Exploring perceptions of National wellbeing: links between inequalities, health, and wellbeing in Ghana

We live in a world currently faced by unprecedented social and environmental changes (WEF, 2017). In the face of such rapid change, it is becoming difficult to understand what population wellbeing might mean as well as the indicators that capture its essence. Since the post-war era, Gross Domestic Product (GDP) has been widely used as an indicator of population wellbeing (Potter et al. 2012). However, in recent times, population wellbeing or how people are doing and their progress is increasingly seen as more than merely the value of economic activity undertaken within a given period of time. In response to the growing discontent with the use of economic measures to reflect societal progress and population wellbeing, there has been a global momentum to develop and encourage the use of community-level indicators of wellbeing (Michalos, 2011; Davern et al., 2017). These initiatives aim to increase public understanding of wellbeing and ideas of the ‘good life’ beyond traditional economic measures. Despite the relevance of these alternative measures for practical and policy purposes, their application remains limited in low to middle-income countries (LMICs), especially sub-Saharan Africa (SSA). The limited usage is due to the narrow focus of current measures and their inability to adequately capture what wellbeing means in the SSA context. Also of critical importance is whether the constituents of these ‘Beyond GDP’ measures represent what really matters to people in their specific contexts and captures the collective, contextual and compositional attributes that shape wellbeing of places in low to middle-income countries. This thesis explores the meaning of wellbeing, with emphasis on the role of inequality as a key contributor to the wellbeing of places in low to middle-income countries (LMICs), using Ghana as a case study. The research focused on three broad objectives: first, to develop an integrated framework for understanding links between inequality and wellbeing in LMICs; second, to explore lived experiences, perceptions and understanding of wellbeing and its indicators in LMICs and finally, to explore the potential pathways that link inequalities, and wellbeing in the context of LMICs. A mixed-method approach involving a conceptual review, key informants interviews, focus group discussions and a survey were used in the research. The conceptual review suggests that the role of place and inequality in wellbeing research is inadequately conceptualized and inequality as a key attribute of the wellbeing of places in LMICs is not given adequate attention. The review thus suggested that an integrated framework will enable researchers to adequately conceptualize inequality and wellbeing. It further shows that inequality affects wellbeing through multiple pathways. First, inequality may lead to poor wellbeing through status anxiety- the psychosocial response of individuals or societies to the perception of their place in the status ladder. Secondly, the ‘social facts’ of communities and societies like inequalities may have long-lasting impacts on social cohesion and community vitality. This is especially important in the context of LMICs where communities, and not individuals, mostly serve as the units of identification and development. Thirdly, inequality is detrimental to population wellbeing in LMICs through the differential accumulation of exposures and experiences that have their sources in the material world, which weakens societies’ willingness to make investments that promote the common good. Results from the key informants and focus group discussions revealed similarities as well as context-specific descriptions or definitions of wellbeing across Ghana. Description of wellbeing consists of an embodiment of both material and non-material circumstances. The descriptions or definitions that people ascribe to wellbeing were complex and context dependent. Perceptions of the relative importance of indicators differed depending on sex, gender, and location. Further, findings from the survey (n=1036) reveal that inequalities affect wellbeing by constraining access to basic amenities like water, food, and housing and also through its effects on community social capital and cohesion. This research makes important contributions to knowledge, policy, and practice. Theoretically, the research links capability framework with an ecosocial theory to demonstrate the multidimensional nature of wellbeing by revealing the contextual influences that simultaneously facilitate and constrain optimum experience of wellbeing. The framework outlined is a useful tool for exploring how structural forces at different scales interact to shape population patterns of wellbeing in low to middle-income countries. The framework is beneficial as it enables researchers to connect interactions between environmental risks and (re)actions with broader socio-economic factors to understand wellbeing inequalities and how populations literally embody inequalities. Moreover, the framework can be applied to the embodiment of other risks (e.g., water/air pollution) within similar (or different) contexts. Methodologically, the research contributes to the conceptualization and measurement of wellbeing in a cross-cultural context and expands health geographers’ substantive focus to include population wellbeing. The research also provides an effective example of an embedded mixed-method design by highlighting the strengths of mixing quantitative methods with other research methods such as focus group discussions and key informants interviews in order to gain a nuanced understanding of wellbeing. In terms of policy, the research highlights to adopt wellbeing as the central focus of policy interventions. It also highlights the need for policies to respect community perspectives and experiences in identifying what matters to forge a common understanding not only of wellbeing but also what is fair and just

