Research Articles Base: Medical Sociology

Medicine Advancement

The most compelling and important medical advance in the last 20 years             Yes, advances in medicine has indicated some changes in dealing to medicine ways and techniques maube used by the physicians as well as healthcare providers as there implies strong sense of direction and goals towards the use of modern medicine in today’s epoch believing that one purpose of certain medical advance integrates real treatment that reflects safety among individuals and help those who suffer from various diseases as modern medicine nowadays have imposed the idea of treating one being effectively in little time without any side effects. (Fuchs and Garber; 2003) Medicine advancement may deal with discovering useful patterns as of today, there can be a number of medical universities that is truly interested for a well-organized medical advances that reflects better recognition and health process status. Thus, it must not be a surprise for authorities that modern medical advances are pursued with great vigor having potential and needed benefits in terms of personal as well as social as it can be compelling and attractive and modern medicine have the sense of collaboration in presenting opportunities for advance in medicine interests respectively. (Fuchs and Garber; 2003)             Furthermore, medical advancement holds the promise of continuous improving of humanitarian health cases as well as extending lives. It also threatens crushing increases in medical costs and due to the rising of costs there implies certain inequality of access to medical care as of the present as challenges to modem health laws is to realize promise upon avoiding the pitfalls. (Fuchs and Garber; 2003) The 20th century witnessed medical advances for health and I believe the most compelling and important advancement in medicine for the past twenty years are in fact many like for instance, the advances in the field of alluring resonance imaging as well as in genetic engineering and also advances in effective drugs that is used for example, in treating gastro-esophageal reflux as well as high blood cholesterol and also, HIV disease and that the medical advances critically improved outcomes of multifaceted medical measures like, organ transplants as well as bypass surgery for those who have acute leukemia and myeloma. (Fuchs and Garber; 2003) Moreover, the 21st century has open doors to technology development for modern medicine as it implies resources of hope for prevention and effective healing also cure for disease and if possible these medical advances will need to be adopted as rapidly and possibly pose certain economic and ethical challenges for medical care laws. The existence of health insurance and its great demand for modern advances as there can be strong influence on development of innovative forms of medicine in such trends as used today as it can be relevant in pursuing good research in medical as there can be changes in quality improving advances in order to accomplish better health outcome. (Fuchs and Garber; 2003)             Aside, advances in medicine has completed against coronary heart disease as it can be striking but, not an evidence that implanting a stent in patients with single-vessel, minimally symptomatic disease is worth the cost. Most proposals for the reform of medicine care financing and delivery would alter spending and incentives at the margin and that sometimes, most relevant contributions of medicine advances are not personified in management and investigative procedures as these advances can lead to new insights into the best ways to use existing medical technologies as well as modify behaviors for an improved medical care. (Fuchs and Garber; 2003) For example, there is genetic variant associated with rheumatoid arthritis as it can trigger the disease only in people exposed to high levels of certain amino acids and the prevention can be through dietary restriction rather than gene therapy as there resulted in interaction of genes and milieu and best advancement is to determine useful alternative whether, modifying a gene or exercise routine and that having the enhanced information concerning innovative technologies, mixture of medical advances and aging of baby boomers will lead to further growth in care spending. Henceforth, public attention in alike access to intervention that avoid disability is greater for slightly successful interference. Furthermore, admission to medical care are to be reasonable alongside other group needs as there face such world of medical occasion and challenge. as there can be dilemmas posed in modern medicine system that will analyze the people’s values and the ability to pertain wisdom and concern to obstinate health problems for the future – not resolving it but to always do better now. (Fuchs and Garber; 2003) Credit:ivythesis.typepad.com

Medicine Advancement

The most compelling and important medical advance in the last 20 years Yes, advances in medicine has indicated some changes...

LIABILITY OF PHYSICIANS, THERAPISTS AND OTHER HEALTH PROFESSIONALS FOR SEXUAL MISCONDUCT WITH PATIENTS

Liability of Physicians, Therapists, and other Health Professionals for Sexual Misconduct with Patients   The role of health care providers has constantly been presented in the past and existing literature. In the work of  (1993), they highlighted the possible liabilities in which medical professionals might encounter the moment they engage in a behavior characteristic of sexual misconduct. Although the work has been instituted within the context of the United States, it attempts to address a more general perspective on the subject under consideration. This is reflected in the actual body of the study, liability for sexual misconduct, which constitutes the bulk of the discussion. The study addressed the therapist-patient relationship and the liabilities on which the medical practitioner is subject to undergo in the context of sexual misconduct. Specifically, it took on the common law doctrines in which sexual misconduct is brought about.            Based on the discussion, the makeup of the therapist-patient relationship is intricate. As a fiduciary relationship, it has its foundation in common trust and assurance. The physician is compelled and obligated, in good faith, to carry out his or her responsibilities at the extent of understanding, expertise, and principles appropriate to the medical profession all together. The physician corresponds to the public as owning greater knowledge, deserving of the trust of the people, and compelled take actions in the welfare of patients. The patient, alternatively, goes into the relationship at his or her most defenseless instant. The physical and psychological interests of the patient are anchored upon the physician’s capability. Thorough and comprehensive physical tests in conjunction with the patient’s private disclosures and perspectives frequently go together with most lines of treatment. The patients’ susceptibility mixed with their understandable reliance on the physician to cure their illnesses leaves the physician in a spot of ascendancy or authority. It is this situation, or virtual disproportion of power in the connection, which has brought about to the norm that having sexual relations with an existing patient is deemed unethical.   The technical discussions regarding the common law doctrines such as negligence, fiduciary duty, negligent infliction of stress, intentional torts, breach of contract/implied warranty and spousal claims were relatively brief. However, the employment of previous cases representing such doctrines significantly helped in comprehending such technical terms.  Moreover, the liabilities presentation with regards to the employer has also provided significant information regarding their existing duties. The work of  (1993) implicated that the employer might also be directly liable for the conduct of their employees. This is especially true in settings such as hospitals wherein a huge number of medical practitioners are required to take care of a much larger number of patients. The liability of the employers regarding their negligence with regards to the employees has similarly provided extra prevention efforts in keeping medical practitioners away from engaging in sexual misconduct towards their patients.         The proscription in opposition to sexual relationships with patients originated hundreds of years to the Hippocratic Oath. And for the reason of the tough and frequently compound emotions induced by the therapist-patient relationship, it is not exceptional or uncharacteristic that sexual attraction involving those involved builds up. This sexual attraction, which of its own accord may not be injurious to the relationship, can beneath the precise circumstances bring about sexual relationship. A sexual relationship is perceived to be as rewarding the physician’s desires at the patient’s cost. Impartiality of treatment is misplaced, or at any rate put at risk, by situating the physician’s concentration to a different place. The researcher concurred that the effects of a therapist-patient relationship are generally unconstructive or detrimental to the patient.   In the work of  (1993) has shown the role of the government in this kind of behavior coming from its medical professionals. Although it has been mainly a discussion on the existing state in the US, the mention of existing criminal laws and civil laws reveals that government institutions are looking into such matters of abuse and exploitation. Another issue in this aspect is that the discussion is based primarily on the context of the therapist as a medical practitioner. One reason that comes to mind is that the role of a therapist in the medical setting has not been deeply entrenched legally, as compared to those other health care providers such as doctors and nurses.   Nonetheless, the position of the paper with regards to the behavior of physicians and other healthcare providers has been clear and understandable. The study has presented that these individuals are bestowed with a power to public with such enormity. And in this context, this kind of power and authority brought about by the fact that human life depended on their skills and competence, great sense responsibility is entailed. Medical practitioners have been highly regarded in society. They have been deemed as among the protectors of the welfare of the public, this esteem should not be taken so lightly or should be used in behaviors marred by perversion and subsequent abuse.       References Credit:ivythesis.typepad.com

LIABILITY OF PHYSICIANS, THERAPISTS AND OTHER HEALTH PROFESSIONALS FOR SEXUAL MISCONDUCT WITH PATIENTS

Liability of Physicians, Therapists, and other Health Professionals for Sexual Misconduct with Patients The role of health care provid...

