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37953 results in Cambridge Textbooks

Page 1790 of 1898

  • 6 - Income inequality and health: in search of fundamental causes

  • from Part B - Explaining health inequalities
  • Edited by Richard Eckersley, Australian National University, Canberra, Jane Dixon, Australian National University, Canberra, Bob Douglas, Australian National University, Canberra
  • Book:
    The Social Origins of Health and Well-being
    Published online:
    14 September 2019
    Print publication:
    12 December 2001, pp 83-104

  • Summary

    Introduction

    Despite the long-held myth of equality and egalitarianism, Australia is a socially and economically divided society: it was from the early days of white settlement (Connell 1977), it has been since (Western 1983; Baxter et al. 1991), it still is today (Fincher and Nieuwenhuysen 1998), and all indications are that it will continue to be so in the future (Megalogenis 2000). In fact, the socio-economic divisions within this country are predicted to widen (Kelly 2000; Steketee and Haslem 2000). Income inequality is a key indicator of this divide. Between 1982 and 1993/94, earnings and private income inequality increased in Australia, and while most of this increase was offset by government-initiated changes to the taxation and welfare systems (Harding 1997), Australia still has marked inequities in its distribution of income. One perspective on the extent of income inequality in Australia is illustrated in figure 6.1. These data indicate the share of total weekly income received by the poorest and richest 20% of families between 1994 and 1998. For each period, families in the bottom quintile of the income distribution received less than 4% of the total income going to Australian families, whereas those in the top quintile received just under 50%. This represents more than a 12-fold difference in share of the nation's income. The extent of Australia's income inequality has also been made apparent in recent international assessments that have shown that Australia is not far behind ‘high’ inequality countries such as the United States and Britain in terms of its level of income disparity (Smeeding and Gottschalk 1999).

    The movement towards a more divided society is of concern, not only because of its inherent injustices and offence to moral sensibility, but also in light of studies showing that income inequality is bad for health. Since the mid-1980s, a growing body of epidemiological and public health research has demonstrated that morbidity and mortality risk is greatest in areas with high levels of income inequality. At present, our knowledge and understanding of how income distribution affects health is limited, although a number of explanations have been proposed. These include differential investment in human, physical and social infrastructure; psychosocial processes related to perceptions of one's position in the socio-economic hierarchy; and social cohesion.

  • 19 - Does our limited analysis of the dimensions of poverty limit the way we seek solutions?

  • from Part E - Implications for policy, interventions and health research
  • Edited by Richard Eckersley, Australian National University, Canberra, Jane Dixon, Australian National University, Canberra, Bob Douglas, Australian National University, Canberra
  • Book:
    The Social Origins of Health and Well-being
    Published online:
    14 September 2019
    Print publication:
    12 December 2001, pp 259-268

  • Summary

    Introduction

    Poverty is rarely about one thing - it is about having no money, no voice, no infrastructure and no opportunities. Voices of the Poor (World Bank 2000).

    Poverty and other forms of social disadvantage are multidimensional in their manifestations, multifactoral in their causes, and complex in the pathways through which they operate on health and well-being. However, there is a danger that the high level of interest in the public health community in the statistical relationship between unequal income distribution and health may lead to an oversimplification of both the nature of poverty and the action required to address health inequality. Also, a preoccupation with describing associations and developing models for explaining causal pathways leaves public health workers open to criticism of developing a research industry that has few tangible benefits for those whose health is most vulnerable.

    This paper raises issues that need to be considered as complex notions of poverty and social disadvantage are transferred from (often complex) sociological to (often relatively simple) public health frameworks. For instance:

  • • Are measures of income and income distribution simply proxies for a more complex and systemic web of disadvantage?

  • • Is poverty better understood as a set of issues affecting an individual, family network or community rather than as a single entity in itself?

  • • Does the current emphasis on relative poverty blind us to the absolute paucity of resources and life chances experienced by some Australians?

  • • Is our limited analysis of the dimensions of poverty preventing a more sophisticated approach to solutions?

