This paper reports experiences of health and well-being common to actors in community gardens in Berlin and Paris. Community gardening has become an ever growing phenomenon since the 1990s, and to a larger extend since 2000 in western European cities. Despite the promising research from the US that has shown that community gardens have a potential for health promotion, there is a dearth of evidence from Europe. This study tries to fill this gap and maps the potential of community gardens for health and well-being as explained and experienced by the gardeners. The effect of community garden projects on human health and well-being cannot be reduced to the effect of nature on health alone. This study shows that there are at least two other major mechanisms at play, if we want to understand the phenomenon or evaluate its effects, namely the effects of community and 'free and open spaces'. Gardeners report health-related experiences with green space, such as stress relief and feeling of calm and vitality and increased well-being through sensual experiences and observing nature. Furthermore the garden projects open up a social space, which for many gardeners creates experiences of health through regular social contact, experiences of joy of sharing and having activities together. Furthermore, the community garden project was proposed to create a context and opportunities for flow, creativity and self-efficacy if it is a free and open space. However, not all experiences on well-being in CGPs are postive, and to all these spaces and their effects there are also certain limitations and conditions. Moreover, this study makes a theoretical contribution to the concept of health and well-being on the basis of the fuzziness around the concept of health encountered in the field. I propose that a holistic concept of health might be most suitable to describe health related to bottom-up community action like community gardens. To assess the effects of such projects in terms of well-being, this concepts should be dissentagled into the concept of health and happiness, whereas happiness in turn relates not only to life satisfaction but also to eudaimonian happiness related to meaning and doing good. Although this research project could not be comprehensive enough to provide all necessary evidence to evaluate health effects of community gardens, we believe that it provides viable paths for investigations into community driven health promotion and emerging healthy settings.

Addressing complex global health challenges, including the burden of noncommunicable diseases (NCDs), will require change in sectors outside of traditional public health. Contemporary regional trade and investment agreements (RTAs) like the Trans-Pacific Partnership (TPP) continue to move further ‘behind-the-border’ into domestic policy space introducing new challenges in the regulation of health risk factors. This dissertation aimed to clarify the pathways through which RTAs influence NCDs, and to explore points along those pathways with the intent of improving the existing evidence base and supporting policy development. This work develops a critical theoretical framework exploring the ideas, institutions, and interests behind trade and investment policy; it also develops a conceptual framework specifying how trade and investment treaty provisions influence NCD rates through the effects of trade and investment on tobacco, alcohol, and ultra-processed food and beverage products, as well as access to medicines and the social determinants of health. Using health impact assessment methodology, three analytical components were designed to examine pathways of influence from RTAs to health outcomes as mediated by the interests of transnational corporations (TNCs). The first component explored the influence of industry during the TPP negotiations and how its health-related interests were reflected in the final TPP text. The second component examined the role of trade and investment liberalisation in health-harmful commodity markets, finding a rise in TNC sales after a period of liberalisation. The third component demonstrated how investor rights and investor-state dispute can challenge the state’s right to regulate if it damages the profits of TNCs, which may threaten effective health regulation, and provides opportunities to strengthen the right to regulate. The work in this dissertation provides support for the thesis that trade and investment policies are a fundamental structural determinant of health and well-being, which are highly influenced by TNCs that guide such policies in the interest of maximising their profits and protections, often to the detriment of public policy and population health. This work identifies the need for more robust health impact assessments of RTAs before future agreements are ratified, as well as an imperative to challenge vested interests that entrench neoliberal policy preferences that have hindered sustainable and equitable development.