THE IMPACT OF PSYCHOLOGICAL AND SOCIOLOGICAL FACTORS ON THE REHAILITATION OF PATIENTS AND THEIR FAMILIES WITH A MEDICAL CONDITION

The Impact of Psychological and Sociological Factors On the Rehabilitation of Patients and their Families with a Medical Condition     PSYCHOLOGICAL FACTOR            Maintaining a well balance psychological thinking after a severe illness poses major challenges to individuals’ adaptive capabilities.  has described stress in a deficit model in which demands made upon an individual exceed the resources available at any given time. Stress can include physical, psychological or environmental factors that can cause distress. Patients are faced with multiple stressful experiences that tend to fluctuate over the course of time. After recovering initially in the physical sense, other challenges begin to surface. These include uncertainties about the ability to return to the previous occupation and handle interpersonal relationships. A severe illness can cause major disruptions to valued and essential activities. The sense of physical frailty and fatigue can also lower the perception of personal control to return to their previous lifestyle and functioning level.                          An individual recovering from a medical condition commonly experiences anxiety and depression. To achieve maximum benefits from rehabilitation, psychological counseling must be included ( 1993). Psychological adjustment problems experienced by individuals in rehabilitation affect the resumption of employment, psychosocial adaptation, and sexual functioning. ( 1991). The second purpose of psychological counseling involves providing behavioral change through identification of stressors that affect the individual ( 1994) and management of risk factors through dietary, smoking, and physical activity change (, 1993; , 1994). Psychological counseling can facilitate change in all of the above risk factors. Perceived control over recovery from disease and its possible reoccurrence is important to individual adjustment (, 1994). Following rehabilitation individuals are aware that some disease are chronic and life threatening.        Individual is advised to attend to the known risk factors of diet, weight, smoking, stress, and physical activity. Even when these behavioral changes are managed, diseases may reoccur. The uncertainty of when and if it will reoccur presents a threatening situation and places great demands on the individual’s emotional functioning (, 1990). Individuals experiencing emotional distress (depression or fatigue) also experience increased length of recovery time (, 1993).  Greater success of rehabilitation depends upon an increased awareness of psychological aspects. (, 1994).  also indicates the need for individuals to reduce levels of anxiety and depression while increasing their ability to handle stress and anger. An individual’s fears of sexual dysfunction, dependency upon others to perform physical tasks, lack of money, and sudden death are often neglected by rehabilitation and medical professionals. Many individuals recovering from illness receive little or no information about sexual activity from their attending physicians. (, 1989) Fears and lack of information experienced by individuals postoperatively can be addressed through psychological counseling. A lack of attention to the psychological aspects can affect employment opportunities (, 1981). A multidisciplinary approach to rehabilitation which includes psychological counseling will improve an individual’s quality of life and increase the probability of persons returning to work. (, 1994). Lack of psychological counseling can explain a large percentage of the individuals who do not resume work following medication (, 1982). Early in the recovery process, psychological counseling can clarify which fears of individuals recovering from rehabilitation are realistic and which are irrational (  1994). The earlier the counseling begins in the recovery process, the more likely the individual will return to work (, 1989).      .                                                       SOCIAL FACTOR          An important resource for individuals recovering from medication is the social network of family, friends, neighbors, and coworkers ( 1986). Higher levels of social support significantly helped the individual to have a better emotional status. (, 1993). Family support of the patient’s participation in a rehabilitation program increased levels of psychosocial recovery (,  1991). The patient’s family experiences are significant change. Seen as an interconnected system, a change in one family member causes the family system to adjust in some way. Issues of role strain, marital quality, and financial concerns place added physical and psychological stress upon the spouse ( 1991). The support of family members is indispensable if care is to be provided in a manner that improves meaningful life for patients (, 1999). The supportive behavior of family members who visit a patient daily and provide bedside care depends on how they perceive the patient’s illness experience through the    stage.                   A reversal of roles within the family member following recovery from the illness with the patient’s spouse (usually the wife) taking on the majority of household duties. (1988). Coping with disease was found easier for those couples that had a satisfactory relationship prior to the onset of illness ( 1986).  also found families with a happy and fulfilling marriage experienced less adverse changes in the family situation following coronary bypass surgery. Finances cause major concern for spouses, with many feeling a high level of financial strain or economic inadequacy, especially when the principle wage earner undergoes medication (, 1988). Spouses experienced more stress than the patient undergoing medication (1991). Following discharge from the hospital inclusion of significant others rehabilitation program could facilitate recovery for the patient and provide needed guidance and information. Significant others, should be informed by rehabilitation counselors regarding psychological factors, and advised to report any long-term depression or other adjustment concerns noted above to the physician. Some members of the social network may act in an overly protective manner which may hinder rehabilitation efforts (1980). Social network members should be informed of needs individuals recovering from medication have for accomplishing tasks, making decisions, and assuming control of their own lives ( 1994). Significant others may need guidance from the rehabilitation counselor regarding not placing individuals recovering from medication in a role of helplessness by providing everything they need, allowing the patient to accomplish tasks on their own. Significant others may require guidance or more information from the rehabilitation counselor regarding medical factors which include noting and informing the physician of any behaviors or activities which are contrary to the physician’s recommendations (non-compliance with; diet, exercise, quitting smoking, or medications). Thus, the psychological distress caused by illness is not only limited to the debilitating impact of the physical symptoms. Patients have a long way to go to cope with the intrusion of the illness causing disruption to various aspects of their daily functioning.  Furthermore, public fears of the illness and social prejudice can cause difficulties in these patients in getting the help when it is most needed. How did the Psychological and Sociological Factors Affect the Nursing Care of the Patient?                  Due to the rapid socioeconomic changes, the family as an institution is undergoing major change. As the family changes, its ability to continue to meet traditional roles and responsibilities so too does changes. The changing family structure is reducing the ability of the family to provide home care for its family members. The provision of care outside the family in long-term care is emerging as an important part. To meet the needs of the changing society, the legislation on Nursing Law was strengthened. Nursing care institutions provide rehabilitation as well as physical care.          Outcomes in nursing and health care system are greatly influenced by factors such as biopsychosocial functioning and patient satisfaction. Base on the reports and researches conducted in eight selected nursing homes in Taiwan. The researchers operationalized the concepts of biopsychosocial function and patient satisfaction with care as outcomes and considered the impact of individual patient and organizational factors on those care outcomes. The following key hypotheses were generated and tested: <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Individual and organizational factors have a positive effect on patients’ biopsychosocial functioning. </li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Patient satisfaction with care contributes to biopsychosocial functioning. </li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Nursing practice patterns have a positive effect on biopsychosocial functioning and an indirect positive effect through patient satisfaction with care. </li> <li class="MsoNormal" style="text-align: justify; line-height: 200%"> Patients’ physical, psychological, and social functioning are positively related.</li>          Current patient care, however, requires more than medical technology to achieve positive outcomes. The role of the nurses becomes increasingly important especially in institutions where the predominance of care managed and delivered by nursing staff.          The psychological behavior of the patient towards nursing care determines the success or the failure of rehabilitation. Psychological factors such as anxiety and depression hinders the efficacy of the rehabilitation. Patients with depression experience greater difficulties in problem solving and have reduced adherence to medical therapy, more functional impairments, and substantial increases in health care utilization. Anxiety-prone individuals gave lower ratings to the quality of information received during hospitalization compared with those patients with lower anxiety. Depression and anxiety might also become a communication barrier between the patient and the medical providers like the nurses. As a result, psychological factor may prolong the recovery of the patient. Moreover, it might also cause the early death of the patient. Medical providers will find it hard to apply the appropriate and necessary treatment for the patient. On the other hand, social factors like family, friends, neighbors, and coworkers helped the individual to have a better emotional status. The support of family members is indispensable if care is to be provided in a manner that improves meaningful life for patients ( 1999). The supportive behavior of family members who visit a patient daily and provide bedside care depends on how they perceive the patient’s illness experience through the stage. How has this informed my Approach to Care Delivery?          By studying how psychological and social factors affect care delivery. I was given a deeper understanding on the importance of psychological and social factors in delivering health and medical services for different patients. As a nurse, it is necessary for me to know first the conditions and circumstances of the patients. In knowing their conditions I can properly adapt appropriate behavior in dealing to patients with such conditions. In that, way I can develop a good communication to the patient and eventually a good nurse and patient relationship.           If this will happened, I can easily convince the patient to take his or her medication. It will also help me in determining the proper health care for the patient. Aside from that as a nurse, handling patient with depression and anxiety needs special care and attention. Part of my task is also to inform the patient’s family the real situation of the patient. As a nurse, it is not only the medical care that I should give but also emotional support for the patient. In delivering medical support, I must also provide emotional comfort. The patient must feel that I care for them, I love them and I really wanted them to recover from their illness.          I must also keep up to date with the different changes in approach in health care delivery. How the Nurse Should Support the Patient or their Family in Bereavement            Many people dying in hospitals or nursing homes have unmet needs for pain relief, physician communication, emotional support, and being treated with respect. ( 2004). According to the author, the majority of deaths in industrialized countries occur in health care institutions. The authors write that family perceptions of quality of care differed by the last place of care for the patient. “Nearly one-fourth of all respondents reported that the patient did not receive any or enough help with pain (24.2 percent) or dyspnea [difficulty breathing] (22.4 percent). Family members of persons whose last place of care was a nursing home or home with home health nursing services had a higher rate of reported unmet needs for pain compared with those persons with home hospice services. Overall, half of family members reported that the patient did not receive enough emotional support.” “Families reported more concerns with whether the patient was always treated with respect when the last place of care was a nursing home, hospital, or home with home health services, compared with persons who died at home with hospice services.” The authors note that family members of patients receiving hospice services were more satisfied with overall quality of care: 70.7 percent rate care as “excellent” compared with less than 50 percent for the other settings of care. “Key findings of our study are that bereaved family members reported high rates of unmet needs for symptom management, concerns with physician communication about medical decision making, a lack of emotional support for themselves, and a belief that their dying family member was not always treated with respect,” the authors state. “A higher rate of concerns with the quality of end-of-life care was reported for persons whose last place of care was a nursing home or hospital.” “Bereaved family members voiced significant concerns with the quality of end-of-life care, regardless of whether care was provided in a nursing home or hospital. Only bereaved family members whose loved one received home hospice services reported higher satisfaction and fewer unmet needs.          For medical providers to be able to support these family members, the extent to which family members are aware of the patient’s condition and the circumstances of his or her care must be known. A number of studies have been published related to how bereaved family members should be treated at hospices and hospitals ( 1995;  1999). Based on information gained in interviews with two bereaved families and from published research findings (, 1997;  1997).          In my experience the most essential and important thing that nurses should do to support the families in bereavement is to tell the truth. Research findings indicate that truth telling is an essential part of medical care (, 1997). Aside from that the family in bereavement must felt satisfied with the medical  services the nurse have provided with the patient. Nurses should act as mediators between doctors and patients and their families. The doctor as well as the nurses must provide the adequate information on the medical treatment given to the patient and the prognosis at the times of admission, following the exacerbation of the disease and informing when or whether the patient was dying.            The lack of information given by doctors and nurses as patients progress through the stage of the patient’s illness indicates the need for continuous updating of information. Therefore, the receipt of adequate information appears to be a determining factor in families’ perceptions of the efficacy of medical care. According to some families in bereavement “they could have adequate talks with patients when given sufficient information about the possible period of survival indicates that family members’ awareness of the prognosis is a determining factor for smooth communication between patients and families.                         REFERENCES “       Credit:ivythesis.typepad.com

THE IMPACT OF PSYCHOLOGICAL AND SOCIOLOGICAL FACTORS ON THE REHAILITATION OF PATIENTS AND THEIR FAMILIES WITH A MEDICAL CONDITION

The Impact of Psychological and Sociological Factors On the Rehabilitation of Patients and their Families with a Medical Condition ...