  • • And most importantly, if, as some argue, the prime cause of health inequalities in developed countries is the very unequal income distribution, and the remedies for this lie so clearly outside the mandate of the health system, are health workers released from any responsibility to act?

    • Additionally, we reflect on the limitations of the income inequality argument that are emerging in the literature, and examine the ways in which an analysis that is based on simple, strong statistical associations between income inequality and health may be limiting effective action to reduce health inequalities. It is not our purpose to throw the baby out with the bath water. We do not dispute the observed relationship between income inequality and health but seek to reflect on the limitations of this approach in understanding the origins of health inequality and in taking action to redress these inequalities.

  • 15 - Family, early development and the life course: common risk and protective factors in pathways to prevention

  • from Part D - Developmental and biological perspectives
  • Edited by Richard Eckersley, Australian National University, Canberra, Jane Dixon, Australian National University, Canberra, Bob Douglas, Australian National University, Canberra
  • Book:
    The Social Origins of Health and Well-being
    Published online:
    14 September 2019
    Print publication:
    12 December 2001, pp 216-224

  • Summary

    Developmental outcomes and pathways

    The current and generally accepted model of development views children's development as the result of the ongoing interaction and transactions between the children and the environment they grow up in. Those interactions have effects on both the child and the environment, and include transactions between the child's family, the neighbourhood and the wider community. All are variously affected as well by the policies and the structures of the government and the broader society in which they exist (Bronfenbrenner 1979; Shonkoff and Phillips 2000).

    Throughout their development, children follow various pathways to particular physical, social, emotional and cognitive developmental outcomes. There is no single straight pathway from early to later development but a number of ‘straight and devious’ pathways to various developmental outcomes (Robins and Rutter 1990). Children may reach the same outcome or 'point’ in different areas of development by a number of different pathways, but the research evidence suggests that certain adverse outcomes in adolescence and adulthood such as criminal behaviour and substance abuse are continuations of anti-social behaviour and mental health problems in childhood (Farrington 1994; Nagin and Tremblay 1999; National Crime Prevention 1999; Robins and Rutter 1990; Werner 1987).

    At various points along the pathway, there are a number of points of change or transitions which involve major re-orientations in how a child relates to his or her environment (Shonkoff and Phillips, 2000). These are important because they tend to be periods when individuals and/or others around them are looking for information and are likely to be more open to some assistance or intervention. Transitions may occur as particular aspects of the child's development (for example, when children are acquiring language or trying to increase their independence from their parents, either as toddlers or as adolescents) and they may also be a result of changes imposed by the child's environment or stage of life. Such life-stage transitions include entering child-care or school, changing from primary to secondary school, and getting a job and leaving home. In addition, certain life events such as moving to a new area, changing schools, and changes in family structure as a result of divorce, the birth of a sibling or the death of a family member also bring with them changes in various aspects of a child's life.

  • 11 - Human settlements: health and the physical environment

  • from Part C - Social organisation and health
  • Edited by Richard Eckersley, Australian National University, Canberra, Jane Dixon, Australian National University, Canberra, Bob Douglas, Australian National University, Canberra
  • Book:
    The Social Origins of Health and Well-being
    Published online:
    14 September 2019
    Print publication:
    12 December 2001, pp 159-177

  • Summary

    Introduction

    The healthy cities movement is not new; it began in the late 19th century in response to industrial city slums. The problems of polluted water, filthy streets and fetid air, together with the lack of any natural parkland gave rise to modern town planning. The role of health professionals in this movement was very significant. This chapter will gather some perspective from the history of settlements before showing how we are facing a set of issues just as critical as those that faced the first industrial cities. It will try to show what those problems are and how some settlements are facing them. The role of health professionals in gaining acceptance of the required integrative approach will be stressed, as will the need for a sense of hope in these debates.

