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Although health services in Australia have an aim to provide inclusive care for their patients/clients, this study highlights how barriers to care can lie at the centre of patient-provider interactions. Racial microaggression is a subtle form of racism that can occur in health settings, leading to further exclusion for First Nations Australians, immigrants and refugees. This paper is guided by Derrida's approach to deconstructionism by unpacking how language is used by health professionals – as holders of organisational power – and how they construct 'truths' or discourses about clients that historically have been marginalised by health services and system. Data comprise 21 interviews with staff from two rural health services. It identified three racial microaggressions were used to justify the challenges of providing care to people from First Nations, immigrant and refugee backgrounds: (1) Participants problematised culture(s) of service users; (2) participants implied cultural superiority in their conceptualisation of 'other' cultures; and (3) participants shared stories of inactions, discomfort and relegating of responsibility. The findings identified these discourses as forms of racial microaggression that can potentially lead to further exclusion of people seeking services and support. [ABSTRACT FROM AUTHOR]

An editorial is presented on the rapid advances in biomedical, biomechanical and bio digital technologies have inspired scholarship that seeks to understand the ways in which practices of sex and intimacy are being transformed by such technologies and the implications this has for health. It mentions that the production of media discourses that uncritically position dating apps as a social problem through analysis of the relationship between media reporting and research.

This paper draws upon literature from economics, and the human capital and equity fields in order to present a theoretical framework for a new multidimensional measure of poverty for Australia. Poverty is about having low living standards; but its measurement has traditionally focused only on an individual's income or on other dimensions of living standards that are not appropriate for contemporary Australian society, such as calorie intake. There are two additional capabilities individuals require for adequate living standards: health and education. Each of these is required for basic functioning within modern society, but have traditionally been ignored by measures of poverty. This paper argues that health is a basic capability people need for a fulfilling life, allowing individuals to participate in activities essential in modern society, and that education can also be seen in this light. As such it is vital that health and education be included in measures of poverty. In order to move Australian poverty measurement forward and build upon the work of the past, poverty measurement must move its focus away from only looking at low income, and take a holistic focus on the living standards of individuals by incorporating assessments of health and education. [ABSTRACT FROM AUTHOR]

Poor health and disease and the nature of interventions to ameliorate them typically generate opportunities and costs. What diseases are prevalent, which interventions are favoured and what factors fuel the nature of health interventions are recurrent concerns for political economists. This paper examines the prevailing viewpoints about what health policy works and what does not. Drawing on evidence from developing countries, it shows that there are many deficiencies in the prevailing orthodoxy which emphasises state, market, and civil society solutions. The paper suggests that health policy debate must be refrained around poverty and social inequality, constructs which are often subordinated to attaining grand ideological goals. [ABSTRACT FROM AUTHOR]

This paper explores the intersection of gender and class concerning welfare clients with medically unexplained symptoms. The study is conducted in Denmark using qualitative interviews with welfare officers and clients. The paper's focus is on how issues of gender and class intersect in the negotiation of illness among welfare officers and clients. The particular client group in question consists of individuals that are defined by their lack of a bio-medical diagnosis. Their 'lack' of identity accentuates how gender and class become central in the categorisation practices, constructing the ill person as either bio-medically sick or as a person who may be suffering but only from diffuse psychological problems. The paper shows that it is predominantly poorly educated women without a bio-medical diagnosis that welfare officers describe as suffering from psychological problems despite the fact that the women themselves focus on physical ailments in their illness stories. Men and better-educated women are described by the welfare officers as tired and exhausted or truly stressed after a long working life. [ABSTRACT FROM AUTHOR]

While recognition of transgender people has increased in Vietnam, this population continues to face significant stigma and discrimination within their families and in public, including in medical settings. Understanding of transgender health is limited, especially regarding the provision of care to transgender people. This paper explores providers' preparedness for delivering transgender care using data from qualitative interviews with twelve healthcare professionals in Hanoi and Ho Chi Minh City. Drawing on the socio-ecological model, we illustrated multi-level factors that influenced the provision of medical services to transgender people, including restrictive legislation (policy level); shortage of transgender-specific services, and lack of training and guidelines (organisational level); and ambiguous perceptions, inappropriate provider-patient communication, and medical knowledge gaps (individual level). Overall, our study has identified a healthcare environment that is under-prepared to meet the complex health needs of transgender individuals. With this study, we call for intervention strategies beyond individual-level support and emphasise the urgency of allowing medical institutions to provide transgender-specific health services including gender-affirming surgery and hormonal treatments. [ABSTRACT FROM AUTHOR]