AGED CARE ASSESSMENT

Aged Care Assessment               Aged patients vary in physical needs, psychosocial needs including family involvement, and pathophysiological disorders that influence the person’s nursing care. In this case, an aged stroke patient is described whereas rapid assessment and early intervention is a requirement ( 1999).   1.         In terms of physical needs, aged patients need more assistance. Diet, nutrition, and eating are given special attention since the patient not able to chew and swallow foods. Since the patient is not capable of normal locomotion, his ability to dress and groom himself is no longer possible. Thus, assistance is always needed. In the same manner, a satisfactory nursing care is based on the need to maintain the skin care, feeding, hydration, positioning, and monitoring vital signs such as temperature, pulse, and blood pressure of the patient. On the other hand, psychosocial needs include attention, care, understanding, and continuous support from other people. The patient may have the tendency of having sudden changes in emotion. Depression is prevalent as a cause of self-acceptance of the disability. This is the reason why family involvement matters a lot especially in the recovery and therapy of the patient. Pathophysiological disorders that influence the person’s nursing care may range from the kind of stroke that the patient had experienced. In general, the risk of another stroke occurrence is recognized. The death of brain tissue may elicit several conditions.   2.         The person who reaches the ageing stage of life biologically changes over time due to cellular senescence. Cellular senescence is the ageing of cells and characterized by the loss of its ability to divide. According to  (2004), “the aging process may derive from changes occurring in parallel in different tissues due to intrinsic cellular mechanisms or changes in one tissue may be predominant”. Cell and tissues are considered to be significant reasons on why people age as described with the presence of strong genetic components that ( 2004;  2000). In the programmed based theories of aging, it was indicated that aging is not a result of random or stochastic process but rather driven by genetically regulated processes ( 2004). This means that the aging of an individual is natural.   References Credit:ivythesis.typepad.com

AGED CARE ASSESSMENT

Aged Care Assessment Aged patients vary in physical needs, psychosocial needs including family involvement, and pathophysio...