    The physical environment of our cities presents a range of problems that concern health professionals: indoor air pollution, toxic chemicals in the workplace, industrial pollution, toxic site remediation, and so on. The focus of this chapter is on the physical environment as it relates to the transport and land use issues associated with the automobile. As with all physical environmental issues, we must consider their social and economic context.

    Healthy cities in history

    The health profession was a major factor in changing the nature of cities in the 19th century. The rapid growth of industrial cities meant that often, simple needs like separating water from waste (well known in every indigenous culture) were unmet. John Snow's ‘discovery’ that a sewage-contaminated well was causing cholera in London was said to have led to a burst of public health awareness in the late 1840s. Sewers were built, and public health approaches were adopted from that period but these improvements were outpaced by the growth of the cities and their polluting industries.

    By the 1890s, the worst depression ever known had led to terrible poverty and crime throughout industrial cities. The air was full of the smoke and smells of the ‘dark satanic mills'. People crowded into tenements, and all the services were overwhelmed. Garbage filled the streets, and epidemics raged through the slums.

    The social, economic and environmental problems of the cities dominated political and academic agendas. In response, the resulting ‘hygiene’ movement spread through the developed world's cities.

  • 4 - Culture, health and well-being

  • from Part A - Historical, global and cultural perspectives
  • Edited by Richard Eckersley, Australian National University, Canberra, Jane Dixon, Australian National University, Canberra, Bob Douglas, Australian National University, Canberra
  • Book:
    The Social Origins of Health and Well-being
    Published online:
    14 September 2019
    Print publication:
    12 December 2001, pp 51-70

  • Summary

    Introduction

    In the 1970s, I spent two years travelling overseas - through Africa, Western and Eastern Europe, the Soviet Union and Asia. The most difficult cultural adjustment I had to make was on my return to Australia. My initial celebration of the material abundance and comfort of the Western way of life soon gave way to a growing apprehension about its emotional harshness and spiritual desiccation. In a way I hadn't anticipated, the experience allowed me to view my native culture from the outside, and in ways I hadn't appreciated before, I realised ours was a tough culture.

    In his book, Biology and the Riddle of Life, the biologist Charles Birch says science inevitably leads to mechanical analyses. Is there nothing more to be said, he asks:

    I think there is. It is to propose that there are two points of view - the inside and the outside, the subjective and the objective, from within and from without… There is an enormous gap between what science describes and what we experience … (T)he solution to the riddle of life is only possible through the proper connection of the outer with the inner experience (1999, p 58, italics in original).

    This chapter is concerned with this connection as it relates to the social determinants of health, and as it is expressed in the relationships between cultural and socio-economic factors. 'Culture’ is a difficult concept because it is defined and used differently between different disciplines, and even within the same discipline. Culture can be taken to include all aspects of society, to describe an entire way of life of a people. However, it is often distinguished from social structure, with a key research goal being a better understanding of how the two interact (Swidler 1986). Larazus (1991, pp 349-83), in his study of emotion and adaptation, distinguishes between ‘culture’ and ‘social structure’ in this way: ‘culture’ provides a set of internalised meanings that we carry into our interactions with the social and physical environment; 'social structure’ refers to the detailed patterns of social relationships and transactions among people with different roles and status within a social system.

    However, Hays (1994) challenges the separation of culture and social structure. Culture, she argues, is a social structure, both internal and external, subjective and objective, ideal and material.

  • 18 - Aboriginal health, policy and modelling in social epidemiology

  • from Part E - Implications for policy, interventions and health research
  • Edited by Richard Eckersley, Australian National University, Canberra, Jane Dixon, Australian National University, Canberra, Bob Douglas, Australian National University, Canberra
  • Book:
    The Social Origins of Health and Well-being
    Published online:
    14 September 2019
    Print publication:
    12 December 2001, pp 247-258

