Critical Review Grading Rubric
KINE 3353: Health and the Human Condition in the Global Community
Fall 2020
Criteria
Ratings
Overview of the chapter
2 pts
Excellent
Reflects a full understanding of all key concepts and discusses main arguments. Takes about 1/3 of the page. Ends with a strong thesis that acknowledges both strengths and limitations.
1 pts
Satisfactory
Reflects a moderate understanding of all key concepts and arguments. Takes about 1/3 of the page. Thesis does not acknowledge both strengths and limitations.
0 pts
Needs Improvement
Overview is either too long or too short and does not accurately summarize the text. Does not end with a thesis statement or does not acknowledge either strengths or weaknesses.
Evaluation of Strengths & Weaknesses
2 pts
Excellent
Critically evaluates the text’s arguments and assumptions, discussing its strengths and weaknesses using appropriate evidence and examples. Synthesizes information and does not merely list. About 1/3rd of a page.
1 pts
Satisfactory
Adequately evaluates the arguments made. Discusses strengths and weaknesses but does not synthesize the information (instead listing) and provides adequate examples. About 1/3rd of a page.
0 pts
Needs Improvement
Does not evaluate either the strengths or weaknesses of the text. Too long or too short.
Conclusion: General Impressions or Recommendations
2 pts
Excellent
Discusses the text’s contribution to public health and any recommendations for improvement. Proficiently supports recommendations made and closing arguments.
1 pts
Satisfactory
Concludes with only either public health contributions or recommendations. Adequately supports recommendations for improvement and closing arguments.
0 pts
Needs Improvement
Does not discuss the text’s contribution to public health nor makes any recommendations for improvement.
Two Key Questions
2 pts
Excellent
At least two thoughtful questions are posed which provoke further thought AND at least one relevant external source is cited.
1 pts
Satisfactory
Only one thoughtful question is posed which provokes further thought, no external sources are cited, or one external source is cited with no questions posed.
0 pts
Needs Improvement
No questions are posed nor are any external sources cited.
Writing, Grammar & APA Format
2 pts
Excellent
Written in APA style using Zotero, in 11-point Times New Roman font, one-inch margins, double-spaced, and paginated with no errors. No spelling or grammar mistakes. 1 page or more.
1 pts
Satisfactory
Written in APA style using Zotero, in 11-point Times New Roman font, one-inch margins, double-spaced, and paginated with a few errors. A few spelling or grammar mistakes. 1 page or more.
0 pts
Needs Improvement
Not written in APA style, in 11-point Times New Roman font, one-inch margins, double-spaced, and paginated or with many errors. Does not use Zotero. Many spelling or grammar mistakes. Less than 1 page. An assignment with 30% or more in Unicheck will automatically rece ...
Long-Term Care TodayDemographics and epidemiological transitions.docxSHIVA101531
Long-Term Care Today
Demographics and epidemiological transitions result in dramatic changes in the health needs of individuals throughout the globe. In recent times, there has been increase in the prevalence of long-term disability in the population—causing increasing need for long-term care services. In addition, the present developing world is experiencing an increase in the demand for long-term care services at a cost much lower than industrialized countries.
Prepare a report in a 3- to 4-page Microsoft Word document comparing the US long-term care system with the long-term care system of a developing country. Research Scholarly Library and the Internet to find relevant content.
Include the following information in your report:
· What are the chronic illness trends of each country?
· What is the incidence and prevalence of elderly consumers of long-term care in the United States as compared to your chosen developing country?
· How does each country expect these numbers to change in the next ten years?
· What are the main characteristics of the elderly population in both the countries? Is there any difference in the long-term health care needs of consumers in both the countries? Provide a rationale for your answer.
· Who are the institutional and non institutional caregivers in both the countries? Support your answer with relevant examples. Explain the factors that affect care giving in each country.
· Is there any difference in the status of quality of care of the elderly consumers in the United States as compared to the developing country?
· Is there any difference in the health care cost provided in the United States as compared to the developing country? Define any social support that may exist to cover health care in both countries.
Support your responses with examples.
Cite any sources in APA format.
15 INTERVIEW QUESTIONS
1. How do you feel about yourself? She cross that one
2. What are your experiences on your everyday interactions with the normal members of the society?
3. What are your everyday experiences with the deaf colleagues in the society?
4. What are your experiences with your family members?
5. How do you relate to your wife? (Married male adults) OR, how do you relate to your husband? (married female adults?)
6. need Q
7. How often do you interact with the members of the society that are not deaf?
8. How do you communicate with members of the society who do not know sign language?
9. What do you do if you encounter an individual who does not know how to communicate in sign language?
10. What was your experience when you were young?
11. How did you feel when you were with your peers when you were little?
12. How did you feel when your peers could not understand your situation when you were little?
13. What was your experience in your family during young age?
14. In case you were discriminated by your peers, how did you feel?
15. Do you remember any one time when you felt low self-esteem due to the treatment that you ...
DIRECTIONSIn this assignment, you will be exploring actual and p.docxlynettearnold46882
The document provides directions for completing an assignment on assessing children's functional health patterns. Students are instructed to:
1) Complete a functional health pattern assessment worksheet for toddlers, preschool-aged, and school-aged children.
2) Discuss Erikson's stages of child development as they relate to each age group.
3) Answer two short answer questions comparing assessments across age groups and how nurses approach children versus adults.
Guidelines are provided on what to include in the assessment for each functional health pattern. A rubric is also included to evaluate students' responses.
