Using data collected in 2007 for Addis Ababa Mortality Surveillance, the paper examines the effect of cause of death/type of illness on choice of health care in adults 12 years and above. The multinomial logit model using bootstrapped standard errors is used to investigate the relationship between dominant type of treatment and the covariates: cause of death, gender, age, education, occupation, ethnicity and religion. Availability of water, television and telephone in the household are used as a proxy for economic status. After controlling for duration of illness (exposure), type of illness, gender and marital status are significant. Those who die of HIV/TB and cancer behave similar in way they seek help, and have high likelihood of using traditional healers as the first point for help compared to those who died as a result of other illnesses. Thus the study concludes that cause of death; gender and marital status affect choice of health service.

The growing Thai community in Eastern Massachusetts has an unofficial ethnic enclave that surrounds the neighborhood of Allston/Brighton. Studies of Thai communities in the United States indicate that Thai-Americans have limited access to quality health care in the United States due to factors that contribute to health disparities such as language barriers and cultural beliefs. As a result, Thai people have different approaches to how they treat illnesses through traditional Thai medicine (TTM), Western medicine (also called biomedicine), or a mixture of both medical systems. This study examines healthways Thai/Thai Americans in Eastern Massachusetts draw on in response to different illnesses. In-depth stories of how this community engages in illness prevention and responses to the experiences of illness illuminated by Thai people’s approaches to different medical systems helps us understand how they present their values when seeking medical care. I argue that responses to various illness episodes experienced by members of the Thai community in Eastern Massachusetts influence perceived health and health-seeking behaviors. Factors that contribute to Thai-American health practices include: religion, sociocultural elements (cultural identity, generational differences, cross-cultural differences, structural violence), and Thai constructs of illness and well-being.

This thesis explores the health-related decisions Latin American immigrant women make in MetroWest Massachusetts. Within public health and biomedical literature, women from Spanish-speaking communities are often measured by their adherence to biomedical guidelines. Several programs have been designed to increase compliance with recommended cancer screenings like Pap smears and mammograms in an effort to reduce health inequities between Latina populations and their white counterparts in the United States (Peek and Han 2009). Community Health Organizations often prioritize biomedical models of care, as Community Health Workers are typically trained in public health and biomedicine. Yet little research has been done on women’s conception of their own health. Using the theoretical concept of patterns of resort, this research examines what women prioritize for their own health needs, why, and what local resources women use to meet these needs. Women have a broad understanding of their own health, and use varying resources to meet the needs of physical, emotional, mental, social and spiritual health needs. By understanding these specific health needs, researchers and those invested in immigrant communities may create more effective programs with women’s health in mind.

BACKGROUND: All human societies have developed ways of maintaining health, dealing with illness and injury in ways that conform to their culture and environment. People worldwide draw upon a variety of healing systems, therapeutic methods, practices, and products, often referred to as Traditional and Complementary Medicine (T&CM). The World Health Organization (WHO) has encouraged member states to develop national policies that advance the integration of T&CM in national healthcare systems to harness their potential contribution to health, wellness, and people-centered health care. Yet, no global guidelines have been developed for assisting countries in structuring and developing such policies, and little is known about the characteristics of existing T&CM policies in Latin America and their level of implementation. METHODS: A qualitative research design was used to conduct a landscape analysis characterizing existing therapeutic pluralism policies in Latin American countries through a comprehensive literature review, a policy focused qualitative content analysis, key informant interviews and a case study analyzing the formulation process of Brazil's National Policy for Integrative and Complementary Health Practices (PNPICS). A technical cooperation tool to guide T&CM policy development and revision for Latin American countries was refined through face validation and an expert consensus method (Delphi process). Data categorization and analysis were performed in MS Excel and NVivo, using deductive and inductive coding. RESULTS: A total of 74 T&CM policy documents from the 16 Latin American countries were identified and characterized according to policy mechanisms. A typology of Latin American policy approaches identified policies as: health services-centered, model of care-based, participatory, and indigenous people-focused. Selection of T&CM practices for policy inclusion vary across countries; criteria change over time in Brazil might have compromised PNPICS’ political status. Lack of PNPICS financing jeopardized its implementation. A technical cooperation tool for T&CM policy development was structured on the policy cycle: national situation analysis, policy formulation, policy implementation, policy monitoring and evaluation, and policy re-formulation, re-prioritization for incremental policy developments. CONCLUSION: With a few exceptions, therapeutic pluralism policy implementation in Latin America seems to be a real challenge, often reducing policies to cultural and political symbols. Continued research is needed on assessing the various stages of the policy process in T&CM. / 2023-09-10T00:00:00Z

