A tuberculose é uma das dez principais causas de morte dentre as doenças infecciosas no mundo, o que evidencia a doença como um problema de saúde pública. A redução da mortalidade por tuberculose em 95% até 2035, proposta pela Estratégia End TB, tem sido desafiadora para o Brasil devido sua extensão territorial, variações culturais e desigualdades na distribuição dos recursos de proteção social e de saúde. Assim, buscou-se analisar a relação espacial e espaço-temporal dos determinantes sociais e o risco de mortes por tuberculose em Cuiabá. Trata-se de um estudo ecológico, realizado na cidade de Cuiabá, capital do estado de Mato Grosso. As unidades de análise do estudo foram as Unidades de Desenvolvimento Humano (UDHs) e a população foi constituída por casos de óbitos que apresentaram como causa básica a TB registrados no Sistema de Informação sobre Mortalidade (SIM) entre 2006 a 2016, residentes na zona urbana do município. Para identificação das áreas de risco das mortes por tuberculose, utilizou-se a estatística de varredura. Em seguida, recorreu-se à técnica da Análise de Componentes Principais que permitiu a elaboração das dimensões dos determinantes sociais. A associação entre os determinantes sociais e as áreas de risco das mortes por tuberculose foi obtida, por meio da regressão logística binária. As modelagens Bayesianas foram empregadas, por meio da abordagem Integrated Nested Laplace Approximation (INLA), para verificar os riscos relativos temporais e espaciais e avaliar sua a relação com covariáveis representativas dos determinantes sociais. Nesse período foram registradas 225 mortes por tuberculose, identificou-se aglomerado de risco para a mortalidade por tuberculose, com RR = 2,09 (IC95% = 1,48-2,94; p = 0,04). No modelo logístico, os determinantes sociais relacionados ao déficit escolar e pobreza estiveram associados ao aglomerado de risco de mortes por tuberculose (OR=2,92; IC95% = 1,17-7,28), a renda apresentou uma associação negativa (OR=0,05; IC95% = 0,00 - 0,70). O valor da curva ROC do modelo foi de 92,1%. Em relação aos modelos Bayesianos observou-se redução do risco de morte por tuberculose entre 2006 (RR=1,03) e 2016 (RR=0,98) e ainda áreas de risco que persistem por mais de uma década. Dentre os determinantes sociais, a renda foi um importante fator associado ao risco de morte por tuberculose, sendo que o aumento de um desvio padrão na renda correspondeu à diminuição de 31% no risco de mortalidade por tuberculose. Os resultados do estudo apontam que existe associação entre os determinantes sociais e o risco de mortalidade por tuberculose no município investigado, sendo este um fenômeno que persiste no tempo. O investimento em políticas públicas de melhoria de distribuição de renda pode favorecer a mudança dessa realidade. Espera-se que os achados possam nortear gestores e trabalhadores no âmbito local e regional / Tuberculosis is one of the top 10 causes of death among infectious diseases in the world, which shows the disease as a public health problem. The reduction of tuberculosis mortality by 95% up to 2035, proposed by the End TB Strategy, has been challenging for Brazil due to its territorial extension, cultural variations and inequalities in the distribution of social protection and health resources. Thus, we sought to analyze the spatial and spatial-temporal relationship of social determinants and the risk of deaths from tuberculosis in Cuiabá.This is an ecological study conducted in the city of Cuiaba, capital of Mato Grosso. The units of analysis of the study were the Human Development Units (UDHs) and the population was constituted by cases of deaths that presented the basic cause of TB registered in the Mortality Information System (SIM) between 2006 and 2016, of the municipality.To identify the risk areas for tuberculosis deaths, the scan statistic was used. Next, we used the technique of Principal Component Analysis that allowed the elaboration of the dimensions of social determinants. The association between social determinants and risk areas for tuberculosis deaths was obtained through binary logistic regression. Bayesian modeling was used, through the Integrated Nested Laplace Approximation (INLA) approach, to verify temporal and spatial relative risks and to evaluate its relationship with covariables representative of social determinants. During this period, there were 225 deaths due to tuberculosis and a risk cluster was identified for tuberculosis mortality, with RR = 2.09 (IC95% = 1.48-2.94, p = 0.04). In the logistic model, the social determinants related to school deficit and poverty were associated with the risk cluster of deaths due to tuberculosis (OR = 2.92, IC95% = 1.17-7.28), income had a negative association (OR = 0.05, IC95% = 0.00 - 0.70). The value of the ROC curve of the model was 92.1%. In relation to Bayesian models, there was a reduction in the risk of death due to tuberculosis between 2006 (RR = 1.03) and 2016 (RR = 0.98), as well as risk areas that persisted for more than a decade. Among the social determinants, income was an important factor associated with the risk of death due to tuberculosis, and the increase of a standard deviation in the income corresponded to a 31% decrease in the risk of mortality due to tuberculosis. The results of the study indicate that there is an association between the social determinants and the risk of mortality due to tuberculosis in the municipality under investigation, which is a phenomenon that persists over time. Investment in public policies to improve income distribution may favor a change in this reality. It is hoped that the findings will guide managers and workers at local and regional levels

