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1.
Lakartidningen ; 1172020 Jan 14.
Artigo em Sueco | MEDLINE | ID: mdl-31935040

RESUMO

The increasing number of displaced persons and the high proportion of refugees with traumatic background and psychiatric symptoms affect the mental health care offered. Sweden has been criticized by the United Nations for the unsatisfactory fulfilment of the right to health for migrants. This article on human rights in mental health care practice, with a focus on migrants, describes the right to the enjoyment of the highest attainable standard of physical and mental health and what this right implies for mental health care services, including the responsibilities of medical staff. The right to a dignified and equal treatment, integrity and participation is required by medical ethics and legislation, but is ultimately also a matter of human rights. The importance of social determinants for health, the right to individually adapted information and participation are discussed. The argued discrimination of undocumented migrants and other patients is exemplified. A human rights-based approach, HRBA, improves the mental health care for migrants by increased participation and empowerment of the rights-holders, and can contribute to realizing the human rights in a transcultural mental health care context. A model for implementation of HRBA methods is introduced.

3.
BMC Public Health ; 19(1): 1571, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31775689

RESUMO

BACKGROUND: That there is a relationship between human rights and health is well established and frequently discussed. However, actions intended to take account of the relationship between human rights and social determinants of health have often been limited by lack of clarity and ambiguity concerning how these rights and determinants may interact and affect each other. It is difficult to know what to do when you do not understand how things work. As our own understanding of this consideration is founded on perspectives provided by the critical realist paradigm, we present an account of and commentary on our application of these perspectives in an investigation of this relationship. FINDINGS: We define the concept of paradigm and review critical realism and related implications for construction of knowledge concerning this relationship. Those implications include the need to theorise possible entities involved in the relationship together with their distinctive properties and consequential power to affect one another through exercise of their respective mechanisms (ways of working). This theorising work enabled us identify a complex, multi-layered assembly of entities involved in the relationship and some of the array of causal mechanisms that may be in play. These are presented in a summary framework. CONCLUSION: Researchers' views about the nature of knowledge and its construction inevitably influence their research aims, approaches and outcomes. We demonstrate that by attending to these views, which are founded in their paradigm positioning, researchers can make more progress in understanding the relationship between human rights and the social determinants of health, in particular when engaged in theorizing work. The same approaches could be drawn on when other significant relationships in health environments are investigated.

4.
BMJ Glob Health ; 4(5): e001560, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31673432

RESUMO

Introduction: This systematic review aims to determine if combination HIV prevention programmes include outcome measures for empowerment, inclusion and agency to demand equal rights and measure the relationship between empowerment and HIV prevention outcomes. Methods: An electronic literature search of PubMed, POPLINE, Index Medicus and Google Scholar was conducted between August and October 2018. We included studies that evaluated combination prevention programmes that had all three types of intervention components and that specifically serve members of populations disproportionately affected by HIV published from 2008 to 2018. The selected studies were screened for inclusion, and relevant data abstracted, assessed for bias and synthesised. Results: This review included a total of 15 studies. Findings indicate that combination HIV prevention programmes for marginalised populations have delivered a variety of theory-based behavioural and structural interventions that support improvements in empowerment, inclusion and agency. However, empowerment, inclusion and least of all agency are not measured consistently or in a standardised way. In addition, analysis of their relationships with HIV prevention outcomes is rare. Out of our 15 included studies, only two measured a relationship between an empowerment, inclusion or agency outcome and an HIV prevention outcome. Conclusion: These findings suggest that policy-makers, programme planners and researchers might need to consider the intermediate steps on the pathway to increased condom use and HIV testing so as to explain the 'how' of their achievements and inform future investments in HIV prevention. This will support replication and expansion of programmes and ensure sustainability of the programmes. PROSPERO registration number: CRD42018106909.

5.
Health Educ Behav ; 46(6): 901-904, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31680556

RESUMO

Public health is the place where science, policy, politics, and activism converge. Each public health issue is a snapshot where we can see the unfolding of the collective processes that define who we are, what we believe, and what we value as a society. Our professional strength is our commitment to community and social justice values, but we are challenged to effectively communicate these values in an individualistic, market-dominated society. It is this language of community, and the values it represents, that must be the core of the narrative animating a more just and healthier society. A public health perspective characterized by social justice argues that public health problems are primarily socially generated and can be predicted based on the level of injustice and inequality in a society. Thus, the solutions to such problems must be through progressive social and public health policies and are best understood as a collective responsibility shared across the various levels of society. When we can develop a narrative that effectively communicates the social justice values that are the foundation of this perspective, ours will be a society that better understands the meaning of public health and responds more appropriately to its challenges. We will then be collectively more effective in better translating our values into caring, and more effective, public policy. This will not be easy, but it will be necessary.

