Search

While universal health coverage (UHC) has been praised as a powerful means to reduce inequalities and improve access to health globally, little has been said about how patients experience and understand its implementation locally. In this article, we explore the experiences of young Chileans with type 1 diabetes when seeking care in Santiago, within Chile's UHC program, which sought to improve people's access to health care. We argue that the implementation of UHC, within a structurally fragmented health system, did not lead to the promised equitable health care delivery. Although UHC aimed to equitably provide universal care, locally it materialized in heterogeneous configurations forcing individuals into positions of precarity and generating new inequalities. Furthermore, for the young people in the study, UHC intersected with their health insurance and socioeconomic status, impacting on the health care they could access, consequently making diabetes care and management a difficult challenge. [ABSTRACT FROM AUTHOR]

Aims This study aims to measure the prevalence rates and patterns of help-seeking behavior as a consequence of being harmed by drinkers in five Asian countries (India, Sri Lanka, Vietnam, Lao PDR and Thailand). Methods A total of 9832 respondents aged 18–65 years from the WHO/ThaiHealth Collaborative Project were surveyed between 2012 and 2014 about their experiences of being negatively affected due to another's drinking, and whether and where they sought help, focusing on four adverse aspects of harms from others' drinking. Results The prevalence of seeking help from any source in the past year due to harm from others' drinking ranged from 7% to 20%. The most common service used by those who were affected by other people's drinking was asking for help from friends, followed by calling the police and using health-related services. The largest proportion of help-seeking was among those reporting property harm, followed by those being harmed physically and sexually by drinkers. Conclusion Given a wide range of harms from others' drinking in the general population and different needs of those affected, prevalence rates for help-seeking behavior due to others' drinking in South and South East Asian countries were low and the help sought was often informal. There is a large knowledge gap in our understanding of the mechanisms of help-seeking behavior and the pathways for access to help among those affected. Further studies are important for enhancing the social response services available and making these more accessible to those who need help. [ABSTRACT FROM AUTHOR]

Recently, social determinants of health frameworks are receiving some criticism in that they do not engage with questions related to individual subjectivity and agency as they relate to health decision-making behavior. This article examines the different ways in which people living in a remote Arnhem Land community in the Northern Territory of Australia, take responsibility for their own health and the extent to which they are able to prevent illness. A number of related sub-questions are explored relating to how people perceive their health and their role in health care in their community, including their engagement with the health clinic, traditional medicines, and the influence of sorcery on ill health and sickness. [ABSTRACT FROM AUTHOR]

Objective: To examine marijuana use by youth in a remote Aboriginal community in Northern Australia over a 5-year period. Design: Participant observation, structured and unstructured interviews. Setting: Remote Indigenous Australian community. Participants: Young Aboriginal people and adult community members. Main outcome measure: Emergent themes of the attitudes towards marijuana use among remote Indigenous residents are reported. Results: Restrictions in the availability of alcohol and petrol have led to increased use of marijuana with serious social and community consequences. Conclusions: Efforts to control licit substances, such as alcohol, in remote communities need to be addressed in the context of understanding of the dynamics of alcohol and drug use in totality as well as interventions that address underlying structural and social inequalities. [ABSTRACT FROM AUTHOR]

Introduction: Clown doctors are a feature in paediatric hospitals, visiting children and families, providing a welcome escape from the reality of hospitalisation. Whilst the use of humour to improve health and wellbeing has been widely researched, limited exploration of the role of clown doctors has occurred. This research aims to elucidate the role of clown doctors within a paediatric hospital. Theory/Methods: In this ethnographic study, participants included the clown doctors and every person with whom they had a meaningful encounter. The narrative of the clown doctors was captured through 1,500 hours of participant observation documented over one year. Interviews and visual methods were utilised, with key informants drawing and explaining their experience of the clown doctors. A constructivist framework was used to analyse emergent themes. Results: Whilst almost universally acknowledged as a positive addition to the hospital, most people who encounter the clown doctors have little conception about the scope of their role. Themes that arose during observation that related to the function of clown doctors included: distraction, anxiety reduction and procedural assistance; entertainment and making people laugh; emotional support and providing comfort; and communication, including translating clinical information to families. These functional elements of the clown doctors are the result of a more complex, intimate human connection that arose due to the nature of the clown being low-status, open, and vulnerable, and in particular existing as an outsider within the medical establishment. These interconnected relationships drove engagement and resulted in clown doctors becoming privy to information, emotions, complaints, jokes, disclosures etc., often not revealed by patients and their families to staff members, or even vice versa. Discussion: While almost universally acknowledged as a positive addition to the hospital, most people who encounter the clown doctors have little conception about the scope of their role. The role of the clown doctors transcends traditional labels, but in crude terms it can be characterised as thus: role leads to function, which in turn leads to outcome. In terms of a joke analogy, function is the punch line of being a clown doctor. Conclusion: The results of this study provide a comprehensive understanding of clown doctors and the complexity of human relationships within a major paediatric hospital, uncovering a profound, nuanced culture cheerfully highlighting the need for a more person-centred approach to healthcare. Lessons Learned: This study has advanced understanding regarding clown doctors' unique contribution to healthcare delivery within a tertiary paediatric health service, highlighting their expertise in role-modelling person-centred interactions. Limitations: This study was conducted within one paediatric health service. The researchers believe however that the novel understandings regarding the role of the clown doctors generated through this study would likely transfer easily to other healthcare settings. Suggestions for Future Research: This study will inform future qualitative and quantitate research studies that aim to describe and measure the role of the clown doctors, as distinct from their activities, and the contribution this has to the experience of patients within health care services. [ABSTRACT FROM AUTHOR]