Stress and burnout amongst professional carers of people with intellectual disability : another health inequity

Purpose of review This paper summarizes trends in the research literature about stress and burnout in the lives of people who are the professional carers of people with intellectual disability. The principal time period considered was from 2004 to 2006. Recent findings Studies reviewed here focus on several themes including inequities affecting professional carers of people with intellectual disability and the possible effects of some models of care on inequities. Implications for people with intellectual disability are also considered. Summary The diaspora of people with intellectual disability into the community and their accompanying services found a whole new set of unpredicted and unprecedented challenges. Life in the community has rendered professional carers of people with intellectual disability more clearly vulnerable to stress and burnout for a variety of complex reasons, some identified and others as yet unrecognized. Lack of support and lack of role definition are particular problems. Presence of physical and mental health inequities result in major disparities in community care for people with intellectual disability.

Understanding causal relationships between the built and social environment, health and associated behaviours and risk factors

Introduction: Built environment interventions designed to reduce non-communicable diseases and health inequity, complement urban planning agendas focused on creating more ‘liveable’, compact, pedestrian-friendly, less automobile dependent and more socially inclusive cities.However, what constitutes a ‘liveable’ community is not well defined. Moreover, there appears to be a gap between the concept and delivery of ‘liveable’ communities. The recently funded NHMRC Centre of Research Excellence (CRE) in Healthy Liveable Communities established in early 2014, has defined ‘liveability’ from a social determinants of health perspective. Using purpose-designed multilevel longitudinal data sets, it addresses five themes that address key evidence-base gaps for building healthy and liveable communities. The CRE in Healthy Liveable Communities seeks to generate and exchange new knowledge about: 1) measurement of policy-relevant built environment features associated with leading non-communicable disease risk factors (physical activity, obesity) and health outcomes (cardiovascular disease, diabetes) and mental health; 2) causal relationships and thresholds for built environment interventions using data from longitudinal studies and natural experiments; 3) thresholds for built environment interventions; 4) economic benefits of built environment interventions designed to influence health and wellbeing outcomes; and 5) factors, tools, and interventions that facilitate the translation of research into policy and practice. This evidence is critical to inform future policy and practice in health, land use, and transport planning. Moreover, to ensure policy-relevance and facilitate research translation, the CRE in Healthy Liveable Communities builds upon ongoing, and has established new, multi-sector collaborations with national and state policy-makers and practitioners. The symposium will commence with a brief introduction to embed the research within an Australian health and urban planning context, as well as providing an overall outline of the CRE in Healthy Liveable Communities, its structure and team. Next, an overview of the five research themes will be presented. Following these presentations, the Discussant will consider the implications of the research and opportunities for translation and knowledge exchange. Theme 2 will establish whether and to what extent the neighbourhood environment (built and social) is causally related to physical and mental health and associated behaviours and risk factors. In particular, research conducted as part of this theme will use data from large-scale, longitudinal-multilevel studies (HABITAT, RESIDE, AusDiab) to examine relationships that meet causality criteria via statistical methods such as longitudinal mixed-effect and fixed-effect models, multilevel and structural equation models; analyse data on residential preferences to investigate confounding due to neighbourhood self-selection and to use measurement and analysis tools such as propensity score matching and ‘within-person’ change modelling to address confounding; analyse data about individual-level factors that might confound, mediate or modify relationships between the neighbourhood environment and health and well-being (e.g., psychosocial factors, knowledge, perceptions, attitudes, functional status), and; analyse data on both objective neighbourhood characteristics and residents’ perceptions of these objective features to more accurately assess the relative contribution of objective and perceptual factors to outcomes such as health and well-being, physical activity, active transport, obesity, and sedentary behaviour. At the completion of the Theme 2, we will have demonstrated and applied statistical methods appropriate for determining causality and generated evidence about causal relationships between the neighbourhood environment, health, and related outcomes. This will provide planners and policy makers with a more robust (valid and reliable) basis on which to design healthy communities.

Caribbean schooling and the social divide – what will it take to change neo-colonial education systems?

