The health and health system of South Africa: historical roots of current public health challenges

The roots of a dysfunctional health system and the collision of the epidemics of communicable and non-communicable diseases in South Africa can be found in policies from periods of the country's history, from colonial subjugation, apartheid dispossession, to the post-apartheid period. Racial and gender discrimination, the migrant labour system, the destruction of family life, vast income inequalities, and extreme violence have all formed part of South Africa's troubled past, and all have inexorably affected health and health services. In 1994, when apartheid ended, the health system faced massive challenges, many of which still persist. Macroeconomic policies, fostering growth rather than redistribution, contributed to the persistence of economic disparities between races despite a large expansion in social grants. The public health system has been transformed into an integrated, comprehensive national service, but failures in leadership and stewardship and weak management have led to inadequate implementation of what are often good policies. Pivotal facets of primary health care are not in place and there is a substantial human resources crisis facing the health sector. The HIV epidemic has contributed to and accelerated these challenges. All of these factors need to be addressed by the new government if health is to be improved and the Millennium Development Goals achieved in South Africa.

Behçet's disease, the Silk Road and HLA-B51: historical and geographical perspectives

Behçet's disease (BD), also known as the Silk Road disease, is a blinding inflammatory disorder of young adults found predominantly between the Mediterranean basin and the Orient, and is strongly associated with the major histocompatibility complex (MHC) antigen HLA-B51. In this article we review the history of Behçet's disease since its first description by Hippocrates, the development of the trading routes collectively known as the Silk Road and the effect of population movement on the distribution of HLA-B51. The global distribution of this antigen among healthy control populations bears a striking similarity both to the ancient trading routes and the distribution of Behçet's disease, suggesting a genetic risk that migrated in parallel with population movement between the Mediterranean and Asia. However, certain indigenous Amerindian peoples have a high prevalence of HLA-B51 but no reported cases of BD. Furthermore, a clear genealogical relationship exists between eastern, but not central, Siberian populations with the Amerindians. Since a high level of recombination within the MHC is known to have occurred in these eastern populations before their migration into Beringia, we suggest that disruption of genetic loci in linkage disequilibria with HLA-B51 may be one reason for the absence of disease in these high HLA-B51-bearing populations. However, a contributory influence of environmental factors is not excluded by this data, and the wide variation that exists in relative risk of HLA-B51 even within Europe would support other non-genetic risk factors on the Silk Road which may be absent, or non-contributory to disease, in the Americas.

The genetic prehistory of the Baltic Sea region

While the series of events that shaped the transition between foraging societies and food producers are well described for Central and Southern Europe, genetic evidence from Northern Europe surrounding the Baltic Sea is still sparse. Here, we report genome-wide DNA data from 38 ancient North Europeans ranging from ~9500 to 2200 years before present. Our analysis provides genetic evidence that hunter-gatherers settled Scandinavia via two routes. We reveal that the first Scandinavian farmers derive their ancestry from Anatolia 1000 years earlier than previously demonstrated. The range of Mesolithic Western hunter-gatherers extended to the east of the Baltic Sea, where these populations persisted without gene-flow from Central European farmers during the Early and Middle Neolithic. The arrival of steppe pastoralists in the Late Neolithic introduced a major shift in economy and mediated the spread of a new ancestry associated with the Corded Ware Complex in Northern Europe.

Economics of human trafficking

Because freedom of choice and economic gain are at the heart of productivity, human trafficking impedes national and international economic growth. Within the next 10 years, crime experts expect human trafficking to surpass drug and arms trafficking in its incidence, cost to human well-being, and profitability to criminals (Schauer and Wheaton, 2006: 164-165). The loss of agency from human trafficking as well as from modern slavery is the result of human vulnerability (Bales, 2000: 15). As people become vulnerable to exploitation and businesses continually seek the lowest-cost labour sources, trafficking human beings generates profit and a market for human trafficking is created. This paper presents an economic model of human trafficking that encompasses all known economic factors that affect human trafficking both across and within national borders. We envision human trafficking as a monopolistically competitive industry in which traffickers act as intermediaries between vulnerable individuals and employers by supplying differentiated products to employers. In the human trafficking market, the consumers are employers of trafficked labour and the products are human beings. Using a rational-choice framework of human trafficking we explain the social situations that shape relocation and working decisions of vulnerable populations leading to human trafficking, the impetus for being a trafficker, and the decisions by employers of trafficked individuals. The goal of this paper is to provide a common ground upon which policymakers and researchers can collaborate to decrease the incidence of trafficking in humans.