6.
Soc Work ; 64(4): 293-300, 2019 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-31566231

RESUMO

Protecting the health and well-being of workers naturally aligns with the social work mission to advance human dignity. The workplace can both create and perpetuate health disparities by shaping health and well-being at multiple levels and in socially patterned ways. Yet workplace issues are rarely on social work research and practice agendas. This article serves as a call to action for social work, as a discipline, to engage with the workplace as a means of advancing the field's core values. It first provides evidence for why engagement with workplaces is critical for advancing social justice. It then presents evidence for the ways in which workplace exposures and experiences, at multiple levels, shape worker health and well-being. Finally, it provides concrete steps for how the skills and values of the social work profession can be applied to the workplace through research, practice, education, and policy efforts, and by extension improve population health and well-being.

7.
Soc Work ; 64(4): 321-328, 2019 Oct 31.
Artigo em Inglês | MEDLINE | ID: mdl-31566240

RESUMO

Modern technology threatens to dramatically alter the U.S. labor economy, but the crumbling social safety net may be insufficient for affected workers. Some advocates propose to address these converging problems through universal basic income (UBI). Authors conducted a preliminary review of social work perspectives on the topic of UBI. They found very little relevant literature, especially among American scholars. Existent social work literature frames UBI as an alternative to the neoliberal welfare state and mass unemployment. Social workers also contribute a critical social justice orientation to UBI scholarship in other disciplines. Grounded in the NASW Code of Ethics, authors argue that it is imperative for American social workers to seriously consider UBI as an answer to growing inequality and the unique expertise that social workers offer as allies of marginalized populations.

8.
BMC Public Health ; 19(1): 1082, 2019 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399049

RESUMO

BACKGROUND: Active transportation (AT), independent mobility (IM), and outdoor time are promising ways to increase children's physical activity. However, in order to create interventions to increase those forms of physical activity, it is important to understand the relationships between area-level socioeconomic status (SES) and type of urbanization with AT, IM, outdoor time, and physical activity, and this was the aim of the study. METHODS: One thousand six hundred ninety-nine children in grades 4 to 6 (mean age: 10.2 ± 1.0 years) from three Canadian regions participated. AT, IM, and outdoor time were assessed using questionnaires and physical activity was measured using the SC-StepRX pedometer. Area-level SES was assessed using the median household income of the census tract in which the school was located and type of urbanization was determined for each school using standardized procedures. Generalized linear and general linear mixed models were used to examine the relationships. RESULTS: Area-level SES and the type of urbanization were generally not related to AT, IM, or physical activity for either gender. However, we observed that both boys and girls living in lower SES areas had decreased odds of spending > 2 h outdoors on weekend days compared to their peers from higher SES areas. Girls living in suburban or rural areas were more likely to spend > 2 h outdoors on weekdays compared to their urban counterparts. CONCLUSIONS: AT, IM, and physical activity are generally not associated with area-level SES or the type of urbanization in this sample of Canadian children. The finding regarding outdoor time showing that both boys and girls of lower SES areas had decreased odds of spending > 2 h outdoors on weekends compared to their peers from higher SES areas suggest that additional efforts should be implemented to offer outdoor play opportunities in lower SES areas.


Assuntos
Exercício/fisiologia , Liberdade , Áreas de Pobreza , Transportes/estatística & dados numéricos , Urbanização , Adolescente , Canadá , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Inquéritos e Questionários , Fatores de Tempo
9.
J Poverty ; 23(2): 144-160, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31452596

RESUMO

The Supplementary Nutrition Assistance Program (SNAP) Challenge encourages critical self-reflection and analysis of biases over seven consecutive days. Active learning methodologies are discussed compared to pre-formed lectures. Adaptive flexibility and empathy are salient skills for social workers that are emphasized in simulations. Students are challenged to only eat the average daily allowance for approved food options ($4.50/day) and chronical their observations. The Challenge improves students' awareness of power and privilege with their future clients. This novel approach not only addresses the Council of Social Work's Core Competencies but also trains new social workers to effectively deliver social services empathically.

