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Article

The Effect of Education on Health and Mortality: A Review of Experimental and Quasi-Experimental Evidence  

Titus Galama, Adriana Lleras-Muney, and Hans van Kippersluis

Education is strongly associated with better health and longer lives. However, the extent to which education causes health and longevity is widely debated. We develop a human capital framework to structure the interpretation of the empirical evidence and review evidence on the causal effects of education on mortality and its two most common preventable causes: smoking and obesity. We focus attention on evidence from randomized controlled trials, twin studies, and quasi-experiments. There is no convincing evidence of an effect of education on obesity, and the effects on smoking are only apparent when schooling reforms affect individuals’ track or their peer group, but not when they simply increase the duration of schooling. An effect of education on mortality exists in some contexts but not in others and seems to depend on (i) gender, (ii) the labor market returns to education, (iii) the quality of education, and (iv) whether education affects the quality of individuals’ peers.

Article

Collective Health: Theory and Practice. Innovations From Latin America  

Ligia Maria Vieira-da-Silva

Throughout history, knowledge and practices on the health of populations have had different names: medical police, public health, social medicine, community health, and preventive medicine. To what extent is the Brazilian collective health, established in the 1970s, identified with and differentiated from these diverse movements that preceded it? The analysis of the socio-genesis of a social field allows us to identify the historical conditions that made possible both theoretical formulations and the achievement of technical and social practices. Collective health, a product of transformations within the medical field, constituted a rupture in relation to preventive medicine and public health and hygiene, being part of a social medicine movement in Latin America that, in turn, had identification with European social medicine in the 19th century. Focused on the development of a social theory of health that would support the process of sanitary reform, collective health has been built as a space involving several fields: scientific, bureaucratic, and political. Thus, it brought together health professionals and social scientists from universities, health care services, and social movements. Its scientific subfield has developed, and the sanitary reform project has had several successes related to the organization of a unified health system, which has ensured universal coverage for the population in Brazil. It has incorporated into and dialogued with several reformist movements in international public health, such as health promotion and the pursuit of health equity. Its small relative autonomy stems from subordination to other dominant fields and its dependence on the state and governments. However, its consolidation corresponded to the strengthening of a pole focused on the collective and universal interest, where health is not understood as a commodity, but as a right of citizenship.

Article

Human Needs: Health  

Toba Schwaber Kerson

Health is a need, a basic requirement for life. Needs can become rights when bodies of people, usually governments or organizations such as the World Health Organization sanction them. While many have declared health as a right, the greatest burden of illness continues to be carried by minority and medically underserved populations. Also, industrialization, urbanization, economic development, and food market globalization have brought with them the poor health habits that place people at risk for cardiovascular and other diseases. Improved health habits and universal health care coverage would help to address the health needs of all.

Article

International Organization and Health/Disease  

Kelley Lee and Julia Smith

Human history has been shaped by shifting patterns of health and disease. Many of the factors influencing those patterns have spanned national borders, such as human and animal migration, armed conflict, colonization, trade and investment, globalization, and environmental change. International studies scholars’ interest in health and disease has slowly evolved over time. After World War II, international health cooperation was accepted as a key function of the United Nations system, with the creation of the World Health Organization (WHO). However, health was deemed a largely technical field, alongside the activities of international health organizations. The limited scholarship produced during the postwar period was largely descriptive of technical and legal issues. It was not until the 1970s, when debates emerged about the appropriate forms of health development assistance, concerns about large commercial interests, and the role of WHO, that scholars began considering the politics of international health cooperation. The Declaration of Alma Ata on Health for All, Essential Drugs List, and International Code of Marketing of Breast Milk Substitutes were expressions of discontent in international health with a status quo perpetuating inequality among states. These initiatives then spurred accusations of “politicization” of WHO’s technical mandate, accompanied by the freezing of the organization’s budget. The study of international organizations and health began to apply critical theoretical approaches, locating health and disease within the liberal world order. From the 1990s onward, the proliferation of new institutional arrangements for international health cooperation prompted studies of this increasingly complex landscape. The term “global health” was coined to reflect the interplay of state and nonstate actors amid globalization, alongside the concept of global health governance (GHG). This encouraged scholarly exchange across international studies, social policy, law, and anthropology. International organizations with health-related impacts, such as the World Trade Organization, and powerful nonstate actors, such as foundations and commercial interests, were incorporated into GHG scholarship. Concurrently, new theoretical approaches to understanding collective action for global health emerged, notably realist notions of global health security, and social constructivist approaches to the framing of problems and solutions. Major disease outbreaks since the early 2000s, including SARS in 2003–2004, Ebola virus in West Africa in 2014–2015, and COVID-19 since 2020, have intensified scrutiny of GHG. The sharp rise in noncommunicable diseases alongside the globalization of market capitalism also drew growing attention. Amid renewed debate about WHO reform, analyses have focused on the lack of coherence among global health actors, weakness of legal and ethical frameworks for collective action, and inadequacy of resources.

