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PubMed1993

Migration and the public sector: a survey.

"A review of the existing literature on human migration reveals relatively few studies that explicitly examine the relationships between public policy decisions and human migration flows. The surveyed literature includes studies of national policies, such as defence spending, migration subsidies and intergovernmental transfers, as well as sub-national policies, such as welfare and unemployment benefits, state and local taxes, education and other public services. Suggestions for incorporating public sector information into existing migration analysis frameworks and further areas of research are provided." The geographical focus is on developed countries. (SUMMARY IN FRE AND GER)

Demography↗
PubMed2002

Community learning disability teams: the need for objective methods of prioritization and discharge planning.

As part of caseload management for community learning disability teams (CLDTs), it would appear reasonable that services would have a mechanism for prioritizing referrals and discharge planning. However, any formal mechanism in relation to these two aspects apparently is lacking within the literature. This theoretical article attempts to illustrate this evidence-base need, and demonstrate how a prioritization and/or discharge planning system would aid CLDTs. In light of the scarcity of material for the learning disability sector, information has been examined from other health domains such as mental health. The paper also presents a discussion on whether rationing of services is best done via explicit or implicit means. Issues related to setting referral criteria and the allocation of referrals are also considered. Although suggestions have been made for CLDTs, it is difficult to do so whilst the evidence base for this sector is so lacking.

Case Management↗
PubMed2004

Providing practical estimates of malaria burden for health planners in resource-poor countries.

In many countries in sub-Saharan Africa, estimates of malaria occurrence used by health planners at all levels are based on data from formal sector health facilities. Since the majority of fever episodes are treated at home and within the community, the burden estimates obtained this way are the tips of the iceberg. A case study from Ghana comparing household data on acute morbidity and treatment-seeking behavior in two districts with health facility data is used as an illustration. For every case of febrile illness seen in the health facilities, there were approximately 4-5 in the community. Many sub-Saharan African countries recommend that all febrile episodes, especially in children, be treated with an antimalarial. Since several countries extend malaria treatment to include the community and the home through public and private, formal and informal sectors, the need for more comprehensive burden estimates becomes urgent.

Adolescent↗
PubMed2005

The emergence of manganese-related health problems in Quebec: an integrated approach to evaluation, diagnosis, management and control.

This paper describes the strategy developed in Quebec to deal with an emerging problem: manganism in welders. Only two cases of manganism had been reported to the Commission de la santé et de la sécurité du travail (CSST, Workers Compensation Board in Quebec) before 2000. In the fall of 2001, the CSST was informed of a possible cluster of manganism and received 20 compensation claims from one plant. Action was rapidly taken to understand and tackle this emerging problem. Under the leadership of the CSST, a coordinating working group implemented medical and environmental subcommittees involving representatives of the different partners of the prevention network. After a literature review to document the health risks associated with manganese and the lack of some important information, a panel of international experts was formed to try to reach agreement on the parameters to consider in the diagnosis and management of manganism. The CSST compensation management policies would be adjusted accordingly. Simultaneously, all the available industrial hygiene data were analyzed to estimate where and at what levels workers were exposed to manganese. To complete these data, the exposure of workers in more than 50 industrial plants was evaluated and existing control measures were documented. All these data have been presented for a revision of the Quebec permissible exposure limit (PEL). In this integrated approach, the next step targets the formation of neurologists and neuropsychologists for a standardized medical evaluation, to complete workplace evaluation in the high risk sectors, inform workers and employers and recommend control measures where required, based on a revised PEL. Many strategies will be used to inform the prevention network (about 1000 people), employers and employees of the risks of overexposure to manganese and of the measures to control exposure in all the plants where workers are susceptible to be exposed to manganese.

Environmental Health↗
PubMed2006

Distributional impacts of mental health care financing arrangements: a comparison of the UK, Germany and Austria.

