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Policies and strategies to promote social equity in health. Background document to WHO - Strategy paper for Europe



This is the second in a series of discussion papers from the WHO Regional Office for Europe. The first covers concepts and principes of equity in relation to health, and should be read in conjunction with this paper (Whitehead 1990). The present paper sets out to develop the discussion further by outlining a strategic approach to promote greater equity in health between different social and occupational groups. This draws on the work of WHO advisory groups and associated litterature listed at the back, together with practical examples from industrialized countries where strategies have been put into action. The first part (section 1-9) of the paper outlines why equity is seen as a priority and distinguishes different policy levels for interventions. Specific equity aspects related to each policy level are then highlighted as well as some case studies. The second part of the paper (section 10-14) deals with putting policy into practice. Special attention is then paid to the need for comprehensive approaches to combat social and occupational inequities in health as illustrated in terms of a strategy matrix. Furthermore the democratice process within which healthy public policies are to be discussed and determined is discussed as well as organizational aspects as regards the implementation of an equity oriented health policy. Finally checklists are presented focusing upon how to make things happen.
Dahlgren, Göran & Margaret Whitehead
Policies and strategies
to promote social
equity in health
Background document to WHO – Strategy paper
for Europe
This working paper was originally published in print form in September 1991. The figure
“The Main Determinants of Health” has been revised in this version.
Arbetsrapport/Institutet för Framtidsstudier; 2007:14
ISSN: 1652-120X
ISBN: 978-91-85619-18-4
Former Working Papers:
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Arbetsrapport/Institutet för Framtidsstudier; 2005:7
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comparative study of 16 countries, 1980-2000.
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Nilsson, Anders & Felipe Estrada, Den ojämlika utsattheten. Utsatthet för brott bland fattiga
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Esser, Ingrid, Continued Work or Retirement? Preferred Exit-age in Western European
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Duvander, Ann-Zofie, Ferrarini, Tommy & Sara Thalberg, Swedish parental leave and gender
equality. Achievements and reform challenges in a European perspective.
Arbetsrapport/Institutet för Framtidsstudier; 2005:12
Jans, Ann-Christin, Family relations, children and interregional mobility, 1970 to 2000.
Arbetsrapport/Institutet för Framtidsstudier; 2005:13
Ström, Sara, Childbearing and psycho-social work life conditions in Sweden 1991-2000.
Arbetsrapport/Institutet för Framtidsstudier; 2005:14
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Lindh, Thomas, Malmberg, Bo & Joakim Palme, Generations at War or Sustainable Social
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Olofsson, Jonas, Stability or change in the Swedish Labour Market Regime?
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Statistical Chimera
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Alm, Susanne, Drivkrafter bakom klassresan –kvantitativa data i fallstudiebelysning
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Duvander, Ann-Zofie, När är det dags för dagis? En studie om vid vilken ålder barn börjar
förskola och föräldrars åsikt om detta
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Johansson, Mats, Inkomst och ojämlikhet i Sverige 1951-2002
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Malmberg, Bo & Eva Andersson, Health as a factor in regional economic development
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Estrada, Felipe & Anders Nilsson, Segregation och utsatthet för egendomsbrott. - Betydelsen
av bostadsområdets resurser och individuella riskfaktorer
Arbetsrapport/Institutet för Framtidsstudier; 2006:6
Amcoff, Jan & Erik Westholm, Understanding rural change – demography as a key to the
Arbetsrapport/Institutet för Framtidsstudier; 2006:7
Lundqvist, Torbjörn, The Sustainable Society in Swedish Politics – Renewal and Continuity
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Lundqvist, Torbjörn, Competition Policy and the Swedish Model.
Arbetsrapport/Institutet för Framtidsstudier; 2006:9
de la Croix, David, Lindh, Thomas & Bo Malmberg, Growth and Longevity from the Industrial
Revolution to the Future of an Aging Society.
Arbetsrapport/Institutet för Framtidsstudier; 2006:10
Kangas, Olli, Lundberg, Urban & Niels Ploug, Three routes to a pension reform. Politics and
institutions in reforming pensions in Denmark, Finland and Sweden.
