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Langmann E, Weßel M. Leaving no one behind: successful ageing at the intersection of ageism and ableism. Philos Ethics Humanit Med 2023; 18:22. [PMID: 38001533 PMCID: PMC10668457 DOI: 10.1186/s13010-023-00150-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023] Open
Abstract
BACKGROUND The concept of 'successful ageing' has been a prominent focus within the field of gerontology for several decades. However, despite the widespread attention paid to this concept, its intersectional implications have not been fully explored yet. This paper aims to address this gap by analyzing the potential ageist and ableist biases in the discourse of successful ageing through an intersectional lens. METHOD A critical feminist perspective is taken to examine the sensitivity of the discourse of successful ageing to diversity in societies. The paper analyzes how ageist and ableist biases can manifest in the ways we conceptualize ageing, drawing on examples in the context of mental health. RESULTS We argue that the conventional approach to successful ageing is limited in its ability to account for the experiences of people who have faced intersectional discrimination throughout their lives. Drawing on examples in the context of mental health, we explore among others the link between depression and disabilities. Furthermore, we shed light on the negative impact of ageist and ableist attitudes concerning the diagnosis and treatment of dementia. DISCUSSION We demonstrate how diversity is often overlooked in discussions of ageing well, and how ageist and ableist biases can manifest in the ways we conceptualize ageing. We argue that focusing solely on the health status as a means of achieving success fails to adequately counter ageism for all people. We further emphasize the role of structural factors, such as ageist attitudes, in shaping the experience of ageing and exacerbating health inequalities. CONCLUSION Overall, our findings emphasize the need for a more nuanced and inclusive understanding of ageing and therefore an intersectional approach to conceptions of ageing well that recognizes and addresses the biases and limitations of current discourses. Thereby, this paper offers valuable insights into the complex intersections between age and disabilities from a bioethical perspective, highlighting the need for a more inclusive and intersectional approach to ageing.
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Affiliation(s)
- Elisabeth Langmann
- Institute of Ethics and History of Medicine, University of Tübingen, Gartenstraße 47, Tübingen, 72074, Germany.
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Vine MM, Mulligan K, Harris R, Dean JL. The Impact of Health Geography on Public Health Research, Policy, and Practice in Canada. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6735. [PMID: 37754595 PMCID: PMC10531040 DOI: 10.3390/ijerph20186735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 08/17/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023]
Abstract
The link between geography and health means that the places we occupy-where we are born, where we live, where we work, and where we play-have a direct impact on our health, including our experiences of health. A subdiscipline of human geography, health geography studies the relationships between our environments and the impact of factors that operate within those environments on human health. Researchers have focused on the social and physical environments, including spatial location, patterns, causes of disease and related outcomes, and health service delivery. The work of health geographers has adopted various theories and philosophies (i.e., positivism, social interactionism, structuralism) and methods to collect and analyze data (i.e., quantitative, qualitative, spatial analysis) to examine our environments and their relationship to health. The field of public health is an organized effort to promote the health of its population and prevent disease, injury, and premature death. Public health agencies and practitioners develop programs, services, and policies to promote healthy environments to support and enable health. This commentary provides an overview of the recent landscape of health geography and makes a case for how health geography is critically important to the field of public health, including examples from the field to highlight these links in practice.
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Affiliation(s)
- Michelle M. Vine
- Department of Health Sciences, Brock University, St. Catharines, ON L2S 3A1, Canada
| | - Kate Mulligan
- Canadian Institute for Social Prescribing, Dalla Lana School of Public Health, University of Toronto, Toronto, ON M5T 3M7, Canada;
| | - Rachel Harris
- Independent Researcher, Hamilton, ON L8P 1H6, Canada;
| | - Jennifer L. Dean
- School of Planning, University of Waterloo, Waterloo, ON N2L 3G1, Canada;
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Lee K, Freudenberg N, Zenone M, Smith J, Mialon M, Marten R, Lima JM, Friel S, Klein DE, Crosbie E, Buse K. Measuring the Commercial Determinants of Health and Disease: A Proposed Framework. INTERNATIONAL JOURNAL OF HEALTH SERVICES : PLANNING, ADMINISTRATION, EVALUATION 2022; 52:115-128. [PMID: 34723675 PMCID: PMC8592108 DOI: 10.1177/00207314211044992] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 07/27/2021] [Indexed: 01/03/2023]
Abstract
The commercial determinants of health (CDoH) describe the adverse health effects associated with for-profit actors and their actions. Despite efforts to advance the definition, conceptualization, and empirical analyses of CDoH, the term's practical application to mitigate these effects requires the capacity to measure the influences of specific components of CDoH and the cumulative impacts of CDoH on the health and well-being of specific populations. Building on the Global Burden of Disease Study, we begin by conceptualizing CDoH as risk factor exposures that span agency and structural influences. We identify 6 components of these influences and propose an initial set of indicators and datasets to rank exposures as high, medium, or low. These are combined into a commercial determinants of health index (CDoHi) and illustrated by 3 countries. Although now a proof of concept, comparative analysis of CDoH exposures by population, over time and space, and their associated health outcomes will become possible with further development of indicators and datasets. Expansion of the CDoHi and application to varied populations groups will enable finer targeting of interventions to reduce health harms. The measurement of improvements to health and wellness from such interventions will, in turn, inform overall efforts to address the CDoH.