BACKGROUND: Although mental health care has undergone substantial re-structuring processes, little attention has been paid to financing issues during these processes. AIMS OF THE STUDY: In this paper the authors seek to examine distributional effects of systems of mental health care financing in the UK, Germany and Austria against the backdrop of ongoing reforms and broader welfare state transformations. METHOD: The article is based on secondary data on mental health care reform processes and financing arrangements. Distributional issues are studied a) on the macro-level related to the sectors 'state', 'market', 'family' and 'voluntary/community' and b) on the individual level. RESULTS AND DISCUSSION: In all of the three countries, shifts towards community care have resulted in a new division of financing responsibilities with a tendency to rising responsibilities for the 'family' and the 'voluntary/community sector'. In addition, strengthening market principles often increases financial burdens for affected individuals and/or their relatives. The study has been limited by the lack of precise data on resource allocation and expenditure for mental health care. IMPLICATIONS FOR HEALTH POLICIES, HEALTH CARE PROVISION AND USE: An increasing focus on the relationship between financing and service provision is required in order to prevent new forms of social exclusion of people with mental disorders. IMPLICATIONS FOR FURTHER RESEARCH: Further research needs to be carried out to increase transparency concerning the complex relationship between provision and the finance of mental health care. In terms of distributional impacts, it needs to be analysed in more detail which persons are affected in which ways. This particularly includes users as well as carers in the formal and informal sector.

Austria↗
PubMed2004

Mental health and social capital in Cali, Colombia.

Mental ill health forms an increasingly significant part of the burden of disease in developing countries. The growing interest in social risk factors for mental health coincides with the development of social capital research which may further inform the social model of mental health. The objective of the study reported here was to discover if there is an independent association between social capital and mental health when taking into account an array of demographic and violence variables. A total of 1168 youth (15-25 years) in a low income community in Cali, Colombia were surveyed. Mental health was measured by a 20 item self-report questionnaire. The instrument used to measure social capital covered structural and cognitive social capital. Twenty-four per cent of the sample were probable cases of mental ill health. Females had a prevalence rate three times higher than males. Using a model which considered demographic and social capital measures as potential risk factors for mental ill health, the significant risk factors emerged as being female, having limited schooling, working in the informal sector, being a migrant, and having low trust in people. The 'classic' poverty type variables (poor education and employment) were more important than social capital, as was the commonly dominant risk factor for mental ill health-being a woman. When violence factors were added to the model, the 'trust' factor fell out and the most important risk factors became (in descending order of importance): being female; no schooling/incomplete primary; and being a victim of violence. The dominance of poverty related factors, as opposed to social capital, prompts renewed attention to the explanatory mechanisms that link income inequality and poor mental health.

Adolescent↗
PubMed1991

Occupational health and safety in Brazil.

BACKGROUND: Brazil is the world's fifth largest and sixth most populous nation. Its economy is varied, with strong manufacturing, agriculture, mining, and service sectors. Therefore, a wide variety of workplace hazards confronts its work force. This paper describes Brazil's occupational safety and health regulatory scheme, workers' compensation system, plant-level practices, training, and data collection. METHODS: We reviewed and analyzed Brazilian regulatory legislation and government and non-governmental organization (NGO) activity in occupational safety and health, as well as the structure and function of the workers' compensation system. We also reviewed available data on injuries and diseases from major sources, including the now-defunct Instituto Nacional do Previdencia Social (INPS) and the workers' compensation scheme, Seguro de Acidente de Trabalho (SAT). RESULTS: The incidence of workplace injuries has decreased in recent years and is now reported to be about 5 per 100 workers per year. The case fatality rate has been constant at about 5 fatalities per 1000 injuries. Less than 6% of reported injuries are classified as "diseases." Brazil's rates are comparable to those of Mexico and Zimbabwe, and two to four times higher than in most industrialized countries. CONCLUSIONS: Brazil has a high incidence of occupational injuries and diseases; these injuries and diseases are underreported; there is a large informal sector at special risk; and Brazil illustrates the disparity that exists in many countries between legislation on the books and legislation that is actually implemented.