The global household: toward a feminist postcapitalist international political economy

The goal of this article is to introduce a new category into international political economy-the global household-and to begin to widen the focus of international political economy to include nonmarket transactions and noncapitalist production. As an economic institution composed of transnational extended families and codwellers (including international migrants and family members left behind in countries of origin), the global household is engaged in coordinating international migration, sending and receiving billions of dollars in remittances, and organizing and conducting market- and non-market-oriented production on an international scale. We first trace the discursive antecedents of the global household concept to theories of the household as a site of noncapitalist production and to feminist ethnographies of transnational families. In order to demonstrate the potential significance and effect of this newly recognized institution, we estimate the aggregate population of global households, the size and distribution of remittances, and the magnitude and sectoral scope of global household production. We then examine the implications of the global household concept for three areas of inquiry: globalization, economic development, and the household politics of economic transformation. Finally, we briefly explore the possibilities for research and activism opened up by a feminist, postcapitalist international political economy centered on the global household.

Ancestry and demography and descendants of Iron Age nomads of the Eurasian Steppe

During the 1st millennium before the Common Era (BCE), nomadic tribes associated with the Iron Age Scythian culture spread over the Eurasian Steppe, covering a territory of more than 3,500 km in breadth. To understand the demographic processes behind the spread of the Scythian culture, we analysed genomic data from eight individuals and a mitochondrial dataset of 96 individuals originating in eastern and western parts of the Eurasian Steppe. Genomic inference reveals that Scythians in the east and the west of the steppe zone can best be described as a mixture of Yamnaya-related ancestry and an East Asian component. Demographic modelling suggests independent origins for eastern and western groups with ongoing gene-flow between them, plausibly explaining the striking uniformity of their material culture. We also find evidence that significant gene-flow from east to west Eurasia must have occurred early during the Iron Age.

Projections of the ethnic minority populations of the United Kingdom 2006-2056

The ethnic minority populations in the UK are growing substantially through immigration, a youthful age structure, and in some cases relatively high fertility. Their diverse demographic and socioeconomic characteristics have attracted considerable academic and policy attention, especially insofar as those distinctive characteristics have persisted in the generations born in the UK. No official projections of the UK ethnic populations have been published since 1979. This article provides projections to 2056 and beyond of 12 ethnic groups. Given overall net immigration and vital rates as assumed in the office for National Statistics 2008-based Principal Projection, and the ethnic characteristics estimated here, the ethnic minority populations (including the Other White) would increase from 13 percent of the UK population in 2006 to 28 percent by 2031 and 44 percent by 2056, and to about half the 0-4 age group in 2056. Alternative projections assume various lower levels of immigration. Possible implications of projected changes are discussed.

Intra-household conflicts in migration decisionmaking: return and pendulum migration in Morocco

By analyzing the migration behavior and transnational residential strategies of first-generation, aging migrants from a particular Moroccan sending region, this study contributes to a conceptual critique of migration theories that identify the household as the most relevant decisionmaking unit. It highlights the role of intra-household power inequalities and conflicts in migration decisionmaking as well as the effects of migration decisions for intra-household power relations. Many labor migrants who left Morocco to work in Europe in the 1960s and 1970s did not realize their wish to return but instead ended up reunifying their families at the destination. An increasing proportion adopts a pendulum migration strategy to reconcile their own wish to retain strong ties with Morocco with the reluctance of children and spouses to return. Migrants who unilaterally decided not to reunify their families usually return after their active working life. However, this unilateral decision also blocks legal entry into Europe for their children, which has generated considerable intergenerational tensions.

