Family policy and inequalities in health in different welfare states.

This article focuses on differences in health and welfare outcomes for families with children in three European countries, discussed in relation to national policies for child and family welfare. Data consist of policy documents and cross-national surveys. The document analysis was based on policy documents that described government policies. The statistical analyses utilize data from the European Social Survey. For the analyses in this article, a sub-sample of child families was selected from the countries Slovenia, Sweden, and the United Kingdom. Data showed that England's policy has mainly addressed socially disadvantaged groups and areas. Sweden and Slovenia are mainly developing universal policies. The United Kingdom has high scores for subjective general health, but a steep income gradient in the population. Parents in England experience the highest level of at-risk-of-poverty. Sweden generally scores well on health outcomes and on level of at-risk-of-poverty, and the gradient in self-rated general health is the mildest. Slovenia has the weakest economy, but low levels of inequality and low child at-risk-for-poverty scores. The Slovenian example suggests that not only the level of economic wealth, but also its distribution in the population, has bearings on health and life satisfaction, not least on the health of children.

Culture in salutogenesis: the scholarship of Aaron Antonovsky.

Aaron Antonovsky wrote extensively, although disjointedly, about the roles of culture in salutogenesis. This paper provides a synopsis of his work in this arena. A literature review identified those of his English language writings in which culture was a subject, and relevant text segments were analysed using an inductive followed by a deductive method. Using thematic network analysis, text segments were sorted inductively by open coding and then analysed. This was followed by deductive text segment coding guided by the constructs of the salutogenic model of health. The analysis revealed that Antonovsky had an expansive interest in the roles of culture in salutogenesis. His writings included attention to the role of culture in: (a) shaping life situations; (b) giving rise to stressors and resources; (c) contributing to life experiences of predictability, load balance and meaningful roles; (d) facilitating the development of the sense of coherence and (e) shaping perceptions of health and well-being. Antonovsky's writings about culture were sometimes conjectural, as well as being obviously influenced by his life experience in the USA and then in Israel, and by the spirit of the times in which he lived. However, he also drew extensively on his own and others' empiricism, leading him to view culture as an integral aspect of the salutogenic model of health. The present analysis provides salutogenesis scholars with a roadmap of Antonovsky's reflections, ponderings and conclusions about culture in the context of salutogenesis. It provides assistance in the form of an overview of Antonovsky's treatment of culture in the context of salutogenesis.

Promoting health in Georgia.

This paper discusses the public health situation in Georgia. In 1991 Georgia became an independent republic following the collapse of the Soviet Union. The armed conflict with Russia in 2008 and political unrest in recent years has presented the Georgian population and politicians with a demanding situation. As part of the WHO European Region, the Commonwealth of Independent States (CIS) including Georgia is on the unfortunate side of a European health divide, with low male life expectancy and high under-five mortality. There is also a high degree of economic inequality in the population. We first look at the main players and the current strategies in public health work. Next we discuss this on the background of health promotion principles and recent international developments in knowledge and policy recommendations in the field of health promotion. Finally we point to some of the major public health challenges that Georgia faces. We conclude that the Georgian focus on reducing risk behaviours and improving access to quality health care is worthy of praise, but that this is not sufficient to solve the current public health challenges. Strategies for working across sectors with social determinants of health should be built into Georgian health thinking and policies. A health promotion work force should be developed. International developments such as the Commission on Social Determinants of Health (CSDH) report, the 'Health 2020' framework and the HP Core Competencies project all provide useful input to future development of healthy public policies in Georgia.

Child diet and healthy growth in the context of rural poverty in the peruvian andes: what influences primary caregivers' opportunities and choices?

