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Understanding India, globalisation and health care systems: a mapping of research in the social sciences
Ramila Bisht, Emma Pitchforth, Susan F Murray
Globalization and Health , 2012, DOI: 10.1186/1744-8603-8-32
Abstract: Current globalisation is regarded as a new phase of world integration with increased density and frequency of international or global social interactions relative to local or national ones. In these new dynamics, nation states are influenced by transnational processes occurring on multiple economic, political and cultural levels [1]. Much public health literature still assumes a default model of a ‘healthcare system’ bounded by a nation state which to varying degrees takes responsibility for the four essential functions of service provision, resource generation, financing and stewardship [2], but there is increasing awareness that globalisation processes are shaping local health systems in important ways [3]. In this article we set out to map through the lens of India’s healthcare and its relationship to transnational health care systems, the current extent and form of the social science approaches to an understanding of this field.India is an illuminating case for which one would expect to find a considerable body of literature. The country has emerged as one of the so-called ‘Rising Powers’ which represent drivers of global economic and social change. Healthcare is one of India’s largest sectors in terms of revenue and employment, and is expanding rapidly. The private sector accounts for more than 80% of total healthcare spending within India [4]. Since ‘liberalisation’ of economic policies in the late 1980s, India has also become increasingly attractive to foreign investors with its low costs and large, English-speaking, workforce. During the 1990s, Indian healthcare grew at a compound annual rate of 16% and today the total value of the sector is more than $34 billion and projected to grow to nearly $40 billion by 2012. The consultancy group Pricewaterhouse Coopers’ Emerging Market Report on Healthcare in India[5] listed a number of ‘flourishing market opportunities’ for foreign as well as national companies: medical tourism (often combining elective surgery and
Understanding service user-defined continuity of care and its relationship to health and social measures: a cross-sectional study
Angela C Sweeney, Diana S Rose, Sarah Clement, Fatima Jichi, Ian Rees Jones, Tom Burns, Jocelyn Catty, Susan McLaren, Til Wykes
BMC Health Services Research , 2012, DOI: 10.1186/1472-6963-12-145
Abstract: In a cross sectional study design, 167 people who experience psychosis participated in structured interviews, including a service user-generated COC measure (CONTINU-UM) and health and social assessments. Constructs underlying CONTINU-UM were explored using factor analysis in order to understand service user-defined COC. The relationships between the total/factor CONTINU-UM scores and the health and social measures were then explored through linear regression and an examination of quartile results in order to assess whether service user-defined COC is related to outcome.Service user-defined COC is underpinned by three sub-constructs: preconditions, staff-related continuity and care contacts, although internal consistency of some sub-scales was low. High COC as assessed via CONTINU-UM, including preconditions and staff-related COC, was related to having needs met and better therapeutic alliances. Preconditions for COC were additionally related to symptoms and quality of life. COC was unrelated to empowerment and care contacts unrelated to outcomes. Service users who had experienced a hospital admission experienced higher levels of COC. A minority of service users with the poorest continuity of care also had high BPRS scores and poor quality of life.Service-user defined continuity of care is a measurable construct underpinned by three sub-constructs (preconditions, staff-related and care contacts). COC and its sub-constructs demonstrate a range of relationships with health and social measures. Clinicians have an important role to play in supporting service users to navigate the complexities of the mental health system. Having experienced a hospital admission does not necessarily disrupt the flow of care. Further research is needed to test whether increasing service user-defined COC can improve clinical outcomes. Using CONTINU-UM will allow researchers to assess service users’ experiences of COC based on the elements that are important from their perspective.
Health care models and social control strategies
Aline Vieira Sim?es,Daniela Márcia Nery Sampaio,Isaiane Santos Bittencourt,Zenilda Nogueira Sales
Revista Saúde.Com , 2011,
Abstract: This study aimed to understand the context of health care models and the social control strategies. It is a bibliographic review of critical and reflexive nature based of the references by technical texts, scientific publications and official documents related to public health policies, assisting in the preparation of candidates in the exam for knowledge. It has been selected eleven books and five articles. The material was categorized into three approaches: Historical Context of Public Health Policies, Health Care Models and Social Control Strategies. The results analysis and discussion subsidized the understanding of public health policies, since the implementation of SUS, and regulates health care; however a large country like Brazil, a single model of health care would not be able to meet the demands of health services, which justifies the implementation of various proposals. And, for social control it was possible to understand its influence on public policy changes, where we have identified the health councils and conferences as social control strategies, involving social actors in a critical and constructive role in the process of changing models of care.