Rethinking care through social reproduction: articulating circuits of migration

Care has come to dominate much feminist research on globalized migrations and the transfer of labor from the South to the North, while the older concept of reproduction had been pushed into the background but is now becoming the subject of debates on the commodification of care in the household and changes in welfare state policies. This article argues that we could achieve a better understanding of the different modalities and trajectories of care in the reproduction of individuals, families, and communities, both of migrant and nonmigrant populations by articulating the diverse circuits of migration, in particular that of labor and the family. In doing this, I go back to the earlier North American writing on racialized minorities and migrants and stratified social reproduction. I also explore insights from current Asian studies of gendered circuits of migration connecting labor and marriage migrations as well as the notion of global householding that highlights the gender politics of social reproduction operating within and beyond households in institutional and welfare architectures. In contrast to Asia, there has relatively been little exploration in European studies of the articulation of labor and family migrations through the lens of social reproduction. However, connecting the different types of migration enables us to achieve a more complex understanding of care trajectories and their contribution to social reproduction.

Outsourcing care: how Peruvian migrants meet transnational family obligations

Migration from Peru has increased dramatically over the past decade, but the social and relational repercussions of these transnational movements have not yet been fully explored. Examination of the way migrants manage their responsibilities to dependent kin in Peru reveals that child fostering makes it possible for adults to migrate in search of better work opportunities by ensuring care for their children and company for their older relatives. For Peruvians engaging in labor migration, child fostering tempers some of the challenges of continuing to participate in established social networks from a distance.

Care workers, care drain, and care chains: reflections on care, migration, and citizenship

In this article, we discuss a case study that deals with the care chain phenomenon and focuses on the question of how Poland and the Ukraine as sending countries and Poland as a receiving country are affected and deal with female migrant domestic workers. We look at the ways in which these women organize care replacement for their families left behind and at those families’ care strategies. As public discourse in both countries is reacting to the feminization of migration in a form that specifically questions the social citizenship obligations of these women, we also look at the media portrayal of the situation of nonmigrating children. Finally, we explore how different aspects of citizenship matter in transnational care work migration movements.

Dynamics of Indian Ocean Slavery Revealed through Isotopic Data from the Colonial Era Cobern Street Burial Site, Cape Town, South Africa (1750-1827)

The Dutch East India Company (VOC) intended the Cape of Good Hope to be a refreshment stop for ships travelling between the Netherlands and its eastern colonies. The indigenous Khoisan, however, did not constitute an adequate workforce, therefore the VOC imported slaves from East Africa, Madagascar and Asia to expand the workforce. Cape Town became a cosmopolitan settlement with different categories of people, amongst them a non-European underclass that consisted of slaves, exiles, convicts and free-blacks. This study integrated new strontium isotope data with carbon and nitrogen isotope results from an 18th-19th century burial ground at Cobern Street, Cape Town, to identify non-European forced migrants to the Cape. The aim of the study was to elucidate individual mobility patterns, the age at which the forced migration took place and, if possible, geographical provenance. Using three proxies, 87Sr/86Sr, δ13Cdentine and the presence of dental modifications, a majority (54.5%) of the individuals were found to be born non-locally. In addition, the 87Sr/86Sr data suggested that the non-locally born men came from more diverse geographic origins than the migrant women. Possible provenances were suggested for two individuals. These results contribute to an improved understanding of the dynamics of slave trading in the Indian Ocean world.

Northwest African Neolithic initiated by migrants from Iberia and Levant

In northwestern Africa, lifestyle transitioned from foraging to food production around 7,400 years ago but what sparked that change remains unclear. Archaeological data support conflicting views: (1) that migrant European Neolithic farmers brought the new way of life to North Africa1-3 or (2) that local hunter-gatherers adopted technological innovations4,5. The latter view is also supported by archaeogenetic data6. Here we fill key chronological and archaeogenetic gaps for the Maghreb, from Epipalaeolithic to Middle Neolithic, by sequencing the genomes of nine individuals (to between 45.8- and 0.2-fold genome coverage). Notably, we trace 8,000 years of population continuity and isolation from the Upper Palaeolithic, via the Epipaleolithic, to some Maghrebi Neolithic farming groups. However, remains from the earliest Neolithic contexts showed mostly European Neolithic ancestry. We suggest that farming was introduced by European migrants and was then rapidly adopted by local groups. During the Middle Neolithic a new ancestry from the Levant appears in the Maghreb, coinciding with the arrival of pastoralism in the region, and all three ancestries blend together during the Late Neolithic. Our results show ancestry shifts in the Neolithization of northwestern Africa that probably mirrored a heterogeneous economic and cultural landscape, in a more multifaceted process than observed in other regions.