FAMILY MEDICAL LEAVE ACT AND COMPENSATION

Family Medical Leave Act 1993: Discovering Pertinent Labor Issues Introduction Important changes in the understanding and management of the Family Medical Leave Act (FMLA) have been developed in the past 10 to 15 years. Various researchers, practitioners and policymakers now acknowledge that leaves for workers can be conceptualized from a functional perspective and that appropriate interventions involve the development of alternative measures to cope up. It was also noted that the establishment of a conducive environment for employment have served effectively in lowering the prevalence of underachievement among workers. At present, this philosophical shift has extended to various settings, including multinational companies and organizations. Managers and directors here have recognized that most of their employees do need to take leaves over the course of the year in order to recuperate from illnesses or to take care for a sick family member. Hence, the Family Medical Leave Act (FMLA) was enacted under the term of former US president Bill Clinton as his government’s alternative way of mitigating these expectations of employees. All companies and organizations are governed by their basic goals and objectives. These objectives are often regarded to as the “corporate vision” or “corporate philosophy” (, 2001). Thus, certain strategies are being implemented with the aim of achieving these goals and objectives, and this constitutes a key element in the characterization of a company or organization. Personnel are undoubtedly an important indicator in determining the characteristics of a company or organization. It is a well known fact that human resources play a crucial role towards differentiation and a potent source of competitiveness for any organization or company. Therefore, any organization must constantly comply in the implementation of the (FMLA) even during periods of recession. However, the determination of the extent to which an organization can invest in terms of the implementation of the (FMLA) depends on the financial capabilities of the company or organization (, 2004). Finances will also be carefully considered in determining the target for ample benefits and compensations, because it should jive with the basic policies of an organization’s human resource development strategy. Law Synopsis             The Family Medical Leave Act (FMLA), which became effective in August 5, 1993, applies to companies with an employee base of 50 persons or higher. The statute provides for the allowance accorded by employers to their employees in taking leaves of absence for twelve weeks within a twelve month working period for the following reasons: child birth and neonatal care, child placement due to foster care or adoption, serious illness of spouse, children or parents, and serious health condition of the employee preventing him/her from performing essential employment functions. Since the implementation of the statute several issues have been raised by employers and employees alike covering the applicability of the law and the consistency of its provisions with other employment welfare legislations (, 2006). In lieu of the present developments in society, there have been significant visions of learning regarding FMLA that evolved. A majority of these learning visions are based on the idea that the implementation of the FMLA involves a social process where knowledge is denied instead of being acquired passively. The implementation of the FMLA, then, transforms into an interactive process. The interaction is being verified through the help of the participants in the implementation process such as the employers and the employees. In this framework, high quality of implementation would mean the continued guidance and support of the active learning process of the employers and the employees. Obviously, this would call for an intensive and phased guiding strategy. When in the active pursuit of the implementation of the FMLA, the interaction of the employers with their employees forms an integral part towards its success. Collaborative learning as a method of implementation is gradually being used by employers nowadays. Through this approach, the employees can learn the advantages and disadvantages of FMLA through the understanding of its policies in the socialization processes. In the process, the employees are able to obtain the chance to see their own ideas in a different aspect and therefore be able to take alternatives into consideration. The relative effectiveness of this approach is determined with the capability of the employees to continuously challenge their pre-acquired knowledge by trying to adapt to the interpretations of their employers. Aside from the employers and the employees, the different resources of FMLA belong to a third category of factors of a learning environment. Moreover, implementation methods of FMLA have shown signs of significant growth over the past years. Consequently, obtaining knowledge becomes more complicated. This is because the transformation of all this information into knowledge requires the employees to possess the appropriate reference frameworks. But employers can certainly help the employees transform FMLA information into valuable knowledge. Review of Related Literature              The implementation of the (FMLA) in most organizations and companies in the past decade has gradually transformed from low-level activities into high-profile contributors to organizational success (. 2002). However, budgets are also elevating at a faster rate than the gross national product. In the midst of this growth and increased influence, managers and executives of companies and organizations are left with confusing question: To what extent should be invested in the implementation of the (FMLA)? Definitely the answer won’t be easy, especially because the actual levels of expenditures needed is often an elusive figure, depending on the financial capabilities of the organization. However, there are basic strategies to could help organizations determine the extent of investment in human resources development. Let Others Do It This strategy involves letting other organizations implement first the FMLA and waiting for the right time to see if there have been positive results from those organizations as far as the performances of their employees are concerned (. 2003). While it may be true that these organizations offer paid leaves and large benefits and compensations for capable, high-value employees, they in turn prevent the possibility of having a significant internal investment in terms of human resource development.  Smaller firms and organizations who struggle to operate efficiently pursue this strategy as a cost-effective approach towards the implementation of the (FMLA). The most appealing advantage of this strategy is that it would provide an excellent alternative for a struggling or financially handicapped organization that cannot afford to implement the serious initiatives under the FMLA. Thus, costs are reduced as organizations are saved from spending too much in the development and implementation of a variety of human resource development programs. However, serious concerns in this type of strategy have also started to emerge, especially since the character of organizations snatching the strategies of other organizations often draws heavy criticism. Invest the Minimum This strategy involves investing only in necessary policies under the FMLA, such as the mandatory twelve (12) workweeks of leave per twelve (12) months and the protection of employee benefits even while on leave. With this strategy, minimal resources are spent by organizations towards the implementation of the FMLA (, 2001).The striking advantage of this strategy is that it utilizes minimal financial resources. The strategy also has a high level of efficiency, especially since the leaves are provided only when they are necessary, and only those people who need the leaves are determined. Another important advantage is that this process is able to adapt to the changing needs and status of the personnel. If efficiency and low costs are needed, this strategy is the most practical for organizations and companies to pursue. As a disadvantage, however, this strategy provides the employees with very minimal opportunities to become versatile on their jobs, as the constant absence in work because of leaves might interrupt their concentration and focus on their respective jobs. This strategy might also be neglecting the preparations for future job opportunities. Also, this strategy may be a hindrance towards the growth and innovation of an organization and its human resources, since FMLA does not include concrete plans regarding the preparation of their employees towards seeking new approaches. Invest Until It Hurts This strategy involves the use of excessive investments in the implementation of the (FMLA). An organization that pursues this strategy invests astronomical amounts of resources on activities in order to meet the need of their personnel to have extended leaves than usual, accompanied by ample compensations and benefits (, 2002). There are several factors which contribute to an organization’s overspending on the implementation of the (FMLA). But the most prominent factor is the organization’s desire to develop a pool of high-valued employees in a variety of approaches solutions and activities, like giving leeway to their employees as far as filing their leaves are concerned. Another factor is the continued expansion and growth of the human resources of rival organizations and companies. This situation all the more puts so much pressure on smaller organizations to strengthen their human resources to ensure efficient operations. The third factor is the sudden emergence of unconventional human resource development options. Due to the innovations in modern technology, organizations suddenly became capable of implementing unconventional options for making their pool of human resources more effective and efficient. The emergence of this type of strategy brings in a critical question: Could an organization invest too much on efforts to implement the FMLA and please their employees? In the advent of changes in the working environments nowadays, the need for vacation and sick leaves becomes imperative for continued growth and development. Therefore, there is a possibility that an organization may invest more than what is necessary. However, when employees spend too much time in their vacation leaves, the costs increase while at the same time depriving them of other important activities they have to accomplish. The proponents of this strategy single out the relationship between the employees’ desire to learn and job satisfaction, which are determining factors for their decision to stay with the organization. These employees rely on the possibility that excellent benefits and compensations even while at leaves might reduce turnover. However, for organizations having difficulty searching for an innovative benefits and compensation package within FMLA, additional training can lead to new ideas, techniques and methods which can lead into improved operations of the organization. Also, since there are unpredictable changes that happen once in a while, it is impossible to foresee the skills needed in the future. However, what is evident is the fact that employees need to set their eyes off work once in a while for growth and development. As a disadvantage, this strategy will definitely generate excessive costs because it represents an inefficient approach towards handling the implementation of FMLA. All types of benefits and compensations may be developed, but they are not necessarily based on business needs, but rather on employee preferences on when they will have to file their leaves. Investing too much on the implementation of FMLA may eventually lead to higher turnover. This is because employees sometimes have the tendency to schedule leaves very early for future opportunities on their own ways, and this could create false expectations. Invest Whenever There Is an Acceptable Return on Investment This strategy is actually very simple in nature, but needs the firm commitment of an organization in order to be implemented. This involves investing on the implementation of the FMLA for as long as there is a return on investment (ROI) in terms of organizational outputs. This strategy requires determining the payoff of employee efforts for a few selected outputs, but evaluating every aspect at some level. In the programs chosen for ROI analysis, the outputs are translated into monetary values and are then compared to the actual costs (investment) to calculate the ROI. Therefore, the level of investment will be increased whenever the return is positive (, 2004). While it may be true that determining the ROI value is challenging, the rewarding part is that it is already being implemented by a number of growing organizations. These organizations perceive ROI as the best way to evaluate the extent of human resource development investments. According to them, matching the investment with the return is the economic approach towards an effective scheme for the implementation of FMLA. Most managers of organizations and companies agree to the impending need to review the expenditures of the implementation of FMLA with a more economic-oriented scrutiny. When compared with other evaluation measures, ROI is able to give a sound perspective in determining the payoff of leaves of employees. The ROI process actually develops a tabulation of six types of data: reaction to the program, learning, application, impact, return on investment and intangible benefits. These types of data reflect the effectiveness and efficiency of the human resource development efforts of an organization, and the means for its improvement (, 2003). This approach also provides a strong link between the organizational needs and employee performance. This is because the ROI process is based on the perspective of beginning with the end in mind. This involves the utilization of predefined organizational measures to determine the success of human resource development programs. The data that will be obtained from this process will represent the critical information needed to secure the continued support for the implementation of FMLA, particularly with managers of small scale organizations. When managers get convinced that the implementation of FMLA is improving their organizational operations and helping them reach critical goals, they will readily support these efforts. Invest With the Rest This strategy involves investing together with other organizations no matter what. With the continued patronization of the implementation of FMLA, this strategy would no doubt become very attractive through time. However, the challenging part in this approach is the fact that the company has to find the correct way to implement FMLA. Only after finding the correct way can the company start taking the necessary steps to make sure that they are considered best practices. When in the process of utilizing this strategy, the relevant policies of FMLA and its interpretation becomes a crucial issue. Fortunately, just like most labor laws in the US, a number of alternative measures are readily available. Probably the most common among the available measurements is the investment as a percentage of a company’s payroll. For instance, the United States companies have an average