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This case study was conducted to give an in-depth analysis of the local stakeholder’s views on the role of education in Babati, Tanzania. The goal is to investigate differences and similarities between the views in Babati and mainstream western views, exemplified by the theory of Martha Nussbaum and Amartya Sen while being attentive to gender and socioeconomic differences. The purpose of this study is to examine local stakeholders' views, mainly guardians and educators on the role of education and to relate these to western mainstream views. The study results have been achieved with the help of the fieldwork executed in Babati, Tanzania where interviews and observations were made.  Previous literature emphasizes that education is considered necessary for enabling problem-solving, and fostering individual and societal advancements. Further, education is declared to be a right for all on the justification that it works to strengthen the respect of human rights, fundamental freedom and the development of human personality. Despite the consensus on the importance of education, the role of education remains complex and differs across contexts and socioeconomic groups, including gender and socioeconomic differences.  The quality, access, and attitudes to education in Tanzania have changed during recent years. These changes resonate with, among other things, higher enrollment, increased number of schools, educators with higher qualifications, and food served at school. The results show that education is perceived as central in the widely agreed upon quest to shape children into “good people” and that lead “good lives”. Although there are obstacles that hinder people from achieving these outcomes and reaching their fullest potential.

I denna studie har vi med ett kvantitativt tillvägagångsätt analyserat hur den självskattade hälsan hos en sjukdomspopulation förhåller sig till socioekonomiska faktorer, social kontext och de tre inkomsthypoteserna. De tre inkomsthypoteserna avser absolutinkomsthypotesen, relativinkomsthypotesen och inkomstskillnadshypotesen. Datamaterialet som ligger till grund för denna studie baseras på registerdata över cirka 7700 patienter över 18 år från Stockholms län som genomgått ryggkirurgi under åren 2006–2016. Den självskattade hälsan analyserades både vid inskrivningstillfället i samband med ryggkirurgi samt som förändringen i den självskattade hälsan från inskrivningstillfället till ett år efter operationen. Till vår vetskap har tidigare forskning inte i någon större utsträckning analyserat sambandet mellan socioekonomiska faktorer och förändringen i självskattad hälsa i samband med vårdinsats, vilket är en del av vårt forskningsbidrag. Resultaten indikerar att social kontext inte har ett statistiskt signifikant samband med förändringen i självskattad hälsa. Vid analys av den initiala hälsonivån finner vi dock tvetydiga resultat för inkomstskillnadshypotesen och relativinkomsthypotesen. Vi finner att absolutinkomsten har en positiv korrelation med den självskattade hälsan både vid inskrivningstillfället och vid förändringen. Vi finner även att universitetsutbildning har ett statiskt signifikant och positivt samband med förändringen i självskattad hälsa dock gäller inte detta för den självskattade hälsan vid inskrivningstillfället. Våra resultat indikerar även att vara född utanför Europa har en statistiskt signifikant negativ korrelation med den självskattade hälsan vid inskrivningstillfället samt vid förändringen i självskattad hälsa. Våra resultat ger en djupare förståelse för vilka faktorer som kan ligga till grund för skillnader i självskattad hälsa hos en sjukdomspopulation. Vidare ger studien underlag för utformning av policyrekommendationer som riktar sig mot en jämnare fördelning av hälsa i samhället genom implementering av tolk och individuellt anpassad information / In this study, we analyzed the correlation between differences in self-reported health, socioeconomic status, social context and the three income hypotheses. The three income hypotheses refer to the absolute income hypothesis, the relative income hypothesis and the income inequality hypothesis. The sample of our study consists of about 7700 individuals age 18 and above from Stockholm county who have gone through surgery due to back pain in the years 2006-2016. With a quantitative approach, we analyzed the correlations between socioeconomic status, social context and health at two times in conjunction to a health care input. To our knowledge has previous research not to a greater extent analyzed the connection between socioeconomic status and the change in health in connection to a health care input, which is part of the contribution of this study. The results indicate that social context does not have a statistically significant correlation with the change in health after a health care input, although we find ambiguous results for the income inequality hypothesis and the relative income hypothesis when analyzing the initial health status. We find that absolute income has a statistically significant and positive correlation with both the initial self-rated health and the change in self rated health over time. An education at university has a statistically significant and positive correlation with the change in self-rated health between the two-time periods, however we do not find this result for the initial health status. Our results indicate that to be born outside of Europe correlates negatively and statistically significant with the change in selfreported health and the initial health status. Our results give a deeper understanding and knowledge to which factors that could explain differences in health for a population with a defined disease. Furthermore, based on our results we give policy recommendations targeted at a more even distribution of health in Sweden through implementing the use of translators and individually customized information.

