The societal costs of problem gambling in Sweden.

BACKGROUND: Problem gambling is a public health issue affecting both the gamblers, their families, their employers, and society as a whole. Recent law changes in Sweden oblige local and regional health authorities to invest more in prevention and treatment of problem gambling. The economic consequences of gambling, and thereby the potential economic consequences of policy changes in the area, are unknown, as the cost of problem gambling to society has remained largely unexplored in Sweden and similar settings. METHODS: A prevalence-based cost-of-illness study for Sweden for the year 2018 was conducted. A societal approach was chosen in order to include direct costs (such as health care and legal costs), indirect costs (such as lost productivity due to unemployment), and intangible costs (such as reduced quality of life due to emotional distress). Costs were estimated by combining epidemiological and unit cost data. RESULTS: The societal costs of problem gambling amounted to 1.42 billion euros in 2018, corresponding to 0.30% of the gross domestic product. Direct costs accounted only for 13% of the total costs. Indirect costs accounted for more than half (59%) of the total costs, while intangible costs accounted for 28%. The societal costs were more than twice as high as the tax revenue from gambling in 2018. Direct and indirect costs of problem gambling combined amounted to one third of the equivalent costs of smoking and one sixth of the costs of alcohol consumption in Sweden. CONCLUSIONS: Problem gambling is increasingly recognized as a public health issue. The societal costs of it are not negligible, also in relation to major public health issues of an addictive nature such as smoking and alcohol consumption. Direct costs for prevention and treatment are very low. A stronger focus on prevention and treatment might help to reduce many of the very high indirect and intangible costs in the future.

Regulating the international surrogacy market:the ethics of commercial surrogacy in the Netherlands and India.

It is unclear what proper remuneration for surrogacy is, since countries disagree and both commercial and altruistic surrogacy have ethical drawbacks. In the presence of cross-border surrogacy, these ethical drawbacks are exacerbated. In this article, we explore what would be ethical remuneration for surrogacy, and suggest regulations for how to ensure this in the international context. A normative ethical analysis of commercial surrogacy is conducted. Various arguments against commercial surrogacy are explored, such as exploitation and commodification of surrogates, reproductive capacities, and the child. We argue that, although commodification and exploitation can occur, these problems are not specific to surrogacy but should be understood in the broader context of an unequal world. Moreover, at least some of these arguments are based on symbolic rhetoric or they lack knowledge of real-world experiences. In line with this critique we argue that commercial surrogacy can be justified, but how and under what circumstances depends on the context. Surrogates should be paid a sufficient amount and regulations should be in order. In this article, the Netherlands and India (where commercial surrogacy was legal until 2015) are case examples of contexts that differ in many respects. In both contexts, surrogacy can be seen as a legitimate form of work, which requires the same wage and safety standards as other forms of labor. Payments for surrogacy need to be high enough to avoid exploitation by underpayment, which can be established by the mechanisms of either minimum wage (in high income countries such as the Netherlands), or Fair-Trade guidelines (in lower-middle income countries such as India). An international treaty governing commercial surrogacy should be in place, and local professional bodies to protect the interests of surrogates should be required. Commercial surrogacy should be permitted across the globe, which would also reduce the need for intended parents to seek surrogacy services abroad.

[Pharmaceutical expenditures in the different municipalities of Rome (Italy): impact of socioeconomic conditions of the resident population]. / Spesa farmaceutica territoriale nelle Aziende Sanitarie di Roma Capitale: impatto delle condizioni socio economiche della popolazione residente.

Pharmaceutical expenditure is a cost item that is monitored continuously, to verify the appropriateness of prescriptions, the good use of available resources and to contain costs. However, socioeconomic differences in the population affect health conditions and consequently health expenditure. A comparison of socio-economic determinants and per-capita pharmaceutical expenditure in the different municipalities of Roma Capitale (Capital city of Rome, Italy) indicates that higher expenditures occur in areas characterized by lower socio-economic conditions.

The hidden practices and experiences of healthcare practitioners dealing with fuel poverty.

BACKGROUND: Fuel poverty negatively impacts a population's health affecting life chances along the life course. Moreover, it represents a substantial inequality in the UK. Healthcare practitioners (HCPs) have a key role in identifying and supporting patients who are fuel poor. METHODS: A qualitative inquiry with District Nurses and General Practitioners, to explore their understanding and experiences of dealing with patients living in fuel poverty. RESULTS: Participants recognize fuel poverty by observing material cues. They perceive their relationship with the patient as pivotal to recognizing the fuel poor. Practitioners' sense of responsibility for their patients' social concerns is determined by their knowledge about the link to health outcomes. The services that they sign-post to are motivated by their experience dealing with the service, or their patients' experiences of the service. CONCLUSION: Participants' reliance on temporary material cues resulted in few experiences of recognition of the fuel poor. HCPs' perceptions of patient pride and the lack of personal relationship between doctor and patient presented barriers to identifying fuel poor patients. A limitation of this study is the small sample size of nine participants. These came from two professional groups, which afforded more depth of exploration, but may limit applicability to other professionals.

