An energy transition can be defined as the adoption of a new primary energy system. As such, it is a structural change that implies a broad shift in technologies and behaviors in order to replace one source of energy with another. Energy transitions motivated by economic, climate, and/or health goals are taking place everywhere in the world. Air pollution, a consequence of fossil fuel-based and solid fuel-based energy use among other sources, is the largest environmental health risk accounting for 6.4 million premature deaths annually. Given the health implications of our energy systems and the social drivers of energy use, access, and burden, energy transitions have the potential to impact health outcomes and associated disparities in a context-dependent manner. The research presented in this dissertation has two objectives: 1) to evaluate the distribution of benefits from energy transitions in the United States (US) and in Ghana; 2) to identify and characterize health outcomes that are relevant to these transitions but are currently understudied. Chapters 2 and 3 are anchored in the US energy policy context. Chapter 2 focuses on the transition away from coal as the primary source of energy in the US and its implications for particulate matter pollution and preterm births. Leveraging a novel dispersion model, I assessed the association between coal PM2.5 and preterm birth rates along with effect modification by race/ethnicity. We observed a positive non-linear relationship between coal PM2.5 and preterm birth rate, which plateaued at higher levels of pollution. The findings of this study suggest that the transition away from coal may have reduced preterm birth rates in the US, but that the association was stronger among non-Hispanic White women compared to non-Hispanic Black women. In Chapter 3, I use a mixed-methods framework to evaluate the first pilot of gas-to-electric stove transition in low-income housing in the US. Through a collaboration with a community-based environmental justice group in New York City, we monitored indoor air quality in participants homes pre- and post-intervention, conducted controlled cooking tests, and carried out focus groups to characterize their experience. Post-intervention, daily NO2 concentrations were 46.3% (95% CI: -67.8%, -10.3%) lower in the intervention arm compared to the control arm. Participants were unanimously pleased with the transition, which had simultaneously improved their cooking experience and partially addressed energy insecurity concerns that plagued their building. Chapters 4 and 5 contribute to the characterization of the health implications associated with Ghana’s commitment to increase access to liquified petroleum gas (LPG) nationally. In Chapter 4, we aimed to describe the country-level incidence of severe cooking-related burns by fuel type in use and to identify effect modifiers. We conducted a nationally representative (n = 7,389) household energy use survey in all 16 regions of Ghana. The incidence rate (95% CI) of cooking-related burns per 1000 person-years among working age females was 8.3 (7.2; 12.0) per 1000 person-years, which was 8 times higher than that of working age males. Among adults, the odds of experiencing a cooking-related burn were doubled among solid fuel users compared to primary LPG users. In Chapter 5, we aimed to understand the effect of an LPG intervention on personal exposure to household air pollution in a peri-urban setting of Ghana and to characterize the distribution of benefits between male and female household members quantitatively and qualitatively. The difference-in-differences results suggested a reduction in exposure to carbon monoxide due to the intervention (-14.2%, 95% CI: -44.1%, 31.6%), which might have benefited male and female participants to the same extent. Importantly, focus group discussions suggested that the ability that LPG affords to cook “on demand” could negatively impact intra-household dynamics and expectations in a way that has not been previously documented. Taken together, our findings from two distinct socioeconomic contexts, highlight the non-uniform distribution of benefits from energy transitions, especially when benefits that are not mediated by air pollution are considered. These results contribute to the understanding that social drivers of inequities should be integrated in the design of energy policies and interventions aimed at generating equitable outcomes. Future directions include a detailed characterization of the context-dependent relative contributions of indoor and outdoor air pollution sources as well as a more systematic integration of quantitative and qualitative methods in policy evaluation.

