Child maltreatment negatively impacts physical, emotional, and the health and well-being of a person, often with lifelong implications. The importance of this study derives from the very necessity of mental health services for children who have suffered trauma. Children’s Assessment Centers (CAC) assess and refer children who have experienced abuse to a therapist in the community. This study examines the use of an enhanced referral process used to connect some CAC clients more quickly to therapeutic services in the community. The study examined whether children who received this expedited referral service were more likely than children who received the standard referral process to see a therapist within three months. The study used data provided by one CAC in California. The CAC provided information on clients who received either the expedited or standard referral process within a 3-month period in 2017. The researcher then contacted the clients’ caregivers to ask whether the child saw a therapist within 3-months of the child’s referral from the CAC. The study used a Chi-square test to analyze whether children who received an expedited referral to mental health services were more likely than children who received the standard referral to receive mental health services within three months. Results indicated no statistically significant difference in access to mental health services for the two groups. However, during data collection, the researcher learned that some children were already engaged in therapy at the time they received the referral, perhaps rendering the referral unnecessary. Implications for social work practice, policy, and research are discussed.

Research shows that in the UK, individuals from black and minority ethnic backgrounds are significantly less likely to access mental health services than the general population. In the absence of literature or robust mental health service access figures for Nepalese people living in the UK (NLU) there is little understanding of the mental health needs and help-seeking preferences of this group. This study aimed to examine factors which are associated with professional help-seeking for mental health difficulties in NLU. The Theory of Planned Behaviour (Ajzen, 1985) was used as a guiding theoretical framework to examine the strongest predictors of intention to seek professional help. Potential predictors, shame/izzat, acculturation, beliefs about the causes of mental distress and demographic variables were measured. The sample were 65 NLU recruited from community centres, health events and online groups across the UK. Results indicated that although a significant number of NLU reported having experienced mental health difficulties, very few had sought professional help. A number of variables significantly correlated with intention to seek professional help, including level of acculturation, non-Western physiological causal beliefs and izzat. According to a multiple-regression analysis of the whole sample, izzat was the most strongly related to intention to seek professional help. A number of barriers to help-seeking were identified such as hoping problems would go away or not wanting to burden others. A significant strength of the study was the use of both Nepalese and English language questionnaires which ensured that a large non-English speaking section of the NLU population was not excluded from the study. Limitations include methodological considerations such as the use of one measure which appeared to have limited validity. Furthermore, the exclusion of illiterate individuals by merit of using a self-report questionnaire limits the generalisability of these findings to the NLU more widely. Low mental health service access rates were identified within this sample relative to the prevalence of mental health difficulties. The clinical implications of this study highlight the need for policy and service level strategies to increase service access rates and the need for mental health services which are sensitive to the culturally specific issues within the population.

The impact of influenza pandemics is felt most greatly in developing states, where the close proximity between humans and disease vectors, weak public health surveillance systems, and poor sanitation make these states particularly vulnerable to influenza pandemics. A vaccine is the most effective intervention to minimise the spread and impact of influenza, and yet, developing states are the least likely to have timely access to a vaccine during a pandemic. According to 'The Committee on Economic, Social and Cultural Rights General Comment No. 14: the Right to the Highest Attainable Standard of Health' there is a clear positive obligation for states to provide access to vaccines during an influenza pandemic, and this obligation is not waived or depleted merely because developing states have resource constraints. There has been a proliferation of literature recently which has considered access to medicines in developing states and the right-to-health. However, there has been little exploration of this issue in respect of pandemic influenza vaccines. This research explores the manner in which developing states procure influenza vaccines during a pandemic, and determines if the current international legal mechanisms which are available to developing states can be successfully used to enhance procurement, and increase the amount of vaccine developing states can access during a pandemic, to a point where they can discharge their right-to-health obligations. In doing so, I argue that the WHO Pandemic Influenza Preparedness Framework, and the flexibilities of the TRIPS Agreement are not able to enhance the procurement of pandemic influenza vaccines by developing states, to the point where states right-to-health obligations can be said to be discharged. From this, I propose an international 'Knowledge Clearing House as a solution to the problems in procurement which are identified in this research.