This study explored opportunities and choices related to child feeding among women living in a remote and low-income district in the Andean highlands. Data were collected through in-depth interviews with mothers (N = 7) with reputations for providing good child care, and who participated in an NGO-run social and health programme. The aim of this study was to learn about women's positive experience with child feeding, in the context of living in low-income communities. Such knowledge could be of substantial practical value to health promotion practitioners, in illuminating existing local circumstances and practices that produce good child nutrition. The women who were most knowledgeable about child health and diet were better educated and had relatively higher social positions in the community. Regarding contextual factors related to child feeding, numerous references were made to the extensive use of own crops and food stuffs, seen to provide a better diet than that available in cities where people buy their food. In discussing food and meal preparation habits, there were clear references to child welfare and health as motivating factors in the choices that were made. The NGO programme was not mentioned by the interviewer, to avoid prompting, yet the respondents referred to it explicitly, and attributed improved health-related knowledge and skills to the NGO education interventions (e.g. education about nutritious meal preparation, child care skills, and sanitation practices). It is concluded that the women were concerned about providing a good diet to their children, they were aware of the impact of feeding practices on child health, and that education about health and diet helped them to improved feeding practices.

The salutogenic model of health in health promotion research.

Despite health promotion's enthusiasm for the salutogenic model of health, researchers have paid little attention to Antonovsky's central ideas about the ease/dis-ease continuum, defined in terms of 'breakdown' (the severity of pain and functional limitations, and the degree medical care is called for, irrespective of specific diseases). Rather, salutogenesis research has a strong focus on how sense of coherence relates to a wide range of specific diseases and illness endpoints. We address two questions: Why has Antonovsky's health concept failed to stimulate research on breakdown, and how can the present emphasis on disease be complemented by an emphasis on positive well-being in the salutogenic model? We show that (i) the breakdown concept of health as specified by Antonovsky is circular in definition, (ii) it is not measured on the 'required' ease/dis-ease continuum, (iii) it is not measureable by any validated or reliability-tested assessment tool, and (iv) it has not so much been rejected by health promotion, as it has not been considered at all. We show that Antonovsky came to view breakdown as but one aspect of well-being. He was open to the idea of well-being as something more positive than the absence of pain, suffering and need for medical care. We suggest ways to move salutogenesis research in the direction of well-being in its positive sense.

Does health promotion need a Code of Ethics? Results from an IUHPE mixed method survey.

BACKGROUND: Health promotion is an ethically challenging field involving constant reflection of values across multiple cultures of what is regarded as good and bad health promotion practice. While many disciplines are guided by a Code of Ethics (CoE) no such guide is available to health promoters. The International Union for Health Promotion and Education (IUHPE) has been nominated as a suitable candidate for developing such a code. It is within this context that the IUHPE Student and Early Career Network (ISECN), through its Ethics Working Group, has taken up the challenge of preparing the foundations for a CoE for health promotion. METHODS: An online survey comprising open and closed-answer questions was used to gather the opinions of IUHPE members regarding the need for a CoE for health promotion. The quantitative data were calculated with descriptive analyses. A thematic analysis approach was used to analyze and interpret the qualitative data. RESULTS: IUHPE members (n = 236) from all global regions responded to the survey. The majority (52%) of the respondents had 11 years' experience or more in the field of health promotion. Ethical dilemmas were commonly encountered. The need for a CoE for health promotion was expressed by 83% of respondents. Respondents also offered their views of possibilities, ideas and challenges regarding the development of a CoE for health promotion. CONCLUSIONS: Considering that health promoters encounter ethical dilemmas frequently in their practice, this study reinforces the need to develop a CoE for the field. The recommendations from the survey provide a good basis for future work to develop such a code.

The International Union for Health Promotion and Education (IUHPE) Student and Early Career Network (ISECN): a case illustrating three strategies for maximizing synergy in professional collaboration.

The International Union for Health Promotion and Education (IUHPE) Student and Early Career Network (ISECN) was constructed upon a foundation of research, using the Bergen Model of Collaborative Functioning (BMCF) as a blueprint to inform its leadership, communication, structure, and culture. The BMCF consists of inputs (partners, mission, and financial resources), throughputs (operational processes), and outputs (synergy and antagony). In this commentary, we use the BMCF to describe the ISECN work, highlighting opportunities, successes, and challenges. We also put forward three strategies derived from the BMCF that have been purposefully employed by ISECN to maximize its production of synergy from the voluntary contributions of its members.