  • Summary

    Aboriginal health and social disadvantage

    In Aboriginal health it is generally assumed that the determinants of mortality and morbidity are complex and multidimensional. The parameters of Aboriginal health disadvantage have been well documented. For example, Aboriginal and Torres Strait Islander life expectancy at birth for the period 1991-6 was estimated to be 56.9 years for males and 61.7 years for females. Life expectancy for nonAboriginal people during the same period was 75.2 years for males and 81.1 years for females. (AIHW 1999, p 134). Death rates, according to available data, are elevated in all age groups of Aboriginal and Torres Strait Islanders relative to nonAboriginal Australians (AIHW 1999, p 131). Aboriginal disadvantage is also well documented with respect to a range of other social indicators. For instance, according to the 1996 census:

  • • Forty-one percent of Aboriginal and Torres Strait Islanders aged 15-64 years were employed (including employment the Community Development Employment Projects (CDEP) scheme jobs); 12% were not employed but seeking work and 47% were not in the labour force. The unemployment rate is calculated as a percentage of those in the labour force, so that at this time, the Aboriginal and Torres Strait unemployment rate was 23%, compared with 9% for nonAboriginal Australians (AIHW 1999, p 19).

  • • The median weekly income for Aboriginal and Torres Strait Islander males over the age of 15 was $189 in 1996, compared with $415 for nonAboriginal males. At the same time, the median weekly income for Aboriginal females was $190, compared with $224 for nonindigenous females (AIHW 1999, p 22).

  • • Forty percent of Aboriginal and Torres Strait Islander people left school before the age of 16 years, compared with 34% of nonindigenous Australians. Two percent of Aboriginal and Torres Strait Islander adults aged 15 years and over had completed a bachelors degree or higher, compared with 11% of nonindigenous Australians (AIHW 1999, p 19).

    • Even a superficial investigation of Aboriginal health disadvantage underscores the need for a complex multi-layered response by Australian governments. A growing body of evidence from social epidemiology that points to the role played by social factors such as relative economic status, educational attainment or social capital in the production of health inequalities. Despite this evidence, there has been limited success in achieving effective co-ordination of governmental interventions in the social determinants of Aboriginal health in sectors other than health.

  • 13 - Health, inequities, community and social capital

  • from Part C - Social organisation and health
  • Edited by Richard Eckersley, Australian National University, Canberra, Jane Dixon, Australian National University, Canberra, Bob Douglas, Australian National University, Canberra
  • Book:
    The Social Origins of Health and Well-being
    Published online:
    14 September 2019
    Print publication:
    12 December 2001, pp 189-204

  • Summary

    Introduction

    The health status and life opportunities of those in poorer communities are less than those elsewhere (Australian Institute of Health and Welfare 1998). Responding to this situation is internationally recognised as requiring a multifaceted national as well as community approach that includes both social and economic initiatives (World Health Organization 1986a). This chapter explores the potential for social capital to provide a framework for developing communities in such a way that the health and life opportunities of poorer communities are improved.

    We address the relationship between social capital and the health and life opportunities of people in communities. This includes not only the individual health of those in communities, as often measured by mortality, morbidity, and quality of life instruments, but also the idea that there are ‘healthy communities’ in and of themselves - communities in which there is a good stock of social capital and other forms of resource. ‘Life opportunities’ refers to the equality of opportunity that comes about through the local availability of many types of resources - for example, access to local childcare to encourage early child development that is so important to later achievements at school and beyond. Indeed, where access to and availability of social, economic and cultural resources are limited, so the life opportunities are also limited and this eventually becomes reflected in health statistics.

    The breadth of views about social capital necessitates a brief investigation of its historical origins and the way different disciplines have conceptualised the links to health and life opportunities. We begin with the theoretical underpinnings, address some of the key empirical findings and them describe the Adelaide study of health development and social capital. This is a study that pays attention to levels and types of local participation in community life, the role of organisations and groups in the generation of social capital in communities, and the predictive value of social capital on health status.

    Historical and theoretical underpinnings

    The 1960s saw the adoption of ideas about social capital as the source for social action in a range of community studies.