This thesis addresses three interrelated challenges of disease mapping and contributes a new approach for improving visualization of disease burdens to enhance disease surveillance systems. First, it determines an appropriate threshold choice (smoothing parameter) for the adaptive kernel density estimation (KDE) in disease mapping. The results show that the appropriate threshold value depends on the characteristics of data, and bandwidth selector algorithms can be used to guide such decisions about mapping parameters. Similar approaches are recommended for map-makers who are faced with decisions about choosing threshold values for their own data. This can facilitate threshold selection. Second, the study evaluates the relative performance of the adaptive KDE and spatial empirical Bayes for disease mapping. The results reveal that while the estimated rates at the state level computed from both methods are identical, those at the zip code level are slightly different. These findings indicate that using either the adaptive KDE or spatial empirical Bayes method to map disease in urban areas may provide identical rate estimates, but caution is necessary when mapping diseases in non-urban (sparsely populated) areas. This study contributes insights on the relative performance in terms of accuracy of visual representation and associated limitations. Lastly, the study contributes a new approach for delimiting spatial units of disease risk using straightforward statistical and spatial methods and social determinants of health. The results show that the neighborhood risk map not only helps in geographically targeting where but also in tailoring interventions in those areas to those high risk populations. Moreover, when health data is limited, the neighborhood risk map alone is adequate for identifying where and which populations are at risk. These findings will benefit public health tasks of planning and targeting appropriate intervention even in areas with limited and poor-quality health data. This study not only fills the identified gaps of knowledge in disease mapping but also has a wide range of broader impacts. The findings of this study improve and enhance the use of the adaptive KDE method in health research, provide better awareness and understanding of disease mapping methods, and offer an alternative method to identify populations at risk in areas with limited health data. Overall, these findings will benefit public health practitioners and health researchers as well as enhance disease surveillance systems.

This thesis presents qualitative research conducted in summer 2017 at the Finger Lakes Free Clinic, which provides free medical and holistic care to people without insurance in upstate New York. The primary goal of this research was to strengthen the relationship between a free clinic and its donors by gathering donor concerns and perceptions regarding federal healthcare policy. Data from 32 interviews with donors, staff, board members, and volunteers, along with 100 hours of participant observation revealed that donors to this clinic were concerned about the potential impact of Congressional healthcare reform yet did not consider federal policy a strong influence on their donations. Rather, donors cited dedication to local giving and personal connections with the clinic as their primary motivations. These motivations suggest the value of viewing the clinic-donor relationship as a relationship of reciprocity. From this framework, the research identifies opportunities for the clinic to reciprocate donor generosity while expanding services in response to a growing need. Insights from the research will guide the clinic's response to federal policy changes and support the clinic's vision of becoming a national model for integrative care.

OBJETIVOS: Determinar la desigualdad de la prevalencia de desnutrición crónica infantil en función a algunos determinantes sociales en países de América Latina y el Caribe (ALC)  MÉTODOS: Se realizó un estudio ecológico con los indicadores de desarrollo de la base de datos del Banco Mundial. Se analizaron los indicadores de 19 países (acceso a electricidad y servicios básicos de agua en población rural, PBI per cápita, gasto en salud per cápita). La desigualdad absoluta y relativa se determinó mediante el Índice de Kuznets absoluto, y relativo, la gradiente de la desigualdad a través de índice de las gradientes de la desigualdad, y para la desigualdad proporcional se usó el (índice de concentración de salud) ICS y la curva de concentración. RESULTADOS: la brecha de las desigualdades en la prevalencia de desnutrición crónica infantil entre los países de ALC se mantuvo prácticamente sin cambios significativos a lo largo del periodo estudiado. El 20% de los países con mayor desventaja concentran el 40% de la prevalencia de desnutrición crónica mientras que el 20% de los países con mayor ventaja solo el 7-8%, medido a través del ICS. CONCLUSIONES: A pesar de que en los Objetivos de Desarrollo del Milenio se encontraban eliminar la desnutrición, ésta permanece. La brecha de desigualdad ha disminuido respecto a la gradiente de desigualdad (desigualdad absoluta), sin embargo, la desigualdad proporcional se ha mantenido igual. Para eliminar esta brecha en ALC se deben generar políticas para distribuir de forma más eficiente y equitativa los recursos destinados al gasto en salud y los sectores relacionados, para de esa forma enfocarse en los determinantes sociales debidos. / OBJECTIVES: determinate the inequality of the prevalence of chronic childhood malnutrition according to some social stratifiers in the countries of Latin America and the Caribbean (LAC) METHODS: An ecological study was carried out at the country level with the development indicators of the World Bank database. The indicators of 19 countries will be analyzed (access to electricity and basic water services in rural areas, GDP per capita, health expenditure per capita). The absolute and relative inequality was determined by the absolute and relative Kuznets index, gradient of the inequality through the graduation index of the inequality, in addition, the proportional inequality was calculated through the index of concentration in health and the curve of concentration. RESULTS: the gap of inequalities in the prevalence of chronic child malnutrition in the LAC countries, remained practically without significant changes throughout the period studied. In addition, 20% of the countries with the greatest disadvantage accounted for 40% of the prevalence of chronic malnutrition compared to 20% of the countries with the greatest advantage, which presented 7-8% of the prevalence through the index of concentration on health. CONCLUSIONS: Although the Millennium Development Goals were to eliminate malnutrition, it was not possible to do so. However, the inequality gap has partially decreased. To eliminate it In LAC, wealth should be distributed more efficiently, and equitable resources allocated to health spending and related sectors. As well as generating Policies to address inequalities in and between countries. / Tesis

