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.

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Sedan 2004 har en stor ökning skett av ensamkommande barn i Sverige och år 2014 kom över 7000 barn hit. Ett ensamkommande barn är ett barn som kommer utan sina föräldrar eller någon som företräder föräldrarna. Det vanligaste hälsoproblemet hos ensamkommande barn är psykisk ohälsa, på grund av bland annat traumatiska upplevelser i deras liv. Syftet med denna studie är att beskriva vad omgivande aktörer har för uppfattning om ensamkommande barns förutsättningar för god hälsa. Undersökningarna för studien har gjorts med hjälp av åtta kvalitativa enskilda intervjuer. Intervjupersonerna var människor som på något sätt har kontinuerlig kontakt med ensamkommande barn i en mindre kommun i Mellansverige. Intervjuerna analyserades i en manifest innehållsanalys. De etiska forskningsprinciperna samt kvalitetskriteriet tillförlitlighet har beaktats under undersökningens gång. I resultatet framkom att integrering, stöd och engagemang från samhället, skolan och omgivande aktörer upplevdes som förutsättningar för ensamkommande barns hälsa. Flera faktorer ansågs ha påverkan på ensamkommande barns hälsa, exempelvis trauman, utbildning, sociala relationer och möjlighet till fritidsaktiviteter. De omgivande aktörerna upplevde att dessa faktorer även kunde påverka och vara avgörande för varandra. Slutsatserna blev att det finns vissa faktorer som i större utsträckning upplevs påverka ensamkommande barns förutsättningar för hälsa. Trots att de ensamkommande barnen i viss mån anses ha goda förutsättningar finns det flera sätt att förbättra och öka deras möjligheter till god hälsa. / Since 2004, the amount of unaccompanied children in Sweden has increased and 2014 over 7000 children came here. An unaccompanied child is a child who is coming without its parents or someone who can act in their place. The most common health problem among unaccompanied children is mental illness, for instance because of traumatic incidents in their lives. The aim of this study is to describe the involved persons’ opinions about unaccompanied children’s opportunities for good health. The surveys for the study have been conducted by eight qualitative separate interviews. The persons interviewed were people who in some way have continuous contact with unaccompanied children in a smaller district in the middle of Sweden. The interviews were analyzed in a manifest content analysis. The ethic principles for research and trustworthiness have been observed during the study. The result shows that integration, support and engagement from the community, school and persons involved were experienced as conditions for unaccompanied childrens health. Several factors were considered influence unaccompanied children’s health, for example trauma, education, social relations and the possibility of recreational activities. The persons involved considered that these factors also could influence and be crucial for each other. The conclusions were that there are some factors that to a greater extent are experienced to influence unaccompanied children’s opportunities for good health. Even though the unaccompanied children in some degree are considered to have good opportunities, there are several ways of improving and increasing their possibilities for good health.

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.

This diploma thesis called 'Unemployment and its influence on health' consists of theoretical and empirical part. In the theoretical part, important terms that are connected to unemployment and labour market are summarized. The definition of the term 'health' is specified and the factors and determinants that influence it are stated as well. The term 'health disorder' and problematics of psychosomatics are discussed too. The practical part is concentrated on examination of the influence of unemployment on health. A quantitative research, method of questioning and questionnaire technique were applied here. The collection of data took place at a regional office of The Jobcentre in České Budějovice. Job seekers registered under this office formed the body of the research. This work has two aims. The first one be the influence of unemployment on health of the unemployed and the second be the finding about the influence of unemployment on development of mental and somatic disorders. The following hypotheses were set up regarding the aims of the work: H1: The unemployed state their health declines during the period of unemployment, H2: Unemployment has a negative effect on mental health of the unemployed, H3: Unemployment has a negative effect on somatic health of unemployed. The hypotheses were not verified during the course of statistical testing. Based on the results of the research, we can deduce that the duration of unemployment doesn't have an impact on the subjective evaluation of physical and mental health. While the duration of unemployment increases, we don't observe any physical or mental heath decline of the unemployed. The conclusions of this research may, however, not be generalized due to the number of respondents and region which was chosen for the research. Statistical testing, however, revealed some interesting facts. These are, for example, the connection between the duration of unemployment and the evaluation of the impact on individual's areas of life, the relation between the duration of unemployment and health state evaluation during the last employment. The research itself could possible serve as a source material or starting point for future studies in this field. The above mentioned findings could after wider research bring knowledge which would be applicable to further practical works with the unemployed.

abstract: The health situation of indigenous peoples is comparable to that of the world's poorest populations, but with the additional burdens of social and cultural marginalization, geographic and cultural barriers to accessing health services, and, in some areas, appropriation of land and natural resources. Cultural transmission (the transfer of beliefs, ideas, and behaviors from one culture to another) from outsider health institutions should presumably aid in closing this health gap by transferring knowledge, practices, and infrastructure to prevent and treat disease. This study examines the biosocial construction of the disease ecology of tuberculosis (TB) in indigenous communities of the Paraguayan Chaco with varying degrees of cultural transmission from outside institutions (government, religious, and NGOs), to determine the influence of cultural transmission on local disease ecologies. Using a biocultural epidemiological framework for the analysis of human infectious disease ecology, this study employed an interdisciplinary, mixed methods approach to examine the interactions of host, pathogen, and the environment in the Paraguayan Chaco. Three case studies examining aspects of TB disease ecology in indigenous communities are presented: (1) The effective cultural transmission of biomedical knowledge to isolated communities, (2) Public health infrastructure, hygiene, and the prevalence of intestinal parasites: co-morbidities that promote the progression to active TB disease, and (3) Community-level risk factors for TB and indigenous TB burden. Findings from the case studies suggest that greater influence from outside institutions was not associated with greater adoption of biomedical knowledge of TB. The prevalence of helminthiasis was unexpectedly low, but infection with giardia was common, even in a community with cleaner water sources. Communities with a health post were more likely to report active adult TB, while communities with more education were less likely to report active pediatric TB, suggesting that healthcare access is the major determinant of TB detection. More research is needed on the role of non-indigenous community residents and other measures of acculturation or integration in TB outcomes, especially at the household level. Indigenous TB burden in the Chaco is disproportionately high, and better understanding of the mechanisms that produce higher incidence and prevalence of the disease is needed. / Dissertation/Thesis / Doctoral Dissertation Social Science and Health 2014