‘Tomorrow comes when tomorrow comes’: Managing Aboriginal Health within an Ontology of Life‐as‐Contingent

ABSTRACT The authors have worked in Australian Aboriginal communities within the Wiradjuri area of central‐western New South Wales. Examining what appear to be distinctive Aboriginal approaches to time, we argue that these stem not from a different notion of time as such but, rather, from the relationship between the social and the self which places a distinctive value on the use and management of time. One way to access the dynamic between time and self is to realise that life is understood as fluid and contingent rather than predictable. This continually subverts the idea that time is measurable and controllable; that life is lived within domesticated sedentary space; and that planning ahead and self‐discipline are virtues. Yet these are notions central to practices associated with contemporary health care. A majority of health care providers, whether Aboriginal or not, are trained in the Australian mainstream health system and may consequently underestimate the implications of different ways in which a person acts on the temporal/spatial dimensions of her life, and how this influences ways in which she manages time in relation to her health and well‐being. Temporal concepts, such as ‘planning’, ‘discipline’, ‘future’, ‘boredom’, or ‘patience’, as well as that of the ‘long‐term’ with regard to managing illness or money, interact with the ways in which Aboriginal people experience themselves as ill or in need of health care, influencing how they act on medical advice. We argue that the key to understanding the use of time lies not in the concept of time per se but in what is involved in developing a responsive social self when the time/space dimensions of the day to day are informed by a fluid and thus contingent ontology of that day to day.     

The Americans With Disabilities Act and Medical Providers: Ten Years After Passage of the Act

This article discusses the impact of the Americans With Disabilities Act (ADA) on health care providers in the last decade. Even though some ADA training has been provided for health care providers, more education will help to improve access to their offices, improve health care practices for their patients with disabilities, and be an incentive for the providers to help raise the consciousness of the rest of the community about the ADA.     

MULTIPLE DIMENSIONS OF URBAN WELL-BEING

This paper examines the trends and changes in medical assistance at birth among poor and non-poor mothers in the state of Uttar Pradesh, India. It also investigates the relative role of public and private health care providers, and social and economic correlates on the non-use of natal care, as well as reasons for this non-use. Data from three rounds of the National Family Health Survey (NFHS) conducted over the period 1992–2006 were used. The wealth indices are estimated separately for rural and urban areas, and state-specific poverty line cut-off points are used to demarcate the poor and non-poor. Results show that birth assistance by skilled health professionals remained at an abysmal level, particularly for the poor. There had been no significant increase in the use of natal care among poor mothers during the period 1992–2006. Moreover, the increase in birth assistance by medical professionals came largely from private health care providers, and the use of natal care from public health centres had stagnated over the years.     

Ageing in remote and cyclone‐prone communities: geography,policy, and disaster relief

Focusing on the experience of independent‐living older adults, this study explored how those in regional Australian coastal communities have coped with repeated natural disasters. Using an exploratory, mixed‐method, and phenomenological approach, an array of non‐probability snowballing techniques was used to seek participation from residents aged 65 years or more, and from emergency services officers, disaster managers, and community health care providers located in regional communities affected by Cyclone Larry (2006) and Cyclone Yasi (2011). The research found that post‐disaster political decisions have had a negative long‐term impact on local economies, causing outmigration by those seeking employment, and resulting in many elderly residents facing a future without family support. As government policies encourage ageing‐in‐place by providing subsidised in situ care, increasingly older adults are remaining in exposed vulnerable locations, reliant on authorities for their survival both day‐to‐day and during an emergency. Findings also uncovered inconsistent disaster management policies between neighbouring local government councils and an unrealistic reliance on in situ care organisations by disaster managers during preparation and recovery stages of a natural hazard. These results highlight the need for those charged with emergency management to reassess both the future natural hazard adaptive capacities of ageing regional communities and policy responses to such challenges.     

Free Health Clinics,Resistance and the Entanglement of Christianity and Commodified Health Care Delivery

Abstract: Free clinics are an important part of the US health care safety net and their numbers are rising. This article offers a critical analysis of the politics of free health clinics in Milwaukee, Wisconsin. It uses the geographies of resistance literature to assess free clinics as a response to the neoliberalization of health care delivery. It underlines the multiple political spaces free clinics occupy as a result of the entanglements of a diverse range of identities and practices within the clinic space. In Milwaukee, the primary entanglement occurs between the progressive Christian identity inspiring the practices of the free clinic's volunteers and the commodified identity of the corporate non‐profit health care systems that dominate health care delivery in the city. This research suggests that understanding the transition from oppositional identities, such as progressive Christianity, to resistance is an important next step in constructing more robust responses to neoliberal capitalism and other exploitive social relations.     

