Mind the Gap: Geographical Inequalities in Health during the Age of Austerity

Background Stockton-on-Tees has the highest geographical inequalities in health in England, with the life expectancy at birth gap between the most and deprived neighbourhoods standing at over 17 years for men and 11 years for women. It is well acknowledged that place can create inequalities in health but there is a debate within geographical research as to whether the health and wellbeing of an individual are determined by their own attributes (the compositional theory) or the political economy and environmental attributes of the area where they live (contextual approach). More recently, it has been argued that these determinants interact with each other, signifying that they are ‘mutually reinforcing’. Method This is one of the first studies that provides the detailed empirical examination of the geographical health divide by estimating the gap and trend in physical and general health (as measured by EQ5D, EQ5D-VAS and SF8PCS) between the most and least deprived areas. It uses a novel statistical technique to examine the causal role of compositional and contextual factors and their interaction during a time of economic recession and austerity. Using a longitudinal survey that recruited a stratified random sample, individual-level survey data was combined with secondary data sources and analysed using multi-level models with 95 percent confidence intervals obtained from nonparametric bootstrapping. In addition, trend analysis was performed to explore the role of austerity. Results The main findings indicate that there is a significant gap in health between the two areas, which remained constant throughout the study period, and that compositional level material factors, contextual factors and their interaction appear to explain this gap. Contrary to the dominant policy discourse in this area, individual behavioural and psychosocial factors did not make a significant contribution towards explaining health inequalities in the study area. Austerity measures are exacerbating inequalities in general and physical health by disproportionately impacting those in deprived areas. The findings are discussed in relation to geographical theories of health inequalities and the context of austerity. The study concludes by exploring the avenues for further research and key policy implications

Placing health in austerity

Book chapter - No Abstract available

Factors Associated with Child Health Card Holding among Mothers of Western Rural Nepal: A Cross Sectional Community Based Study

The use of Child Health Card (CHC) has been found effective to assess overall health status of children worldwide. The tool is simple, cost-effective and easy to use yet standard enough to interpret. Nepal recently made contextual modifications in 2006 and has incorporated it into the Health Management Information System. The card is issued to all children during their first visit for immunization. In Nepal, CHC is considered a valid and authentic report for immunization but little has been studied about its holding. The objective of our study was to find its retention rate along with the factors associated. A community-based cross-sectional study was carried out in 10 village development committees of Kapilvastu district between November 15 and December 15, 2010. A total of 190 households were selected using lot quality assurance sampling technique. Higher retention rate (88.9%) of CHC was found while status of complete immunization was significantly associated with its retention [adjusted OR: 41.92, (95%CI; 2.66-658), p=0.008] after adjusting for growth monitoring, ethnicity, place of delivery, antenatal visit, breastfeeding and mother's age. This study can guide the health system and the family members the measures to sustain higher coverage and retention of CHC which can further guide to the best possible health outcomes for the child

The road to sustainable Kigali: a contextualized analysis of the challenges

Rwanda, despite being a predominantly rural country, has remarkably performed in the post-conflict (late 1990s) period on the socio-economic fronts. Contemporary challenges in Rwanda's capital city, Kigali, are widespread informality, both in the economy and urban built environment. Informality significantly hinders human health and wellbeing attainment. This paper assesses the development trajectory of Kigali with reference to the Sustainable Development Goals (SDGs) using mixed research methods, including field visit. In doing so, the study dwells on three theories; postcolonial urbanism, post-conflict state building and neoliberalism. The paper diagnoses informality, polarized health sector and governance, as critical limitations to the attainment of sustainable development in Kigali. It argues that urban development in post-conflict Kigali is deeply rooted in capitalist and neoliberal ideology, where the state functions as the architect and facilitator of wealth accumulation for the few elites. Based on the analyses of the current development patterns, inclusive governance is identified as a key intervention to achieve sustainable development in Kigali

Learning for global health in cities - Community resilience and the strengthening of learning systems. CR&DALL Working Paper WP1101/2024

This paper investigates what the COVID-19 pandemic has revealed about the resilience of cities’ communities and learning systems. In terms of community resilience, it explores issues of multi-sectoral planning as well as bottom-up citizen and NGO/CSO led practices and topdown policies and practice from national governments and regional/municipal administrations. Regarding learning systems, this account focuses on the roles of local government, formal (schools, colleges, universities) and non-formal institutions of learning, including IGOs and NGOs/CSOs within the youth and adult education sectors as well as the learning in the workplace and initiatives coming from businesses and foundations. It considers the ways in which these actors have worked both independently, and together in networks of to ensure continued provision of pre-existing formal and non-formal learning during the crisis. It also considers innovations, many collaborative between stakeholders, that have emerged during the pandemic, particularly with regard to the use of new technology, technology transfer and informal learning directed towards awareness raising and public health education. The paper is illustrated through case studies with a particular focus on municipalities that have declared themselves learning cities. A series of challenges for all actors and recommendations are made

Learning for a Better Future

Various international scholars and associates of the PASCAL (Place, Social Capital and Learning Regions) International Observatory (Africa hub), under the auspices of the Centre for Local Economic Development (CENLED) based at the University of Johannesburg (UJ), have contributed chapters in this scholarly book. The book aims to demonstrate how a combination of globalisation, pandemics and the impact of innovation and technologies are driving towards a world in which traditional ideas are being challenged. The book carries forward a dual context and relevance: to South African social, educational, economic and cultural development, and the broader international context and action directed at how lifelong learning for all can be fostered in communities as a foundation for a just, human-centred, sustainable world. The distinctive contribution of this book to the production of a local body of knowledge lies in the symbiotic relationships between these objectives, so that South Africa could serve as a test case in working towards approaches that have a wider international significance

Learning for a Better Future

Various international scholars and associates of the PASCAL (Place, Social Capital and Learning Regions) International Observatory (Africa hub), under the auspices of the Centre for Local Economic Development (CENLED) based at the University of Johannesburg (UJ), have contributed chapters in this scholarly book. The book aims to demonstrate how a combination of globalisation, pandemics and the impact of innovation and technologies are driving towards a world in which traditional ideas are being challenged. The book carries forward a dual context and relevance: to South African social, educational, economic and cultural development, and the broader international context and action directed at how lifelong learning for all can be fostered in communities as a foundation for a just, human-centred, sustainable world. The distinctive contribution of this book to the production of a local body of knowledge lies in the symbiotic relationships between these objectives, so that South Africa could serve as a test case in working towards approaches that have a wider international significance