PUSHING POVERTY TO THE PERIPHERY: HIV-POSITIVE AFRICAN AMERICAN WOMEN's HEALTH NEEDS, THE RYAN WHITE CARE ACT, AND A POLITICAL ECONOMY OF SERVICE PROVISION

2008 ◽  
Vol 16 (2) ◽  
pp. 112-127 ◽  
Author(s):  
Alyson Anthony O'Daniel
2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
L Cavazzana ◽  
M Errico ◽  
A Gimigliano ◽  
R Anniverno ◽  
L Bernardo ◽  
...  

Abstract Issue Many diseases show differences in incidence, symptoms, and severity between men and women, combined with a different response to therapies. There are some international experiences of health policies about Gender Medicine, but the practical realizations are few and, for the female sex, usually focused only on fertile age. Description of the problem A Milan hospital (ASST Fatebenefratelli Sacco) decided to dedicate one of its sites, with gynecological and pediatric vocation but also with an Internal Medicine Unit in within, entirely to women's health. The focus of this site is a holistic approach to women's health needs, both physiologic and pathologic. Realized without additional institutional funds, this project was designed between June and October 2019, started in December 2019 and is still ongoing. Results One of the first actions taken was to admit only women in the Internal Medicine Unit. The Unit is now entirely focused on dealing with most frequent female pathologies, in particular on autoimmune, vascular, endocrinology and nephrology conditions. The Mental Health Unit, already specialized in supporting pregnancy and new mothers, is going to activate a “Mother-Baby Unit” to support potential hospitalization issues. Among its major aims, the Occupational Medicine Unit supports female workers in managing maternity leave. New outpatient clinical paths have been planned to strengthen key moments of women's life: developmental age, fertile age, menopause, and senescence. Based on multi-professional teams, these programs are targeted toward age-specific needs and combine knowledge of disease epidemiology with sociological needs. To better face emerging issues, a path is activated for each area every month. Conclusions The birth of the first Italian hospital entirely dedicated to Gender Medicine allows care of women's health on a holistic perspective. This is, indeed, a key step in the general appraisal of Gender Medicine at the national and international levels. Key messages A gender hospital with a holistic approach to women’s health needs, both physiologic and pathologic, was borne in Milan. Integrated clinical paths have been activated to assist women in the key moments of their life (developmental age, fertile age, menopause, and senescence).


2021 ◽  
Author(s):  
◽  
Rose Namoori-Sinclair

<p>This research examines in-depth the health and wellbeing experiences of 30 Kiribati migrant women navigating their way to achieve New Zealand permanent residency under the Pacific Access Category (PAC) policy. The political and economic rationality underpinning PAC was to meet New Zealand’s labour demand for industrial growth. It also provides successful applicants with the opportunity to work, live and study in New Zealand indefinitely. The purpose of the research was two-fold. Firstly, to assess the health and wellbeing experiences of migrant women who travelled to New Zealand under the PAC scheme, using Kiribati women as a case study to comment on issues of responsibility for healthcare and wellbeing. Secondly, to identify gaps in personal and policy-related aspects of healthcare and wellbeing, and determine how access to appropriate healthcare and social services for PAC migrant women can be facilitated. The experiences of these migrant women indicated shortcomings in provision of health and social services that this thesis terms the ‘PAC gap’. Although the PAC policy offers them the opportunity to live permanently in New Zealand, the current state of the PAC policy features gaps in service provision that result in gender and health inequality, financial hardship and stress, poor housing, unemployment and poverty. The health and wellbeing impact of the existing conditions of the PAC policy was exacerbated by the contrasting influence of neoliberalism as a policy, ideology, and a form of governmentality in the New Zealand environment (Larner, 2000a; Suaalii, 2006), and the markedly different maneaba system that is central to the social and political life in Kiribati (Tabokai, 1993; Uakeia, 2017; Whincup, 2009). Te maneaba is a traditional meeting hall, where communal meetings take place, and unimane (male elders) make decisions for the governing and wellbeing of the village people (Tabokai, 1993). It is a form of governmentality that shapes and influences how an I-Kiribati thinks and acts (Foucault, 1991). This system is at odds with a neoliberal approach that stresses self-responsibility and individualism. These contrasting forms of governmentality ‘talk past each other’ or are totally different (Metge & Kinloch, 1984). I recruited 30 I-Kiribati women who were successful PAC migrants: six from Auckland, six from Hamilton, and eighteen from Wellington. These women were selected in different years from 2012 through to 2015. To identify the PAC gaps, I employed an indigenous research method called te maroro/talanoa (to exchange ideas and experience freely and openly), complemented by the use of the feminist oral history method that transfers the needs and voices of women from the margin to the centre. This thesis draws on Foucault’s governmentality theory, a critical discourse on neoliberalism, and research on migration and the colonial history of Kiribati. It also draws on work by both Pacific and non-Pacific scholars that articulate how health and wellbeing are rooted in our lived culture and values. This thesis also stresses the need for cultural competency and integration of policy, service provision and community engagement. These materials have all guided my analysis to unpack the women’s health and wellbeing experiences. The research findings on the drawbacks of neoliberal governmentality and maneaba governmentality, and understanding of te maneaba system in a new way, strengthen Pacific studies. These contribute to the literature on Kiribati’s indigenous knowledge and cultural values and Kiribati migration as well as to the impact and effectiveness of the PAC policy for Kiribati and Pacific migration. This thesis demonstrates the need to extend the engagement of Pacific indigenous knowledge and values to the design and implementation of policies at national, regional and global levels. This thesis recommends a hybrid neoliberal-maneaba residential model to address the issues of the current system, such as stress and difficulty finding a job offer, and close PAC gaps. The new model entails a more open and transparent communication between both the New Zealand and Kiribati governments when designing a cultural competent and coherent strategic framework. By working in the best interests of all parties (i.e. New Zealand and the Kiribati governments and PAC migrant groups) this would support future successful PAC applicants to settle well in New Zealand. This would contribute to improved health outcomes for these women, their utu and kainga, without undermining the richness and values of Kiribati’s culture rooted in te maneaba system. These stories articulate a consistent requirement for a hybrid neoliberal-maneaba system, to create a residency model that works for successful PAC applicants, the government of New Zealand and Kiribati, and Kiribati families living in both countries. This would avoid repeating the stress and pain most of these PAC migrant women had experienced because of lack of government support as perceived under te maneaba system. The recommended residency model would also benefit other eligible countries (Fiji, Tonga, and Tuvalu) participating in the PAC scheme.</p>