Structural adjustment programs and housing affordability in Accra, Ghana

Due to the persistent socio-economic problems that have beset African countries since the late 1970s, many of them have been forced to accept IMF and World Bank sponsored Structural Adjustment Programs (SAPs). Ghana came under one such program in 1983. While proponents of the program point to growth in GDP and other measures as evidence of successful adjustment in Ghana, critics have pointed to the negative impacts on the labor market, women, farmers and the like. This paper seeks to add to the debate by examining the impacts of SAPs on housing production, delivery and affordability from 1983–1998. It argues that since shelter is a very important basic need, what happens to its production, affordability and access under the SAPs should be considered among the criteria for judging their success or failure. The paper examines housing affordability in Accra, Ghana, using standard measurement criteria applied by lending institutions to determine affordability. It uses market data to compare and contrast housing prices and income ratios in Ghana from 1980 to 1998. The analysis is based on a combination of primary and secondary data from market surveys, the Ministry of Housing, the Ghana Statistical Services and a variety of other sources. It concludes that not all the dramatic increases in the price of both developed and undeveloped land over the past 16 years can be wholly attributed to the ongoing Structural Adjustment Programs (SAPs) per se. Nonetheless, SAP inspired policies such as currency devaluation and hikes in interest rates have contributed greatly to these changes. The end result is that real estate prices have been pushed beyond the affordability of a significant proportion of Ghana's population.     

The greying of resource communities in northern British Columbia: implications for health care delivery in already-underserviced communities

The delivery of 'rural' health care services has long confronted the geographic problems of distance, low user densities, low-order facilities and caregiver shortages. As a result, rural and remote communities across Canada have struggled with health care delivery. For rural and remote communities in resource hinterlands, population ageing driven by industrial restructuring presents a significant departure from past experience. Drawing on examples from northern British Columbia (BC), this paper examines this context of ageing in rural and remote locations with the purpose of highlighting impending challenges for health care service provision. In the first part of this paper, we provide a demographic overview of population change and ageing in northern BC. In the second part, we present data on the availability of services throughout the region to support seniors who age-in-place. Population ageing, in areas that have never dealt with this issue before, highlights not only important servicing questions but also important policy questions about how to provide for needs that the policy and community context are not presently equipped to meet.     

ALTERNATIVE MEDICINE IN WESTERN INDUSTRIALIZED COUNTRIES: AN AGENDA FOR MEDICAL GEOGRAPHY

The range of health and health care topics amenable to geographical analyses in Western industralized countries has increased tremendously in the past two decades. These studies of health care systems have focused on the health organization, delivery, and utilization of biomed-ical services, however, to the virtual exclusion of analyses of a wide variety of alternative approaches to health and healing in these countries. This lacuna is regrettable in view of the fact that people's health care behaviour suggests that medical pluralism is a persisting reality in the industrialized countries. There is indeed a coexistence of biomedicine with several alternative therapies and, in recent years, there has been resurgence in the popularity and use of alternative medicine.     

Caregiving as mobility constraint and opportunity: married daughters providing end of life care in northern Ghana

In the global south where care services are sparse and familial care remains practically and socially important, end of life care often occurs within families. Furthermore, in health care related policy development, care is often assumed to be ensured by ‘traditional’ norms of extended family relationships. In this context, the demands of providing care may require care providers to relocate, as well as reorganize their everyday responsibilities. This article contributes to geographies of care by offering an examination of the mobility constraints experienced by married and externally-resident daughters seeking to provide end of life care to a parent in northern Ghana. Drawing on ethnographic research, I examine how particular familial relationships are embedded with socially constructed labour obligations, leading to conflicting responsibilities at a parent’s end of life. I then consider how a woman as a daughter works to overcome these constraints to provide end of life care. I conclude that understanding the mobility of care providers can contribute to avoiding potentially damaging assumptions of ‘traditional’ norms of care and is an important consideration towards understanding the geographies of care in the rural global south.     