Arbetsrapport/Institutet för Framtidsstudier; 2006:11
Korpi, Martin, Does Size of Local Labour Markets Affect Wage Inequality? A Rank-size Rule of
Income Distribution
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Lindbom, Anders, The Swedish Conservative Party and the Welfare State. Institutional
Change and Adapting Preferences.
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Enström Öst, Cecilia, Bostadsbidrag och trångboddhet. Har 1997 års bostadsbidragsreform
förbättrat bostadssituationen för barnen?
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Nahum, Ruth-Aïda, Child Health and Family Income. Physical and Psychosocial Health.
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Nahum, Ruth-Aïda, Labour Supply Response to Spousal Sickness Absence.
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Brännström, Lars, Making their mark. Disentangling the Effects of Neighbourhood and School
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Lindh, Thomas & Urban Lundberg, Predicaments in the futures of aging democracies.
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Ryan, Paul, Has the youth labour market deteriorated in recent decades? Evidence from
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Amcoff, Jan, Regionförstoring – idé, mätproblem och framtidsutsikter
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Johansson, Mats & Katarina Katz, Wage differences between women and men in Sweden –
the impact of skill mismatch
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ISSN: 1652-120X
ISBN: 978-91-85619-18-4
... At the core of these models is the assumption that health "behavior has multiple levels of influences, often including intrapersonal (biological, psychological), interpersonal (social, cultural), organizational, community, physical environmental, and policy" (Sallis et al., 2008, p. 466) and that "behavior change is expected to be maximized when environments and policies support healthful choices" (Sallis et al., 2008, p. 466). These levels integrate factors that are broadly formulated as determinants of health and include the person's individual characteristics and behaviors, the social and economic conditions, the physical and built environment, and local resources (Barton & Grant, 2006;Dahlgren & Whitehead, 1991;Marmot, 2005). As comprehensive and multilevel frameworks, these are useful for (a) understanding the multiple and interacting factors influencing health, and thereby (b) guiding the development of more comprehensive public health interventions and more integrated and multisectoral urban plans aiming to improve conditions in health-promoting domains such as housing, employment, education, quality of urban physical environment, social support, mobility, and social services . ...
... Complementing this approach, the health map developed by Barton and Grant (2006) was used as a model for local analysis of the relationship between health and place. This conceptual framework is informed by the main determinants of the health model (Dahlgren & Whitehead, 1991, showing how various spheres of living conditions-the social, economic, built, and physical environmental determinants of health-are interconnected, thus providing a glimpse of the pathways through which policy and planning decisions may affect health ( Figure 1). ...
... Figure 3 depicts the multidimensional framework used in Stage 1-Health Profile. It is inspired by the main determinants of the health model (Dahlgren & Whitehead, 1991 and by the Utrecht health profile model (City of Utrecht, 2018). In each dimension, quantitative and qualitative data were collected using various kinds of data sources (e.g., death and disease ...
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As a cross-sectoral issue, the promotion of health needs to be addressed across all policies. In Portugal, as more competencies are being transferred to local governments, the integration of health considerations into municipal plans remains a challenge and guidance on how to develop an integrated municipal health strategy is absent. The aim of this study is to describe the conceptual and methodological approach that informed the development of an integrated and multisectoral municipal health strategy in the City of Coimbra. Its design followed a population health approach with a geographic lens, looking at how the population’s health outcomes and health determinants were geographically distributed across the municipality, as well as the extent to which policies from multiple sectors can address them. The planning cycle followed an iterative workflow of five actions: assessing, prioritizing, planning, implementing, and monitoring. Following a participatory planning approach, several participatory processes were conducted involving local stakeholders and citizens (e.g., population-based surveys, workshops, Delphi, collaborative sessions) to identify problems, establish priorities, and define measures and actions. The strategic framework for action integrates 94 actions across multisectoral domains of municipal intervention: sustainable mobility and public places, safe and adequate housing, accessible healthcare, social cohesion and participation, education and health literacy, and intersectoral and collaborative leadership. Findings shed light on important aspects that can inform other municipal strategies, such as the adoption of a place-based approach, focused on geographic inequalities, health determinants and stakeholder participation, and the application of a health in all policies framework.
... The practice of engagement is separate from the wider contextual, health system and individual factors that are important for engagement, but in uence this practice rather than being engagement itself (21,43,44). Contextual in uences include community dynamics, social resources, socioeconomic status, responsibilities, stigma, social norms, social capital and support, societal demands and politics (21,22,45). ...