Reducing health disparities and achieving health equity in maternal and infant health is a critical concern for social work and public health stakeholders more generally. This three-paper dissertation is dedicated to exploring program or policy modifiable social determinants of maternal and infant health with a particular focus on vulnerable populations. Paper one explores the influence of household members on women’s sexual and reproductive behaviors. Paper two studies the impact of smoke-free regulations on birth outcomes in Latin America. Lastly, paper three looks at the effects of police use of force, and racialized police use of force, on maternal and infant health. The findings of these papers provide important information to inform programs and policies aimed at improving reproductive health and well-being in the U.S. and Latin America.

Prior 1994 South Africa had a fragmented health system designed along racial lines. One system was highly resourced and benefitted the few and the other was under-resourced and was for the black majority. Attempts to deal with these disparities did not fully address the inequities. The objective of the NHI is to address the inequalities by ensuring that all South African have access to affordable, quality healthcare services regardless of their socio-economic status. The majority of the participants do not understand the meaning and the implications of the national health insurance. Among the health professionals that were interviewed, there were no consultations before the implementation of the NHI. The health economists verbalized that it will be too expensive as the majority of citizens do not pay taxes. More roadshows need to be done to make communities aware of the planned strategy which will benefit all. / Health Studies

Prior 1994 South Africa had a fragmented health system designed along racial lines. One system was highly resourced and benefitted the few and the other was under-resourced and was for the black majority. Attempts to deal with these disparities did not fully address the inequities. The objective of the NHI is to address the inequalities by ensuring that all South African have access to affordable, quality healthcare services regardless of their socio-economic status. The majority of the participants do not understand the meaning and the implications of the national health insurance. Among the health professionals that were interviewed, there were no consultations before the implementation of the NHI. The health economists verbalized that it will be too expensive as the majority of citizens do not pay taxes. More roadshows need to be done to make communities aware of the planned strategy which will benefit all. / Health Studies

No description available.

This thesis undertakes an in-depth examination of the power of human rights advocacy in combating women's vulnerability to HIV/AIDS. Focusing on sub-Saharan Africa, the thesis explores the gender discrimination that lies at the core of women's susceptibility to the virus. Culturally-imposed social roles are depicted as the fundamental cause of the violation of women's human rights, including their right to health. The objective of the thesis is to analyze the potential of using a human rights approach to address this issue. It adopts the assumption that "the mobilization of shame" triggered by civil society's actors can alter states' human rights practices. Looking at a specific type of actors, namely the transnational advocacy networks, the thesis concludes that "the human rights approach to HIV/AIDS" can be an efficient and effective strategy to pressurize governments to implement their international human rights obligations.

Bibliography: leaves 203-219. / 219 leaves : ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Concerned with the contribution of commonsense understandings of disease to social differentials in health outcomes. Argues that understandings in part reflect the social circumstances of an individual and mediate preventive activities and use of services, thereby influencing health outcomes. These are examined using the specific health outcomes of tooth loss and tooth decay. / Thesis (Ph.D.)--University of Adelaide, Dept. of Public Health, 2000

The objective of this study was to examine if intra-racial income inequality contributes to higher infant mortality rates (IMRs) for African-Americans. The conceptual framework for this study is derived from Richard Wilkinson's psychosocial environment interpretation of the income inequality and health link. The hypotheses examined were that race/ethnicity-specific IMRs are influenced by intra-race/ethnicity income inequality, and that these effects of income inequality on health are mediated by level of social mistrust and/or risk profile of the mother. Using state-level data from several sources, the 2000 National Center for Health Statistics Linked Birth Infant Death database, 2000 U.S. Census, and 2000 General Social Survey, a number of regression equations were estimated. Results indicated that the level of intra-racial/ethnic income inequality is a significant predictor of non-Hispanic Black IMRs, but not the IMRs of non-Hispanic Whites or Hispanics. Additionally, among Blacks, the effect of their intra-racial income inequality on their IMRs was found to be mediated by the risk profile of the mother, namely, the increased likelihood of smoking and/or drinking and/or less prenatal care by Black women during pregnancy. Implications of the findings are discussed.