Socioeconomic status and chronic child malnutrition: Wealth and maternal education matter more in the Peruvian Andes than nationally.

This study investigated the association of parents' socioeconomic status (SES) with child stunting in the Peruvian Andes and in Peru nationally. It was hypothesized that the relationship of SES to child stunting would be weaker in the Andean compared with the national sample. This is consistent with earlier research indicating that the relationship of SES to health may be weak in poor regions. The data were from the Demographic and Health Survey 2004 to 2006. Two samples of children 3 to 60 months old were compared: a national sample (n = 1426) and an Andean sample (n = 543). Malnutrition was measured using the indicator "stunting," which is small stature for age. Socioeconomic status was measured using parental education, occupation, and household wealth index (WI). In both samples, SES was significantly related to stunting. The odds of stunting in the poorest WI quintile were significantly higher than in the richest quintile. The same pattern was observed in children of mothers having incomplete primary education compared with children of mothers having complete secondary or higher education. The odds of stunting were significantly lower in children of mothers working at home compared with mothers in professional occupations. The associations of WI and maternal education with stunting were significantly stronger in the Andean compared with the national sample; the study did not find support for the hypothesis. Even in very poor regions such as the Andes, SES may be associated with child health, suggesting the importance of public health measures to overcome the health disadvantages experienced by children living in low SES households.

Social determinants of rest deprivation amongst Ghanaian women: national and urban-rural comparisons with data from a cross-sectional nationally representative survey.

BACKGROUND: Rest deprivation (rest/napping/sleep 6 or less hours daily) is a clinically recognised risk factor for poor health, but its epidemiology is little studied. This study reports prevalence's and social correlates of rest deprivation in Ghana. METHODS: Data are from the 2008 Ghana Demographic and Health Survey. Women ages 15-49 were recruited in a national sampling design. Respondents were 4,916 women in the national sample, a sub-sample of 530 women in the three northernmost rural regions and a sub-sample of 853 women in urban Greater Accra. RESULTS: Prevalence's of rest deprivation were 0.13% nationally, 14.5% in Greater Accra and 16.8% in the North. The significant correlates nationally were age, education, wealth index, Christian religion and literacy. In Accra, they were age, wealth index, having household electricity, and possession of a refrigerator, a stove and a mobile phone. In the North, they were education, occupation, drinking water source, possession of motorcycle/scooter, Christian religion, literacy, and possession of a clock and a cupboard. In logistic regression analyses controlling for age in the national sample, the significant odds ratios were 1.40 for no education compared to secondary and higher education, 0.78-0.43 for the four poorer wealth quintiles compared to the richest wealth index quintile, and 0.55 for Christian religion compared to all others.Also controlling for age, the significant odds ratios in Accra were 2.15 for the second richest wealth quintile compared to the richest quintile and 0.16 for possession of a mobile phone. In the North they were 0.49 for Christian religion compared to all others, 1.87 for having a protected compared to an unprotected water source, and 0.41 for having a cupboard in the home. CONCLUSIONS: Education, wealth and religion were related to rest deprivation nationally but not in the urban and rural regions (except for religion in the North). This suggests caution in generalising about the social correlates of rest deprivation at a regional level, based on national-level data. Qualitative research in local contexts is needed in order to illuminate the social determinants of rest pattern, and to provide guidance about better ways to measure such determinants in future survey research.

Work life and mental well-being: single and coupled employed mothers in Southern Europe and Scandinavia.