Background: The importance of tackling economic, social and health-related inequities is increasingly accepted as a core concern for the post-Millennium Development Goal framework. However, there is a global dearth of high-quality, policy-relevant and actionable data on inequities within populations, which means that development solutions seldom focus on the people who need them most. INTREC (INDEPTH Training and Research Centres of Excellence) was established with this concern in mind. It aims to provide training for researchers from the INDEPTH network on associations between health inequities, the social determinants of health (SDH), and health outcomes, and on presenting their findings in a usable form to policy makers. Objective: As part of a baseline situation analysis for INTREC, this paper assesses the current status of SDH training in three of the African INTREC countries - Ghana, Tanzania, and South Africa - as well as the gaps, barriers, and opportunities for training. Methods: SDH-related courses from the three countries were identified through personal knowledge of the researchers, supplemented by snowballing and online searches. Interviews were also conducted with, among others, academics engaged in SDH and public health training in order to provide context and complementary material. Information regarding access to the Internet, as a possible INTREC teaching medium, was gathered in each country through online searches. Results: SDH-relevant training is available, but 1) the number of places available for students is limited; 2) the training tends to be public-health-oriented rather than inclusive of the broader, multi-sectoral issues associated with SDH; and 3) insufficient funding places limitations on both students and on the training institutions themselves, thereby affecting participation and quality. We also identified rapidly expanding Internet connectivity in all three countries, which opens up opportunities for e-learning on SDH, though the current quality of the Internet services remains mixed. Conclusions: SDH training is currently in short supply, and there is a clear role for INTREC to contribute to the training of a critical mass of African researchers on the topic. This work will be accomplished most effectively by building on pre-existing networks, institutions, and methods.

This thesis looks at fundamental disagreements about the role of society in the delivery of health care services. In particular, it develops an argument for viewing health care as a human right, and in doing so, argues that society is at least partially responsible for the health of its members. In the first section of the thesis, I argue that health is a human need, and that the institutional goal of health care is to restore to an individual their health. As an institution, health care is a primary social good and, as such, it ought to be afforded the same institutional protections as other primary social goods, and encoded as a “human right.” In the second section, I tackle the “Difficult Costs” objection, noting that while there is high financial cost associated with the provision of health care services, the moral and social cost of not providing health care and viewing it as a human right far outweighs the financial costs. With another appeal to Rawlsian principles, by way of reflective equilibrium, I argue that the design of an institution is paramount to the cost-effective distribution of health care resources in accordance with the view that health care is a human right. In the final section, I acknowledge that the objections to health care as a human right should be taken seriously, and that they form the basis of the limits to this right. I argue that any right to health care cannot be extended beyond the restoration of basic, species-typical normal human function. I acknowledge that the Rawlsian ideal has difficulty rendering decisions where priority is a central concern. Finally, I suggest that these limitations can be overcome when the right to health care is viewed as progressively realizable, in conjunction with other basic human rights.

