Social Capital, Narratives of Fragmentation, and Schizophrenia: An Ethnographic Exploration of Factors Shaping African-Caribbeans’ Social Capital and Mental Health in a North London Community

Recent research studies have proposed the concept of social capital—broadly defined as social networks, community cohesion, and participation—as a social risk factor for health disparities and the high rates of schizophrenia among individuals of Caribbean heritage in England. However, many of the existing studies lack sociohistorical contexts and do not capture the experiential dimensions of individuals’ social capital. This paper adds to the debate by examining the mechanisms and sociocultural processes that shape the understandings and experiences of social capital in a sample of British African-Caribbeans. Drawing on ethnographic and survey data collected over 2 years in a North London community, the paper focuses on participants’ every day experiences and the stories they tell about their community and social fragmentation. These stories suggest that social changes and historical forces interact to affect the social capital and emotional well-being of local African-Caribbean residents. I argue that my participants’ collective narratives about their social environment contribute to the emotional tone of the community, and create added stressors that may impact their mental health.     

Has the Rajiv Aarogyasri Community Health Insurance Scheme of Andhra Pradesh Addressed the Educational Divide in Accessing Health Care?

Background

Equity of access to healthcare remains a major challenge with families continuing to face financial and non-financial barriers to services. Lack of education has been shown to be a key risk factor for ''catastrophic'' health expenditure (CHE), in many countries including India. Consequently, ways to address the education divide need to be explored. We aimed to assess whether the innovative state-funded Rajiv Aarogyasri Community Health Insurance Scheme of Andhra Pradesh state launched in 2007, has achieved equity of access to hospital inpatient care among households with varying levels of education.

Methods

We used the National Sample Survey Organization 2004 survey as our baseline and the same survey design to collect post-intervention data from 8623 households in the state in 2012. Two outcomes, hospitalisation and CHE for inpatient care, were estimated using education as a measure of socio-economic status and transforming levels of education into ridit scores. We derived relative indices of inequality by regressing the outcome measures on education, transformed as a ridit score, using logistic regression models with appropriate weights and accounting for the complex survey design.

Findings

Between 2004 and 2012, there was a 39% reduction in the likelihood of the most educated person being hospitalised compared to the least educated, with reductions observed in all households as well as those that had used the Aarogyasri. For CHE the inequality disappeared in 2012 in both groups. Sub-group analyses by economic status, social groups and rural-urban residence showed a decrease in relative indices of inequality in most groups. Nevertheless, inequalities in hospitalisation and CHE persisted across most groups.

Conclusion

During the time of the Aarogyasri scheme implementation inequalities in access to hospital care were substantially reduced but not eliminated across the education divide. Universal access to education and schemes such as Aarogyasri have the synergistic potential to achieve equity of access to healthcare.     

“A Great Complication of Circumstances” – Darwin and the Economy of Nature

In 1749, Linnaeus presided over the dissertation “Oeconomia Naturae,” which argued that each creature plays an important and particular role in nature’s economy. This phrase should be familiar to readers of Darwin, for he claims in the Origin that “all organic beings are striving, it may be said, to seize on each place in the economy of nature.” Many scholars have discussed the influence of political economy on Darwin’s ideas. In this paper, I take a different tack, showing that Darwin’s idea of an economy of nature stemmed from the views of earlier naturalists like Linnaeus and Lyell. I argue, in the first section of the paper, that Linnaeus’ idea of oeconomia naturae is derived from the idea of the animal economy, and that his idea of politia naturae is an extension of the idea of a politia civitatis. In the second part, I explore the use of the concept of stations in the work of De Candolle and Lyell – the precursor to Darwin’s concept of places. I show in the third part of the paper that the idea of places in an economy of nature is employed by Darwin at many key points in his thinking: his discussion of the Galapagos birds, his reading of Malthus, etc. Finally, in the last section, I demonstrate that the idea of a place in nature’s economy is essential to Darwin’s account of divergence. To tell his famous story of divergence and adaptation, Darwin needed the economy of nature.     