Article

Global Health and Global Health Education  

Michele Eggers-Barison and Lalit Khandare

Global health has been gradually gaining more traction in social work education. Global health addresses prevalent health vulnerabilities and collective responsibilities that transcend national borders. Global health is a multidimensional issue, which elicits an interdisciplinary multidimensional response. Various disciplines are in search of definitions, theoretical frameworks, and practice methodologies, including the development of competencies to meet global health needs. The need for social workers to critically engage in health inequities within social, cultural, economic, and political contexts globally is essential to bring effective change in the lives of those most marginalized and impacted by global health inequities. Social work is well positioned to address these needs through international social work practice and professional global standards to advocate for just policies and practice and to enhance equity and inclusiveness to promote social justice and human rights.

Article

The Role of Historically Black Colleges and Universities in Advancing Health Equity  

Orlando L. Taylor, Nicole L. Retland, Briana Jeffreys, Elaine Meredith, Melissa E. Wynn, and Pamela L. Carter-Nolan

The end of the Civil War marked a period when America’s medical practitioners considered the Black populace to be unworthy of proper health care on par with that of its White populace. Although slavery had officially ended, its vestiges remained prevalent in the lives of formerly enslaved persons. Indeed, lingering health issues permeated the generations that have followed, such that diseases that are highly treatable have often resulted in premature illness and death. Historically, the health-care industry has even blamed the formerly enslaved and subsequent generations for their own health conditions. In the early post–Civil War years, state and local statutes legalizing segregation in the American South (known as the Jim Crow laws) cemented these views and perpetuated unfair and unequal health-care conditions. In more recent years, COVID-19 exacerbated an already dire situation, and a disproportionate share of illness and death has occurred among African Americans and other underrepresented masses. Historically Black colleges and universities (HBCUs) can lead the way in bringing some semblance of equality to this situation. Primarily increasing the fiscal resources of HBCUs so that they can further advance the education of a more diverse health-care workforce is a critical component for providing culturally sensitive health care for the nation. HBCUs already play a disproportionate role in these efforts andwill likely continue their role to effect much-needed change in the prevalence of treatable illnesses and deadly diseases among America’s Black population. While continuing their historic mission to educate the Black populace of the United States, resulting from generations of racial exclusionary and discriminatory practices by predominantly White institutions, HBCUs continue to provide compassionate culturally sensitive education in the public health-care field. Moreover, they provide real-time testimony for the nation’s higher education enterprise on how to provide equality in health-care education.

Article

New Technologies and Costs in Healthcare  

Vincenzo Atella and Joanna Kopinska

New sanitation and health technology applied to treatments, procedures, and devices is constantly revolutionizing epidemiological patterns. Since the early 1900s it has been responsible for significant improvements in population health by turning once-deadly diseases into curable or preventable conditions, by expanding the existing cures to more patients and diseases, and by simplifying procedures for both medical and organizational practices. Notwithstanding the benefits of technological progress for the population health, the innovation process is also an important driver of health expenditure growth across all countries. The technological progress generates additional financial burden and expands the volume of services provided, which constitutes a concern from an economic point of view. Moreover, the evolution of technology costs and their impact on healthcare spending is difficult to predict due to the revolutionary nature of many innovations and their adoption. In this respect, the challenge for policymakers is to discourage overadoption of ineffective, unnecessary, and inappropriate technologies. This task has been long carried out through regulation, which according to standard economic theory is the only response to market failures and socially undesirable outcomes of healthcare markets left on their own. The potential welfare loss of a market failure must be confronted with the costs of regulatory activities. While health technology evolution delivers important value for patients and societies, it will continue to pose important challenges for already overextended public finances.