of about 1.2 percent, while other excellent companies spend about 3 percent to 5 percent. These relevant data may have different ranges depending on the definition of actual investments. The disadvantage, however, is that there would possibly be no agreement in terms of what costs should be involved. Some other alternative measures include direct and indirect costs, and direct, out-of-pocket expenses. The actual investment per employee can also be different. The most common measure is the direct cost of learning divided by the number of employees and averages from ,000 to ,200. Other measures involve focusing on expenditures as a percentage of revenue or expenses in operations. The primary advantage of this strategy is earning the benefits of the best practices in terms of the implementation of FMLA. Also, relevant data becomes readily available. If the implementation of FMLA is able to represent excellent practices, the results will undoubtedly reflect what most companies want to achieve. Also, the implementation of FMLA has started to become an approach that appeals to a majority of corporate managers who are very eager to make comparisons of their investments with others whom they admire and respect (, 2003). However, there are several issues that may cause concerns with this strategy. What one company invests may not necessarily be what another company needs. Each company is different in terms of its employees, systems, philosophy and markets. Because of this, companies may need either a larger or smaller investment as against a best-practice firm. Also, the implementation of FMLA in terms of a medium-level investment may sometimes lead to unsatisfactory results. This would force the company to implement programs in order to meet the minimum requirements. This situation most commonly occurs when there is a specific number of hour or days allotted to formal learning programs. Current Issues on the Employer’s Side             A study conducted by the  (2006) to evaluate the operation of the Family Medical Leave Act 1993 showed that the statute pose administrative burdens for employers especially in the area of record-keeping and coordinated compliance together with other labor laws. Apart from this, reports from employers have also shown dramatic increases in the absences of employees for brief periods of time indicating that the reasons for doing so may not be as serious as the situations contemplated by the law.             These issues on the part of the employers imply that they view the law as administratively burdensome through the requirement of certification and recertification as needed in the processing of the leave request from employees. With the increasing number of requests, the employer needs to allocate company time and even added personnel in the human resources departments together with the need to obtain temporary workers to take the place of the employee on leave for the duration of the employment. These burdens may already exist because of the operation of labor laws enacted earlier than the FMLA but the burden becomes heavier with the compliance requirements provided by the statute. (, 2006)             In consideration of these employer issues, Congress passed bills intending to simplify the operation of the law in relation to administrative burdens to employers. These bills include recommendations to narrow the definition of the factors considered as serious health conditions to validly support a leave application, establishment of minimum leave requirements of half-day in order to prevent leaves for non-serious reasons, and the increasing of the requirements of notification from employees. (, 2006) Although these bills were accorded a non-priority status in Congress, the emergence or re-emergence of these issues in the future would support their enactment, if these issues become relevant in the future. Other difficulties that employers encounter upon the implementation of FMLA include: A. Difficulty in Gathering Information Employers have the primary role to make specific identifications of all the possible sources of evaluation information which includes observable employee behaviors. However, when employees often are on vacation leaves, then gathering this pertinent information becomes extremely difficult. This is because aside from the observations of the immediate supervisor, performance evaluation information can still come from a variety of other sources, including the employees, subordinates, and work products (, 2001). Whenever a company utilizes performance information from individuals other than the employee’s immediate supervisor to build up the employee’s annual evaluation, the management informs the employees of the possible sources at the start of the performance cycle, where they receive their performance plans.     B. Difficulty in Development and Presentation of Performance Plans Employers are the ones who develop their employees’ performance plans according to instructions on the Employee Work Profile form. The plans are signed by the employers and then passed on to the management for approval. But with their employees often on leaves, employers cannot make sure that their performance plans are complete and adequate before signing the forms (, 2003). The employers also discuss the performance plans with their employees in a clear and organized manner. Generally, discussions are conducted within 30 days of the start of the performance cycle. But this is also the time when most employees take their leaves (, 2003).   C. Difficulty in Documentation of Performance   Employers encounter a hard time documenting their employees’ performance and provide feedback to them from time to time throughout the performance cycle while they are on leaves. Instead, documentation are done only in the form of memos, and these are retained in the manager’s confidential files, instead of being in the employees’ personnel files (, 2002). D. Difficulty in Identification of Substandard Performance Employers also are unable to exercise their authority to determine substandard or unacceptable performance of their frequently on-leave employees (. 2002). Employers normally address minor or marginal performance issues through performance counseling and coaching.     Current Issues on the Employee’s Side             The provisions of the Family Medical Leave Act cover the application of law to different situations. Serious illnesses as justification for the leave application include injury, impairment, injury, physical or mental health condition, and continued treatment done by a health care provider. During the duration of the leave, the employer is obliged to maintain the employee’s coverage under the health plan. After the duration of the leave, the employer must take the employee back restoring him or her to the same or a similar job. (, 2006). An issue arises in the accommodation of employees returning from their leave. Since the law requires the employer to restore employee to the same position, this creates a situation that could be beneficial or non-beneficial to the employee depending upon the situation. This benefits the employee, when the employer allows the former to do a reasonably lighter work due to an injury, disability or the inability to temporarily or completely perform pervious tasks. This does not benefit the employee, when the employer expects the employee perform the same tasks prior to the injury or serious illness despite the inability of the employee to comply. This implies that this provision of the law is open to abuse requiring the employer to seek existing modes of redress.                  Moreover, the  (2006) provides that employers may not require an employee eligible under the FMLA to agree to a reasonable accommodation instead of taking leave. Again, this may work to the advantage as well as the disadvantage of employees depending on their level of information regarding the options available to them and their degree of assertion of their interests. On one hand, employers may opt to recommend an option that offers the least burdens to the company even if this may not work to the best advantage of the employee. If the employee accedes due to lack of knowledge about other options or the merits of available options, the law opens the possibility of employers taking advantage of their employees. On the other hand, well-informed employees able to identify the options and weigh the merits of these alternatives may assert the option that best serve their interests based on the assumption that all the options do not defeat the rights of the employers or other employees. In this instance, the operation of law allows the employee to negotiate application to a different accommodation or take leave.               In addition, seeking redress for violations of the law proves to be difficult for employees. FMLA was assigned to the US Department of Labor’s Employment Standards Administration particularly the Wage and Hour Division together with the responsibility to investigate violations. Upon satisfactory proof of violation, the division files a court action in behalf of the employee. An employee with a valid compliant have the option to bring a civil action directly in court but it cannot file a compliant with the division without first filing the civil action. (, 2006) This implies that employees with grievances have to first go to the courts before seeking redress from the division despite the primary responsibility of the division of investigating violations giving it the best position to settle complaints. Impact on Industries The recent efforts of the US government to educate the public of the existence of FMLA would definitely make learning easy for every individual who desires to do so. Also, the growing impact of information and communications technology (ICT) fits in with the larger transformation towards a knowledge-based industry. Most companies and organizations are already adapted to ICT. Nowadays, they are more and more using artificial intelligence systems in order to educate their employees regarding FMLA. Learning processes of FMLA are being influenced by the interaction of two major factors. On the one hand, the instructional factors: the educational philosophy brought about by the employers / management and its conversion into didactical ideas. On the other hand, organizational factors: the employees, infrastructure and policies related in this area. It is obvious that the employees must possess a sound vision of policies, while the employers must use of the operating budget efficiently in order to effectively perform their educative role in society. Nevertheless, the employers need an interaction between both factors. This is because in order to respond to the new visions of FMLA, they will eventually transform into a model together with the various aspects of the working environment. In return, the employees will have to continuously monitor their limitations and along the process introduce innovations. Conclusion             Overall, the rationale of enacting labor legislations suffices to justify the viability of the legislation despite the issues that have arisen on the side of both employers employees. Despite the claims of employers that many of them provide more than adequate benefits to their employees, the fact remains that there are still employers implementing the barest minimum in terms of employee benefits. The disparity in the benefits accorded by different employers required legal intervention in enhancing the required benefits to improve the standing of employees. The important consideration is ensuring adequate benefits and the implementation of the law is justified by this objective. Despite the issues raised by employees, the legislation has improved the general condition of employees but there is need to direct their issues towards legislative reform channels in order to enhance the law. Some employers argue that the fast pace of globalization ultimately becomes the driving force behind the formulation of agreements and rules for business conduct, such as the FMLA. The implementation of FMLA may have the potential to create enormous economic and social consequences. They can easily drive away the major employees within a company. They can also determine how and where people should work. However, earning the approval of the US government for the amendments on FMLA would never be easy. Organizational change amidst the implementation of FMLA undergoes through a series of stages. At every stage, the effective management of human resource (HR) and cultural issues is critical. This is initiated by the identification of the HR issues and their significance for the company’s activities. If not handled properly, this could lead to the further downfall of the organization instead of going upward towards the ladder of success. It is a common knowledge that the implementation of FMLA benefits companies and organizations especially those which are relatively new and is still in their early stages of development. Through the implementation of FMLA, companies and organizations will show signs of rapid growth brought about by the re-energized workforce. And it is further being expected that within the next years the tremendous growth and advancements in human resource development will continue in companies and organizations because of the implementation of FMLA. Therefore, the continued growth and development will also make it imperative for localization to occur in companies and organizations in the years to come as the impacts of the implementation of FMLA make their way. The implementation of FMLA offers companies and businesses tremendous benefits in terms of improvement to their human resource policies in terms of the control of the business and the creative aspects of entrepreneurship to co-exist peacefully, However, companies and businesses must not lose sight of its core competencies while introducing the implementation of FMLA. Otherwise, the image of these companies and businesses might be put in jeopardy. Meanwhile, some see the implementation of FMLA only as something that hinders the productivity of businesses.  However, upon close examination, the implementation of FMLA could actually pave the way for companies and businesses to improve even more their capabilities in enabling the peaceful coexistence of controlling their business and the leave aspects of their human resources. The bottom line is they would be able significantly gain in accepting the implementation of FMLA. However, the question remains whether companies and businesses could be able to implement and accept the impacts of the implementation of FMLA, and whether these options can be acceptable to the key stakeholders. Any business transformation brought about by the implementation of FMLA may also involve the sharing of expertise. Nowadays, most companies and businesses have traditionally relied on the inside-out approach. It is important to note that the implementation of FMLA would have many implications on a business’ values and culture as well as its resources. The key stakeholders definitely would be concerned with such options and need to be convinced of the positive aspects (. 2002). Somehow, companies and businesses will be able to overcome this barrier in managing strategic changes brought about by the implementation of FMLA in the process of implementing any of the above mentioned strategic options.                               REFERENCES Credit:ivythesis.typepad.com

