Making the links between community structure and individual well-being: community quality of life in Riverdale, Toronto, Canada

Older People's Usage Pattern, Satisfaction with Community Facility and Well-Being in Urban Old Districts

Community facilities are an important element that supports older people's daily life and promotes their well-being. However, there is a dearth of comprehensive studies on the effect of planning and design of different types of community facilities on older people's usage patterns and satisfaction. This study aims to provide a framework to explore the relationship among the planning of community facilities, older people's usage and satisfaction level and well-being for different types of community facilities. Both spatial analysis and questionnaire survey (n = 497) methods are employed in this study. This study finds that commercial (89.34%), municipal (83.10%) and leisure (88.13%) facilities are most commonly used by older people. This study suggests that older people's frequency of visiting community facilities is mainly affected by the purpose of visiting a community facility. Planning and design quality of the community facility are found to be significantly associated with older people's satisfaction level with using a community facility. In addition, older people's higher satisfaction level and usage level of community facilities could increase their physical and psychological well-being. The findings of this study not only contribute to the knowledge gap of older people's usage and satisfaction with using community facilities but also suggest that planners should aim toward a better distribution of community facilities to improve older adults' well-being.

Maintaining Population Health in a Period of Welfare State Decline: Political Economy as the Missing Dimension in Health Promotion Theory and Practice

There is increasing recognition in the health promotion and population health fields that the primary determinants of health lay outside the health care and behavioural risk arenas. Many of these factors involve public policy decisions made by governments that influence the distribution of income, degree of social security, and quality and availability of education, food, and housing, among others. These non-medical and non-lifestyle factors have come to be known as the social determinants of health. In many nations – and this is especially the case in North America – recent policy decisions are undermining these social determinants of health. A political economy analysis of the forces supporting as well as threatening the welfare state is offered as a means of both understanding these policy decisions and advancing the health promotion and population health agendas. The building blocks of social democracies – the political systems that seem most amenable to securing the social determinants of health - are identified as key to promoting health. Health promoters and population health researchers need to “get political” and recognize the importance of political and social action in support of health.

'Don't fix what ain't broke': evaluating the effectiveness of a Men's Shed in inner-regional Australia

Men's Sheds and similar community programmes are known to encourage help-seeking behaviour and thus improve the health and well-being outcomes for the men who attend. This paper investigates this issue through a community needs assessment of a Men's Shed programme in inner-regional Australia. The immediate purpose of this research was to help direct future funding initiatives, and provide recommendations for potential changes and improvements to the programme. A community-level needs assessment is a systematic process used to determine and address gaps or needs between current and desired conditions within a particular community. We sought to explore how particular formats and structures of Men's Sheds programmes contribute to improve social and medical well-being, and whether there are key programme characteristics that could be emulated. In total, 22 surveys and 20 interviews were conducted with the men who participated in the programme. The report finds 95% of men are satisfied with the current running of the programme. While there were areas that have been identified for improvement, most men reported that they are content with the current format and would not like to see major changes to its implementation. The results of this research confirm the known benefits of these types of programmes. This paper provides other community programmes with some insight into the key success factors for running a Men's Shed.

Spatial Accessibility to Health Care Services: Identifying under-Serviced Neighbourhoods in Canadian Urban Areas

BACKGROUND

Urban environments can influence many aspects of health and well-being and access to health care is one of them. Access to primary health care (PHC) in urban settings is a pressing research and policy issue in Canada. Most research on access to healthcare is focused on national and provincial levels in Canada; there is a need to advance current understanding to local scales such as neighbourhoods.

METHODS

This study examines spatial accessibility to family physicians using the Three-Step Floating Catchment Area (3SFCA) method to identify neighbourhoods with poor geographical access to PHC services and their spatial patterning across 14 Canadian urban settings. An index of spatial access to PHC services, representing an accessibility score (physicians-per-1000 population), was calculated for neighborhoods using a 3km road network distance. Information about primary health care providers (this definition does not include mobile services such as health buses or nurse practitioners or less distributed services such as emergency rooms) used in this research was gathered from publicly available and routinely updated sources (i.e. provincial colleges of physicians and surgeons). An integrated geocoding approach was used to establish PHC locations.

