Effects of Contiguity. The European Union and Russia: the Asymmetry of Relations.

This paper concentrates on the relations between the EU and Russia. A closer look at these relations shows that one dialogue within them ? the energy dialogue ? is developing more intensively than the others. This creates an asymmetry in the relations between the two actors. Thus the paper sets out to find the answer to the question, ?Why are the EU ? Russian relations imbalanced?? The analysis is made within three streams: interdependence, the study of polities and the study of images. Interdependence between the EU and Russia is analysed within the framework of the theory of power and interdependence by Joseph Nye Jr. and Robert Keohane; polities are contrasted using the notions of the governance approach and images are examined through applying the study of images of Robert Jervis in the case of the EU?Russia relations. The paper comes to the conclusion, that the contradictions and ambiguities of polities and images are so big and strong, that the only link that keeps the two actors together is the interdependence link. These are effects of contiguity

Health Systems in Transition: Priorities, Policies and Health Outcomes

The dissertation deals with the links between health care systems and health outcomes in the so-called 'transition' countries. The main questions to be addressed are: ''Do health care systems and their transitions influence health outcomes in the transition area and i f they do - how?" The combination o f qualitative techniques and econometric methods allowed for a creation o f the structural classifications o f the health care systems in transition and produced important findings. Firstly, health care transitions, and especially their structural component, are found to be significant in determining health status in the CEE and CIS countries. Secondly, however, the socio-economic determinants o f health were established to also play a major role in determining health inequalities in the transition area. Powered by TCPDF (www.tcpdf.org

‘Being’ or ‘feeling’ healthy : determinants of objective and subjective health in broader Europe

BACKGROUND The East-West health divide in Europe is well documented, in both objective and subjective health. Ever since the Cold War, the West European countries have fared better in terms of health than their Eastern neighbours. However, the question still remains whether this divide is determined simply by differing socio-economic conditions or whether determination of individual health is qualitatively different and cannot be generalised between East and West. Therefore, this chapter analyses the determinants of both objective and subjective health in Eastern and Western Europe. METHODS To better understand the differences of health determination in the East and West, multi-level analysis on the dataset of the European Social Survey (ESS) is performed. The data covers 30 countries and almost 300 thousand individuals over seven rounds, and provides proxies for the main socio-economic determinants and two measures of health: self-reported health and functional ability. Health determinants are measured at both the individual and country-levels, and are divided into economic, political, and social determinants, lifestyles and health care. The standard demographics – age, gender, education and marital status – are also controlled for. RESULTS The analysis reveals that determinants of objective and subjective health are not the same between East and West. Clear differences in determinants of health exist between West European and East European countries particularly in terms of objective health, measured through functional status. Furthermore, overall country context does not influence health as much in the East. CONCLUSIONS The results might signify that different processes occur in East and West Europe where health is concerned. All the findings once more reinforce the anomaly of the East European region, and recommend that researchers treat comparisons of different health indicators, as well as their determinants, between these two regions with a high degree of caution

‘Being’ or ‘feeling’ healthy : determinants of objective and subjective health in broader Europe

BACKGROUND The East-West health divide in Europe is well documented, in both objective and subjective health. Ever since the Cold War, the West European countries have fared better in terms of health than their Eastern neighbours. However, the question still remains whether this divide is determined simply by differing socio-economic conditions or whether determination of individual health is qualitatively different and cannot be generalised between East and West. Therefore, this chapter analyses the determinants of both objective and subjective health in Eastern and Western Europe. METHODS To better understand the differences of health determination in the East and West, multi-level analysis on the dataset of the European Social Survey (ESS) is performed. The data covers 30 countries and almost 300 thousand individuals over seven rounds, and provides proxies for the main socio-economic determinants and two measures of health: self-reported health and functional ability. Health determinants are measured at both the individual and country-levels, and are divided into economic, political, and social determinants, lifestyles and health care. The standard demographics – age, gender, education and marital status – are also controlled for. RESULTS The analysis reveals that determinants of objective and subjective health are not the same between East and West. Clear differences in determinants of health exist between West European and East European countries particularly in terms of objective health, measured through functional status. Furthermore, overall country context does not influence health as much in the East. CONCLUSIONS The results might signify that different processes occur in East and West Europe where health is concerned. All the findings once more reinforce the anomaly of the East European region, and recommend that researchers treat comparisons of different health indicators, as well as their determinants, between these two regions with a high degree of caution

