Jaime Sapag

Capital social y promoción de la salud en América Latina

Latin America faces common development and health problems and equity and overcoming poverty are crucial in the search for comprehensive and high impact solutions. The article analyzes the definition of social capital, its relationship with health, its limitations and potentialities from a perspective of community development and health promotion in Latin America. High-priority challenges are also identified as well as possible ways to better measure and to strengthen social capital. Particularly, it is discussed how and why social capital may be critical in a global health promotion strategy, where empowerment and community participation, interdisciplinary and intersectorial work would help to achieve Public Health aims and a sustainable positive change for the global development. Also, some potential limitations of the social capital concept in the context of health promotion in Latin America are identified.

Social capital and healthy urbanization in a globalized world.

This paper critically reviews the extent in which social capital can be a resource to promote health equity in urban contexts. It analyzes the concept of social capital and reviews evidence to link social capital to health outcomes and health equity, drawing on evidence from epidemiological studies and descriptive case studies from both developed and developing countries. The findings show that in certain environments social capital can be a key factor influencing health outcomes of technical interventions. Social capital can generate both the conditions necessary for mutual support and care and the mechanisms required for communities and groups to exert effective pressure to influence policy. The link between social capital and health is shown to operate through different pathways at different societal levels, but initiatives to strengthen social capital for health need to be part of a broader, holistic, social development process that also addresses upstream structural determinants of health. A clearer understanding is also needed of the complexity and dynamics of the social processes involved and their contribution to health equity and better health. The paper concludes with recommendations for policy and programming and identifies ten key elements needed to build social capital.

Social capital and health in Latin America and the Caribbean: a systematic review

OBJECTIVE To identify validated information available on the relationship between social capital (SC) and health in Latin America and the Caribbean (LAC). METHODS A systematic search for papers published from January 1990-June 2007 was conducted on the Medline, SciELO, LILACS, and the Cochrane Library databases. All of the research and review articles published by scientific journals that evaluated CS and its relationship to health in LAC were included in the analysis. RESULTS Fifteen articles were found (11 original research and 4 reviews). The health topics examined by the research articles were: (a) mortality and life expectancy, (b) mental health, (c) injuries, (d) nutritional status, and (e) immunization. The validity of these works, the results, and the principal conclusions were analyzed in depth. CONCLUSIONS Despite limitations inherent to the CS concept and the studies identified, it was confirmed that scientific evidence exists to support the possible association between CS and health in LAC. CS could play a protective role in certain health areas, such as injury prevention and mental health; not withstanding, the relationship between CS and health could vary according to CS subtype and socioeconomic context and culture. It is therefore imperative to continue social epidemiology research that thoroughly investigates the relationship between social determinants and specific aspects of health in LAC context.

Social capital and self-rated health in urban low income neighbourhoods in Chile

Objective: To examine the potential association between social capital and self-rated health within a low income community of Santiago, Chile. Method: Cross-sectional survey, based on in-home interviews in the municipality of Puente Alto in Santiago, Chile. The participants were 781 residents of four neighbourhoods within Puente Alto (mean age 45.5 years). Results: Principal components analysis with varimax rotation identified five domains of social capital: perceived trust in neighbours, perceived trust in organisations, reciprocity within the neighbourhood, neighbourhood integration, and social participation (Cronbach alphas: 0.58 to 0.77). Trust and reciprocity were significantly associated with better self-rated health. For example, a one standard deviation increase in trust in neighbours was associated with an adjusted odds ratio of 1.10 (95% confidence interval, CI: 1.05 to 1.15) for reporting good self-rated health. By contrast, social participation was associated with a lower odds (0.89, 95% CI: 0.89 to 1.06) of reporting good health. Conclusion: Neighbourhood social cohesion, measured by trust and reciprocity, is associated with higher self-rated health. However, social participation did not appear to be associated with better health in this predominantly low income neighbourhood. These findings provide preliminary support to the relevance for social capital as a determinant of health in Chile.