Article

Public Health Impact of Breastfeeding  

Colin Binns and Mi Kyung Lee

Breastfeeding is one of the best public health “buys” available for countries at all levels of development. In the first year of life, appropriate infant nutrition (exclusive breastfeeding to around 6 months) reduces infant mortality and hospital admissions by 50% or more. Early life nutrition has important influences, including on childhood illnesses, obesity, cognitive development, hospitalizations, and later chronic disease. Breastfeeding is consistent with the historical cultural practices of all societies, and its benefits of breastfeeding last a lifetime. While the development of infant formula has been of benefit to some infants, its inappropriate promotion has resulted in a decline of breastfeeding, and, as a result, health gains in many countries have not been as great as they could have been. The health benefits of breastfeeding will provide some protection against the effects of climate change, which will cause a decline in potable water supplies and increases in the incidence of some infections. Infant formula production has very high environmental costs, while breastfeeding as well as being the best infant feeding intervention also has very low environmental impact. An important part of the sustainable development agenda must be to promote breastfeeding and its benefits and to reverse the inappropriate promotion and use of infant formula.

Article

Cancer Control and Prevention in Argentina  

Yolanda Eraso

Starting in the 1920s, the first initiatives to organize the control of cancer in Argentina soon revealed the presence of different actors and interests, a specialized cancer institute, a women’s voluntary organization, state authorities, university departments, cancerologists, and gynecologists. Initially concentrated around the activities of the Institute of Experimental Medicine for the Study and Treatment of Cancer in Buenos Aires, cancer interventions expanded in the following decades through university departments and gynecology services, which outlined a decentralized approach for reining in the centralized efforts from the institute. While a therapeutic-based approach with substantial funding for research institutes characterized industrialized countries’ initiatives until the end of World War II, in Argentina it was within the field of cancer diagnosis where specialists sought to create the foundational structures of cancer organization. Early detection of tumors, it was argued, favored a good prognosis with surgical treatment, placing the burden of cancer control on public education, the availability of diagnostic services, and doctors’ knowledge of cancer identification. From the 1920s to the early 1980s, three distinct periods can be identified: first, an institutional approach, where the first cancer institute attempted to concentrate all the activities related to the control of cancer, that is, lay education, scientific research, diagnosis and treatment, patients’ support, and cancer statistics; second, a state approach, inaugurated by the arrival of Juan Domingo Perón to government, where the centralization of cancer initiatives became a state affair; and third, a long period characterized by the retirement of the state—marked by political unrest and a succession of military governments until the return of democracy in 1983—informed by decentralizing policies, the prominent role of civil society actors, such as voluntary organizations and medical societies, and the relative sway of the Pan American Health Organization. Throughout these three periods, all these actors played a role, and their ambivalent relationship and, often poor, interaction shaped the country’s efforts to control and prevent a disease that, since the 1940s, has steadily occupied the second cause of death. As the early detection strategy prevailed, responsibility for cancer control and prevention was constantly redistributed among the public, doctors, educators, and those who financed cancer services. The national state emerged as a feeble agent in cancer governance and, as discussed in the final section, this legacy is still felt today.

Article

Public Health Social Work  

Sarah Gehlert, Julie A. Cederbaum, and Betty J. Ruth

Public health social work is a substantive area within the discipline of social work that applies social work and public health theories, frameworks, research, and collaborative practices to address contemporary health issues through a transdisciplinary lens. It is epidemiologically informed and characterized by prevention, health promotion, and other integrative practices. With its strong focus on health impact and population health, public health social work is central to the profession’s viability and success for tackling pervasive 21st-century challenges, such as health inequity, behavioral health integration, chronic disease, health reform implementation, and global health.

