Migration and Trafficking: The Unintended Consequences of Security and Enforcement Frameworks and the Revictimization of Vulnerable Groups

Chapter 5 turns to a more immutable element of biography that also defines the typical do-it-yourselfer: most are white, middle-class men and thus operate from a position of considerable privilege in society, including in public space and in interactions with authority. People of color and people from low-income communities, on the other hand, are heavily disincentivized from participating in activities that skirt legal boundaries due to common societal prejudices and inequality. Some informal urbanisms occur in communities worldwide (and among under-served communities in certain contexts), but members of legally vulnerable groups in American cities are less likely to break the law to make local streetscape improvements, even though their communities often need official investment. Interventions by privileged do-it-yourselfers and the cultural values they represent, while more appealing to authorities, can provoke unwelcoming receptions and unintended consequences in the communities they aim to improve.

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Surviving the Anthropocene: How evaluation can contribute to knowledge and better policymaking

Evaluation ◽

10.1177/13563890211034539 ◽

2021 ◽

pp. 135638902110345

Author(s):

Juha I. Uitto

Keyword(s):

Indigenous Peoples ◽

Ecosystem Health ◽

Transformational Change ◽

Unintended Consequences ◽

Vulnerable Groups ◽

Global Environment Facility ◽

Natural Systems ◽

Durable Solutions ◽

Climate Crisis ◽

Do So

We live in the Anthropocene in which human impact on Earth is the dominant force. At the same time, humans are very much part of the ecosystem. This close interdependency is brought home by the COVID-19 pandemic as well as by anthropogenic climate change. Ecosystem health and human health are closely interlinked. Transformational change is required to avoid further catastrophes caused by the three environmental crises that human actions have caused: climate crisis; nature crisis; and pollution and waste crisis. Evaluation can contribute to finding durable solutions based on sound science and experiences from the field, but to do so evaluation must broaden its vision. Theory-based approaches will remain central, but they must be open to the full human and natural systems in which the intervention that is the evaluand operates. Evaluations must also pay attention to unintended consequences of all interventions to the environment, to social and power relations, to women, indigenous peoples and vulnerable groups. I identify three principles for evaluation in the Anthropocene, at the nexus of human and natural systems, and illustrate them using examples from evaluations from the Global Environment Facility: (a) integrating human and natural systems; (b) geographical approaches; and (c) addressing the drivers.

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Brief interventions for NCDs risk factors

European Journal of Public Health ◽

10.1093/eurpub/ckaa165.1077 ◽

2020 ◽

Vol 30 (Supplement_5) ◽

Author(s):

J Breda

Keyword(s):

Risk Factors ◽

General Population ◽

Economic Benefits ◽

Unintended Consequences ◽

Brief Interventions ◽

Vulnerable Groups ◽

Social Benefits ◽

Noncommunicable Diseases ◽

Wide Range

Abstract Background Brief interventions (BIs) are short, structured, nonconfrontational conversations to motivate and support individuals to consider and plan changes in unhealthy behaviours. Noncommunicable diseases (NCDs) are a huge global burden responsible for a large number of premature deaths and other economic and social challenges. The WHO “Best Buys” report highlights BIs as an effective tool to address NCD risk factors in the general population. BIs are not quick fixes, but part of a long-term behavior change strategy. An integrated BI package is needed to prevent unintended consequences, such as increased physical activity leading to increased consumption of unhealthy foods. BIs can be applied in a wide range of settings, including primary care in the general population, prisons and other settings for vulnerable groups. Results BI deliver immediate and long-term health, economic and social benefits. For example, BIs for smoking cessation can help individuals increase their life expectancy by up to 10 years, as well as reducing the risk of NCDs including stroke, lung cancer and CHD. Economic benefits include increased personal income and higher productivity, whilst social benefits include improved relationships and children being less likely to take up smoking. Conclusions WHO have published reports and training packages focused on the 5As and 5Rs brief interventions model in four major NCD risk factors: smoking, alcohol, unhealthy nutrition and physical inactivity. However, BI implementation remains low. To address this, WHO are currently working on a Manual for Integrated BI for NCD risk factors to support countries to implement, establish and promote BIs in their primary health care setting. It will contain information on health systems organization, intervention delivery, training and capacity building for healthcare professionals, referrals and follow-up, health literacy, and monitoring and evaluation strategies.

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Improving access to primary health care: a cross-case comparison based on an a priori program theory

International Journal for Equity in Health ◽

10.1186/s12939-021-01508-0 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Catherine Spooner ◽

Virginia Lewis ◽

Cathie Scott ◽

Simone Dahrouge ◽

Jeannie Haggerty ◽

...

