Understanding Health and Health
         Measurements
              in

        Jamaica




                           Edi...
Understanding Health and Health
         Measurements
              in

        Jamaica




               ii
Understanding Health and Health
                             Measurements
                                      in

      ...
Paul Andrew Bourne
66 Long Wall, Stony Hill
Kingston 9, Jamaica




© 2010 by Paul Andrew Bourne
All rights reserved. Publ...
Dedicated to


 Paul A. Bourne, Jnr.

     DruAnn Bourne

Kerron and Kimani Bourne

          And

My wife - Evadney Bourn...
Contents
Prologue                                                                                  xiv

Chapter One       ...
Paul A. Bourne
Chapter Eight                                                                               184

Determinan...
Chapter Fifteen                                                                              363

Child Health Disparities...
Chapter Twenty Two                                                                           545

Hypertensive and modelin...
Chapter Twenty Nine                                                                          731

Self-rated health status...
Chapter Thirty Six                                                                   903

Quality of Life of Youths in Jam...
Chapter Forty Three                                                                        1108

Patient care: Is interper...
Chapter Fifty                                                                             1312

Health status and Medical ...
Chapter Fifty Six                                                                           1509

Good Health Status of Ru...
Prologue
       Health is a final product, an ingredient, an end, and a means to an end. This means it

provides answers t...
practice and culture as health is apart of the cultural expression of people and more than a social

construction.

      ...
One economist began the study of the determinants of health, Michael Grossman. As

such, Grossman’s work forwarded that he...
no social support, are equally sharing the same health status as the elderly who have not been on

medication because they...
institutions in the researching of image of health status and quality of life in a Caribbean society.

This provides furth...
Acknowledgement


Health is an end, a product and an ingredient in all human production as well as a means to an

end. Peo...
iii.   An Epidemiological Transition of Health Conditions, and Health Status of the Old-Old-
        To-Oldest-Old in Jama...
Sciences; HealthMed Journal; International Journal of Collaborative Research on Internal

Medicine and Public Health; Jour...
Upcoming SlideShare
Loading in …5
×

Understanding Health and Health Measurements in Jamaica

659 views

Published on


Paul A. Bourne is the Director of Socio-Medical Research Institute, Kingston, Jamaica. He is the author of Growing Old in Jamaica: Population Ageing and Senior Citizens’ Wellbeing, and A Simple Guide to the Analysis of Quantitative Data. An Introduction with hypotheses, illustrations and references, and coauthored Probing Jamaica’s Political Culture, volume 1: Main Trends in the July – August 2006 Leadership and Governance Survey, and A landscape Assessment of Political Corruption in Jamaica

Published in: Education
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total views
659
On SlideShare
0
From Embeds
0
Number of Embeds
3
Actions
Shares
0
Downloads
7
Comments
0
Likes
0
Embeds 0
No embeds

