Making unhealthy places: The built environment and non-communicable diseases in Khayelitsha, Cape Town.

In this paper, we examine how economic, social and political forces impact on NCDs in Khayelitsha (a predominantly low income area in Cape Town, South Africa) through their shaping of the built environment. The paper draws on literature reviews and ethnographic fieldwork undertaken in Khayelitsha. The three main pathways through which the built environment of the area impacts on NCDs are through a complex food environment in which it is difficult to achieve food security, an environment that is not conducive to safe physical activity, and high levels of depression and stress (linked to, amongst other factors, poverty, crime and fear of crime). All of these factors are at least partially linked to the isolated, segregated and monofunctional nature of Khayelitsha. The paper highlights that in order to effectively address urban health challenges, we need to understand how economic, social and political forces impact on NCDs through the way they shape built environments.

"Choice Set" for health behavior in choice-constrained settings to frame research and inform policy: examples of food consumption, obesity and food security.

OBJECTIVES: Using the nexus between food consumption, food security and obesity, this paper addresses the complexity of health behavior decision-making moments that reflect relational social dynamics in context-specific dialogues, often in choice-constrained conditions. METHODS: A pragmatic review of literature regarding social determinants of health in relation to food consumption, food security and obesity was used to advance this theoretical model. RESULTS AND DISCUSSION: We suggest that health choice, such as food consumption, is based on more than the capacity and volition of individuals to make "healthy" choices, but is dialogic and adaptive. In terms of food consumption, there will always be choice-constrained conditions, along a continuum representing factors over which the individual has little or no control, to those for which they have greater agency. These range from food store geographies and inventories and food availability, logistical considerations such as transportation, food distribution, the structure of equity in food systems, state and non-government food and nutrition programs, to factors where the individual exercises a greater degree of autonomy, such as sociocultural foodways, family and neighborhood shopping strategies, and personal and family food preferences. At any given food decision-making moment, many factors of the continuum are present consciously or unconsciously when the individual makes a decision. These health behavior decision-making moments are mutable, whether from an individual perspective, or within a broader social or policy context. We review the construct of "choice set", the confluence of factors that are temporally weighted by the differentiated and relationally-contextualized importance of certain factors over others in that moment. The choice transition represents an essential shift of the choice set based on the conscious and unconscious weighting of accumulated evidence, such that people can project certain outcomes. Policies and interventions should avoid dichotomies of "good and bad" food choices or health behaviors, but focus on those issues that contribute to the weightedness of factors influencing food choice behavior at a given decision-making moment and within a given choice set.

Making unhealthy places: The built environment and non-communicable diseases in Khayelitsha, Cape Town.

In this paper, we examine how economic, social and political forces impact on NCDs in Khayelitsha (a predominantly low income area in Cape Town, South Africa) through their shaping of the built environment. The paper draws on literature reviews and ethnographic fieldwork undertaken in Khayelitsha. The three main pathways through which the built environment of the area impacts on NCDs are through a complex food environment in which it is difficult to achieve food security, an environment that is not conducive to safe physical activity, and high levels of depression and stress (linked to, amongst other factors, poverty, crime and fear of crime). All of these factors are at least partially linked to the isolated, segregated and monofunctional nature of Khayelitsha. The paper highlights that in order to effectively address urban health challenges, we need to understand how economic, social and political forces impact on NCDs through the way they shape built environments.

[The meaning of "individual" social capital for diabetics receiving care in a Colombian city]. / El significado del capital social "individual" en diabéticos receptores de cuidado en un contexto urbano colombiano.

The aim of this study was to understand the meaning of social capital in relation to type 2 diabetes according to gender, within an urban setting in Colombia, based on a qualitative design for symbolic interactionism. Twenty-four women and 16 men with diabetes, family members, and healthcare personnel participated in six focus groups. A total of 850 codes emerged that comprised a set of 142 codes for ego, alter, and alter ego. Three categories and 20 subcategories were identified for the "coding paradigm design". The meaning differed between men and women. Social ties in social networks, created daily through trust and solidarity for care, were valued differently due to the social experiences and events resulting from self-confidence, self-efficacy for social support, and mainly self-esteem vis-à-vis management and control of the disease. An individual's social resources are reified for the management and care of the disease as a strategy to mitigate health inequalities.

