Social science & medicine
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Social science & medicine · Feb 2018
Tackling racism as a "wicked" public health problem: Enabling allies in anti-racism praxis.
Racism is a "wicked" public health problem that fuels systemic health inequities between population groups in New Zealand, the United States and elsewhere. While literature has examined racism and its effects on health, the work describing how to intervene to address racism in public health is less developed. While the notion of raising awareness of racism through socio-political education is not new, given the way racism has morphed into new narratives in health institutional settings, it has become critical to support allies to make informing efforts to address racism as a fundamental cause of health inequities. ⋯ Our anti-racism praxis for allies includes five core elements: reflexive relational praxis, structural power analysis, socio-political education, monitoring and evaluation and systems change approaches. We recognize that racism is a modifiable determinant of health and racial inequities can be eliminated with the necessary political will and a planned system change approach. Anti-racism praxis provides the tools to examine the interconnection and interdependence of cultural and institutional factors as a foundation for examining where and how to intervene to address racism.
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Social science & medicine · Feb 2018
Biocultural citizenship and embodying exceptionalism: Biopolitics for sickle cell disease in Brazil.
In 2006, the committee that developed the National Health Policy for the Black Population (NHPBP) chose sickle cell disease as their "flag to demand health rights." The drafting of this policy was official recognition from the Ministry of Health for racial differences of its citizens in order to address certain inequalities in the form of racial health reparations. Through an ethnographic study which consisted of participant observation, life-story and semi-structured interviews, and surveys in the urban centers of Rio de Janeiro, São Paulo, Salvador, Belo Horizonte, and Brasília between November 2013 and November 2014, I introduce a new conceptual approach called biocultural citizenship. It is a flexible mode of enacting belonging that varies depending on disease status, skin color, social class, recognition of African lineage, and other identifiers. ⋯ Specifically, I demonstrate that the SCD movement strategically uses Blackness to make claims for health rights. Biocultural citizenship is dependent on the idea of biological and cultural difference that is coproduced by the State and Afro-Brazilian citizens. The use of biology to help legitimate cultural claims, especially in the Black Atlantic, contributes a new and distinct way to think about how race and skin color are used as tools of agency for diasporic communities.
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Social science & medicine · Jan 2018
Going viral in PNG - Exploring routes and circumstances of entry of a rabies-infected dog into Papua New Guinea.
In this qualitative study implemented in November 2016, we elicited narratives about fictional rabies incursions from key employees (n = 16) of the National Agriculture and Quarantine Inspection Authority in Papua New Guinea (PNG) to explore the potential circumstances and routes of entry of a rabies-infected dog, and direct rabies preparedness. Although PNG is rabies free, proximity to rabies-endemic Indonesia poses a risk of introduction and it is expected that an outbreak in PNG would have devastating human health impacts consistent with other countries with similarly low human development indices and abundant free-roaming dogs. Participants used their local and professional knowledge to create plausible narratives in response to contextual, but fictitious, newspaper stories. ⋯ Consequently, dogs changed ownership frequently. The findings of this study have important implications for rabies preparedness in PNG; there is potential for wide geographic dissemination of rabies in dogs before outbreak detection. However, common patterns of travel - trade of dogs via Papuan towns and use of traditional trade routes - do provide opportunity for targeted surveillance and response in the event of an incursion.
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Social science & medicine · Nov 2017
Kids in space: Measuring children's residential neighborhoods and other destinations using activity space GPS and wearable camera data.
Defining the boundary of children's 'neighborhoods' has important implications for understanding the contextual influences on child health. Additionally, insight into activities that occur outside people's neighborhoods may indicate exposures that place-based studies cannot detect. This study aimed to 1) extend current neighborhood research, using data from wearable cameras and GPS devices that were worn over several days in an urban setting; 2) define the boundary of children's neighborhoods by using leisure time activity space data; and 3) determine the destinations visited by children in their leisure time, outside their neighborhoods. ⋯ Person-centered neighborhood definitions may serve to better represent children's everyday experiences and neighborhood exposures than previous methods based on place-based measures. As schools and other residential locations (friends and family) are important destinations outside the neighborhood, such destinations should be taken into account. The combination of image data and activity space GPS data provides a more robust approach to understanding children's neighborhoods and activity spaces.
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Social science & medicine · Oct 2017
Review Meta AnalysisRacial residential segregation and adverse birth outcomes: A systematic review and meta-analysis.
Persistent racial disparities in adverse birth outcomes are not fully explained by individual-level risk factors. Racial residential segregation-degree to which two or more groups live apart from one another-may contribute to the etiology of these birth outcome disparities. Our aim was to assess associations between segregation and adverse birth outcomes by race. This review focused on formal measures of segregation, using Massey and Denton's framework (1998) that identifies five distinct operationalizations of segregation, in addition to proxy measures of segregation such as racial composition, in order to gain a deeper understanding of the operationalizations of segregation most salient for birth outcomes. ⋯ Associations between segregation and adverse birth outcomes differ by race. Methodological heterogeneity between studies may obscure true associations. Research can be advanced through use of multilevel frameworks and by examining mechanistic pathways between segregation and adverse birth outcomes. Elucidation of pathways may provide opportunities to intervene to reduce seemingly intractable racial disparities in adverse birth outcomes.