Background Acculturation has effects on mental health outcomes among young newly arrived migrants and refugees. Innovative methods, such as the Time Travel Method, can help understand cultural heritage, contribute to improved acculturation and subsequently lead to positive individual as well as societal outcomes.    Aim The aim was to explore the experiences, acceptability and use of the Time Travel Method, an educational method using applied cultural heritage education, among Finnish students and young migrants and refugees introduced to the method.  Methods Data was collected during 7 weeks of internship at the Ostrobothnian Children’s Cultural Network in Finland. Participant observations and letters written by participants during Time Travel events were coded and analysed using observational method and secondary analysis of qualitative data. Result The Time Travel Method was found to be appreciated by the participants by creating a safe space which allowed for cultural expressions, learning and social cohesion. A variance in narrative and perspective between Finnish and newly arrived students was observed. The Time Travel Method allowed for improved communication, reflection and expressions of feelings. The recognition of similarities between cultures was valuable to the participants. Conclusion The Time Travel Method functions as a bridge between cultures allowing for successful acculturation. Interprofessional joint actions on all societal levels are required. Further development and initiatives focusing on culture may increase awareness of the impact of cultural heritage.

Introducción La anemia en mujeres en edad fértil sigue siendo un problema de salud pública a nivel mundial. Las intervenciones con enfoque biomédico no son suficientes para solucionar dicho problema, ya que también está ligada a los determinantes sociales. Objetivo Determinar la desigualdad en la distribución en prevalencia de anemia en mujeres en edad fértil a nivel mundial en los años 2000, 2005, 2010 y 2015. Métodos Se realizó un estudio ecológico a nivel mundial. Se utilizó la base de datos del Banco Mundial para los años 2000, 2005, 2010 y 2015; de donde se obtuvo la prevalencia de anemia en mujeres en edad fértil y los indicadores sociales gasto en salud per cápita y expectativa de vida al nacer. Se calcularon las métricas estándar de brecha y gradiente de desigualdad social en la prevalencia de anemia. Resultados La distribución en la prevalencia de anemia en mujeres en edad fértil a nivel mundial es desigual. La prevalencia es mayor en los países con menor expectativa de vida al nacer y gasto en salud. El 20% de países con menor expectativa de vida al nacer y gasto en salud per cápita concentran el 30% de la prevalencia de anemia en mujeres en edad fértil. Conclusiones La desigualdad en la prevalencia de anemia ha disminuido a nivel mundial. Es importante considerar los determinantes sociales, para seguir disminuyendo la desigualdad y por ende la prevalencia de anemia. Es importante mejorar las estrategias que se están tomando actualmente. / Introduction Anemia in women of childbearing age continues to be a public health problem worldwide. Interventions with a biomedical approach are not enough to solve this problem since it is also linked to social determinants. Objective To determine the inequality in the distribution in the prevalence of anemia in women of childbearing age worldwide in the years 2000, 2005, 2010 and 2015. Methods A worldwide ecological study was carried out. The World Bank database was used for the years 2000, 2005, 2010 and 2015; from which the prevalence of anemia in women of childbearing age and the social indicators for health expenditure per capita and life expectancy at birth were obtained. The standard metrics of gap and gradient of social inequality in the prevalence of anemia were calculated. Results The distribution in the prevalence of anemia in women of childbearing age is unequal worldwide. The prevalence is higher in countries with lower life expectancy at birth and health spending. The 20% of countries with the lowest life expectancy at birth and health spending per capita account for 30% of the prevalence of anemia in women of childbearing age. Conclusions Inequality in the prevalence of anemia has decreased worldwide. It is important to consider social determinants, to continue reducing inequality and therefore the prevalence of anemia. It is important to improve the strategies that are currently being taken. / Tesis

