Poverty and non-communicable diseases in South Africa

Background: High levels of wealth inequality with improved health statistics in South Africa (SA) provide an important opportunity to investigate non-communicable diseases (NCDs) among the poor. Aims: This paper uses two distinct national data sets to contrast patterns of mortality in rich and poor areas and explore the associations between poverty, risk factors, health care and selected NCDs diseases in South African adults. Methods: Causes of premature mortality in 1996 experienced in the poorest magisterial districts are compared with those in the richest, using average household wealth to classify districts. Logistic and multinomial regression are used to investigate the association of a household asset index and selected chronic conditions, related risk factors and healthcare indicators using data from the 1998 South African Demographic and Health Survey. Results: NCDs accounted for 39% and 33% of premature mortality in rich and poor districts respectively. The household survey data showed that the risk factors hypertension and obesity increased with increasing wealth, while most of the lifestyle factors, such as light smoking, domestic exposure to ``smoky'' fuels and alcohol dependence were associated with poverty. Treatment status for hypertension and asthma was worse for poor people than for rich people. Conclusions: The study suggests that NCDs and lifestyle-related risk factors are prevalent among the poor in SA and treatment for chronic diseases is lacking for poor people. The observed increase in hypertension and obesity with wealth suggests that unless comprehensive health promotion strategies are implemented, there will be an unmanageable chronic disease epidemic with future socioeconomic development in SA.

The contribution of three components of nutrition knowledge to socio-economic differences in food purchasing choices

Objectives: To assess socio-economic differences in three components of nutrition knowledge, i.e. knowledge of (i) the relationship between diet and disease, (ii) the nutrient content of foods and (iii) dietary guideline recommendations; furthermore, to determine if socio-economic differences in nutrition knowledge contribute to inequalities in food purchasing choices. Design: The cross-sectional study considered household food purchasing,nutrition knowledge, socio-economic and demographic information. Household food purchasing choices were summarised by three indices, based on self-reported purchasing of sixteen groceries, nineteen fruits and twenty-one vegetables. Socio-economic position (SEP) was measured by household income and education. Associations between SEP, nutrition knowledge and food purchasing were examined using general linear models adjusted for age, gender, household type and household size. Setting: Brisbane, Australia in 2000. Subjects: Main household food shoppers (n 1003, response rate 66?4 %), located in fifty small areas (Census Collectors Districts). Results: Shoppers in households of low SEP made food purchasing choices that were less consistent with dietary guideline recommendations: they were more likely to purchase grocery foods comparatively higher in salt, sugar and fat, and lower in fibre, and they purchased a narrower range of fruits and vegetables. Those of higher SEP had greater nutrition knowledge and this factor attenuated most associations between SEP and food purchasing choices. Among nutrition knowledge factors, knowledge of the relationship between diet and disease made the greatest and most consistent contribution to explaining socio-economic differences in food purchasing. Conclusions: Addressing inequalities in nutrition knowledge is likely to reduce socio-economic differences in compliance with dietary guidelines. Improving knowledge of the relationship between diet and disease appears to be a particularly relevant focus for health promotion aimed to reduce socio-economic differences in diet and related health inequalities.

Literacy and numeracy project: Final report 2009

Literacy and numeracy are critical for young people during and after their schooling. The subjects and courses that students undertake during their school years incorporate a range of academic literacy and numeracy practices which students must be able manage if they are to be successful. Pathways beyond schooling also require specific, and changing, understandings of, and proficiencies with, literacy and numeracy as new communication technologies increasingly impact on further study, work, and everyday life. Teaching and learning numeracy is a new emphasis in the SACE and as yet we have little understanding about the ways in which secondary schools handle this area. Students in Years 10 and 11 are at a crucial point in their educational and life pathways as they begin to refine their future aspirations. For those who have difficulty with academic literacies and numeracies – and often a long history of such problems – this period can be fraught unless teachers are able to provide specific support when it is needed, or students are able to access it from care-givers or community members. The School to Work Literacy and Numeracy Project involved teachers from nine schools across the three sectors and university researchers working together to design curriculum interventions for students with a history of low measurable achievement in literacy and/or numeracy. The project started from the premise that working with ‘rich tasks’, an approach to learning and assessment developed in the Productive Pedagogies work undertaken in Queensland (Hayes et al., 2006), would improve students’ motivation, engagement and learning and that this work could best be done by teachers working in school-based, cross-curriculum teams with a school leadership team member and a university researcher as mentor. A key idea in designing rich tasks is that students will have opportunities to demonstrate their learning in assessments which are aligned with the learning expectations (for example a film festival to publicly launch student-produced films, advertising to sell student-made cubby-houses, a household budget based on students’ likely incomes in future work). In other words the assessments should be designed to allow for authentic communication and displays of what the students have learned through serious engagement with the curriculum. The project was conducted from Term 1-4 2009, with follow-up checks with some project teachers in the early weeks of 2010.

