Decentralization, democratization, and health: the Philippine experiment

In 1991, the Philippines joined a growing list of countries that reformed health planning through decentralization. Reformers viewed decentralization as a tool that would solve multiple problems, leading to more meaningful democracy and more effective health planning. Today, nearly two decades after the passage of decentralization legislation, questions about the effectiveness of the reforms persist. Inadequate financing, inequity, and a lack of meaningful participation remain challenges, in many ways mirroring broader weaknesses of Philippine democracy. These concerns pose questions regarding the nature of contemporary decentralization, democratization, and health planning and whether these three strategies are indeed mutually enforcing.     

Cities without cavities: democracy, risk, and public health

This essay examines the history of fluoride debates in four Canadian cities. It argues that fluoride's opponents were primarily motivated by what they saw as the health and environmental risks of adding fluoride to the water supply. They also believed that fluoridating the public water supply was a fundamental violation of civil liberties. The fluoride debates have much to teach us about how people evaluate potential health risks and how they respond to state interventions in the field of public health.     

COVID-19, mental health,and rurality: A pilot study

COVID-19 has caused enormous economic and social disruptions that may have lasting effects on employment, income, and working conditions. Critically, these disruptions often have a negative impact on mental health. While significant research has examined the relationship between COVID-19 and mental health, most of these studies focus on urban centres. This paper presents results from a pilot study conducted in two rural counties in Ontario, Canada on the experiences of residents from small and rural communities related to COVID-19. Based on 3496 survey results, this study quantifies the negative impact of COVID-19 on overall mental health and the confounding role of gender, income, and age. Results must be used to expand the dialogue around rural mental health and to ensure appropriate programs and policies are developed.     

Homelessness,nature, and health: toward a feminist political ecology of masculinities

Engaging with feminist political ecology and leveraging experiences from a 16-month critical ethnography, this research explores ways in which masculinities served as both a rationale and an outcome of men facing homelessness living in the margins of an urban municipal public park – a space known as ‘the Hillside.’ Ethnographic narratives point to Hillside residents making their home in nature, connecting experiences in nature with various masculinities, and the gendered eschewing of social services. These portrayals further highlight the perceived feminization of social services within a context of rapidly neoliberalizing urban environments, and illustrate the ways participants positioned and engaged with social services. Entanglements of health and nonhuman nature prompt a feminist political ecological engagement with masculinity. Experiences from the Hillside add textured richness to discourses concerning the ways in which contemporary landscapes are constructed, perceived, experienced, and co-constituted through and with gender.     

Many voices: Medical anthropologists explore the meaning of health,illness, and cure

Franz Boas organized and shaped American anthropology. No academic discipline of similar scope owed so much to just one person. Within three decades of coming to the United States from Germany he had trained the anthropologists who established its place within the universities and redirected its tone and ethos as well as its theories. The biographies under review help us understand the background, aims, and drive of the man. We shall consider, in particular, the impact he had on the political and ethical tone of the field, the prevalence of women in it, and the importance of his scientific background.     

Hygiene,health, and bodily knowledge, 1880-1940: a New Zealand case study

One of the key aims of the Dunedin Southern Suburbs project has been to examine the factors that structured opportunity in a period of rapid modernization in New Zealand, 1880-1940. This article argues that health was a key determinant of opportunity and examines how people thought about their bodies and sought to maintain health. It argues that older, humoral theories about health were maintained alongside new understandings wrought by the germ theory and that both placed a high value on regimen. Mothers were regarded as the household experts on health but lacked a vocabulary to communicate with their daughters about menstruation. While bodily health was an ideal to be striven for, there was little communication about bodily pleasure, a situation subject to change with the adoption of family limitation.     

Social capital, environmental health and collective action: a Hamilton, Ontario case study

This article explores the relationships among environmental health, social capital and collective action in the industrial city of Hamilton, Ontario, Canada. Survey results from 512 households are used to document intra-urban variation in levels of social capital (defined as norms, networks and trust) and collective action in the context of environmental health issues, and specifically air quality. Despite real differences between areas in terms of socio-demographic characteristics, little variation in either social capital or collective action by area was observed. Further, while social networks and community involvement were significant predictors of collective action, indicators of norms and trust were not. Hence, the conception of social capital as a unitary construct that produces place-specific benefits is not reflected in the example explored here.     

Stigmatized ethnicity, public health, and globalization

The prejudicial linking of infection with ethnic minority status has a long-established history, but in some ways this association may have intensified under the contemporary circumstances of the "new public health" and globalization. This study analyzes this conflation of ethnicity and disease victimization by considering the stigmatization process that occurred during the 2003 outbreak of Severe Acute Respiratory Syndrome (SARS) in Toronto. The attribution of stigma during the SARS outbreak occurred in multiple and overlapping ways informed by: (i) the depiction of images of individuals donning respiratory masks; (ii) employment status in the health sector; and (iii) Asian-Canadian and Chinese-Canadian ethnicity. In turn, stigmatization during the SARS crisis facilitated a moral panic of sorts in which racism at a cultural level was expressed and rationalized on the basis of a rhetoric of the new public health and anti-globalization sentiments. With the former, an emphasis on individualized self-protection, in the health sense, justified the generalized avoidance of those stigmatized. In relation to the latter, in the post-9/11 era, avoidance of the stigmatized other was legitimized on the basis of perceiving the SARS threat as a consequence of the mixing of different people predicated by economic and cultural globalization.     

Homelessness,poverty, and risks to health: beyond at risk categorizations of street children1

Homeless and street children are commonly portrayed in the academic and welfare literature as a prime category of ‘children at risk’. They have attracted world‐wide attention due to rising numbers in cities of the Western and developing world coupled with a discourse of childhood that ascribes risk to poor urban children unaccompanied by adults on the streets. This paper presents a critique of views about homeless and street children that rest upon an unhelpful blanket generalization of risk and, more specifically, that adopt polemical or categorical statements about homelessness as the most salient risk factor for poor health. Current research is distancing itself from a discourse that sets global characteristics for a ‘street lifestyle’, aiming instead to contextualize research on street children. Many studies have also questioned the stereotypical expectation that homeless children are the most vulnerable in deprived environments, arguing that poverty, not homelessness per se, carries the most significant risks to children's health. A risk discourse is unhelpful where it promotes a stereotype of vulnerability about children, resulting in further discrimination and social exclusion; it is most helpful when it focuses attention on ways to negotiate adverse situations. Some challenging academic and practical questions need to be raised regarding risk assumptions and risk assessment.     

Wealth alone does not buy health: Political capacity,democracy, and the spread of AIDS

Although there have been have numerous studies on AIDS documenting its mortality, its epidemiological features, and its relationship to poverty and development, few studies have systematically analyzed how political factors and policies may help curtail the spread of AIDS. In this paper I consider how a variety of domestic factors influence HIV infection rates across countries. I argue that states with higher state capacity are better able to reduce the spread of the HIV/AIDS epidemic. Moreover, I argue that while strong autocracies can implement efficient policies with fewer constraints, democracies tend to be more responsive to the needs of the population and can be more efficient in curtailing the spread of HIV/AIDS. I empirically evaluate the hypotheses using a cross-sectional time-series sample of 117 countries. The empirical results indicate that greater state capacity indeed appears to help curtail HIV/AIDS infection rates.