Estimating the burden of disease attributable to smoking in South Africa in 2000

Objectives To quantify the burden of disease attributable to smoking in South Africa for 2000. Design The absolute difference between observed lung cancer death rate and the level in non-smokers, adjusted for occupational and indoor exposure to lung carcinogens, was used to estimate the proportion of lung cancer deaths attributable to smoking and the smoking impact ratio (SIR). The SIR was substituted for smoking prevalence in the attributable fraction formula for chronic obstructive pulmonary disease (COPD) and cancers to allow for the long lag between exposure and outcome. Assuming a shorter lag between exposure and disease, the current prevalence of smoking was used to estimate the population-attributable fractions (PAF) for the other outcomes. Relative risks (RR) from the American Cancer Society cancer prevention study (CPS-II) were used to calculate PAF. Setting South Africa. Outcome measures Deaths and disability-adjusted life years (DALYs) due to lung and other cancers, COPD, cardiovascular conditions, respiratory tuberculosis, and other respiratory and medical conditions. Results Smoking caused between 41 632 and 46 656 deaths in South Africa, accounting for 8.0 - 9.0% of deaths and 3.7 - 4.3% of DALYs in 2000. Smoking ranked third (after unsafe sex/sexually transmitted disease and high blood pressure) in terms of mortality among 17 risk factors evaluated. Three times as many males as females died from smoking. Lung cancer had the largest attributable fraction due to smoking. However, cardiovascular diseases accounted for the largest proportion of deaths attributed to smoking. Conclusion Cigarette smoking accounts for a large burden of preventable disease in South Africa. While the government has taken bold legislative action to discourage tobacco use since 1994, it still remains a major public health priority.

Chinese Australians’ Chineseness and their mathematics achievement : the role of habitus

Large-scale international comparative studies and cross-ethnic studies have revealed that Chinese students, living either in China or overseas, consistently outperform their counterparts in mathematics. Empirical research has discussed psychological, educational, and cultural reasons behind Chinese students’ better mathematics performance. However, there is scant sociological investigation of this phenomenon. The current mixed methods study aims to make a contribution in this regard. The study conceptualises Chineseness through Bourdieu’s sociological notion of habitus and considers this habitus of Chineseness generating, but not determining, mechanism that underpins commitment to mathematics learning. The study firstly analyses the responses of 230 Chinese Australian participants to a set of questionnaire items. Results indicate that the habitus of Chineseness significantly mediates the relationship between participants’ commitment to mathematics learning and their mathematics achievement. The study then reports on the interviews with five participants to add nuances and dynamics to the mediating role of habitus of Chineseness. The study complements the existing literature by providing sociological insight into the better mathematics achievement of Chinese students.

The use of prescribed drugs for common chronic conditions in South Africa in 1998

Purpose To determine the prescribed drug-utilisation pattern for six common chronic conditions in adult South Africans in a cross-sectional survey. Methods 13 826 randomly selected participants, 15 years and older, were surveyed by trained fieldworkers at their homes in 1998. Questionnaires included socio-demographic, chronic-disease and drug-use data. The prescribed drugs were recorded from participants' medication containers. The Anatomical Therapeutic Classification (ATC) code of the drugs for tuberculosis (TB), diabetes, hypertension, hyperlipidaemia, other atherosclerosis-related conditions, such as heart conditions or cerebrovascular accidents (CVA), and asthma or chronic obstructive pulmonary disease (COPD), was recorded. The use of logistic regression analyses identified the determinants of those patients who used prescription medication for these six conditions. Results 18.4% of the women and 12.5% of the men used drugs for the six chronic conditions. Men used drugs most frequently for hypertension (50.9%) and asthma or chronic bronchitis (24.3%), while in women it was for hypertension (59.9%) and diabetes (17.5%). The logistic regression analyses showed that women, wealthier and older people, and those with medical insurance used these chronic-disease drugs more frequently compared to men, younger or poor people, or those without medical insurance. The African population group used these drugs less frequently than any other ethnic group. The inappropriate use of methyldopa was found for 14.8% of all antihypertensive drugs, while very few people used aspirin. Conclusions The methodology of this study provides a means of ascertaining the chronic-disease drug-utilisation pattern in national health surveys. The pattern described, suggests an inequitable use of chronic-disease drugs and inadequate use of some effective drugs to control the burden of chronic diseases in South Africa. Copyright © 2004 John Wiley & Sons, Ltd.