Bien que la relation entre l’état de santé perçu et les mesures de santé physique et mentale soit bien documentée dans les pays développés, très peu d’études ont examiné cette association dans le monde en développement, particulièrement en Afrique subsaharienne. De même, les études menées dans divers contextes sociaux ont documenté que les femmes et les personnes de plus faible statut socioéconomique (SSÉ) sont les plus susceptibles de porter un lourd fardeau des incapacités et de la mauvaise santé perçue, mais il n’est pas connu si ces associations existent aussi dans les pays africains. L'objectif général de cette recherche doctorale était d’aboutir à une meilleure compréhension de la stratification sociale de la santé en Afrique subsaharienne. Plus spécifiquement, cette étude visait à: 1) Examiner les associations entre la santé perçue et les mesures de santé physique et mentale (maladies chroniques, incapacités et dépression) parmi les adultes à Ouagadougou, Burkina Faso, et évaluer comment ces associations varient selon le sexe, le niveau d’éducation et l'âge; 2) Analyser les différences en matière d’incapacité cognitive et physique entre les hommes et les femmes âgés de 50 ans et plus à Ouagadougou et évaluer la mesure dans laquelle les différences observées pourraient être attribuables aux inégalités de genre en matière de conditions sociales et de santé à travers le cycle de vie; 3) Examiner la relation entre le SSÉ et une multitude de mesures d’incapacités parmi les adultes âgés de 18 ans et plus dans 18 pays d’Afrique subsaharienne et déterminer si les différences socioéconomiques dans les incapacités sont caractérisées par une divergence, convergence ou stabilité à travers l’âge. Les résultats de nos analyses sont présentés sous forme de trois articles scientifiques, qui se sont appuyés sur les données de l'Enquête santé réalisée en 2010 dans l'Observatoire de Population de Ouagadougou (OPO) et de la World Health Survey réalisée en 2002-2004 par l’OMS. Dans le premier article, nous avons trouvé que la mauvaise santé perçue était fortement associée aux maladies chroniques et aux incapacités, mais pas à la dépression. L’effet des incapacités sur la mauvaise santé perçue s’intensifiait avec l’âge et avec la diminution du niveau d’éducation. Par contre, l’effet des maladies chroniques semblait diminuer avec l’âge. Aucune variation selon le sexe n’était observée dans les associations de la santé perçue avec les maladies chroniques, les incapacités et la dépression. Ces résultats suggèrent que les différentes sous-populations définies selon le niveau d'éducation et l'âge pondèrent différemment les composantes de santé dans la santé perçue à Ouagadougou. Les résultats du second article indiquaient que le genre féminin était positivement associé à des niveaux plus élevés de détérioration cognitive et de mobilité réduite. L'excès des femmes dans ces incapacités était seulement partiellement expliqué par les inégalités de genre dans l’état nutritionnel, le statut matrimonial et, dans une moindre mesure, l'éducation. Ces résultats suggèrent que l’amélioration de l'état nutritionnel et des opportunités d'éducation à travers le cycle de vie pourrait prévenir la détérioration cognitive et la mobilité réduite et réduire partiellement l'excès féminin dans ces incapacités. Dans le troisième article, nous avons montré que le manque d'éducation était positivement associé à des niveaux plus élevés d'incapacités, et le différentiel d’état de santé fonctionnel entre les différents niveaux d'éducation restait stable à travers l'âge. Ces résultats suggèrent qu’en Afrique subsaharienne, comparativement aux individus hautement éduqués, les personnes faiblement éduquées ont moins de ressources économiques et sociales et de saines habitudes de vie qui ont des effets bénéfiques, constants sur la santé fonctionnelle selon l’âge. / Although the relationship between self-rated health (SRH) and physical and mental health is well documented in developed countries, very few studies have analyzed this association in the developing world, particularly in sub-Saharan Africa. Furthermore, research in various social contexts has documented that disability and poor SRH are more common among women and persons with lower socioeconomic status (SES), but it is unclear whether these associations also hold in sub-Saharan African settings. The general objective of the present thesis was to better understand the social stratification in health in sub-Saharan Africa. More specifically, this study aimed to: 1) To examine the associations of SRH with measures of physical and mental health (chronic diseases, functional limitations, and depression) among adults in Ouagadougou, Burkina Faso, and how these associations vary by sex, education level, and age; 2) To analyze differences in cognitive impairment and mobility disability between older men and women in Ouagadougou, Burkina Faso, and to assess the extent to which these differences could be attributable to gender inequalities in life course social and health conditions; 3) To examine the relationship between SES and multiple disability measures among adults aged 18 and older in 18 sub-Saharan African countries and to determine whether socioeconomic differences in disability are characterized by an increase, decrease or stability with increasing age. The results of our analyses are in three scientific research articles, which rest upon data taken from a cross-sectional interviewer-administered health survey conducted in 2010 in areas of the Ouagadougou Health and Demographic Surveillance System, and the World Health Survey conducted in 2002-2004 by the World Health Organization (WHO). In the first article, poor SRH was strongly associated with chronic diseases and functional limitations, but not with depression. The effect of functional limitations on poor SRH intensified with age and with decreasing education level. In contrast, the effect of chronic diseases appeared to decrease with age. No variation by sex was observed in the associations of SRH with chronic diseases, functional limitations, and depression. These findings suggest that different subpopulations delineated by age and education level weight the components of health differently in their self-rated health in Ouagadougou. The results of the second article indicated that female gender was positively associated with higher levels of cognitive impairment and mobility disability. The female excess in these disabilities was only partially explained by gender differences in nutritional status, marital status and, to a lesser extent, education. These results suggest that enhancing nutritional status and educational opportunities throughout life span could prevent cognitive impairment and mobility disability and partly reduce the female excess in these disabilities. In the third article, we found that the lack of education was positively associated with poorer functional health, and the health gap between educational levels remains static with increasing age. These findings suggest that, in sub-Saharan Africa, compared to the well educated, the undereducated have fewer economic and social resources and health-promoting behaviors which have beneficial, albeit constant effects on functional health over the life course.