Exploring child maltreatment and its relationship to alcohol and cannabis use in selected Latin American and Caribbean countries

OBJECTIVES Research from developed countries shows that child maltreatment increases the risk for substance use and problems. However, little evidence on this relationship is available from developing countries, and recognition of this relationship may have important implications for substance demand reduction strategies, including efforts to prevent and treat substance use and related problems. Latin America and the Caribbean is a rich and diverse region of the world with a large range of social and cultural influences. A working group constituted by the Inter-American Drug Abuse Control Commission and the Center for Addiction and Mental Health in June, 2010 identified research on this relationship as a priority area for a multinational research partnership. METHODS This paper examines the association between self-reported child maltreatment and use in the past 12 months of alcohol and cannabis in 2294 university students in seven participating universities in six participating countries: Colombia, El Salvador, Jamaica, Nicaragua, Panama and Uruguay. The research also considers the possible impact of religiosity and minimal psychological distress as factors contributing to resiliency in these samples. RESULTS The results showed that experience of maltreatment was associated with increased use of alcohol and cannabis. However, the effects differed depending on the type of maltreatment experienced. Higher levels of religiosity were consistently associated with lower levels of alcohol and cannabis use, but we found no evidence of an impact of minimal psychological distress on these measures. CONCLUSIONS This preliminary study shows that the experience of maltreatment may increase the risk of alcohol and cannabis use among university students in Latin American and Caribbean countries, but that higher levels of religiosity may reduce that risk. More work to determine the nature and significance of these relationships is needed.

Estrategias innovadoras para el cuidado y el autocuidado de personas con enfermedades crónicas en América Latina

OBJETIVOS: Identificar estrategias innovadoras dirigidas a mejorar el cuidado y el autocuidado de los pacientes con enfermedades cronicas (EC) en America Latina y explorar el interes en crear una red latinoamericana de profesionales en ese campo. METODOS: Estudio descriptivo exploratorio basado en una encuesta aplicada a expertos clave con reconocido liderazgo nacional o regional en la atencion de pacientes con EC. El cuestionario de 25 preguntas recababa informacion sobre su experiencia en iniciativas de cuidado y autocuidado de pacientes con EC, la descripcion de las iniciativas exitosas, la percepcion de la capacidad de los paises para innovar en este ambito y el interes en participar en una red de profesionales latinoamericanos en ese campo, entre otras. Se realizo un analisis de contenidos para elaborar recomendaciones para la Region. RESULTADOS: Se obtuvo respuesta de 17 (37,8%) de los 45 expertos invitados; 82,4% afirmo conocer o participar en alguna iniciativa innovadora en el tema planteado. Existe un incipiente desarrollo de los tres tipos de estrategias innovadoras: cuidado por pares, cuidadores informales y telecuidado, esta ultima es la menos explorada. Hay un real interes en conformar una red latinoamericana para el desarrollo de estrategias innovadoras dirigidas al autocuidado de pacientes con EC. CONCLUSIONES: Las bases para una red de trabajo conjunto son promisorias y es prioritario fortalecer las competencias en esta area y desarrollar propuestas innovadoras para mejorar la atencion de los pacientes con EC en la Region. Las medidas innovadoras deben ser complementarias y se deben ajustar al contexto especifico de cada escenario.

Capital social y salud mental en comunidades urbanas de nivel socioeconómico bajo, en Santiago, Chile: Nuevas formas de entender la relación comunidad-salud

BACKGROUND Many studies suggest that social capital, defined as those intangible resources of a society or community (trust, participation and reciprocity), that might facilitate collective action, can be associated with positive health effects. AIM To explore the relationship between social capital an the level of mental health, in urban communities of Santiago, Chile. MATERIAL AND METHODS In a qualitative-quantitative cross-sectional design, two low income neighborhoods in the municipality of Puente Alto were selected. Interviews to key agents and focus groups, as well as surveys (407) to adults from a representative random sample of households, were conducted, measuring social capital, using a locally devised questionnaire and mental health using the General Health Questionnaire (GHQ-12 instrument). A qualitative analysis based on the grounded theory and a quantitative analysis through correlations and simple and logistic regression models were applied. RESULTS The quantitative analysis found an association between female gender, education and having a chronic disease, with low levels of mental health. At the same time, the trust component of social capital might be associated with a better mental health status. Qualitatively, all the components of social capital were identified as important for a better mental health. CONCLUSIONS This study suggests the existence of a positive relationship between social capital and mental health. Developing trust in a community might be a useful tool to work in mental health at the community level.