Negotiating user preferences, discrimination, and demand for migrant labour in long-term care

The restructuring of long-term care for older people has been marked both by the role of the market and by the role of migrant labor. This article develops the analysis of these processes at the microlevel of the provision of care. It draws on data collected as part of a cross-national comparative study on the employment of migrant care workers in residential care homes and home care services for older people in England and Ireland. The article examines, first, the ways in which divisions of race, ethnicity, and citizenship shape the preferences of service providers/employers and some service users as regards who provides care. Second, it examines how the institutional context of quasi-markets in long-term care shapes the negotiation of demand for migrant labor, the racialized preferences of individual users, alongside the rights of care workers to non-discrimination. It is argued that market-oriented policies for personalization, as well as for cost containment, raise implications for divisions of race, ethnicity, and citizenship in the provision of long-term care. At the same time, those divisions point to the limits of framing care in terms of the preferences of the individual as opposed to the social relations in which care is embedded.

Migration in far west Nepal: intergenerational linkages between internal and international migration of rural-to-urban migrants

In Nepal, international labor migration to India and overseas, as well as internal migration to the rural Nepalese lowlands, is of high socioeconomic significance. Scholarly debates about migration in Nepal have gradually shifted from an economic to a more holistic perspective, also incorporating social dimensions. However, little evidence has been generated about internal migration to urban destinations and the potential linkages between international and internal migration. This article draws on Bourdieu's “Theory of Practice” and sees migration as a social practice. Accordingly, migration practice is regarded as a strategy social agents apply to increase or transfer capitals and ultimately secure or improve their social position. Evidence for this argument is based on a qualitative case study of rural to urban migrants in Far West Nepal conducted in July and August 2009. The study at hand addresses linkages between internal and international migration practices and provides insight about a social stratum that is often neglected in migration research: the middle class and, more precisely, government employees. The authors show that social relations are crucial for channeling internal migration to a specific destination. Furthermore, they unveil how internal migration is connected to the international labor migration of former generations. Finally, the authors examine how migration strategies adopted over generations create multi-local social networks rooted in the family's place of origin.

Transnational spaces of care: migrant nurses in Norway

This article argues that international nurse recruitment from Latvia to Norway is not a win–win situation. The gains and losses of nurse migration are unevenly distributed between sender and receiver countries. On the basis of empirical research and interviews with Latvian nurses and families they left behind, this article argues that nurse migration transforms families and communities and that national health services now become global workplaces. Some decades ago feminist research pointed to the fact that the welfare state was based on a male breadwinner family and women’s unpaid production of care work at home. Today this production of unpaid care is “outsourced” from richer to poorer countries and is related to an emergence of transnational spaces of care. International nurse recruitment and global nurse care chains in Norway increasingly provide the labor that prevents the new adult worker model and gender equality politics from being disrupted in times where families are overloaded with elder care loads.

Who has time for Ćejf? Postsocialist migration and slow coffee in neoliberal Chicago

The official end to communism in Eastern Europe marked the onset of major migratory movements. Perhaps the most abrupt of these population shifts was the displacement of more than two million people in Yugoslavia's violent dissolution. Much of the existing literature on refugee migration has focused on victimization and citizenship claims. Alternatively, I draw on ethnographic research among Bosnian refugee-immigrants in Chicago to examine how a group of adult women migrants used one commodity - coffee - to manage and evaluate their displacements. The kind of slow-coffee drinking described here is informed by an ethics of consumption developed under Yugoslav socialism, nostalgias for pre-Yugoslav Islam and pre-Ottoman Bosnia, and exposure to U.S. neoliberalism. Placing consumption at the center of analysis reveals the structural constraints of the postconflict period and brings to light refugees’ active navigations of everyday life and society in their postsocialist present, lived out as refugees in the United States.