RESULTS

The results found that the three methods, Simple Ratio, Neighbourhood Simple Ratio, and 3SFCA that produce City level access scores are positively correlated with each other. Comparative analyses were performed both within and across urban settings to examine disparities in distributions of PHC services. It is found that neighbourhoods with poor accessibility scores in the main urban settings across Canada have further disadvantages in relation to population high health care needs.

CONCLUSIONS

The results of this study show substantial variations in geographical accessibility to PHC services both within and among urban areas. This research enhances our understanding of spatial accessibility to health care services at the neighbourhood level. In particular, the results show that the low access neighbourhoods tend to be clustered in the neighbourhoods at the urban periphery and immediately surrounding the downtown area.

Social Determinants of Health: Present Status, Unanswered Questions, and Future Directions

This article reviews the current status of theory and research concerning the social determinants of health. It provides an overview of current conceptualizations and evidence on the impact of various social determinants of health. The contributions of different disciplines—epidemiology, sociology, political economy, and the human rights perspective—to the field are acknowledged, but profound gaps persist in our understanding of the forces that drive the quality of various social determinants of health and why research is too infrequently translated into action. Many of these gaps in knowledge concern the political, economic, and social forces that make implementation of public policy agendas focused on strengthening the social determinants of health problematic. The author identifies the areas of inquiry needed to help translate knowledge into action.

A four-part ecological model of community-focused therapeutic recreation and life skills services for children and youth with disabilities

AIM

This article presents a four-part model of community-focused therapeutic recreation and life skills services for children's rehabilitation centres.

METHOD AND RESULTS

The model is based on 15 years of clinical and management practice in a Canadian context combined with evidence from the literature on community-focused service delivery. The model incorporates an ecological approach and principles from models of therapeutic recreation, community capacity building, and health promotion, as well as client/family-centred care. The four pillars of the model reflect a set of integrated services and principles designed to support the participation of children and youth with disabilities in community activities. The pillars involve providing community outreach services, providing community development services, sharing physical and educational resources with community partners, and promoting the organization as a community facility that provides adapted physical space and specialized instruction. The lessons learned in implementing the model are discussed, including the importance of ensuring the sustainability of community recreation programmes.

CONCLUSIONS

The model will be of use to managers and service organizations seeking to develop an integrated programme of community-focused therapeutic recreation and life skills services based on a collaborative capacity-building approach.

A social capital framework for palliative care: supporting health and well-being for people with life-limiting illness and their carers through social relations and networks

CONTEXT

Social relations and networks are vital for sustaining and enhancing end-of-life care. The social capital concept supports a framework to understand the association between social relations and well-being; yet, to date, there has been very limited investigation of social capital in the palliative care literature. A framework for understanding social contexts in end-of-life care is necessary.

OBJECTIVES

To summarize the literature on social capital, well-being, and quality of life for key outcomes to inform a model of social capital in palliative care.

METHODS

The electronic databases MEDLINE (1997 to March 2011), Embase (1997 to March 2011), CINAHL (1997 to March 2011), and PsycINFO (1997 to March 2011) were searched using key/MeSH search terms of "social capital," "palliative care," and "well-being" and/or "quality of life." The literature was reviewed to identify key concepts to develop and inform a palliative care social capital framework.

RESULTS

A total of 93 articles were included in the literature review, with only two articles identifying discourse on social capital and palliative care. Four key areas integrating the social capital outcomes informed a framework for palliative care.

CONCLUSION

The social capital concept provides a structure for understanding how the organization and meaning of social contexts can potentially enhance or hinder end-of-life care. Research that identifies specificity in application of social capital concepts is fundamental to issues of access to services, sustaining levels of care, quality of life, and well-being. The importance of "bridged" social capital relations and networks for improved resource acquisition and information flow was identified in the literature and outlined within the palliative care social capital framework. Differential access to social capital by disadvantaged groups provides further impetus to engage a model of social capital for palliative care.

