The link between family social capital and child health has not been well investigated in developing countries. This study assessed socioeconomic inequalities in child health and in family social capital in South Africa. It also assessed the relationship between family social capital and child health. Four waves of the National Income Dynamics Study panel data were used to investigate the relationship between family social capital and child health. Socioeconomic inequalities were assessed using the concentration index. To assess the relationship between family social capital and child health, regressions models were fitted using a selected set of explanatory variables, including an index of family social capital. Child health in this study was operationalized to include: stunting, wasting, and parent-reported health of a child. Results showed that children from the poorest families bear the largest burden of stunting, wasting, and ill health. Similarly, children from poorer households possessed more family social capital when compared to children from more affluent families. Although family social capital was expected to improve child health, the study findings suggest that in South Africa, the socioeconomic status of a family has a greater effect on child health than family social capital.

Background: The Western Cape province of South Africa has the highest recorded prevalence rates of Fetal Alcohol Spectrum Disorders (FASD) in the world. In the last decade rates of fetal alcohol syndrome (FAS) and partial fetal alcohol syndrome (PFAS) prevalence of 68.0 - 89.2 per 1000 (May et al., 2007), 67.2 per 1000 (Urban et al., 2008), and 59.3 - 91.0 per 1000 (May et al., 2013) have been published after research was conducted in towns in the Western Cape (WC). Educating learners with FASD is a challenge as a result of the large range of cognitive impairments associated with heavy prenatal alcohol exposure. Determining a burden of cost to the education system may be one way to motivate for the development of prevention and intervention strategies. Methods: I designed questionnaires that were distributed to the educator and principal of a cohort of learners including learners with FAS and PFAS. Data were collected on educational impacts of variables associated with educator time use. Additional costs as a result of the use of educator's time by learners with FAS/PFAS were scaled up using risk differences and published statistics to reflect a cost burden to the WC Education Department. Results: The additional cost burden of disruptions caused by learners with FAS and PFAS for the WC Education Department is USD 7,010,166 in educator time for one academic year. The additional burden for learners with FAS/PFAS requiring additional assistance with lesson content to the WC is USD 5,754,885 in educator time for one academic year. The additional cost burden of public primary school learners with FAS/PFAS who had repeated a year of schooling was USD 3,876,565 in educator time based on 2012 salaries. Conclusions: These findings indicate that there is a large burden of cost to the education system when educator time is viewed as an economic input in education. Efforts need to be directed towards prevention programs to reduce the prevalence of learners with FAS/PFAS in the classroom. Educator training programs must be created to ensure that educators are equipped to manage the challenges posed by learners with FAS/PFAS in the classroom.

As community-based governance structures in the service delivery of primary health care, health committees can promote the quality, accessibility and responsiveness of service delivery. More specifically, health committees provide a platform for community members to advocate for their health needs and meaningfully participate in decision-making, oversight and monitoring of service delivery. Hence, health committees provide a bottom-up strategy to realise the right to health and a people-centred health system. Previous research has found that Health Committees in the Cape Metropole of South Africa face similar challenges as their counterparts globally. In South Africa health committees' role and mandate often seem to be unclear and weak policy frameworks have resulted in wide variations in health committee functionality. Health care providers, particularly health facility managers, have been identified to play a key role in creating a supportive environment for health committees' genuine and effective participation. Particularly, health care providers' misunderstandings of health committees' roles and responsibilities as well as their lack of engagement with health committees can form barriers to health committee's functioning. A gap in understanding exists on the impact training of health care providers could have on health committees' meaningful participation. While many health committee members in the Cape Metropole of the Western Cape Province were already trained, health care providers had not been trained until May 2015. Present realist evaluation sought to describe and explore the immediate and short-term impact of this pilot training on health care providers' responsiveness towards health committees. Pre- and post-training questionnaires, direct observations and semi-structured interviews were employed as research methods. The training evaluation was enriched by participants' diverse professional positions and work environments as well as their various experiences and relationships with health committees. The study reveals that the training played a role in increasing health care providers' responsiveness towards health committees' roles and functions. Health care providers demonstrated understandings and intentions towards building effective working relationships with health committees. However, training is recommended to be followed up on and to be continuous to ensure intentions are translated into practice and to account for the dynamic nature of health facilities, health committees and the health system in which they reside. In this manner, health care providers can increasingly contribute to building sustainable relationships with health committees to promote meaningful and effective community participation, the strengthening of people-centred health systems and the progressive realisation of the right to health.

Background: The increased smoking prevalence in some parts of the world, particularly in Low and Middle Income Countries (LMICs) is a major concern among tobacco control advocates and governments. The higher smoking-related disease prevalence associated with this is expected to fall among the sub-populations least able to pay for healthcare services in LMICs. This, in turn, will perpetuate the vicious cycle of poverty and disease. The current study contributes to developing an understanding of the socioeconomic disparities in smoking in Namibia and their potential association with per capita health-related expenditures. Method: Data from the Namibia 2013 Demographic and Health Survey, a nationally representative survey, are used in the study. Three main variables for healthcare costs are constructed, namely out-patient disease (OPD) costs, inpatient disease (IPD) costs and total out of pocket (OOP) payments. Concentration curves and indices are estimated for all three variables as well as for smoking intensity and smoking prevalence. Further, three Tobit regression models are run to examine the associations of the different healthcare costs with smoking intensity. Results: The concentration index of smoking prevalence is estimated at -0.05 compared to -0.18 for smoking intensity. Thus, both smoking prevalence and smoking intensity, in relation to their socioeconomic status, are concentrated among the poor. In contrast, the concentration index of OPD healthcare costs is calculated at 0.34 compared to 0.65 for IPD healthcare costs reflecting disproportionately higher healthcare costs among the rich. The concentration index of the overall total annual OOP payments is 0.55. Tobit regression analysis, however, does not find any statistically significant relationship between the smoking intensity and the amount spent on health care costs, regardless of whether these were IPD, OPD healthcare costs or total OOP payments. Conclusion: Namibia's current policies on demand reducing tobacco control policies can be strengthened by these findings. Smoking is an important determinant of several non-communicable diseases and has the potential to exacerbate health care costs across socioeconomic strata. Understanding the socioeconomic disparities in smoking is imperative for developing appropriate interventions against smoking.