FAMILY MEDICAL LEAVE ACT AND COMPENSATION

Family Medical Leave Act 1993: Discovering Pertinent Labor Issues Introduction Important changes in the understanding and management of ...

The Influence of the Social Groups in China: Case of Fake Milk Powder

The Influence of the Social Groups in China: Case of Fake Milk Powder               One of the most relevant issues in China today is the issue of malnutrition. Malnutrition is usually evident due to the poverty and overpopulation in China that brings about deaths and illnesses to children and infants, most especially. However, the recent malnutrition issue in China is largely attributed to the selling and distribution of the fake milk powders in the Chinese market that had been ingested by infants. These milk products were distributed to the different provinces in China, thus led to the spread of illness in rural areas and villages, called the big head disease. The incident led the death of thirteen and malnutrition of 171 Chinese infants, due to protein and nutrient deficiency in the substandard and cheap milk powder (2004). It has been reported that the fake milk products contain 1.74% protein in contrast to the standard protein content of normal milk products of 12.8% ( 2005), thus, indicating protein deficiency that must not be given to infants. This incident led to the capture and confiscation of the different milk products from milk manufacturers to prevent further distribution in the Chinese market and affect the growth and nutrition of children.             In relevance to this issue are the response and the influence of different social groups present in China. The presence, response and influence of these social groups in China determine the actions of the government and business firms, which may provide relevant activities in response to a variety of issues, such as health, economic, social, and political. Several social groups or also termed market segments are present in China; including consumer groups, peer groups, geographical groups, ethnic groups, business groups, the government or the political group, and financial or economic groups, which stratify the Chinese society. Formation of these different social groups depends on how they share the same opinions, subjects, likes, goals, interests, experiences, and way of thinking and reacting, thus, forming a connected network of individuals that actively exchange knowledge and information (2004). Consumer groups in China are one important aspect and mover of its economy, for they determine the success and failure of goods and services introduced in the market. Success and failure of goods and services are also determined by peer groups, which become the reference for choosing whether a certain good is a “must have”, creating an imitation dynamics from other consumers or peers (2004), and are a part of the consumer group. Geographical groups are considered social groups as they influence the similarities across countries through the hierarchical structure of its international relationships (2004). In addition, ethnic groups are also present in the different provinces and states in China, which retains the cultural practices and beliefs of the country. The internal and external activities of the different social groups determine the numerous and different social issues addressed by the whole nation, thus affect the two most important group formed in any society, the business and the political group or the government.     Business groups in the Chinese society is an alliance formed between the firm and its market that creates a formal or informal type of relationship ( 2007), thus, emphasizing and reinforcing a strong tie or bond of commercial relationships and activities. The business groups present in China produces and influences the different market activities in the country, thus, contributing to the mobilization and progress of its economy, politics and society. Another major group formed is its government or political group, which controls, governs, legislates, and supervises all the financial, economic, political, and social activities in the country. The actions and provisions of the government, being a political and governing body in the country provides the order, peace and unity in the Chinese society. The four major social groups previously discussed influences the actions and response of the business firms and the government, due to several aspects, including the size of the groups, their needs, their opinions regarding a certain issue, the impacts or effects on the groups, and their location, influence, and response. Taking note of these certain aspects provides the business firms and the government with valuable and important information, which could guide and influence their decisions and actions in response to a certain social issue, such as the distribution of fake powdered milk products that led to the death of a number of infants in China. Consumer and peer groups can influence and moderate the activities of business firms, for example, milk-manufacturing firms, depending on their demand and consumption for milk products, which depends on their education, employment and social status. Consumer and peer groups have a great influence on the production and operation of milk manufacturers, thus, determining their position in the Chinese market. On the other hand, the consumer and peer group also influences and moderates the activities of the government, for the response and influence of such groups lead the government to restrict, make rules and regulations, govern, and control the operations of milk manufacturers, especially in response or desire for targeting international markets. In the case of the fake milk products, the role of the government becomes very crucial in solving the issue for they should be able to restrict the manufacture and distribution of the products to the provinces and states in China through preliminary investigation and study of samples of the product before distribution and introduction to the Chinese market. Likewise, the influence of the geographical and ethnic groups in China moderates the activities of business firms and the government, for their needs, location, education, and social status become the basis for the actions and response of the business firms and the government. For example, the consumption of the ethnic groups on milk products depends on their education and employment, thus, determining the success of the product in such groups. Similarly, their geographical location becomes an important factor in the distribution of products, thus, reinforcing the role of the government in making the possible way of reaching the minority or ethnic groups in the provinces. In this regard, the consumption and response of the social groups concerning the introduction of the milk products in the market provide the business firms with valuable and relevant information on their needs and wants. This influences the policy decision-making of the government through a variety of processes or approaches, such as campaign contributions or communication activities, money giving, and commonweal contributions (2006). With this, the problems of the social groups become provided with possible solutions, which may also affect the operations of the business firms. In relevance to the fake milk products case, the distribution and manufacture of the fake milk products were halted, thus, also stopping the operations of the milk manufacturers. Thus, it can be concluded that the response of the different social groups in China influenced the actions and responses of the Chinese government to solve the product quality problem of the milk products, in order to alleviate and totally eradicate the negative effects of the defective goods. In this regard, it can be understood that due to the negative effects presented with the consumption of the product, the government was able to reinforce its role and activities in the Chinese society, thus, restricting the operations of the milk manufacturers. With this, a chain reaction could be recognized, which indicates that the response and actions of the social groups influence the actions and response of the government and the different business firms.                Credit:ivythesis.typepad.com

