Capitals and capabilities: linking structure and agency to reduce health inequalities

While empirical evidence continues to show that low socio-economic position is associated with less likely chances of being in good health, our understanding of why this is so remains less than clear. In this paper we examine the theoretical foundations for a structure-agency approach to the reduction of social inequalities in health. We use Max Weber's work on lifestyles to provide the explanation for the dualism between life chances (structure) and choice-based life conduct (agency). For explaining how the unequal distribution of material and non-material resources leads to the reproduction of unequal life chances and limitations of choice in contemporary societies, we apply Pierre Bourdieu's theory on capital interaction and habitus. We find, however, that Bourdieu's habitus concept is insufficient with regard to the role of agency for structural change and therefore does not readily provide for a theoretically supported move from sociological explanation to public health action. We therefore suggest Amartya Sen's capability approach as a useful link between capital interaction theory and action to reduce social inequalities in health. This link allows for the consideration of structural conditions as well as an active role for individuals as agents in reducing these inequalities. We suggest that people's capabilities to be active for their health be considered as a key concept in public health practice to reduce health inequalities. Examples provided from an ongoing health promotion project in Germany link our theoretical perspective to a practical experience.

A Swiss neighbourhood index of socioeconomic position: development and association with mortality

Area-based measures of socioeconomic position (SEP) suitable for epidemiological research are lacking in Switzerland. The authors developed the Swiss neighbourhood index of SEP (Swiss-SEP).

Trends in the Association Between Socioeconomic Status and Obesity in U.S. Adults: 2002-2012

Since the 1980s, the prevalence of obesity has more than doubled to over 30 percent of the adult population (Thorpe, 2004). Obesity is a key contributing factor to continually rising national healthcare costs. Addressing its negative implications is essential not only from a cost perspective, but also for the betterment of our nation¿s general health and wellbeing. Obesity is reportedly associated with a 35% increase in inpatient and outpatient spending, as well as a 77% increase in related necessary medications (Sturm, 2002). Obesity, which some have argued should be classified as a disease in itself, has roughly the same association with the development of chronic health conditions as does 20 years of aging (Sturm, 2002). Defined as ambulatory care-sensitive conditions, these obesity-related chronic health diagnoses ¿ like diabetes, cardiovascular disease, and hypertension ¿ are in turn the primary drivers of current healthcare spending, as well as future predicted health expenditures. It is well established that lower socioeconomic status (SES) is associated with higher rates of obesity and the subsequent development of aforementioned obesity-related conditions. Socioeconomic status has traditionally been defined by education, income, and occupation (Adler, 2002); however, this study found empirical evidence for education being the most fundamental of these three SES indicators in determining obesity outcomes. For both men and women, as education levels increased, the likelihood of an individual being obese decreased. However, with less education, there was increased disparity between the obesity rates for men and women. Women consistently saw higher rates of obesity and were more impacted in terms of obesity onset by belonging to a lower SES category than men. In addition, this study assessed whether the impact of one¿s socioeconomic status on obesity-related health outcomes (specifically the negative impact low-SES as measured by education level) has changed over time. Results deriving from annual data from the National Health Interview Survey (NHIS) for all years from 2002 to 2012 indicate that the association between low-socioeconomic status and negative health outcomes has not increased in magnitude over the past decade. Instead, obesity rates have increased across the overall U.S. adult population, most likely due to a number of larger external societal factors resulting in increased caloric intake and decreased energy expenditure across every SES group. In addition, while the association between low-SES and obesity has not worsened, a consequence of the Great Recession has been a larger percentage of the U.S. population in lower-SES, which is still consistently subject to the same worse health outcomes.