Boundaries and e-health implementation in health and social care
King Gerry,O’Donnell Catherine,Boddy David,Smith Fiona
BMC Medical Informatics and Decision Making , 2012, DOI: 10.1186/1472-6947-12-100
Abstract: Background The major problem facing health and social care systems globally today is the growing challenge of an elderly population with complex health and social care needs. A longstanding challenge to the provision of high quality, effectively coordinated care for those with complex needs has been the historical separation of health and social care. Access to timely and accurate data about patients and their treatments has the potential to deliver better care at less cost. Methods To explore the way in which structural, professional and geographical boundaries have affected e-health implementation in health and social care, through an empirical study of the implementation of an electronic version of Single Shared Assessment (SSA) in Scotland, using three retrospective, qualitative case studies in three different health board locations. Results Progress in effectively sharing electronic data had been slow and uneven. One cause was the presence of established structural boundaries, which lead to competing priorities, incompatible IT systems and infrastructure, and poor cooperation. A second cause was the presence of established professional boundaries, which affect staffs’ understanding and acceptance of data sharing and their information requirements. Geographical boundaries featured but less prominently and contrasting perspectives were found with regard to issues such as co-location of health and social care professionals. Conclusions To provide holistic care to those with complex health and social care needs, it is essential that we develop integrated approaches to care delivery. Successful integration needs practices such as good project management and governance, ensuring system interoperability, leadership, good training and support, together with clear efforts to improve working relations across professional boundaries and communication of a clear project vision. This study shows that while technological developments make integration possible, long-standing boundaries constitute substantial risks to IT implementations across the health and social care interface which those initiating major changes would do well to consider before committing to the investment.
The ethics of everyday practice in primary medical care: responding to social health inequities
John S Furler, Victoria J Palmer
Philosophy, Ethics, and Humanities in Medicine , 2010, DOI: 10.1186/1747-5341-5-6
Abstract: Some see doctors as bound by a notion of care that is blind to a patient's social position, while others respond to this issue through invoking notions of justice and human rights where access to care is a prime focus. Both care and justice orientations however conceal important tensions linked to the presence of bioethical principles underpinning these. Other normative ethical theories like deontology, virtue ethics and utilitarianism do not provide adequate guidance on the problem of social health inequities either.This paper explores if Bauman's notion of "forms of togetherness" provides the basis of a relational ethical theory that can help to develop a response to social health inequities of relevance to individual physicians. This theory goes beyond silence on the influence of social position of health and avoids amoral regulatory approaches to monitoring equity of care provision.The socially patterned nature of disease and illness is now a commonplace understanding of health [1]. Social disadvantage and vulnerability, differences in income, occupational group and status, quality of housing and level of education are not just distal and remote influences on the health of a community. The impact of such influences is felt by individuals, real patients who present in clinical practice. Each of us takes our place in the inequitable social gradient of health, embodying a lifetime of socially patterned resources, choices and relationships that create health and illness. The unequal lives of patients and the health effects of social disadvantage are thus a daily reality of medical care. The family physician particularly cannot avoid the effects of social disadvantage in their ongoing relationship with their patients. How to respond to these inequities is challenging and there is a lack of adequate ethical guidance on the matter.Primary care occupies a unique place in the effort to understand how physicians might respond to this issue as it is so closely linked to th
Social and cultural dimensions of hygiene in Cambodian health care facilities
Pascale Hancart-Petitet, Céline Dumas, Anne-Laure Faurand-Tournaire, Alice Desclaux, Sirenda Vong
BMC Public Health , 2011, DOI: 10.1186/1471-2458-11-83
Abstract: We conducted qualitative surveys in various public and private health facilities in Phnom Penh, the capital city and in provinces. We observed and interviewed 319 participants, health care workers and patients, regarding hygiene practices and social relationships amongst the health care staff and with patients. We also examined the local perceptions of hygiene, their impact on the relationships between the health care staff and patients, and perceptions of transmission risks. Data collection stem from face to face semi-structured and open-ended interviews and focus group discussions with various health care staffs (i.e. cleaners, nurses, midwives and medical doctors) and with patients who attended the study health facilities.Overall responses and observations indicated that hygiene practices were burdened by the lack of adequate materials and equipements. In addition, many other factors were identified to influence and distort hygiene practices which include (1) informal and formal social rapports in hospitals, (2) major infection control roles played by the cleaners in absence of professional acknowledgment. Moreover, hygiene practices are commonly seen as an unessential matter to be devoted to low-ranking staff.Our anthropological findings illustrate the importance of comprehensive understanding of hygiene practices; they need to be considered when designing interventions to improve infection control practices in a Cambodian medical setting.The frequency of bloodborne pathogens transmission in health settings has been considered to be high in developing countries [1]. Despite many studies and surveys on infection control and transmission risks in medical settings, the underlying social and cultural logics contributing to this transmission are not well documented [2,3]. Besides epidemiological aspects, hospital hygiene is shaped by medical norms and social-cultural representations, and hygiene practices always take place within social relations [4-9].In Cambodia, H
Universitas Psychologica , 2005,
Abstract: As a part of a mayor research this study outlines the concern of investigate social representations regarding care healthand the anchorage process of construction. We believe that the role of the culture is decisive at the time to adopt a styleof health care. Theoretical analysis about culture-health care implies three issues: 1. Behaviors are emboiled in culturalscripts. 2. Health-care reveals behavioral paradoxes. 3. Gender perspective. Empirical data were obtain from a pilotsample of women all of which are residents in La Plata, Argentina. The personal interview was modeled on thesemiestructured clinical interview.