Impact of Agroecology Adoption, Migration and Remittance Receipt on Household Welfare

This thesis aims to examine the impact of two livelihood strategies on household wellbeing in Northern and Central Malawi. Specifically, the study aims to examine how agroecology adoption, migration and remittance receipt impact household food security and asset poverty levels. Prior research has revealed that agroecological farming methods and remittance receipt can increase productivity, yield stability and resilience of family farmers as well as increase their incomes and propel them out of poverty. Agroecology as an alternative agricultural approach has gained momentum through some high-level FAO meetings as well as reports highlighting its potential. Migration and remittances flows have also become vital components in the livelihood and development strategies of several households in the developing world. However, relatively few empirical studies link agricultural innovations adoption, migration and remittance receipt to household food security and asset levels, partly due to data unavailability and the complexities in data requirements. This study benefited from a longitudinal data and also adopted propensity matching scores techniques to gauge the effects of agroecology adoption, migration and remittance receipt on household food security and asset levels. Results of our analysis reveal that households that adopt agroecological farming practices, adopt migration as a livelihood strategy or receive remittances were more likely to be food secure and reports high asset levels, compared to non-agroecology adopting households, households without migrants members and non-remittance receiving households, respectively. This study makes important contributions to theory, methodology and policy. Theoretically, this study demonstrates potentials of agroecology farming practices and remittance receipts towards enhancing household welfare in terms of improving food security and poverty reduction. It also reveals that household inequalities in terms of access to land, educational status and health of household head influence adoption of agroecology. Methodologically, it reflects the superiority of longitudinal data analysis and propensity score matching techniques to establishing causality. Policy implications and directions for future research are suggested

A GLOWING footprint: Developing an index of wellbeing for low to middle income countries

Our world faces unprecedented, intense and rapid change. As such, it is difficult to fathom how we might monitor related impacts on the wellbeing of population(s) affected. In the past, the world has typically relied upon measures of economic health or wellbeing such as gross domestic product (GDP). As the world ends its commitment to the Millennium Development Goals (MDGs), and embarks on a commitment to the Sustainable Development Goals, questions about where we as a global society should continue our investments in wellbeing and efforts to measure those outcomes are now up for debate. These questions are particularly poignant for those populations most vulnerable to change: low to middle income countries (LMICs). This paper reviews existing “beyond GDP” measures of population wellbeing as a foundation for developing a truly global index of wellbeing (GLOWING) that can be used by LMICs to document change, and measure the impact of policy, across space and over time. The paper describes a proposed index of wellbeing that is simple, meaningful, and built on the use of available secondary data at the ecological level. It is built on the foundation of the innovative Canadian Index of Wellbeing, and hinges on plans for a proof of concept inEast Africafollowed by a scaling up, all of which is founded on the twin pillars of capacity building and empowerment

Pregnancy intention and gestational age at first antenatal care (ANC) visit in Rwanda

The final publication is available at Elsevier via https://dx.doi.org/10.1016/j.midw.2018.08.017 © 2019. This manuscript version is made available under the CC-BY-NC-ND 4.0 license https://creativecommons.org/licenses/by-nc-nd/4.0/Background With antenatal care (ANC) coverage now widely seen as a success story in Sub-Sahara Africa (SSA), attention has begun to shift towards exploring the full life-saving potential that ANC holds. Objectives This study examines association between pregnancy intention and gestational age at first antenatal care (ANC) visit in Rwanda, where ANC coverage is nearly universal. Methods We use survival analysis and apply the lognormal model in Stata SE 15 to compute time ratios (TR) that provide a direct metric for time to first ANC check-up. Results Despite nearly universal coverage, only 25% of pregnant mothers start ANC within the timeframe recommended by WHO. Women with unintended pregnancies are even more likely to delay ANC (TR = 11.4%, Z = 2.48, p < 0.05) than women with intended pregnancies. The effect of pregnancy intention on time to first ANC accentuates when we control for parity in the hazard models. There is also educational divide, with early start of ANC limited to pregnant women with secondary education or higher. Interaction effects suggest significant interaction between parity (≥ 4) and unintended pregnancy (TR = 11.1%, Z = -2.07, p < 0.05) on gestational age at first ANC. Other predictors of time to first ANC are contact with health care provider and perceived barriers. Conclusion With near universal coverage, the next big challenge to harness the full life-saving potential of ANC in Rwanda would be ramping up prompt start of prenatal care, timeliness of successive checkup intervals, and adherence to recommended number of visits, as opposed to simply increasing attendance. Preventing unwanted pregnancies in multiparous mothers through family planning would also significantly to the goal of universal ANC coverage in Rwanda

