Hans Peeters

What role do traditional beliefs play in treatment seeking and delay for Buruli ulcer disease?--insights from a mixed methods study in Cameroon.

Background Victims of Buruli ulcer disease (BUD) frequently report to specialized units at a late stage of the disease. This delay has been associated with local beliefs and a preference for traditional healing linked to a reportedly mystical origin of the disease. We assessed the role beliefs play in determining BUD sufferers’ choice between traditional and biomedical treatments. Methods Anthropological fieldwork was conducted in community and clinical settings in the region of Ayos and Akonolinga in Central Cameroon. The research design consisted of a mixed methods study, triangulating a qualitative strand based on ethnographic research and quantitative data obtained through a survey presented to all patients at the Ayos and Akonolinga hospitals (N = 79) at the time of study and in four endemic communities (N = 73) belonging to the hospitals’ catchment area. Results The analysis of BUD sufferers’ health-seeking behaviour showed extremely complex therapeutic itineraries, including various attempts and failures both in the biomedical and traditional fields. Contrary to expectations, nearly half of all hospital patients attributed their illness to mystical causes, while traditional healers admitted patients they perceived to be infected by natural causes. Moreover, both patients in hospitals and in communities often combined elements of both types of treatments. Ultimately, perceptions regarding the effectiveness of the treatment, the option for local treatment as a cost prevention strategy and the characteristics of the doctor-patient relationship were more determinant for treatment choice than beliefs. Discussion The ascription of delay and treatment choice to beliefs constitutes an over-simplification of BUD health-seeking behaviour and places the responsibility directly on the shoulders of BUD sufferers while potentially neglecting other structural elements. While more efficacious treatment in the biomedical sector is likely to reduce perceived mystical involvement in the disease, additional decentralization could constitute a key element to reduce delay and increase adherence to biomedical treatment.

Commensuration and policy comparison: How the use of standardized indicators affects the rankings of pension systems

This article presents an analysis of the process of commensuration in the field of pension policy. It looks at the consequences of reducing disparate and variable characteristics of pension systems to a limited set of standardized policy indicators. Although techniques of scoring complex systems through common indicators are applied today in fields as diverse as scientific research, human resources management and international development, this article is the first to examine the process of commensuration in the field of pensions. The empirical analysis looks at three cases where international institutions use standardized pension indicators to score and rank the performance of national pension systems. The first case examines the use of replacement rates in the international benchmarking of pension systems. We then focus on how rankings diverge considerably depending upon which function of the pension system is under assessment. Finally, we discuss how the public–private mix of a pension system affects the ranking of pension adequacy due to the way in which second and third pillar pensions are measured. The cases illustrate some of the problems associated with scoring and ranking the outcomes of unique and complex pension systems by means of internationally standardized indicators.

Lifecourses, pensions and poverty among elderly women in Belgium: Interactions between family history, work history and pension regulations

ABSTRACT The precarious financial situation of many elderly women in developed countries is well established. Nevertheless, in-depth insight into the persistent vulnerability of this group remains largely absent. In this article, we demonstrate how a specific focus on the interaction between work history, family history and pension regulations can provide greater insight into the mechanisms that produce poverty among elderly women in Belgium. To that end, we make use of register data on some 9,000 women aged 65–71. Data on the poverty risk of these women is linked to career and family data, spanning over 45 years. We find that pension policy can indeed account for the higher poverty risk of some groups of elderly women (e.g. divorcees) as compared to others (e.g. widows). Similarly, pension policy can, to a large extent, directly or indirectly explain how previous lifecourse events, such as marital dissolution or childbirth, affect old-age poverty risk. However, our study also reveals some unexpected findings. Most notably, pension regulations fail to account for the beneficial situation of married women. Indeed, our analyses suggest that capital (income) may prove more decisive than pension rights in explaining the low poverty risk of married women when compared to other marital groups. Drawing from our findings, we conclude with some suggestions as to where pension policy should go from here.

Review: Theoretical Approaches: Peter Hedström, Dissecting the Social: On the Principles of Analytical Sociology. Cambridge: Cambridge University Press, 2005, 177 pp., ISBN 0521796679, £15.99

Most of these possibilities are to be found in this volume, which is a fascinating, inspiring and thought-provoking book and definitely highly recommended reading. At some points, problems with Luhmann’s theory are made explicit; at others, they become evident to the attentive reader. The authors make a marvellous effort to adopt, apply, but also to critically complement and further develop certain issues. Of course, the authors who are trying to apply and to use Luhmann’s theories cannot be blamed for the problems inherent in his theories. In this respect, the reader may wonder whether this book has already moved beyond Luhmann.