Research objectives: This study examined research, media, and public opinion related to maternal health in order to understand some of the social and structural factors that influence the passage of comprehensive maternal health policies in the United States. This study also examined the messaging of race and racism in media and health communication. Research objectives were: 1.) To summarize the perinatal care experiences of Black birthing people through a scoping review of the literature, 2.) To explore media depictions of maternal mortality in terms of the groups, causes, and solutions discussed in coverage, and 3.) To test the effects of two different approaches to communicating maternal health on public beliefs about the causes of racial health disparities and public support for structural policies. Methods: The review of the literature followed a scoping review protocol and developed tailored search strings to retrieve relevant articles in three databases. The review protocol included developing selection criteria, screening articles retrieved from three databases, charting the data, and identifying themes across articles using an ecological health model as a conceptual guide. For the second paper – a content analysis of news media coverage of maternal mortality – relevant news articles were retrieved using NexisUni, an online database of newspaper articles. A codebook was developed deductively using previous research and grey literature on maternal health, and articles were subsequently coded for the presence or absence of codes that assessed how articles framed causes, solutions, and social groups in their coverage of maternal mortality in the United States. The third paper tested the effects of articles that communicated the maternal health issues faced by Black birthing people using a web-based survey experiment. Participants in this study were recruited using Qualtrics’ panel services, and were randomly assigned to read either a narrative or nonnarrative article communicating the relationship between race and adverse maternal health outcomes. Participants were then asked to respond to the questions that assessed their agreement with structural causes for racial health disparities and their support for policies to improve maternal health. Findings: The scoping review found that Black birthing people described factors at the interpersonal, organizational, community, and policy level in their accounts of their perinatal care experiences. This included their interactions with their providers, the dominant models of care in healthcare settings, institutional representation, and the limitations of care covered through existing Medicaid policies. The content analysis of media found that newspaper coverage of maternal health reflected the factors described in research. Media predominantly focused on structural causes and solutions for maternal health (e.g., access to services and care, social determinants of health, structural racism) and described racial disparities in maternal mortality. The final study built on the findings of the media analysis by testing the effects of news articles that described the role of social and structural factors on the maternal health outcomes of Black birthing people. Data from the experiment showed that participants who read a narrative article about the issue had greater support for structural policies than participants who read a nonnarrative article. The difference in agreement with structural causes for racial health disparities between participants in the narrative and nonnarrative groups was not statistically significant. Additionally, data showed significant differences in treatment effects and policy support across groups distinguished by race and gender.

Inequalities in levels of health between regions within a country are frequently regarded as a problem. Zimbabwe is characterised by poor and unequal conditions of health (both the state of people’s health and health services). The health system of the country shows severe spatial inequalities that are manifested at provincial, district and even local levels. This research therefore examines and analyses the spatial inequalities and temporal variation of health conditions in Zimbabwe. Composite indices were used to determine the people’s state of health in Zimbabwe. Administrative districts were ranked according to the level of people’s state of health. Cluster analysis was also performed to demarcate administrative districts according the level of health service provision. Districts with minimum difference were demarcated in a single cluster. Clusters were delineated using data on patterns of diseases and health and such clusters were used to demarcate the country’s spatial health system according to the Adapted Epidemiological Transition Model. This was used to evaluate the applicability of the model to Zimbabwe. It emerged from the research that generally the country’s health conditions are poor and the health system is characterised by severe spatial inequalities. Some districts are experiencing poor health service provision and serious health challenges and are still in the age of pestilence and famine but others have good health service provision as well as highly developed health conditions and are in the age degenerative diseases of the epidemiological transition model. It further emerged that the country’s health has been evolving with signs of improvement since the 1990s. Recommendations were made regarding possible adjustment to previous strategies and policies used in Zimbabwe, for the development of the health system of the country. New strategies were also recommended for the improvement of the health system of the country. Some proposals are made for further research on the spatial development of health in the country. / Geography / D. Litt et. Phil. (Geography)