Social science & medicine
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Issues around health equity in conflict-affected fragile states have received very little analysis to date. This paper examines the main factors that threaten health equity, the populations that are most vulnerable and potential strategies to improve health equity. The methods employed are a review of the published and grey literature, key informant interviews and an analysis of data on social determinants of health indicators. ⋯ Strategies to strengthen health equity include strengthening pro-equity policy and planning functions; building provider capacity to provide health services; and reducing access and participation barriers for excluded groups. In conclusion, conflict is a key social determinant of health. More data is needed to determine how conflict affects within-country and between-country equity, and better evaluated strategies are needed to reduce inequity.
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Social science & medicine · Jan 2010
Right and access to healthcare for undocumented children: addressing the gap between international conventions and disparate implementations in North America and Europe.
Limited access to healthcare for vulnerable immigrant children in Europe and North America is increasingly worrisome as immigration policies harden. This paper analyzes the gap between States' obligations under international human rights law and the disparate local implementations in diverse countries. ⋯ It is argued that the lack of available data on the magnitude of the problem and on its individual and public health consequences stems from the conflicting situation faced by health institutions required to simultaneously protect the best interest of each child and allocate limited resources. Collaboration in research is urgently needed to assist policy-makers and institutions make informed decisions.
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Social science & medicine · Jan 2010
Spatial analysis of heat-related mortality among the elderly between 1993 and 2004 in Sydney, Australia.
This study analyzed the geographical patterns of heat-related mortality among the population aged 65 and over within the metropolitan area of Sydney, Australia between 1993 and 2004, and evaluated the role of some physical and socio-demographic risk factors associated with it. The effect of temperature on all-cause mortality during unusually hot days was investigated using spatial analytic techniques, such as cluster analysis and spatial regression analysis. Generalized Linear Models (GLMs) were used to investigate the role of daily average temperature, ozone (O(3)) and particulate matter of diameter less than 10 microm (PM(10)) at the regions that showed a significant increase in mortality on unusually hot days. ⋯ A combination of social and environmental factors may be at play. Our results suggest an effect of temperature on mortality of the elderly population in Sydney Statistical Division at the SLA level. More spatially-based research would be beneficial once climate datasets with improved spatial coverage become available.
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Social science & medicine · Jan 2010
Responses to intimate partner violence in Kakuma refugee camp: refugee interactions with agency systems.
Intimate partner violence (IPV) has been recognised as a significant problem amongst forcibly displaced communities, and great progress has been made by the United Nations High Commission for Refugees (UNHCR) in responding to IPV and other forms of sexual and gender based violence. However, they have not always effectively engaged refugee communities in these activities, with potentially negative consequences for the health and protection of women. This study was conducted in Kakuma refugee camp, north-west Kenya. ⋯ Whilst community responses to IPV might often be appropriate and helpful, the findings of the current study suggest that in Kakuma they do not necessarily result in the protection of women. Yet women in Kakuma are reported to be reluctant to report their cases to UNHCR and its implementing agencies. A more effective protection response from UNHCR might involve closer co-operation with individuals and structures within the refugee communities to develop a co-ordinated response to IPV.
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Social science & medicine · Dec 2009
Exploring patient involvement in healthcare decision making across different education and functional health literacy groups.
Education and health literacy potentially limit a person's ability to be involved in decisions about their health. Few studies, however, have explored understandings and experiences of involvement in decision making among patients varying in education and health literacy. This paper reports on a qualitative interview study of 73 men and women living in Sydney, Australia, with varying education and functional health literacy levels. ⋯ Both education groups described how aspects of the patient-practitioner relationship (e.g. continuity, negotiation, trust) and the practitioner's interpersonal communication skills influenced their involvement. Health information served a variety of needs for all groups (e.g. supporting psychosocial, practical and decision support needs). These findings have practical implications for how to involve patients with different education and literacy levels in decision making, and highlight the important role of the patient-practitioner relationship in the process of decision making.