The structure of health in Europe : The relationships between morbidity, functional limitation, and subjective health

The main objective of this study is to explore the relationships between the three commonly used proxies of health, morbidity, functional limitation, and subjective health, using the most recent data from 18 European countries. The existing studies on the topic are outdated, limited to the United States and to elderly population. Data on 32,679 respondents of the European Social Survey (2014) were analyzed using structural equation modeling. The results suggest that (a) morbidity and functional limitation lead to poorer self-rated health, and (b) morbidity increases the probability of reporting functional limitation(s). Moreover, functional limitation mediates the relationship between morbidity and self-rated health. The model as a whole holds across both genders and all age groups. However, specific tests (SEM multi-group analyses, t-tests) show differences in the health structure between all seven subsamples compared with each other. When both gender and age are taken into account the differences in the structure of health seem to diminish, apart from the elderly, suggesting that the health structure of the elderly differs from others. It is recommended for policy planners to acknowledge the group differences when shaping the policies and health services

Public evaluation of health services across 21 European countries : The role of culture

Aims: This work examined the role of cultural values in understanding people’s satisfaction with health services across Europe. Methods: We used multilevel linear regression analysis on the seventh round of the European Social Survey from 2014, including c. 40,000 respondents from 21 countries. Preliminary intraclass correlation analyses led us to believe that some explanations of variance in the dependent variable were to be found at the country level. In search of country level explanations, we attempted to account for the role of national culture in influencing citizens’ attitudes towards health systems. This was done by using Hofstede’s dimensions of power distance, individualism, masculinity and uncertainty avoidance, giving each country in the survey a mean aggregated score. Results: In our first model with individual level variables, being female, having low or medium education, experiencing financial strain, and reporting poor health and unmet medical needs were negatively associated with individual satisfaction with national healthcare systems, with the latter variable showing the strongest effect. After including Hofstede’s cultural dimensions in our multilevel model, we found that the power distance index variable had a negative effect on the dependent variable, significant at the 0.1 level. Conclusions: Citizens are likely to evaluate their national health system more negatively in national cultures associated with autocracy and hierarchy

A Public Mental Health Study Among Iraqi Refugees in Sweden : Social Determinants, Resilience, Gender, and Cultural Context

This public mental health study highlights the interactions among social determinants and resilience on mental health, PTSD and acculturation among Iraqi refugees in Sweden 2012-2013. Objectives: The study aims to understand participants' health, resilience and acculturation, paying specific attention to gender differences. Design: The study, using a convenience sampling survey design (N = 4010, 53.2% men), included measures on social determinants, general health, coping, CD-RISC, selected questions from the EMIC, PC-PTSD, and acculturation. Results: Gender differences and reported differences between life experiences in Iraq and Sweden were strong. In Sweden, religious activity was more widespread among women, whereas activity reflecting religion and spirituality as a coping mechanism decreased significantly among men. A sense of belonging both to a Swedish and an Iraqi ethnic identity was frequent. Positive self-evaluation in personal and social areas and goals in life was strong. The strongest perceived source of social support was from parents and siblings, while support from authorities generally was perceived as low. Self-rated health was high and the incidence of PTSD was low. A clear majority identified multiple social determinants contributing to mental health problems. Social or situational and emotional or developmental explanations were the most common. In general, resilience (as measured with CD-RISC) was low, with women's scores lower than that of men. Conclusions: Vulnerability manifested itself in unemployment after a long period in Sweden, weak social networks outside the family, unsupportive authorities, gender differences in acculturation, and women showing more mental health problems. Though low socially determined personal scores of resilience were found, we also identified a strong level of resilience, when using a culture-sensitive approach and appraising resilience as expressed in coping, meaning, and goals in life. Clinicians need to be aware of the risks of poorer mental health among refugees in general and women in particular, although mental health problems should not be presumed in the individual patient. Instead clinicians need to find ways of exploring the cultural and social worlds and needs of refugee patients. Authorities need to address the described post-migration problems and unmet needs of social support, together comprising the well-established area of the social determinants of health