... We focused on adult engagement as adults make up 95% of people living with HIV globally (43). ...
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Background As the crisis-based approach to HIV care evolves to chronic disease management, supporting ongoing engagement with HIV care is increasingly important to achieve long-term treatment success. However, ‘engagement’ is a complex concept and ambiguous definitions limit its evaluation. To guide engagement evaluation and interventions to improve HIV outcomes, we sought to identify critical, measurable dimensions of engagement with HIV care for people on treatment from a health service-delivery perspective. Methods We used a pragmatic, iterative approach to develop a framework, combining insights gained from researcher experience, a narrative literature review, framework mapping, expert stakeholder input and a formal scoping review of engagement measures. These inputs helped to refine the inclusion and definition of critical elements of engagement behaviour that could be evaluated by the health system Results The final framework presents engagement with HIV care as a dynamic behaviour that people practice rather than an individual characteristic or permanent state, so that people can be variably engaged at different points in their treatment journey. Engagement with HIV care for those on treatment is represented by three measurable dimensions: ‘retention’ (interaction with health services), ‘adherence’ (pill-taking behaviour), and ‘active self-management’ (ownership and self-management of care). Engagement is the product of wider contextual, health system and personal factors, and engagement in all dimensions facilitates successful treatment outcomes, such as virologic suppression and good health. While retention and adherence together may lead to treatment success at a particular point, this framework hypothesises that active self-management sustains treatment success over time. Thus, evaluation of all three core dimensions is crucial to realise the individual, societal and public health benefits of antiretroviral treatment programmes. Conclusions This framework distils a complex concept into three core, measurable dimensions critical for the maintenance of engagement. It characterises elements that the system might assess to evaluate engagement more comprehensively at individual and programmatic levels, and suggests that active self-management is an important consideration to support lifelong optimal engagement. This framework could be helpful in practice to guide the development of more nuanced interventions that improve long-term treatment success and help maintain momentum in controlling a changing epidemic.
... The wider social determinants of health are important determinants of CVD and associated risk factors [24]. Individuals of lower socioeconomic status (SES) experience increased morbidity and mortality on average [25]. ...
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Background Social and environmental risk factors in informal settlements and slums may contribute to increased risk of cardiovascular disease (CVD). This study assesses the socioeconomic inequalities in CVD risk factors in Brazil comparing slum and non-slum populations. Methods Responses from 94,114 individuals from the 2019 Brazilian National Health Survey were analysed. The United Nations Human Settlements Programme definition of a slum was used to identify slum inhabitants. Six behavioural risk factors, four metabolic risk factors and doctor-diagnosed CVD were analysed using Poisson regression models adjusting for socioeconomic characteristics. Results Compared to urban non-slum inhabitants, slum inhabitants were more likely to: have low (less than five days per week) consumption of fruits (APR: 1.04, 95%CI 1.01–1.07) or vegetables (APR: 1.08, 95%CI 1.05–1.12); drink four or more alcoholic drinks per day (APR: 1.05, 95%CI 1.03–1.06); and be physically active less than 150 minutes per week (APR: 1.03, 95%CI 1.01–1.04). There were no differences in the likelihoods of doctor-diagnosed metabolic risk factors or CVD between the two groups in adjusted models. There was a higher likelihood of behavioural and metabolic risk factors among those with lower education, with lower incomes, and the non-White population. Conclusions Brazilians living in slums are at higher risk of behavioural risk factors for CVD, suggesting local environments might impact access to and uptake of healthy behaviours.
... The instrument consisted of six main sections, divided according to the model of Dahlgren and Whitehead [44]: (1) sociodemographic characteristics of surveyed physicians (gender, age, occupation, and education level of the respondent); (2) physician's assessment of the clinical status of the young older adults and nonagenarians/centenarians (age groups divided into 65-89 as young older adults (aging tendency and 85+ ratio) and 90-115 as nonagenarians/centenarians) [34]; estimated health or disease of patients in the past three years, definition of most common diseases, estimated comorbidities, amount of patients infected with SARS-CoV-2. Questions included "completely healthy", "little limited ability", "marked by disease", or "suffers a lot", a horizontal analog scale (rating scales) to assess the amount of young older adults and nonagenarians/centenarian patients, a horizontal analog scale (rating scales) that took values between 0 (best condition) and 100 (worst condition), open-ended "yes" or "no" and multiple-choice questions; (3) physician's assessment of the behavioral, lifestyle, and nutritional factors of the young older adults and the nonagenarians/centenarians (use of drugs, tobacco and alcohol, nutrition, mental health). ...