This thesis looks at fundamental disagreements about the role of society in the delivery of health care services. In particular, it develops an argument for viewing health care as a human right, and in doing so, argues that society is at least partially responsible for the health of its members. In the first section of the thesis, I argue that health is a human need, and that the institutional goal of health care is to restore to an individual their health. As an institution, health care is a primary social good and, as such, it ought to be afforded the same institutional protections as other primary social goods, and encoded as a “human right.” In the second section, I tackle the “Difficult Costs” objection, noting that while there is high financial cost associated with the provision of health care services, the moral and social cost of not providing health care and viewing it as a human right far outweighs the financial costs. With another appeal to Rawlsian principles, by way of reflective equilibrium, I argue that the design of an institution is paramount to the cost-effective distribution of health care resources in accordance with the view that health care is a human right. In the final section, I acknowledge that the objections to health care as a human right should be taken seriously, and that they form the basis of the limits to this right. I argue that any right to health care cannot be extended beyond the restoration of basic, species-typical normal human function. I acknowledge that the Rawlsian ideal has difficulty rendering decisions where priority is a central concern. Finally, I suggest that these limitations can be overcome when the right to health care is viewed as progressively realizable, in conjunction with other basic human rights.

No description available.

While previous health research with Aboriginal populations focused almost exclusively on Aboriginal Peoples of First Nations descent living on reserves or in isolated rural communities in Canada, this study focusing on diabetes aimed to engage Aboriginal Peoples of First Nations and Métis descent living in an urban Ontario setting. Type 2 diabetes mellitus is a progressive metabolic disorder that affects Aboriginal Peoples of Métis and First Nations descent disproportionately compared to the rest of the Canadian population. To understand this disparity in diabetes incidence and to address issues with existing diabetes prevention and management strategies, this study: a) explores the perceptions surrounding Type 2 diabetes and its prevention from First Nations and Métis community people and health service providers and policy makers; and b) informs the existing diabetes prevention, management and care strategies in light of these perceived understandings. Primary data was collected through 40 in-depth one-on-one narrative interviews with First Nations and Métis people, health service providers and policy makers. Thematic codes that emerged through the narrative analysis of this data revealed that to fully understand the social determinants of diabetes in an urban First Nations and Métis people’s context required the application of intersectionality theory, since production of First Nations and Métis diabetes is socially determined and deeply intersectional. By combining the concepts of the social determinants of health and intersectional approaches, narrative analysis of the primary data revealed that diversities in socio-economic, cultural, legal and spatial contexts determine First Nations and Métis people’s life choices and have a strong bearing on their health outcomes. First Nations and Métis participants’ narratives revealed that dimensions of marginalization were reflected not only through inadequate material resources, but also through intersections of multiple factors such as colonial legacies, stereotyping, legal statuses, and the pan-Aboriginal nature of government policies and services. First Nations and Métis community members indicated that preventive programming aimed at avoiding or managing diabetes should be grounded in balancing and restoring the positive aspects of physical, mental, spiritual and emotional health and should also balance their diverse needs, lived realities, and social circumstances. The views of health service providers and policy makers captured in this thesis tended to reflect an understanding of diabetes causation grounded in both biomedical and intersecting social determinants of health. At the pragmatic level, however, the solution to this health issue presented by health service providers and policy makers addresses only the measurable individualistic biomedical risk factors of diabetes. Policy makers also discussed the need for developing qualitative indicators of the success of presently implemented health programs. Overall, the results of this study indicated that effective diabetes prevention and management strategies for urban First Nations and Métis people must recognize and address the diversities in their historical, socio-economic, spatial and legal contexts as well as their related entitlement to health services. A comprehensive diabetes prevention strategy should target the social determinants of health that are specific to urban First Nations and Métis people and must build on community strengths.

