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Biomedical subjects

Daniel D Reidpath

Publications and source records attributed to Daniel D Reidpath.

13 recordsLinked to original sources
PubMed2006

Structure, (governance) and health: an unsolicited response.

BACKGROUND: In a recently published article, it was suggested that governance was the significant structural factor affecting the epidemiology of HIV. This suggestion was made notwithstanding the observed weak correlation between governance and HIV prevalence (r = .2). Unfortunately, the paper raised but left unexamined the potentially more important questions about the relationship between the broader health of populations and structural factors such as the national economy and physical infrastructure. METHODS: Utilizing substantially the same data sources as the original article, the relationship between population health (healthy life expectancy) and three structural factors (access to improved water, GDP per capita, and governance) were examined in each of 176 countries. RESULTS: Governance was found to be significantly correlated with population health, as were GDP per capita, and access to improved water. They were also found to be significantly correlated with each other. CONCLUSION: The findings are discussed with reference to the growing interest in structural factors as an explanation for population health outcomes, and the relatively weak relationship between governance and HIV prevalence.

Journal Article↗
PubMed2005

'He hath the French pox': stigma, social value and social exclusion.

Goods and resources are finite, and social forces heavily pattern their distribution. One of the principal mechanisms for shaping the distribution of resources is by regulating entitlement to community membership itself. By restricting groups' membership of community, so access to social goods and resources diminishes, which in turn has a negative impact on the health and wellbeing of the excluded groups. It is argued here that community membership is determined on the basis of the perceived social value of groups and individuals and stigmatisation is the marking of individuals and groups who are 'unworthy' of social investment. Using the notion of reciprocity we show how groups may be stigmatised and socially excluded as a mechanism for protecting limited social resources from exploitation. This perspective provides an empirically testable framework for the understanding of stigma and social exclusion that goes beyond the largely descriptive work that currently populates the field. We illustrate the process of stigmatisation and social exclusion and discuss how this suggests new styles of intervention, as well as new directions for research.

Humans↗
PubMed2005

Population health. More than the sum of the parts?

The past decade has seen an upsurge of interest in the development of summary measures of population health. Almost invariably the measures have relied on "rolling up" individual level health data such as mortality data or life expectancy data. The approach, however, of treating population health as a synthesis of aggregated individual level data is a historical and statistical convenience. Although there has been some debate in the literature about whether one should also examine the equity of the distribution of health, the general practice has been to treat the level of a population's health and the distribution of health within a population as separate issues. Without recourse to contentious notions of equity, this paper examines the possibility of treating populations as more than simply the sum of their parts by combining individual level health data with population level data about the distribution of health. This approach may provide policy makers with additional ways of thinking about what it means to improve a population's health.

Health Status↗
PubMed2003

"Love thy neighbour"-it's good for your health: a study of racial homogeneity, mortality and social cohesion in the United States.

This paper explores the idea that in societies that experience racial tension, increasing racial heterogeneity will be associated with poorer health outcomes, and this effect will be observable in the health of both the minority and the majority group. Here, the association between mortality and racial homogeneity in the United States is examined. The level of racial homogeneity, indexed by the proportion of blacks in each state of the 50 states in the US, was examined in relation to all-cause mortality, adjusted for age and disaggregated by race and sex. The level of poverty in each state was controlled for in ordinary least squares regression models. The level of racial homogeneity was significantly associated with age adjusted mortality rates for both blacks and whites, accounting for around 30% of the variance in mortality rates in the total population and the white population. Every 1% increase in the percentage of the state population who were black was associated with an increase in the total mortality rate of 5.06 per 100000 and an increase in the white mortality rate of 3.58 per 100000. Based on the data, this suggests, for example, that racial heterogeneity in Mississippi accounts for around 14% of the white mortality rate and in New York and Delaware it accounts for around 7%. These results appear to support the social cohesion thesis that in societies that are intolerant, mortality rates will increase as the proportion of racial or ethnic minorities increase in population. Limitations and explanations for the findings are discussed.

Black or African American↗
PubMed2003

"Typhoid Mary" and "HIV Jane": responsibility, agency and disease prevention.

The construction of disease risks as knowable, calculable and preventable in dominant social science and public health discourses has fostered a certain kind of logic about individual risk and the responsibility for infection. Disease control measures that have developed out of this logic typically fail to recognise the socio-structural roots of many high-risk behaviours that are linked to the spread of infection. Instead, they hold the disease carrier responsible for managing his/her own risk of infection of others, and rely on constraining the agency of the carrier (e.g. by constraining movement, contact or occupation). In occupations associated with a high risk of infection, the idea of responsibility of the actor implicitly raises issues of "professional responsibility". Using the case of "Typhoid Mary" and a hypothetical case of "HIV Jane", this paper explores some of the problems with making sex workers responsible for the prevention of HIV transmission. It argues that for the notion of "responsibility" to make any sense, the HIV-positive person must be in a position to exercise responsibility, and for this they must have agency.

Carrier State↗
PubMed2003

Measuring health in a vacuum: examining the disability weight of the DALY.

