Change, psychosocial stress and health in an era of globalization

In the last decades, globalization has produced an acceleration of social, economic and political changes worldwide. These changes had a number of positive effects including enhancing political freedom, living standards and health conditions. However, many of them have also produced adverse health consequences, especially when they have been implemented in a sudden, rapid and unexpected way. This is especially true among those populations whose ability to adjust to the new circumstances generated by rapid change was limited. The aim of the present research project was to examine the health consequences of rapid social, economic and political change following globalization as well as to investigate the role of psychosocial factors in explaining these relationships. A theoretical framework proposing major psychosocial pathways connecting rapid change with health-related outcomes has been developed. A series of case studies from countries affected by rapid change supported the hypothesized relationships included in the framework. Countries of interest were the former Soviet Union nations, China, Japan, Micronesia Islands, New Zealand, Australia, Canada, and the United States. The limited ability of certain populations to adjust to rapid changes induced by globalization as well as the pace of change of social, economic and political reforms are discussed

Challenges for reducing inequities in health and healthcare for the 21st Century

Human life expectancy during the time of the Roman Empire was approximately 28 years. In 1990, global life expectancy had increased to 65 years. The advances in life expectancy in the 20th century were remarkable by any standard. Although many factors contributed to this enhanced life expectancy, including medical technologies, by far the largest proportion of the increase occurred as a consequence of economic growth, rising living standards and nutrition. Despite the large improvements in terms of life expectancy, significant health variations still remain between countries and across different socioeconomic classes with in countries. As the 20th century proceeded, a growing dichotomy existed between those who are healthy and have access to medical care and those who are not healthy and do not have access to such services. Moreover, evidence shows that such inequities in health and healthcare are increasing. The present paper will analyze the dynamics of shifts in health profile during the early period of the last century and describe the major determinants of inequities in health and healthcare at the international level. Challenges facing the reduction in inequalities in health and healthcare will be discussed

Should socioeconomic factors be considered as traditional risk factors for cardiovascular disease, as confounders, or as risk modifiers?

A large number of studies show that cardiovascular disease and its traditional risk factors are associated with socioeconomic conditions. However, their etiological role in the development of cardiovascular outcomes is not always well understood. In particular, it is unclear whether socioeconomic factors should be considered as traditional risk factors for CVD, as confounders, or as risk modifiers. In this article, after examining whether socioeconomic conditions meet the criteria for the three definitions, we argue that none of them fully captures the complexity of their contribution in shaping the epidemic of heart disease across and within societies. We argue instead that socioeconomic factors are the “causes of the causes” of heart disease. Implications for research and interventions to reduce heart disease are discussed

Potential impact of adjustment policies on vulnerability of women and children to HIV/AIDS in sub-Saharan Africa

This paper evaluates the potential impact of adjustment policies of the International Monetary Fund and the World Bank on the vulnerability of women and children to HIV/AIDS in sub-Saharan Africa. A conceptual framework, composed of five different pathways of causation, is used for the evaluation. These five pathways connect changes at the macro level (e.g. removal of food subsidies) with effects at the meso (e.g. higher food prices) and micro levels (e.g. exposure of women and children to commercial sex) that influence the vulnerability of women and children to HIV/AIDS. Published literature on adjustment policies and socioeconomic determinants of HIV/AIDS among women and children in sub-Saharan Africa was reviewed to explore the cause-effect relationships included in the theoretical framework. Evidence suggests that adjustment policies may inadvertently produce conditions facilitating the exposure of women and children to HIV/AIDS. Complex research designs are needed to further investigate this relationship. A shift in emphasis from an individual approach to a socioeconomic approach in the study of HIV infection among women and children in the developing world is suggested. Given the potential for adjustment policies to exacerbate the AIDS pandemic among women and children, a careful examination of the effects of these policies on maternal and child welfare is urgently needed

Has the relation between income inequality and life expectancy disappeared? Evidence from Italy and top industrialised countries