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Longevity is rightly considered one of the greatest achievements of modern society. Biomedical research has shown that aging is the major risk factor for many diseases, so to find the right answers to aging it is necessary to identify factors that can positively influence longevity. This study investigated the clinical status, nutritional behavior, lifestyle, and social and community determinants of the well-being of young older adults and nonagenarians/centenarians in Salerno and province through the judgment of their physicians. Data were collected through an online survey. Multivariate Poisson and logistic regression models were used to calculate significant predictors of the outcomes of interest. The interesting finding was that cardiovascular disease was a risk factor for young older adults, while it was a protective factor for nonagenarians/centenarians, meaning that as age increased, heart problems tended to decrease. Certain foods were found to be a significant protective factor for both young older adult and nonagenarian–centenarian patients. In addition, psychosomatic disorders were found to be determinant for the young older adults, while depression was a risk factor for the nonagenarians/centenarians because they were not always gratified by their long lives and often felt like a burden on the family. The protective significant variable among the determinants of community well-being for both young older adults and nonagenarians/centenarians was the retention of honorary achievement. Based on our results, we are able to support the hypothesis of a difference between the young older adults and the nonagenarians/centenarians in clinical status, nutritional behaviors, lifestyle, and determinants of community well-being. However, societies need more social and educational programs that are able to build “a new idea of old age” by improving and supporting the young older adults and the nonagenarians/centenarians, with the goal of intergenerational solidarity, well-being, and social inclusion, as well as preventive interventions on lifestyles and nutrition, which will allow us to provide a new key to understanding aging.
... As Mrs T's case shows, our current model of care with central decision making and care co-ordination by the asthma physician through multiple separate specialist referrals (Table 1) might not lead to the best outcomes, nor might it meet patient needs and preferences, resulting in impaired cooperation and self-management. Getting the best possible outcomes for individuals living with multimorbidity is heavily reliant on an optimal combination of personal factors (an individuals' capacity, motivation, and readiness to share responsibility with their care provider), health care professional factors (skills, knowledge, motivation to implement personalised care and navigate the care system in collaboration with the patient) and organisational factors (available resources, accessibility, support within the system) [24,127,128]. A consistent message from the evidence reviewed in this paper is that complexity in the composition of multimorbidities/treatable traits as well as in the variability of emotional, cognitive and behavioural support needs of individuals living with DBS calls for a stratified personalised clinical approach. ...
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Three to ten percent of people living with asthma have difficult-to-treat asthma that remains poorly controlled despite maximum levels of guideline-based pharmacotherapy. This may result from a combination of multiple adverse health issues including aggravating comorbidities, inadequate treatment, suboptimal inhaler technique and/or poor adherence that may individually or collectively contribute to poor asthma control. Many of these are potentially “treatable traits” that can be pulmonary, extrapulmonary, behavioural or environmental factors. Whilst evidence-based guidelines lead clinicians in pharmacological treatment of pulmonary and many extrapulmonary traits, multiple comorbidities increase the burden of polypharmacy for the patient with asthma. Many of the treatable traits can be addressed with non-pharmacological approaches. In the current healthcare model, these are delivered by separate and often disjointed specialist services. This leaves the patients feeling lost in a fragmented healthcare system where clinical outcomes remain suboptimal even with the best current practice applied in each discipline. Our review aims to address this challenge calling for a paradigm change to conceptualise difficult-to-treat asthma as a multimorbid condition of a "Difficult Breathing Syndrome" that consequently needs a holistic personalised care attitude by combining pharmacotherapy with the non-pharmacological approaches. Therefore, we propose a roadmap for an evidence-based multi-disciplinary stepped care model to deliver this.