Article

Health Literacy  

Vivian Jackson and Wendy Jones

The revised NASW Standards and Indicators for Cultural Competence in Social Work Practice (2015) requires social workers to “provide and advocate for effective communication with clients of all cultural groups, including people of limited English proficiency or low literacy skills, people who are blind or have low vision, people who are deaf or hard of hearing, and people with disabilities” (p. 43). This article focuses on one component of this standard—literacy, specifically health literacy. It presents a summary overview of health literacy and its implications for social work practice. It also presents the history of the concept and provides various definitions and types of health literacy as described in the literature. The authors describe the association between health literacy levels of the population, the intricacies of health systems, and their impact on health outcomes. The negative impact for marginalized populations including persons with limited English proficiency and immigrants and refugees—a major focus of the social work profession—signals the need for action at multiple levels. The authors explore a multifaceted approach to health literacy at the clinical, organizational, and policy levels with reference to the role of the social work profession.

Article

Health Disparities, a Social Determinant of Health and Risk: Considerations for Health and Risk Messaging  

Nancy Grant Harrington

Health disparities are differences in health outcomes between socially disadvantaged and advantaged groups. This essay provides a brief review of the voluminous literature on health disparities, with a focus on several major threads including populations of interest, incidence and prevalence of morbidity and mortality, determinants of health, health literacy and health information seeking, media influences on health disparities, and efforts to reduce disparities. Populations of interest tend to be defined primarily by socioeconomic status (income/education), race, ethnicity, and sex or gender; however, differences in sexual orientation, immigrant status, geography, and physical and mental disability are also of concern. Determinants of health can be categorized along a number of dimensions, but common designations consider behavioral, social, and environmental factors that lead to health disparities, as well as differences in access to health care and health services. Of central interest to communication researchers, differences in health literacy and health information seeking are revealed between advantaged and disadvantaged groups. Media influences involve the effects of access or exposure to different kinds of health information on the health behavior and health outcomes of different groups, as well as the effects of health disparity media coverage on public support for initiatives to reduce health disparities. Efforts to reduce health disparities are extensive and involve government and foundation efforts and research-driven interventions. Taking a broader view, this essay briefly discusses trends in scholarship on health disparities, noting the precipitous increase in academic journal article publications on the topic, including the publication of journals specifically focused on publishing health disparities scholarship. Future directions for research are suggested, and recommendations for interventions to improve health disparities offered by the Principal Investigators of the 10 Centers for Population Health and Health Disparities are presented. Finally, an annotated list of primary sources (books, special issues of journals, reports) and a list of sources for further reading are offered to provide a starting point for beginning scholars to orient themselves to research in health disparities.

Article

Mental Health Disparities  

Rhonda Wells-Wilbon, Rhea Porter, Taylor Geyton, and Anthony Estreet

Millions of Americans are affected by a mental illness or disorder each year. Given the prevalence, it is unfortunate that significant disparities exist within mental health care. Some of the most common reasons mental health disparities exist include stigma, previous negative experiences, limited mental health literacy, lack of culturally aware providers and services, language access, and lack of financial resources. Additionally, members of racial and ethnic, gender, and sexual orientation minority groups, who already encounter higher levels of bias, experience poorer mental health outcomes due to disparities than their counterparts. Grounded in the values and ethics of the profession, it is no surprise that social workers play a vital role in reducing mental health disparities.

Article

Indigenous Health Policy  

Ian Anderson and Kate Silburn

The United Nations estimates that there are more than 476 million Indigenous peoples across the globe, which is almost 7% of the world’s population. Although Indigenous peoples are defined in a variety of political and cultural ways, there is increasing recognition of the seven defining criteria for indigeneity as set out by UN Permanent Forum on Indigenous Issues. Globally, Indigenous peoples tend to do less well than benchmark populations in health and social outcomes—although the degree of difference varies markedly between countries. Of the vast range of different in-country policy and service responses that address these inequalities, the collection of accurate and relevant data on Indigenous peoples is key to monitoring their health outcomes. Health and data researchers and policymakers have advocated for stronger Indigenous governance of both the data and health system responses. To achieve this, they have increasingly engaged a variety of global governances systems. Principally, but not exclusively, this advocacy has targeted UN mechanisms such as the Permanent Forum on Indigenous Issues and the Human Rights Council Expert Mechanism on the Rights of Indigenous Peoples.