When an eco-feedback system joins the family

The dynamic, chaotic, intimate and social nature of family life presents many challenges when designing interactive systems in the household space. This paper presents findings from a whole-of-family approach to studying the use of an energy awareness and management system called “Ecosphere”. Using a novel methodology of inviting 12 families to create their own self-authored videos documenting their energy use, we report on the family dynamics and nuances of family life that shape and affect this use. Our findings suggest that the momentum of existing family dynamics in many cases obstructs behaviour change and renders some family members unaware of energy consumption despite the presence of an energy monitor display in the house. The implication for eco-feedback design is that it needs to recognise and respond to the kinds of family relations into which the system is embedded. In response, we suggest alternative ways of sharing energy-related information among families and incentivising engagement among teenagers.

Child health and the income gradient : evidence from Australia

The positive relationship between household income and child health is well documented in the child health literature but the precise mechanisms via which income generates better health and whether the income gradient is increasing in child age are not well understood. This paper presents new Australian evidence on the child health–income gradient. We use data from the Longitudinal Study of Australian Children (LSAC), which involved two waves of data collection for children born between March 2003 and February 2004 (B-Cohort: 0–3 years), and between March 1999 and February 2000 (K-Cohort: 4–7 years). This data set allows us to test the robustness of some of the findings of the influential studies of Case et al. [Case, A., Lubotsky, D., Paxson, C., 2002. Economic status and health in childhood: the origins of the gradient. The American Economic Review 92 (5) 1308–1344] and Currie and Stabile [Currie, J., Stabile, M., 2003. Socioeconomic status and child health: why is the relationship stronger for older children. The American Economic Review 93 (5) 1813–1823], and a recent study by Currie et al. [Currie, A., Shields, M.A., Price, S.W., 2007. The child health/family income gradient: evidence from England. Journal of Health Economics 26 (2) 213–232]. The richness of the LSAC data set also allows us to conduct further exploration of the determinants of child health. Our results reveal an increasing income gradient by child age using similar covariates to Case et al. [Case, A., Lubotsky, D., Paxson, C., 2002. Economic status and health in childhood: the origins of the gradient. The American Economic Review 92 (5) 1308–1344]. However, the income gradient disappears if we include a rich set of controls. Our results indicate that parental health and, in particular, the mother's health plays a significant role, reducing the income coefficient to zero; suggesting an underlying mechanism that can explain the observed relationship between child health and family income. Overall, our results for Australian children are similar to those produced by Propper et al. [Propper, C., Rigg, J., Burgess, S., 2007. Child health: evidence on the roles of family income and maternal mental health from a UK birth cohort. Health Economics 16 (11) 1245–1269] on their British child cohort.

Out-of-pocket expenditures for hospital care in Iran : who is at risk of incurring catastrophic payments?

Since the beginning of 1980s, the Iranian health care system has undergone several reforms designed to increase accessibility of health services. Notwithstanding these reforms, out-of-pocket payments which create a barrier to access health services contribute almost half of total health are financing in Iran. This study aimed to provide a greater understanding about the inequality and determinants of the out-of-pocket expenditure (OOPE) and the related catastrophic expenditure (CE) for hospital services in Iran using a nationwide survey data, the 2003 Utilisation of Health Services Survey (UHSS). The concentration index and the Heckman selection model were used to assess inequality and factors associated with these expenditures. Inequality analysis suggests that the CE is concentrated among households in lower socioeconomic levels. The results of the Heckman selection model indicate that factors such as length of stay, admission to a hospital owned by private sector or Ministry of Health and Medical Education, and living in remote areas are positively associated with higher OOPE. Results of the ordered-probit selection model demonstrate that length of stay, lower household wealth index, and admission to a private hospital are major factors contributing to the increase in the probability of CE. Also, we find that households living in East Azarbaijan, Kordestan and Sistan and Balochestan face a higher level of CE. Based on our findings, the current employer-sponsored health insurance system does not offer equal protection against hospital expenditure in Iran. It seems that a single universal health insurance scheme that covers health services for all Iranian—regardless of their employment status—can better protect households from catastrophic health spending.

Assessing the welfare effects of microfinance in Vietnam : empirical results from a quasi-experimental survey

This article analyses the effects of NGO microfinance programmes on household welfare in Vietnam. Data on 470 households across 25 villages were collected using a quasi-experimental survey approach to overcome any self-selection bias. The sample was designed so that member households of microfinance programmes were compared with non-member households with similar characteristics. The analysis shows no significant effects of participation in NGO microfinance on household welfare, proxied by income and consumption per adult equivalent.

Effects of microfinance on poverty reduction in Vietnam : a pseudo-panel data analysis

The development of microfinance in Vietnam since 1990s has coincided with a remarkable progress in poverty reduction. Numerous descriptive studies have illustrated that microfinance is an effective tool to eradicate poverty in Vietnam but evidence from quantitative studies is mixed. This study contributes to the literature by providing new evidence on the impact of microfinance to poverty reduction in Vietnam using the repeated cross - sectional data from the Vietnam Living Standard s Survey (VLSS) during period 1992 - 2010. Our results show that micro - loans contribute significantly to household consumption.