Willingness to Pay: Australian Consumers and “On the Farm” Welfare

The success of welfare legislation for nonhuman animals rests upon primary producer compliance that, in turn, is affected by public willingness to pay (WTP) for such initiatives. Although the topic of the welfare of animals on farms (and relevant legislation) is becoming increasingly important to the Australian public, there remain relatively few recent assessments of the variables that may affect WTP and, therefore, support initiatives aimed at improving the welfare of animals living on farms. This study surveyed 1,224 community members in Queensland, Australia. The study assessed respondents' self-rated knowledge of, and concern regarding, farm animal welfare. In addition, the survey asked respondents how much more they would be prepared to pay for animal-based products to ensure that they came from a source where the Five Freedoms were met. Although self-rated knowledge and level of concern were found to affect WTP, the study found only concern for farm animal welfare actually predicted consumer behavior. Further analyses showed a potential confound between knowledge levels and locality. This article discusses the implications of this for future initiatives to increase WTP.     

Patients’ Knowledge,Attitudes, Behaviour and Health Care Experiences on the Prevention,Detection, Management and Control of Hypertension in Colombia: A Qualitative Study

Hypertension is a leading cause of premature death worldwide and the most important modifiable risk factor for cardiovascular disease. Effective screening programs, communication with patients, regular monitoring, and adherence to treatment are essential to successful management but may be challenging in health systems facing resource constraints. This qualitative study explored patients’ knowledge, attitudes, behaviour and health care seeking experiences in relation to detection, treatment and control of hypertension in Colombia. We conducted in-depth interviews and focus group discussions with 26 individuals with hypertension and 4 family members in two regions. Few participants were aware of ways to prevent high blood pressure. Once diagnosed, most reported taking medication but had little information about their condition and had a poor understanding of their treatment regime. The desire for good communication and a trusting relationship with the doctor emerged as key themes in promoting adherence to medication and regular attendance at medical appointments. Barriers to accessing treatment included co-payments for medication; costs of transport to health care facilities; unavailability of drugs; and poor access to specialist care. Some patients overcame these barriers with support from social networks, family members and neighbours. However, those who lacked such support, experienced loneliness and struggled to access health care services. The health insurance scheme was frequently described as administratively confusing and those accessing the state subsidized system believed that the treatment was inferior to that provided under the compulsory contributory system. Measures that should be addressed to improve hypertension management in Colombia include better communication between health care professionals and patients, measures to improve understanding of the importance of adherence to treatment, reduction of co-payments and transport costs, and easier access to care, especially in rural areas.     

Linking Human Health and Livestock Health: A “One-Health” Platform for Integrated Analysis of Human Health,Livestock Health,and Economic Welfare in Livestock Dependent Communities

Background

For most rural households in sub-Saharan Africa, healthy livestock play a key role in averting the burden associated with zoonotic diseases, and in meeting household nutritional and socio-economic needs. However, there is limited understanding of the complex nutritional, socio-economic, and zoonotic pathways that link livestock health to human health and welfare. Here we describe a platform for integrated human health, animal health and economic welfare analysis designed to address this challenge. We provide baseline epidemiological data on disease syndromes in humans and the animals they keep, and provide examples of relationships between human health, animal health and household socio-economic status.

Method

We designed a study to obtain syndromic disease data in animals along with economic and behavioral information for 1500 rural households in Western Kenya already participating in a human syndromic disease surveillance study. Data collection started in February 2013, and each household is visited bi-weekly and data on four human syndromes (fever, jaundice, diarrhea and respiratory illness) and nine animal syndromes (death, respiratory, reproductive, musculoskeletal, nervous, urogenital, digestive, udder disorders, and skin disorders in cattle, sheep, goats and chickens) are collected. Additionally, data from a comprehensive socio-economic survey is collected every 3 months in each of the study households.

Findings

Data from the first year of study showed 93% of the households owned at least one form of livestock (55%, 19%, 41% and 88% own cattle, sheep, goats and chickens respectively). Digestive disorders, mainly diarrhea episodes, were the most common syndromes observed in cattle, goats and sheep, accounting for 56% of all livestock syndromes, followed by respiratory illnesses (18%). In humans, respiratory illnesses accounted for 54% of all illnesses reported, followed by acute febrile illnesses (40%) and diarrhea illnesses (5%). While controlling for household size, the incidence of human illness increased 1.31-fold for every 10 cases of animal illness or death observed (95% CI 1.16–1.49). Access and utilization of animal source foods such as milk and eggs were positively associated with the number of cattle and chickens owned by the household. Additionally, health care seeking was correlated with household incomes and wealth, which were in turn correlated with livestock herd size.