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Affiliation(s)
- Kelley Lee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | | | - Marco Zenone
- London School of Hygiene & Tropical Medicine, London, UK
| | - Julia Smith
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Melissa Mialon
- Trinity Business School, Trinity College Dublin, Dublin, Ireland
| | - Robert Marten
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | | | - Sharon Friel
- School of Regulation and Global Governance, Australian National University, Canberra, Australia
| | | | - Eric Crosbie
- School of Public Health, University of Nevada Reno, Reno, USA
| | - Kent Buse
- George Institute for Global Health UK, Imperial College London, London, UK
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Structural determination and social practice: towards a new understanding of ‘structure’ in health inequality research. SOCIAL THEORY & HEALTH 2021. [DOI: 10.1057/s41285-021-00163-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Meltzer A, Muir K. An ecological and systems thinking approach for support to siblings with and without disabilities. SOCIAL THEORY & HEALTH 2021. [DOI: 10.1057/s41285-020-00158-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Yakubovich AR, Heron J, Feder G, Fraser A, Humphreys DK. Long-term Exposure to Neighborhood Deprivation and Intimate Partner Violence Among Women: A UK Birth Cohort Study. Epidemiology 2020; 31:272-281. [PMID: 31764275 PMCID: PMC7004477 DOI: 10.1097/ede.0000000000001144] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Accepted: 11/13/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Intimate partner violence is the most common form of violence perpetrated against women. To our knowledge, the effect of neighborhood disadvantage on intimate partner violence against women has never been investigated prospectively outside the United States. METHODS We used data from the Avon Longitudinal Study of Parents and Children in the United Kingdom, which followed our target sample, 7,219 women, from birth and their mothers (from pregnancy). At age 21, 2,128 participants self-reported the frequency of experiencing physical, psychological, or sexual intimate partner violence since age 18. Participants' exposure to neighborhood-level deprivation and family-level socioeconomic characteristics (e.g., income) were measured at 10 time points from baseline (gestation) until children were 18 years old. We estimated the effect of cumulative exposure to greater neighborhood-level deprivation on the risk of experiencing intimate partner violence using marginal structural models with stabilized inverse probability weights, accounting for time-varying confounding by socioeconomic indicators and sample attrition. RESULTS A one-unit increase in cumulative exposure to more severe neighborhood deprivation was associated with a 62% increase in participants' frequency of experiencing intimate partner violence (95% confidence interval 11%, 237%) and 36% increase in their risk of experiencing any intimate partner violence (95% confidence interval 1%, 85%). CONCLUSIONS In our study, cumulative exposure to greater neighborhood deprivation over the first 18 years of life was associated with women's increased risk of experiencing intimate partner violence in early adulthood. Future studies should test this association across contexts, including underlying mechanisms, and evaluate preventive strategies that target structural disparities.