Social Determinants of Health, the Chronic Care Model, and Systemic Lupus Erythematosus  [PDF]
Edith M. Williams,Kasim Ortiz,Teri Browne
International Journal of Chronic Diseases , 2014, DOI: 10.1155/2014/361792
Abstract: Systemic lupus erythematosus (SLE) is a chronic inflammatory rheumatic disease that disproportionately affects African Americans and other minorities in the USA. Public health attention to SLE has been predominantly epidemiological. To better understand the effects of this cumulative disadvantage and ultimately improve the delivery of care, specifically in the context of SLE, we propose that more research attention to the social determinants of SLE is warranted and more transdisciplinary approaches are necessary to appropriately address identified social determinants of SLE. Further, we suggest drawing from the chronic care model (CCM) for an understanding of how community-level factors may exacerbate disparities explored within social determinant frameworks or facilitate better delivery of care for SLE patients. Grounded in social determinants of health (SDH) frameworks and the CCM, this paper presents issues relative to accessibility to suggest that more transdisciplinary research focused on the role of place could improve care for SLE patients, particularly the most vulnerable patients. It is our hope that this paper will serve as a springboard for future studies to more effectively connect social determinants of health with the chronic care model and thus more comprehensively address adverse health trajectories in SLE and other chronic conditions. 1. Introduction Systemic lupus erythematosus (SLE) is a chronic inflammatory rheumatic disease that is characterized by autoantibody production and multiple organ system involvement, including a high prevalence of polyarthritis [1–4]. In the United States, over the past four decades, SLE incidence has increased and claims one of the highest mortality rates among rheumatic diseases [5, 6]. SLE incidence, prevalence, morbidity, and mortality are all much higher among minorities than whites in the United States. SLE incidence rates among African American women are 3 to 4 times higher than white women, while men have much lower rates than women in general [7], and Hispanics, Asians, and Native Americans are also more likely to develop lupus than non-Hispanic Whites [8, 9]. The overall spectrum of SLE clinical presentation is similar across different ethnic groups, but there appears to be some differences in the autoantibody profile, frequency of certain specific disease complications, and the severity and overall prognosis of the condition [10]. For example, there is cumulative evidence that lupus nephritis (LN)/renal disease is more prevalent in African and Hispanic Americans, as well as Chinese and other
Strategies on Reducing Social Inequalitiesin Health Care
Sofia Zyga; Vasilios Kanellopoulos; Helen Bakola
Choregia , 2010,
Abstract: Health was and will always be the supreme good for human kind. From this scope, people should have equal opportunities for health and all healthcare systems must be build around the term of equity. The aim of this review article is to present, through extensive literature and relevant articles review from Internet, the main aspects of todays inequalities in healthcare provision and the strategies that must be followed so as different social-economical groups have the same access in health care. Also special credit is given on how the political systems must design their healthcare policies according to the facts (social-economical layers) and status of their citizens (diseases).
Social support needs for equity in health and social care: a thematic analysis of experiences of people with chronic fatigue syndrome/myalgic encephalomyelitis
Jose C de Carvalho Leite, Maria de L Drachler, Anne Killett, Swati Kale, Luis Nacul, Maggie McArthur, Chia Hong, Lucy O'Driscoll, Derek Pheby, Peter Campion, Eliana Lacerda, Fiona Poland
International Journal for Equity in Health , 2011, DOI: 10.1186/1475-9276-10-46
Abstract: The participants were 35 adults with CFS/ME in England, purposively selected to provide variation in clinical presentations, social backgrounds and illness experiences. Accounts of experienced needs and needs-related encounters with health and social services were obtained through a focus group (n = 6) and semi-structured interviews (n = 35). These were transcribed and needs related topics identified through data-led thematic analysis.Participants emphasised needs for personalised, timely and sustained support to alleviate CFS/ME impacts and regain life control, in three thematic areas: (1) Illness symptoms, functional limitations and illness management; (2) practical support and social care; (3) financial support. Access of people with CFS/ME to support from health and social services was seen to be constrained by barriers stemming from social, cultural, organisational and professional norms and practices, further heightened for disadvantaged groups including some ethnic minorities. These reduced opportunities for their illness to be explained or associated functional limitations and social disadvantages to be addressed through social support. Participants sought more understanding of bio-psycho-social aspects of CFS/ME, of felt needs of people with CFS/ME and of human rights and disability rights, for providing person-centred, equitable care.Changes in attitudes of health practitioners, policy makers and general public and more flexibly organised health and social care provision are needed to address equity issues in support needs expressed by people with CFS/ME, to be underpinned by research-based knowledge and communication, for public and professional education. Policy development should include shared decision-making and coordinated action across organizations working for people with CFS/ME, human rights and disadvantaged groups. Experiences of people with CFS/ME can usefully inform an understanding of equity in their health and social care.Providing equitable
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