Bir Karayip toplumunda üst sosyal gruplarda sağlık, hastalık ve sağlık hizmeti arama davranışlarının varyasyonları

AMAÇ: Çalışmanın amacı üst sınıf hakkında onların genel sağlık durumları, hastalıkları, hastalıklarının tipolojisi, sağlık hizmeti arama davranışları ve bunları belirleyen faktörler hakkında karar vericilere uygun bilgi sağlamaktır. YÖNTEM: Kesitsel bir çalışmanın 6.783 kişilik örneğinden en varsıl birinci ve ikinci %20’lik gruptan olan2.734 kişi örnek olarak alındı. Veri toplamak için bir soru formu uygulandı. Verilerin kaydedilmesinde ve analizinde SPSS for Windows 16.0 programı kullanıldı. Soru formu Dünya Bankasının Yaşam Standartları ölçüm Çalışmasına göre şekillendirildi. BULGULAR: Örneğin büyük çoğunluğu (%83,3) iyi ve üzeri sağlık durumundaydı. Çok kötü sağlık durumu bildiren %0,5 ve son dört hafta içinde hasta olduğunu bildiren %15,3 katılımcı vardı. Ortadan en iyiye sağlık durumu ile istatistiksel olarak korele dört değişken gözlendi. Model, ortadan en iyiye sağlık durumu ile %33,2’lik varyans ortaya koydu ve veriler için uygundu. Üç değişken kendi tarafından bildirilen hastalık ile istatistiksel olarak korele idi. Anlamlı değişikenler (sağlık hizmeti arama davranışı, iyi sağlık durumu ve medeni hali) kendi tarafından bildirilen hastalıkta değişkenliğin %72,4’ünü oluşturdu. Üç değişken sağlık hizmeti arayanların anlamlı prediktörüydü. İstatistiksel olarak anlamlı prediktörler (iyi sağlık durumu, kendi tarafından bildirilen hastalık ve medeni hali) üst sınıfın sağlık hizmeti arama davranışındaki değişkenliğin %76,4’ünü oluşturdu. SONUÇ: Jamaika’da kırsalda yaşayanlar genel popülasyon ile ve en varsıl ilk iki %20’lik grupla karşılaştırıldığında daha düşük düzeyde ortadan çok iyiye sağlık durumuna sahiptir. Üst sosyal tabakanın sadece %4’ünün toplum sağlığı hizmetlerini kullanmasına rağmen, bu gruptada toplum ağlığı hizmetlerine talep devam etmektedir. Bu durum ülkenin sağlık hizmeti sisteminin genel planlamasında dikkate alınmalıdır.

Variations in health, illness and health care-seeking behaviour of those in the upper social hierarchies in a caribbean society

AIM: To provide pertinent information on the upper class in regards to their general health status, illnesses, typology of illnesses, health care seeking behaviours and factors which determine their (1) moderate-to-very good health status, (2) illness, and (3) health care seeking behaviour in order to make available to policy specialists and public health practitioners information on this group, to be used as a guide in their decision making policies. METHOD: A sample of 2,734 respondents from the wealthiest 20% and second wealthy social hierarchies was extracted from a cross-sectional survey of 6,783 respondents. An administered questionnaire was used to collect the data, which were stored and analyzed using SPSS for Windows 16.0. The questionnaire was modelled on the World Bank’s Living Standards Measurement Study household survey. RESULTS: The majority of the sample stated at least good health status (83.3%), with 0.5% indicating very poor health status, and 15.3% who indicated an illness in the last 4-week period. Four variables emerged as statistically correlated with moderate-to-very good health status of those in the upper class (i.e. second wealthy and wealthiest 20%). The model explained 33.2% of the variance in moderate-to-very good health status, and that the model is a good fit for the data.Three variables emerged as statistically correlated with self-reported illness. The significant variables (i.e. health care-seeking behaviour, good health status, and marital status) accounted for 72.4% of the variability in self-reported illness. Three variables emerged as statistically significant predictors of health care-seekers - Model fit. The statistically significant predictors (i.e. good health status, self- reported illness, marital status) accounted for 76.4% of the variance in health care-seeking behaviour of the upper class. CONCLUSION: Rural residents continue to have lower moderate-to-very good health status when compared to the general population, and the second wealthy and the wealthiest 20% in Jamaica. Although only 4 percent of the upper social hierarchy utilizes the public health care system, there is still a demand for public health services for this group, and it must be taken into account as a part of the general planning for the health care system of the country.