Child Maltreatment and Its Relationship to Drug Use in Latin America and the Caribbean: An Overview and Multinational Research Partnership

Child maltreatment and substance abuse are both international public health priorities. Research shows that child maltreatment increases the risk for substance use and problems. Thus, recognition of this relationship may have important implications for substance demand reduction strategies, including efforts to prevent and treat substance use and related problems. Latin America and the Caribbean is a rich and diverse region of the world with a large range of social and cultural influences. To date, relatively little work has addressed the link between child maltreatment and substance use in the region. A working group constituted by the Inter-American Drug Abuse Control Commission (CICAD) and the Centre for Addiction and Mental Health (CAMH) in June, 2010 identified this area as a priority area for a multinational research partnership. This paper summarizes existing information on drug use and child maltreatment in six participating countries, Colombia, El Salvador, Jamaica, Nicaragua, Panama and Uruguay, and considers the implications of child maltreatment prevention for demand reduction strategies to address substance use issues. A CICAD/CAMH-sponsored multinational research partnership has been formed, which will involve research on the link between child maltreatment and substance misuse, expertise exchange and resource sharing.

THEORETICAL AND METHODOLOGICAL ASPECTS OF SOCIAL REPRESENTATIONS

This manuscript is aimed at discussing the plural nature of the main conceptual, theoretical and methodological features of the social representations in their various manifestations. As a base to discuss the topics, we used the main texts that amalgamated the vision of the main researchers of psychology, sociology and nursing. According to Moscovici, social representations correspond to acts of thoughts in which subjects relate to the object, and that object through some process is replaced by symbols, turning it into a representation in the subjects mind. This process involves different mechanisms of contextualization, processing, construction and interpretation by sociocultural and linguistic aspects. In the transdisciplinary perspective, social representations emerge as a multidimensional field that permits questioning the nature of knowledge and the relationship individual-society, implanted in the main post-modern epistemological currents.This manuscript is aimed at discussing the plural nature of the main conceptual, theoretical and methodological features of the social representations in the...

Global mental health: transformative capacity building in Nicaragua

Background Mental health is increasingly recognised as integral to good public health, but this area continues to lack sufficient planning, resources, and global strategy. It is a pressing concern in Latin America, where social determinants of health aggravate existing inequities in access to health services. Nicaragua faces serious mental health needs and challenges. One key strategy for addressing gaps in mental health services is building capacity at the primary healthcare and system levels. Objective Using the framework of best practice literature, this article analyses the four-year collaborative process between the National Autonomous University of Nicaragua in León (UNAN-León) and the Centre for Addiction and Mental Health (CAMH) in Canada, which is aimed at improving mental healthcare in Nicaragua. Design Based on a critical analysis of evaluation reports, key documents, and discussion among partners, the central steps of the collaboration are analysed and main successes and challenges identified. Results A participatory needs assessment identified local strengths and weaknesses, expected outcomes regarding competencies, and possible methodologies and recommendations for the development of a comprehensive capacity-building programme. The partners delivered two international workshops on mental health and addiction with an emphasis on primary healthcare. More recently, an innovative Diploma and Master programme was launched to foster interprofessional leadership and effective action to address mental health and addiction needs. Collaborative activities have taken place in Nicaragua and Canada. Discussion To date, international collaboration between Nicaragua and CAMH has been successful in achieving the jointly defined goals. The process has led to mutual knowledge sharing, strong networking, and extensive educational opportunities. Evidence of effective and respectful global health capacity building is provided. Lessons learned and implications for global health action are identified and discussed.Background Mental health is increasingly recognised as integral to good public health, but this area continues to lack sufficient planning, resources, and global strategy. It is a pressing concern in Latin America, where social determinants of health aggravate existing inequities in access to health services. Nicaragua faces serious mental health needs and challenges. One key strategy for addressing gaps in mental health services is building capacity at the primary healthcare and system levels. Objective Using the framework of best practice literature, this article analyses the four-year collaborative process between the National Autonomous University of Nicaragua in León (UNAN-León) and the Centre for Addiction and Mental Health (CAMH) in Canada, which is aimed at improving mental healthcare in Nicaragua. Design Based on a critical analysis of evaluation reports, key documents, and discussion among partners, the central steps of the collaboration are analysed and main successes and challenges identified. Results A participatory needs assessment identified local strengths and weaknesses, expected outcomes regarding competencies, and possible methodologies and recommendations for the development of a comprehensive capacity-building programme. The partners delivered two international workshops on mental health and addiction with an emphasis on primary healthcare. More recently, an innovative Diploma and Master programme was launched to foster interprofessional leadership and effective action to address mental health and addiction needs. Collaborative activities have taken place in Nicaragua and Canada. Discussion To date, international collaboration between Nicaragua and CAMH has been successful in achieving the jointly defined goals. The process has led to mutual knowledge sharing, strong networking, and extensive educational opportunities. Evidence of effective and respectful global health capacity building is provided. Lessons learned and implications for global health action are identified and discussed.