What roles do contemporaneous and cumulative incomes play in the income–child health gradient for young children? Evidence from an Australian Panel

The literature to date shows that children from poorer households tend to have worse health than their peers, and the gap between them grows with age. We investigate whether and how health shocks (as measured by the onset of chronic conditions) contribute to the income–child health gradient and whether the contemporaneous or cumulative effects of income play important mitigating roles. We exploit a rich panel dataset with three panel waves called the Longitudinal Study of Australian children. Given the availability of three waves of data, we are able to apply a range of econometric techniques (e.g. fixed and random effects) to control for unobserved heterogeneity. The paper makes several contributions to the extant literature. First, it shows that an apparent income gradient becomes relatively attenuated in our dataset when the cumulative and contemporaneous effects of household income are distinguished econometrically. Second, it demonstrates that the income–child health gradient becomes statistically insignificant when controlling for parental health and health-related behaviours or unobserved heterogeneity.

The private problem with public service: Rural teachers in educational markets

Staffing rural and remote schools is an important policy issue for the public good. This paper examines the private issues it also poses for teachers with families working in these communities, as they seek to reconcile careers with educational choices for children. The paper first considers historical responses to staffing rural and remote schools in Australia, and the emergence of neoliberal policy encouraging marketisation of the education sector. We report on interviews about considerations motivating household mobility with 11 teachers across regional, rural and remote communities in Queensland. Like other middle-class parents, these teachers prioritised their children’s educational opportunities over career opportunities. The analysis demonstrates how teachers in rural and remote communities constitute a special group of educational consumers with insider knowledge and unique dilemmas around school choice. Their heightened anxieties around school choice under neoliberal policy are shown to contribute to the public issue of staffing rural and remote schools.

Energy efficient home with price sensitive stochastically programmable TCAs

Introduction of dynamic pricing in present retail market, considerably affects customers with an increased cost of energy consumption. Therefore, customers are enforced to control their loads according to price variation. This paper proposes a new technique of Home Energy Management, which helps customers to minimize their cost of energy consumption by appropriately controlling their loads. Thermostatically Controllable Appliances (TCAs) such as air conditioner and water heater are focused in this study, as they consume more than 50% of the total household energy consumption. The control process includes stochastic dynamic programming, which incorporated uncertainties in price and demand variation. It leads to an accurate selection of appliance settings. It is followed by a real time control of selected appliances with its optimal settings. Temperature set points of TCAs are adjusted based on price droop which is a reflection of actual cost of energy consumption. Customer satisfaction is maintained within limits using constraint optimization. It is showed that considerable energy savings is achieved.

Improving access to housing for low-income communities in Dhaka: From rhetoric to reality in community participation

The research explores how community participation can address affordable housing problems of the poor in Dhaka. The research, based on extensive interviews, community focus groups and household surveys in different Dhaka slums, identifies the limiting factors to promote community participation in affordable housing creation. In Dhaka housing options for poor are currently limited to affordable shelters in informal settlements. Public housing programs have failed to reach the poor and meet affordability levels due to a number of factors including lack of beneficiary participation. Beneficiary participation, though widely recognized for success in housing initiatives, often deteriorates in process of implementation into mere involvement, not reflecting community needs and aspirations and thus failing to meet its core objectives. This research identified the most significant impediments as well as opportunities to advance participation in their own housing provisions in Dhaka city.

Being Thrifty on a $100K Wage: Austerity in Family Finances

Understanding how families manage their finances represents a highly important research agenda given the recent economic climate of debt and uncertainty. To have a better understanding of the economics in domestic settings, it is very important to study the ways money and financial issues are collaboratively handled within families. Using an ethnographic approach, we studied the everyday financial practices of fifteen middle-income families. Our preliminary results show that there is a strong tendency to live frugally; that, people apply various and creative mechanisms to minimize their expenses and save money seemingly irrespectively of their income. To this end we highlight some implications for designing technologies to support household financial practices.

Collecting in an urban context: Relationships between collections and space in the home

Collecting has become a popular hobby within Western society, with collectables including anything from ‘bottle tops’ to ‘skyscrapers’. As the nature and size of these collections can impact upon the use of space in the home, the purpose of this study is to explore the relationship between the collections, space in the home and the impacts on others. This qualitative study explores the experiences of 11 Australian collectors, investigating the motivations, practices and adaption techniques used within their urban home environment. The themes of sentimentality, sociability and spatial tensions, including physical, personal and use of space are discussed within the context of their home and family environments. Overall the practice of collecting objects is a complex, varied, sentimental and sociable activity, providing enjoyment, knowledge and friendships. Space can be a central consideration to the practice of collecting as collections shape and are shaped by the available space in a household.

Fixing the alignment: An exploration of budgeting practices in the home

Budgeting is an important means of controlling ones finances and reducing debt. This paper outlines our work towards designing more user centred technology for individual and household budgeting. Based on an ethnographically informed study with 15 participants, we highlight a misalignment between people's actual budgeting practices and those supported by off-the-shelf budgeting aids. In addressing this misalignment we outline three tenets that may be incorporated into future work in this area. These include (1) catering for the different phases of engagement with technology; (2) catering for the practices of hiding and limiting access to money, and; (3) integrating materiality into technical solutions.