Income and Health in Canada: Canadian Researchers' Conceptualizations Make Policy Change Unlikely

The research reported here identified and evaluated gaps in Canadian knowledge and research activity concerning the role of income and its distribution in influencing health outcomes. The study consisted of an analysis of 241 recent Canadian research studies, the components of which were compared with 40 U.K. and 40 Finnish studies that applied advanced conceptualizations of the income-health relationship. Canadian health researchers rarely made explicit their conceptualizations of how income was approached in their studies, and most did not identify the structural mechanisms that mediate the income-health relationship. There were few Canadian longitudinal studies capable of illuminating the role of income in health across the lifespan. Many Canadian studies identified pathways by which income might influence health, but these conceptualizations were underdeveloped. Canadian researchers need to strengthen their conceptualizations of how income and its distribution affect health. While empirical research is only one contributor to positive policy change, the narrow nature of Canadian work will do little to influence this process. Interdisciplinary work on the political, economic, and social forces that contribute to income inequalities has the potential, when combined with political and social action, to facilitate public policy in support of health.

Beyond foodscapes: considering geographies of Indigenous well-being

Direct associations between food and health have been pursued traditionally through nutrition and health policy studies; however, geography has much to offer in providing a disciplinary context that can support a critique of this literature and the recognition of the critical significance of broader associations between culture, environment and well-being. This paper explores the potential of these opportunities by reviewing existing interests in food geographies and the wider attention being given to geographies of health and well-being. We then turn to consider dimensions of Indigenous life, health and well-being and we highlight the complex intersection of people, place and 'nature-culture' relations. In particular, we propose the need to move beyond a foodscape approach and suggest how a more culturally complex reading of food and food practices may be made to enhance research and policy concerning Indigenous health and well-being.

Subjective quality of life according to work status following interdisciplinary work rehabilitation consequent to musculoskeletal disability

INTRODUCTION

Individualized subjective quality of life (ISQoL) is the appraisal of quality of life according to personal values, desired goal attainment and life priorities. "Gap" is a way to operationalize ISQoL. ISQoL is rarely measured by interdisciplinary work rehabilitation (IWR) programs attended by the musculoskeletal disorder (MSD) population. These programs commonly measure pain intensity, physical capacity, perceived disability, distress and return to work.

OBJECTIVES

The aims of this study were to compare ISQoL according to work status and reference values and to explore the relationships between ISQoL and common IWR measures.

METHODS

Six months after completing an IWR program, 40 working and 31 not-working participants completed questionnaires documenting work status, pain, ISQoL gap, health-related quality of life (SF-36, PCS and MCS), perceived disability and distress.

RESULTS

No significant difference in global ISQoL gap was found between working and not-working participants. When compared to reference values considerable variability exists but globally, for both groups, ISQoL gap scores were below average. The following clinical variables were related to global ISQoL (P < 0.05): pain (r = -0.42), PCS (r = -0.37), MCS (r = -0.56), perceived disability (r = 0.37) and distress (r = 0.61). High distress, present in both groups, explains 38% of the global ISQoL gap variance and PCS adds 4%.

CONCLUSION

Following IWR programs for the chronic MSD population, global ISQoL gap is not related to work status. The use of a client-centered interactive computerized measure of ISQoL reveals that domains related to emotional well-being are likely the most problematic for the persistently disabled MSD population.

Community perspectives on the impact of policy change on linking social capital in a rural community

Understanding what undermines or builds social capital is important when estimating the impact that changes in social capital have on people's lives. The aim of this paper is to illustrate how the consequences of neo-liberal policy initiatives have impacted on linking social capital in one small and vibrant rural community in Australia. Policy changes affecting all levels of government and various commercial agencies have undermined people's capability for a range of actions which bring personal and community-wide social and economic returns. Rationalisation and regionalisation of services and commercial agencies, including local government amalgamation, and increased workloads have undermined people's capabilities for community engagement. Policy outcomes are at odds with the stated policy agenda of building community capacity.