Objective: To investigate the relation between income inequality and life expectancy in Italy and across wealthy nations.Design and setting: Measure correlation between income inequality and life expectancy at birth within Italy and across the top 21 wealthy countries. Pearson correlation coefficients were calculated to study these relations. Multivariate linear regression was used to measure the association between income inequality and life expectancy at birth adjusting for per capita income, education, and/or per capita gross domestic product.Data sources: Data on the Gini coefficient ( income inequality), life expectancy at birth, per capita income, and educational attainment for Italy came from the surveys on Italian household on income and wealth 1995-2000 and the National Institute of Statistics information system. Data for industrialised nations were taken from the United Nations Development Program's human development indicators database 2003.Results: In Italy, income inequality (beta = -0.433; p 0.05). In cross national analyses, income inequality had a strong negative correlation with life expectancy at birth (r =-0.864; p < 0.001).Conclusions: In Italy, a country where health care and education are universally available, and with a strong social safety net, income inequality had an independent and more powerful effect on life expectancy at birth than did per capita income and educational attainment. Italy had a moderately high degree of income inequality and an average life expectancy compared with other wealthy countries. The cross national analyses showed that the relation between income inequality and population health has not disappeared

User fees impact access to healthcare for female children in rural Zambia

The World Bank and International Monetary Fund favor healthcare user fees. User fees offer revenue and may decrease inappropriate care. However, user fees may deter needed care, especially in vulnerable populations. A cross-sectional analysis of healthcare utilization in a large Zambian hospital was conducted for children 3-6 years of age during a 1-month observation period. Diagnoses and treatments were compared using paired t-tests. Chi-squared tests compared outpatient service use. The relative risk of admission was determined for each stratum. Logistic models were developed to evaluate the impact of age, gender, and the age-gender interaction on hospital admissions. Trends suggest female children may be less likely to present for care when user fees are imposed. However, treatment type, treatment number, and number of diagnoses did not differ between genders. The relative risk of admission was highest for males 5-6 years old. Neither age nor gender alone was a significant determinant of hospital admission. However, the age-gender interaction was significant with female admissions least likely when costs were incurred. We conclude that user fees appear to decrease differentially utilization of inpatient care for female children in rural Zambia

'Globesization': ecological evidence on the relationship between fast food outlets and obesity among 26 advanced economies

The aim of this study was to investigate the relationship between the density of fast food restaurants and the prevalence of obesity by gender across affluent nations. Data on Subway’s restaurants per 100,000 people and proportions of men and women aged 15 years or older with a body mass index (BMI) higher or equal than 30 Kg/m2 were obtained for 26 of 34 advanced economies. Countries with the highest density of Subway restaurants such as the US (7.52 per 100,000) and Canada (7.43 per 100,000) tend also to have a higher prevalence of obesity in both men (31.3% and 23.2% respectively) and women (33.2% and 22.9% respectively). On the other hand, countries with a relatively low density of Subway restaurants such as Japan (0.13 per 100,000) and Norway (0.19 per 100,000) had a lower prevalence of obesity in both men (2.9% and 6.4% respectively) and women (3.3% and 5.9% respectively). Unadjusted linear regression models showed a significant correlation between the density of Subway’s outlets and the prevalence of adult obesity (β=.46; p=0.02 in men and β=.48; p=0.013 in women). When the data were weighted by population size, the association became substantially stronger in both men and women (β=.85; p=0.0001 and β=.84; p=0.0001, respectively). Covariate adjustment did not reduce the size of the associations. Our study raises serious concerns about that the diffusion of fast food outlets worldwide and calls for coordinated political actions to address what we term ‘globesization’, the ongoing globalization of the obesity epidemic

Neighbourhood social environment and depressive symptoms in mid-life and beyond

This prospective study examines the relationship between aspects of the neighbourhood social environment and subsequent depressive symptoms in over 7,500 participants of the English Longitudinal Study of Ageing (ELSA). Neighbourhood social environment at baseline was operationalised using four items capturing social cohesion and three items capturing perceived safety and associations with the Center for Epidemiologic Studies Depression Scale (CES-D) at two-year follow-up were assessed. Friendship quality and personal sense of control were tested as mediators of this relationship using structural equation modelling. Neighbourhood social cohesion was found to be associated with reporting fewer depressive symptoms independent of demographic and socioeconomic factors and baseline depressive symptoms. Friendship quality and sense of control mediated this association. The study highlights that greater personal sense of control, higher quality friendships and fewer depressive symptoms are found in neighbourhoods seen to be characterised by higher social cohesion