Subjective perceptions of unmet need for health care in Europe among social groups: Findings from the European social survey (2014) special module on the social determinants of health.

Background: Unmet need can be defined as the individually perceived subjective differences between services judged necessary to deal with health problems and the services actually received. This study examines what factors are associated with unmet need, as well as how reasons for unmet need are distributed across socioeconomic and demographic groups in Europe. Methods: Multilevel logistic regression models were employed using data from the 7th round of the European Social Survey, on people aged 25–75. Self-reported unmet need measured whether respondents had been unable to get medical consultation or treatment in the last 12 months. Reasons for unmet need were grouped into three categories: availability, accessibility and acceptability. Health status was measured by self-reported health, non-communicable diseases and depressive symptoms. Results: Two-thirds of all unmet need were due waiting lists and appointment availability. Females and young age groups reported more unmet need. We found no educational inequalities, while financial strain was found to be an important factor for all types of unmet need for health care in Europe. All types of health care use and poor health were associated with unmet need. Low physician density and high out-of-pocket payments were found to be associated with unmet need due to availability. Conclusion: Even though health care coverage is universal in many European welfare states, financial strain appeared as a major determinant for European citizens’ access to health care. This may suggest that higher income groups are able to bypass waiting lists. European welfare states should, therefore, intensify their efforts in reducing barriers for receiving care

Superdiversity, migration and use of internet-based health information : results of a cross-sectional survey conducted in 4 European countries

Background Studies of factors associated with the use of Internet-based health information generally focus on general, rather than migrant populations. This study looked into the reasons why Internet-based health information is used and the effects of migration-related factors, other socio-demographic characteristics and health-related factors on the tendency to consult the Internet. Methods In a cross-sectional survey conducted in eight superdiverse neighbourhoods - two each in Birmingham, United Kingdom; Bremen, Germany; Lisbon, Portugal and Uppsala, Sweden - participants were presented with six scenarios and asked to indicate the resources they most relied on when addressing a health concern from a given list. The scenarios included establishing the underlying causes of a health concern and seeking information about prescription drugs, treatments and services available as part of the public healthcare system. The list of resources included the public healthcare system, alternative medicine, family and friends, and the Internet. Frequencies for which the Internet was consulted for each different scenario were calculated and compared across the participating cities. The association between consulting Internet-based health information and migration-related factors, and further socio-demographic characteristics as well as health-related factors such as self-reported health and health literacy was assessed using multivariable logistic regressions. Results Of the 2570 participants from all four cities who were included in the analyses, 47% had a migrant background and 35% originated from non-EU countries. About a third reported relying on Internet-based health information for at least one of the given scenarios. The two most frequently chosen scenarios were to find out about other possible treatments and prescription drugs. Generally, using Internet-based health information was negatively associated with being a first generation migrant (OR 0.65; 95% CI 0.46–0.93), having poor local language competency (OR 0.25; 95% CI 0.14–0.45), older age (≥60 years, OR 0.21; 95% CI 0.15–0.31), low education (OR 0.35; 95% CI 0.24–0.50) and positively associated with low trust in physicians (OR 2.13; 95% CI 1.47–3.10). Conclusion Our findings indicate the need to consider migration background and language competency when promoting the provision of healthcare services via the Internet so that information and services are widely accessible