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Affiliation(s)
- Alexa R. Yakubovich
- From the Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, Canada
| | - Jon Heron
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
| | - Gene Feder
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Abigail Fraser
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
- MRC Integrative Epidemiology Unit at the University of Bristol, Bristol, United Kingdom
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - David K. Humphreys
- From the Department of Social Policy and Intervention, University of Oxford, Oxford, United Kingdom
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Carey G, Crammond B, Malbon E. Personalisation schemes in social care and inequality: review of the evidence and early theorising. Int J Equity Health 2019; 18:170. [PMID: 31694649 PMCID: PMC6836323 DOI: 10.1186/s12939-019-1075-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 10/04/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Personalisation is a growing international policy paradigm that aims to create both improved outcomes for individuals, and reduce fiscal pressures on government, by giving greater choice and control to citizens accessing social services. In personalisation schemes, individuals purchase services from a 'service market' using individual budgets or vouchers given to them by governments. Personalisation schemes have grown in areas such as disability and aged care across Europe, the UK and Australia. There is a wealth of evidence in public health and health care that demonstrates that practically all forms of social services, programs and interventions produce unequal benefit depending on socio-economic position. Research has found that skills required to successfully negotiate service systems leads to disproportionate benefit to the 'middle class. With an unprecedented emphasis on individual skills, personalisation has even greater potential to widen and entrench social inequalities. Despite the increase in numbers of people now accessing services through such schemes, there has been no examination of how different social groups benefit from these schemes, how this widens and entrenches social inequities, and - in turn - what can be done to mitigate this. METHODS This article presents a meta-review of the evidence on personalisation and inequality. A qualitative meta-analysis was undertaking of existing research into personalisation schemes in social services to identify whether and how such schemes are impacting different socio-economic groups. RESULTS No research was identified which seeks to understand the impact of personalisation schemes on inequality. However, a number of 'proxies' for social class were identified, such as education, income, and employment, which had a bearing on outcome. We provide a theoretical framework for understanding why this is occurring, using concepts drawn from Bourdieu. CONCLUSION Personalisation schemes are likely to be entrenching, and potentially expanding, social inequalities. More attention needs to be given to this aspect of personal budgets by policymakers and researchers.
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Affiliation(s)
- Gemma Carey
- Centre for Social Impact, University of New South Wales, UNSW, Sydney, NSW 2052 Australia
| | | | - Eleanor Malbon
- Centre for Social Impact, University of New South Wales, UNSW, Sydney, NSW 2052 Australia
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Malbon E, Carey G, Meltzer A. Personalisation schemes in social care: are they growing social and health inequalities? BMC Public Health 2019; 19:805. [PMID: 31234807 PMCID: PMC6591823 DOI: 10.1186/s12889-019-7168-4] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 06/13/2019] [Indexed: 11/21/2022] Open
Abstract
Background The connection between choice, control and health is well established in the literature on the social determinants of health, which includes choice and control of vital health and social services. However, even in the context of universal health and social care schemes, the ability to exercise choice and control can be distributed unequally. This paper uses the case of the Australian National Disability Insurance Scheme (NDIS) to examine these issues. The NDIS is a major policy reform based on an international trend towards personalisation in social care. It aims to increase choice and control over services and supports for people who have or acquire a permanent disability, thereby boosting citizen empowerment and improving health and social outcomes. Methods The research is a structured review of empirical evidence on the administration and outcomes of the NDIS to identify how social factors constrain or enable the ability of individuals to exercise choice within personalised care schemes. Results We show how social determinants of health at the individual level can collide with the complexity of policy delivery systems to entrench health inequalities. Conclusion Many social policy reforms internationally focus on improving empowerment through enabling choice and control. However, if administrative systems do not take account of existing structural inequities, then such schemes are likely to entrench or grow social inequality. Our research indicates that more attention must be given to the design of policy delivery systems for personalisation schemes to ensure health equity.
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Affiliation(s)
| | - Gemma Carey
- Centre for Social Impact, UNSW, Kensington, Australia.
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Crépault JF. Cannabis Legalization in Canada: Reflections on Public Health and the Governance of Legal Psychoactive Substances. Front Public Health 2018; 6:220. [PMID: 30128310 PMCID: PMC6089329 DOI: 10.3389/fpubh.2018.00220] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 07/16/2018] [Indexed: 11/13/2022] Open
Abstract
The Canadian government is "taking a public health approach to legalizing, strictly regulating and restricting access to cannabis." There is, however, no universally accepted definition of a public health approach to cannabis. This paper presents what such an approach is, and is not, and discusses its applicability to legal psychoactive substances more generally. It critically reflects on the role of the public health sector in the governance of addictive substances and activities, noting its function of "responsibilizing" individuals and coaxing them to self-regulate-and the contradiction involved when other state actors involved in governance are actively inciting consumption of those substances and activities.
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Affiliation(s)
- Jean-François Crépault
- Communications and Partnerships, Centre for Addiction and Mental Health, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Revisiting Goffman: frames of mental health in the interactions of mental healthcare professionals with diasporic Muslims. SOCIAL THEORY & HEALTH 2018. [DOI: 10.1057/s41285-018-0064-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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