Individualism as Habitus: Reframing the Relationship between Income Inequality and Health

Public health literature has demonstrated a negative effect of income inequality on a number of health outcomes. Researchers have attempted to explain this phenomenon, drawing on psychosocial and neo-materialist explanations. This paper argues, however, that these approaches fail to recognize the crucial role of culture, focusing specifically on the cultural value of individualism. Through a review of the literature and Pierre Bourdieu’s theory of practice as a theoretical framework, I provide support for the proposition that an ideology based in individualism is the context within which income inequality, social fragmentation, material deprivation, and consequently poor health outcomes are produced. I further offer recommendations for continued research into the role of cultural determinants in the income inequality-health relationship

Farmers’ perceptions of benefits and risks from wastewater irrigation in Accra, Ghana

As safe water sources become scarcer and more polluted, the use of wastewater in urban agriculture may produce many benefits but may also lead to crop and soil contamination and endanger farmers and consumers. To effectively manage wastewater use in agriculture, it is important to understand how stakeholders feel impacted by the practice.

Validity of measures for chronic disease in African settings

Epidemiological Change and Chronic Disease in Sub-Saharan Africa offers new and critical perspectives on the causes and consequences of recent epidemiological changes in sub-Saharan Africa, particularly on the increasing incidence of so-called ‘non-communicable’ and chronic conditions. Historians, social anthropologists, public health experts and social epidemiologists present important insights from a number of African perspectives and locations to present an incisive critique of ‘epidemiological transition’ theory and suggest alternative understandings of the epidemiological change on the continent. Arranged in three parts, ‘Temporalities: Beyond Transition’, ‘Numbers and Categories’ and ‘Local Biologies and Knowledge Systems’, the chapters cover a broad range of subjects and themes, including the trajectory of maternal mortality in East Africa, the African smoking epidemic, the history of sugar consumption in South Africa, causality between infectious and non-communicable diseases in Ghana and Belize, the complex relationships between adult hypertension and paediatric HIV in Botswana, and stories of cancer patients and their families as they pursue treatment and care in Kenya. In all, the volume provides insights drawn from historical perspectives and from the African social and clinical experience to offer new perspectives on the changing epidemiology of sub-Saharan Africa that go beyond theories of ‘transition’. It will be of value to students and researchers in Global Health, Medical Anthropology and Public Health, and to readers with an interest in African Studies

Urbanicity, Social Capital, and Depression in Older Adults: An Analysis of Two African Countries

Depression is a significant contributor to global morbidity and mortality and is the primary cause of disability worldwide. Older adults are an age group that may be more vulnerable to depression due to a higher prevalence of many known risk factors. Moreover, evidence also suggests that living in urban locations can increase the risk of depression and other mental illnesses. Thus, as the world’s population continues to age and urbanize, the burden of depression could increase. However, very few studies on the links between urbanicity and depression in older adults have been conducted in low- and middle-income settings such as sub-Saharan Africa, despite its rapid urbanization and substantial increases in the size of its aging population. Through quantitative analyses of secondary data from the Ghana and South Africa samples of the World Health Organization (WHO) Study on Global AGEing and Adult Health (SAGE), this dissertation therefore sought to explore the relationship between urbanicity and depression among older adults in an African context. The study specifically used multivariable logistic regression to examine the association between current urban residence and depression in Ghanaian and South African older adults as well as whether urbanicity of residence across the life course was associated with depression in these populations. It also assessed the influence of urbanicity on the relationship between depression and social capital—a purported protective factor—through structural equation modeling. Results indicated that there was no significant association between urbanicity and depression based on current residence or life-course residence in either country. Additionally, urbanicity did not substantially modify the effects of social capital on depression in either nation, but urban-rural differences in the level and composition of social capital were observed. Moreover, while trust was associated with a lower risk of depression in South Africa overall, sociability and trust were associated with an increased risk of depression in Ghana. These findings provide some insight into the socio-contextual determinants of depression in Ghanaian and South African older adults and may help to inform decisions on the allocation of mental health resources as well as policies and interventions to address later-life depression in these populations

Global inequalities: the impact on health

This chapter discusses concepts of inequality and inequity in relation to health both within and between nations. It explores inequalities in health by characteristics, such as social class, gender, ethnicity, and the intersection of these. The chapter discusses the importance of the social gradient of health. It addresses competing explanations for health and social inequalities globally, including poverty and material deprivation, psychosocial factors, discrimination, and structural determinants of health. The ‘social gradient in health’ expresses the idea that health status is often patterned and that each successive increment in social position confers additional advantage. The way in which inequalities are measured, and the ethical priorities adopted for health interventions may impact our understanding, of whether inequalities are improving or worsening with time. Acknowledging social causation as an explanation for health inequalities, several possible mechanisms have been explored to explain how social conditions affect health