10.
J Int Bioethique Ethique Sci ; Vol. 30(2): 17-39, 2019 07 02.
Artigo em Francês | MEDLINE | ID: mdl-31460735

RESUMO

Chapter 1. Climate justice: addressing the responsibility for climate changeAt the heart of climate justice is research and understanding of the inequalities associated with global warming. By seeking to address all dimensions of vulnerability to climate change, particularly social vulnerability, the concept of climate justice contributes to developing our responsibility to address the climate emergency. However, in an operational approach, climate justice has several approaches depending on who is interested and claims it. From the climate justice demanded to repair an ecological debt, to climate justice as a principle of action recognized and implemented in public policies, many perspectives are emerging to think of a development model that is more united and respectful of the rights of everyone, including the most vulnerable and the most deprived.


Assuntos
Mudança Climática , Justiça Social , Humanos , Fatores Socioeconômicos
11.
Am J Bioeth ; 19(9): 52-54, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31419197
12.
BMJ Paediatr Open ; 3(1): e000503, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31423469

RESUMO

Inequities have a profound impact on the health and development of children globally. While inequities are greatest in the world's poorest countries, even in rich nations poorer children have poorer health and developmental outcomes. From birth through childhood to adolescence, morbidity, mortality, growth and development are socially determined, resulting in the most disadvantaged having the highest risk of poor health outcomes. Inequities in childhood impact across the life course. We consider four categories of actions to promote equity: strengthening individuals, strengthening communities, improving living and working conditions, and promoting healthy macropolicies. Inequities can be reduced but action to reduce inequities requires political will. The International Society for Social Paediatrics and Child Health (ISSOP) calls on governments, policy makers, paediatricians and professionals working with children and their organisations to act to reduce child health inequity as a priority. ISSOP recommends the following: governments act to reduce child poverty; ensure rights of all children to healthcare, education and welfare are protected; basic health determinants such as adequate nutrition, clean water and sanitation are available to all children. Paediatric and child health organisations ensure that their members are informed of the impact of inequities on children's well-being and across the life course; include child health inequities in curricula for professionals in training; publish policy statements relevant to their country on child health inequities; advocate for evidence-based pro-equity interventions using a child rights perspective; advocate for affordable, accessible and quality healthcare for all children; promote research to monitor inequity as well as results of interventions in their child populations. Paediatricians and child health professionals be aware of the impact of social determinants of health on children under their care; ensure their clinical services are accessible and acceptable to all children and families within the constraints of their country's health services; engage in advocacy at community and national level.

13.
BMC Public Health ; 19(1): 997, 2019 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340795

RESUMO

BACKGROUND: The term evidence based medicine was introduced in the early 1990s in clinical medicine to educate clinicians about how to assess the 'credibility' of research to ensure best treatments for their patients. The evidence based medicine paradigm has become more diffuse in times of austerity and randomised controlled designs are being used to address complex issues in public health and disability research. This research is not addressing inequalities in terms of disability nor how people can live well with disabilities. MAIN TEXT: We argue that there are four ways that public health research needs to change if it wants to address inequalities linked to disability: 1) rethinking theoretical connections between public health and disability; 2) building ethics and equity into interventions through a human rights approach; 3) ensuring ethical inclusion through intersectionality; and 4) evaluating policy and other social impacts to ensure they capture diversity. We argue that these are key issues to building a social determinants of flourishing. CONCLUSIONS: We need to understand how disability might have an accumulative impact across the life course, as well as how to ensure equity for people living with disabilities. This means conceptualising a social determinants of flourishing where we evaluate how exactly randomised controlled trials and public health interventions, not only lead to greater equality but also ensure rights to health and wellbeing.