This paper provides evidence on (1) refugees' subjective well-being, (2) their access and barriers to health care utilization and (3) their perception of health care provision in Austria, one of the countries most heavily affected by the European "refugee crisis". It is based on primary data from the Refugee Health and Integration Survey (ReHIS), a cross-sectional survey of roughly five hundred Syrian, Iraqi and Afghan refugees. Results indicate that refugees' self-rated health falls below the resident population's, in particular for female and Afghan refugees. Whereas respondents state overall high satisfaction with the Austrian health system, two in ten male and four in ten female refugees report unmet health needs. Most frequently cited barriers include scheduling conflicts, long waiting lists, lack of knowledge about doctors, and language. Although treatment costs were not frequently considered as barriers, consultation of specialist medical services frequently associated with co-payment by patients, in particular dental care, are significantly less often consulted by refugees than by Austrians. Refugees reported comparably high utilization of hospital services, with daycare treatment more common than inpatient stays. We recommend to improve refugees' access to health care in Austria by a) improving the information flow about available treatment, in particular specialists, b) fostering dental health care for refugees, and c) addressing language barriers by providing (web-based) interpretation services.

This study explores the relationship between race and surgical treatment and radiation therapy use for localized breast cancer patients in the state of Florida in 2001. The study will be useful in raising awareness of the relationship between Black race and appropriate breast cancer treatment within the Florida Cancer Data System. The Healthy People 2010 initiatives call to eliminate racial disparities and the high placement of breast cancer on the national research agenda make this study timely and insightful for health policymakers, clinicians and other health researchers. Also, the study evaluates the effect of other health system and patient related factors such as insurance provider and rural versus urban residence, to the appropriate use of cancer therapy in order to present an up-to-date and accurate picture of the quality of breast cancer care for women in the state of Florida. The study used multivariate logistic regression modeling and chi-square distribution to compare models in order to disentangle the effects of age, rural residence, marital status and primary health insurance provider from race and to determine how these factors influenced breast conserving surgery versus mastectomy use. Further, the second research question exclusively focused on the population that received breast conserving surgery in order to examine the impact of race and the other covariates as explanatory measures of appropriate receipt of radiation therapy. The first hypothesis found that there was no statistically significant difference between Black and White women in terms of receipt of breast conserving surgery for treatment of localized breast cancer. The second hypothesis, which focused on appropriate receipt of radiation therapy following breast conserving surgery, found that there was a statistically significant interaction between Black race and Medicaid as primary health insurance provider. The study concludes by examining possible areas of improvement in data collection in the State of Florida. Also, the study contains recommendations as to previously unexplored facets of breast cancer research and breast cancer health policy that could be beneficial in the reduction of health and healthcare disparities in other geographic areas and in other diseases.

Preventative care services allow patients to be fully equipped with the knowledge, tools, and other resources to help them discover and treat many diseases and illnesses so that the burden of costs will not fall on patients and their families. Since the passage of the Affordable Care of Act (ACA) by President Barack Obama, the requirement for health insurance coverage has not translated to utilization of preventative care services. The purpose of this study is to determine the motivation for African Americans who have insurance coverage and access to care who are not taking advantage of opportunities for screenings and health education. The health belief model was used to determine how belief and modifying factors influence health decisions. The quantitative study required use of a secondary dataset to determine utilization of preventative care services, insurance affordability, future access to care and understanding of the health care law. The study included testing the statistical significance of these factors among African Americans, White Americans, and Hispanic Americans who participated in the Healthy Americas Survey. Using the program SPSS to process data analyzation and organize output, results reveal that African American participants are concerned about the future ability to access and afford care. With a history of distrust amongst African Americans and the health industry, social implications are for administrators and providers to bridge the gap by offering health education to those in their immediate communities and requesting and implementing feedback from those same individuals.

No description available.

The overall objective of this study is to promote the human rights to health of Nigerian women to have access essential medicines, to enhance their human capabilities for human development. This thesis argues for an improvement of women’s access to medicines within the context of patent law and rights in the international IP regime of the Trade Related Aspect of Intellectual Property (TRIPS) Agreement and Nigeria’s national patent system. Towards this goal, the thesis makes the point that patent law and its exclusive rights, both the TRIPS Agreement and national law of Nigeria, do not exist in a social welfare vacuum. The legal text of patent law, which confers rights on inventors when enforced, translates to many other things outside the sphere of property rights; indeed, it can be a matter of life and death. It is argued in this regard that patent right could, in effect, interfere with access to medicines and therefore, the right to health and prospects for human development. The thesis therefore argues that, in the construction, interpretation and enforcement of patent law in Nigeria, there is a need to take into consideration its impact on public health. It is against this backdrop that the research assesses the legal framework of pharmaceutical patents and the implications for women’s access to medicines, from a right to health and human development perspective. This interdisciplinary study is with a view to suggesting ways in which Nigeria’s patent system can be more human development and human rights friendly in the interest of public health, particularly, the use of the TRIPS flexibilities to enhance access to life-saving medicines in Nigeria. Since Nigeria as a member of the World Trade Organisation, is bound by its treaty obligation to adopt the provisions of the TRIPS Agreement, the thesis makes proposals for ways in which the Nigerian government and law-makers, can adapt the patent rules and the flexibilities to suit development objectives and promote public health within the benchmark allowed in TRIPS. In this respect, this thesis critically investigates the practical implications of the available flexibilities and options in the TRIPS Agreement that can be used to address the effects of patents on access to medicines. While this thesis concedes the view that the hindrances to accessibility of essential drugs in Nigeria are multi-faceted and demand a multi-dimensional approach for a lasting solution, it is specifically argued that the TRIPS flexibilities are significant means for addressing the challenges of affordable access to important health treatments within the context of patent law. However, it is emphasised that utilising the flexibilities will require that Nigeria’s patent system is strategically designed to take full advantage of the available safeguards and options. To this end, this study recommends ways to incorporate the flexibilities to enhance access to medicines in Nigeria while avoiding the technical and regulatory pitfalls that have trailed the enforcement of the flexibilities by other developing countries.