Cette thèse porte sur les représentations et pratiques relatives aux corps et aux soins dans un village des Andes sud‐péruviennes. Cet objet, a priori classique pour l’ethnologie andine, est ici abordé dans une situation dynamique, pluraliste et politisée avec une approche qui se distingue clairement de la démarche habituellement suivie. Si ces représentations et pratiques ont tout d’abord été appréhendées au sein des espaces domestiques et auprès des guérisseurs, c’est ensuite le poste de santé, structure officielle de santé publique, qui a été pris en compte dans le pluralisme médical local. Ses rapports avec les villageois ont alors été analysés sous l’angle du pouvoir. Et son influencesur les pratiques de soins, sur les corps et sur les représentations correspondantes a été interrogée. Afin de saisir les transformations en cours depuis plus d’une trentaine d’années, une perspective diachronique a finalement été suivie. C’est ainsi qu’a pu être mise au jour une dynamique de contrôle et de normalisation des corps et des individus par la santé publique. Phénomène qui se traduit pour l’instant par une transformation des pratiques de soins mais aussi des corps individuels ainsi que par une différenciation croissante du corps social. Avec le renouvellement générationnel, ceprocessus de transformation, relativement récent mais néanmoins profond, peut probablement mener à un véritable basculement socioculturel ici résumé par l’expression "d’un corps à l’autre" qui désigne non seulement le passage "d’un corps individuel à l’autre" mais aussi celui "d’un corps social à l’autre". / This thesis focuses on representations and practices related to bodies and cares in a South Peruvian Andes village. This object, which seems classical in Andean ethnology, is discussed here in a dynamic, pluralistic and politicized situation with an approach which is clearly distinguishable from the usual processes. If these representations and practices have first been understood in domestic spaces and among healers, it is then the health station, a formal structure of public health, which has been taken into account in the local medical pluralism. Its relationships with the villagers were then analyzed interms of power. Its influence on care practices, on the body and its corresponding representations was questioned. To capture the changes taking place for over thirty years, a diachronic perspective was finally chosen. Thus, a dynamic of control and normalization of bodies and individuals by the public health could be brought to light. A phenomenon that resulted so far in transforming care practices but also individual bodies, as well as in increasing differentiation of the society. With generational renewal this transformation process, relatively new but nevertheless deep, can possiblylead to a real sociocultural swing here summarized by the expression "from one body to another" which refers not only to the passage of an "individual body to another" but also "from a social body to another".

This dissertation examined health care utilization patterns across conventional health care (CHC), complementary and alternative medicine (CAM), and public health care (PHC) systems among Canadians aged fifty and older. I argued that utilization research is currently limited by a primary focus on discrete use of health care services, largely within the CHC system (i.e., medical doctors, specialists, hospitals). However substantial growth in use of CAM and PHC, particularly among late middle-age cohorts, suggests the need to widen the research lens from discretionary service use within health care systems to include medical pluralism or use across health care systems. To address the lack of research on medical pluralism and the need for a comprehensive overview of service use, I used two different strategies to create discrete patterns of service use and non-use. To frame the predictors of these patterns, a medical pluralism paradigm was proposed, which suggests that there are distinct social location and health characteristics that may explain use across health care systems. Five hypotheses were tested using data pooled from two cycles of the Canadian Community Health Survey (Cycles 2.1 [2003] and 3.1 [2005]) to create an overall sample (n=117,824). Results from the deductive (variable oriented) and inductive (person centred) strategies were compared. Differences in both the number and form of patterns are apparent. Across both strategies, the most common pattern is dual use of CHC (medical visits, specialist visits) and PHC (flu shots, sex-specific screening) but not CAM (chiropractors, other CAM providers). Consistent with the literature, women use more types of services overall than do men. The gender effect is significantly mediated by age: older men are less likely to use services across the three health care systems than older women. Strong evidence for a socioeconomic gradient in medical pluralism is also found. Higher levels of income and education increase the likelihood of using services across the three health care systems compared to low and middle levels of both income and education. The relationship between race and health service use was much less significant. Long-term immigrants demonstrate tri-use patterns close to those of Canadian born individuals; however, service differentials remain even after controlling for health needs, in favour of native-born Canadians. Medical pluralism is also associated with health related-need as support was found for both illness and wellness care. Lastly, regional differences point to a greater likelihood of medical pluralism in western Canada, but not always in urban areas. In future, a longitudinal examination of medical pluralism is necessary and would help establish the sequencing of services and how services are used in relation to the disablement process. Health policy would thus benefit from insight into the extent of service duplication for specific conditions and clarify the role of medical doctors in referral processes. / Graduate

