Vesna Leskošek

Social determinants of health: the indicators for measuring the impact of poverty on health

Social determinants of health: the indicators for measuring the impact of poverty on health Introduction: The link between poverty and health is an important research topic of national and international organisations, including the WHO, which has issued several important reports that proved the impact of social determinants on peoples health, of which poverty was one of the most important. The aim of this article is to define the indicators of the social determinants of health, which is important for better planning and policy-making. Method: data was gathered through the comparative analysis of different sources of socioeconomic indicators, which are presented schematically, ranked in the structural field and analysed from the perspective of their impact on health. Results: Indicators are divided into ten different fields that present a socioeconomic determinant of health. The fields are: material deprivation (including income and other material items necessary for everyday living), followed by social capital, (un)employment, housing and homelessness, education and profession, living environment, health, crime and safety, accessibility and ethnicity. The table includes 100 indicators that are used in various states for planning and policy-making. The extent and diversity of the indicators shows the complexity of the social determinants of health, which are often overlooked or are insufficiently understood. Conclusion: Poverty is a structural problem with an important impact on health. Because living in poverty is a specific way of life, ways of tackling the problem of poverty are also specific. They have to include relations of power, the accessibility of resources and opportunities to escape from the poverty. Health plays an important role in that but it depends on the capabilities and readiness of the states to ensure this for all people regardless of their social status, material wealth or other circumstances. The list of indicators can contribute to achieving that goal. Družbene Determinante Zdravja: Nabor Kazalnikov za Merjenje Vpliva Revščine na Zdravje Uvod: Povezava med revščino in zdravjem je vrsto let predmet proučevanja nacionalnih in mednarodnih organizacij, tudi WHO, ki je o tem izdal več poročil. Ugotovili so vpliv družbenih dejavnikov, še posebno revščine, na zdravje ljudi. Namen članka je opredeliti kazalnike družbenega vpliva na zdravje, ker je spremljanje vpliva pomembno za načrtovanje ustreznih politik. Metoda: Podatki so pridobljeni s primerjalno analizo različnih virov socialno-ekonomskih kazalnikov, ki so predstavljeni shematsko, razvrščeni v strukturna področja in analizirani z vidika njihovega vpliva na zdravje. Rezultati: Kazalniki so razvrščeni v deset področij, ki predstavljajo socialno-ekonomske determinante zdravja, in sicer materialno prikrajšanost, ki vključuje dohodek in za življenje nujne dobrine, socialni kapital, zaposlitev in brezposelnost, stanovanje in brezdomnost, izobraževanje in poklic, življenjsko okolje, zdravje, kriminal in varnost, dostopnost in etničnost. Vključenih je prek 100 kazalnikov, ki jih različne države uporabljajo za pregled stanja in načrtovanje politik. Obseg in raznolikost kazalnikov kažeta na kompleksnost družbenih vplivov na zdravje, ki so pogosto spregledani ali niso dovolj poglobljeno razumljeni. Zaključek: Revščina je družbenostrukturni problem, ki ima velik vpliv na zdravje. Ker je življenje v revščini specifično, so specifični tudi načini spopadanja z revščino, ki so odvisni od družbene moči, dostopnosti do virov in od možnosti za izhod iz revščine. Zdravje je pri tem ključen dejavnik, ki je odvisen od zmožnosti in pripravljenosti držav, da ga zagotovijo vsem, ne glede na družbeni položaj, materialne sposobnosti ali druge okoliščine. Nabor predstavljenih kazalnikov lahko pripomore k boljšemu spremljanju stanja in načrtovanju ustreznih politik.

Community and social capital in Slovenia—the impact of transition

The transition from socialism to capitalism has many impacts on the everyday life of the people of Slovenia. Amongst others it has an impact on their community ties and their choices regarding participation in public life. Community can enable or diminish the basic processes, such as solidarity, equal choices and opportunities, and respect for the differences that are needed for an inclusive society. This article researches such processes through the concept of social capital and provides some responses necessary for the political and professional planning of social policy and the practice of social services.

Internationalisation of social work doctoral studies: experiences and perspectives in the changing context of European higher education

ABSTRACT The internationalisation of doctoral education in social work has become a newly developing area particularly in Europe during the last two decades. It has been promoted by two factors: (1) the reform of higher education (Bologna reform), which contributed to the development of doctoral study and (2) the establishment of European funding programmes that would allow international cooperation and ensure the quality of the programmes. Also, in the European Qualification Framework the knowledge, skills and competences gained by doctoral qualification are defined. In this article, we analyse three international doctoral projects that were developed in Europe in last 10 years. We focus on what the advantages and obstacles are of these policy frameworks and what their impact on international cooperation is in the development of doctoral programmes. The analysis shows that differences in national terms and conditions of the study remain a major obstacle for joint doctoral programmes, but it is precisely international cooperation that significantly contributes to the quality of doctoral studies. The analysis also shows that the current policy framework of higher education in the EU does not solve the problems; on the contrary, it contributes to it.