PhD, Unversity of the Witwatersrand, Faculty of Health, School of Public Health / Rationale Understanding how to ensure and sustain the health and health equity of urban populations is of increasing importance as over half of the world population is now urban (UNFPA, 2007). Urbanisation is taking place rapidly across Africa, with fifty percent of the continent expected to be residing in urban areas by 2030 (UNFPA, 2007). South Africa has experienced a faster rate of urbanisation compared to neighbouring countries, with almost sixty percent of the population estimated to be urban (Kok & Collinson, 2006). This process of urban growth is accompanied by in-migration from within the country and across borders. Urban growth places pressure on limited, well-located and appropriate housing, resulting in the development of informal settlements within and on the periphery of urban areas. In addition to the multiple exposures to a variety of health hazards in informal settlements, HIV presents a contextual challenge, particularly in South Africa where the highest HIV prevalence is found within urban informal settlements (Shisana, Rehle, Simbayi, Parker, Zuma, Bhana et al., 2005). South African local government has a ‘developmental mandate’ which calls for government to work with citizens to develop sustainable interventions to address their social, economic and material needs (The Republic of South Africa, 1998a). This requires local government to address the challenges of urban growth, migration, informal settlements and HIV, as outlined above (Bocquier, 2008; Landau & Singh, 2008; Landau, 2007). The current (2007 – 2011) South African National Strategic Plan (NSP) for HIV signalled a welcome shift in HIV policy, with recognition of the role of government in ensuring that (1) internal and cross-border migrant groups and (2) residents of informal settlements are able to access the continuum of HIV-related services, which includes prevention, testing, support, treatment, and access to basic services. However, guidelines are lacking to assist local government in addressing HIV-related concerns with migrant groups and in informal settlements at the local level. As a result, migrant groups and residents of informal settlements struggle to access HIV-related services, including healthcare, adequate housing, and basic services such as water, sanitation and refuse removal. Given the developmental mandate of local government in South Africa (The Republic of South Africa, 1998a), this raises the question: how should local government respond to the urban challenges of migration and informal settlements in the context of high HIV prevalence? This thesis explores how the challenges of migration and informal settlements – within a context of high HIV prevalence – interact to generate a specific urban reality that requires an appropriate urban health response at the local government level. The question of how to address the gap between discourse, theory and action is tackled. Various frameworks for urban health have been developed that aim to assist in understanding the impact of city living on urban health, several of which draw on the concept of the social determinants of urban health (SDUH) (for example Galea, Freudenberg, & Vlahov, 2005; WHO, 2008b, 2008a). However, as I will go on to argue, none of the existing urban health frameworks deal adequately with the specific complexities of developing country urban environments. In particular, the frameworks have failed to adequately account for guiding local government in responding to the challenges identified above, namely: urban growth and informal settlements; internal and cross-border migration; high HIV prevalence; and, the responsibilities of a developmental local government. Aim Based on the findings from four studies, this PhD research aims to generate a revised urban health framework that will address the following specific challenges that I argue are associated with developing country contexts: (1) urban growth and informal settlements; (2) internal and cross-border migration; (3) high HIV prevalence; and, (4) the responsibilities of developmental local government. It is proposed that this revised framework will assist local government in responding to the interlinked challenges of informal settlements and migration in a context of high HIV prevalence. Methods A series of four studies were undertaken in Johannesburg. A review of international and local literature – including existing policy – was undertaken. In order to engage with the complexity of the urban environment, the four studies draw on both quantitative and qualitative methods. These include: a cross-sectional household survey across Johannesburg inner-city and one urban informal settlement (n = 487); a cross-sectional survey with ART clients at four ART sites in the inner-city (n = 449); and semi-structured interviews with community health worker volunteers, healthcare providers, local level policy makers and programmers involved with urban health and HIV in Johannesburg. By reflecting on involvement in participatory photography and film projects, the experiences of rural migrants who enter the city through ‘hidden spaces’ are examined; the concept of ‘being hidden’ is explored as a tactic employed by marginalised groups so that they are able to find a way to enter and participate in the city. Through the four studies, a series of four central themes were identified: (1) rights to the urban social determinants of health; (2) urban livelihoods; (3) policy and governance; and (4) urban methodologies. These four themes assist in synthesising the study findings and generating a revised approach to guide local government in responding to urban health challenges in a developmental way. Key findings The developmental mandate of local government is evolving very slowly (Paper I, V). Local level responses to the interlinked urban health challenges of migration, informal settlements and HIV are lacking (Paper I, V). Where they do exist, HIV is not viewed as an intersectoral developmental challenge and vertical HIV programmes prevail (Paper V). It will be argued that informal settlements require integrated local developmental responses (Paper V). In general, policies and guidelines that outline the right to basic healthcare and ART for crossborder migrants are not implemented at the local level (Papers I and III). In addition, residents of informal settlements struggle to access adequate housing and basic services (Papers IV and V). Some internal migrant groups, who reside in ‘hidden spaces’ of the innercity, are found to employ deliberate tactics in order to evade the state, whilst others are marginalised through a lack of state intervention (Paper II). The research shows that innovative methods are required to engage with urban populations, both for research and intervention purposes. Participatory approaches are found to be useful methods for engaging with urban migrant groups and this research draws on participatory photography and film projects as examples (Paper II, V). It is essential that urban public health practitioners and other development professionals learn how to engage with the complexities of the urban environment. A review of existing urban health frameworks finds that whilst these frameworks are themselves complex, and include the multiple levels and determinants that ultimately impact health outcomes, they result in generalised and static models of urban health. I argue that these existing frameworks are unable to inform responses to the specific complexities present within a particular urban context. Through the synthesis of the four study findings, an alternative approach to assist local government and other stakeholders in responding to urban health challenges is proposed. The idea of ‘concept mapping’ is suggested as a way to vii enable local government, and other actors, to engage with the complexities of the urban context in a participatory way. A core set of components have been identified that can be used to guide the creation of city-specific ‘concept maps’, that are able to work towards identifying and addressing the specific urban health needs associated with different areas within a city. A recommitment to intersectoral action, ‘healthy urban governance’ and public health advocacy is considered critical to the effectiveness of such an approach. It is suggested that the resultant ‘concept map’ will assist local government in responding in a developmental way to the interlinked challenges of migration and informal settlements in a context of high HIV prevalence. Implications Based on the findings of the PhD research, a new approach to urban health is suggested. ‘Concept mapping’ is presented as a new tool to assist local government in achieving its developmental mandate and address urban health. Whilst developed to address the challenges faced by urban migrants and residents of informal settlements in a context of high HIV prevalence, the concept map approach is likely to be a useful tool for considering the health and development needs of other urban groups. Future research is needed to evaluate the effectiveness of the application of participatory ‘concept mapping’ to assisting local level urban health policy makers, planners, and other stakeholders respond to the interlinked challenges of migration and informal settlements in a context of HIV.