When Professor N’Dri Assie-Lumumba asked me to reflect on what ‘ubuntu’ might mean in the context of education in the Caribbean, the first thing that came to mind was an image of pit latrines in impoverished primary schools in poor countries. In this essay, I argue that the continuing problem of pit latrines in these schools symbolizes the failure to solve the problem of poverty, neglect and inadequate provision of education services for people at the bottom rungs of Caribbean and other decolonising societies. I ask what implications the ‘ubuntu’ concept chosen for the 2015 CIES conference would have for reforming education in a direction that combines global reform, ethics and good sense. Educators rarely consider toilets when they are thinking about what is needed to reform the system. But talking about toilets draws attention to the entrenched inequity that persists in education systems across the globe – an inequity that forces many schools and young people to remain at the base of the social pyramid, and that perpetuates a dysfunctional model of education holding back many societies. Starting from the twin images of social pyramids and toilets, we can ask some pointed questions about education reform.

Social policy implications relating to road trauma in a rapidly motorising world : the example of China

The World Health Organization (WHO) identifies road trauma as a major public health issue in all countries, though most notably among low-to-middle income countries and particularly those experiencing rapid motorisation, such as China. As China transitions from a nation of bicycle riders and pedestrians to one where car ownership is increasingly desired, there is need to address the accompanying social policy challenges. With this increased motorisation has come an increased road trauma burden, shouldered disproportionately among the population. Vulnerable road users (i.e., pedestrians, cyclists, motorcyclists) are of primary concern because they are most frequently killed in road crashes, representing approximately 70% of all Chinese road-related fatalities. The aim of this paper is to summarise the scale of the road trauma burden, highlight the disparity of this burden across the Chinese population, and discuss the related social policy implications in dealing with the impact of deaths and of otherwise healthy lives diminished by injury and disability. Future research priorities are also discussed and include the need to strive to provide detailed information on the level of inequity of the road trauma burden across the population and identify appropriate social supports and healthcare services required, both preventative and post-crash, so these can be developed and implemented throughout China.

Prosocial norms and degree heterogeneity in social networks

We provide empirical evidence to support the claims that social diversity promotes prosocial behavior. We elicit a real-life social network and its members’ adherence to a social norm, namely inequity aversion. The data reveal a positive relationship between subjects’ prosociality and several measures of centrality. This result is in line with the theoretical literature that relates the evolution of social norms to the structure of social interactions and argues that central individuals are crucial for the emergence of prosocial behavior.

Land wars in India: Contestations, social forces and evolving neoliberal urban transformation

Land wars in India: Contestations, social forces and evolving neoliberal urban transformation
The recent incidents of ‘land wars’ in India have highlighted the contradictions and challenges of the neoliberal urban transformation through a range of issues across governance, equity and empowerment in the development agenda. Simply put, a strong top down approach and corporate-political nexus have determined the modality of land acquisition, compensation and ultimately the nature of its consumption leaving out majority urban poor from its benefits. The paper focuses on the concept of neoliberalism as a modality of urban governance and emergence of the grassroots activism as a countermagnate to neoliberalist hegemony by examining the inequity and marginalization that embody these ‘land wars’ in India and the forms of resistance from the grassroots - their capacity, relationship and modus operandi. Emerging lessons suggest the potential for advancing governance from the bottoms up leading to more equitable distribution of resources. It is however argued that there is a need for a stronger conception of the ‘grassroots’ in both epistemological and empirical context. In particular, the preconditions for the ‘grassroots organisations’ to foster and play a more effective role requires a more inclusive notion of ‘institutionality and plurality’ within the current political economic context. The empirical focus of the paper is ‘land wars’ observed in Kolkata, West Bengal, however references to other examples across the country have also been made.