The aim of the thesis is the assessment of developments in the approach towards the "European" strategy Health 2020 by Czech political players while using methods of critical discourse analysis and the assessment of the development of the Health 2020 agenda during the period 2010-2012 in the context of previous activities of the World Health Organization. The approach of the Czech health care political players to the strategy had been assessed on the basis of governmental programmatic statements since 1998, the National Reform Program of Czech Republic 2011 and interviews with participants in the Czech health policy and Czech health care. The approach of Czech health policy towards the Health 2020 strategy had been evaluated as extremely problematic. The course of creation and discussion of Health 2020 in 2012 had become a critical barrier for the Czech Ministry of Health. As a result, no wider awareness of this strategy exists in Czech health policy, neither does exist a Czech translation of this strategy. Lastly, the goals of Czech health policy do not reflect in a single point of the goals of the Health 2020 strategy.

Hypertension, a medical condition, predisposes to other cardiovascular diseases, and can be impacted by the social determinants of health (SDOH). Self-measured blood pressure monitoring (SMBP) is an evidence-based approach to hypertension control, but not much is known about the influence of SDOH on SMBP. This dissertation aims to: 1) highlight the SDOH factors whose relationship with SMBP have been explored in research studies; 2) examine the relationship between SDOH and SMBP among United States (U.S.) adults with high blood pressure; and 3) examine the current state of SMBP in the U.S., highlight policy implications from the empirical study and provide recommendations. Aims 1 and 2 were informed by an adapted SDOH framework, which comprised of upstream structural determinants, and downstream intermediary determinants. Aim 1 was achieved via a scoping review of studies across three databases following the PRISMA-SCR checklist. Aim 2 was achieved via a cross-sectional analysis of data from adult respondents to the 2019 Behavioral Risk Factor Surveillance System, with self-reported hypertension. Bivariate and Multiple Logistic regression analyses were conducted. Aim 3 involved a literature scan on policy concerning SMBP, highlighting the policy implications of findings from the empirical study, and providing recommendations for policy/practice. For aim 1, findings suggest that research studies examined the relationship of relatively more structural determinants, than the few, but highly significant intermediary determinants, with SMBP. For aim 2, looking at the structural determinants, males and those who identify as Black and other minority racial groups were more likely to report SMBP. For intermediary determinants, respondents who consumed fruits, vegetables, and exercised were likely to report SMBP, while those who smoke, who drink, and those with poor mental health days were less likely to report SMBP. Respondents with health coverage and whose provider recommended SMBP were likely to report SMBP use. Those ≥65 years were more likely to report SMBP. For aim 3, I recommend that the Centers for Medicare and Medicaid Services lead policy efforts on SMBP reimbursements. Also, healthcare practices should strengthen their technological infrastructure e.g., telehealth to promote access, and Electronic Health Records to promote efficient data collection and tracking.

