Scientific literature is concerned with the impact that climate change will have on natural disasters in the near future. These events disrupt our daily lives and can cause damage that may never be repaired. Merging science and social science, the study of vulnerability looks at how human systems will be impacted by these natural disasters. In the United States, hurricanes in the Gulf Coast are projected to increase in intensity as well as have an increased capacity for damage with a rise in sea level. Therefore, it is important to understand who is systematically vulnerable to these impacts of natural disasters and how we can mitigate this damage. Through this thesis, I argue that these impacts of hurricanes will put already vulnerable populations at a greater risk for damage caused by these events in the future. I will briefly outline the scientific basis on which the claims of increased hurricane activity are founded, as well as outline concepts of vulnerability. I examine case studies of Hurricanes Andrew and Katrina, both of which can inform how social disparities delineate vulnerability in the United States. Based upon this historical understanding that recovery from a storm is highly contingent upon social and economic resources available to an individual or community, I argue that vulnerable communities must be highlighted. I then project vulnerability based upon demographic characteristics of communities within the Gulf Coast in order to highlight these areas of necessary attention.

During the last year of World War I (1918), a second deadly foe was causing mortality around the world. Spanish Influenza killed an estimated 50-100 million people worldwide, including 50,000 people in Canada during the 1918-1919 pandemic. This thesis examines the impact of Spanish Influenza on people living in Vancouver, British Columbia, Canada between June of 1918 and June of 1919. Statistical analysis with SPSS was used to determine the association between influenza-caused deaths and socio-demographic characteristics such as age, gender, immigration status, and employment. In Vancouver, those who were between the ages of 19 to 39, and those who were employed, showed higher odds of dying from influenza during the epidemic. / Graduate

This thesis seeks to address the complex forms assumed by the problem of human trafficking in the contemporary world and in particular to analyse and overcome certain identified shortcomings in existing models of intervention. It begins by locating the problem historically through its foundations in slavery, and explores the incomplete nature of the abolition of that institution. These observations provide the context for the emergence of contemporary forms of exploitation. The complexity of the problem of human trafficking is reflected in the variety of approaches to intervention thus far attempted and in the lack of consensus among stakeholders concerning the effectiveness of competing models. The tendency towards institutional failure in current approaches, and the consequent growth of the trafficking phenomenon are compounded by the ability of criminal networks to infiltrate and corrupt the very systems that are meant to safeguard vulnerable populations. This thesis argues that the shortcomings of existing models are themselves evidence that one of the foundational reasons for the emergence of human trafficking as a networked global crime is the security deficit created by the replacement of the structures of state with criminal networks embedded within communities. These observations are supported by empirical evidence in the form of i) a detailed review of records relating to a number of prosecutions and ii) first-hand observations and interviews with officials and civil society organisations in India, the United Kingdom and the Netherlands. I argue, in conclusion, that the evolution of models of intervention, leading to the creation of a preferred multidisciplinary model, show that this security deficit is best countered by emergent partnerships between the structures of the state, communities and civil society groups. Such innovations prefigure new hybrid structures, which offer a degree of hope for holistically tackling common global problems and networked crimes such as human trafficking.