Childhood conditions, migration, and mortality: Migrants and natives in 19th‐century cities

Migrants often have lower mortality than natives in spite of relatively unfavorable social and economic characteristics. Although migrants have a short-run advantage due to the selective migration of healthy workers, persistent health and mortality differences between migrants and natives may be long-run effects of different experiences in childhood. We made use of a natural experiment resulting from rural-to-urban migration in the mid-19th century. Mortality was much higher in urban areas, especially in rapidly growing industrial cities. Migrants usually came from healthier rural origins as young adults. Data used in this study is available from 19th-century Belgian population registers describing two sites: a rapidly growing industrial city and a small town that became an industrial suburb. We found evidence of three processes that lead to differences between the mortality of migrants and natives. First, recent migrants had lower mortality than natives, because they were self-selected for good health when they arrived. This advantage decreased with time spent in the destination. Second, migrants from rural backgrounds had a disadvantage in epidemic years, because they had less experience with these diseases. Third, migrants from rural areas had lower mortality at older (but not younger) ages, even if they had migrated more than 10 years earlier. We interpret this as a long-run consequence of less exposure to disease in childhood.

Beggars, metaphors, and stigma: a missing link in the social history of leprosy

Students of leprosy stigma are at odds over its sources, intensity, and current presistence. On the basis of a study of leprosy in Thailand that combined an archival survey with anthropological field-work, the present article offers a different thesis on these issues from those that have been proposed thus far. The thesis suggests that prior to the discovery of a cure for the disease, its sufferers encountered ambivalent rather than severly stigmatizing reactions. Yet the public's selective exposure-mainly to beggars with the disease-paved the way to the perception of leprosy as the epitome of stigmatization and to its transformation into a metaphor for degradation. Progress in the medical treatment of the disease significantly improved patients' social acceptance but also allowed them to keep their illness a secret. Their consequent disappearance from the public eye turned the figurative use of leprosy in the spoken language into the main source of shaping its image. This development contributed to the irrefutability and perpetuation of the negative image, and even to its intensification to the extent of utter divorce from concrete reality. After expounding this thesis, the paper discusses its potential contribution to resolving the disputes over the roots, severity, and persistence of leprosy stigma on the international level.

"Now if you have only sons you are dead": migration, gender, and family economy in twentieth century northwestern Ghana

This article explores the interconnectedness between labor migration, gender, and the family economy in northwestern Ghana in the 20th century. It focuses specifically on the Dagaaba of the Nadowli and Jirapa administrative districts of what is now the Upper West Region (UWR). It examines how the relationships between men and women in terms of roles, status, access to productive resources and inheritance, changed in tandem with broader changes in society in the 20th century; changes that over time produced enhanced value and elevated status for women in the family. These changes in gender relations are reflected increasingly in the belief among elderly men that ‘now if you have only sons, you are dead’. By focusing on the lived experiences of ordinary women and men in the migration process, it argues that even though indigenous social structures privileged men over women in almost all spheres of life, Dagaaba women were nonetheless significantly active in shaping the history of their communities and that gender relations in Dagaaba communities were not static — they changed over time and generation. This article contributes to the ongoing discussion of the internal migration phenomenon in West Africa, which has so far attracted scant historical analysis.

Building an image of Villages-in-the-City: a clarification of China's distinct urban spaces

Villages-in-the-city (chengzhongcun) as distinct urban spaces in Chinese cities have attracted a lot of scholarly attention, and the term has been variously interpreted. The term "urban village" was initially borrowed and applied to describe this urban phenomenon. While the term in a Western context refers to a planned neighbourhood that features good urban planning and design, the question posed in this essay is: are villages-in-the-city the Chinese equivalent of urban villages? Furthermore, within China, villages-in-the-city are always regarded as migrant enclaves, no different from Zhejiang village or Xinjiang village in Beijing. Are they the same kind of settlement? A primary aim of this essay is to reassert the differences between villages-in-the-city and urban villages that have developed in the United Kingdom. A secondary objective is to explore the variations between villages-in-the-city and Zhejiang village. Through investigating the variations between these urban morphologies, this study attempts to fill gaps in the current literature and hence clarify the misconceptions and confusion about Chinese villages-in-the-city.