Violence before pregnancy and the risk of violence during pregnancy

Abstract Objective: To investigate the relationships among different forms of violence before and during pregnancy. Material and methods: An anonymous questionnaire (adapted NorAQ) was given to 1269 women after childbirth. Results: The response rate was 80% (n=1018). Different forms of violence were experienced by 46.9% of the women; 9.2% reported violence in pregnancy. Suffering from the consequences of violence was reported by 43.8% of the women; sexual (76.6%) and psychological (54.1%) ranked the highest. Past experience of any form of violence increased the risk of violence in pregnancy, violences experienced in adulthood even more than that in childhood [odds ratio (OR) 4.2, 95% confidence interval (CI) 2.7–6.5 vs. OR 1.9, 95% CI 1.2–2.9]. The onset of violence during pregnancy is rare. Violence was most frequently exerted by the intimate partner. Conclusion: Healthcare systems have access to most women of reproductive age, thus they have the unique opportunity to identify and adequately manage violence against women and its consequences.

Abuse of pregnant women in the healthcare system

Abstract Objective: The purpose of this study was to determine the incidence of abuse in healthcare system during pregnancy and its impact on pregnancy outcomes. Materials and methods: A validated screening Norvold Abuse Questionnaire for the identification of female victims of four kinds of abuse: emotional, physical, sexual, and the abuse in the healthcare system was anonymously offered to all women in the first 2 days postpartum. Results: The study group consisted of 1018 women, 6.2% of which reported experiencing abuse in healthcare system during pregnancy. Affected women had a higher incidence of preterm delivery (OR 2.4; 95% CI 1.2–4.8) and cesarean section rate (OR 2.0; 95% CI 1.1–3.6). Sexual abuse and abuse in healthcare system during childhood were associated with abuse in healthcare system during pregnancy (OR 4.4; CI 95% 1.2–16.2 and OR 6.9; CI 95% 1.3–35.4, respectively). Conclusions: Our study indicates that as many as 6.2% of pregnant women experience abusive encounters with perinatal care providers. These pregnancies eventually end more often preterm and by cesarean section. This possibly causal relationship should be further explored.

The role of health services in encouraging disclosure of violence against women

Abstract Introduction The aim of the survey was to assess the differences in disclosure by the type of violence to better plan the role of health services in identifying and disclosing violence. Methods A validated, anonymous screening questionnaire (NorAQ) for the identification of female victims of violence was offered to all postpartum women at a single maternity unit over a three-month period in 2014. Response rate was 80% (1018 respondents). Chi square test was used for statistical analysis (p<0.05 significant). Results There are differences in disclosure by type of violence. Nearly half (41.5%) of violence by health care services was not reported, compared to 33.7% physical, 23.4% psychological, and 32.5% sexual that was reported. The percentage of violence in intimate partnership reported to health care staff is low (9.3% to 20.8%), but almost half of the violence experienced by heath care services (44%) is reported. Intimate partnership violence is more often reported to the physician than to the psychologist or social worker. Violence in health care service is reported also to nurses. Conclusions Disclosure enables various institutions to start with the procedures aimed at protecting victims against violence. Health workers should continuously encourage women to speak about violence rather than asking about it only once. It is also important that such inquiries are made on different levels of health care system and by different health care professions, since there are differences to whom women are willing to disclose violence.

The health condition of female victims of violence / Zdravje žensk, ki doživljajo nasilje