Consumer trust in the Australian food system - The everyday erosive impact of food labelling.

Consumer trust in food system actors is foundational for ensuring consumer confidence in food safety. As food labelling is a direct communication between consumers and food system actors, it may influence consumer perceptions of actor trustworthiness. This study explores the judgements formed about the trustworthiness of the food system and its actors through labelling, and the expectations these judgements are based on. In-depth, semi-structured interviews with 24 Australian consumers were conducted. Theoretical sampling focussed on shopping location, dietary requirements, rurality, gender, age and educational background. The methodological approach used (adaptive theory) enabled emerging data to be examined through the lens of a set of guiding theoretical concepts, and theory reconsidered in light of emerging data. Food labelling acted as a surrogate for personal interaction with industry and government for participants. Judgements about the trustworthiness of these actors and the broader food system were formed through interaction with food labelling and were based on expectations of both competence and goodwill. Interaction with labelling primarily reduced trust in actors within the food system, undermining trust in the system as a whole. Labelling has a role as an access point to the food system. Access points are points of vulnerability for systems, where trust can be developed, reinforced or broken down. For the participants in this study, in general labelling demonstrates food system actors lack goodwill and violate their fiduciary responsibility. This paper provides crucial insights for industry and policy actors to use this access point to build, rather than undermine, trust in food systems.

The Arab Spring and health: two years on.

The "Arab Spring" has touched almost all countries in the Middle East and North Africa. While most attention has focused on security and political developments, there are significant consequences for population health. These include immediate problems, such as violent deaths and injuries, population displacement, and damage to essential infrastructure, but also longer term vulnerabilities not yet addressed by the political changes, including high unemployment, the low status of women, erosion of already weak welfare systems, and rising food prices. It will be important to tackle these underlying issues while not repeating the mistakes made in other countries that have undergone rapid political transition.

Inequality of pension arrangements among different segments of the labor force in China.

Social security for older people in China today has been established institutionally. However, there are substantial problems such as coverage, affordability, fund management, and corruption. This paper aims to provide a general picture of China's social security system for older people and to argue that the inequality of pension arrangements among different segments of the labor force is one of the most conspicuous problems challenging the Chinese government. Four unequal aspects of the pension system concerning the financing resources and pension levels are examined in this paper: (1) unequal institutional arrangements among different sectors, (2) unbalanced governmental expenditure in pension provision, (3) an increasing gap in pension levels between urban and rural areas, and (4) uncovered groups such as the unemployed and self-employed. Historical, economic, and political reasons all contribute to this unequal institution under transition from socialism to a market-oriented economy. At present, it is urgent for the central government to take measures to integrate the various pension arrangements into the unified Old Age Insurance and to reduce the gaps among different regions.

The influence of world societal forces on social tolerance. A time comparative study of prejudices in 32 countries.

Societal variation in xenophobia, homophobia, and other prejudices is frequently explained by the economic background and political history of different countries. This article expands these explanations by considering the influence of world societal factors on individual attitudes. The empirical analysis is based on survey data collected within the World Value Survey and European Values Study framework between 1989 and 2010. Data are combined to a three-wave cross-sectional design including about 130,000 respondents from 32 countries. Results show that xenophobia and homophobia are influenced by the national political history, societal affluence, and the presence of international organizations. Global forces, however, are of particular importance for homophobia.

Overturning anti-miscegenation laws: news media coverage of the Lovings' legal case against the state of Virginia.

This study fills a gap in scholarship by exploring historical news coverage of interracial relationships. It examines coverage by The New York Times, Washington Post and Times-Herald, and Chicago Tribune of the progression of the landmark civil rights case of Loving v. Virginia, in which the Supreme Court overturned Virginia's anti-miscegenation law, which prohibited marriage between any White and non-White person. An analysis of the frames and sources used in these publications' news stories about the case indicate all three publications' coverage favored the Lovings.

Rural income transfer programs and rural household food security in Ethiopia.

