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Inequality, material well-being, and subjective well-being: exploring associations for children across 15 diverse countries
- Authors:
- MAIN Gill, et al
- Journal article citation:
- Children and Youth Services Review, 97, 2019, pp.3-13.
- Publisher:
- Elsevier
Children's material well-being, and the levels of wealth and inequality in societies within which children live, are important factors in determining outcomes. However, less is known about the extent to which these factors have an impact children's subjective well-being, especially in an internationally comparative context. This study draws on data from the Children's Worlds survey, an international study of child subjective well-being, to explore links between national level indicators of wealth and inequality (GDP and Gini coefficients), individual indicators of material well-being (the material resources children report having access to), and subjective well-being. The survey covers 15 diverse countries covering the continents of Europe, Asia, Africa and South America, with samples of at least 3000 per country, ages 8, 10 and 12. Analysis takes the form of a multilevel, varying intercepts and slopes model, examining the association between financial and material resources and inequality and subjective well-being across and between countries. Findings suggest that material resources that children report are significantly associated with subjective well-being, while indicators of financial resources and inequality at the national level are not. While a significant association between material resources and subjective well-being is found across the whole sample, the magnitude of this association, and the association between school- and country-level material resources, varies markedly. Within different countries, the strongest material resources-related predictor of overall subjective well-being may be either at the individual, school or country level. (Publisher abstract)
Instruments for research on transition: applied methods and approaches for exploring the transition of young care leavers to adulthood
- Authors:
- HARDER Annemiek T., et al
- Journal article citation:
- Children and Youth Services Review, 33(12), December 2011, pp.2431-2441.
- Publisher:
- Elsevier
The transition to adulthood of young people leaving care is an important area for researchers. Young people who have been in care show relatively poor outcomes in comparison to young people who have not been in care, and run a high risk of social exclusion. However, little is known about the different research approaches and research instruments that are being used in studying this topic. This review explores the approaches and instruments that are used in empirical studies that focus on young care leavers' transitions to adulthood. The results show that the studies apply a diversity of topics and instruments, but that there is also considerable overlap. The quality of data varies significantly between countries. To make better comparisons on the transition from out-of-home care to adulthood between different countries, a common research framework and one or more research instruments should be developed that can assess this transition and the situation of young care leavers in international contexts.
Incontinence and trauma: sexual violence, female genital cutting and proxy measures of gynecological fistula
- Authors:
- PETERMAN Amber, JOHNSON Kiersten
- Journal article citation:
- Social Science and Medicine, 68(5), March 2009, pp.971-979.
- Publisher:
- Elsevier
This paper specifically examines the co-occurrence of incontinence and two potential sources of trauma: sexual violence and female genital cutting using the most recent Demographic and Health Surveys in Malawi, Rwanda, Uganda and Ethiopia. Multivariate selection models are used to control for sampling differences by country. Results indicate that sexual violence is a significant determinant of incontinence in Rwanda and Malawi, however not in Uganda. Simulations predict that elimination of sexual violence would result in from a 7 to a 40% reduction of the total burden of incontinence. In contrast, no evidence is found that female genital cutting contributes to incontinence and this finding is robust for types of cutting and high risk samples. Results point to the importance of reinforcing prevention programs which seek to address prevention of sexual violence and for the integration of services to better serve women experiencing both sexual violence and incontinence.
‘He is now like a brother, I can even give him some blood’ – relational ethics and material exchanges in a malaria vaccine ‘trial community’ in The Gambia
- Authors:
- GEISSELER P. Wenzel, et al
- Journal article citation:
- Social Science and Medicine, 67(5), September 2008, pp.696-707.
- Publisher:
- Elsevier
This paper explores social relations within the ‘trial community’ (staff and volunteers) of a Malaria Vaccine Trial (MVT), implemented by the Medical Research Council (MRC) in The Gambia between 2001 and 2004. It situates ethical concerns with medical research within the everyday life of scientific fieldwork. Based upon discussions with volunteers and staff, processes of mediation between scientific project and study population, and between formal ethics, local ethical debates and everyday practice is explored. Material contact and substantial transactions, notably of blood and medicine, are central to the construction of the MVT. These transactions are guided by a concrete and relational form of ethics, which contrasts with the abstract and vertical formal ethical principles underwriting the scientific study protocol. The success of the MVT owed much to these kinship-like ethics. One possible conclusion from these observations is that research ethics should be understood, not just as a quasi-legal frame but also as an open, searching movement, much in the same way that kinship is not merely a juridical institution and a prescriptive frame of rules, but a network made through relational work. However, this conclusion raises new problems: by contrasting formal, abstract principles to intimate, immediate relations, and economic justice to personal morality, we accept that the order of medical research is moved further out of the public and political, and into the domains of either quasi-legal claims or of private morality. Irrespective of the undeniable importance of clear-cut rules and of good face-to-face relations, a third essential foundation of medical research ethics is the democratically constituted public sphere, including equitable health services, and transparent institutions to facilitate open debate and regulate particular interests. Ultimately, the ethics of global science can rely neither on principles nor trust but requires citizenship and democratic government.