CoordenaÃÃo de AperfeiÃoamento de NÃvel Superior / O objetivo desse trabalho à explorar os contextos de vulnerabilidade que interferem na realizaÃÃo ou nÃo do teste de HIV entre os homens que fazem sexo com outros homens. De modo mais especÃfico, busca-se explorar quais fatores individuais, sociais e programÃticos podem se estabelecer como incentivos e barreiras para a realizaÃÃo do teste de HIV, delineando o quadro de vulnerabilidades dos HSH. Ainda, explora-se como as recomendaÃÃes do MinistÃrio da SaÃde para a realizaÃÃo do teste de HIV sÃo entendidas e vivenciadas pelos HSH. O referencial teÃrico adotado foi construcionista e o quadro da vulnerabilidade foi o raciocÃnio utilizado como base de toda essa pesquisa. O estudo traz um panorama geral da epidemia da aids entre os HSH em nÃvel internacional e nacional, bem como as recomendaÃÃes polÃticas internacionais que influenciaram as respostas brasileiras ao HIV/aids, e a construÃÃo de polÃticas pÃblicas nacionais referentes ao teste de HIV. Essa pesquisa possui carÃter exploratÃrio, abordagem qualitativa e utilizou a metodologia do Rapid Assessment, de pressupostos antropolÃgicos. Foram realizadas 40 entrevistas semi-estruturadas com HSH de pelo menos 18 anos de idade, com sorologia para HIV positiva e negativa, e que nunca realizaram o teste, residentes na cidade de Fortaleza. As entrevistas foram realizadas em vÃrios lugares da cidade, a fim de alcanÃar uma amostra variada de informaÃÃes, sendo fixos apenas uma ONG e um ServiÃo de AtenÃÃo Especializada de referÃncia em HIV/aids. As informaÃÃes foram analisadas por meio da tÃcnica de anÃlise de conteÃdo do tipo categorial. Os resultados mostram que os motivos para a realizaÃÃo do teste de HIV entre os HSH foram: perceberem-se em risco, exigÃncia do parceiro, autocuidado e temor à doenÃa, doaÃÃo de sangue, incentivos dos profissionais da saÃde, oficinas de prevenÃÃo e eventos LGBT. Jà as barreiras ao teste foram: pobreza, falta de conhecimento de modo geral sobre prevenÃÃo e transmissÃo do HIV, preconceito com as sexualidades nÃo heterosssexuais, estigma em relaÃÃo Ãs prÃticas homoerÃticas e à aids, homofobia, discriminaÃÃo referente à aids e baixa ou nenhuma percepÃÃo de risco. As barreiras programÃticas foram: falta de conhecimento acerca dos locais, dos procedimentos e do tempo confiÃvel para realizar o teste, descrenÃa das recomendaÃÃes de testagem do MinistÃrio da SaÃde, desconfianÃa da eficÃcia do teste rÃpido, homofobia, despreparo para lidar com questÃes da sexualidade homoerÃtica e emocionais decorrentes do resultado positivo entre os profissionais da saÃde, campanhas governamentais escassas e ineficazes para estimular a busca ao diagnÃstico e falta de reconhecimento com as polÃticas em HIV/aids criadas para HSH quando no cotidiano nÃo hà essa identidade. Os resultados mostram ainda que esses motivos possuem impacto direto no nÃo seguimento das recomendaÃÃes de testagem tornando a populaÃÃo HSH de Fortaleza vulnerÃvel à epidemia. Baseado no conceito ampliado de saÃde, polÃticas pÃblicas devem ser elaboradas considerando o conceito de integralidade de modo que essa populaÃÃo seja assistida em seus direitos, o que terà consequÃncia na reduÃÃo da vulnerabilidade ao HIV/Aids. / This work aims to explore the contexts of vulnerability