Article

Religion, Aging, and Public Health  

Jeff Levin and Ellen Idler

Religion, in both its personal and institutional forms, is a significant force influencing the health of populations across the life course. Decades of research have documented that expressions of faith and the practice of spiritual pursuits exhibit significantly protective effects for physical and mental health, psychological well-being, and population rates of morbidity, mortality, and disability. This finding has been observed across sociodemographic categories, across nations and cultures, across specific disease outcomes, and regardless of one’s religious affiliation. A salutary religious effect on health and well-being is especially apparent among older adults, but is also observed across generations and age cohorts. Moreover, this association has been persistently found for various religious indicators, including attendance at worship services, prayer and other private practices, subjective feelings of religiosity, and numerous measures of religious behaviors, attitudes, beliefs, and experiences. Finally, a protective or primary preventive effect of religion has been observed in clinical, epidemiologic, social, and behavioral studies, regardless of research design or methodology. Faith-based organizations also have contributed to the health of populations, in partnerships or alliances with medical institutions and public health agencies, many of these dating back many decades. Examples include congregational health promotion and disease prevention programs and community-wide interventions, especially targeting the health and well-being of older congregants and those in less well-resourced communities, as well as faith–health partnerships in healthcare delivery, public health policymaking, and legislative advocacy for healthcare reform. Religious denominations and institutions also play a substantial role in global health development throughout the world, individually and in partnership with national health ministries, transnational medical mission organizations, and established nongovernmental agencies. These efforts focus on a wide range of goals and objectives, including building public health infrastructure, addressing ongoing environmental health needs, and responding to acute public health challenges and crises, such as infectious disease outbreaks. Constituencies include at-risk populations and cohorts throughout the life course, and programming ranges from perinatal care to maternal and child healthcare to geriatric medicine.

Article

The People’s Health Movement  

Ravi Narayan, Claudio Schuftan, Brendan Donegan, Thelma Narayan, and Rajeev B. R.

The People’s Health Movement (PHM) is a vibrant global network bringing together grass-roots health activists, public interest civil society organizations, issue-based networks, academic institutions, and individuals from around the world, particularly the Global South. Since its inception in 2000, the PHM has played a significant role in revitalizing Health for All (HFA) initiatives, as well as addressing the underlying social and political determinants of health with a social justice perspective, at global, national, and local levels. The PHM is part of a global social movement—the movement for health. For more than a century, people across the world have been expressing doubts about a narrowly medical vision of health care, and calling for focus on the links between poor health and social injustice, oppression, exploitation, and domination. The PHM grew out of engagement with the World Health Organization by a number of existing civil society networks and associations. Having recognized the need for a larger coalition, representatives of eight networks and institutions formed an international organizing committee to facilitate the first global People’s Health Assembly in Savar, Bangladesh, in the year 2000. The eight groups were the International People’s Health Council, Consumer International, Health Action International, the Third World Network, the Asian Community Health Action Network, the Women’s Global Network for Reproductive Rights, the Dag Hammarskjold Foundation and Gonoshasthaya Kendra. All these groups consistently raised and opposed the selectivization and verticalization of Primary Health Care (PHC) that followed Alma Ata leading to what was called Selective PHC (i.e., not the original comprehensive PHC). These groups came together to organize the committee for the first People’s Health Assembly and then to form the Charter Committee that led to the People’s Health Charter, which finally led to the actual PHM. Within PHM, members engage critically and constructively in health initiatives, health policy critique, and formulation, thus advancing people’s demands. The PHM builds capacities of community activists to participate in monitoring health-related policies, the governance of health systems, and keeping comprehensive PHC as a central strategy in world debate. The PHM ensures that people’s voices become part of decision-making processes. The PHM has an evolving presence in over 80 countries worldwide, consisting of groups of individuals and/or well-established PHM circles with their own governance and information-sharing mechanisms. It additionally operates through issue-based circles across countries.