No notes for slide

Understanding Health and Health Measurements in Jamaica

  1. 1. Understanding Health and Health Measurements in Jamaica Editor Paul A. Bourne i
  2. 2. Understanding Health and Health Measurements in Jamaica ii
  3. 3. Understanding Health and Health Measurements in Jamaica Paul A. Bourne Socio-Medical Research Institute, Kingston, Jamaica (Formerly Biostatistician and Social Demographer, Dept of Community Health and Psychiatry, University of the West Indies, Mona) iii
  4. 4. Paul Andrew Bourne 66 Long Wall, Stony Hill Kingston 9, Jamaica © 2010 by Paul Andrew Bourne All rights reserved. Published 2010 CATALOGUING IN PUBLICATION DATA Understanding Health and Health Measurements in Jamaica by Paul Bourne Includes bibliographical references ISBN: Covers design by Paul Bourne Book design by Paul Bourne Printed in Jamaica iv
  5. 5. Dedicated to Paul A. Bourne, Jnr. DruAnn Bourne Kerron and Kimani Bourne And My wife - Evadney Bourne v
  6. 6. Contents Prologue xiv Chapter One 1 Health Measurement Paul A. Bourne Chapter Two 25 Variations in social determinants of health using an adolescence population: By different measurements, dichotomization and non-dichotomization of health Paul A. Bourne Chapter Three 51 Social Determinants of Health in a developing Caribbean nation: Are there differences based on municipalities and other demographic characteristics? Paul A. Bourne Chapter Four 85 Sociomedical Public Health in Jamaica Paul A. Bourne Chapter Five 116 The validity of using self-reported illness to measure objective health Paul A. Bourne Chapter Six 135 Modelling social determinants of self-evaluated health of poor older people in a middle-income developing nation Paul A. Bourne Chapter Seven 160 Men’s health in Jamaica: Those in the wealthy social hierarchies vi
  7. 7. Paul A. Bourne Chapter Eight 184 Determinants of self-reported health conditions of people in the lower socioeconomic strata, Jamaica Paul A. Bourne Chapter Nine 209 Paradoxities in self-evaluated health data in a developing country Paul A. Bourne Chapter Ten 233 Self-reported health and health care utilization of older people Paul A. Bourne, Christopher A.D. Charles, Cynthia G. Francis & Stan Warren Chapter Eleven 274 Health of females in Jamaica: using two cross-sectional surveys Paul A. Bourne Chapter Twelve 294 Self-rated health of the educated and uneducated classes in Jamaica Paul A. Bourne Chapter Thirteen 318 Dichotomising poor self-reported health status: Using secondary cross-sectional survey data for Jamaica Paul A. Bourne Chapter Fourteen 339 Retesting and refining theories on the association between illness, chronic illness and poverty: Are there other disparities? Paul A. Bourne vii
  8. 8. Chapter Fifteen 363 Child Health Disparities in an English-Speaking Caribbean nation: Using parents’ views from a national survey Paul A. Bourne, Cynthia Grace Francis & Elaine Edwards Chapter Sixteen 391 Disparities in self-rated health, health care utilization, illness, chronic illness and other socioeconomic characteristics of the Insured and Uninsured Paul A. Bourne Chapter Seventeen 422 Social determinants of self-reported health across the Life Course Paul A. Bourne Chapter Eighteen 443 Variations in health, illness and health care-seeking behaviour of those in the upper social hierarchies in a Caribbean society Paul A. Bourne Chapter Nineteen 468 Self-reported health and medical care-seeking behaviour of uninsured Jamaicans Paul A. Bourne Chapter Twenty 491 Health of children less than 5 years old in an Upper Middle Income Country: Parents’ views Paul A. Bourne Chapter Twenty One 515 An Epidemiological Transition of Health Conditions, and Health Status of the Old-Old-To- Oldest-Old in Jamaica: A comparative analysis Paul A. Bourne viii
  9. 9. Chapter Twenty Two 545 Hypertensive and modeling their social determinants of self-rated health status in a middle- income developing nation Paul A. Bourne and Christopher Charles Chapter Twenty Three 570 Chronic health conditions in Jamaica: Diabetes mellitus, hypertension and arthritis Paul A. Bourne Chapter Twenty Four 595 Childhood Health in Jamaica: changing patterns in health conditions of children 0-14 years Paul A. Bourne Chapter Twenty Five 624 Gender differences in self-assessed health of young adults in an English-speaking Caribbean nation Paul A. Bourne and Christopher AD. Charles Chapter Twenty Six 654 Self-reported health and medical care-seeking behaviour of uninsured Jamaicans Paul A. Bourne Chapter Twenty Seven 677 Self-evaluated health and health conditions of rural residents in a middle-income nation Paul A. Bourne Chapter Twenty Eight 704 Health Status of Urban and Peri-Urban Residents: Are there Health Disparities between the municipalities in Jamaica? Paul A. Bourne ix
  10. 10. Chapter Twenty Nine 731 Self-rated health status of young adolescent females in a middle-income developing country Paul A. Bourne Chapter Thirty 751 The quality of sample surveys in a developing nation P.A. Bourne, C.A.D. Charles, N. South-Bourne, D. Eldemire-Shearer, M.D. Kerr-Campbell Chapter Thirty One 783 The image of health status and quality of life in a Caribbean society Paul A. Bourne, Donovan A. McGrowder, Christopher A.D. Charles, Cynthia G. Francis Chapter Thirty Two 802 Determinants of Quality of Life of youths in an English Speaking Caribbean nation Paul A. Bourne Chapter Thirty Three 819 The uninsured ill in a developing nation Paul A. Bourne Chapter Thirty Four 850 Health of males in Jamaica Paul A. Bourne Chapter Thirty Five 874 Good Health Status of Older and Oldest Elderly in Jamaica: Are there differences between rural and urban areas? Paul A. Bourne x