Perceived health is associated with visiting natural favourite places in the vicinity

Visiting favourite natural settings may serve as a resource for regulating negative feelings and coping with perceived stress. The authors investigated the association between perceived health, the selection and experiential qualities of favourite places in four residential areas; 211 respondents (average age 40 years) responded to the questionnaire. Respondents with a certain amount of health complaints, such as headaches, chest or stomach pains, and faintness or dizziness, were more likely to select natural favourite places than those with few complaints. Respondents with health complaints benefited more in emotional terms from their visits to the favourite place although they did not visit their places more frequently than others. The change toward positive feelings was associated in particular with natural favourite places and relaxing in them. The results give impetus to research on the self-regulation of mood and neighbourhood context in health.

Is there a link between rates of common mental disorder and deficits in social capital in Gospel Oak, London?

Previous research in Gospel Oak indicates high-rates of common mental disorder. This paper explores how far deficits in social capital may be linked to these rates. Interviews, focus groups and participant observation were conducted to assess social capital in Gospel Oak from the phenomenological experience of residents. The data suggested that most residents perceived the neighbourhood to be rich in well-developed facilities, services and associational activity. Residents also generally expressed satisfaction with local trust and reciprocity. The results do not support the hypothesis that rates of common mental disorder in Gospel Oak are linked to deficits in social capital. Compositional factors may be more important in accounting for these rates.

Local services and amenities, neighborhood social capital, and health

Recent work on health and place has examined the impact of the environment on health. At the local level, research has followed several strands, such as contextual effects of neighborhoods, the impact of differential access to services and amenities, effects of a neighborhood's collective efficacy, and the relationship between social capital and health. Of these four approaches, social capital has generated the most debate; some scholars discuss social capital as a key epidemiological variable, while others discount or dismiss its utility. We undertook this research to assess whether the concept of social capital could increase our understanding of the impact of neighborhoods on residents' health. We utilized key informant interviews and focus groups to understand ways in which residents of diverse neighborhoods in one large California city perceived that their local communities were affecting health. We argue in this paper that using the term "social capital" to discuss social resources and their mobilization in a particular neighborhood highlights the ways in which social resources can vary in relation to economic resources, and that residents of neighborhoods with differing levels of services and amenities face different issues when mobilizing to improve their neighborhoods. Additionally, the projects that people invest in vary by neighborhood socioeconomic status. We draw on the paired concepts of "bridging" and "bonding" social capital, and discuss that while stores of bonding social capital may be more uniform across neighborhoods of varying SES, bridging social capital tends to be found in greater amounts in neighborhoods of higher SES which allows them greater success when mobilizing to improve their neighborhoods.

The welfare state as a determinant of women’s health: support for women’s quality of life in Canada and four comparison nations

The case is made that characteristics associated with the advanced welfare state in industrialised nations are primary contributors to women's quality of life. This is so since women's health and well-being are particularly sensitive to decisions made in relation to the spending priorities of governments, the extent to which services are provided, and the degree to which women are supported in moves towards equity. Data from the Organization for Economic Cooperation and Development, United Nations Human Development Program, and other sources are used to examine these influences upon quality of life of women in Canada as compared to that of women in Denmark, Sweden, the UK and the US. A consistent pattern was seen by which national features impacting on women's quality of life are more likely to be seen in nations with a social welfare orientation as compared to nations with market approaches to policy development.

The profile of professionals in health and education fields at work in their communities

Social roles mold attitudes of actors who play the part in the community, and affect behavioral and moral attitudes and social conscience. There is a diversity of behaviors that demonstrates the extension to which individuals are in constant participation in the community life. A group profile of professional's health and education may supply information on the disciplinary approach in Community Health. Objective: to examine the profile of professionals at work in the Health and Education fields. Subjects participated in answering questions concerning professional work, leisure/religious activities, feeding/sleep habits, prevention and contraceptive methods, medical and/or psychological treatment and medicine/herbal use. Characteristics of the professional group regarding life style and the paradox of the practice of safe sex behavior were recorded. There exists the possibility to improve the quality of life for people in communities by reducing the sources of stress and tension by promoting physical and mental health. Methods should be investigated to allow for the promotion of a quality of life in a small fraction of the population engaged in health and education work in their own communities.