Eco-cultural health,global health,and sustainability

Anthropogenic stress on the earth’s ecosystems has resulted in widespread prevalence of ecosystem distress syndrome, a quantifiable set of signs of ecosystem degradation. At the same time, the planet is witnessing rapid declines in global cultural diversity and in the vitality of the world’s cultures, which closely mirror, and are interrelated with, ecological degradation. As a consequence of this converging crisis of loss of ecosystem and cultural health, global health and sustainability are increasingly under threat. An eco-cultural health perspective based on understanding the linkages between human activities, ecological and cultural disruption, and public health is essential for addressing these threats and achieving global sustainability.     

Socioeconomic determinants of health. Children,inequalities, and health.

This article describes a growing body of evidence showing the adverse effects of the widening income gap on the health and welfare of children and young people. The effects of this go well beyond morbidity and mortality and can also be seen in the areas of crime, violence, and educational attainment. There is a need for evidence based policy in this area, but meanwhile there is scope for intervention in pregnancy and the early years, and good evidence that this is effective. A number of well evaluated interventions not necessarily directly related to health, such as early learning programmes and social support for parents, promise to have beneficial health effects.     

Placebo, meaning, and health

Placebos are boon and bane to medical theory and clinical practice. On the one hand, randomized controlled trials employ concealed allocations of placebo to control for effects not due to specific pharmacological mechanisms. As a result, nearly all of evidence-based medicine derives from principles and practices based on placebo. On the other hand, medical researchers and physicians have tended to ignore, minimize, or deride placebos and placebo effects, perhaps due to values emphasizing scientific understanding of mechanistic pathways. We argue that intention, expectation, culture, and meaning are central to placebo-effect phenomena and are substantive determinants of health. We introduce three dualities that are integral to placebo/meaning phenomena: body-mind, subconscious-conscious, and passive-active. These placebo-related dualities should be acknowledged, explored with research, and incorporated in theory. While we view consideration of placebo and meaning effects as essential to any adequate understanding of human health, we feel that lessons from this area of inquiry may already provide practical tools for astute clinicians. Toward this end, we list eight specific clinical actions: speak positively about treatments, provide encouragement, develop trust, provide reassurance, support relationships, respect uniqueness, explore values, and create ceremony. These clinical actions can empower patients to seek greater health and may provide a healthful sense of being cared for.     

Childlessness,health, and marital satisfaction

Abstract

Data on the health and well‐being of 2,480 married couples in an urban area‐probability sample suggest that parenthood detracts from the physical and psychological health of husbands and wives, particularly among younger couples. Rates of joint marital satisfaction also were lower for active parents than for former parents and childless couples, regardless of the duration of the marriage and the wife's age and employment status. That parenthood may be detrimental to both health and marital satisfaction is suggested by the finding that former parents were better off than active parents on both indices, though not as well off as childless spouses.     

Housing,health, and illness.

Cases referred to a community physician in his role as medical adviser to a housing authority were reviewed. A new system of classifying health problems was devised because conventional diagnostic classification was found to be inappropriate. The effectiveness of medical intervention was apparently low, since only 29 out of 612 (4.7%) applications for rehousing on medical grounds were successful. The effectiveness of the community physician''s role was limited by the available resources and the number of cases he could take before the housing committee. It is proposed that the use of medical resources for intervention in such cases is acceptably efficient, though this proposal is based on value judgement rather than on economic grounds. Doctors should be concerned in improving housing conditions, which are still unacceptably poor in many parts of Britain, in the interests of improving general standards of public health.     

Freedom,responsibility, and health.

Freedom and responsibility, how much of each and how they are balanced, have profound implications for our personal lives and for our work. The health of a population and its achievement in the workplace are enhanced when individuals have some freedom and some responsibility, but not too much of either, and when civil associations of individuals rather than individuals acting alone are the essential social units. The consistent association of social contacts with health and productivity provides strong support for the premise that intimate relationships are the focus around which people''s lives revolve. Membership of a "social network" may be merely conforming to a reigning social norm, and this could mean having to pay an important price in the loss of creativity associated with individualism. But social conformity should not prevent individuals from going their own way, and it should be possible to combine the luxury of individuality with an active life in civic affairs. Less than complete freedom may fall short of existential utopia, but it may be best for our health and wellbeing.