Courtesy stigma is the public disapproval evoked as a consequence of associating with a stigmatized individual or group. While there are few examples of research applying the concept of courtesy stigma to the professional associates of stigmatized persons, courtesy stigma has been shown to limit the social support and social opportunities available to family members who come to share some of the shame, blame and loss associated with their family member’s stigma(s). Research on the occupational health of persons performing frontline service work examines various sources of workplace demands and rewards, including the availability of public funding for the health and social service sectors, the devaluation of feminized forms of care-oriented work, and the downloading of responsibility for providing care to poorly paid or unpaid workers in the community and home. This research project blends the literatures on courtesy stigma and the occupational health of frontline service workers to understand the work experiences of those providing frontline social services to sex workers. A mixed methods design is used to study the workplace experiences of a small group of workers in a non-profit organization providing support and educational services to sex workers. The findings reveal that courtesy stigma is a discernable experience among this vulnerable group of service workers, affecting their work, community and family contexts. Courtesy stigma played a significant role in staff perceptions of others’ support for themselves and their work activities, leading to diminished opportunities for collaborative relationships, emotional exhaustion, altered service practices, and a low sense of workplace accomplishment. Thus, courtesy stigma forms part of the package of conditions that leads to high turnover, diminished workplace health, and a loss of service capacity in the frontline health and social service sector. The dissertation concludes with a consideration of the implications of the findings for the literatures on courtesy stigma and frontline service work, arguing that courtesy stigma is an underestimated determinant of occupational health for frontline service providers serving socially denigrated groups.

Best Practices: Does it mean the same thing in the Aboriginal community as it does in the Health Authorities when it comes to diabetes care? / Population Health

The present thesis entitled "Health and social situation of unemployed persons living in Český Krumlov" deals with the issue of unemployment in the context of a human life situation. The five chapters the theoretical section define issues of health and its determinants with emphasis on the social determinants of health, and also deal with the characteristics of unemployment from an economic and social health point of view, the definition of the competencies of the Labour Office and other employment services, as well as with specific information about Český Krumlov including unemployment statistics relating to its territory. The practical part is based on quantitative research study. To collect data for this survey, interviewing method (a questionnaire) was used. A specific questionnaire was created, which contained mostly closed questions in the form of scales with a bilateral scale used for measuring the living situations of people questioned. Research tool focused on the subjective evaluation of the respondents in the areas of financial, social and health situation. The research sample consisted of individuals registered as jobseekers with the Labour Office in Český Krumlov. That means I used a deliberate choice through institutions. The selection was conducted by direct addressing potential respondents upon arriving at the Labour Office workplace in Český Krumlov. The questionnaires were distributed personally, so the return was 96.7%. After elimination of incomplete or logically incorrectly completed questionnaires, a total of 353 questionnaires were collected using the afformentioned procedure. The aim was to describe the health and social situation of unemployed persons living in Český Krumlov region and determine whether there is a relationship between social and health situation of the unemployed, and the relationship between unemployment length records and social situation of the unemployed. In line with the objectives of the work, two basic research questions were established in the following wording: "Does the subjective assessment of selected characteristics of the social situation reflect in the subjective evaluation of selected aspects of health of the unemployed?" And "Does the length of registration reflect in the subjective evaluation of the social situation of the unemployed?" To the research questions, the hypotheses were determined, which assumed that increasing the value of one variable will increase the value of the other variable. As the characteristics of the social situation for the first research question were chosen: duration of the records, perception of unemployment, living with a partner and financial situation. Health was due to the characteristics of the social situation assessed from three aspects - overall, mental and physical. The results of this research thus show that three out of four selected characteristics are reflected in the health of unemployed people in at least two respects. In terms of social situation, the results confirmed that the duration of the unemployment records are deteriorating financial situation and also the tolerance of the people around towards the unemployed from the perspective of the job seekers. These findings not only correspond with the current knowledge in this area, but also point out that the health and social problem of unemployment is still relevant even today, when the existential threat to the unemployed is averted. The diploma thesis could thus serve the Labour Office in Český Krumlov in the basic orientation about the health and social status of their registered candidates. Furthermore, it could be an incentive for local nonprofit organizations to establish cooperation with the unemployed if needed. The thesis could also enrich the existing research dealing with this issue in one of the regions with the highest unemployment rates in the country.