Converging global evidence highlights the dire consequences of climate change for human mental health and wellbeing. This paper summarises literature across relevant disciplines to provide a comprehensive narrative review of the multiple pathways through which climate change interacts with mental health and wellbeing. Climate change acts as a risk amplifier by disrupting the conditions known to support good mental health, including socioeconomic, cultural and environmental conditions, and living and working conditions. The disruptive influence of rising global temperatures and extreme weather events, such as experiencing a heatwave or water insecurity, compounds existing stressors experienced by individuals and communities. This has deleterious effects on people’s mental health and is particularly acute for those groups already disadvantaged within and across countries. Awareness and experiences of escalating climate threats and climate inaction can generate understandable psychological distress; though strong emotional responses can also motivate climate action. We highlight opportunities to support individuals and communities to cope with and act on climate change. Consideration of the multiple and interconnected pathways of climate impacts and their influence on mental health determinants must inform evidence-based interventions. Appropriate action that centres climate justice can reduce the current and future mental health burden, while simultaneously improving the conditions that nurture wellbeing and equality. The presented evidence adds further weight to the need for decisive climate action by decision makers across all scales.
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Global sustainability is a major health concern facing our planet today. The healthcare sector is a significant contributor to environmentally damaging activity. Reusable cloths should be considered as an environmentally friendly alternative to the predominantly used single-use surface wipes in cleaning and disinfection of environmental surfaces in healthcare settings. To understand its feasibility, a rapid review of current policies on surface decontamination in healthcare settings was conducted. A life cycle impact assessment (LCIA) was then carried out to compare the impact of reusable cotton and microfibre cloths versus conventional single-use cloths, with three compatible disinfectants. Seven countries were included in the rapid review of policies. For the LCIA, inputs, outputs, and processes across the life cycle were included, using EcoInvent database v3.7.1 and open LCIA software. Sixteen European-recommended environmental impact categories and eight human health categories were considered. Infection prevention policies examined do not require single-use wipes for cleaning and disinfection. The disinfectant with the highest environmental impact was isopropyl-alcohol. The most environmentally-sustainable option for clinical surface decontamination was the microfibre cloth when used with a quaternary ammonium compound. The least environmentally sustainable option was cotton with isopropyl-alcohol. Impacts were primarily attributed with the use of the disinfectant agent and travel processes.
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La mortalidad materna se distribuye de forma desigual en Nicaragua, afectando posiblemente en mayor medida a pueblos afrodescendientes y originarios. En base a los datos más recientes, en las instituciones de salud se producen tres de cada cuatro muertes maternas (2019-2020), una de cada dos mujeres experimenta morbilidad durante su primer parto y una de cada cuatro complicaciones potencialmente fatales para la vida (2010-2011). Dentro de las limitaciones del sistema de salud propias al nivel de desarrollo del país, los déficits en la calidad técnica y relacional de los cuidados profesionales, comunitarios y familiares durante el embarazo, parto o cesárea, y postparto (epcp) podrían explicar una parte significativa de la morbimortalidad materna. En este marco, la presente tesis por compendio de publicaciones se fija como objetivo identificar para Nicaragua cómo los determinantes estructurales de género, raza y clase social están limitando el acceso de las mujeres y criaturas a cuidados de calidad durante el epcp. Como objetivos específicos, plantea (OE1) valorar la calidad técnica y relacional de los cuidados profesionales durante el parto, (OE2) determinar cómo el sistema de género impacta en la configuración y operativa del sistema de cuidados y el modelo de atención durante el epcp, y (OE3) identificar cómo la intersección de las opresiones impacta sobre la calidad de la atención y cuidados. Se desarrolló una investigación de tipo exploratorio tomando las experiencias de parto y cesárea de las mujeres en el país como objeto de estudio. Se obtuvieron datos cuantitativos y cualitativos mediante un cuestionario en el que participaron 24 mujeres. Además, se llevó a cabo un análisis interdisciplinario de la episiotomía como práctica integrada en el modelo de atención durante el parto prevalente a nivel mundial, la que fue seleccionada por practicarse sin sostén de la Medicina Basada en Evidencia y por sus impactos. Para ello, se aplicó un análisis bibliográfico sobre 116 documentos en base a los términos: «episiotomía», «Mutilación genital femenina», «género», «raza», «poder», «paradigma