Ethics and the ethnography of medical research in Africa
- Authors:
- MOLYNEUX Sassy, GEISSLER P. Wenzel
- Journal article citation:
- Social Science and Medicine, 67(5), September 2008, pp.685-695.
- Publisher:
- Elsevier
The ethics of medical research have grown as an area of expertise and debate in recent years, with two broad approaches emerging in relation to transnational research: (1) the refinement of guidelines and strengthening of review, processes primarily to protect the right of individual research participants and strengthen interpersonal relations at the micro-level; and (2) considering more centrally, as crucial ethical concerns, the wider interests of whole populations, the functioning of research institutions, the processes of collaboration, and the ethics of inequitable international relations. The authors see the two areas of debate and action as complementary, and believe that social science conducted in and around transnational medical research environments can bring these two perspectives together in a more ‘situated ethics’ of research. The authors outline the two emerging approaches to medical ethics, summarise each of seven papers selected from a conference for inclusion organised by the authors and highlight two areas of lively debate at the conference itself: the appropriateness and value of ethics guidelines and review boards for medical research; and the ethical review of social science research. Together, the papers and debates point to the importance of focusing on the ethics of relationships and on justice in both biomedicine and social science research, and on giving greater voice and visibility to the field staff who often play a crucial and under-supported role in ‘doing ethics’ in the field. They also point to the potential value of social science research on the range of relationships operating at different levels and time scales in medical research, including those surrounding community engagement activities, and the role and functioning of ethics review boards. The article concludes by highlighting the ethical priority of capacity strengthening in medical research, social science and research ethics in Africa to ensure that local and national priorities and concerns are considered at both the micro and macro levels.
‘A load too heavy’: critical reflections on the child labour problem in Africa's small-scale mining sector
- Author:
- HILSON Gavin
- Journal article citation:
- Children and Youth Services Review, 30(11), November 2008, pp.1233-1245.
- Publisher:
- Elsevier
This paper provides an extended analysis of the child labour problem in the artisanal and small-scale mining (ASM) sector, focusing specifically on the situation in sub-Saharan Africa. In recent years, the issue of child labour in ASM has garnered significant attention from the International Labor Organization (ILO), which has been particularly active in raising public awareness of the problem; and, has proceeded to implement policies and collaborative project work aimed at curtailing children's participation in ASM activities in a number of African countries. The analysis concludes with a critical appraisal of an ILO project recently launched in the Talensi–Nabdam District in the Upper East Region of Ghana, which sheds light on how the child labour problem is being tackled in practice in ASM communities in sub-Saharan Africa.
Scaling-up antiretroviral treatment in Southern African countries with human resource shortage: how will health systems adapt?
- Authors:
- VAN DAMME Wim, KOBER Katarina, KEGELS Guy
- Journal article citation:
- Social Science and Medicine, 66(10), May 2008, pp.2108-2121.
- Publisher:
- Elsevier
Scaling-up antiretroviral treatment (ART) to socially meaningful levels in low-income countries with a high AIDS burden is constrained by (1) the continuously growing caseload of people to be maintained on long-term ART; (2) evident problems of shortage and skewed distribution in the health workforce; and (3) the heavy workload inherent to presently used ART delivery models. If we want to imagine how health systems can react to such challenges, we need to understand better what needs to be done regarding the different types of functions ART requires, and how these can be distributed through the care supply system, knowing that different functions rely on different rationales (professional, bureaucratic, social) for which the human input need not necessarily be found in formal healthcare supply systems. Given the present realities of an increasingly pluralistic healthcare supply and highly eclectic demand, we advance three main generic requirements for ART interventions to be successful: trustworthiness, affordability and exclusiveness – and their constituting elements. We then apply this analytic model to the baseline situation (no fundamental changes) and different scenarios. In Scenario A there are no fundamental changes, but ART gets priority status and increased resources. In Scenario B the ART scale-up strengthens the overall health system: we detail a B1 technocratic variant scenario, with profoundly re-engineered ART service production, including significant task shifting, away from classical delivery models and aimed at maximum standardisation and control of all operations; while in the B2 community-based variant scenario the typology of ART functions is maximally exploited to distribute the tasks over a human potential pool that is as wide as possible, including patients and possible communities. The latter two scenarios would entail a high degree of de-medicalisation of ART.