A discriminação étnico-racial é um evento estressor capaz de produzir múltiplos danos físicos e mentais. Apesar do crescente interesse científico mundial e de ser tema estratégico para a saúde coletiva, permanece pouco estudado no Brasil, especialmente quando comparado aos EUA, responsável por expressiva produção acadêmica nessa área. Acerca das comunidades remanescentes de quilombo, são ainda mais escassos os dados disponíveis na literatura sobre a sua situação de saúde, sendo nula a investigação abrangendo discriminação étnico-racial entre esses indivíduos. Buscando contribuir para essas questões, a presente pesquisa analisou as frequências de discriminação entre os adultos quilombolas do município de São Lourenço do Sul/RS, por intermédio da escala Experiences of Discrimination, além de verificar as condições sociodemográficas e de saúde dessa população, mensurados pelos questionários da Pesquisa Nacional de Saúde adaptados para esse trabalho. Foram realizadas 103 entrevistas, sendo a amostra composta por 55,3% de mulheres, 71,8% com idades entre 18 e 59 anos e 72,8% da raça/cor preta. A prevalência de discriminação étnico-racial percebida em algum momento da vida foi de 59,2%, resultado superior ao encontrado em outros estudos importantes acerca do tema no país. As frequências com que os entrevistados reportaram ter sofrido discriminação nos contextos cotidianos investigados variaram de 1,9% ao pedir crédito ou empréstimo bancário até 28,2% ao frequentar a escola. Os itens acerca de agravos em saúde revelaram alta (64,1%) frequência de doenças crônicas, sendo a hipertensão arterial sistêmica (45,6%) a doença mais prevalente. Foram baixos os índices de tabagismo e de uso abusivo de álcool. Os resultados desse estudo permitem concluir que a prevalência de discriminação racial nas comunidades remanescentes de quilombo do município de São Lourenço do Sul foi alta e o local no qual ela foi percebida com maior frequência foi o ambiente escolar. É de suma importância que se reconheça a existência da prática do racismo dentro da sociedade brasileira para que se sistematizem ações para transformar essa realidade. / The ethnic-racial discrimination is a stressor event related to multiple physical and mental damages. However, despite the growing scientific interest in a global scale, it remains little studied in Brazil, especially when compared to the USA, responsible for expressive academic production in this area. Concerning the remaining communities of quilombo, the data available in the literature about their health status is even scarcer, with no research covering ethnic-racial discrimination on these individuals. In order to analyze these questions, the present study investigated the frequencies of discrimination among quilombola adults in the city of São Lourenço do Sul / RS, through the scale “Experiences of Discrimination”, beside verifying the sociodemographic and health conditions of this population, measured by questionnaires of the National Health Survey adapted for this work. A total of 103 interviews were conducted, with 55.3% of women, 71.8% between 18 and 59 years old, and 72.8% of blacks. The prevalence of ethnic-racial discrimination perceived at some point in life was 59.2%, a result superior to that found in other important studies on this matter in the country. The frequencies with which respondents reported discrimination in the daily contexts of the questionnaire ranged from 1.9% when applying for credit or bank loan up to 28.2% when attending school. The items about health problems revealed a high (64.1%) frequency of chronic diseases, with systemic arterial hypertension (45.6%) being the most prevalent disease. The rates of smoking and alcohol abuse were low. The results of this study allow us to conclude that the prevalence of racial discrimination in the remaining communities of quilombo in the municipality of São Lourenço do Sul was high and the place where it was most frequently perceived was the school environment. It is extremely important to recognize the existence of the practice of racism within Brazilian society to systematize actions to change this reality.