The Influence of the Social Groups in China: Case of Fake Milk Powder

The Influence of the Social Groups in China: Case of Fake Milk Powder One of the most relevant issues in China today is t...

Social Capital and Health

ABSTRACT ❿ Individuals tend to be healthier the higher they are on the income ladder. But nations with a higher GDP/capita are not necessarily healthier nations. A relationship has been found, however, between income inequality and population health status. Some of the literature that seeks to interpret these findings is reviewed. Some suggest equality may affect health through its impact on social cohesion or social capital. There are various mechanisms or dynamics through which different types of social capital might have an impact on health. Social capital may contribute directly to health or may result in policies that are more supportive of healthy outcomes. I f there is one canonical fact in population health research it is that social status and health are strongly related: in virtually every Western nation there is a relationship between the social status of individuals, variously measured, and a wide variety of health indicators. Epidemiological studies have generally measured socio-economic status (ses) in terms of income, educational attainment and occupational prestige scores. They have found relationships between ses and such health indicators as the incidence of cancer, heart or cardiovascular disease, hypertension, degree of obesity and morbidity and mortality in general. 1 Income and health The simplest explanations for the relationships generally describe purchasing power (from income), knowledge power (from education) and employment power (from prestige and control) as resources that elevate or sustain health status. Unfortunately, however, ses has been incorporated into many empirical epidemiological studies with little explicit theorizing about society and the social hierarchies within it to which ses may correspond. Is ses an indicator of where an individual stands on a single static social hierarchy or is it instead a rough indicator of membership in a sociologically defined social class engaged in relations with other classes? Adler et al. conclude that “[s]ocial class is among the strongest known predictors of illness and health and yet is, paradoxically, a variable about which very little is known.” 2 A growing interest in the concept “social capital” coincides with serious attention being paid to theoretical conceptions of the nature of social relations and society by population health researchers. At the individual level, the relationship between income and health within Western nations seems to be curvilinear, almost logarithmic in shape, such that we cannot determine a poverty threshold below which health is threatened and above which health is randomly distributed or solely influenced by factors unrelated to income. Instead, the relationship seems to produce a smooth (but weakening) gradient wherein people are healthier the higher they are on the income ladder. The income and health relationship is not recreated across countries, however. Richard Wilkinson has demonstrated that, among oecd countries and given a certain degree of societal wealth, nations with a higher gdp/capita are not necessarily healthier nations. 3 If the purchasing power of income explains the relationship between income and health among individuals then this finding across countries is not intuitively obvious, since presumably the average citizen of a wealthier society has greater purchasing power, and thence better health, than does the average citizen of a poorer one. A relationship among communities (or societies) that focuses on community- level attributes rather than on characteristics of individuals, as Wilkinson’s does among oecd countries, is called an ecological relationship. We would predict that the individual-level relationship between income and health would translate naturally into an ecological relationship between societal wealth and the health of populations. This may not be the case. In the “relative hypothesis” psychosocial mechanisms have been proffered to explain why an individual’s income affects his/her health and may serve to elucidate the (non) relationship described by Wilkinson. A psycho- social interpretation might argue that the material resources procured by income are not the primary mechanisms by which income affects health: what matters are peoples’ perceptions of themselves and their standing relative to others. If people compare themselves to their in-country peers, and suffer poorer health when they fall short in the comparison, then it does indeed make sense that income and health are related within but not between nations. What counts are comparisons among peers, and one’s peers reside in one’s own country. This form of an individuallevel relationship between income and health would not necessarily translate into an ecological relationship between wealth and population health because of its focus on relative rather than absolute income. Another explanation focuses on risky behaviour. We might argue that cultures of “acceptable” activities congregate within income classes. If smoking, sedentary activities and poor diet choices, for example, are more prevalent within poorer classes than within wealthier ones, then the individuallevel, income-health relationship may reflect the influences of these activities on health status. A distribution of (non-) healthful behaviours may contribute to health inequalities, and if such behaviours manifest themselves similarly within countries, an ecological relationship between societal wealth and health need not surface. The debate on the nature and strength of the wealth and health relationship has not neared resolution within population health discourse. For those pursuing a neo-materialist interpretation of the structure of society and pathways to health, the purchasing power of wealth and/or the distribution of risk behaviours matter. In support of the neo-materialist position, John Lynch and his colleagues have presented further evidence that wealth is related to health among an expanded data-set of 33 Western countries. 4 In return,  has argued that the choice of countries for inclusion in analysis matters: among the 21 richest countries in 1995 the relationship between wealth and health is actually negative; among the 23 countries with the highest life expectancy the relationship is non-existent. 5 Income inequality and health Societal wealth does not predict much, if any, mortality among the wealthy nations of the industrialized Western world.  noted, however, among the nine nations of the Luxembourg Income Study, that income inequality, measured by determining the percentage of overall wealth owned by the poorest 70 percent of the populace, is strongly related to population health status. 6 Several studies have found that this and other measures of income inequality are related to various health indicators within nations as well. For example, the relationship between income inequality and health is strong among the American states, 7 and among American metropolitan areas. 8 In Canada, by contrast, Ross et al. failed to find statistically significant relationships between income inequality and health among Canadian provinces and again among Canadian metropolitan areas. 9 This may be because Canada does not have enough variability in inequality among provinces or cities for a relationship to manifest itself at these levels. There may be a threshold effect as well: the Canadian provinces/cities are more equal than nearly every American state/city and may have maximized the health benefits accrued from income equality. On the other hand, while I did not find a relationship between average household income and mortality rates among 30 health districts in Saskatchewan, I did find a nearly significant relationship between a crude measure of income inequality and the mortality rate. 10 This is somewhat surprising since we would expect income inequality to be less relevant for health, and less variable, at smaller levels of geopolitical aggregation, yet the populations of these health districts are quite small (ranging in size from about 11,000 to 220,000 people). Why would a place with a relatively equal distribution of incomes have healthier people? proffer several types of explanations. 11 First, the individual-level relationship between income and health may “create” this ecological relationship (even though it may not contribute to the ecological relationship between wealth and health).  note that because the individual-level relationship between income and health is curvilinear, should a given society with a given income distribution be transformed into a more equal one the poorer peoples’ health would improve more than the richer peoples’ health would deteriorate. 12 As a result the average level of population health would improve.  modelled this possibility among the American states and found that the individual-level relationship between income and health mathematically predicts a weaker ecological relationship between income inequality and health than has been noted empirically. 13 A multilevel exercise by among American communities determined that the ecological relationship was non-significant after controlling for individual household income. 14 In contrast,  found a modest empirical relationship between income inequality and self-rated health status among American states after controlling for individual income. 15 There is some, but not incontrovertible, evidence, therefore, that the ecological relationship between income inequality and health is more than simply a reflection of the relationship between income and health among individuals. Second, “an inequitable income distribution may have direct consequences on peoples’ perceptions of their social environment that influence their health.” 16 Wilkinson in particular has advocated explanations of this sort. 17 This argument, similar to the relative hypothesis delineated above, might go as follows. A society with a wide distribution in incomes is one with a pronounced status order. People in all levels of the order are cognizant of one another (e.g., via direct interaction or communications media). Those falling short in psychosocial comparisons with others will feel this shortcoming quite strongly, given the width of the gap, and consequently will suffer poorer health than will the “losers” of comparisons in more equal places. Ill health might develop through the damaging emotions caused by such relative deprivation, emotions such as anxiety and arousal, feelings of inferiority and low self-esteem, shame and embarrassment, and recognition of the need to compete to acquire resources that cannot be gained by any other means. This line of explanation, like the relative hypothesis, is attractive because it moves directly from income inequality, a characteristic of a collective, to emotion, meaning or perception and thence to physical health, dramatically illustrating how income inequality can “get under the skin,” as would say. It is not certain that this form of explanation necessarily represents an alternative explanation, however. If ill health-inducing emotions are distributed along a status order that corresponds with the hierarchy of incomes then the argument proffered by  and  may apply here as well. If such emotions are distributed throughout an unequal society in a less predictable or different fashion, then this form of explanation provides additional insight into the income inequality and health relationship. Third, it has been noted that income inequality can only be applied to populations and not to individuals and can only be defined in relational terms. 18 This ecological aspect of social structure might influence health indirectly through other ecological processes, e.g., “an inequitable income distribution may be associated with a set of social processes and policies that systematically underinvest in human, physical, health and social infrastructure, and this underinvestment may have health consequences.” 19  suggest that “areas that tolerate high income inequality are also less likely to support the human, physical, cultural, civic and health resources in that area.” Unequal places may have more violent crime. 20 These background factors may “create a context of community infrastructure through policies that affect education, public health services, transportation, occupational health regulations, availability of healthy food, zoning laws, pollution, housing, etc.” 21 Such contextual explanations look to collective or ecological aspects of societies that are associated with income inequality: individual-level “outcomes” such as health status and their ecological counterparts such as population health status are much further down the explanatory line. Enter social cohesion, posited as one particularly important contextual means by which income inequality adversely affects population health. Social cohesion, social capital and health: preliminary work propose that societies with a high degree of income inequality are also ones with low social cohesion, and that one of the ways in which income inequality affects health is through the presence or absence of this social resource. describes social cohesion as the social nature of public life, “dominated by peoples” involvement in the social, ethical and human life of the society, rather than being abandoned to market values and transactions. People come together to pursue and contribute to broader, shared social purposes.” describe social capital, a concept often linked with social cohesion in population health discourse, as “the stock of investments, resources and networks that produce social cohesion, trust and a willingness to engage in community activities.” Supposedly, then, something about social spaces with some kinds of participation and trust facilitates or produces good health. Wilkinson notes that it is particularly difficult to determine causality in this instance. “Although a narrower income distribution leads to a more egalitarian social ethic … [i]f a more egalitarian social ethos were to develop exogenously, for reasons unrelated to income distribution, it is implausible that such a society would tolerate great material inequalities without making efforts to reduce them.” A cohesive community should be understood in direct relation to its degree of social inequality, according to , such that cohesion and inequality are opposite principles of social organization. Increased social equality corresponds with co-operative and supportive social relations, and such relations, about “mutuality, reciprocity, sharing, and a recognition that the needs of others are needs for us”23 are hypothesized to have a profound effect on health. Ichiro Kawachi, Bruce Kennedy and their colleagues have done empirical tests of the income inequality, social cohesion and health hypothesis among the American states. Social capital, measured via three trust questions and one “participation in secondary asso- ciations” question, aggregated to the level of the state, was strongly related to both income inequality and mortality. 24 They conclude that social capital does indeed mediate the relationship between the other two: greater inequality leads to decreased participation in the public space and to greater mistrust, both of which then influence health. They have since shown that the same measure of social capital is also related to aggregated self-rated health status, even after controlling for individual-level proximal causes of health.  found a similar result among post code sectors in western Scotland 26 while I found a nearly significant relationship between a crude measure of social capital, incorporating measures of participation in secondary associations and voting activity, and mortality rates among Saskatchewan’s health districts. 27 In contrast with the  finding among the American states, however, my measures for social capital and income inequality were not significantly related to one another. Although the  interpretation of “what causes what” may be (and has been) contested, the empirical results are stimulating, especially given the simplicity of the sometimes crude and opportunistic measures of social capital. What are they measuring? Describing social capital  defined social capital as “the aggregate of the actual or potential resources which are linked to possession of a durable network of more or less institutionalized relationships of mutual acquaintance and recognition—or in other words to membership of a group.” 28 Membership in a social group provides personal resources that may be currently active (actual) or appropriable at a later time or in a new circumstance (potential). “Trust between members of a network ‘oils the wheels’ of social and economic exchange, reducing transaction costs, allowing group members to draw on favours, circulate privileged information, and gain better access to opportunities.” 29 Measures of the amount of participation in and/or number of clubs and secondary associations 30 can be interpreted as attempts to evaluate the prevalence of such networks of mutual acquaintance in a given community.  description of social capital has been particularly influential. [S]ocial capital is defined by its function. It is not a single entity but a variety of different entities, with two elements in common: they all consist of some aspect of social structures, and they facilitate certain actions of actors—whether persons or corporate actors— within the structure. Like other forms of capital, social capital is productive, making possible the achievement of certain ends that in its absence would not be possible… [S]ocial capital is not completely fungible but may be specific to certain activities… [It] inheres in the structure of relations between actors and among actors. 