that interfere on the (non) realization of the HIV test among men who have sex with other men. In a more specific way, it aims to explore which individual, social and programmatic factors may be established as encouragement and hurdles for the realization of the HIV test, outlining the vulnerability framework of the Men Who Have Sex with Men (MSM). It also explores how the recommendations of the Ministry of Health for the realization of the HIV test are extended and experienced by the MSM. The adopted theoretical reference was constructionist and the vulnerability framework was the reasoning used as a basis for the whole research. The study brings a general panorama of the aids epidemics among the MSM on a national and international level, as well as the international recommendations policy that have influenced the Brazilian responses to HIV/aids, and the building of national public policies that refer to the HIV test. This research has an exploratory character, qualitative approach, and used the methodology of Rapid Assessment, which has anthropological presuppositions. Forty semi-structured interviews were done with MSM who were at least 18 years of age, with both positive and negative serology for HIV, and who had never done the test, living in the city of Fortaleza. The interviews were done in many places around the city, aiming to get a wider sample of information, being a constant for the research only a NGO and a Service of Specialized Attention of Reference to HIV/aids. The information was analyzed through the technique of content analysis that was category-based. The results show that the reasons for the realization of the HIV test among the MSM were: they perceived they were at risk, a demand from the partner, self-care and fear of the disease, blood donation, encouragement from the healthcare professionals, prevention workshops and LGBT events. On the other hand, the barriers to the test were: poverty, lack of general knowledge about HIV prevention and transmission, prejudice against the non-heterosexual sexualities, stigma in relation to the homoerotic practices and to aids itself, homophobia, discrimination referring to aids and low or no perception of the risk. The pragmatic barriers were: lack of knowledge about the places, the procedure and reliable time to do the test, discredit for the test recommendation from the Ministry of Health, discredit for the efficiency of the quick test, homophobia, lack of preparation to deal with questions of the homoerotic sexuality and emotional reasons deriving from the positive results among the healthcare professionals, lack of and inefficient governmental campaigns for the stimulation to look for the diagnosis and lack of identification with the HIV/aids policies created for MSM when in everyday life there is no such identification. The results also show that these reasons have a direct impact on the non-following of the recommendations of testing, making the MSM population from Fortaleza vulnerable to the epidemics. Based on the wide concept of health, public policies must be elaborated taking into consideration the concept of integrality in such a way that this population can be assisted in their rights, which will have a consequence in the reduction of the vulnerability to the HIV/aids.