Introduction

Epidemiological Change and Chronic Disease in Sub-Saharan Africa offers new and critical perspectives on the causes and consequences of recent epidemiological changes in sub-Saharan Africa, particularly on the increasing incidence of so-called ‘non-communicable’ and chronic conditions. Historians, social anthropologists, public health experts and social epidemiologists present important insights from a number of African perspectives and locations to present an incisive critique of ‘epidemiological transition’ theory and suggest alternative understandings of the epidemiological change on the continent. Arranged in three parts, ‘Temporalities: Beyond Transition’, ‘Numbers and Categories’ and ‘Local Biologies and Knowledge Systems’, the chapters cover a broad range of subjects and themes, including the trajectory of maternal mortality in East Africa, the African smoking epidemic, the history of sugar consumption in South Africa, causality between infectious and non-communicable diseases in Ghana and Belize, the complex relationships between adult hypertension and paediatric HIV in Botswana, and stories of cancer patients and their families as they pursue treatment and care in Kenya. In all, the volume provides insights drawn from historical perspectives and from the African social and clinical experience to offer new perspectives on the changing epidemiology of sub-Saharan Africa that go beyond theories of ‘transition’. It will be of value to students and researchers in Global Health, Medical Anthropology and Public Health, and to readers with an interest in African Studies

Explaining population trends in cardiovascular risk in South Africa and England 1998-2017

The ExPoSE project, based at the University of Greenwich, UK and Stellenbosch University, South Africa, aimed to examine epidemiologic transitions by identifying and quantifying the drivers of change in CVD risk in the middle-income country of South Africa compared to the high-income nation of England. The project produced a harmonised dataset of national surveys measuring CVD risk factors in South Africa and England for others to use in future work. The harmonised dataset includes data from nationally-representative surveys in South Africa derived from the Demographic and Health Surveys, National Income Dynamics Study, South Africa National Health and Nutrition Examination Survey, and Study on Global Ageing and Adult Health, covering 11 cross-sections and approximately 156,000 individuals aged 15+ years, representing South Africa’s adult population from 1998 to 2017. Data for England come from 17 Health Surveys for England (HSE) over the same time period, covering over 168,000 individuals aged 16+ years, representing England's adult population. Data for England can be obtained from the UK Data Service. Files made available include the code used within the scope of the ExPoSE Project https://www.exposeproject.net to import and harmonise microdata on cardiovascular risk factors and other information from a set of population surveys conducted in South Africa and England between 1997 and 2017

Explaining population trends in cardiovascular risk: protocol for a comparative analysis of health transitions in South Africa and England using nationally representative survey data

Introduction Cardiovascular diseases (CVD) are the leading cause of death globally and share determinants with other major non-communicable diseases. Risk factors for CVD are routinely measured in population surveys and thus provide an opportunity to study health transitions. Understanding the drivers of health transitions in countries that have not followed expected paths compared with those that exemplified models of ‘epidemiologic transition’, such as England, can generate knowledge on where resources may best be directed to reduce the burden of disease. This study aims to examine the notions of epidemiological transition by identifying and quantifying the drivers of change in CVD risk in a middle-income African setting compared with a high-income European setting. Methods and analysis This is a secondary joint analysis of data collected within the scope of multiple population surveys conducted in South Africa and England between 1998 and 2017 on nationally representative samples of the adult population. The study will use a validated, non-laboratory risk score to estimate and compare the distribution of and trends in total CVD risk in the population. Statistical modelling techniques (fixed-effects and random-effects multilevel regression models and structural equation models) will be used to examine how various factors explain the variation in CVD risk over time in the two countries. Ethics and dissemination This study has obtained approval from the University of Greenwich (20.5.6.8) and Stellenbosch University (X21/09/027) Research Ethics Committees. It uses anonymised microdata originating from population surveys which received ethical approval from the relevant bodies, with no additional primary data collection. Results of the study will be disseminated through (1) peer-reviewed articles in open access journals; (2) policy briefs; (3) conferences and meetings; and (4) public engagement activities designed to reach health professionals, governmental bodies, civil society and the lay public. A harmonised data set will be made publicly available through online repositories

Income inequality and depressive symptoms in South Africa: A longitudinal analysis of the National Income Dynamics Study

Research suggests that income inequality may detrimentally affect mental health. We examined the relationship between district-level income inequality and depressive symptoms among individuals in South Africa—one of the most unequal countries in the world—using longitudinal data from Wave 1 (2008) and Wave 3 (2012) of the National Income Dynamics Study. Depressive symptoms were measured using the Center for Epidemiological Studies of Depression Short Form while district Gini coefficients were estimated from census and survey sources. Age, African population group, being single, being female, and having lower household income were independently associated with higher depressive symptoms. However, in longitudinal, fixed-effects regression models controlling for several factors, district-level Gini coefficients were not significantly associated with depressive symptoms scores. Our results do not support the hypothesis of a causal link between income inequality and depressive symptoms in the short-run. Possible explanations include the high underlying levels of inequality in all districts, or potential lags in the effect of inequality on depression