  • Preface

  • Edited by Richard Eckersley, Australian National University, Canberra, Jane Dixon, Australian National University, Canberra, Bob Douglas, Australian National University, Canberra
  • Book:
    The Social Origins of Health and Well-being
    Published online:
    14 September 2019
    Print publication:
    12 December 2001, pp x-xiv

  • Summary

    Why publish yet another book about the social determinants of health? This was the initial reaction of a reader to whom Cambridge University Press sent our book proposal. The response is unsurprising. The past decade has seen the publication of some 15 books, major reports or special journal issues dealing with the social determinants of health. The number of individual journal articles has soared.

    Can there really be a need for another overview of the subject? Cambridge's reader went on to say the initial scepticism was immediately dispelled by the originality of the material and the arguments put forward by the individual contributors: ‘I am persuaded that this book will make a substantial, and novel, contribution to the literature, both in Australasia as well as internationally.'

    We are also confident of the value of this book—for two main reasons. First, the existing literature has focused on the North American and European situations; we want to put the Antipodes on the social epidemiological map. Secondly, the recent literature has concentrated on socio-economic inequality as a prime determinant of health; we believe this book adds important historical, global and cultural dimensions to the social sources of health and well-being.

    The book has its origins in the establishment of the Health Inequalities Research Collaboration by the Australian Commonwealth Department of Health and Aged Care to promote a better understanding of why some groups in the community are healthier than others. One of the early tasks of the Collaboration was to organise a major conference, held in Canberra in July 2000. Its aim was to build scientific, public and policy recognition of the importance of the social determinants of health. New Zealand participants and perspectives were included because research and policy development in this area are more advanced there than in Australia.

    From the conference came the book. It brings together leading scholars from both countries to establish a baseline of what we know and what we need to do. There are, inevitably, omissions. Between conference and book, a few contributions fell by the wayside. But other perspectives were added, particularly on the implications for policy, intervention and research.

  • Part 7 - Our virtues

  • Friedrich Nietzsche
  • Edited by Rolf-Peter Horstmann, Humboldt-Universität zu Berlin
  • Edited and translated by Judith Norman, Trinity University, Texas
  • Book:
    Nietzsche: Beyond Good and Evil
    Published online:
    05 June 2012
    Print publication:
    22 November 2001, pp 109-130

  • Summary

    Our virtues? – We probably still have our virtues too, although of course they will not be those trusting and muscular virtues for which we hold our grandfathers in honor – but also slightly at arm's length. We Europeans from the day after tomorrow, we firstborn of the twentieth century, – with all of our dangerous curiosity, our diversity and art of disguises, our worn-out and, as it were, saccharine cruelty in sense and in spirit, – if we happen to have virtues, they will presumably only be the ones that have learned best how to get along with our most secret and heartfelt propensities, with our most fervent desires. So let us look for them in our labyrinths! where, as we know, so many things lose their way, so many things get entirely lost. And is there anything more beautiful than looking for your own virtues? Doesn't this almost mean: believing in your own virtue? But this “believing in your own virtue” – isn't this basically what people used to call their “good conscience,” that venerable, long-haired pigtail of a concept that hung on the back of our grandfathers' heads, and often enough behind their intellects too? And so it seems that however up-to-date and unworthy of grandfatherly honor we might otherwise appear, there is nevertheless one respect in which we are the worthy grandchildren of these grandfathers, we last Europeans with a good conscience: we still wear their pigtail.

  • Preface

  • Friedrich Nietzsche
  • Edited by Rolf-Peter Horstmann, Humboldt-Universität zu Berlin
  • Edited and translated by Judith Norman, Trinity University, Texas
  • Book:
    Nietzsche: Beyond Good and Evil
    Published online:
    05 June 2012
    Print publication:
    22 November 2001, pp 3-4