The following research project thematically analysed in-depth interviews of 5 socially vulnerable Romanian Roma women who support themselves only by means of begging in public spaces of Malmö, Sweden. This paper examined women’s experiences of victimization and their consequences, reasons behind the incidents as well as relationship with the police officers during their time spent in Sweden. The interviews put forward four common themes: frequent harassment during daytime, several grounds for victimisation, negative health consequences and deficient relation with police officers. Women described their experiences of sexual harassment, verbal and physical abuse, feelings of constant stress, paranoia and fear. Interviewed study participants claimed that they are victimized because they are Roma women and thus visible as a result of specific clothing and their activity of begging. Nearly all women reported lack of trust towards justice system. Discussion concludes with several policy suggestions.

There has been little discussion in the literature regarding the financial value of the services provided to the participants in health fairs. This article examines the financial value of preventive services provided through a community health fair in an economically depressed area of southwest Virginia. Current Procedural Terminology codes were assigned to the services provided in order to estimate costs participants might incur for such services. An average 50-year-old man would have paid up to $320 to obtain commonly recommended preventive services available free at the fair. An average 50-year-old woman would have paid up to $495. Overall, over $58,000 in services were provided through the health fair. This community health fair provided preventive services that many participants otherwise might have found to be cost-prohibitive.

There is a growing body of literature about public participation in health-system priority setting in different contexts and levels of governance, however, explicit focus on vulnerable populations’ participation is lacking. This dissertation incorporated a mix of methodological approaches to address this gap. First, a scoping review was used to synthesize the literature on priority-setting frameworks to understand whether and how applications of the frameworks involve the public and vulnerable populations in different contexts. Second, an interpretive description study was used to examine stakeholder participation at the district level in a low-income country, Uganda. Third, a qualitative description study design was used to qualitatively assess vulnerable women’s participation in health-system priority setting within a district in Uganda, from the perspectives of both vulnerable women and decision-makers. The research chapters complement and build on one another to make substantive, methodological, and theoretical contributions. Specifically, insights gained from the scoping review demonstrate that while priority-setting frameworks may require participation of all stakeholders, in practice certain stakeholder groups, namely the public and especially vulnerable populations, are not consistently integrated into priority-setting processes. The empirical research provides a rich understanding of the roles of different stakeholders in the priority-setting process and provides explanations about why vulnerable women, as a subset of the public, are not participating. This adds to the evidence base that policy-makers can access to guide future attempts to engage publics in health-system priority setting. These studies collectively contribute to a wider understanding of public’s and vulnerable populations’ participation in health-system priority setting in low-income contexts where health disparities are pronounced, and health resources are especially scarce. Policy-makers should aim to support vulnerable populations’ participation in health-system priority setting. Clear articulation of which vulnerable populations should participate and how they should participate can facilitate priority-setting processes. Co-developing participatory methods, frameworks, and guides with vulnerable populations can reinforce their participation and lead to mechanisms of participation that are more responsive to their needs. / Thesis / Doctor of Philosophy (PhD) / Public participation is often considered a cornerstone of fair and legitimate priority setting. Yet, little is known about whether and how the participation of vulnerable populations is operationalized in the field of health-system priority setting. An in-depth understanding of who participates and who does not, and how participation is enabled and/or hindered is essential to ensure that policy-makers can support participation. This dissertation addresses gaps in knowledge through: 1) a literature synthesis examining the operationalization of stakeholder participation within priority-setting frameworks, with specific attention to the publics’ and vulnerable populations’ participation, in cases where the frameworks have been applied to health-system priority setting; 2) supportive qualitative evidence on the roles, leverages, and challenges of different stakeholders’ participation in district-level health-system priority setting in Uganda; and 3) examining vulnerable women’s participation within one Ugandan district, specifically outlining barriers to their participation, and solutions to address these barriers and support vulnerable women’s participation in health-system priority setting. Collectively these studies can inform policy-making and development of public participation strategies that specifically target vulnerable populations for participation in health-system priority setting.

The purpose of this dissertation was to explore the mechanism of association between social determinants of health (SDH), particularly limited health literacy, and disparate outcomes related to cardiovascular disease in vulnerable populations. Specific aims were to 1) compare quality of life (QOL), anxiety, and depressive symptoms between genders in implantable cardioverter defibrillator (ICD) recipients; 2) examine the association between multi-morbidity burden and QOL; 3) determine whether health literacy levels independently predict CVD risk in the male prison population; 4) examine the relationship between health literacy and decisiveness regarding end of life (EOL) choices, and 5) examine SDH as predictors of perceived poor health status in ICD recipients. Specific aim one was addressed by analysis of data collected from individuals in the Swedish ICD and Pacemaker Registry. Multiple linear regression was used to determine predictors of anxiety, depression, and quality of life in men and women. A higher prevalence of anxiety symptoms in women was noted with no differences in depressive symptoms noted between the genders. The majority of the variance in the predictive models for QOL was explained by the addition of the psychosocial variables for both genders. Specific aim two was addressed by analysis of data collected from individuals in the Swedish ICD and Pacemaker Registry. Logistic regression was used to determine predictors of QOL. Greater multi-morbidity burden was associated with lower QOL in ICD recipients. Specific aim three was addressed by analysis of data collected from male inmates enrolled in a bio-behavioral educational and counselling intervention program to reduce CVD risk. Nonlinear regression was used to determine whether health literacy was an independent predictor of CVD risk while controlling for social and clinical variables. Inmates with adequate levels of health literacy had lower ten year CVD risk profiles than those inmates with inadequate health literacy. Specific aim four was addressed by analysis of data collected from ICD recipients. Multinomial regression was used to determine predictors of decisiveness regarding EOL choices. Within the context of terminal illness, health literacy and race were found to be predictors of decisiveness regrading generator replacement while gender was found to be a predictor of decisiveness regarding the withdrawal of defibrillation therapy. Specific aim five was addressed by analysis of data collected from ICD recipients. Logistic regression was used to determine predictors of perceived poor health status. Residential status in the Central Appalachian region of Kentucky, not working outside the home, higher levels of health literacy, and comorbid depression were predictors of perceived poor/very poor health status.