Assuntos
Pessoas com Deficiência , Direitos Humanos , Saúde Pública/ética , Ensaios Clínicos Controlados Aleatórios como Assunto/ética , Determinantes Sociais da Saúde/ética , Ética em Pesquisa , Política de Saúde , Humanos , Fatores Socioeconômicos
14.
Int J Equity Health ; 18(1): 112, 2019 07 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337403

RESUMO

BACKGROUND: People's social and economic circumstances are important determinants of their health, health experiences, healthcare access, and healthcare outcomes. However, patients' socioeconomic circumstances are rarely asked about or documented in healthcare settings. We conducted a systematic review of published reasons for why patients' socioeconomic contexts (including education, employment, occupation, housing, income, or wealth) should, or should not, be enquired about. METHODS: Systematic review of literature published up to and including 2016. A structured literature search using databases of medicine and nursing (pubmed, embase, global health), ethics (Ethicsweb), social sciences (Web of Science), and psychology (PsychINFO) was followed by a 'snowball' search. Eligible publications contained one or more reasons for: asking patients about socioeconomic circumstances; collecting patients' socioeconomic information; 'screening' patients for adverse socioeconomic circumstances; or linking other sources of individual socioeconomic data to patients' healthcare records. Two authors conducted the screening: the first screened all references, the second author screened a 20% sample with inter-rater reliability statistically confirmed. 'Reason data' was extracted from eligible publications by two authors, then analysed and organised. RESULTS: We identified 138 eligible publications. Most offered reasons for why patients' should be asked about their socioeconomic circumstances. Reasons included potential improvements in: individual healthcare outcomes; healthcare service monitoring and provision; population health research and policies. Many authors also expressed concerns for improving equity in health. Eight publications suggested patients should not be asked about their socioeconomic circumstances, due to: potential harms; professional boundaries; and the information obtained being inaccurate or unnecessary. CONCLUSIONS: This first summary of literature on the subject found many published reasons for why patients' social and economic circumstances should be enquired about in healthcare settings. These reasons include potential benefits at the levels of individuals, health service provision, and population, as well as the potential to improve healthcare equity. Cautions and caveats include concerns about the clinician's role in responding to patients' social problems; the perceived importance of social health determinants compared with biomedical factors; the use of average population data from geographic areas to infer the socioeconomic experience of individuals. Actual evidence of outcomes is lacking: our review suggests hypotheses that can be tested in future research.


Assuntos
Confidencialidade/normas , Revelação/normas , Relações Profissional-Paciente/ética , Fatores Socioeconômicos , Assistência à Saúde/organização & administração , Serviços de Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Reprodutibilidade dos Testes
16.
Nurse Educ Today ; 80: 59-66, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31271940

RESUMO

BACKGROUND: In both the United Kingdom (UK) and the United States (US), health inequities are proving resistant to improvement. Nurses are ideally placed to advocate for social justice. It is therefore important that nurse education encourages awareness of the social determinants of health and equips students to act to address health inequity. However, little is known about student nurses' attitudes to social justice and poverty and the impact of pedagogical strategies used to teach the determinants and patterns of health inequities. OBJECTIVES: To assess and compare UK and US student nurses' attitudes towards social justice and poverty before and after learning about social determinants of health and health inequities. DESIGN: Cross-sectional study with embedded before and after design using validated measures. SETTING: Two universities: one urban UK university and one US university with urban and rural campuses. PARTICIPANTS: 230 student nurses in the UK (n = 143) and US (n = 87) enrolled in courses teaching content including health inequities and social determinants of health. RESULTS: Student nurses generally disagreed with stigmatizing statements about people living in poverty and mostly agreed with statements promoting social justice. However, US students were significantly more likely to have positive attitudes towards both social justice (p = 0.001) and poverty (p < 0.001). In multiple regression analyses, engagement in social justice-promoting activities, activism and higher levels of education were associated with positive attitudes to social justice and poverty. Statistically significant positive changes in attitudes to poverty and social justice after their courses were observed only among US student nurses. CONCLUSION: UK and US student nurses' attitudes to poverty and social justice were generally positive. Education around social determinants of health and health inequity had a different effect in the UK and the US. There is a need to explore further what specific components of educational programmes lead to positive changes in attitudes.