New therapeutic landscapes in Africa: parental categories and practices in seeking infant health in the Republic of Guinea
- Authors:
- LEACH Melissa, et al
- Journal article citation:
- Social Science and Medicine, 66(10), May 2008, pp.2157-2167.
- Publisher:
- Elsevier
In considering African health care practice, it is usual to draw strong distinctions between biomedical and traditional practices, and between public and private health institutions. Whilst distinctions between traditional and biomedical, and between public and private medicine make sense from the vantage point of health professionals, we question how far these distinctions are pertinent in shaping health-seeking behaviour given experience of them. This paper argues that other distinctions are becoming far more important to African therapeutic landscapes to the ways that people evaluate the salience of different health providers to their problems. It draws on ethnographic research and illustrative evidence from 1550 ‘infant health biographies’ from rural and urban areas in the Republic of Guinea, where 93% of health expenditure takes place outside the state sector. We outline the distinctions that inform parents' health-seeking practices here. These include distinctions between women's and children's health providers (at state health centres), and those that men frequent (private pharmacies); between familiar ailments with known therapies (whether self-treatment, biomedical or herbal), and unfamiliar ones requiring expert diagnostics (whether from Islamic healers, diviners or doctors); between illnesses treatable by injection, and those aggravated by injection; between types of payment; and between high quality/strong medicines, and poor quality/weak ones. As people engage with emergent therapeutic landscapes, relations of knowledge and expertise, and forms of social solidarity, are emerging with significant implications for potential pathways of health system development, how these are conceptualised, and the forms of citizenship and partnership they might involve.
Tobacco use in sub-Sahara Africa: estimates from the demographic health surveys
- Authors:
- PAMPEL Fred, et al
- Journal article citation:
- Social Science and Medicine, 66(8), April 2008, pp.1772-1783.
- Publisher:
- Elsevier
Despite the growing problem of global tobacco use, accurate information on the prevalence and patterns in the world's poorest nations remains sparse. For sub-Sahara Africa, in particular, a weak knowledge base limits the targeting of strategies to combat the potential growth of tobacco use and its harmful effect on future mortality. To describe the prevalence and social patterns of the use of cigarettes and other tobacco in Africa, this study examines population-based data from 16 Demographic Health Surveys (DHS) of men aged 15–54 years and women aged 15–49 years in 14 nations. Descriptive statistics show the highest cigarette use among men in several nations of east central Africa and Madagascar, lowest use in nations of west central Africa, and medium use in nations of southern Africa. Multinomial logistic regression results for men show highest cigarette use among urban, less educated, and lower status workers. Results for women show much lower prevalence than men but similar social patterns of use. The DHS results thus give new and comparable information about tobacco use in low-income nations, disadvantaged social groups, and an understudied region of the world.
Accounting for institutional change in health economic evaluation: a program to tackle HIV/AIDS and gender violence in Southern Africa
- Authors:
- JAN Stephen, PRONYK Paul, KIM Julia
- Journal article citation:
- Social Science and Medicine, 66(4), February 2008, pp.922-932.
- Publisher:
- Elsevier
There has been growing interest in the application of institutionalist perspectives in the health economics literature. This paper investigates the institutionalist notion of social value and its use in economic evaluation with particular reference to a program to address HIV/AIDS and gender violence in Southern Africa (IMAGE). Institutions are the rules that govern the conduct between individuals, groups and organisations. Their social value stems from their capacity to reduce the uncertainty in human interactions thereby both reducing transaction costs and, importantly, enabling the initiation and sustainability of various activities (instrumental value). Furthermore, institutions tend to be formed around certain ethical positions and as a consequence, act in binding future decision making to these positions (intrinsic value). Incorporating such notions of social value within a conventional welfare-based measure of benefit is problematic as institutional development is not necessarily consistent with individual utility. An institutionalist approach allows for these additional domains to be factored into economic evaluation. IMAGE is an intervention to reduce gender violence and HIV through microfinance, health education and community development, and involves significant initial investment in institution-building activities, notably through training activities with program staff and community members. The key to employing an institutionalist approach to the evaluation of IMAGE is in understanding the nature of those actions that can be seen as institution-building and determining: (1) the instrumental value of follow-up activities by appropriate amortisation of transaction costs over an horizon that reflects the economies gained from the intervention; and (2) the intrinsic value of any transformation in the community through a cost-consequences approach informed by an a priori conceptual model. This case study highlights how health sector interventions can effect institutional changes and how these are captured within a theory-based economic evaluation framework.