The Influences of Health Insurance and Access to Information on Prostate Cancer Screening among Men in Dominican Republic

Objectives. Although research demonstrates the public health burden of prostate cancer among men in the Caribbean, relatively little is known about the factors that underlie the low levels of testing for the disease among this population. Study Design. A cross-sectional study of prostate cancer testing behaviours among men aged 40–60 years in Dominican Republic using the Demographic and Health Survey (2013). Methods. We use hierarchical binary logit regression models and average treatment effects combined with propensity score matching to explore the determinants of prostate screening as well as the average effect of health insurance coverage on screening. The use of hierarchical binary logit regression enabled us to control for the effect of unobserved heterogeneity at the cluster level that may affect prostate cancer testing behaviours. Results. Screening varied significantly with health insurance coverage, knowledge of cholesterol level, education, and wealth. Insured men were more likely to test for prostate cancer (OR = 1.65, p=0.01) compared to the uninsured. Conclusions. The expansion and restructuring of Dominican Republic universal health insurance scheme to ensure equity in access may improve health access that would potentially impact positively on prostate cancer screening among men

Assessing the psychometric properties of a modified global wellbeing measure in Ghana

We live in a world faced by unprecedented environmental change. As such, it is difficult to fathom how we might define, measure, and monitor related impacts on population wellbeing. This is especially the case in low to middle income countries that lack holistic national wellbeing measures but are the most impacted by global environmental changes. As part of a larger research program that aims to develop a Global Index of Wellbeing (GLOWING), this paper reports the assessment of the psychometric properties of a community wellbeing measure, using Ghana as a case study. Informed by the ecosocial and capabilities frameworks and in-depth qualitative and focus group discussions, survey data (n = 1036) were collected from three regions in Ghana to assess population wellbeing across several domains. Using structural equation modelling, psychometric properties of this modified wellbeing measure were tested to show the relative contribution of each domain to overall wellbeing. Pathways between domains and overall wellbeing were also investigated. The modified wellbeing measure showed good sensitivity, validity, and reliability which makes it suitable as a valuable tool for measuring wellbeing in Ghana and perhaps other LMIC settings. Furthermore, while the range of wellbeing constructs showed significance across the three regions studied, their relative importance differed, underscoring the importance of place to the measurement of wellbeing. Multivariate analysis shows a multiple range of factors [living conditions, sense of community, perception of environmental quality and political participation] were associated with wellbeing, requiring innovative, flexible and action-oriented approaches to improving population wellbeing. In this regard, we propose modifications to the scale to enable it to capture the role of place, while allowing for comparisons across space

The relationship between climate change, globalization and non-communicable diseases in Africa: A systematic review.

Climate change and non-communicable diseases (NCDs) are considered the 21st Century's major health and development challenges. Both pose a disproportionate burden on low- and middle-income countries that are unprepared to cope with their synergistic effects. These two challenges pose risks for achieving many of the sustainable development goals (SDGs) and are both impacted by globalization through different pathways. While there are important insights on how climate change and or globalization impact NCDs in the general literature, comprehensive research that explores the influence of climate change and or globalization on NCDs is limited, particularly in the context of Africa. This review documents the pathways through which climate change and or globalization influence NCDs in Africa. We conducted a comprehensive literature search in eight electronic databases-Web of Science, PubMed, Scopus, Global Health Library, Science Direct, Medline, ProQuest, and Google Scholar. A total of 13864 studies were identified. Studies that were identified from more than one of the databases were automatically removed as duplicates (n = 9649). Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a total of 27 studies were eventually included in the final review. We found that the impacts of climate change and or globalization on NCDs act through three potential pathways: reduction in food production and nutrition, urbanization and transformation of food systems. Our review contributes to the existing literature by providing insights into the impact of climate change and or globalization on human health. We believe that our findings will help enlighten policy makers working on these pathways to facilitate the development of effective policy and public health interventions to mitigate the effects of climate change and globalization on the rising burden of NCDs and goal 3 of the SDG, in particular