Subduing power : Indigenous sovereignty matters

The concept of ‘power’ can refer to the institutionalised and embodied capacity and right to dominate through a variety of means including ideology, politics, science, religion, class, race, gender and sexuality. Early feminist theorising within the West, for example, conceptualised the structure and nature of power as being connected to male domination and authority within society. Marxists, alternately, argue it is the ruling class that holds power and exercises it as owners of the means of production. In a general sense, we can say that as feminists have tied power to patriarchy and Marxists’ definitions of power have been connected to capitalism. The essays in this section, though, are less concerned with such totalising conceptualisations of power than they are with processes of interpellation or subject creation within dominant or dominating discursive spaces.1 Not power as such, but its many workings and apparatuses.

Imaginging the good Indigenous citizen : race war and the pathology of partiarchal white sovereignty

In June 2007, the Australian federal government sent military and policy into Indigenous communities in the Northern Territory on the premise that sexual abuse of children was rampant and a national crisis. This article draws on Foucault’s work on sovereignty and rights to argue that patriarchal white sovereignty as a regime of power deploys a discourse of pathology in the exercising of sovereign right to subjugate and discipline Indigenous people as good citizens.

Attributing human uniqueness and human nature to cultural groups : distinct forms of subtle dehumanization

Research on subtle dehumanization has focused on the attribution of human uniqueness to groups (infrahumanization), but has not examined another sense of humanness, human nature. Additionally, research has not extended far beyond Western cultures to examine the universality of these forms of dehumanization. Hence, the attribution of both forms of humanness was examined in three cross-cultural studies. Anglo-Australian and ethnic Chinese attributed values and traits (Study 1, N = 200) and emotions (Study 2, N = 151) to Australian and Chinese groups, and rated these characteristics on human uniqueness and human nature. Both studies found evidence of complementary attributions of humanness for Australians, who denied Chinese human nature but attributed them with greater human uniqueness. Chinese denied Australians human uniqueness, but their attributions of human nature varied for traits, values, and emotions. Study 3 (N = 54) demonstrated similar forms of dehumanization using an implicit method. These results and their implications for dehumanization and prejudice suggest the need to broaden investigation and theory to encompass both forms of humanness, and examine the attribution of both lesser and greater humanness to outgroups.

Editorials: A different kind of treatment

Health professionals' duty of care includes combating racism in society as well as in health care settings. The Australian Government's proposed changes to the Racial Discrimination Act 1975 and the repeal of section 18C has transfixed national debates on legally defining racial discrimination.1 Under these changes, racial discrimination would no longer include acts that “offend, insult, humiliate or intimidate” a person based on the person's race, colour or national or ethnic origin and instead be limited to acts that “incite hatred” or “cause fear of physical harm”.2 These proposed changes have been framed in the context of enabling “free speech”, yet, evidence presented in this issue of the Journal shows that they have potential to cause harm. In this issue, Kelaher and colleagues highlight the prevalence of racism as experienced by Indigenous Australians and its deleterious effects on mental health.3 Alarmingly, almost every Aboriginal Victorian participating in this study reported an experience of racism in the preceding 12 months, which included jokes, stereotypes, verbal abuse and exclusionary practices. The experiences of racism reported here neither incited hatred nor caused fear of physical harm, yet resulted in harm such as psychological distress, especially when meted out in our health care system. These findings are a stark reminder that racism is indeed an important health issue, and as health professionals, our duty of care extends to contributing to these broader policy discussions...