Accidents, Occupational↗
PubMed1996

Hazards in cottage industries in developing countries.

Occupational health and safety research and prevention programs in developing countries have focused almost exclusively on large-scale industries. The informal sector--especially home-based arts and crafts industries such as pottery, jewelry, weaving, and woodworking, as well as other cottage industries--are a major and neglected part of the economies of developing countries. These industries have many hazards, including lead, silica, toxic woods, cadmium, dyes, and ergonomic problems. Since the work is often done in the home and can involve whole families, the entire family, including children, can be at risk. Prevention programs involving training and education about the hazards, suitable precautions, and development of safer substitutes are needed. This will also require training of local health care providers in the diagnosis and treatment of occupational diseases related to hazards in these cottage industries.

Art↗
PubMedDate not supplied

Physical activity of poor urban women in Cali, Colombia: a comparison of working and not working women.

We have previously presented evidence that the physical activity level (PAL) and total energy expenditure (per kg body weight) of poor urban women who "work" (engage in income-earning activities) is similar to those who do not "work" (but do tend to household and childcare responsibilities) (Spurr et al. [1996] Am J Clin Nutr 63:870-878; [1997] Med Sci Sports Exerc 29:1255-1262). These findings were unexpected and raised questions regarding the actual types of activities engaged in by the two groups. In this article we address those questions by comparing the time allocation of the two groups. Time allocation during waking hours (14.2 +/- 1.1 hours/day) was recorded in minute-by-minute diaries by trained observers for two consecutive days for 52 working women and 28 not-working women. The working women were engaged in predominately informal sector economic activities, such as street vending, childcare, and domestic service, in addition to their own household and childcare responsibilities. The activities of the not-working women were largely restricted to household and childcare responsibilities. The working women tended to spend less time in resting activities and TV-watching and more time in travel and miscellaneous work activities, but other between-group differences were not significant. We conclude that the time allocation of working women is similar to that of not-working women because 1) many of the activities engaged in are the same or similar, and 2) some working women are only engaged in income-earning activities for limited time periods.

Adult↗
PubMed1989

The ecological model and the study of child abuse in Nigeria.

Physical abuse and exploitative child labor are two common forms of child abuse in Nigeria. Exploitative child labor exists in both the formal and informal sectors where children work as hairdressers, beggars' assistants, hawkers, and as factory and agricultural workers under conditions characterized by long hours, hazardous environment, and meager remuneration. Research on the incidence of physical abuse in Nigeria is less systematic, and few empirical studies are available. Physical abuse is primarily the result of corporal punishment which has become excessive. Poverty and the existence of a dependent capitalist economy are often proffered as the primary causes of child abuse. While both explanations have some validity, their unidimensional nature limits their explanatory capacity. These explanations also lead to the belief that very little can be done to improve the quality of children's lives until the social order is restructured. The ecological model proposes that child abuse can best be understood if it is analyzed multidimensionally with emphasis on the individual, family, social environment, and cultural milieau, as well as the dynamic interaction between these levels. This model appears appropriate for the study of child abuse in Nigeria, and its application is advocated as a vehicle for improving the quality of child abuse research.

Child↗
PubMed1989

Child health and child care in Okelele: an indigenous area of the city of Ilorin, Nigeria.

This paper provides a detailed analysis of the survival rates and health problems of a cohort of children born during a 5-yr period in part of the city of Ilorin, Nigera. The findings are linked to a demographic and environmental study which indicates that the study area was relatively stable in terms of family structure and population turnover. Most people work in the informal sector, in trading, small scale crafts and service industries. At the time the survey began, in 1979, the provision of piped water supplies to the area was unreliable and sanitation provisions rudimentary. Most of the people had little or no formal education and were very poor. The study indicated that health status had improved over the 5-yr period, compared to a baseline study conducted in 1979. Common causes of child mortality and morbidity included diarrhea, acute respiratory infections, measles, and malaria. The infant mortality rate was 41.5/1000. The availability of clinic care at nominal cost, and the attendance of mothers at the clinic for checkups and immunization, resulted in a higher level of health for their children than otherwise would have been possible. Some problems of primary health care in the area are mentioned, in the light of Nigeria's current budgetary problems, and the utilization of existing strong social support networks to improve health care and environmental sanitation and water supply is suggested.