Based on household food security surveys conducted in Ethiopia, this study seeks to understand the roles and limitations of income transfer projects as determinants of households' food security. By covering the Food-For-Work Programs (FFWPs) and the Productive Safety Net Programs (PSNPs), the study shows that these programs served as temporary safety nets for food availability, but they were limited in boosting the dietary diversity of households and their coping strategies. Households which participated in the programs increased their supply of food as a temporary buffer to seasonal asset depletion. However, participation in the programs was marred by inclusion error (food-secure households were included) and exclusion error (food-insecure households were excluded). Income transfer projects alone were not robust determinants of household food security. Rather, socio-demographic variables of education and family size as well as agricultural input of land size were found to be significant in accounting for changes in households' food security. The programs in the research sites were funded through foreign aid, and the findings of the study imply the need to reexamine the approaches adopted by bilateral donors in allocating aid to Ethiopia. At the same time the study underscores the need to improve domestic policy framework in terms of engendering rural local institutional participation in project management.

[The stakes of online gambling in Canada: a public health analysis]. / Les enjeux de l'etatisation du jeu en ligne au Canada: une analyse de santé publique.

Available data show that online gamblers spend more money and dedicate more time to playing compared to gamblers who do not play online, and are more likely to experience gambling problems. Among online players, young people and poker players show higher rates of gambling problems. These observations can be explained in part by such dangerous aspects of online gambling (and also electronic gaming machines) as: immediate and convenient accessibility; ability to pay electronically and to play on credit; anonymity; and the possibility for players to consume alcohol or other drugs while playing. These are elements that could facilitate the development or the intensification of problem gambling. This being said, the public discourse about the inevitability of legalized online gambling is quite unanimous and built upon such arguments as: the imperative duty of the state to protect the population against the dangers of the online gambling black market; and the fact that the medium in itself provides excellent consumer safeguards. A growing number of legislators are following the trend and choosing to establish state control over online gambling. We present some epidemiological and analytical data that challenge some of these assertions and decisions. We recommend a better integration of public health arguments into the commercialization and marketing of online gambling.

Crime, shame, reintegration, and cross-national homicide: a partial test of reintegrative shaming theory.

Reintegrative shaming theory (RST) argues that social aggregates characterized by high levels of communitarianism and nonstigmatizing shaming practices benefit from relatively low levels of crime. We combine aggregate measures from the World Values Survey with available macro-level data to test this hypothesis. Additionally, we examine the extent to which communitarianism and shaming mediate the effects of cultural and structural factors featured prominently in other macro-level theoretical frameworks (e.g., inequality, modernity, sex ratio, etc.). Findings provide some support for RST, showing homicide to vary with societal levels of communitarianism and informal stigmatization. However, while the effects of modernity and sex ratio were mediated by RST processes, suppression was indicated for economic inequality. Implications for theory and research are discussed.

Community influences on white racial attitudes: what matters and why?

Tracing the roots of racial attitudes in historical events and individual biographies has been a long-standing goal of race relations scholars. Recent years have seen a new development in racial attitude research: Local community context has entered the spotlight as a potential influence on racial views. The race composition of the locality has been the most common focus; evidence from earlier decades suggests that white Americans are more likely to hold anti-black attitudes if they live in areas where the African-American population is relatively large. However, an influential 2000 article argued that the socioeconomic composition of the white community is a more powerful influence on white attitudes: In low-socioeconomic status (SES) locales, "stress-inducing" deprivations and hardships in whites' own lives purportedly lead them to disparage blacks. The study reported here reassesses this "scapegoating" claim, using data from the 1998 to 2002 General Social Surveys linked to 2000 census information about communities. Across many dimensions of racial attitudes, there is pronounced influence of both local racial proportions and college completion rates among white residents. However, the economic dimension of SES exerts negligible influence on white racial attitudes, suggesting that local processes other than scapegoating must be at work.

The neoliberal state and the penalization of misery.

The strategy adopted by the neoliberal state to maintain social order and safeguard private property in a context of economic deregulation and social precariousness has destroyed the welfare state and aggravated poverty, depriving the masses of any form of social protection while subjecting them to repression. The reinforcement of the repressive state apparatus is associated with the social instability provoked by the lack of social policies, the degradation of living conditions for the great majority of the population, and the amplification of income and property inequalities both in the so-called capitalist periphery and in the richest industrialized countries. The penalization of misery is revealed as a new expression of class domination.

Metropolitan reform in Allegheny County: the local failure of National Urban Reform Advocacy, 1920-1929.