The Disability Adjusted Life Year (DALY) is a widely used summary measure of population health combining years of life lost due to mortality and years of healthy life lost due to disability. A feature of the DALY is that, in the assessment of morbidity, each health condition is associated with a disability weight. The disability weight lies on a scale between 0 (indicating the health condition is equivalent to full health) and 1 (indicating the health condition is equivalent to death). The disability weight associated with each health condition is currently fixed across all social, cultural and environmental contexts. Thus blindness in the United Kingdom has the same disability weight as blindness in Niger in spite of structural interventions in the UK that make the disability less severe than in Niger. Although the fixed disability weight is defended on grounds that it supports a strongly egalitarian flavour in the DALY, we argue that the lack of consideration of realistic contexts results in a measure that will underestimate the burden associated with morbidity in disadvantaged populations and overestimate the burden in advantaged populations. There is, consequently, a loss of information on possible non-clinical points of intervention. Disaggregated estimates of the burden of disease such as those in the World Health Report 2000 should be interpreted with caution.

Australia↗
PubMed2003

Refugee intake: reflections on inequality.

BACKGROUND: Refugees represent one of the most marginalized populations with generally poor health outcomes and requirements often very different from, and in excess of, the populations in the countries of asylum. It stands to reason that countries that accept refugees should have the resources to support them. Although governments in industrialised countries are often vociferous about the generosity of their support for refugees, the appearance is that it is the poorest nations that bear the greatest burden. This has important implications for the allocation of resources to support the health and welfare needs of refugees. The distribution of refugees globally and the wealth of the countries of asylum are examined in this paper. METHOD: Data on the numbers of refugees accepted in each country were obtained from the United Nations High Commissioner for Refugees. These were used to analyse the 'fairness' of the distribution of refugees according to the economic capacity of the host countries. FINDINGS: A similar distribution of refugees prevails in the poorest quintile of countries and in the richest. Although there is considerable between-country variation, when account is taken of economic capacity, the poorest countries bear the greatest burden. INTERPRETATION: The distribution of refugees is in stark contrast to the humanitarian rhetoric of the industrialized countries. The implications of the inequitable distribution on health cannot be overemphasized.

Demography↗
PubMed2002

Objectivity in priority setting tools in reproductive health: context and the DALY.

The Disability Adjusted Life-Year (DALY) heralded a new age in the development of an evidence base for priority setting and resource allocation. The DALY was intended to represent sound measurement of the incidence and prevalence of conditions in a process by which burden of disease would be determined, health conditions prioritised and interventions evaluated. However, in the reification of objectivity, sight was lost of critical aspects of health and disease, namely that they are not independent of the context in which they occur. This is powerfully illustrated by many reproductive health conditions. Priority setting and resource allocation exercises need to take into account both objective measures and contextually relevant factors. Based on comparative data that highlights the effect of the development gradient on the burden of disease, this paper discusses the implications of context in the assessment of population health and priority setting, with a focus on reproductive health.

Cost of Illness↗
PubMed2002

An ecological study of the relationship between social and environmental determinants of obesity.

There is growing concern with the increasing prevalence of obesity in industrialised countries, a trend that is more apparent in the poor than in the rich. In an ecological study, the relationship between an area measure of socioeconomic status (SES) and the density of fast-food outlets was examined as one possible explanation for the phenomenon. It was found that there was a dose-response between SES and the density of fast-food outlets, with people living in areas from the poorest SES category having 2.5 times the exposure to outlets than people in the wealthiest category. The findings are discussed.

Australia↗
PubMed2002

Relationship between body mass index and the use of healthcare services in Australia.

OBJECTIVE: To examine the relationship between body mass index (BMI) and the use of medical and preventive health services. RESEARCH METHODS AND PROCEDURES: This study involved secondary analysis of weighted data from the Australian 1995 National Health Survey. The study was a population survey designed to obtain national benchmark information about a range of health-related issues. Data were available from 17,033 men and 17,174 women, > or =20 years or age. BMI, based on self-reported weight and height, was analyzed in relation to the use of medical services and preventive health services. RESULTS: A positive relationship was found between BMI and medical service use, such as medication use, visits to hospital accident and emergency departments (for women only); doctor visits, visits to a hospital outpatient clinics; and visits to other health professionals (for women only). A negative relationship was found in women between BMI and preventive health services. Underweight women were found to be significantly less likely to have Papanicolaou smear tests, breast examinations, and mammograms. DISCUSSION: This research shows that people who fall outside the healthy weight range are more likely to use a range of medical services. Given that the BMI of industrialized populations appears to be increasing, this has important ramifications for health service planning and reinforces the need for obesity prevention strategies at a population level.

Ambulatory Care↗
PubMed1992

Psychology ethics down under: a survey of student subject pools in Australia.

A survey of the 37 psychology departments offering courses accredited by the Australian Psychological Society yielded a 92% response rate. Sixty-eight percent of departments employed students as research subjects, with larger departments being more likely to do so. Most of these departments drew their student subject pools from introductory courses. Student research participation was strictly voluntary in 57% of these departments, whereas 43% of the departments have failed to comply with normally accepted ethical standards. It is of great concern that institutional ethics committees apparently continue to condone, or fail to act against, unethical research practices. Although these committees have a duty of care to all subjects, the final responsibility for conducting research in an ethical manner lies with the individual researcher.

Australia↗