Adolescent↗
PubMed1983

Interstate migration in Mexico: variations on the Todaro theme.

"This study of migration in Mexico is based upon a modified Todaro approach and utilizes census data in a simultaneous equations model of 13 variables. It is unique in several ways: (a) it introduces proxy variables for employment probability and cost of migration that have not heretofore been found in the literature, but for which data are often available; (b) it illustrates that in some important cases census data have advantages not available through surveys; and (c) it finds that in some sense land reform in Mexico may have operated perversely. Finally, the study opens a new avenue for the study of informal sector growth."

Agriculture↗
PubMed2004

Field based evidence of enhanced healthcare utilization among persons insured by micro health insurance units in Philippines.

Underutilization of healthcare is common among rural and low-income population segments in countries with lower income or inequitable income distribution. Micro health insurance units (MIUs) are created by informal sector groups because people cannot access health insurance or are dissatisfied with the programmes they can access. The policy choice to support MIUs relies on evidence that affiliation with these schemes increases healthcare utilization. This article examines new evidence of the association between affiliation with MIUs and healthcare utilization. We analyzed field data collected in 6 MIUs in the Philippines in 2002 (through a household survey encompassing 890 insured- and 1063 uninsured households). The two cohorts did not differ in demographic parameters, and differed only marginally in income and education levels, both higher amongst the insured. Insured persons reported higher hospitalization rates, higher rates of professionally-attended deliveries, lower rates of delivery at home, a higher frequency of primary-care physician encounters, a higher rate of diagnosed chronic diseases, and better drug compliance among chronically ill. Increased utilization by the insured is not due to adverse selection, judging by two facts: morbidity of the two cohorts, as assessed by a proxy indicator (the reported number of episodes of illness) did not differ; and rates of deliveries were even slightly higher among the uninsured. We conclude that MIUs in the Philippines can alleviate underutilization of heath care.

Adolescent↗
PubMed2005

Municipal solid waste management challenges in developing countries--Kenyan case study.

This paper provides an overview of the state of municipal solid waste management (MSWM) by local authorities in Kenya as a case study of a low-income developing country. Approaches of possible solutions that can be undertaken to improve municipal solid waste (MSW) services are discussed. Poor economic growth (1.1% in 1993) has resulted in an increase in the poverty level which presently stands at 56%. Migration from the rural areas to the urban areas has resulted in unplanned settlements in suburban areas accommodating about 60% of the urban population on only 5% urban land area. Political interference also hampers smooth running of local authorities. Vulnerability of pollution of surface and groundwater is high because local authorities rarely considered environmental impact in siting MSW disposal sites. Illegal dumping of MSW on the river banks or on the roadside poses environmental and economic threats on nearby properties. Poor servicing of MSW collection vehicles, poor state of infrastructure and the lack of adequate funding militate against optimization of MSW disposal service. The rural economy needs to be improved if rural-urban migration is to be managed. Involvement of stakeholders is important to achieve any meaningful and sustainable MSWM. The role of the informal sector through community-based organizations (CBOs), Non-Governmental Organizations (NGOs) and the private sector in offering solutions towards improvement of MSWM also is explored.

Community Participation↗
PubMed2000

Ergonomics in industrially developing countries: does its application differ from that in industrially advanced countries?