Pregnant Adolescents in Vietnam : Social context and health care needs

Background: The number of childbearing adolescents in Vietnam is relatively low but they are more prone to experience adverse outcome than adult women. Reports of increasing rates of abortion and prevalence of STIs including HIV among youth indicate a need to improve services and counselling for these groups. Midwives are key persons in the promotion of young people’s sexual and reproductive health in Vietnam. Aim: The overall aim of this thesis is to describe the prevalence and outcome of adolescent pregnancies in Vietnam (I), to explore the social context and health care seeking behavior of pregnant adolescents (II), as well as to explore the perspectives of health care providers and midwifery students regarding adolescent sexuality and reproductive health service needs (III, IV). Methods: The studies were conducted from 2002 to 2005, combining qualitative and quantitative research methods. A population based prospective survey was used to estimate rates and outcomes of adolescent pregnancies (I). Pregnant and newly delivered adolescents’ experiences of childbearing and their encounters with health care providers were studied using qualitative interviews (II). Health care providers’ perspective on adolescent sexual and reproductive health (ASRH) and views on how to improve the quality of abortion care was explored in focus group discussions (FGD). The values and attitudes of midwifery students about ASRH were investigated using questionnaires and interviews (IV). Descriptive statistics was used to analyse quantitative data (I, IV) and content analysis were applied for qualitative data (II, III, and IV). Findings: Adolescent birth rate was similar to previously reported in Vietnam but lower when compared to other Asian countries. The incidence of stillborn among adolescents was higher than for women in higher reproductive ages. The proportion of preterm deliveries was 20 % of all births, higher than previous findings from Vietnam. About 2 % of the deliveries were home deliveries, more common among women with low education, belonging to ethnic minority and/or living in mountainous areas (I). Ambivalence facing motherhood, pride and happiness but also worries and lack of self-confidence emerged as themes from the interviews; and experience of ‘being in the hands of others’ in a positive, caring sense but also in a sense of subordination in relation to husband, family and health care providers (II). Health care providers at abortion clinics and midwifery students generally disapproved of pre-marital sex, but had a pragmatic view on the need for contraceptive services and counselling to reduce the burden of unwanted pregnancies and abortions for young women. Providers and midwifery students expressed a need for training on ASRH issues (III, IV). Conclusion: Cultural norms and gender inequity make pregnant adolescent women in Vietnam vulnerable to sexual and reproductive health risks. Health care providers experience ethical dilemmas while counselling unmarried adolescents who come for abortion and this has a negative impact on the quality of care. Integrated ASRH in education and training programmes for health care providers, including midwives, as well as continued in-service training on these issues are suggested to improve reproductive health care services in Vietnam.

Associação entre as narrativas em saúde bucal e condições socioeconômico-culturais: a dentição como reflexo da desigualdade social

This anthropological study investigates the lived-experience of oral diseases in the context of poverty in Northeast Brazil. During six months in 2004???, ethnographic interviews, narratives and participant-observation with 31 residents of the low-income community, Dendê, located in Fortaleza, Ceará were conducted and analyzed utilizing a hermeneutic-dialetic method. It is revealed that precarious life conditions make prioritizing caretaking a difficult task. Despite suffering tooth pain, seeking a dentist's care is perceived as "a luxury" not a citzens' right. Difficulties in accessing services and poor quality restorations, favor tooth extractions as the most effective intervention. The deterioration of one's oral health is lamented by community members who seek help from popular clinics, politicians and traditional healers. The experience of dental disease differs according to social class, leaves oral scars of inequity, harms self-esteem and inhibits social inclusion. In this context, "treating" the Teeth of Inequity demands that we deepen our comprehension of the social determinants of health, reduce injustice in the access to quality care, remove demoralizing stigmas and empower the community to confront structural forces which affect its life

Social Panorama of Latin America 2006

Includes bibliography

Population, social equity and changing production patterns

Includes bibliography

Inequity Measures for Evaluations of Environmental Justice: A Case Study of Close Proximity to Highways in NYC

Assessments of environmental and territorial justice are similar in that both assess whether empirical relations between the spatial arrangement of undesirable hazards (or desirable public goods and services) and socio-demographic groups are consistent with notions of social justice, evaluating the spatial distribution of benefits and burdens (outcome equity) and the process that produces observed differences (process equity. Using proximity to major highways in NYC as a case study, we review methodological issues pertinent to both fields and discuss choice and computation of exposure measures, but focus primarily on measures of inequity. We present inequity measures computed from the empirically estimated joint distribution of exposure and demographics and compare them to traditional measures such as linear regression, logistic regression and Theil’s entropy index. We find that measures computed from the full joint distribution provide more unified, transparent and intuitive operational definitions of inequity and show how the approach can be used to structure siting and decommissioning decisions.

Agriculturización, inequidad distributiva y fractura del tejido social

Los cambios operados en la actividad agrícola en nuestro país a lo largo de las últimas dos décadas, identificados genéricamente bajo la denominación de agriculturización, han generado múltiples impactos, muchos de ellos de carácter contradictorio. Así, el crecimiento de la actividad económica, el incremento en los saldos exportables y en los recursos fiscales conviven, entre otras manifestaciones, con la agudización de las tensiones derivadas de la concentración económica, con nuevos impactos e incertidumbres de carácter ambiental, con desequilibrios territoriales crecientes, con la ampliación de la brecha laboral y con el incremento en la inequidad distributiva. Este trabajo presenta los resultados de un análisis exploratorio orientado a pequeñas localidades de la región pampeana, en el cual se visualiza el surgimiento de fuertes signos de fractura del tejido social, derivados del crecimiento de la inequidad distributiva de la riqueza en el interior del espacio rural. Dos tendencias fundamentales constituyen los emergentes de este proceso: 1°) los cambios en los estilos de vida de los sectores relacionados con la actividad agrícola, visibles fundamentalmente en modificaciones en las pautas de consumo (sobre todo entre los jóvenes); y 2°) la heterogeneización de las percepciones de los pobladores sobre la valorización del trabajo en la comunidad. La reconstrucción de estos procesos, escasamente abordados en la literatura académica, se realizó a través de estrategias metodológicas que combinan métodos cuanti y cualitativos, tomando como caso de estudio una pequeña localidad en la Provincia de Santa Fe