  11. 11. Chapter Thirty Six 903 Quality of Life of Youths in Jamaica Paul A. Bourne Chapter Thirty Seven 928 Factors that Influence Wellbeing of the Working Aged Population in Jamaica Paul A. Bourne Chapter Thirty Eight 953 A conceptual framework of wellbeing in some Western nations Paul A. Bourne Chapter Thirty Nine 983 Social parameters of self-evaluated health of poor aged Jamaicans Paul A. Bourne Chapter Forty 1021 A Comparative Analysis of Health Status of men 60 + years and men 73 + years in Jamaica: a Multivariate Analysis Paul A. Bourne Chapter Forty One 1050 A Multi-level Comparative Assessment of Self-rated Wellbeing of Young Adults and Elderly Jamaicans Paul A. Bourne Chapter Forty Two 1085 Self-reported Health of Youth: Using Health Conditions to measure Health Paul A. Bourne xi
  12. 12. Chapter Forty Three 1108 Patient care: Is interpersonal trust missing? Paul A. Bourne, Cynthia G. Francis & Maureen D. Kerr-Campbell Chapter Forty Four 1135 Does Trust Change Well-Being: Different typology of trust Paul A. Bourne Chapter Forty Five 1171 Subjective psychosocial wellbeing in Jamaica: should religiosity, governance of the country and interpersonal trust be into consideration in patient care? Paul A. Bourne Chapter Forty Six 1217 Difference in social determinants of health between the poor and the wealthy social strata in a Caribbean nation Paul A. Bourne Chapter Forty Seven 1242 Socioeconomic correlates of self-evaluated health status of elderly with diagnosed chronic medical conditions, Jamaica Paul A. Bourne Chapter Forty Eight 1269 Paul A. Bourne Chapter Forty Nine 1284 Factors associated with objective wellbeing in Jamaica: Is objective index still a good measure of health? Paul Andrew Bourne, Donovan McGrowder and Oniel Jones xii
  13. 13. Chapter Fifty 1312 Health status and Medical Care-Seeking Behaviour of the poorest 20% in Jamaica Paul Andrew Bourne Chapter Fifty One 1340 Is income a stronger determinant of self-rated health status than other socioeconomic and psychological factors? Paul A. Bourne Chapter Fifty Two 1367 Biosocial determinants of health and health seeking behaviour of male youths in Jamaica Paul A. Bourne Chapter Fifty Three 1393 Determinants of self-rated private health insurance coverage in Jamaica Paul Andrew Bourne and Maureen Kerr-Campbell Chapter Fifty Four 1422 Ill-males in an English-Speaking Caribbean Society Paul A. Bourne, Christopher A.D. Charles, Donovan A. McGrowder Chapter Fifty Five 1458 Happiness among Older Men in Jamaica: Is it a health issue? Paul Andrew Bourne, Chloe Morris, Denise Eldemire-Shearer xiii
  14. 14. Chapter Fifty Six 1509 Good Health Status of Rural Women in the Reproductive Ages Paul A. Bourne and Joan Rhule Chapter Fifty Seven 1547 Predictors of Good Health Status of Rural Men in Jamaica Paul A Bourne Chapter Fifty Eight 1570 Decomposing Mortality Rates and Examining Health Status of the Elderly in Jamaica Paul A. Bourne, Donovan A. McGrowder and Tazhmoye V. Crawford Chapter Fifty Nine 1599 Difference in social determinants of health between men in the poor and the wealthy social strata in a Caribbean nation Paul A. Bourne and Denise Eldemire-Shearer Epilogue 1621 Paul Andrew Bourne xiv
  15. 15. Prologue Health is a final product, an ingredient, an end, and a means to an end. This means it provides answers to and for many issues as such it cannot be left unresearched in any population as many matters would be left unresolved. It holds a society together, and is germane to the stock of wealth of the individual, community, country, region and world. Economic growth, socio- economic development, quality of life, work and prosperity are based on the health of people, a community, society, nation and the world. The conceptualization of health whether it is (1) antithesis of illness, (2) self-rated health status, (3) life expectancy or (4) health life expectancy are embedded in life - cognitive functionality and functional status of people, which accounts for the contribution of people to production, productivity and the social world. While health is well established as a by-product in a society as was stated earlier, it is more needed because of its importance in existence than the end product of being healthy. The importance of health to quality life, production, productivity and social functionality provides the impetus for studying this phenomenon. Clearly with the significance of health to standard of living, economic growth and development of a society, then it is critical to the planning process of people, a nation and the world. The crux of health is such, therefore, that its measurement, image, conceptualization, realities and culture are primary to the understanding of many ends – the economic realities, productivity, happiness, life satisfaction, life expectancy and healthy life expectancy. Health is embedded in any conceptualization and/or measurement of life expectancy and healthy life expectancy because the former construction provides the primary ingredient in the calculations of long life, lived years and healthy lived years. Thus, by denying a study on health and its measurement is to create absence in understanding peoples’ perception, xv