This paper explores which measures of health accurately reflect the functional capabilities of individuals -- that is, in what measures of health do those classified as having poorer health actually have poorer functional outcomes. Using the 2003 Survey of Disability, Ageing and Carers, cross-tabulations, chi-squared analysis, and logistic regression models were used to identify the relationship between functional outcomes (core activity limitations and employment and education participation) and various measures of health and disability (composite disability measure, health utility scores and general health assessment). Both the composite disability measure and the health utility score accurately capture individual functional capacity -- with both measures being related to employment participation, employment and education restrictions, and core activity imitations. The health utility scores can also be divided into a categorical measure and still reflect this functional capacity. The general health assessment measure is also related to functional capacity and can potentially be used in the place of both the composite disability measure and the health utility score. [ABSTRACT FROM AUTHOR]

This paper presents the findings of a qualitative study of the impact of casualised and independent contractor work place arrangements on the psycho-social health of 72 workers in regional Victoria. It contributes to our understanding of the crisis in rural Australia in its use of qualitative methods focusing on the impact of work on health and well-being. There is some evidence in the literature that casualised work arrangement enhance the health and well-being of workers by giving them a sense of autonomy and freedom to negotiate their conditions of work. On the other hand, these arrangements may make an already vulnerable group even more vulnerable to uncertain work conditions, poor pay and uncertainty for their future with a significantly negative impact on their health and wellbeing. The results of these interviews support this latter perspective and show that these workers do not experience freedom and autonomy, but rather lowered social status, insecurity and serious limitations to their ability to manage their health, psychological wellbeing and social relations. [ABSTRACT FROM AUTHOR]

Objectives: This paper examines social inequality in children's health following the election of Evo Morales. Bolivia is marked by dramatic socioeconomic, ethnic and geographic inequality in children's health. The Morales government initiated several public health reforms designed to provide more equal access to public health services. Methods: Analysis was conducted using Bolivia Demographic and Health Survey data from 2003 to 2008. Results: The analysis shows some improvements in children's health. However, inequality in access to doctors, child mortality and child nutritional status did not diminish. In contrast, inequalities in immunization declined dramatically. Conclusions: Results suggest that aspects of health that are easier to implement such as immunization are more accessible to public policy than are more complex health problems like malnutrition and high child mortality. [ABSTRACT FROM AUTHOR]

Menopause is an important health transition for women, but health-related research has largely failed to account for menopause in a meaningful way, especially when making group comparisons. Age often stands in for menopausal status; at times, it is treated as a dichotomy; however, these are clearly oversimplifications. Menopause is a process that takes place over several years, and varies in onset, length, and expression through symptoms. Defining menopause dichotomously or linking it with age obscures variability in women's experiences and overlooks patterns in physical health, mental health, and quality of life. This paper reviews research to highlight menopausal differences by age, race, and lifestyle factors in the United States. It suggests ways to incorporate a life course-based view of menopause in health research, improving our understanding of women's health outcomes on multiple dimensions. [ABSTRACT FROM AUTHOR]

The increased use of information technology in health care allows researchers to generate data on rates of medication use among population groups, raising questions as to whether these rates are too high or too low. This paper presents findings from a study of records of all prescription medication dispensed in one New Zealand region (Te Tāirawhiti) over a one year period. The study examined patterns of psychotropic medication use amongst older people, by age, gender, ethnicity and socio-economic position. It concludes that the chances of being defined as needing psychotropic medication, that is, of being 'medicalised', are not evenly spread through the elderly population. Gender, age and ethnicity impacted significantly on whether prescriptions were received. Our results suggest the need for a nuanced understanding of the medicalisation of unhappiness and deviant behaviour amongst the elderly which takes into account barriers to treatment for some social groups. [ABSTRACT FROM AUTHOR]

Because the HIV/AIDS crisis in Kenya is causing the death and disablement of so many prime- aged adults, households are increasingly being headed by adolescents and the elderly. The purpose of this paper is to examine the health status of one of the most vulnerable groups in Kenyan society - adolescent women - and to explore how the type of household head impacts on their health status. Using data from the 2003 Kenya Demographic and Health Survey (KDHS), an indicator of illness signs was used as the dependent variable for health status. Significant differences were found in the health status of adolescent women in households headed by adolescents, prime-aged adults, and the elderly. Even when controlling for demographic factors, residing in an adolescent headed household increased the odds that an adolescent woman would have recently experienced some signs of illness. Other factors which also increased the odds of illness were being married and being in the older age group (20-24). Wealth barely had any impact on illness. Service providers need to pay special attention to the needs of adolescents in non-adult headed households. [ABSTRACT FROM AUTHOR]