Assuntos
Atitude do Pessoal de Saúde , Pobreza/psicologia , Justiça Social/psicologia , Estudantes de Enfermagem/psicologia , Adulto , Estudos Transversais , Bacharelado em Enfermagem , Feminino , Humanos , Masculino , Psicometria/instrumentação , Psicometria/métodos , Reino Unido , Estados Unidos , População Urbana
17.
Artigo em Russo | MEDLINE | ID: mdl-31251863

RESUMO

The problem of refusal of immunodiagnostic of tuberculosis has a significant public resonance in Russia, but it is not widely covered by research. The purpose of study is to determine causes of refusal of legitimate representatives of children to carry out measures for mass immunodiagnostic of tuberculosis and to suggest possible ways of adjusting this negative phenomenon. In a cross-sectional study, the results of a questionnaire survey of 269 respondents - legal representatives of children who systematically refused to carry out immunodiagnostic of tuberculosis, are being studied. Results. The main reasons for the refusal included distrust of quality of the test (31.6%), insufficient semantic motivation (23.0%), fear of adverse reactions, complications (17.8%), negative information received from Internet (13.4%) or mass media (12.3%). Denial of the problem of tuberculosis or its displacement into a remote social environment was demonstrated by 60.6% of respondents (95% CI 54.7-66.3). Respondents are characterized by a high percentage of people (46.8%, 95% CI 40.9-52.8) who have not undergone chest X-ray examinations for more than two years, as well as individuals whose children are not vaccinated with BCG (11.9%, 95% CI 8.3-16.0). Replacement of the regulated method of detection of latent tuberculosis infection by the method chosen by the respondent will allow to examine children about half (52.4%) of the respondents. However, that will require a change in regulatory framework of the Russian Federation. The greatest part of refusals from immunodiagnostic of tuberculosis is associated with defects in sanitary education, resulting in distrust of the quality of tests and insufficient semantic motivation for implementing tests. The respondents are characterized by denial of the problem of tuberculosis. The significant percentage of respondents demonstrate risky behavior regarding the transmission of tuberculosis behavior. They have not been tested for a long time on tuberculosis, and their children are not vaccinated with BCG. The acuteness of the problem can be reduced through greater flexibility in choosing the survey technique and activation of sanitary education of population.


Assuntos
Recusa do Paciente ao Tratamento , Tuberculose , Criança , Estudos Transversais , Humanos , Motivação , Federação Russa , Inquéritos e Questionários , Tuberculose/diagnóstico
19.
Int J Equity Health ; 18(1): 95, 2019 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-31221156

RESUMO

BACKGROUND: Health social enterprises in Africa working with community health workers (CHWs) are growing rapidly but understudied. In particular, gender equality issues related to their work has important public health and equity implications. METHODS: Particularly suited for generating timely findings from reviews at the intersection of overlapping disciplines, we utilized the rapid evidence assessment (REA) methodology to identify key unanswered research questions at the intersection of the fields of gender equality, social enterprises and community health workers. The REA used a series of structured Google Scholar searches, expert interviews and bibliography reviews to identify 57 articles in the academic and grey literatures that met the study inclusion criteria. Articles were thematically coded to identify answers to "What are the most important research questions about the influence of gender on CHWs working with health social enterprises in Africa?" RESULTS: The analysis identified six key unanswered research questions relating to 1) equitable systems and structures; 2) training; 3) leadership development and career enhancement; 4) payment and incentives; 5) partner, household and community support; and 6) performance. CONCLUSION: This is the first study of its kind to identify the key unanswered research questions relevant to gender equality in health social enterprises in Africa using community health workers. As such, it sets out a research agenda for this newly emerging but rapidly developing area of research and practice with important public health implications.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Serviços de Saúde Comunitária/estatística & dados numéricos , Agentes Comunitários de Saúde/organização & administração , Agentes Comunitários de Saúde/estatística & dados numéricos , Direitos Humanos/estatística & dados numéricos , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Adulto , África , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais
20.
J Int Bioethique Ethique Sci ; 30(1): 95-115, 2019 05 28.
Artigo em Espanhol | MEDLINE | ID: mdl-31210528

RESUMO

The issue of equality in diversity and the recognition of the rights of homosexuals has been in recent years an intense and interesting point of debates, interrogations and mutations of the legal world. The case of Argentina is a typical example. On July 15, 2010, Argentina became the first country in Latin America to change its national legislation by the adoption of Law 26 618 to allow themarriage between people of the same sex.


Assuntos
Homossexualidade Feminina , Homossexualidade Masculina , Direitos Humanos , Legislação como Assunto , Casamento , Argentina , Feminino , Humanos , América Latina , Masculino
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