Author(s):  
Jenna M Napoleone ◽  
Robert M Boudreau ◽  
Brittney S Lange-Maia ◽  
Samar R El Khoudary ◽  
Kelly R Ylitalo ◽  
...  

Abstract Background Little is known about how adverse, midlife metabolic profiles impact future physical functioning. We hypothesized that a higher number of midlife metabolic syndrome (MetS) components are associated with poorer physical performance in early old age for multi-ethnic women. Methods MetS status from 1996-2011 (8 visits) and objective physical performance in 2015/2016 (short physical performance battery (SPPB; 0-12), 40-foot walk (m/s), 4-meter gait speed (m/s), chair stands (sec), stair climb (sec)) were assessed in the Study of Women’s Health Across the Nation (SWAN; n=1722; age 65.4±2.7 years; 26.9% African American, 10.1% Chinese, 9.8% Japanese, 5.5% Hispanic). Poisson latent class growth modeling identified MetS component trajectory groups: none (23.9%), 1=low-MetS (28.7%), 2=mid-MetS (30.9%), and &gt;3=high-MetS (16.5%). Adjusted linear regression related MetS groups to physical performance outcomes. Results High-MetS versus none had higher BMI, pain, financial strain, and lower physical activity and self-reported health (p&lt;0.0001). Compared to White, African American and Hispanic women were more likely to be in the high-MetS groups and had worse physical functioning along with Chinese women (SPPB, chair stand, stair climb, and gait speed - not Hispanic). After adjustments, high-MetS versus none demonstrated significantly worse 40-ft walk (β:-0.08; 95% CI:-0.13, -0.03), gait speed (β:-0.09; 95% CI:-0.15, -0.02), SPPB (β:-0.79; 95% CI: -1.15, -0.44), and chair stands (β:0.69; 95% CI: 0.09, 1.28), but no difference in stair climb. Conclusions Midlife MetS groups were related to poor physical performance in early old age multi-ethnic women. Midlife management of metabolic function may improve physical performance later in life.


2021 ◽  
Vol ahead-of-print (ahead-of-print) ◽  
Author(s):  
Peter Nugus ◽  
Joanne Travaglia ◽  
Maureen MacGinley ◽  
Deborah Colliver ◽  
Maud Mazaniello-Chezol ◽  
...  

PurposeResearchers often debate health service structure. Understanding of the practical implications of this debate is often limited by researchers' neglect to integrate participants' views on structural options with discourses those views represent. As a case study, this paper aims to discern the extent to which and how conceptual underpinnings of stakeholder views on women's health contextualize different positions in the debate over the ideal structure of health services.Design/methodology/approachThe researchers chose a self-standing, comprehensive women's health service facing the prospect of being dispersed into “mainstream” health services. The researchers gathered perspectives of 53 professional and consumer stakeholders in ten focus groups and seven semi-structured interviews, analyzed through inductive thematic analysis.Findings“Women's marginalization” was the core theme of the debate over structure. The authors found clear patterns between views on the function of women's health services, women's health needs, ideal client group, ideal health service structure and particular feminist discourses. The desire to re-organize services into separate mainstream units reflected a liberal feminist discourse, conceiving marginalization as explicit demonstration of its effects, such as domestic abuse. The desire to maintain a comprehensive women's health service variously reflected post-structural feminism's emphasis on plurality of identities, and a radical feminist discourse, holding that womanhood itself constituted a category of marginalization – that is, merely being at risk of unmet health needs.Originality/valueAs a contribution to health organizational theory, the paper shows that the discernment of discursive underpinnings of particular stakeholder views can clarify options for the structure of health services.


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