tecnocrático», «modelo biomédico», «parto», «patriarcado», «colonialidad», «dispositivo», «biopoder» y «biopolítica». Finalmente, la respuesta del sistema de género y del sistema de cuidados a las necesidades de las mujeres y criaturas durante el epcp en el país fue analizada durante el curso de la epidemia del zika, aplicando un análisis crítico feminista sobre los discursos construidos por actores públicos y privados de peso en la arena política nacional. Este análisis se aplicó sobre 30 productos comunicacionales. Los resultados señalan que la calidad de los cuidados profesionales a las mujeres y criaturas durante el parto en Nicaragua presenta deficiencias, mostrando intervencionismo obstétrico, violencia obstétrica y prácticas sin consentimiento, generando impactos sobre la salud física y psicológica de las mujeres y sobre la construcción social del género. Ante la crisis del zika, el sistema de género se fortaleció, reforzando la violencia de género en el campo simbólico, así como la violencia estructural y la desigualdad social en el sistema de cuidados y, por tanto, para el conjunto de las macroestructuras sociales. Dentro del paradigma tecnocrático de atención, la tesis sostiene que la episiotomía se practica como una mutilación genital femenina que refuerza la colonialidad y la construcción social del género, la raza y la clase social. En conjunto, los hallazgos indican que la desigualdad en salud y derechos sexuales y reproductivos en Nicaragua se nutre de la adscripción de este campo a la esfera de lo privado, lo que faculta y exacerba la discriminación sexista, racista y clasista sobre las mujeres que caen fuera de la categoría de la blanquitud. En tal caso, desintegrar la política sexual y reproductiva que a efectos pragmáticos se observa desplegada a nivel mundial ―centrada en el hacer vivir a ciertas mujeres y criaturas y dejar morir a otras― y dotar esta problemática del estatus de problema público requieren situar como prioridad desarticular el sistema de género.
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Our everyday behaviours in life can positively and negatively impact our health, thus cumulatively shaping our lifestyles as more or less healthy. These behaviours are often determined by our knowledge, literacy, motivations and socioeconomic backgrounds. The authors aimed to assess health behaviours and explore variables that may affect persons studying to become future healthcare professionals in Poland. This study was conducted with a group of 275 undergraduate students attending the Poznan University of Medical Sciences representing six different majors of study. We used self-reported, cross-sectional survey conducted through the use of a questionnaire that consisted of one standardised scale (Juczy ´ nski’s Health Behaviour Inventory) as well as a self-developed health literacy measure. The students showed average to high levels of health-promoting behaviours (mean HBI = 82.04 ± 11.26). Medium to strong associations were found between these behaviours and high scores on the health literacy scale (p = 0.001, r = 0.45 between total scores of the two scales). Dietetics students and female respondents scored significantly better on both scales, which suggests that their self-reported behaviours and health literacy were higher than those of other participants. Exhibiting health-protective behaviours and high health literacy is likely to result in the better individual health of our respondents, but, more importantly, will also influence their future professions. As members of the healthcare workforce they will be responsible for the health of the population and it is crucial for them not only to provide care, education, and guidance, but also to act as role-models for their patients and society.
Our paper empirically examines the influence of the digital transformation process on life expectancy employing a sample of 20 European countries over the period from 2015 to 2020. In the models, digitalization is captured by six measures. Our results illustrate that using the internet and online activities reduce life expectancy, whereas business digitization, e-commerce, digital public services, and higher digital skills in the population can improve the life expectancy of men and women, leading to a reduction in the gender gap. Furthermore, we detect that men are significantly more affected by the implementation of digital transformation, while online administrative procedures also lead to a rise in life expectancy but only in women. These effects only exist in the long term. We also find that digital connectivity, business digitization, e-commerce, and digital skills help people survive longer during the Covid-19 pandemic.
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The aim of this article is to study how the ideas of a sustainable society have developed and adapted to Swedish politics. It starts with the assumption that new ideas have a greater possibility to make a difference if they adapt to the political culture, and if important actors make the ideas their own. This issue is studied for the years 1988-2004. One conclusion is that social democratic welfare ideology has given its imprint in the rhetoric of a sustainable society. Another conclusion is that the ideas has been obtained in party ideology from left to right and been adapted to traditional ideological differences.