During the 1920-1929 period, the Civic Club of Allegheny County supported political consolidation of the county's municipalities and townships. Civic Club leaders sought boundary reform to tackle perceived social problems and political inefficiencies in the Pittsburgh region. This policy was aligned with a national network of Progressive urban reformers, some of whom guided the Civic Club's plans. These reform efforts culminated in the 1929 Metropolitan Charter, which was rejected by Allegheny County voters. Traditional explanations of this failed vote emphasize the high threshold for success of the charter. However, such accounts ignore the apparent disjunction between the national perception of regional problems and the local reception of recommended solutions. Reform advocates were unable to adapt national Progressive theories to the local context of Allegheny County. This article first describes the national network of Progressive Era research that prescribed metropolitan solutions for urban problems in cities such as Pittsburgh. The article then examines attempts by the Civic Club of Allegheny County to introduce these theories to Allegheny County, Pennsylvania. The failure of the 1929 Metropolitan Charter is reevaluated, and the implications of these events for current proponents of metropolitanism and political reform are discussed.

Unsightly urban menaces and the rescaling of residential segregation in the United States.

In this article, the author uses a slum clearance project in Lexington, Kentucky, as a lens through which to examine the spatial dynamics of racial residential segregation during the first half of the twentieth century. At the time, urban migration and upward socioeconomic mobility on the part of African Americans destabilized extant residential segregation patterns. Amid this instability, various spatial practices were employed in the interest of maintaining white social and economic supremacy. The author argues that such practices were indicative of a thoroughgoing reinvention of urban socio-spatial order that in turn precipitated the vastly expanded scale of residential segregation still found in U.S. cities today. Evidence of this reinvented ordering of urban space lies in the rendering of some long-standing African American neighborhoods as "out of place" within it and the use of slum clearance to remove the "menace" such neighborhoods posed to it.

"The very model of modern urban decay": outsiders' narratives of industry and urban decline in Gary, Indiana.

In the eyes of many, the steel city of Gary, Indiana, entered a period of decline in the middle of the twentieth century. The once great city was seemingly racked by job loss, crime, racial division, or moral decay. Which of these caused the decline of the city depended upon the perspective of the story's teller. Each narrative of decline contained a different moment where the city went wrong and it began to decay. For some it was the moral decay of the 1950s, for others it was the rise of black power and politics in the 1960s, for still others it was the white backlash against civil rights in the 1970s. Some saw a microcosm of America, some saw a dangerous cauldron of race and ethnicity. The source of decline and the origins of the urban crisis were largely in the eye of the beholder. The stories people chose to tell about Gary mattered because for much of the twentieth century, Gary was at the center of American narratives about industrialism. These were outsider narratives of decline read onto the Indiana steel city because Gary represented larger debates. People read onto Gary their changing expectations and anxieties about industry and industrial spaces. This article traces the changing attitudes outsiders held toward Gary from the middle of the twentieth century through the period of deindustrialization at the end of the century and examines American narratives about deindustrialization and urban decline.

"But burn - no": the rest of the crowd in three civil disorders in 1960s Chicago.

Examining the internal dynamics of three civil disturbances on the West Side of Chicago during the late 1960s, this article describes the presence of numerous people who were not participating in the upheaval. It pays particular attention to "counterrioters," civilian residents of the neighborhoods and members of local organizations, who tried to persuade those engaging in violence to stop. Local dissent from the tactic of violence suggests that historians should describe these events using the neutral language of social science rather than the politically loaded labels of "riot" or "rebellion." The article argues that American historians of urban disorders should use the methods of European scholars of the crowd to study the actions of participants in order to ascertain their political content, rather than relying on an examination of their motives.

Decentralization, democratization, and health: the Philippine experiment.

In 1991, the Philippines joined a growing list of countries that reformed health planning through decentralization. Reformers viewed decentralization as a tool that would solve multiple problems, leading to more meaningful democracy and more effective health planning. Today, nearly two decades after the passage of decentralization legislation, questions about the effectiveness of the reforms persist. Inadequate financing, inequity, and a lack of meaningful participation remain challenges, in many ways mirroring broader weaknesses of Philippine democracy. These concerns pose questions regarding the nature of contemporary decentralization, democratization, and health planning and whether these three strategies are indeed mutually enforcing.

Rights to food with a human face in the global south.

This article seeks to dispel the popular myth surrounding the food crises which precipitated food riots in the global South in 2008. Arguing from a structural and historical perspective, the article suggests that global hunger is a deep-rooted crisis that is embedded in the social and structural variables associated within the nation-state that places a restraint on the self-regulating capacity of nation-states in the South. Internationalizing the food crisis, however, will do more harm to the south's agricultural transformation and rural development. The article argues for integrated rural development that will increase output growth through an institutional, technological, and marketing strategy.