<p>Urban Aboriginal health and health-related issues are steeped within the sociohistorical, sociocultural, and sociopolitical experiences of Aboriginal peoples since European contact. Thus, urban Aboriginal health issues are very complex in that they consist of aspects associated with collective as well as individual cultural and political life experiences. Therefore, in order to adequately address Aboriginal health issues a comprehensive and multidisciplinary approach is required.</p> <p>This study examines how Anishnawbe Health Toronto, an urban Aboriginal community health centre, addresses the specific healthcare needs of the urban population through a multidisciplinary culturally appropriate healthcare model. As my research evolved, a few themes emerged from the data. First, the health issues experienced by the clientele were inherently complex and simultaneously infused with a culturally collective and individualistic quality. Second, practitioners acknowledged and addressed the complex nature of the clients’ health problems through a unique model of health care created at the centre. Third, the philosophy, infrastructure, and model of health care at Anishnawbe Health Toronto goes beyond the notion of merely offering access to both systems of health care, and instead constitutes an innovative and culturally appropriate system of care which is under Aboriginal control, development and implementation. Therefore, through my analysis of these themes, I conclude that the model of health care developed at the centre is an example of complex solutions designed to address complex Aboriginal health issues and as a result, facilitate the embodiment of self-determination in the area of health care.</p> / Doctor of Philosophy (PhD)

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No description available.

<p>This thesis analyse how life-histories are expressed and reformulated in connection to a life crisis of ill health. The study is based on ten interviews with people who in connection with ill health have made use of treatments within both orthodox medicine and complementary medicine and who have also developed various forms of self-treatment. The overall aim is, with a point of departure in the concepts health, healing and trust, to analyse narratives as a practice through which the respondents create identity and a life-context. The signifi cance of constructing the (auto)biography of the healing narrative – a form of narrative and performative act – runs as the main thread through the thesis. This act makes up the practice that is recurrently discussed in several of the thesis’ chapters and is synonymously termed the telling of healing narratives or or to narrate health and healing. The analysis of the narrative’s The analysis of the narrative’s healing main themes is mirrored in the order of the chapters. The study is broadly thematic and structured as a generalised healing process beginning with upheaval, continuing with crisis and social drama, and further to the endeavour of expressing values and judgements in a public context.</p><p>The interview themes of self-treatment and alternative treatment have occasioned the investigation into what an ethno-medical perspective can bring to analyses of people’s experiences of ill health in an everyday medical context. One of the points of having the concept ethno-medicine as a starting point is that every practice or narrative formation is ascribed with a potential for interpretation in its creation of knowledge. Another chapter deals with two themes of identity and life-history construction in the practice of healing narratives – the need for a chronology and reappraised perspectives on body, health and lifestyle. Healing narratives can be understood as a genre of life-historical narratives where life is often described as a linear course of events. A model by the anthropologist Victor Turner on the course and content of social drama is used as a comment to analyses of three respondents’ narratives in another chapter. A drama can be understood as a tragic course of events, based on an accident or an upsetting incident that roughly revolves around event/crisis, chaos and the striving for restoration. The concept of other journals is then used to make visible the everyday medical administrative practice and refers to the documentation used in the form of collected documents, written notes, and diaries. As an unexpected part of healing processes, the necessity of familiarising oneself with rules, laws and health insurance systems in order to be able to claim one’s rights is brought forward.</p><p>The social transformation process of various care practices in society makes up both a context and a commonly occurring theme in the narratives that the thesis is based upon. A modern health culture that gains strength from loosely composed social movements exerts infl uence on all levels of society. With an increased individual responsibility, the need grows to fi nd one’s own healing strategies and to create one’s own life-history in narratives that mirror this transformation in an everyday context. Healing narratives can be seen as a form of evaluation of health-care practices where experiences of treatment and notions of health and cure and healing are concretised.</p>