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The study analyzes three generations of future studies on work life and leisure, performed at the Secretariat and later the Swedish Institute for Future Studies. The ideal types of Tore Frängsmyr, “The efficient society” and “The good life”, are used as analytical tools. The primary information consists of program declarations and reports from projects in the 1970- 1980- and 1990s. In the 1970s the original plan to produce a final report failed, and the analyses here show that differences in terms of the ideal types here used could explain the failure. While in one of the reports studied, the focus is on how Sweden is to maintain a high export ratio and a prominent position in international competition, the two other reports are written from an explicit Marxist perspective and discuss how the sharp split between work and leisure in modern capitalist societies could be remedied. That is, while the first report is focused on “The efficient society”, the two latter deal exclusively with a version of “The good life”. The final report from the project of the 1980s is characterized by a reserved, but still in some sense accepting, attitude towards the high-technological society. Utopian thoughts of a completely different society are non-existing, but the discussion mainly focuses on ways to make high-technological society as tolerable as possible to humans. In terms of the here used terminology the report can be said to deal with “The good life” within the realms of “The efficient society”. In the final report from the 1990s the point of departure is that industrial society is being replaced by a new post-industrial one. Unlike in earlier projects here studied, the entire discussion of driving forces behind societal development is on the structural level. The possibilities of individuals to shape their future seem small or non-existing. Neither are consequences at the individual level of structural development in focus. It’s is diffi
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The paper argues that the Swedish ‘neo-liberal’ party (Moderaterna) has adapted its policies because of the popularity of the ‘universal’ Swedish welfare state. The party has come to accept that the modern welfare state is irreplaceable. We furthermore argue that the party’s moderate electoral platform in 2006 is earnest. In the “short run” the party can only hope to achieve incremental changes and it recognises this. Simultaneously however, the party in the “long run” wants to gradually change society. Over time the party in its rhetoric and ideological statements has emphasised the short and the long run differently. These differences between the ‘neo-liberal’ 1980s and 2006 should not conceal that the mechanism of welfare popularity largely remains the same. The party’s actual policy proposals tend to suggest incremental changes only in both periods.
Among the most central questions at the intersection of demography and economics is the impact of large scale demographic processes on long-run economic performance. The classical version of this inquiry, occupying thinkers from Malthus towards those from the mid-to-late 20th century, had to do with whether rapid population growth threatened economic growth. This classical inquiry has been superseded by more sophisticated questioning in which the focus on growth rate of the aggregate population has been replaced by focus on the growth rates of age-specific population sub-groups. Disaggregating the effects of population growth by age-group is generally accepted to be a fundamental improvement over classical inquiry because people’s economic roles and contributions vary by age: the young are net consumers and beneficiaries of human capital investments, adults are net producers and savers, and the old are (at least in theory or to a greater degree than adults) net consumers. Thus the economic consequences of rapid growth in the population size of the young and the elderly could potentially have a depressing impact on growth, while rapid growth in the population size of adults could stimulate growth. The demographic transition brings with it a three stage process in which a baby boom cohort moves through the population’s age pyramid. The life cycle of this cohort creates a first stage in which there is rapid growth in youth population, then a second stage in which there is rapid growth in the adult population, and finally a third stage in which there is rapid growth in the elderly population. The first and third stages can be thought of as the challenging stages since economies must confront the challenge of providing for large dependent populations. However, the second stage can be thought of as a demographic gift or dividend stage since growth in the productive adult population can potentially boost economic growth. The traditional mechanisms for the demog
Traditionally, pension systems aim to fulfill a number of functions which include income security and consumption smoothing in old age, as well as income redistribution. The main rationale for pension reform lies in the interaction between current demographic trends (e.g. increasing old age dependency ratios) and the design of existing pension systems (particularly, the so called Pay-As-You-Go public systems). Under certain conditions, population aging can in fact undermine the ability of a pension system to fulfill those very aims for which it was created, putting pensioners at risks of higher poverty and inequality, besides creating large fiscal pressures on governments and threaten economic growth. In the literature, we find two main approaches to this debate. On the one hand, economic theory helps us formalize the mechanisms through which aging affects a pension system, given its possible features (e.g. type of benefit offered, degree of actuarial fairness or type of financing); it also helps us quantify costs or returns associated to different pension designs and, consequently, to different pension reform options. On the other hand, the policy debate is centered on models of reform which take from concrete country experiences; overall, it focuses mostly on whether funding pensions (i.e. privatizing and individualizing retirement savings, away from Pay-As-You-Go systems) is the best option for reducing many of the negative economic impacts associated to population aging. After having illustrated both sides of the debate – the theoretical and the empirical - our paper makes two main claims. Firstly, the debate should be re-framed away from whether funding is the best option for pension reform in the face of population aging, towards a redefinition of the problem which rather focus on the type of benefit offered, its coverage, its eligibility conditions and actuarial design (as this controls important behavioral and efficiency implications). Secondly, an