Although an increasing number of studies emphasise migrants' knowledge about their healthcare rights as crucial for their healthcare usage, almost none examine the conditions under which migrants acquire this knowledge. This study contributes to the literature by studying the main determinants of migrants' knowledge about their healthcare rights: Self-interest and necessity, human capital, and social capital. I use unique data collected through the project Migrants' Welfare State Attitudes (MIFARE), where we surveyed 10 different migrant groups within Denmark, the Netherlands, and Germany on their relation to the welfare state, including healthcare. Analysing a total sample of 6,864 migrants using multinomial logistic regression analyses I find that migrants' knowledge about their healthcare rights depends mainly on their education and language skills. Both factors enable migrants to grasp health-related information and to become informed about their healthcare rights. I also observe a network effect since healthcare experiences of family members contribute to migrants' healthcare knowledge. Social ties to the co-ethnic community, however, do not explain why some migrants know more about their healthcare rights than others. Lastly, I find large differences between migrant groups, which remain even after controlling for all relevant factors. [ABSTRACT FROM AUTHOR]

The study used data from the Household, Income and Labour Dynamics in Australia (HILDA) Survey to explore three hypotheses: (1) that income and wealth both predict economic security perception, mental health, and physical health; (2) that gradients in health outcomes are better explained by wealth than income; and (3) that economic security perception is better explained by wealth than income. We conducted fixed effects regression analysis. After controlling for other variables in our model, both income and wealth appeared to have positive and significant associations with economic security perception and a range of mental health outcomes, but not physical health. There was also some evidence to support our second hypothesis, that gradients in health outcomes are better explained by wealth than income, however only for mental health. Our third hypothesis was not supported by the data. While both income and wealth were strongly related to economic security perception, it was better explained by income than wealth. We recommend that future studies are designed to evaluate the role of economic security as a mediating variable in the relationship between income, wealth and health, because the implications are substantial. [ABSTRACT FROM AUTHOR]

In the context of persisting health inequities within many multicultural and socially diverse countries like Australia, there is a call for health services to implement culturally inclusive systems and practices. Nowhere is this more important than in regional, rural and remote Australia where consumers are diverse, health services are scarce, and services designed for particular groups of the population are lacking. Drawing on interviews with 20 staff of a rurally-based, mainstream community health service, this article examines the role of discourse in the transition to a culturally inclusive health centre. In doing so, the power struggles inherent in such a process are highlighted. The article contends that improvements in the health outcomes of First Nation and culturally Other groups within the Australian population is contingent upon systematic resistances that disrupt and re-arrange existing dominant discourses. This calls for a disruption of current race relations in both broader social fields as well as those supporting biomedical assumptions about the delivery of healthcare in the mainstream health sector. Alternative discourses must be promoted in both these fields. [ABSTRACT FROM AUTHOR]

Research on cultural capital mobilised in healthcare largely focuses on how patients of low-socioeconomic status or ethnic minority groups struggle in the healthcare field. This study examines how providers, care coordinators, and administrators use their own cultural capital resources to bolster equity in health services, and explores the limitations of such efforts. Thirty-five hours of interviews with Hispanic and non-Hispanic White personnel at U.S. community health centres are used to explore how individuals on the 'supply-side' of healthcare may exhibit flexible expectations of patient cultural capital. Participants acknowledge how factors such as immigration status and family roles affect patient ability to exhibit traditionally high-value cultural capital in clinical interactions. Yet, providers' flexible expectations and cultural knowledge alone cannot deliver comprehensive care to indigent patients of colour. Persistent systemic barriers like high costs and limited public programs require healthcare workers to navigate care outside of interactions with patients. Participants describe the precarious process of drawing favours from professional social networks to coordinate access for patients facing multiple forms of social marginalisation. While acknowledging the importance of cross-cultural skills, this research explains processes impeding professional cultural training interventions in their ability to correct health service inequities on a broad scale. [ABSTRACT FROM AUTHOR]