This study design was to identify and examine how disaster experience, self-efficacy, and demographic factors influence disaster preparedness in community-dwelling older adults. Current data indicates the United States is rapidly aging. Parallel to this significant increase among the elderly population, natural disasters are more prevalent. Consequently, older adults are affected adversely by these disasters and exposure to social vulnerabilities during the disaster cycle. For the purpose of this study, non-identifiable secondary data were analyzed. Sources of the data were the 2007 and 2008 National Center for Disaster Preparedness surveys. The sample focus of this study was adults 50 and older. Regression analyses identified important predictors of disaster preparedness in the survey respondents. Sample adults with previous disaster experience are two times more likely to be in a higher category for having an emergency plan than those respondents with no observable effects of self-efficacy and no previous disaster experience. The frequency of natural disasters in the United States has generated a renewed interest in disaster management, in particular, disaster preparedness. Nevertheless, the focal point of disaster preparedness is no longer the rudimentary stockpile of water, a first aid kit, and a battery operated radio. To advance the field of disaster management it is vital for gerontologist to approach disaster preparedness by differentiating between stockpiling supplies and social cognitive interventions that fundamentally alters preparedness behavior.

Diante da realidade de segregação residencial existente no Brasil, determinada pela heterogeneidade de renda, de condições sociais entre bairros e distritos, evidencia-se uma sociedade cada vez mais penneada por iniquidades sociais e ambientais. Somado a isto, há o fato do crescimento da concentração populacional em áreas urbanas. Este e outros fatores geram transformações nas estruturas das cidades acentuando conflitos referentes ao uso e ocupação do solo. Tais conflitos requerem agilidade de suprir demandas de fornecimento de serviços essenciais, tais como de abastecimento de água e esgotamento sanitário, especialmente quando se trata destes serviços às populações vulneráveis. Para apoio a medição e visualização desse cenário, de forma a elaborar políticas públicas e empresarias, é fundamental a utilização de indicadores, os quais, no entanto, não estão prontamente disponíveis. Emerge assim a necessidade de proposição de indicadores que mensurem o fornecimento dos serviços às populações vulneráveis em áreas urbanas. Neste contexto, com estudo de caso para o Estado de São Paulo, Brasil, a pesquisa teve como enfoque atuar na interface teórica e prática para proposição de indicadores. Foram realizadas, então, revisão bibliográfica, análise documental e discussão crítica com base no aprendizado do estudo de caso. Doze indicadores foram propostos e um sistema de indicadores de benchmarking dos serviços de abastecimento e esgotamento sanitário voltados às populações vulneráveis foi estruturado. O sistema e os indicadores foram identificados por meio do alinhamento de diferentes visões dos atores, o que permitiu que fossem condizentes com a realidade dos serviços, e posteriormente, mais facilmente implementados. / The income heterogeneity and social conditions between neighborhoods and districts show a society increasingly permeated by social and environmental inequities by means the reality of residential segregation that exists in Brazil. In addition, there is population growth occurred concentrated in urban areas, this and other factors that generate transformations in the structures of cities accentuating conflicts regarding the use and occupation. Such conflicts require flexibility to supply demands for essential services such as to provi de water and sanitation services, especially aimed to vulnerable populations. For the measurement and visualization ofthis scenario, in order to produce the policies and business, it is essential to use of indicators, which, however, are not readily available. Thus emerges the need to propose indicators that measure the provision of services to vulnerable populations in urban areas. In this context, with case study in Sao Paulo State, Brazil, the research was focused on theoretical and practical interface to proposed indicators. Were performed also, literature review, document analysis and critical discussion based on the learning case study. Twelve indicators were proposed and a system of benchmarking indicators for the water supply and sanitation services to targeted vulnerable populations was structured. The framework and indicators were proposed by aligning different views of the actors, in a way to be consistent with the reality of services and more easily implemented.