Abstract Introduction: The article addresses one of the most vulnerable social groups - women who have experienced various types of violence. The problem is presented through a discussion of the consequences of violence on women’s health. Based on the analysis of the research data, the article proposes measures that should boost health care policies in handling violence against women. Methods: The source of data is the Survey on Violence Against Women in the private sphere and partnership relations conducted in 2010. The sample consisted of 3000 women, equally stratified by age, type of neighbourhood and region. The research was quantitative and the response rate was 25% (n=752), which is an average response rate when researching intimate spheres accompanied by fear, shame or emotional distress. Results: The results have shown that violence has a powerful and lasting effect on health. In some cases, injuries lead to lasting disability. Psychological and mental disorders are also present, including depression, nightmares, fear, shame, anger, the feeling of threat and distrust. The problems are compounded by a distrust of professional help, which further affects their health condition. Conclusions: health policies should include training and knowledge of the causes, dynamics and consequences of violence, so that women could be encouraged to report violence. The first step was made when the relevant rules of procedures were adopted, but the process must continue with the drawing of protocols, the definition of the responsibility of individual professions within health care and cooperation with other institutions. Izvleček Uvod: Članek se nanaša na eno najranljivejših družbenih skupin, in sicer na ženske, ki doživljajo različne oblike nasilja. Problem je prikazan z vidika posledic, ki jih ima nasilje na zdravje. Na osnovi analize raziskovalnih podatkov so podani predlogi za krepitev zdravstvenih politik do nasilja nad ženskami. Metode: Vir podatkov je Nacionalna raziskava o nasilju nad ženskami v zasebni sferi in partnerskih razmerjih iz leta 2010, izvedena na vzorcu 3.000 žensk, enakomerno stratificiranem po starosti, tipu naselja in po regiji. Raziskava je kvantitativna, odzivnost 25-odstotna (n=752), kar je običajna odzivnost pri raziskovanju intimnih področij, ki jih spremlja strah, sram ali duševne stiske. Rezultati: Ti pokažejo, da ima nasilje močen in dolgotrajen vpliv na zdravje. Poškodbe v nekaterih primerih vodijo v trajno invalidnost. Psihične in duševne težave se pojavljajo kot depresija, nočne more, strah, sram, jeza, občutek ogroženosti, nezaupanje. Težave spremlja nezaupanje v strokovno pomoč, kar ima posledice na slabše zdravje. Zaključki: Zdravstvene politike morajo vključevati vednost o vzrokih, dinamiki in o posledicah nasilja, da lahko krepijo ženske pri razkrivanju nasilja. Prvi koraki so narejeni s sprejetjem ustreznih pravilnikov, treba pa je nadaljevati izdelavo protokolov, odgovornost posameznih poklicev v zdravstvu in sodelovanje z drugimi ustanovami.

High Wire: The Precarious Financial Lives of American Families

The dilemma of domestic work in postapartheid South Africa should not be viewed as an isolated phenomenon of marginal interest to sociologists. The globalization of paid domestic work means that hundreds of thousands of women from poor countries in the global South are living in a form of servitude, as they work for low wages, under abusive conditions in wealthier countries as part of a ‘‘global care chain.’’ In this brilliant study, Shireen Ally demonstrates how these relations of servitude have resisted change in ‘‘the national care chain’’ in contemporary South Africa. Post-apartheid South Africa is a contradictory place. On the one hand there is deepening inequality, poverty and widespread collective violence in the form of xenophobic attacks against foreigners and violent protests about the failure of the local state to deliver substantive social citizenship in the shape of access to housing, jobs, water, electricity and sanitation. On the other hand the new constitution embodies a powerful vision of participatory democracy, new institutions to protect human rights, and the redrafting of apartheid labor legislation included one of the most extensive and expansive efforts anywhere in the world to recognize paid domestic work as a form of employment. These state efforts to modernize and professionalize domestic work as a form of employment were remarkable. Existing labor legislation was extended inter alia to include a landmark national minimum wage, mandatory formal contracts of employment, extensive leave, formal registration, as well as access to unemployment insurance benefits, which Ally points out was a ‘‘world first.’’ However, a central thesis of the book is that the outcome has been disempowering for domestic workers. With analytical depth and sensitivity, Ally demonstrates the persistence of servitude. Paradoxically, the book suggests that domestic workers’ lives have not changed much under democracy and many feel that ‘‘things are worse than before.’’ While they are the beneficiaries of ‘‘an extensive democratic statecraft’’ attempting to turn ‘‘servants’’ into workers with the same rights as other workers, their social position as migrant ‘‘mother-workers,’’ often caring for their employers’ children at the expense of their own, has not been affected. Ally explains this paradox in the tension between the forms of formal power deployed by the post-apartheid state in its efforts to protect these ‘‘vulnerable’’ workers and the forms of informal power generated by the intimate nature of their work. This involves a ‘‘contradictory collision of depersonalizing rights and personalizing intimacy’’ (p. 187). In the absence of state protection under apartheid, South African domestic workers had elaborate ‘‘practices of power’’ rooted in their highly personalized relationships with employers, as a way to control their work. ‘‘In the absence of labor rights defining leave provisions, sitting down every morning with tea and talking to one’s employer about her problems became a way to ensure an extended Christmas vacation’’ (p. 13). These informal mechanisms for negotiating working conditions have continued and demonstrate these women’s creativity and assertiveness. Another paradox Ally identifies in this highly original exploration is that the political inclusion of domestic workers has ironically depoliticized them. Making domestic workers the subjects of rights through their construction as ‘‘vulnerable’’ defined their political status as incapacitated and inert. With the state positioning itself as the representative and protector of domestic workers’ interests, they were demobilized, their unions displaced and weakened and their voices muted. Thus Ally argues that ‘‘the attempt to turn ‘servants’ into workers through liberal democratic rights, rather