Levels of health development: a new tool for comparative research and policy formulation

Female life expectancy, gender stratification, health status, and level of economic development: a cross-national study of less developed countries

A number of studies have attempted to account for cross-national differences in life expectancy, but relatively few have focused on female life expectancy, and even fewer on the relevance of predictors linked to gender stratification theory. The present study seeks to assess the utility of gender stratification theory in accounting for cross-national differences in female life expectancy in less developed countries. An incremental model building strategy is used to develop a final model that combines predictors linked to both industrialism theory and gender stratification theory. The analysis is based on multiple regression and cross-sectional samples that vary in size from 40 to 97 countries. Evidence is presented that several aspects of women's status have a positive effect on female life expectancy. Indicators of women's educational status, women's economic status, and women's reproductive autonomy all prove to be important predictors of female life expectancy. Analysis of interaction effects suggests that the strength of the effects of some aspects of women's economic status and the effect of some aspects of health status on female life expectancy vary with the level of economic development. A comprehensive assessment of the relative strength of alternative measures of women's education is carried out, and evidence is presented that it does make a difference how the level of women's education is measured.

Constructing a complex of contagion: the perceptions of AIDS among working prostitutes in Costa Rica

This paper explores the perceptions of HIV/AIDS held by a group of women working as prostitutes in San José, Costa Rica. Adopting the theoretical perspective of critical medical anthropology, the analysis of the prostitutes' constructions of HIV/AIDS is linked to the political and historical context of power that constitutes a medical cultural hegemony. The way in which the research participants associate threats of HIV/AIDS with violence to create a complex of contagion that both perpetuates and challenges the hegemonic model of disease is discussed. Specifically, biomedicine's designation of the prostitute as the "vector" of disease is contrasted with the position that the prostitutes create for themselves. Through a critical analysis of this complex of contagion, oppressive power structures come into sharp focus.

International stratification and the health of women: an empirical comparison of alternative models of world-system position

Women's health status is investigated in the context of stratification in the world-system. We investigate three alternative conceptualizations of the world-system for their effects on women's health status, using country-level data. The models investigate the effects of world-system position, military expenditures, and health resources on women's health status. Comparison of the alternative conceptualizations of world-system position indicate that a continuous model is only negligibly better than three- or five-block models at explaining women's health status. Regardless of how it is measured, world-system position has dramatic effects on women's health.

[Relationship between ideology and efficiency of health care systems. Notes on the reform of the Spanish health care system]

This paper explores the relation between ideology and efficiency of the health care systems. In order to achieve this goal, this study: analyzes the relation between ideology and health care system organization, defines the concept of health care system efficiency, and reviews the relation between health care organization and efficiency. The last part of the paper is devoted to discuss the relevance of the conclusions of the above mentioned analyses to the debate on the reform of the Spanish National Health Care System.

Health indicators and the organization of health care systems in western Europe

OBJECTIVES

This study investigated the association between health care systems and health indicators in developed countries.

METHODS

Cross-national comparisons were conducted with regression analysis between 17 Western European countries with two types of health care systems: national health services and social security systems.

RESULTS

Health care expenditures were inversely correlated to potential years of life lost to females and to infant mortality rates; they were positively correlated to life expectancy for females. Regression models predicted that countries with national health services systems would have lower infant mortality rates at similar levels of gross domestic product (GDP) and health care expenditures. Finally, increases in health care expenditures would decrease the ratio of observed to predicted infant mortality rates according to GDP; this decrease would be greater in countries with national health services than in those with social security systems. The model predicted this difference to be about 13% at average levels of health expenditures.

CONCLUSIONS

National health services seem to be more efficient at producing lower infant mortality rates than social security systems in Western European countries.

A causal model of high rates of child mortality

The distribution of child mortality has often been misunderstood because of insufficient attention to its context. High rates of child mortality in developing countries have variously been attributed to child neglect, cultural traditions of child care, population pressure, low maternal educational levels, lack of medical care, and insufficient basic resources. The model proposed in this article organizes factors leading to high child mortality rates onto three tiers to contextualize the medical causes of death and the debate over traditions of child care. The proximate tier includes the immediate biomedical conditions that result in death, typically involving interactions of malnutrition and infection. The intermediate tier includes child care practices and other behavior that increase the exposure of children to causes of death on the proximate tier. The ultimate tier encompasses the broad social, economic, and cultural processes and structures that lead to the differential distribution of basic necessities, especially food, shelter, and sanitation. The ultimate tier thus forms the context of causes located on the other tiers. Research from rural Mexico, Central America, and Africa supports various parts of the model, particularly concerning traditional parental behavior, which has often been interpreted as child neglect but appears in many cases to result ultimately from economic scarcity. Links from tier to tier in the model especially warrant further attention from both researchers and policy makers.

The political and economic determinants of health outcomes: a cross-national analysis

This article investigates the impact of selected political and economic processes on the well-being of domestic populations within samples of 50 to 84 peripheral and noncore nations. Existing research by Cereseto and Waitzkin on the relative merits of market versus socialist systems for the provision of health and welfare needs of their populations is extended by employing a more complex model than the original study. More specifically, the authors assess the impact on measures of population health and mortality rates of regime ideology, state strength, multinational corporate penetration, and position in the world economy. In general, high levels of democracy and strong left-wing regimes are associated with positive health outcomes, and strong right-wing regimes have populations with lower life expectancies and higher levels of various measures of mortality. These findings support the conclusion that political systems make a difference in health and well-being independent of national (gross national product per capita) and international (investment dependency) economic factors.

The health status of women in the world-system

The health status of women is examined within the context of a global political economy. The authors present a beginning attempt to model some key macrolevel processes linked to the health of women. In particular, a structural modeling technique known as LVPLS (or "soft modeling") is used to empirically test one recent formulation of world-system theory. The findings give added emphasis to the importance of the larger economic forces that affect women's health.

Changes in disease patterns and related social trends

Social environment is a major determinant of health and disease patterns in any community. The 19th century revolution in public health had as its cornerstone the improvement of social and physical environment. The favorable social development has since that time significantly contributed to the decrease of traditional health hazards in developed countries. New public health problems, chronic diseases have emerged in these countries. In some of these nations a new trend has started that may be called the second revolution in public health, i.e. the reduction of chronic diseases. However, the major part of the world's population still suffers from the traditional illnesses that should and could have been set aside by the 19th century revolution. Obviously, the social environment has not been altered sufficiently in these areas to have the desired impact on the health status. The observations from the Eastern European countries stress the need for a purposeful avoidance of deprivation in the social and physical environment as prerequisites for the prevention and control of diseases. Generally, low socio-economic status has been found to relate to an increased risk in many diseases. Usually there is a definite time lag between changes in social trends and disease patterns which causes difficulties for research in this area. The same fact generates problems for the planning and implementation of interventions to prevent the socially affected diseases. Changes in disease patterns are not only determined by altered social trends, but disease patterns can also influence social tendencies in several ways. Studying the interaction of social and health trends quantitatively and experimentally has yielded results which are hard to interpret. Therefore, observational and 'soft' methods are employed here to describe the relationship of social and health trends more aptly.