The Integration of Mental Health Care in Rural Iran

Iran’s rural mental health care system emerged in a context that included experiments in health care prior to the 1979 Revolution and the establishment of a primary health care (PHC) system after the Revolution. Beginning in the 1980s, Iran integrated mental health care into the existing PHC system by treating mental illness much like a communicable disease. Iran advanced treatment options compatible with the existing system, added new training for existing care providers, and incorporated specialists. The integration of mental health care led to the rapid improvement of health outcomes. The integration also created the unintended consequence of privileging pharmaceutical treatments and overlooking mental illnesses affected by somatization.     

日本老年护理保险制度的发展与启示

日本是世界上老年护理保险制度较为完善的国家之一。日本的护理保险制度在设立上注重开放服务领域,鼓励服务主体多元化,基本实现了护理服务的社会化;同时,它注重与国情结合,大力支持居家护理和社区护理服务,在很大程度上解决了日本老年人护理服务的问题。中国与日本有着相似的东方养老模式,在借鉴日本的经验时,要兼顾效率与公平,注重制度的建设与法律的完善,重视疾病的预防,积极为家庭护理提供支持,促进老年护理服务的社会化。     

A Spatial-Temporal Analysis of Health Care and Mortality Inequalities in China

Two geographers specializing in China TYalyze that country's health care inequality from 1990 to 2008, for the purpose of: (1) examining spatial-temporal variations of health care inequality at multiple scales (the regional, provincial, and county levels); (2) exploring whether economic growth and transition to a market economy have exacerbated the unevenness of health care; and (3) analyzing the impact of health care inequality on health outcomes, especially mortality. The authors apply GIS-based spatial statistical methods to detect spatial-temporal patterns of health care, and use multilevel regression to examine the linkages between health care, mortality, and regional economic inequality, and ultimately to assess the sensitivity of health care inequality to geographic scale and examine whether reforms implemented to date have resulted in more equitable access to health care. The paper also demonstrates how the concurrent transitions of decentralization, marketization, globalization, and urbanization in China have interactively contributed to health care inequality and mortality.     

Dedicated Followers of Fashion? Bioarchaeological Perspectives on Socio‐Economic Status,Inequality, and Health in Urban Children from the Industrial Revolution (18th–19th C), England

The 18th and 19th centuries in England were characterised by a period of increasing industrialisation of its urban centres. It was also one of widening social and health inequalities between the rich and the poor. Childhood is well‐documented as being a stage in the life course during which the body is particularly sensitive to adverse socio‐economic environments. This study therefore aims to examine the relationship between health and wealth through a comprehensive skeletal analysis of a sample of 403 children (0–17 years), of varying socio‐economic status, from four cemetery sites in London (c.1712–1854). Measurements of long bone diaphyseal length, cortical thickness, vertebral neural canal size, and the prevalence of a range of pathological indicators of health stress were recorded from the Chelsea Old Church (high status), St Benet Sherehog (middle status), Bow Baptist (middle status), and Cross Bones (low status) skeletal collections. Children from the low status Cross Bones site demonstrated deficient growth values, as expected. However, those from the high status site of Chelsea Old Church also demonstrated poor growth values during infancy. Fashionable child‐care practices (e.g. the use of artificial infant feeds and keeping children indoors) may have contributed to poor infant health amongst high status groups. However, differing health risks in the lower status group revealed the existence of substantial health inequality in London at this time. © 2016 The Authors International Journal of Osteoarchaeology Published by John Wiley & Sons Ltd.     

The Dynamics and Volatility of Commercial and Residential Property Prices: Theory and Evidence*

Abstract. This article investigates the dynamics of property prices and their interaction with output growth in a general equilibrium model. Closed form solutions and testable hypotheses are derived from a mildly restricted version of the model. The testable hypotheses are broadly supported empirically. In particular, (1) the volatility of commercial property prices is higher than that of residential property prices, (2) each of the lagged, contemporary, and forward commercial property prices is positively correlated with residential property prices, (3) the contemporaneous covariance between the two property prices is larger than the lagged covariance, and (4) output growth is positively correlated with both property prices. These results are consistent with simulations results that are based on a more general specification of the model.     