Transnational Marriage: Modern Imaginings, Relational Realignments, and Persistent Inequalities

In the context of shifting cultural anchors as well as unstable global economic conditions, new practices of intimacy and sexuality may become tactics in an individual’s negotiation of conflicting desires and potentials. This article offers reflection on the interface between global forces, powerful transcultural narratives, and state policies, on the one hand, and local, even individual, constructions and tactics in regard to sexuality, marriage, migration, and work, on the other. The article focuses on the life trajectory of Gudiya, an ambitious young Hindu woman who started out life with little social capital and few economic resources in a dusty corner of what was then the tiny kingdom of Nepal. Gudiya’s story highlights the ways in which she has engaged in relational realignments aimed at bringing her closer to the life she imagines, even as she has encountered new and persistent forms of inequality both local and transnational in scale.

Impact of surgical technique on operative morbidity and its socioeconomic benefit in thyroid surgery

The aim of this retrospective cohort study was to evaluate the rate of complications in relation to the extent of surgery and some of its consequences.

Socioeconomic determinants of health related quality of life in childhood and adolescence: results from a European study

STUDY OBJECTIVE: The objective of this study was to investigate the impact of two different socioeconomic status (SES) measures on child and adolescent self reported health related quality of life (HRQoL). The European KIDSCREEN project aims at simultaneous developing, testing, and implementing a generic HRQoL instrument. DESIGN AND SETTING: The pilot version of the questionnaire was applied in school surveys to students from 8 to 18 years of age, as well as to their parents, together with such determinants of health status as two SES indicators, the parental educational status and the number of material goods in the family (FAS, family affluence scale). PARTICIPANTS: Students from seven European countries: 754 children (39.8%; mean: 9.8 years), and 1142 adolescents (60.2 %; mean: 14.1 years), as well as their respective parents. MAIN RESULTS: In children, a higher parental educational status was found to have a significant positive impact on the KIDSCREEN dimensions: physical wellbeing, psychological wellbeing, moods and emotions, bullying and perceived financial resources. Increased risk of low HRQoL was detected for adolescents in connection with their physical wellbeing. Family wealth plays a part for children's physical wellbeing, parent relations and home life, and perceived financial resources. For adolescents, family wealth furthermore predicts HRQoL on all KIDSCREEN dimensions. CONCLUSIONS: There is evidence to suggest that exposure to low parental educational status may result in a decreased HRQoL in childhood, whereas reduced access to material (and thereby social) resources may lead to a lower HRQoL especially in adolescence.

Childhood leukaemia and socioeconomic status: what is the evidence?

The objectives of this systematic review are to summarise the current literature on socioeconomic status (SES) and the risk of childhood leukaemia, to highlight methodological problems and formulate recommendations for future research. Starting from the systematic review of Poole et al. (Socioeconomic status and childhood leukaemia: a review. Int. J. Epidemiol. 2006;35(2):370-384.), an electronic literature search was performed covering August 2002-April 2008. It showed that (1) the results are heterogeneous, with no clear evidence to support a relation between SES and childhood leukaemia; (2) a number of factors, most importantly selection bias, might explain inconsistencies between studies; (3) there is some support for an association between SES at birth (rather than later in childhood) and childhood leukaemia and (4) if there are any associations, these are weak, limited to the most extreme SES groups (the 10-20% most or least deprived). This makes it unlikely that they would act as strong confounders in research addressing associations between other exposures and childhood leukaemia. Future research should minimise case and control selection bias, distinguish between different SES measures and leukaemia subtypes and consider timing of exposures and cancer outcomes.

A Socioeconomic Approach to the Development of E-Learning

A multitude of products, systems, approaches, views and notions characterize the field of e-learning. This article attempts to disentangle the field by using economic and sociological theories, theories of marketing management and strategy as well as practical experience gained by the author while working with leading edge suppliers of e-learning. On this basis, a distinction between knowledge creation e-learning and knowledge transfer e-learning is made. The various views are divided into four different ideal-typical paradigms, each with its own characteristics and limitations. Selecting the right paradigm to use in the development of an e-learning strategy may prove crucial to success. Implications for the development of an e-learning strategy in businesses and educational institutions are outlined.