Schools and healthcare organizations face questions of validation in leadership and investment in human capital, which raises important public policy questions. External forces such as economics, pressure groups, and oversight organizations as well as worker availability are at issue. Unlike education, segments of the healthcare industry are doing very little long-range planning concerning human capital development. A new paradigm must be developed for the healthcare industry if it is to face the challenges of a shrinking, less prepared workforce, in an aging nation. This case study uses the home health care and supplemental staffing industry to focus on an emerging public policy issue--requiring criminal background checks of healthcare workers. The study looks at the development of the National Healthcare Clearinghouse, critically analyzing the plan to determine how original goals shifted and affected its actualization. The primary and continued concern was on a negative aspect of hiring workers for the industry--that is to "screen-out" persons with an unacceptable criminal record. To assess attitudes among healthcare organizations, 3273 surveys were sent out to agency directors, with 28% responding. Subsequently and through research of the literature and follow-up interviews, a positive agenda emerged related to staff development through firm-specific and industry recognition of a career lattice. This recognition leads to potentially improved employment practices. The negative agenda raises issues such as privacy rights, due process and consumer protection. The positive agenda could reduce turnover, better protect clients and improve competency and salaries. Many significant steps to improve service work are closely linked to political processes and those legislative steps are poorly suited to achieve effective and efficient solutions. An industry based clearinghouse should be a proactive and positive corporate solution to a public concern that has advantages, especially in terms of costs, but may not survive a major financial crisis. This project was no exception. The survey results indicate that current criminal background checks are not effective. An accompanying survey of human resource needs provides a wealth of information to evaluate the current employment environment, and develop collaborative solutions. Recommendations are made to bring the project, although abandoned by a trade association, to fruition.

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Tobacco use remains a significant issue in the Gulf Cooperation Council countries (GCC), a political and economic union consisting of Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. Tobacco is responsible for 11.6% and 5.3% of mortalities among men and women, respectively, and causes US$ 34.5 billion financial loss. Tobacco use is expected to slightly decline in GCC countries by 2025, except in Oman, where tobacco use is expected to increase. In GCC countries, tobacco use is influenced by similar socio-cultural and environmental factors acting independently or interacting with other factors. In 2006, the six GCC countries ratified the Framework Convention on Tobacco Control (FCTC) treaty, which was developed by the World Health Organization. The FCTC is composed of evidence-based policies that address environmental and behavioral factors. While FCTC policies have shown a positive effect in many countries, little is known about the impact of the FCTC in GCC countries. Given the past influence of the tobacco industry in culturally and politically connected countries, it becomes necessary to examine tobacco use in the GCC region to prevent the initiation of use and reduce the economic burden associated with tobacco use. The goal of this study was to examine the impact of tobacco control policies on preventing tobacco use among youth in the GCC countries. The study used a mixed-method approach to investigate tobacco control policies. The specific aims of the study were: 1) evaluate the implementation of FCTC measures in the six GCC countries at the national level; 2) examine the relationship between youth susceptibility to initiate tobacco use and key FCTC provisions in five GCC countries; and 3) investigate the occurrence of tobacco use in Arabic media to assess compliance with the FCTC provision on banning tobacco advertisement, promotion, and sponsorship in the GCC region. The longitudinal review of tobacco control measures in the six GCC countries between 2008 and 2020 showed progress in implementing measures related to tobacco packaging, smoking cessation, and tobacco sale to minors in most GCC countries while much less progress in implementing measures related to tobacco prices and taxes and eliminating illicit tobacco trade. Examining the self-reported intention to initiate tobacco use by youth indicated that a person’s susceptibility to begin tobacco use statistically declined over time from the pre- to post-FCTC ratification in Bahrain (15.6% in 2002 to 8.9% in 2015) and Qatar (11.3% in 2004 to 7.3% in 2018), while it increased in the UAE (4.9% in 2002 to 9.3% 2013). Consistent with previous literature, exposure to smoking in public places and tobacco marketing activities increased susceptibility to initiate tobacco use among youth at a statistically significant level. In contrast, exposure to anti-tobacco education in media statistically reduced susceptibility. Finally, the in-depth examination of incidents of tobacco use in Arabic media showed a total of 32,084 incidents of tobacco use in 92 TV series broadcasted between January 2017 and December 2019, suggesting that on-screen tobacco use has not been completely banned in Arabic media. The findings of this study should lead to more collective action in the region. Policymakers should dedicate more efforts to address environmental factors that influence tobacco use, and anti-tobacco advocacy groups should enhance youth engagement in tobacco control activities. Policy surveillance remains the ultimate solution to assess the impact of legal intervention in health outcomes and amend interventions when unintended consequences occur. Future research should continue tracking tobacco control measures at the national and local levels and share policy surveillance data across countries to better assist with the decision-making process. Researchers should examine the implementation process and enforcement activities related to tobacco control policies. Moreover, it is critical to understand the history of the influence of the tobacco industry in the GCC region and examine the current activities of the tobacco industry in order to counter them effectively. Mixed methods research may be an optimal option for researchers to examine the cause-effect relationships and uncover gaps that hinder tobacco control policies from addressing the issue. / Public Health

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