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Oliver Razum

Publications and source records attributed to Oliver Razum.

12 recordsLinked to original sources
PubMed2004

Deteriorating health satisfaction among immigrants from Eastern Europe to Germany.

BACKGROUND: Migrants from Eastern Europe constitute more than 5% of Germany's population. Since population health in their countries of origin is poor their health status upon arrival may be worse than that of the native-born German population (hypothesis H1). As a minority, they may be socio-economically disadvantaged (H2), and their health status may deteriorate quickly (H3). METHODS: We compared data from 1995 and 2000 for immigrants from Eastern Europe (n = 353) and a random sample of age-matched Germans (n = 2, 824) from the German Socioeconomic Panel. We tested H1-3 using health satisfaction, as a proxy for health status, and socioeconomic indicators. We compared changes over time within groups, and between immigrants and Germans. We assessed effects of socio-economic status and being a migrant on declining health satisfaction in a regression model. RESULTS: In 1995, immigrants under 55 years had a significantly higher health satisfaction than Germans. Above age 54, health satisfaction did not differ. By 2000, immigrants' health satisfaction had declined to German levels. Whereas in 1995 immigrants had a significantly lower SES, differences five years later had declined. In the regression model, immigrant status was much stronger associated with declining health satisfaction than low SES. CONCLUSION: In contrast to H1, younger immigrants had an initial health advantage. Immigrants were initially socio-economically disadvantaged (H2), but their SES improved over time. The decrease in health satisfaction was much steeper in immigrants and this was not associated with differences in SES (H3). Immigrants from Eastern Europe have a high risk of deteriorating health, in spite of socio-economic improvements.

Journal Article↗
PubMed2004

Self-help: What future role in health care for low and middle-income countries?

In the debate on 'Third options' for health care delivery in low- and middle-income countries it is proposed that self-help should play a larger role. Self-help is expected to contribute towards improving population health outcomes and reducing government health care expenditure. We review scope and limitations of self-help groups in Europe and South Asia and assess their potential role in health care within the context of health sector reform.Self-help groups are voluntary unions of peers, formed for mutual assistance in accomplishing a health-related purpose. In Europe, self-help groups developed out of dissatisfaction with a de-personalised health care system. They successfully complement existing social and health services but cannot be instrumentalized to improve health outcomes while reducing health expenditure.In South Asia, with its hierarchical society, instrumental approaches towards self-help prevail in Non-governmental Organizations and government. The utility of this approach is limited as self-help groups are unlikely to be sustainable and effective when steered from outside. Self-help groups are typical for individualistic societies with developed health care systems - they are less suitable for hierarchical societies with unmet demand for regulated health care. We conclude that self-help groups can help to achieve some degree of synergy between health care providers and users but cannot be prescribed to partially replace government health services in low-income countries, thereby reducing health care expenditure and ensuring equity in health care.

Editorial↗
PubMed2003

Cardiovascular risk factor levels in a lower middle-class community in Ankara, Turkey.

STUDY OBJECTIVE: To assess the prevalence of risk factors for coronary heart disease (CHD) in a lower middle-class urban community of Turkey. DESIGN: Cross-sectional study in an age- and sex-stratified random community sample with equal sample size per stratum. Direct age-standardization using the standard world population to allow international comparison of findings. Logistic regression modelling to identify risk factors for obesity. SETTING: Gülveren, a residential area in Ankara, total population 23,000 persons. PARTICIPANTS: A total of 1672 adults aged 25-64 years and resident in the study community were interviewed, 1272 (76.1%) of those came for physical examination. MAIN RESULTS: The age-standardized prevalence of hypertension according to WHO MONICA criteria was 18.6% (95% confidence interval: 16.1-21.1%) among women and 12.3% (9.7-14.9%) among men; of obesity (body mass index, BMI > or =30 kg/m2) 51.0% (47.6-54.3%) among women and 15.1% (12.0-18.2%) among men; of current smoking 20.1% (17.5-22.6%) among women and 64.8% (61.4-68.2%) among men; of hypercholesterolaemia 20.1% (17.4-22.9%) among women and 13.8% (10.8-16.8%) among men; and of low high density lipoprotein (HDL) 48.4% (44.8-52.1%) among women and 40.6% (36.0-45.2%) among men. In the regression model, age, female sex, non- and ex-smoking were associated with obesity. CONCLUSIONS: The prevalence of smoking, obesity and low HDL is high in this urban, lower middle-class population, even in comparison with industrialized countries. Unexpectedly, women have less favourable CHD risk profiles than men, except for smoking. Preventive action should be community-wide and address the common risk factors simultaneously to avoid replacement effects such as becoming obese after quitting smoking.

Adult↗
PubMed2003

Health co-operatives: review of international experiences.

There is renewed interest in the revival of health co-operative as a "third option" for meeting health care needs of populations in developing countries in the context of health sector reforms. This article reviews some international experiences with health co-operatives. We briefly assess the history of health co-operatives in industrialized countries where they originated and review past experience from China and the states of Kerala and Gujarat in India to explore the viability of health co-operatives for the provision of health care. In industrialized countries, co-operatives came into existence as autonomous entities with voluntary participation, aiming to contribute to the welfare of their members. In recent years, however, co-operatives are being envisaged as a mechanism to overcome economic barriers in access to health care, despite lack of evidence of their cost-effectiveness and sustainability. In China, health co-operatives achieved universal coverage of basic health services but became dysfunctional when state support was withdrawn. In Gujarat/India, co-operatives have been useful to provide primary health care services and not as a mechanism to run hospitals and provide medical care for the general population. In Kerala/India, health co-operatives could not successfully compete with expanding state health services and private services unless they were managed like private enterprises. In terms of managerial effectiveness and sustainability co-operatives can not be "prescribed" to compensate for the deteriorating access to health services following market-oriented health sector reforms in developing countries.

Community Health Services↗
PubMed2002

Time travel with Oliver Twist--towards an explanation foa a paradoxically low mortality among recent immigrants.

First-generation immigrant populations in industrialized countries frequently have a lower mortality than the host population, a finding that is unexpected and often dismissed as the result of bias. We propose an alternative explanation for a real, albeit temporal, mortality advantage. We base our argument on two premises: First, that there are differences in the progression of the health transition between the immigrants' countries of origin and industrialized host countries; and, second, that there are differences in the speed at which changes in mortality from various causes occur after migration. Mortality from treatable communicable and maternal conditions, still high in many countries of origin, quickly declines to levels close to those of the host country. Mortality from ischaemic heart disease, the most common cause of death in the host countries, takes years or decades to rise to comparable heights. This is because of the time lag between increases in risk factor levels and an increased risk of coronary death. Hence, first-generation immigrants may initially experience a lower mortality than the host population, a point that has so far been under-appreciated in discussions of immigrant mortality. After adopting a western lifestyle immigrants face an increasing risk of ischaemic heart disease. The increase occurs on top of a persisting risk from conditions associated with childhood deprivation, e.g. stomach cancer and stroke--the unfinished agenda of the health transition that immigrants experience.

Communicable Diseases↗