PDF

___

1. Casas JA, Dachs JN, Bambas A. Health disparity in Latin America and the Caribbean: The role of social and economic determinants. In: Pan American Health Organisation. Equity and health: Views from the Pan American Sanitary Bureau, Occasional Publication No. 8. Washington DC; 2001: pp. 22-49.
2. Wagstaff A (2001). Poverty, equity, and health: Some research findings. In: Equity and health: Views from Pan American Sanitary Bureau. Pan American Health Organization, Occasional publication No. 8, Washington DC, US, pp.56-60.
3. Suarez-Berenguela RM. Health system inequalities and inequities in Latin America and the Caribbean: Findings and policy implications. In: Pan American Health Organization, (PAHO). Investment in health: Social and economic returns, Scientific and Technical Publication, No. 582. Washington DC: PAHO, WHO; 2001.pp.119-142.
4. Pan American Health Organization, (PAHO). Investment in health: Social and economic returns, Scientific and Technical Publication, No. 582. Washington DC: PAHO, WHO; 2001.
5. Pan American Health Organization, (PAHO). Equity and health: Views from the Pan American Sanitary Bureau, Occasional Publication, No. 8. Washington DC: PAHO, WHO; 2001.
6. Alleyne GAO. Health and economic growth. In: Pan American Health Organisation. Equity and health: Views from the Pan American Sanitary Bureau, Occasional Publication No. 8. Washington DC; 2001: pp. 265-269.
7. World Health Organization. Preventing Chronic Diseases a vital investment. Geneva: WHO; 2005.
8. Marmot M. The influence of Income on Health: Views of an Epidemiologist. Does money really matter? Or is it a marker for something else? Health Affairs. 2002; 21: 31-46.
9. Vila PM, Swain GR, Baumgardner DJ, Halsmer SE, Remington PL, Cisler RA. Health disparities in Milwaukee by socioeconomic status. Wisconsin Med J 2007; 106(7): 366-372.
10. Van West-Charles RA. Equity and health: A Caribbean perspective. In: Equity and health: Views from Pan American Sanitary Bureau. Pan American Health Organization, Occasional publication No. 8, Washington DC, US, pp.131-134.
11. Blanc PD, Yen IH, Chen H, Katz PP, Earnest G, Balmes JR, Trupin L, Friedling N, Yelin EH, Eisner MD. Area-level socio-economic status and health status among adults with asthma and rhinitis. Eur Respir J 2006; 27: 85-94.
12. Kiefer CW. Health work with the poor: A practical guide. New Brunswick, NJ: Rutgers University Press; 2000: p. 78.
13. Foster AD. Poverty and illness in low-income rural areas. The Am Economic Review 1994; 84(2):216- 220.
14. Ferrer RL, Palmer R. Variations in health status within and between socioeconomic strata. J Epidemiol Community Health 2004; 58: 381-387.
15. Van Agt HME, Stronks K, Mackenbach JP. Chronic illness and poverty in the Netherlands. Eur J of Public Health 2000; 10:197-200.
16. Fox J ed. Health inequalities in European Countries. Aldershot: Gower Publishing Company Limited; 1989.
17. Illsley R, Svenson PG, ed. Health inequalities in Europe. Soc Sci Med 1990; 31(special issue):223- 420.
18. WHO. Dying for change - Poor peoples experience of health and ill health. Retrieved on th 29 October from http://www.who.int/hdp/publications/en/index.html.
19. Sen A. Poverty: An ordinal approach to measurement. Econometricia 1979; 44, 219-231.
20. Statistical Institute Of Jamaica. Jamaica Survey of Living Conditions, 2007 [Computer file]. Kingston, Jamaica: Statistical Institute of Jamaica [producer], 2007. Kingston, Jamaica: Planning Institute of Jamaica and Derek Gordon Databank, University of the West Indies [distributors], 2008.
21. Kahneman D, Riis J. Living, and thinking about it, two perspectives. Quoted in: Huppert, F.A., Kaverne, B. and N. Baylis, The Science of Well- being, Oxford University Press; 2005.
22. Finnas F, Nyqvist F, Saarela, J. Some methodological remarks on self-rated health. The Open Public Health J 2008; 1: 32-39.
