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The Social Determinants of Health and the Role of the Health Care System: A Case Study of the Significance of Good Governance in Public Hospitals in South Africa

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Health 2016年第12期8卷 1288-1306页

作者： Adam Fusheini john eyles Jane Goudge Centre for Health Policy/MRC Health Policy Research Group School of Public Health Faculty of Health Sciences University of the Witwa-tersrand Johannesburg South Africa Department of Health Policy Planning and Management School of Public Health University of Health and Allied Sciences Ho Ghana School of Geography and Earth Sciences McMaster University Hamilton Canada

Increasingly international and national policies are being directed at actions for the social determinants of health and for an integrated approach to health care provision, not only in terms of institutional cooperation but also stakeholder involvement. A key component of both these policies is the development of good governance principles in all health care agencies and organizations. A neglected dimension in these debates has been the role of the public hospital which remains a vital and expensive dimension of service provision. In a case study of a public hospital in South Africa, this paper charts the readiness of its management principles and activities to provide quality health care linked to population health and to contribute to the non-medical determinant of health. Using Taylor’s principles of good governance, we conclude that there is a mixture of good and not so good governance activity. The paper concludes by examining the external constraints on the public hospital and by providing suggestions for future activities.

关键词： Social Determinants of Health Healthcare System Public Hospitals Governance and Governance Principles South Africa

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Mental health in a Canadian Old Order Mennonite community

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Health 2013年第3期5卷 538-556页

作者： Kathryn Fisher K. Bruce Newbold john eyles Susan Elliott School of Geography and Earth Sciences McMaster University Hamilton Canada School of Geography and Earth Sciences McMaster University Hamilton Canada. School of Public Health and Health Systems University of Waterloo Waterloo Canada

This paper presents the results of a 2010 survey exploring the determinants of rural mental health in two farming groups in Waterloo, Ontario, Canada: Old Order Mennonites (OOMs) and non-OOM farmers. Comparing these two groups reduces the likely impact of many contextual features impacting both groups, such as local economic conditions. We explore a comprehensive list of health determinants to assess their relative importance and thus enable policy action to focus on those having the greatest impact. The mental component summary (MCS) of the short- form health survey (SF-12) was used to measure mental health. We compare mental health in the two populations and use multiple regression to determine the relative importance of the determinants in explaining mental health. The results show that OOMs experience better mental health than non-OOMs, in part due to the strong mental health of OOM women. Coping, stress and social interaction shape mental health in both groups, reflecting the broader determinants literature and suggesting these are important across many populations with different life circumstances. Other determinants are important for one group but not the other, underscoring the diversity of rural populations. For example, different social capital measures shape mental health in the two groups, and sense-of-place is associated with mental health in only one group (OOMs). The results are discussed in terms of their implications for future health determinants research and policy action to address rural mental health.

关键词： Social Determinants of Health Rural Mental Health Short-Form Health Survey (SF-12)

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