El significado del capital social "individual" en diabéticos receptores de cuidado en un contexto urbano colombiano / The meaning of "individual" social capital for diabetics receiving care in a Colombian city / O significado do capital social "individual" em diabéticos que precisam de cuidados dentro de um contexto urbano colombiano

Comprender el significado del capital social de la diabetes tipo 2 según género, dentro un contexto urbano colombiano. Investigación cualitativa del interaccionismo simbólico. 25 mujeres y 16 hombres, diabéticos, familiares, vecinos y personal asistencial participaron en seis grupos focales. Emergieron 850 códigos que se integraron en un set de 142 códigos de códigos para el ego, el alter y alter ego. Tres categorías y veinte subcategorías fueron identificadas para el diseño del "paradigma de la codificación". El significado no es igual para hombres y mujeres. Los vínculos sociales de las redes sociales, creados cotidianamente por la confianza y la solidaridad para el cuidado, son valorados de manera diferente, debido a experiencias y hechos sociales resultantes de la autoconfianza, la autoeficacia para el apoyo social principalmente y, la autoestima frente al manejo y control de la enfermedad. Los recursos sociales de un individuo son reificados para el manejo y cuidado de la enfermedad como estrategia para disminuir las inequidades en salud.

The aim of this study was to understand the meaning of social capital in relation to type 2 diabetes according to gender, within an urban setting in Colombia, based on a qualitative design for symbolic interactionism. Twenty-four women and 16 men with diabetes, family members, and healthcare personnel participated in six focus groups. A total of 850 codes emerged that comprised a set of 142 codes for ego, alter, and alter ego. Three categories and 20 subcategories were identified for the "coding paradigm design". The meaning differed between men and women. Social ties in social networks, created daily through trust and solidarity for care, were valued differently due to the social experiences and events resulting from self-confidence, self-efficacy for social support, and mainly self-esteem vis-à-vis management and control of the disease. An individual's social resources are reified for the management and care of the disease as a strategy to mitigate health inequalities. .

Compreender o significado do capital social, diabetes tipo 2 por sexo, um contexto urbano da Colômbia. pesquisa qualitativa do interacionismo simbólico. 25 mulheres e 16 homens, diabéticos, familiares, vizinhos e cuidadores participaram seis grupos focais. 850 códigos se que foram integrados em um conjunto de 142 codes para o ego, o alter e alter ego. Três categorias e vinte subcategorias foram identificados para o projeto de "codificação de paradigma". O significado não é o mesmo para homens e mulheres. Laços sociais das redes sociais criadas diariamente pela confiança e solidariedade são valorizados cuidado diferente, porque as experiências sociais e fatos resultantes da auto-confiança, auto-eficácia e de apoio social, principalmente, auto-gestão e controle em relação a doença. Os recursos sociais de um indivíduo são reificadas para a gestão o cuidado da doença como uma estratégia para reduzir as desigualdades na saúde.

[Developing an interlocution model for the health system based on studying the Colombian Guajira]. / Desarrollo de un Modelo de Interlocución para el Sistema de Salud basado en el Caso de la Guajira Colombiana.

OBJECTIVES: This article shows the development of an interlocution model regarding the health system's local performance in La Guajira from 2005 to 2007. It was aimed at producing conditions for social participation and improving the system's performance according to local conditions, needs and expectations. METHODS: Such model was developed by using ethnographic techniques during the investigation's first and second phases and participative techniques during its third phase. The methodology sought to collect information leading to choosing intervention strategies for improving user-participation ability and capacity and creating spaces of trust for interlocution between the actors and negotiating action for improving the system. Intervention-strategies were based on system and user ethnography, including printed pedagogical material and three modules in the form of participative workshops. The model was tested in four localities in the Guajira, leading to working tables for health being created, encouraging participation by users and institutional decision-makers. RESULTS: It was noted that users could participate as informed citizens and critical consumers, strengthening their interlocution abilities, broadening their knowledge, producing vocabulary and meaning shared with the institutional actors and using local mechanisms and social participation networks. CONCLUSION: Effective strategies must be found for motivating greater participation by institutions, especially health promoting entities and subsidised regime insurers.