  • Summary

    Suppose that truth is a woman – and why not? Aren't there reasons for suspecting that all philosophers, to the extent that they have been dogmatists, have not really understood women? That the grotesque seriousness of their approach towards the truth and the clumsy advances they have made so far are unsuitable ways of pressing their suit with a woman? What is certain is that she has spurned them – leaving dogmatism of all types standing sad and discouraged. If it is even left standing! Because there are those who make fun of dogmatism, claiming that it has fallen over, that it is lying flat on its face, or more, that dogmatism is in its last gasps. But seriously, there are good reasons for hoping that all dogmatizing in philosophy was just noble (though childish) ambling and preambling, however solemn, settled and decisive it might have seemed. And perhaps the time is very near when we will realize again and again just what actually served as the cornerstone of those sublime and unconditional philosophical edifices that the dogmatists used to build – some piece of folk superstition from time immemorial (like the soul-superstition that still causes trouble as the superstition of the subject or I), some word-play perhaps, a seduction of grammar or an over-eager generalization from facts that are really very local, very personal, very human-all-too-human.

  • Part 2 - The free spirit

  • Friedrich Nietzsche
  • Edited by Rolf-Peter Horstmann, Humboldt-Universität zu Berlin
  • Edited and translated by Judith Norman, Trinity University, Texas
  • Book:
    Nietzsche: Beyond Good and Evil
    Published online:
    05 June 2012
    Print publication:
    22 November 2001, pp 25-42

  • Summary

    O sancta simplicitas! What a strange simplification and falsification people live in! The wonders never cease, for those who devote their eyes to such wondering. How we have made everything around us so bright and easy and free and simple! How we have given our senses a carte blanche for everything superficial, given our thoughts a divine craving for high-spirited leaps and false inferences! – How we have known from the start to hold on to our ignorance in order to enjoy a barely comprehensible freedom, thoughtlessness, recklessness, bravery, and joy in life; to delight in life itself! And, until now, science could arise only on this solidified, granite foundation of ignorance, the will to know rising up on the foundation of a much more powerful will, the will to not know, to uncertainty, to untruth! Not as its opposite, but rather – as its refinement! Even when language, here as elsewhere, cannot get over its crassness and keeps talking about opposites where there are only degrees and multiple, subtle shades of gradation; even when the ingrained tartuffery of morals (which is now part of our “flesh and blood,” and cannot be overcome) twists the words in our mouths (we who should know better); now and then we still realize what is happening, and laugh about how it is precisely the best science that will best know how to keep us in this simplified, utterly artificial, well-invented, well-falsified world, how unwillingly willing science loves error because, being alive, – it loves life!

  • Part 5 - On the natural history of morals

  • Friedrich Nietzsche
  • Edited by Rolf-Peter Horstmann, Humboldt-Universität zu Berlin
  • Edited and translated by Judith Norman, Trinity University, Texas
  • Book:
    Nietzsche: Beyond Good and Evil
    Published online:
    05 June 2012
    Print publication:
    22 November 2001, pp 75-92

  • Summary

    In Europe these days, moral sentiment is just as refined, late, multiple, sensitive, and subtle as the “science of morals” (which belongs with it) is young, neophyte, clumsy, and crude: – an attractive contrast, and one that occasionally becomes visible, embodied in the person of the moralist himself. Considering what it signifies, the very phrase “science of morals” is much too arrogant and offends good taste, which always tends to prefer more modest terms. We should admit to ourselves with all due severity exactly what will be necessary for a long time to come and what is provisionally correct, namely: collecting material, formulating concepts, and putting into order the tremendous realm of tender value feelings and value distinctions that live, grow, reproduce, and are destroyed, – and, perhaps, attempting to illustrate the recurring and more frequent shapes of this living crystallization, – all of which would be a preparation for a typology of morals. Of course, people have not generally been this modest. Philosophers have all demanded (with ridiculously stubborn seriousness) something much more exalted, ambitious, and solemn as soon as they took up morality as a science: they wanted morality to be grounded, – and every philosopher so far has thought that he has provided a ground for morality. Morality itself, however, was thought to be “given.” What a distance between this sort of crass pride and that supposedly modest little descriptive project, left in rot and ruin, even though the subtlest hands and senses could hardly be subtle enough for it.

Page 1790 of 1898