  16. 16. practice and culture as health is apart of the cultural expression of people and more than a social construction. The outlook of Jamaicans on what constitutes health is not necessarily the dictates of international agencies’ perspectives because they are the bodies’ response for so doing as the culture in this geopolitical space is different while is similar to those in other jurisdictions. It follows, therefore, that the definitions health and its influence are linked to the culture. Within the contextualization of health based on peoples’ experiences means that examining health in one jurisdiction cannot be superimposed on another geopolitical space, indicating the value of exploring peoples’ perspectives in any planning and administration of policies for them. Despite the World Health Organization’s (WHO) conceptualization of health, which was outlined in the Preamble to its Constitution in 1946, the discourse on health continues even in 2000. Prior to WHO’s definition of health which expanded from the absence of illness to social, psychological and physical wellbeing, health was measured used the antithesis of illness. Using the “antithesis of diseases” to measure health is viewed as narrowed which B.B. Longest says is the “…absence of infection or the shrinking of a tumour” which can be called dysfunctions. According to Bok [25], the definition offered by the WHO is too broad and difficult to measure, and at best it is a phantom. Other intelligentsia point to the WHO’s definition as a difficulty for policy formulation, because its scope is ‘too broad’. The question is “Is the conceptual definition formulated by WHO so broad that those policies faced difficulty in formation”, and by extension should we regress to a pre-1946 conceptualization of health because a construct is difficult to operationalize today? Undoubtedly, health extends beyond diseases and is tied to cultural and psychological elements, personal responsibility, lifestyle, environmental and economic influences as well as quality nutrition. Those conditions are termed determinants of health. xvi
  17. 17. One economist began the study of the determinants of health, Michael Grossman. As such, Grossman’s work forwarded that health was more than the absence of illness to increase income, education, occupation and many other determinants. In 2005, the WHO began a thrust into the study of the social determinants of health, which was supporting the previous study by Michael Grossman, Smith and Kingston and others. The empirical research, therefore, was recognizing the value of an expanded definition of health as was the intent of WHO. Again, the discourse of health did not cease propositition of WHO’s definition of health or the works of many scholars. The antithesis of illness (not reporting a health condition) marks an old conceptualization of health that appears to linger in contemporary societies, instead of the use of wellbeing to indicate the new position of health. Dr. Buzina admits that wellbeing is fundamentally a biomedical process (using health conditions, morbidity or diagnosed illness). This conceptual framework derives from the Newtonian approach of basic science as the only mechanism that could garner information, and empiricism being the only apparatus to establish truth or fact. It is still a practice and social construction that numerous scholars and medical practitioners continue to advocate despite new findings. Simply put, many scholarships still put forward a perspective that the absence of physical dysfunction is synonymous with wellbeing (or health, or wellness). Such a viewpoint appears to hold some dominance in contemporary societies, and this is a widespread image held in Jamaica. Then there are issues such as the death of an elderly person’s life-long partner; a senior citizen taking care of his/her son/daughter who has HIV/AIDS; an aged person not being able to afford his/her material needs; someone older than 64 years who has been a victim of crime and violence and continues to be a victim; seniors who reside in volatile areas who live with a fear of the worst happening, the inactive aged, and generally those who have retired with xvii
  18. 18. no social support, are equally sharing the same health status as the elderly who have not been on medication because they are not suffering from biomedical conditions to the extent that they need to be given drugs. Many studies on the health of Jamaicans have been on reproductive health matters, health conditions, and sexual behaviors. Caribbean scholars have failed to recognize the discourse on health and the disparities which may exist between the international conceptualization and peoples’ perspective of health. Because health is an ingredient in health and its measurement is critical to other areas in the socioeconomic life of a people, then the difference perspectives of health must be examined in order to provide a better understanding of how people view this construct, and how planning an effective address their concerns owing to a better position of people. The current work emerged out of a need to grapple with the different perspective of health held by Jamaicans, their health, health measurement and likely disparities which may occur because of those differences. This book is the enveloped of a new of published manuscripts on health measurement, and health as viewed by Jamaicans. The book commences with a discussion on health measurement as it seeks to provide a comprehensive expression of the differences in viewpoints, their existence, historical perspectives and influence on health. The proceeding chapters will be an expansion of social determinants, health measurement, validity of health and dichotomization of health, and quality of sample surveys, using only data on Jamaicans. This book is intended to provide insights into health and health measurement in Jamaica, and to depict disparities which exist between particular perspectives on health and health measurement, using data on Jamaicans and comparing these with other societies. Of the many chapters in this book, I collaborated with a number of scholars from different academic xviii