Voluntarism and long-term care in the countryside: the paradox of a threadbare sector

This article contributes to the burgeoning literature on the geographies of voluntarism by addressing how voluntary sector providers in rural communities respond to the downloading of responsibilities for health and social care associated with public service restructuring. Drawing on a qualitative analysis of long-term care in Ontario, it focuses on the consequent actions of non-profit organizations, community support groups and volunteer caregivers in three different rural settings. Despite evidence of increasingly disproportionate levels of voluntarism amongst rural communities, the results reveal sector- and place-specific opportunities that allow voluntary sector providers to overcome the limitations of the rural service environment. The findings suggest that in the longer run, however, the growing dependence on local solutions will only exacerbate the uneven geographies of health and social care across rural space. Resolving this paradox remains a critical yet neglected challenge for sustainable rural services and communities.     

Public Production of Anti‐Retroviral Medicines in Brazil, 1990–2007

This article examines Brazil's experience with the public production of anti‐retroviral drugs (ARVs) and highlights the important role of the state in guaranteeing access to life‐saving medicines and fulfilling human rights commitments. The key to understanding the government's successful intervention in the pharmaceutical market and provision of treatment rests on the synergistic, albeit political, relationship between reform‐minded public servants and civil society activists. This article argues that three key factors led to the government becoming a direct producer of ARVs: 1) a pre‐existing infrastructure of public laboratories that have served the public health system to a greater or lesser degree since the 1960s; 2) strong civil society pressures, including public health activists both inside and outside the government; and 3) a pharmaceutical sector characterized by high prices and controlled by transnational drug companies.     

Strengthening Innovation Through Closer Bilateral Integration

While the Canadian economy has outperformed the US economy over the past decade by several macroeconomic indicators, both economies have been characterized by relatively slow real economic growth and relatively high unemployment rates. One focus of bilateral cooperation that could promote improved economic, social, and environmental conditions in both countries over time is scientific and technological (S&T) innovation. It is widely acknowledged that technological change associated with innovation has been the single most important contributor to productivity growth, and it is also the likely source of success in meeting major public policy challenges facing both countries in areas such as renewable energy and health care.     

GENERAL EQUILIBRIUM OF A REGIONAL ECONOMY WITH A FINANCIAL SECTOR–PART II: A SIMPLE BEHAVIORAL MODEL

ABSTRACT. Simple behavioral assumptions are incorporated into an accounting framework that provides linked budget and balance sheets for sectors of a regional economy. A short-run Keynesian-type model is developed where quantities rather than prices adjust, and where regional prices and interest rates are equal to national levels. The analysis highlights the importance of the financial services sector as an active factor in regional growth. Consumer deposit and debt preferences, and limitations imposed on credit extension by the financial services sector can have important effects on the regional economy as evidenced by changes in the export multiplier.     

Access anxiety: HIPAA and historical research

The Health Insurance Portability and Accountability Act of 1996 (HIPAA) establishes new standards for the protection of private health information in the United States. The Privacy Rule, one of the specific regulatory provisions of the act, went into effect 14 April 2003 for covered health care providers, institutions, and businesses. The Privacy Rule directly affected medical archivists and their collections. It has significant implications for historians of health care, as well. The Privacy Rule is the first major regulation that protects the privacy of the deceased in perpetuity. It establishes requirements that researchers must satisfy in order to gain access to "individually identifiable health information" held by HIPAA-protected institutions. While these requirements will burden historians in some cases, the Privacy Rule could open up opportunities for well-prepared historians to work with a more extensive range of twentieth-century documents.     

The space between: using ‘relational ethics’ and ‘relational space’ to explore relationship-building between care providers and care recipients in the home space

Geographers and other social scientists have a longstanding interest in ‘geographies of aging’ focused on the provision of care to vulnerable older populations and the challenges and experiences of caregivers [Skinner, M. W., Cloutier, D., & Andrews, G. J. (2014). Geographies of ageing: Progress and possibilities after two decades of change. Progress in Human Geography, 1–24]. This qualitative research project explores strategies for relationship-building used by home support workers and older residents according to a ‘relational ethics’ framework, enacted in the ‘relational space’ of the home environment. This framework rests on four principles: engagement, embodiment, mutual respect and environment, and argues that ‘relationships’ between care providers and care recipients must be preserved as the real essence or heart of the health care experience. Two linked conclusions are drawn from the research: that the treatment of the environment can be expanded using a social geographic lens to capture the more active influence of ‘homes’ on relationship-building and second, the relational ethics framework is useful in the home care context to characterize and ground the importance of relationships in the home care domain and the importance of home care to foster aging in place for vulnerable older persons.