23. Helasoja V, Lahelma E, Prattala R, Kasmel A, Klumbiene J, Pudule I. The sociosociodemographic patterning of health in Estonia, Latvia, Lituania and Finland. European J of Public Health 2006; 16:8-20.
24. Molarius A, Berglund K, Eriksson C, et al. Socioeconomic conditions, lifestyle factors, and self-rated health among men and women in Sweden. European J Public Health 2007; 17:125- 33.
25. Leinsalu M. Social variation in self-rated health in Estonia: a cross-sectional study. Soci Sci and Medicine 2002; 55:847-61.
26. Idler EL, Benjamin Y. Self-rated health and mortality: A Review of Twenty-seven Community Studies. J of Health and Social Behavior 1997; 38: 21-37.
27. Idler EL, Kasl SV. Self-ratings of health: Do they also predict change in functional ability. Journal of Gerontology: Social Sciences 1995; 50B:S344- S353.
28. Bourne PA. Dichotomising poor self-reported health status: Using secondary cross-sectional survey data for Jamaica. North American J of Med Sci. 2009; 1(6): 295-302.
29. Bourne PA. Medical Sociology: Modelling Well- being for elderly People in Jamaica. West Indian Medical Journal 2008; 57: 596-04.
30. Bourne PA. Health determinants: Using secondary data to model predictors of well-being of Jamaicans. West Indian Medical Journal 2008;57: 476-480
31. Smith KR, Waitzman NJ. Double jeopardy: Interaction effects of martial and poverty status on the risk of mortality. Demography 1994; 31:487- 507.
32. Ross CE, Mirowsky J. 1999. Refining the association between education and health: The effects of quantity, credential, and selectivity. Demography 1999; 36:445-460.
33. Gore WR. Sex, marital status, and mortality. American Journal of Sociology 1973; 79:45-67.
34. Lillard LA, Panis CWA. 1996. Marital status and mortality: The role of health. Demography 1996; 33:313-327.
35. Moore EG, Rosenberg MW, McGuinness D. Growing old in Canada: Sociodemographic and geographic perspectives. Ontario, Canada: Nelson; 1997.
36. Cohen S, Wills TA. Stress, social support, and the buffering hypothesis. Psychological bulletin 1985 98:31-357.
37. Ganster DC, Fusilier MR, Mayers BT. The social support and health relationship: Is there a gender difference? Journal of Occupational Psycholog 1986; 59:145-153.
38. Koo J, Rie J, Park K. Age and gender differences in affect and subjective well-being. Geriatrics and Gerontology International 2004; 4:S268-S270.
39. World Health Organization, (WHO). Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, June 19-22, 1946; signed on July 22, 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on April 7, 1948. “Constitution of the World Health th Organization, 1948.” In Basic Documents, 15 ed. Geneva, Switzerland: WHO, 1948.
40. Engel G. A unified concept of health and disease. Perspectives in Biology and Med 1960; 3:459-485.
41. Engel G. The care of the patient: art or science? Johns Hopkins Med J 1977; 140:222-232.
42. Engel G. The need for a new medical model: A challenge for biomedicine. Sci 1977; 196:129-136.
43. Engel G. The biopsychosocial model and the education of health professionals. Annals of the New York Academy of Sciences 1978; 310: 169- 181.
44. Engel GL. The clinical application of the biopsychosocial model. Am J of Psychiatry 1980; 137:535-544.
45. Longest BB. Health Policymaking in the United rd States, 3 . Chicago: Foundation of the American College Healthcare; 2002.
46. Brannon L, Feist J. Health psychology. An th introduction to behavior and health, 6 ed. Los Angeles: Wadsworth; 2007.
47. Planning Institute of Jamaica, (PIOJ), Statistical Institute of Jamaica, (STATIN). Jamaica Survey of Living Conditions, 2007. Kingston: PIOJ, STATIN; 2008.
48. Statistical Institute of Jamaica, (STATIN). Sociodemographic statistics, 2007. Kingston: STATIN; 2008.
49. Wilks R, Younger N, Tulloch-Reid M, McFarlane S, Francis D: Jamaica health and lifestyle survey 2007-8. Kingston: Tropical Medicine Research Institute (TMRI), University of the West Indies, Mona; 2008.