  19. 19. institutions in the researching of image of health status and quality of life in a Caribbean society. This provides further insights into the health data and quality of life of Jamaicans. While this chapter create an understanding of the disparities between health and quality of life, it highlights the growing differences in the two concepts, and the validity of adopting a new approach in the collection of health data away from self-rated (or reported) health status, antithesis of illness, and self-reported health conditions. The various postulations, perspectives and conceptualizations which exists outside of Jamaica, do not guarantee the same in a particular geopolitical space as this emerged in many of the chapter of this text. The introduction of interpersonal trust in this text was by design as it allows medical practitioners, medical sociologists, and policy makers an insight into the inclusion of trust in discourse on health, health measurement and wellbeing. Thus, it is fitting that the last chapters of this book be on trust as it symbolizes the way forward in health research and health measurement. The final chapter examines religiosity, governance of the country, and interpersonal trust as they interface with health and health measurement, and they thereby are significant in a health discourse. Paul Andrew Bourne Socio-Medical Research Institute xix
  20. 20. Acknowledgement Health is an end, a product and an ingredient in all human production as well as a means to an end. People want to be healthy because it offers opportunities, privilege, economic growth and development, and happiness. Thus, ill-health contributes to lower satisfaction with life as it retards choices and increase peoples’ perspectives of a likeliness of suppressed opportunities. These opportunities are more than economic pursuits, costs and economic choices as health is life, and life is health. The health of a people, society, community and nation is a blueprint for life. As such, without this guiding blueprint, life ceases and emptiness unfolds itself. The emptiness to which we speak is a life without health, as there can be no health with life. Health is not merely the absence of illness, ailment or infirmity. As it is the dream of all upper animals and provide an avenue for the pursuit of other internal and external things. On the contrary, with the absence of health, the desire of all other things become minute as health embodies life. Following the ill-health of my six year old son (Kimani Bourne), I was brought into the recognition of the importance of health to life, and without it how distasteful your accomplishments are. Kimani was diagnosed with diabetes on February 8, 2010, and later went in a diabetic coma about three weeks later that month. This spiraled a search into understanding diabetes mellitus, juvenile diabetes and chronic health conditions. Following the examination of health conditions (ailment or illness) and general health status emerged some empirical studies on Jamaicans. These are as follows: i. Disparities in self-rated health, health care utilization, illness, chronic illness and other socioeconomic characteristics of the Insured and Uninsured; ii. Health of children less than 5 years old in an Upper Middle Income Country: Parents’ views; xx
  21. 21. iii. An Epidemiological Transition of Health Conditions, and Health Status of the Old-Old- To-Oldest-Old in Jamaica: A comparative analysis; iv. Hypertensive and modeling their social determinants of self-rated health status in a middle-income developing nation; v. Chronic health conditions in Jamaica: Diabetes mellitus, hypertension and arthritis vi. Childhood Health in Jamaica: changing patterns in health conditions of children 0-14 years, and vii. Self-reported Health of Youth: Using Health Conditions to measure Health Outside of the ill-health of my son (younger of the twins, Kerron and Kimani Bourne), which is the primary purpose for this book, there are many other peoples that contribute to the completion of the text. Mr. Maxwell S. Williams who implore me to evaluate the health conditions affecting Jamaican children. This gave rise of the evolution of many empirical works on health, health measurement and health conditions in Jamaica. Then there were literature search on health, health measurement and health conditions in Jamaica. Limited findings emerged on the texts that assess the general health of the Jamaican populace as well as health measurement. Those facts challenge a need for a landscape of information on health and health measurement. This then gave impetus to the collating of different studies on health and health measurement, particularly on Jamaica. A number of the chapters were firstly written as research for presentation on a radio programme on Nationwide FM, Jamaica. The programme was hosted by Messrs. Dennis Brooks and Damion Blake. Following the departure of Mr. Blake as co-host of the programme, he was replaced by Mr. George Davis. A few chapters were cowritten with some Caribbean and Non-Caribbean scholars. I wish to thanks all the authors who coauthored some of the chapters with me as well as the named individuals identified previously. My heart felt appreciation and thanks to you as well as those who critique the chapters. In addition to the aforementioned individuals, many of the chapters were submitted to and published different journals. These journals are North American Journal of Medical xxi
  22. 22. Sciences; HealthMed Journal; International Journal of Collaborative Research on Internal Medicine and Public Health; Journal of Clinical and Diagnostic Research (JCDR); Maxwell Publishers, and Journal of Men’s Health. As the holders of the copyright of the various articles, the editors of those journals were contacted, I am indeed thankful for their additional permission to publish the chapters. Finally, I am wholehearted thankful to my son, Paul Andrew Bourne, Junior, who named the book. Thank you all, and to the readers, I hope the book will provide invaluable information on the issues of health and health measurements in Jamaica. xxii

×