Introducción: El no uso de los servicios formales de la salud es un punto prioritario para la sociedad, dado que pone en evidencia las debilidades de la capacidad de atención del sistema de salud e insta su mejora, más aún en la población gineco-obstétrica y pediátrica. No se conoce con exactitud la influencia de los determinantes sociales de la salud en esta conducta en las poblaciones estudiadas. Objetivos: Evaluar la asociación y distribución del no uso de servicios formales de salud en la población gineco-obstétrica y pediátrica y los determinantes sociales de la salud. Materiales y métodos: El presente estudio es un transversal analítico, a partir de los datos del estudio poblacional ENDES 2019. Las variables de resultado fue el NUSFS para atención prenatal y atención de parto en mujeres en edad fértil. Asimismo, se evaluó este comportamiento en la búsqueda de atención para menores de 5 años que presentaron diarrea y fiebre y/o tos en los 14 días. Las variables de exposición fueron los determinantes sociales de la salud, tanto estructurales como intermedios. Se reportaron razones de prevalencia crudas y ajustadas, se tomó en cuenta la estructura compleja de la muestra. Resultados: Se encontró asociación del NUSFS para atención prenatal con estado civil conviviente (RPa=5.23 IC95%=1.34-20.39), estar afiliada al SIS (RPa=4.09 IC95%=1.08-15.41) y que perciba ingresos (RPa=3.33 IC95%=1.16-9.56). El NUSFS para atención de parto, se vieron asociados la edad de la madre comprendida entre los 35 a 49 años (RPa=0.62 IC95%=0.44-0.87), que la mujer se autorreconozca como “Mestiza” (RPa=0.53 IC95%=0.35-0.80), residir en zonas rurales (RPa=1.92 IC95%=1.48-2.48) y tener 4 o más niños nacidos (“4 hijos” RPa=1.53 IC95%=1.08-2.16). El NUSFS para diarrea en menores de 5 años se asocia la edad del jefe del hogar entre 30 y 39 años (RPa=0.71 IC95%=0.54-0.93), que la madre hable una lengua amazónica (RPa=1.97 IC95%=1.01-4.30) y que resida en la selva (RPa=1.55 IC95%=1.02-2.35). Por último, el NUSFS para la atención de fiebre/tos se asoció a la edad de la madre (“25 a 34 años” RPa=0.79 IC95%=0.68-0.93, “35 a 49 años” RPa=0.63 IC95%=0.51-0.77), pertenecer al quintil “Pobre” (RPa=1.27 IC95%= 1.07-1.50) y residir en una zona rural (RPa=0.73 IC95%=0.62-0.86). Conclusiones: Existe asociación entre el no uso de los servicios formales de la salud en las poblaciones gineco-obstétricas y pediátricas y los determinantes sociales de la salud. / Introduction: The non-use of formal health services (NUFHS) is a priority for society, since it highlights the weaknesses in the capacity of the health system and urges its improvement, even more so in the gynecological-obstetric and pediatric populations. The influence of the social determinants of health on this behavior in the populations studied is not exactly known. Objectives: To evaluate the association and distribution of the non-use of formal health services in the gynecological-obstetric and pediatric population and the social determinants of health. Materials and methods: This study is a cross-sectional analysis, based on data from the ENDES (NHS) 2019 population study. The outcome variables were the NUFHS for prenatal care and delivery in women of childbearing age. Likewise, this behavior was evaluated in seeking care for children under 5 years of age who had diarrhea and fever and/or cough within 14 days. The exposure variables were the social determinants of health, both structural and intermediate. Crude and adjusted prevalence ratios were reported, taking into account the complex structure of the sample. Results: Association of the NUFHS was found for prenatal care with cohabiting marital status (aPR=5.23 CI95%=1.34-20.39), being affiliated with SIS (aPR=4.09 CI95%=1.08-15.41) and receiving income (aPR=3.33 CI95 %=1.16-9.56). The NUFHS for delivery care was associated with the age of the mother between 35 and 49 years (aPR=0.62 CI95%=0.44-0.87), that the woman is self-recognized as "Mestiza" (aPR=0.53 CI95%= 0.35 -0.80), resides in rural areas (aPR=1.92 CI95%=1.48-2.48) and has 4 or more children born (“4 children” aPR=1.53 CI95%=1.08-2.16). The NUFHS for diarrhea in children under 5 years of age is associated with the age of the head of the household between 30 and 39 years (aPR=0.71 CI95%=0.54-0.93), that the mother speaks an Amazonian language (aPR=1.97 CI95%=1.01- 4.30) and lives in the jungle (aPR=1.55 CI95%=1.02-2.35). Finally, the NUFHS for fever/cough care was associated with the mothers age (“25 to 34 years old” aPR=0.79 CI95%=0.68-0.93, “35 to 49 years” aPR=0.63 CI95%=0.51 -0.77), belonging to the “Poor” quintile (aPR=1.27 95% CI= 1.07-1.50) and residing in a rural area (aPR=0.73 95% CI=0.62-0.86). Conclusions: There is an association between the non-use of formal health services in the gynecological-obstetric and pediatric populations and the social determinants of health. / Tesis