Inhabitants' and professionals' social representations of health determinants in a disadvantaged urban area in France: a qualitative analysis = représentations sociales des déterminants de santé dans une zone urbaine défavorisée en France : analyse qualitative auprès d'habitants et de professionnels

Background and objective. - Access to care in French disadvantaged urban areas remains an issue despite the implementation of local healthcare structures. To understand this contradiction, we investigated social representations held by inhabitants of such areas, as well as those of social and healthcare professionals, regarding events or behaviours that can impact low-income individuals' health. Method. - In the context of a health diagnosis, 288 inhabitants living in five disadvantaged districts of Aix-les-Bains, as well as 28 professionals working in these districts, completed an open-ended questionnaire. The two groups of respondents were asked to describe what could have an impact on health status from the inhabitants' point of view. The textual responses were analyzed using the Alceste method. Results. - We observed a number of differences in the way the inhabitants and professionals represented determinants of health in disadvantaged urban areas: the former proposed a representation mixing personal responsibility with physiological, social, familial, and professional aspects, whereas the latter associated health issues with marginalization (financial, drug, or alcohol problems) and personal responsibility. Both inhabitants and professionals mentioned control over events and lifestyle as determinants of health. Discussion. - The results are discussed regarding the consequences of these different representations on the beneficiary - healthcare-provider relationship in terms of communication and trust.

A Quantitative Study of Social Capital Components, Self-Reported Health Status and Social Determinants of Health

This quantitative descriptive co-relational study used telephone survey interviews and stratified random sampling to collect data related to Social Capital (SC) and its components (trust and safety, reciprocity, civic engagement and collective action) and selected determinants of health variables in Niagara Region, Canada. Among the four components of social capital, trust and safety levels were highest among all participants (m=5.42, SD=1.0), with community engagement yielding the lowest mean score for the sample (m=1.93, SD=.8). Reciprocity had the strongest association with all other components of SC (r=0.51). Those most likely to report low levels of SC and health were unattached and low-income females. Males were more likely to report higher trust and safety levels and higher levels of self-rated health. In this study, a linear relationship between self-reported health status and SC was not found. Marital and employment status were associated with differences in mean scores of SC and self-reported health.

The determinants of the health status in a developing country: results from the Colombian case

El artículo busca encontrar evidencia empírica de los determinantes de la salud, como una medición de capital salud en un país en desarrollo después de una profunda reforma en el sector salud. Siguiendo el modelo de Grossman (1972) y tomando factores institucionales, además de las variables individuales y socioeconómicas. Se usaron las encuestas de 1997 y 2000 donde se responde subjetivamente sobre el estado de salud y tipo de afiliación al sistema de salud. El proceso de estimación usado es un probit ordenado. Los resultados muestran una importante conexión entre las variables individuales, institucionales y socioeconómicas con el estado de salud. El efecto de tipo de acceso al sistema de salud presiona las inequidades en salud.

Determinants of participation in worksite health risk appraisal (HRA) programs

The purpose of this study was to apply the Behavioral Model of Health Services Utilization to examine an existing worksite HRA program to identify and examine the roles of determinants of participation in HRA programs. The program consisted of three activities: questionnaire, physical examination, and group interpretation sessions. All of the 1821 employees were eligible for the program; 523 (29%) participated in at least one activity. Results from bivariate analyses suggest that being female, being white, having fewer dependents, and having higher medical claims for the past year were positively associated with participation. Results of logistic regression suggest that Age, Sex, Race, Marital, Number of Dependents, Job Title, Months with the Company, and a log transformed value of Employee's Total Medical Claims were all significant determinants of participation. Applications of the logistic regression models, other factors that should be investigated in future studies, and the limitations of the study were discussed. ^