There is nowadays a widespread sense that things have gone badly wrong for young workers in advanced economies, and that the difficulty is caused by a fall in their appeal to employers. It is tempting to attribute the problem to a trend in labour demand that favours older, more experienced workers over younger, less experienced ones. The same line of interpretation has been widely favoured for the other major dimension of employee skill: educational attainment. The contemporary fall in the pay of less educated workers, as compared to more educated ones, in the US and the UK in particular, has been widely attributed to the spread of information technology and globalisation, both of which are taken to raise the productivity of more educated workers relative to less educated ones. An influential account of developments in the US claims that ‘relative demand shifts favouring more skilled workers are … essential to understanding longer-run changes in the US wage structure’ (Katz and Autor 1999: 1513). The same factors might had similar effects in the experience dimension of skill, thereby impairing labour market prospects for young workers. The validity of these propositions has however been contested. Doubts have been raised concerning the existence of skill-bias in technical change (Card and DiNardo 2002). Some commentaries deny the existence of an underlying trend unfavourable to youth (OECD 2002: 20-29). This paper investigates the evidence concerning trends in youth relative pay and employment in developed economies since the mid-1970s, focusing on structural change on the demand-side of the labour market. It improves on previous research by including more countries, and by controlling for macroeconomic fluctuations, which affect youth employment particularly keenly. It then considers the growth of educational participation, as a further, supply-side, influence that complicates the interpretation of changes in youth outcomes.
One subject that has received ample attention in recent years is the potential negative effects of spatial concentrations of disadvantage on participation in society, particularly in terms of labour market participation and educational careers. This study contributes to the literature on the effects of neighbourhood and school on individual educational outcomes by examining whether and to what extent adolescent educational achievement is determined by neighbourhood and school population characteristics. By using an unusually rich administrative data set of leaving certificates for around 26,000 upper secondary school students who were registered as residing in any of the three metropolitan areas of Sweden in the school year 2004, cross-classified multilevel analyses show that characteristics attributable to upper secondary schools matter much more for the variability in achievement than do neighbourhoods. There are also indications of contextual effects at each level (particularly among boys with an immigrant background) that operate above and beyond the impact of observed individual-level background attributes. Since the estimated effects of concentrations of (dis)advantage and immigrant density at neighbourhood and school level point in different directions, this study demonstrates the benefits of analysing the effects of neighbourhood and school on individual educational outcomes at the same time.
This study examines labour supply responses to spousal sickness absence (SSA) using a Swedish longitudinal panel data, from 1996-2002. The overall results present an evidence of a decrease in labour supply in response to spousal sickness absence. The effect on labour supply increases with spousal earnings level. Women react stronger than men, and more often respond to current shorter term SSA, whereas men mostly react to longer term SSA.
This paper contributes to the important policy related literature on income and health by providing a detailed investigation of the family income/child health relationship using matched parent–child survey data from the Swedish Survey of Living Conditions (ULF). This study differs from previous work in the field in a number of respects. First, we focus on both physical as well as on the psychosocial health of the child. Second, we focus on the parent’s socioeconomic background as well as on the liquidity constraint problems the household faces. We find little evidence of an income gradient or effect on children’s physical and psychosocial health. However, our study suggests that the occurrence of liquidity constraints in the household increases the likelihood of the child having a lower psychosocial health status.
The questions addressed in this paper are: (i) does wage inequality increase with local population size, and if so, (ii) what are possible factors behind this increase? In a cross-section analysis of Swedish local labour markets using unique full population data, the article shows that urban scale, i.e. size of local population, has significant positive effects on wage inequality. Testing for potential explanations, labour market diversification, human capital, migration, age structure and employment are shown to be significantly associated with inequality. Given these effects, the article raises the question of how to understand and incorporate scale effects into models of long-term change in wage inequality.