31 Thus social capital achieves; it facilitates ends. While  definition implicitly describes social capital as a resource that facilitates ends for an individual,  definition remains open to ends benefiting a social group. This variety of ends appears somewhat analogous to Putnam’s distinction (in this volume) between private and public returns. Both definitions imply that social capital is not a single “something.” A full description of a  social capital should identify the relevant social structure and the attributes of this structure that, through simple or complicated means that may incorporate social action, facilitate specified ends for specified individuals or groups. Such a description of social capital does not distinguish what social capital is from what social capital does, a distinction that  (in this volume) deems essential, but subsequent empirical and theoretical work may find that certain attributes of social structure do indeed work to achieve a multitude of ends, thereby allowing us to separate analytically these attributes from their effects. There are multiple forms of social capital. A given network of mutual acquaintance with long-term obligations and trust is not necessarily one with deeply held norms pertaining to a common good, nor need it be a network that facilitates the flow of certain kinds of information. (These are three forms of social capital described .) It follows, then, that such multiple social capitals can work to achieve various ends. Thus, for example, social capital has been thought to promote economic growth and development 32 and the performance of political institutions, 33 as well as the health of populations. Figure 1 is a visual rendering of a society’s social structure that may help to clarify various social capitals and their “effects.” This rendering of social structure, a network of social relations and the attendant ideas/beliefs articulated by and within such rela- tions, distinguishes deep structure from the interconnected political, economic and civil spheres and distinguishes these from shallow social structure. Social structure transcends any one person’s conception of it but is constantly reproduced in every-day interaction, i.e., reconstituted and reaffirmed in mind, action, communication and interaction. Each object in the picture is intrinsically social, therefore, a pattern of social actions, relations and meanings, both the condition and outcome of action. I am concerned here with the influence of social relations in one sphere upon social relations within another, certainly, but also with arguing that social relations in general are multifaceted, enact multiple dimensions of social structure simultaneously and, ultimately, are all pertinent for population health. Those aspects of social relations pertaining to deep structure and to the economic and political spheres that produce (ill-) health have received substantial attention from medical sociologists; social relations in the civil space pertain to the social capital and health discourse in particular and represent a relatively untapped arena of inquiry. The definition of a given social structure will also determine the range of possible reasons why such attributes of social structure produce health inequalities: neighbourhoods may vary from one another in only a few dimensions while entire societies likely vary along many of the dimensions depicted in Figure 1. Power is the differential capacity to command resources and gives rise to structured, asymmetric relations of domination and subordination among social actors. Class relations and other embedded power imbalances (by gender, sexual orientation, age, race or ethnicity, language, geographic location and/or religion, for example), if pronounced, probably belong to the deepest structures of society. They influence many aspects of the social structure but are not explicitly recognized by actors in most interactions. Deeply held norms about the “right” and “good” usually remain unrecognised as well, examples of which might include the nature of God in one society or the truth of scientific findings in another. To my mind, then, deep structure contains both realistic/materialistic (e.g., embedded power relations or control over resources) and ideational aspects (e.g., strongly held shared norms and beliefs) blended in some kind of synthetic ontology. Although it is difficult to prove that any one aspect of social structure “causes” another, I would argue that the shape of deep structure strongly influences the shapes taken by the other elements in the image. Thus aspects of deep structure will influence activity and the distribution of material resources in the economic sphere. They will influence control of human resources and/or people within the political sphere, including the state and such substructures as the judiciary, civil service, police and military. They will also influence activity within the civil sphere, including relations with close friends and neighbours, so-called strong or bonding relationships; relations with more distant friends, associates and colleagues, so-called weak or bridging relationships; civic activities linking the individual and the state, so-called linking relationships; and those secondary or voluntary associations that are not directly financed or maintained by the state.  argue that class relations (and politics too) should be incorporated into the income inequality-social cohesionhealth discourse argue that class should be considered as a phenomenon in its own right: the proper objects of study for sociologists interested in the social determinants of health are “beneath-thesurface relations, in the present context crucially including those of class, perceivable and examinable only through their effects.  proposition that the degree of adherence to neo-liberal tenets in a society will influence both the distribution of wealth and social cohesion (and especially trust) describes how the deepest structures of society shape the civil, political and economic spheres. 36 According to Coburn, a deeply embedded belief in the ability of markets to allocate resources properly will influence the nature of social relations in the civil space and the distribution of resources in the economic sphere, in part via its dance with class relations and through its influence on the nature of the welfare state. According to these perspectives, then, aspects of deep structure shape social relations in many spheres of patterned interaction. Most conceptions of social capital focus on attributes of civil society. They explore participation in networks based within that nebulous place between the family and the state, excluding the economic sphere, and focus on trust among members of such networks and the collaborative actions they enact. Questions asked of individuals assessing “trust in most people” pertain to the nature of social relations throughout all of social structure and may or may not serve to measure trust in other members of civil networks in particular. As such, trust in “most people” is better conceived as a product of a civil societybased social capital than a component of such a social capital. The work by  and his colleagues among the regions of Italy pertains to relationships among the civil, economic and political spheres. Thus the prevalence of voluntaristic activities such as participation in soccer clubs or church choirs and civic activities such as voting or reading a local newspaper (in the civil sphere) may be related to one or all of the performance of political institutions, socioeconomic modernity and income inequality. argue that actions such as participation in secondary associations and prescriptions such as adherence to civic norms and duties may influence economic development.explicitly incorporates the nature of the state and state-citizen relations into his conception of social capital and its correlates. 38 The empirical and theoretical insights provided by these researchers reinforce my belief, articulated by , that “the economy, the state and civil society are, in fact, inextricably interrelated. I have depicted shallow structures as aspects of the social structure that rest upon deep structure and the interrelated economic, political and civil spheres, influencing these others somewhat but more properly reflecting more deeply embedded social relations. Many aspects of social structure reproduced in interaction are often consciously articulated: e.g., culture (art, music, television, movies), education, media communications and moral standards referring to beauty and taste. These aspects of social structure may also serve to promote health-producing actions and thence good or ill health, i.e., social capital. It makes sense to me, however, to limit the social capital concept to the civil sphere since most aspects of social structure could be otherwise deemed a health-producing social capital of sorts. We could argue that cooperative class relations facilitate co-operative relations between workers and supervisors in the workplace and thence better health for all of those participating in the labour market, or that deeply held beliefs concerning the rightness of neo-liberal tenets facilitate the ends of a dominant ethnic group and thence good health for that group (but poor health for others). These might be called “social capital,” aspects of social structure that facilitate certain actions and achieve certain ends (i.e., population health) for certain groups. The concept loses analytical meaning in such instances, however, by potentially encompassing all of social relations. The nature of social relations in the civil space, the extent to which they are embedded in social relations pertaining to other aspects of social structure and the ends they can facilitate for groups and individuals delimit a manageable conception of social capital. Why might social capital within the civil space influence the health of people? Like the individual- and ecological- level relationships described above, we can analytically distinguish between the contextual and compositional effects of social capital on health. Contextual effects, or instrumental benefits, refer to social capitalrelevant aspects of social structure that influence the population health of groups through indirect means. Compositional effects, or intrinsic benefits that result from contributing to social capital, refer to the direct influences of participation in multiplex networks, or adherence to prescriptive norms, for example, on the health of the participants themselves, simply by virtue of participating or adhering. Compositional effects: The actions and ideals that individuals engage in or express which serve to contribute to the store of a given social capital might be health-inducing in and of themselves. This explanation is analogous to the arguments described above wherein the income inequality and health or wealth and health relationships simply or partially reflect the individual-level income and health one. Thus Wilkinson suggests that friendship patterns “can reflect, on the one hand, people’s social ease and confidence, or, on the other, the extent to which social contact provokes anxiety, negative social comparisons, feelings of inadequacy and angst.” 40 There is a broad literature on the effects of various kinds of social support and social relationships on health, 41 and patterns of mutual acquaintance in a social capital context may serve to sustain health along these lines. Knowledge of the resources inherent in one’s networks may promote a sense of mastery or personal control and reduce stress. show evidence that participation in the civic space is related to mental health status (and physical health status too, but less strongly) in Australia. 42 On the other hand, did not find individual-level relationships between participation in a local association and self-rated health status in Scotland while I describe few relationships between participation in various kinds of secondary associations and self-rated health status among individuals in eight of Saskatchewan’s health districts. 43 These constitute only a few of the individual- level actions and perceptions that might contribute to a social capital in the civil space, however. Contextual factors: To the degree that large-scale bureaucratic institutions are embedded within the non-political and non-economic social world, social capital within the civil space may influence the performance of political institutions in particular, demonstrated theoretically and empirically by With, I have also speculated about means by which social capitals may affect the governing performance of regional health authorities specifically, although an empirical test of the relationship in Saskatchewan did not support the hypothesis. 45 Other characteristics of political institutions which might also be influenced by social relations in the civil space, such as adherence to welfarestate principles, are especially pertinent to health. argue that American states with low levels of interpersonal trust (a consequence of some social capitals?) are less likely to invest in human security and provide generous safety nets. 46 Interpersonal trust supposedly accompanies more egalitarian patterns of political participation that often result in the passage of policies which ensure the security of all its members, policies perhaps pertaining to education, transportation, pollution, child welfare and zoning laws. Social capitals may influence access to services and amenities, since socially cohesive communities may be more successful at uniting to ensure that budget cuts do not affect health and social services. A state that seeks to redress social inequality in general may serve to reduce income inequality through welfare measures, thereby potentially improving the population’s health by the means, both materialistic and psycho- social, suggested above. To my mind this constitutes the more plausible line of causality among social capitals in the civil space, income inequality and population health status: not that income inequality threatens the nature of social relations so much as the distribution of income reflects, in part, the nature of social relations in the civil and political spheres and the deeper parts of social structure. Social relations in the civil space may also influence economic development and growth, the concern of many of the papers in this volume. Suffice it to say that to the degree that additional wealth aggregated to the level of the community contributes to health (debated above) the influence of civil space social relations upon the economic sphere will have implications for population health. To the degree that social relations within the civil sphere affect deep structure, social capitals may mitigate class, racial, ethnic, gendered, religious and other power imbalances. Networks of mutual acquaintance spanning these potential chasms may introduce people to perspectives different from their own and produce a spirit of tolerance, thereby lessening the magnitude of influence embedded relations have upon social relations in general and health inequalities along racial lines, for example, in particular. At any of the macro, meso and micro levels, some forms of social capital may influence health-related behaviours by promoting diffusion of health-related information (i.e., via the information channels described by Coleman), thus increasing the likelihood that healthy norms of behaviour are adopted, or by exerting social control (i.e., via the effective sanctions also described by Coleman) over deviant health-related behaviour. They may mitigate against the incidence of crime, juvenile delinquency and access to firearms within communities. With respect to psycho-social determinants of health, participation in co-operative networks that venture far into the civil space may produce social trust. 47 Lavis and provide evidence from the World Values Survey that the expression of trust is related to self-rated health status in Canada at the individual level, 48 although I found that multiple forms of social and political trust were unrelated to self-rated health status in Saskatchewan. provide evidence that trust and health may be related at the ecological level, although this does not imply that individually held trust necessarily produces health for that individual  has shown (in this volume) that community-level social capital seems to influence degree of happiness. Compositional aspects of a civil space-oriented social capital may be a determinant of health, certainly, but do not in my opinion constitute the most important contributions of social capital theory to population health research. Individual-level relationships have been explored in depth by social epidemiologists and others over the years; contextual effects are less well understood, and more difficult to model, than are compositional ones, and thereby represent a promising area for exploration and conceptualization. A final caveat: I have described potential influences on health of social capitals located within the civil space but do not claim that civil society necessarily provides the most potent influence of the social structure on health. The interrelatedness of the three spheres with deep social structure implies that population health researchers should always set civil society within the larger sociopolitico- economic context. At this time it appears that theories focusing on consensus are popular with governments and policy makers, perhaps due to the rapid and overwhelming pace of change in modern societies, as are theories that support smaller government by emphasizing the role of civil society. In my opinion, theories of the social determinants of health that seek to be comprehensive should additionally encompass deeply embedded conflict and inequality and the roles of state and economy for producing good health for populations. Epilogue Social capital is the new kid on the block when it comes to exploring the social determinants of the health and well-being of Canadians, evidenced by a plethora of new research studies in Canada that implicitly or explicitly seek to explore social capitals and their effects. Just to name a few, the nre project based at Concordia University is currently exploring processes of inclusion and exclusion among Canadian rural communities while the Equality/Security/Community project, based at ubc and concerned with describing the distribution of well-being in Canada, is focusing on economic, political and social determinants of public policies and their outcomes. Two studies based at the University of British Columbia, the Resilient Communities project and the Sawmills project, are exploring social capital and both economic resiliency and population health among coastal communities in British Columbia. Similar relationships are being investigated among these coastal communities and among a larger regional and national sample of communities by researchers from the Equality, Security and Community project and the Georgia Basin Futures project at ubc. The Left Out project, based at the universities of Alberta and Toronto, is exploring issues of exclusion and belonging as they pertain to social cohesion and health in Edmonton and Toronto while the Deconstructing the Local Determinants of Health project at McMaster university is exploring social capital as one of the determinants of the health of residents in Hamilton neighbourhoods. Results from these and other investigations should shed light on many of the issues raised in this paper and increase our understanding of the social determinants of the health of Canadians. Credit:ivythesis.typepad.com

Social Capital and Health

ABSTRACT ❿ Individuals tend to be healthier the higher they are on the income ladder. But nations with a higher GDP/capita are...