Determinants of general practitioner use among women in Australia

This study investigates the use of general practitioner services by women in Australia. Although there is a universal health insurance system (Medicare) in Australia, there are variations in access to services and out of pocket costs for services. Survey data from 2350 mid-age (45-50 years) and 2102 older (70-75 years) women participating in the Australian Longitudinal Study on Women's Health were linked with Medicare data to provide a range of individual and contextual variables hypothesised to explain general practitioner use. Structural equation modelling showed that physical health was the most powerful explanatory factor of general practitioner use. However, after adjusting for self-reported health, out of pocket cost per consultation was inversely associated with use of services. The out of pocket cost was generally lower for women with low socioeconomic status but cost was also directly related to geographical remoteness. Women living in more remote areas had higher out of pocket costs and poorer access to services. Women who reported better access to care were more likely to be satisfied with their most recent general practice consultation and less likely to be sceptical of the value of medical care. These results show the need for health policies that improve the equitable use of general practitioner services in Australia. (C) 2001 Elsevier Science Ltd. All rights reserved.

Free-trade agreements: challenges for global health

In this study new free-trade agreements are discussed, which are based on the breaking down of tariff and technical barriers and normally exclude most of the poorest countries in the world. Considering the current context of economic globalization and its health impacts, seven controversial points of these treaties and their possible implications for global public health are presented, mainly regarding health equity and other health determinants. Finally, this research proposes a greater social and health professionals participation in the formulation and discussion of these treaties, and a deeper insertion of Brazil in this important international agenda.

Santé et besoins en soins des personnes âgées: différences liées au genre [Health status and care giving needs in the elderly: gender related differences].

The health status and need for care differ depending on the gender. The most notable differences are life expectancy, life expectancy in good health and the prevalence of geriatric syndromes or chronic illnesses. Some social health determinants (social isolation or financial precariousness) seem to act as risk factors for vulnerability, mostly amongst old or very old women. Through some examples of differences between men and women in terms of health and caregiving needs, this article tries to heighten the awareness of health professionals to a gender based approach of the elderly patient in order to promote the best possible equity in healthcare.

On decomposing the causes of changes in income-related health inequality with longitudinal data

Regression-based decomposition procedures are used to both standardise the concentration index and to determine the contribution of inequalities in the individual health determinants to the overall value of the index. The main contribution of this paper is to develop analogous procedures to decompose the income-related health mobility and health-related income mobility indices first proposed in Allanson, Gerdtham and Petrie (2010) and subsequently extended in Petrie, Allanson and Gerdtham (2010) to account for deaths. The application of the procedures is illustrated by an empirical study that uses British Household Panel Survey (BHPS) data to analyse the performance of Scotland in tackling income-related health inequalities relative to England & Wales over the five year period 1999 to 2004.

IPH response to A Healthier Future: A 20 year vision for health and wellbeing in Northern Ireland

The Institute of Public Health in Ireland aims to promote cooperation for public health between Northern Ireland and Ireland, to tackle inequalities in health and influence public polices in favour of health. In its work, the Institute emphasises a holistic model of health which recognises the interplay of a wide range of health determinants, including economic, social and environmental factors as well as health and social services.

Response to Draft Guidance on Health in Strategic Environmental Assessment

The Institute of Public Health in Ireland welcomes the opportunity to comment on the Draft Guidance on Health in Strategic Environmental Assessment.  Our organisation aims to improve health on the island of Ireland by working to combat health inequalities and influence public policies in favour of health. The Institute applies a holistic model of health which emphasises a wide range of health determinants, including economic, environmental, social and biological factors. Our work is based on the premise that improving health and reducing health inequalities can only be achieved through addressing these broad determinants of health.

The London Health Inequalities Strategy - Draft for public consultation

This is the very first Health Inequality Strategy to be published for public consultation by the London Mayor. As such it represents a momentous step forward in galvanising action across London to address the health inequalities which prevent many Londoners from enjoying their life to the full and making the most of what London has to offer. The Greater London Authority Act 2007 requires that the strategy identifies the health inequalities, the priorities for reducing them and the role to be played by a defined list of key partners in order to implement the strategy. It defines health inequalities as inequalities in respect of life expectancy or general state of health which are wholly or partly a result of differences in respect of general health determinants۪, which it describes as: (a) standards of housing, transport services or public safety; (b) employment prospects, earning capacity and any other matters that affect levels of prosperity; (c) the degree of ease or difficulty with which persons have access to public services; (d) the use, or level of use, of tobacco, alcohol or other substances, and any other matters of personal behaviour or lifestyle, that are or may be harmful to health, and any other matters that are determinants of life expectancy or the state of health of persons generally, other than genetic or biological factors.