Informed by Bourdieu and Passeron's theory of reproduction, we investigated relationships between the cultural and economic capitals of South Korean parents and the capitals and self-rated health of their adult children in cross-sectional survey data from the 2006 Korea Welfare Panel Study. Parental education and childhood economic circumstances manifested independent associations with the self-rated health of the adult respondents. Much of the connection between parental capitals and respondent self-rated health was explained by respondent education. Educational attainment and household income but not receipt of monetary inheritance from their parents were significantly associated with the self-rated health of the respondents. Lastly, parental educational attainment was associated with the self-rated health of the women but not the men over and above the capitals held by the respondents themselves. Our study illuminates the importance of the intergenerational transmission of multiple forms of capital in the production of good health for South Korean adults. In particular, we propose that wealthy and well-educated South Korean parents employ their capitals to develop math and linguistics skills in their children that facilitate good performance in the standardised university entrance exams, success in the labour and/or marriage markets and, ultimately, good self-rated health for their adult children. [ABSTRACT FROM AUTHOR]

Living kidney donation is an alternative treatment option for end-stage renal failure. Prospective donors are protected from risk by counselling and assessment processes, to ensure they are fully informed about all the stages of donation. Drawing on in-depth interviews with 25 living kidney donors from across New Zealand, this article discusses donors' experience of the pre-donation screening process, donation workup coordination, psychological preparation, and post-operative follow-up care and support. In particular, the article examines donor perceptions of the informed consent process. The findings indicate that donors' experience of the consent process may be at odds with the New Zealand Code of Health and Disability Services Consumers' Rights 1996. Instead of a primary healthcare focus on the threshold elements of informed consent, this study indicates that more effort should be made to adequately inform donors and to clearly spell out each stage of the donation process to better meet donors' needs. [ABSTRACT FROM AUTHOR]

Whilst 'biographical disruption' remains important for explaining how people rebuild biography following the onset of chronic illness, it does not self-evidently explain the problem of managing a fluctuating chronic condition such as non-specific low back pain. Chronic illness rarely leads to long-term improvement; the trajectory is not always linear, and sudden or gradual improvements alongside deterioration are commonly experienced. In the case of low back pain, self-management often involves utilisation of non-pharmaceutical approaches, personal resources for accommodating pain and disability, as well as managing symptoms with clinical treatments to relieve pain. Such a multifaceted approach -- not only concerned with the reduction of symptoms -- shifts focus beyond the 'disease' state and a single point of disruption, drawing attention to the use of 'health maintenance actions' to facilitate a proactive response to illness management. We propose this new approach as an alternative way of understanding the experience of patients with fluctuating health conditions such as low back pain. [ABSTRACT FROM AUTHOR]

In this study we analyze data from Statistics Canada's General Social Survey, a cross-sectional and nationally representative survey of Canada's population, to assess the impact of three dimensions of social capital on self-rated health. We measure these dimensions, which consist of social networks and social support, civic participation and social participation, with a comprehensive set of 5 indicators. To avoid reverse causality due to the cross-sectional nature of the data, we employ an instrumental variable simultaneous equations bivariate probit regression model. Our findings indicate that all of the tested dimensions of social capital have a positive and significant impact on self-rated health. These findings suggest that social capital plays an important role in enhancing the health of Canada's population. Endogeneity was detected in all of our estimations. Consequently, this study also has important methodological implications in that we demonstrate that relying solely on naive estimations leads to biased results. [ABSTRACT FROM AUTHOR]

The study, designed as a pilot, aimed to explore lay perceptions of air quality from participants who were selected to represent three different social categories: age; health status; and geographical location. We compared responses from younger with older participants who held memories of about air quality prior to the Clean Air Act (1956). We also explored possible differences in perception due to health status by including some participants who identified themselves as having asthma. Finally, we compared possible differences in perception between two economically and geographically distinct areas of Greater Nottingham in England. Semi-structured interviews were carried out with 22 participants recruited through schools, church groups and residential homes. Our findings suggest that no air (apart from the seaside) is perceived as automatically safe and therefore healthy. We found that perceptions of 'good' air seem to vary with age and health whereas experiences of air quality are associated with socio-economic status. Perceptions of air are shown to be suffused with historical significance, as well as embodying projections embedded from within the local environment and material context. [ABSTRACT FROM AUTHOR]

The aim of this article is to highlight a link between housing and health that may have been underestimated: the pathway from poor health towards marginal housing in caravan parks. Almost all research on links between housing and health is derived from large-scale surveys and correlational analyses which suggest a causation path from poor housing to poor health. The big picture of such studies may in fact disguise a reality for a smaller group where poor health leads to class 'slide' and reduced housing options. Qualitative data and life histories from interviews probe such 'reverse' links and also flesh out contextual backgrounds. It is argued in this article that evidence from interviews with 10 caravan park managers and 50 residents from 16 parks in outer Melbourne and rural Victoria supports general arguments that poor health appears to be a pathway leading to marginal housing. [ABSTRACT FROM AUTHOR]