Au cours des vingt dernières années, la santé de la reproduction s’est imposée comme une priorité d’action pour le développement des pays du Sud. Au Sénégal, et dans le département de Saint-Louis, d’indiscutables progrès ont été réalisés mais certaines statistiques restent accablantes et les inégalités de santé, loin de se réduire, demeurent et se creusent. Lorsque ces disparités sont appréhendées au prisme du territoire, des configurations particulières se dessinent et font apparaître des fractures spatiales qui dépassent l’opposition classique entre la ville et la campagne. Désormais, certains quartiers et villages partagent de mêmes préoccupations sanitaires, tandis que des localités rurales acquièrent progressivement des équipements et des comportements que l’on réservait autrefois en ville. Comprendre et mesurer les inégalités territoriales de santé de la reproduction pour pouvoir travailler à leur réduction, tel est le sens de cette étude. / For the past twenty years, reproductive health has been a top priority for the developing countries. In Senegal and in The Saint-Louis department, undeniable progress has been achieved but some statistics remain bleak and health inequalities, far from decreasing tend to grow. When we look closer at these disparities over the studied region, one can observe particular configurations with layouts highlighting spatial splits which go beyond the known urban/rural divide. From now on urban areas and villages share the same sanitary concerns, while rural communities gradually acquire equipment and new habits previously reserved for towns. To understand and estimate the territorial reproductive health inequalities in order to get them to decrease, such is the goal of this study.