Health Profile of England 2007

This profile is an update of the first published in 2006. The Health Profile of England is intended to be of use to public service professionals and officials within the local community - such as local councillors and primary care trust directors of public health - who are in a position to exert influence over the planning, commissioning, procurement and delivery of public health programmes. But the document will also be of interest to a much wider audience - anyone with an interest in the profile of health and health determinants in this country.

Gender inequality in health among elderly people in a combined framework of socioeconomic position, family characteristics and social support

This study analyses gender inequalities in health among elderly people in Catalonia (Spain) by adopting a conceptual framework that globally considers three dimensions of health determinants : socio-economic position, family characteristics and social support. Data came from the 2006 Catalonian Health Survey. For the purposes of this study a sub-sample of people aged 65–85 years with no paid job was selected (1,113 men and 1,484 women). The health outcomes analysed were self-perceived health status, poor mental health status and long-standing limiting illness. Multiple logistic regression models separated by sex were fitted and a hierarchical model was fitted in three steps. Health status among elderly women was poorer than among the men for the three outcomes analysed. Whereas living with disabled people was positively related to the three health outcomes and confidant social support was negatively associated with all of them in both sexes, there were gender differences in other social determinants of health. Our results emphasise the importance of using an integrated approach for the analysis of health inequalities among elderly people, simultaneously considering socio-economic position, family characteristics and social support, as well as different health indicators, in order fully to understand the social determinants of the health status of older men and women.

La "bientraitance", exploration du concept et essai d'utilisation en santé publique: une expérience à Fribourg (Suisse). ["Bientraitance": conceptual exploration and an example of its application in public health: an experience from Fribourg, Switzerland]

Since the year 2000, the concept of "bientraitance" (for which no equivalent term has yet emerged in either the English or German language) has gained widespread credence among educators, sociologists and health professionals in France and Belgium. This concept emphasizes a constructive approach to care and education rather than merely one of prevention of disasters. Applied in public health, and in particular to mental health promotion, the use of the concept of "bientraitance" can help promote both effectiveness and meaning in the design and planning of community interventions. The article presents an example of an intervention for children and adolescents in Fribourg, Switzerland. The underpinning hypothesis is that the children and youth groups (such as sports clubs, artistic and cultural associations, scouts and guides) represent largely untapped, or under-tapped, informal health resources with a favourable cost-effectiveness profile. "Bientraitance" criteria are used in selecting certain associations offering structured extracurricular group educational activities and collective out-of-school (or after school) programmes. Support is provided to the organisations selected for recruiting new members, in particular those with potentially lower levels of access, for example disabled children or new migrants. The results will be evaluated for the impact of participation in various out-of-school activities on health and health determinants from a prospective and comparative perspective. This paper shows how the concept of "bientraitance" can be useful in the development of a public health intervention.

Measuring early childhood health : a composite index comparing Colombian departments

This paper presents a composite index of early childhood health using a multivariate statistical approach. The index shows how child health varies across Colombian departments, -administrative subdivisions-. In recent years there has been growing interest in composite indicators as an efficient analysis tool and a way of prioritizing policies. These indicators not only enable multi-dimensional phenomena to be simplified but also make it easier to measure, visualize, monitor and compare a country’s performance in particular issues. We used data collected from the Colombian Demographic and Health Survey, DHS, for 32 departments and the capital city, Bogotá, in 2005 and 2010. The variables included in the index provide a measure of three dimensions related to child health: health status, health determinants and the health system. In order to generate the weight of the variables and take into account the discrete nature of the data, we employed a principal component analysis, PCA, using polychoric correlation. From this method, five principal components were selected. The index was estimated using a weighted average of the components retained. A hierarchical cluster analysis was also carried out. We observed that the departments ranking in the lowest positions are located on the Colombian periphery. They are departments with low per capita incomes and they present critical social indicators. The results suggest that the regional disparities in child health may be associated with differences in parental characteristics, household conditions and economic development levels, which makes clear the importance of context in the study of child health in Colombia.