Keyword(s):

Health Care ◽

Primary Health Care ◽

Scale Up ◽

Unintended Consequences ◽

Logic Model ◽

Vulnerable Groups ◽

Care Needs ◽

Causal Pathways ◽

Primary Health ◽

The Impact

Abstract Background Inequitable access to primary health care (PHC) remains a problem for most western countries. Failure to scale up effective interventions has been due, in part, to a failure to share the logic and essential elements of successful programs. The aim of this paper is to describe what we learned about improving access to PHC for vulnerable groups across multiple sites through use of a common theory-based program logic model and a common evaluation approach. This was the IMPACT initiative. Methods IMPACT’s evaluation used a mixed methods design with longitudinal (pre and post) analysis of six interventions. The analysis for this paper included four of the six sites that met study criteria. These sites were located in Canada (Alberta, Quebec and Ontario) and Australia (New South Wales). Using the overarching logic model, unexpected findings were reviewed, and alternative explanations were considered to understand how the mechanisms of each intervention may have contributed to results. Results Each site addressed their local access problem with different strategies and from different starting points. All sites observed changes in patient abilities to access PHC and provider access capabilities. The combination of intended and observed consequences for consumers and providers was different at each site, but all sites achieved change in both consumer ability and provider capability, even in interventions where there was no activity targeting provider behaviors. Discussion The model helped to identify, explore and synthesize intended and unintended consequences of four interventions that appeared to have more differences than similarities. Similar outcomes for different interventions and multiple impacts of each intervention on abilities were observed, implying complex causal pathways. Conclusions All the interventions were a low-cost incremental attempt to address unmet health care needs of vulnerable populations. Change is possible; sustaining change may be more challenging. Access to PHC requires attention to both patient abilities and provider characteristics. The logic model proved to be a valuable heuristic tool for defining the objectives of the interventions, evaluating their impacts, and learning from the comparison of ‘cases’.

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EFFECT OF SARS-COV-2 ON PREGNANCY AND FETUS (LITERATURE REVIEW)

Актуальні проблеми сучасної медицини Вісник Української медичної стоматологічної академії ◽

10.31718/2077-1096.21.2.208 ◽

2021 ◽

Vol 21 (2) ◽

pp. 208-213

Author(s):

О.S. Shkolnyk ◽

A.M. Shlemkevych ◽

O.M. Malanchuk ◽

Yе.B. Sharhorodska ◽

H.R. Akopyan

Keyword(s):

Risk Factors ◽

Pregnant Women ◽

Medical Literature ◽

Pathological Condition ◽

Unintended Consequences ◽

World Health ◽

Vulnerable Groups ◽

Necessary Condition ◽

The World ◽

The Impact

Aim of the study: analysis of modern medical literature on risk factors for the pathological condition of the fetus in women who had COVID-19 during pregnancy. The authors analyzed the scientific medical literature on the study of the impact of COVID-19 infection on the course and complications of pregnancy and the condition of the fetus. The characteristics of the possible risks of a number of adverse consequences for the mother and child due to the postponed COVID-19 disease are given. In Ukraine, studies of genetic and demographic processes, which were carried out in recent years, have shown that the demographic crisis that is observed in the country is socially determined, significantly deepening due to reproductive losses, which is manifested in an increase in the frequency of lost pregnancies and the birth of inferior offspring in women with pathology of the reproductive system. The low level of reproductive health is largely due to the high level of perinatal losses. In Ukraine, the rate of perinatal and child mortality exceeds the data of European countries. Under these conditions, reducing perinatal mortality, preserving the life and health of newborns is a necessary condition for the demographic development of Ukraine and a factor of national security. COVID-19, a disease caused by Coronavirus 2 Severe Acute Respiratory Syndrome (SARS-CoV-2), has spread rapidly around the world. On March 12, 2020, the World Health Organization has designated the outbreak as a pandemic. Because pregnant women are at greater risk of complications and severe disease, they have been identified as “vulnerable groups”. Changes in the mother's immune system during pregnancy can influence the response to infections, particularly viruses. Pregnant women with COVID-19 may have risk factors for thrombosis, and the adaptation of the mother's vessels during pregnancy is critical for certain periods of pregnancy. The role of the placenta in COVID-19 infection is currently not well-researched. A number of potential mechanisms may be involved in the vertical transmission of viruses from the mother to the trophoblast. Scientists are conducting research on the likelihood of infection with SARS-CoV-2 in utero or during childbirth. The unintended consequences of the COVID-19 pandemic threaten the health of pregnant women. It is likely that the consequences of COVID-19 will be evident in the future for a number of years. Epidemiological information is critical for identifying differential responses of the population and analyzing data on the impact of COVID-19 in socio-economic and ethnic groups. In summary, it will be important to evaluate population-level data from these results to determine trends associated with the COVID-19 pandemic.

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