Many European mothers, single and coupled, combine work outside the home and family life. The effects of this on their mental well-being may vary depending on the level of support available from the State's welfare system, since welfare may buffer working mothers from some of the stress that can arise from trying to manage significant responsibilities on the job and at home. Welfare may be especially important for single working mothers, for whom the burden of multiple roles may be even heavier. The present study assessed levels and predictors of well-being of single and coupled employed mothers in Greece, Portugal and Spain, where welfare support is relatively limited. Results were compared to a parallel study with data from Denmark, Norway and Sweden, where welfare support is relatively comprehensive. Coupled mothers in Scandinavia had significantly lower financial hardship, longer education, higher life satisfaction, more enriching jobs, practical support, financial support and social participation than coupled mothers in the Southern European sample. On the other hand, the Scandinavian coupled mothers had higher levels of work family conflict than coupled mothers in Southern Europe. Single mothers in Scandinavia, compared to single mothers in Southern Europe, had significantly longer education, higher life satisfaction and positive affect, more enriching jobs, confidant support, practical support, financial support and social participation. Level of job stress was the same for all mother groups. All groups differed significantly from each other in level of financial hardship, with Scandinavian coupled mothers being best off, followed by Scandinavian single mothers, Southern European coupled mothers, and Southern European single mothers. The regional differences suggest that single motherhood per se need not be a risk factor for poorer well-being, and that welfare policies may have a protective effect for the mental well-being of single mothers.

Work life and mental wellbeing of single and non-single working mothers in Scandinavia.

BACKGROUND: This study examined levels and predictors of mental wellbeing in Scandinavian working single and non-single mothers, with a special focus on financial stress, job characteristics and work-family conflict. METHODS: The European Social Survey Round 2 (2005) provided questionnaire data from 73 single and 432 non-single working mothers in Denmark, Sweden and Norway. Respondents answered questions about the outcome variables life satisfaction, happiness, and positive affect, and predictor variables financial stress, job characteristics, work-family conflict, and social support. Hierarchical multiple regression was used to assess the relationships between predictor variables and mental wellbeing outcomes. RESULTS: Single working mothers scored significantly lower on life satisfaction and happiness, but not on positive affect, than did non-single mothers. Financial stress was higher in the single mother group. There were no significant differences in levels of enriching or stressful job characteristics, or in levels of social support. While financial stress and work-family conflict were important predictors in both groups, the relationship between financial stress and wellbeing was far stronger in the single mother group. Confidant support was a significant predictor only in the single mother group, and social participation only in the non-single mothers group. CONCLUSIONS: This study suggests that the Scandinavian welfare democracies have not yet been successful in relieving the financial pressure experienced by single working mothers. Development of efficient financial support systems should be prioritized. Ways to reduce work-family conflict in both single and non-single mothers in Scandinavia should also be given increased attention.

Social determinants of health in very poor ruralities.

Globally, research on social determinants of health has built a considerable knowledge base over the last decade. Still, not much of this research has been carried out in the extremely poor areas of the world, like for instance Africa south of the Sahara. In very poor ruralities, classic indicators of socioeconomic status are not well suited. Few people have any education, monetary income is not a good measure of material standing and people cannot be classified by occupation as they make their livelihood from a variety of activities. For efforts towards health equity to benefit the poorest of the poor, more suitable indicators of social health determinants must be identified. Health research might benefit from knowledge developed in neighbouring fields like development research, anthropology and sociology.

Hunting happiness or promoting health? Why positive psychology deserves a place in health promotion.

This commentary asks the question of whether positive psychology represents an egoistic pursuit of happiness, which is in conflict with basic values within health promotion. A look at key concepts and research findings within positive psychology reveals common ground with health promotion. Similarities are evident in conceptualization of health, resource focus, value focus and consequences for policy. Some influences of happiness on health and functioning are described.

The IUHPE Student and Early Career Network (ISECN): an update.

The year 2007 saw the birth of a new IUHPE baby: ISECN - the IUHPE Student and Early Career Network. This commentary presents some of the work that has been undertaken by ISECN this past year. We have appointed regional contacts, presented a poster about our network in a conference in Osaka, Japan, initiated a working group for communication with a specific focus on increasing equity in the way ISECN communicates with its members, launched a website (www.isecn.org), and held two global conference call meetings, connecting members from almost every corner of the planet. Also addressed in this Commentary is our role as Stream Managers for the IUHPE's new online offering, "Views on Health Promotion Online" and the formation of a working group to start developing a Code of Ethics for health promotion. These new projects will benefit ISECN, and contribute to the betterment of health promotion generally. All IUHPE members who are at the early stages of their careers are urged to join us.