic cooperativeness, one of the most important components of our highly organized society, is along with a greatly enlarged brain relative to body size a spectacular outlier in the animal world. The "social-brain hypothesis" suggests that human brain expansion reflects an increased necessity for information processing to create social reciprocity and cooperation in our complex society. The present study showed that the young adult females (n = 66) showed greater Cooperativeness as well as larger relative global and regional gray matter volumes (GMVs) than the matched males (n = 89), particularly in the social-brain regions including bilateral posterior inferior frontal and left anterior medial prefrontal cortices. Moreover, in females, higher cooperativeness was tightly coupled with the larger relative total GMV and more specifically with the regional GMV in most of the regions revealing larger in female sex-dimorphism. The global and most of regional correlations between GMV and Cooperativeness were significantly specific to female. These results suggest that sexually dimorphic factors may affect the neurodevelopment of these "social-brain" regions, leading to higher cooperativeness in females. The present findings may also have an implication for the pathophysiology of autism; characterized by severe dysfunction in social reciprocity, abnormalities in social-brain, and disproportionately low probability in females.

The politics of boganism and public relations in contemporary Australia

What is meant by the term ‘bogan’ and how does its popular usage distinguish a new public occupying a particular class position and social presence in Australian society. Examining a number of media texts, this paper explores the bogan phenomenon and asks if it normatively repositions Marxist ideas of class within the contemporary construct of lifestyle politics and classless capitalism (Beck). Challenging the idea the term is politically benign, the paper argues that the rise ‘boganism’ and its stigmatic associations has implications for public relations. In particular, it argues successful framing techniques designate a group of people occupying social risk positions and that are dis-empowered by eco-discourses and targeted for social control. These marginalised publics lack the sociocultural resources required for participation in the public sphere and as such are malleable and highly receptive to intrinsic and extrinsic forms of public relations.

Transitional labour markets : a social investment and risk mitigation strategy for social policy

Drawing on transitional labor market (TLM) theory, this introductory chapter highlights major themes, overviews the contributions to this volume and suggests a future agenda for policy makers. The focus of applied research projects has been the impact of post-modem social transformations on systems of social protection, looking through the lens of the labor market and shifts in household and family structure. The Transitional Labor Market project uses the TLM model as a means of developing new thinking on how flexibility and innovation might be paired with social investment and new forms of social protection. TLM theory emphasizes the importance of institutions and of the links between different institutions which frequently operate as policy silos, rather than integrated systems to buffer risks and support capability and enhance employability. The great advantage of the TLM model is that it draws attention to the right places for strategic reform. It does not offer a standard set of institutions to facilitate transitions however.

Future directions in Australian social policy : new ways of preventing risk

Future directions in Australian social policy: new ways of preventing risk, no. 49: growth.
The papers presented in this issue of Growth aim to explore the scope for new directions in social policy in the light of critical shifts in working life, household relations and the economy.

Oral language competence, social skills and high-risk boys : what are juvenile offenders trying to tell us?

A cross-sectional study examining the oral language abilities and social skills of male juvenile offenders is described. Fifty juvenile offenders and 50 non-offending controls completed measures of language processing and production, and measures of social skill and IQ. Information about type of offending, substance use histories and learning/literacy problems was also gathered.

Young offenders performed significantly worse on all language and social skill measures, but these differences could not be accounted for on the basis of IQ. Just over half of the young offenders were identified as language impaired. This subgroup was compared with non-language impaired offending peers on a range of variables. The findings have particular implications in the areas of early intervention for high-risk boys and investigative interviewing of juvenile offenders.

Gambling and corporate social responsibility (CSR) : re-defining industry and state roles on duty of care, host responsibility and risk management

During the 1990s, states embraced legalised gambling as a means of supplementing state revenue. But gaming machines (EGMs, pokies, VLTs, Slots) have become increasingly controversial in countries such as Australia, Canada and New Zealand, which experienced unprecedented roll-out of gaming machines in casino and community settings; alongside revenue windfalls for both governments and the gambling industry. Governments have recognised that gambling results in a range of social and economic harms and, similar to tobacco and alcohol, have introduced public policies predicated on harm minimisation. Yet despite these, gaming losses have continued to climb in most jurisdictions, along with concerns about gambling-related harms. The first part of this article discusses an emerging debate in Ontario Canada, that draws parallels between host responsibility in alcohol and gambling venues. In Canada, where government owns and operates the gaming industry, this debate prompts important questions on the role of the state, duty of care and regulation ‘in the public interest’ and on CSR, host responsibility and consumer protection. This prompts the question: Do governments owe a duty of care to gamblers?

The article then discusses three domains of accumulating research evidence to inform questions raised in the Ontario debate: evidence that visible behavioural indicators can be used with high confidence to identify problem gamblers on-site in venues as they gamble; new systems using player tracking and loyalty data that can provide management with high precision identification of problem gamblers and associated risk (for protective interventions); and research on technological design features of new generation gaming products in interaction with players, that shows how EGM machines can be the site for monitoring/protecting players. We then canvass some leading international jurisdictions on gambling policy CSR and consumer protection.

In light of this new research, we ask whether the risk of legal liability poses a tipping point for more interventionist public policy responses by both the state and industry. This includes a proactive role for the state in re-regulating the gambling industry/products; instituting new forms of gaming machine product control/protection; and reinforcing corporate social responsibility (CSR) and host responsibility obligations on gambling providers – beyond self-regulatory codes. We argue the ground is shifting, there is new evidence to inform public policy and government regulation and there are new pressures on gambling providers and regulators to avail themselves of the new technology – or risk litigation