Agriculturización, inequidad distributiva y fractura del tejido social

Los cambios operados en la actividad agrícola en nuestro país a lo largo de las últimas dos décadas, identificados genéricamente bajo la denominación de agriculturización, han generado múltiples impactos, muchos de ellos de carácter contradictorio. Así, el crecimiento de la actividad económica, el incremento en los saldos exportables y en los recursos fiscales conviven, entre otras manifestaciones, con la agudización de las tensiones derivadas de la concentración económica, con nuevos impactos e incertidumbres de carácter ambiental, con desequilibrios territoriales crecientes, con la ampliación de la brecha laboral y con el incremento en la inequidad distributiva. Este trabajo presenta los resultados de un análisis exploratorio orientado a pequeñas localidades de la región pampeana, en el cual se visualiza el surgimiento de fuertes signos de fractura del tejido social, derivados del crecimiento de la inequidad distributiva de la riqueza en el interior del espacio rural. Dos tendencias fundamentales constituyen los emergentes de este proceso: 1°) los cambios en los estilos de vida de los sectores relacionados con la actividad agrícola, visibles fundamentalmente en modificaciones en las pautas de consumo (sobre todo entre los jóvenes); y 2°) la heterogeneización de las percepciones de los pobladores sobre la valorización del trabajo en la comunidad. La reconstrucción de estos procesos, escasamente abordados en la literatura académica, se realizó a través de estrategias metodológicas que combinan métodos cuanti y cualitativos, tomando como caso de estudio una pequeña localidad en la Provincia de Santa Fe

Agriculturización, inequidad distributiva y fractura del tejido social

Los cambios operados en la actividad agrícola en nuestro país a lo largo de las últimas dos décadas, identificados genéricamente bajo la denominación de agriculturización, han generado múltiples impactos, muchos de ellos de carácter contradictorio. Así, el crecimiento de la actividad económica, el incremento en los saldos exportables y en los recursos fiscales conviven, entre otras manifestaciones, con la agudización de las tensiones derivadas de la concentración económica, con nuevos impactos e incertidumbres de carácter ambiental, con desequilibrios territoriales crecientes, con la ampliación de la brecha laboral y con el incremento en la inequidad distributiva. Este trabajo presenta los resultados de un análisis exploratorio orientado a pequeñas localidades de la región pampeana, en el cual se visualiza el surgimiento de fuertes signos de fractura del tejido social, derivados del crecimiento de la inequidad distributiva de la riqueza en el interior del espacio rural. Dos tendencias fundamentales constituyen los emergentes de este proceso: 1°) los cambios en los estilos de vida de los sectores relacionados con la actividad agrícola, visibles fundamentalmente en modificaciones en las pautas de consumo (sobre todo entre los jóvenes); y 2°) la heterogeneización de las percepciones de los pobladores sobre la valorización del trabajo en la comunidad. La reconstrucción de estos procesos, escasamente abordados en la literatura académica, se realizó a través de estrategias metodológicas que combinan métodos cuanti y cualitativos, tomando como caso de estudio una pequeña localidad en la Provincia de Santa Fe

Women Of India: Developmental setbacks of gender inequity

This project examines rural Indian women and discusses the strong correlation between gender inequity and the setbacks that have crippled development. The embedded caste system has created a distinct social hierarchy, which has incidentally deprived women of their freedom and voice. Gender inequity and social stratification are direct causes of the AIDS epidemic, research revealing a contingency between lack of empowerment and exposure to the disease. Additionally, the HIV/AIDS virus carries a strong cultural stigma, which influences whether or not women will seek treatment if infected, since AIDS victims face extreme social isolation and discrimination, in India. This project discusses several cause-and-effect frameworks related to gender inequity, which have stunted the growth and success of India.