Article

Community-Oriented Primary Health Care for Improving Maternal, Newborn, and Child Health  

Amira M. Khan, Zohra S. Lassi, and Zulfiqar A. Bhutta

Nearly 80% of the world’s population lives in low- and middle-income countries (LMICs) and these regions bear the greatest burden of maternal, neonatal, and child mortality, with most of the deaths occurring at home. Much of global maternal and child mortality is attributable to easily preventable and treatable conditions. However, the challenge lies in reaching the most vulnerable communities, especially the rural populations, making it imperative that maternal, newborn, and child health (MNCH) interventions focus on communities in tandem with facility-based strategies. There is widespread consensus that delivering effective primary health care (PHC) interventions through the continuum of care, starting from pregnancy to delivery and then to the newborn, infant, and the young child, is an integral component of health strategies in high-, middle- and low-income settings. Despite gaps in research, several effective community-based PHC approaches have been proven to impact MNCH positively. Implementation of these strategies is needed at scale in LMICs and in partnership with all stakeholders including the public and private sector. Community-based PHC, operating on the principles of community engagement and community mobilization, is now more critical than ever. Further robust studies are needed to evaluate certain strategies of community-based PHC and their impact on maternal and child health outcomes, such as the use of mobile technology and social franchises. Recognition of community health workers (CHWs) as a formal cadre and the integration of community-based health services within PHC are vital in strengthening efforts to impact maternal, neonatal, and child health outcomes positively. However, despite the importance of community-based PHC for MNCH in LMICs, the existence of a strong health system and skilled workforce is central to achieving positive health outcomes in these regions.

Article

Displacement, Natural Hazards, and Health Consequences  

Christelle Cazabat

When natural hazards lead to disasters, they can affect people in many ways, including damaging their housing and negatively impacting their livelihoods. Each year, millions of people are injured or killed as a result of disasters. They can also force people out of their homes: In 2020, 30.7 million new internal displacements linked with disasters, mostly storms or floods, were recorded throughout the world. Between 2010 and 2020, disaster displacements were recorded in 198 countries and territories, making the issue truly global. Such displacement can have severe and long-lasting consequences on physical and mental health, often similar to those of conflict-related displacement. Psychosocial trauma and the deterioration of living standards and housing conditions often alter displaced people’s well-being and their ability to maintain healthy lives or obtain treatment and care. People with disabilities or long-term illnesses are particularly vulnerable in displacement, as are children and older people. Depression and anxiety, malnutrition, communicable diseases, and lack of access to sexual and reproductive health are among the most frequent issues for internally displaced people. The health consequences of displacement linked with disasters vary depending on affected people’s pre-existing conditions and sociodemographic characteristics, the duration and severity of their displacement, and the type of support they are able to access. In cases of mass and protracted displacement, the health of people in communities of refuge and the health systems in the areas of origin and refuge can also be affected, with repercussions on the broader society. Although some of these impacts are relatively frequent and should be systematically considered by national and local governments, humanitarian organizations, and aid providers, each situation requires tailored approaches. Information on the health impacts of displacement remains limited, but the body of knowledge is growing as awareness increases on the scale of current and future displacement crises linked with disasters in a changing climate.

Article

Health Effects of Incarceration  

Justin Berk, Ann Ding, and Josiah Rich

Since 1976, incarcerated individuals in the United States have an established right to healthcare. This has created a national system charged with addressing the unique challenges of healthcare delivery in jails and prisons. As incarcerated populations are often excluded from large research studies, evidence-based practices must often be extrapolated from community data. There is a wide variation in care delivery across institutions nationwide. Challenges in correctional settings include a “dual loyalty” to patients’ health and facility security and the toxic effects of disciplinary practices including solitary confinement, violence, communicable disease control, an aging population, discharge planning for community reentry, and a high prevalence of substance use disorder and mental health disease. Although incarceration may offer a unique opportunity to address chronic health issues of a difficult-to-reach population, the net health effects in the United States seem to be mostly negative. Mass incarceration in the United States has led to significant health consequences at the individual, family, and community levels and has exacerbated health, socioeconomic, and racial disparities. As most incarcerated individuals return to the community, healthcare delivery during incarceration plays a substantial role in the health of communities at all levels.

Article

Primary Health Care  

Rebecca S. Ashery

The passage of the Affordable Care Act (ACA) has injected new life into primary health care by establishing the primary care medical home (PCMH) as a cornerstone of health-care reform legislation. In addition to the PCMH, the ACA has a number of primary-care components that can open opportunities for social workers. Concerns remain for payment reform in the implementation of the PCMH. The implementation of the ACA is still a work in progress, with anticipated modifications and changes as issues arise.