Demographic characteristics of industrially developing countries (IDCs) and some comparisons with industrially advanced countries (IACs), particularly those aspects relevant to ergonomics, are presented. The majority of IDC populations are engaged in subsistence agriculture (the "informal" sector) and consideration is given to the scope for ergonomics interventions, aimed primarily at raising productivity to alleviate the poverty suffered by rural families. Ergonomics issues prevalent in the "formal" sector are also discussed and the importance of finding simple, low-cost solutions through participatory approaches emphasised. The possible contributions of ergonomics to alleviating problems common to both sectors, such as transport, are also indicated and attention is drawn to the difficulties of applying formal standards. The improvement of living and working conditions from incorporating an ergonomics approach into the sustainable livelihoods model, by enhancing human capital, is described in the context of the other livelihood assets. This demonstrates the importance of the cultural dimension for the successful delivery of ergonomics benefits. The application of ergonomics differs between IDCs and IACs particularly through the limited infrastructure in IDCs to support ergonomics activity and interventions. This broaches the different contributions that can be made by ergonomics and occupational health practitioners and implies the need for closer collaboration between these professions.

Agriculture↗
PubMed2001

The torturous road to democracy--domestic crisis in Nepal.

Largely unnoticed by the outside world, an armed Maoist insurgence has wrested control of areas in 45 of Nepal's 75 administrative regions and has resulted in more than 1700 deaths since 1996.(1) State figures indicate that 1000 of these people were Maoist and about 400 were police-120 of whom died in attacks on police outposts in early April and July of 2001 alone. The remainder were "class enemies" of the "People's War"-ie, members of ruling parties. As public security collapses, the consequences for the Nepalese are random imprisonment, torture, and risk of extrajudiciary execution from both sides. Torture has increased greatly as a consequence of the insurgence, but was already deeply rooted in Nepalese authority and used as a primary approach to solving crime. More than 70% of Nepalese prisoners claim to have been tortured while in custody, and at least 50% claim they signed confessions as a result. INSEC (Informal Sector Service Centre), a human rights organisation, documented 1035 cases of state perpetrated torture in the year 2000,(2) which has been suggested to be a gross underestimate of the true figure. The long-term physical, social, and psychosocial consequences for survivors are often severe. The Centre for Victims of Torture, Nepal, a non-government organisation based in Kathmandu, has been studying the effect of torture on survivors, and has implemented Nepal's only treatment programmes for those brave enough to seek help.

Humans↗
PubMed1998

Pathways of dependence: the impact of health and social care restructuring--the voluntary experience.

The current emphasis on community over institutionally based modes of health and social care delivery in the UK, together with legislative change, has placed a renewed emphasis on the role of the informal sector in service provision. Simultaneously, there has been an attempt to modify the provider-role of the statutory sector, in favour of an evolving role as purchaser and enabler of independently provided services. Drawing on material that forms part of a 3 year study into health and social care restructuring, and its effect on the caring networks of elderly dependent populations, this paper focuses on the changing role of the voluntary sector. Using empirical material drawn from the Scottish environment, it illustrates how the restructuring process may be modifying the voluntary sector and contributing to a growth in geographical inequity in voluntary service provision. In doing so, it considers four main factors affecting local voluntary organisations--the growth of contracting, external constraints on voluntary provisioning, the influence of the local authority and Wolch's concept of the "Shadow State". It highlights the emerging social and spatial manifestations arising from such change, and how these modifications may also be contributing to a growth in geographical inequity for service recipients linked within the dependence network.

Catchment Area, Health↗
PubMed1989

Cost-containing medical technology.

The types of technologies most likely to contain healthcare costs are ones which (a) bring about a reduction in the volume of contact between the non-institutionalized populations and the medical profession, (b) permit the delivery of services and care in non-institutional settings, (c) enhance self-care or caregiving by the informal sector, and (d) shift the provision of services from the highly trained and costly fee-for-service professions and hospitals to those in the primary care subsector. To translate new technologies into cost savings or reduction in the rate of growth of healthcare expenditure, provincial governments must make some essential organizational changes and resource allocation decisions. As well, some form of technology assessment, if not essential, would be a very useful adjunct.

Ambulatory Care↗