Kavita Sivaramakrishnan

Social support, volunteering and health around the world: Cross-national evidence from 139 countries

High levels of social capital and social integration are associated with self-rated health in many developed countries. However, it is not known whether this association extends to non-western and less economically advanced countries. We examine associations between social support, volunteering, and self-rated health in 139 low-, middle- and high-income countries. Data come from the Gallup World Poll, an internationally comparable survey conducted yearly from 2005 to 2009 for those 15 and over. Volunteering was measured by self-reports of volunteering to an organization in the past month. Social support was based on self-reports of access to support from relatives and friends. We started by estimating random coefficient (multi-level) models and then used multivariate logistic regression to model health as a function of social support and volunteering, controlling for age, gender, education, marital status, and religiosity. We found statistically significant evidence of cross-national variation in the association between social capital variables and self-rated health. In the multivariate logistic model, self-rated health were significantly associated with having social support from friends and relatives and volunteering. Results from stratified analyses indicate that these associations are strikingly consistent across countries. Our results indicate that the link between social capital and health is not restricted to high-income countries but extends across many geographical regions regardless of their national-income level.

A Global View on the Effects of Work on Health in Later Life

PURPOSE OF THE STUDY Work is an important environment shaping the aging processes during the adult years. Therefore, the cumulative and acute effects of work characteristics on late-life health deserve great attention. Given that population aging has become a global trend with ensuing changes in labor markets around the world, increased attention is paid to investigating the effects of the timing of retirement around the world and the macroeconomic benefits often associated with delaying retirement. It will be essential for societies with aging populations to maintain productivity given an aging workforce and for individuals it will be crucial to add healthy and meaningful years rather than just years to their lives. DESIGN AND METHODS We first describe the available evidence about participation of older workers (65+) in the labor force in high, middle, and low-income countries. Second, we discuss the individual-level and societal influences that might govern labor-force participation of older adults. Thirdly, we review evidence on the association between work on the one and physical, mental, and cognitive health in later life on the other. RESULTS AND IMPLICATIONS Globally, both is true: work supports healthy aging and jeopordizes it. We draw implications for policymaking in terms of social protection, HR policies, and older employee employability.

Adolescent Risk-Taking, Cancer Risk, and Life Course Approaches to Prevention

Adolescent risk-taking may have long-term consequences for adult cancer risk. Behaviors such as smoking and sexual activity, commonly initiated during adolescence, may result--decades later--in cancer. Life course epidemiology focuses on unique vulnerabilities at specific development periods and their importance to later development of disease. A life course epidemiological perspective that integrates social and biological risk processes can help frame our understanding how specific adult cancers develop. Moreover, life course perspectives augment traditional public health approaches to prevention by emphasizing the importance of unique windows of opportunity for prevention.

WHO Commission on the social determinants of health: a bold new venture

There was a time, not long ago, when scientists working on social determinants of health ended every paper with a reverential bow to policy with a weak comment about the relevance of their results for policymakers. This was especially true for social epidemiologists who often had high hopes of contributing to the policy debates about health equity. Most of these comments were very naive from a policy perspective albeit well intentioned. In the policy world, there was often a parallel nod to building the evidence base from which one could make sound policy or even political decisions. Again, policymakers had a slim grasp of what constituted strong evidence from a scientific perspective. We know that changes in policies are based on much more than evidence alone, but history has also taught us that strong science can ultimately influence political debates and policy implementation. We have only to look at the recent tobacco policies sweeping North America and now much of Europe to see that we … Correspondence: Lisa F. Berkman, Harvard Center for Population and Development Studies, 9 Bow Street, Cambridge, MA 02138, USA, e-mail: lberkman{at}hsph.harvard.edu

Transplant Buccaneers: P.K. Sen and India’s First Heart Transplant, February 1968

ABSTRACT:On 17 February 1968, Bombay surgeon Prafulla Kumar Sen transplanted a human heart, becoming the fourth surgeon in the world to attempt the feat. Even though the patient survived just three hours, the feat won Sen worldwide acclaim. The ability of Sens team to join the ranks of the worlds surgical pioneers raises interesting questions. How was Sen able to transplant so quickly? He had to train a team of collaborators, import or reverse engineer technologies and techniques that had been developed largely in the United States, and begin conversations with Indian political authorities about the contested concept of brain death. The effort that this required raises questions of why. Sen, who worked at a city hospital in Bombay that could not provide basic care for all its citizens, sought a technology that epitomized high-risk high-cost, health care. To accomplish his feat, Sen navigated Cold War tensions and opportunities, situating his interests into those of his hospital, municipal authorities, Indian nationalism, Soviet and American authorities, the Rockefeller Foundation, and others. The many contexts and interests that made Sens work possible created opportunities for many different judgments about the success or failure of medical innovation.

Making heart-lung machines work in India: Imports, indigenous innovation and the challenge of replicating cardiac surgery in Bombay, 1952-1962

In 1962, surgeons at two hospitals in Bombay used heart-lung machines to perform open-heart surgery. The devices that made this work possible had been developed in Minneapolis in 1955 and commercialized by 1957. However, restrictions on currency exchange and foreign imports made it difficult for surgeons in India to acquire this new technology. The two surgeons, Kersi Dastur and PK Sen, pursued different strategies to acquire the ideas, equipment, and tacit knowledge needed to make open-heart surgery work. While Dastur tapped Parsi networks that linked him to local manufacturing expertise, Sen took advantage of opportunities offered by the Rockefeller Foundation to access international training and medical device companies. Each experienced steep learning curves as they pursued the know-how needed to use the machines successfully in dogs and then patients. The establishment of open-heart surgery in India required the investment of substantial labor and resources. Specific local, national, and transnational interests motivated the efforts. Heart-lung machines, for instance, took on new meanings amid the nationalist politics of independent India: Even as surgeons sought imported machines, they and their allies assigned considerable value to ‘indigenous’ innovation. The confluence of the many interests that made Sen and Dastur’s work possible facilitated the uneasy co-existence of conflicting judgments about the success or failure of this medical innovation.

The physician–patient relationship in the age of precision medicine

The completion of the Human Genome Project was heralded as a step towards “personalized medicine,” offering patients individualized treatments based on genomic profiling. More recently, this vision has been eclipsed by the promise of “precision medicine” (PM), emphasizing benefits to patients from more precise diagnosis and treatment based on a range of biomarkers, along with data about patients’ environment, lifestyle, and behaviors. Cynics may object that PM is mostly hype and exists primarily in documents whose very titles—e.g., “Toward Precision Medicine”—indicate their promissory nature. We disagree. PM is part of a longstanding attempt to reorient medical diagnosis and treatment to take advantage of genomics research and other approaches leveraging big data, such as electronic medical record research and crowd-sourced health tracking. These efforts are progressively elaborating an increasingly coherent vision of a different kind of medicine. As the prospects and challenges of PM loom before us, there ais urgent need to consider its implications for the social organization of medicine, particularly for the physician–patient relationship.