Conclusion

This study platform provides a unique longitudinal dataset that allows for the determination and quantification of linkages between human and animal health, including the impact of healthy animals on human disease averted, malnutrition, household educational attainment, and income levels.     

“Eating Hay”: The Ecology,Economy and Culture of Viliui Sakha Smallholders of Northeastern Siberia

Contemporary rural Viliui Sakha of northeastern Siberia, Russia, are a Turkicspeaking people practicing horse and cattle breeding in the subarctic. This article details their story of survival in the north as one not only of adapting a southern subsistence to an extreme climate but also to the effects of Russian colonization, Soviet collectivization, and post-Soviet decentralization. In the post-Soviet period a majority of rural Viliu Sakha adapted to the loss of a centralized agro-industrial state farm system by developing a smallholder food production system relying on cattle husbandry supplemented with other subsistence sources including fish, game, forage, other domesticates, and garden products. In the twenty-first century, this “cows-and-kin” system represents a resilient smallholder adaptation based on reviving pre-Soviet production knowledge, recalling ecological knowledge, and relying on kin. The article concludes with a discussion of the future of cows-and-kin by exploring issues of alienated youth, accessing land and the overwhelming concern of inhabitants about the local effects of global climate change.

Politics of Plasticity: Implications of the New Science of the “Teen Brain” for Education

Culture, Medicine, and Psychiatry - In recent years, claims that developmental brain science should inform pedagogical approaches have begun to influence educational policies. This article...     

Market Liberalism in Health Care: A Dysfunctional View of Respecting “Consumer” Autonomy

The unfortunately vast history of paternalism in both medicine and clinical research has resulted in perpetually increasing respect for patient autonomy and free choice in Western health care systems. Beginning with the negative right to informed consent, the principle of respect for autonomy has for many patients evolved into a positive right to request treatments and expect accommodation. This evolution of patient autonomy has mirrored a more general social attitude of market liberalism where increasing numbers of patients have come to embody the role of the “consumer.” This paper explores this transformation and critiques the current way in which respect for patient autonomy is put into practice. Ultimately, this paper concludes that the consumer view of patient autonomy is dysfunctional. Moreover, this paper argues that, based on the inherent goals of medicine, some form of paternalism is required in any meaningfully therapeutic relationship.     

Coverage and Quality of Antenatal Care Provided at Primary Health Care Facilities in the ‘Punjab’ Province of ‘Pakistan’

Background

Antenatal care is a very important component of maternal health services. It provides the opportunity to learn about risks associated with pregnancy and guides to plan the place of deliveries thereby preventing maternal and infant morbidity and mortality. In ‘Pakistan’ antenatal services to rural population are being provided through a network of primary health care facilities designated as ''Basic Health Units and Rural Health Centers. Pakistan is a developing country, consisting of four provinces and federally administered areas. Each province is administratively subdivided in to ‘Divisions’ and ‘Districts’. By population ‘Punjab’ is the largest province of Pakistan having 36 districts. This study was conducted to assess the coverage and quality antenatal care in the primary health care facilities in ‘Punjab’ province of ‘Pakistan’.

Methods

Quantitative and Qualitative methods were used to collect data. Using multistage sampling technique nine out of thirty six districts were selected and 19 primary health care facilities of public sector (seventeen Basic Health Units and two Rural Health Centers were randomly selected from each district. Focus group discussions and in-depth interviews were conducted with clients, providers and health managers.

Results

The overall enrollment for antenatal checkup was 55.9% and drop out was 32.9% in subsequent visits. The quality of services regarding assessment, treatment and counseling was extremely poor. The reasons for low coverage and quality were the distant location of facilities, deficiency of facility resources, indifferent attitude and non availability of the staff. Moreover, lack of client awareness about importance of antenatal care and self empowerment for decision making to seek care were also responsible for low coverage.

Conclusion

The coverage and quality of the antenatal care services in ‘Punjab’ are extremely compromised. Only half of the expected pregnancies are enrolled and out of those 1/3 drop out in follow-up visits.