Why does teen pregnancy and sexually transmitted diseases remain hig.docxvelmakostizy
Why does teen pregnancy and sexually transmitted diseases remain high in the U.S.
What can healthcare providers do that decrease the rate of teen pregnancy and STD’s in the US?
* These questions should be researched and incorporated in the body of the paper and answered.
This is my introduction already done.
Adolescent Sex
Teen pregnancy and sexually transmitted diseases continue to be an important healthcare issue in the 20
th
century.
Although teen pregnancy rates have dropped there are still concerns and healthcare problems that are associated with teen pregnancy.
Often times they are afraid to discuss sex with their parents and deny will deny being sexually active at all.
There are problems that manifest with
adolescent pregnancy for the mother and often times the infants as well.
The high school drop out rate among pregnant high school students is approximated at about
70 percent and is cited as the number reason teens drop out prior to graduation
.
There is also an estimated $7 billion revenue cost associated with teen pregnancy in the United States alone.
[KD2]
The risk of young people engaging in early sexual intercourse is largely due to the lack of sexual education, peer pressure and social influences.
Chlamydial infection, gonorrhea, HIV/AIDS, primary and secondary syphilis, and hepatitis B virus infection are amid the highest reported STDs with chlamydia noted as the most dominate which is likely due to the fact that there is more vigorous testing.
Some of the other noted STDs are genital herpes, trichomoniasis, Chancroid, and HPV.
Often times and without any signs or symptoms present more than one pathogen is involved with sexually transmitted diseases. Typically the only environments in which there remain viable pathogens is the bodily fluids from the genitourinary tract requiring there to be intimate contact for them to be acquired.
Although it affects men and women chlamydia is predominately seen in young women and is the most common nationally known sexually transmitted disease in the U.S.
Bodily fluids from the genitourinary tract are typically the environments in which there remain viable pathogens, so intimate contact is generally required to obtain STDs.
Chlamydia infections are asymptomatic in most women and can be transmitted during childbirth with the
potential of a newborn developing pneumonia as a complication.
If it is not treated
chlamydia can spread to the uterus and fallopian tube creating further health problems and permanent damage to the reproductive system.
Teaching abstinence is the most affective way to prevent pregnancy and STDs but sexuality and curiosity of sex begins at a young age and exploration into sexuality is a natural part of personal development.
I feel it is our
[KD3]
role and responsibility as healthcare providers to provide adolescents and teens with the information and risk factors involved with having sex.
They need to be educated on contraceptives, pregnancy and S.
$60.00 Due 1213Theory Application PaperThe paper will co.docxaryan532920
$60.00 Due 12/13
Theory Application Paper
The paper will comprise of cited research on the effectiveness of the model(s) or theories related to your identified issue of HIV among homeless youth, a gap analysis, and a proposed intervention that would help fill the gap.
Guidelines for Submission: Submit a 10 page word document that uses 11-pt Times New Roman font with 1 inch margins. Utilize at least 10 references to support your claims. All citations and other formatting conventions should follow the most current version of AMA style.
TOPIC: HIV Among Homeless Youth in the US
Your paper needs to include the following:
· Introduction –Compete- see pages 4-5
1 Briefly review the chosen issue or behavior.
○ Explain the history, public health implication, affected population, and economic and/or social consequences.
○ State why the issue you chosen is an important one to address.
○ Explain how addressing this issue might lead to better conditions.
· Theories, Models, and Gap Analysis
1 Describe the different social and behavioral health models that people in the field have used to address this behavior/issue.
○ Identify a gap that still exists despite the current efforts in the field. What could be done to address the gap? What behavioral change must occur?
○ Support all claims with relevant and reputable resources and examples. You may want to reference the work done in your research summaries.
· Intervention
1 Propose a behavioral intervention that would help to fill the gap you have described above. This does not need to be an original intervention, you may choose an intervention that has already been proposed. The purpose is to propose an intervention that would best fill the gap you have identified.
■ You are not expected to provide an in depth proposal with all the details of the intervention.
■ For example: An intervention for school aged children who smoke may be an after school program to enhance positive interaction among peers.
○ Explain how your intervention utilizes the chosen theory/model. What specific components of the theory/model are being used in your intervention?
○ Support your proposed intervention with evidence from the literature. Reference the work completed in your research summaries.
○ Make a table/visual/figure that illustrates the relationship between your theory/model and the proposed intervention. This visual should show which components of the theory/model are being used and where in the intervention.
Conclusion
○ Summarize the major concepts from this paper.
○ How does your intervention achieve the desired behavioral change?
○ What limitations are there to your proposed plan?
○ Discuss potential next steps.
RUBIC:
Excellent
Satisfactory
Needs Improvement
Not Evident
Introduction
Meets the
“Satisfactory” criteria and explains how addressing this issue might lead to better conditions
Succinctly identifies chosen issue/behavior, explains the history, pub ...
Global Events Scoring GuideCRITERIA NON-PERFORMANCE BASIC .docxwhittemorelucilla
Global Events Scoring Guide
CRITERIA NON-PERFORMANCE BASIC PROFICIENT DISTINGUISHED
Explain the
response to a global
event at the local
and national levels.
Does not explain the
response to a global
event at the local or
the national level.
Explains the response
to a global event at
either the local or the
national level, but not
both; or the
explanation does not
fully address the
response.
Explains the
response to a
global event at the
local and national
levels.
Explains the response to a
global event at the local
and national levels, and
describes how the
response impacted
outcomes.
Explain how social
attitudes and issues
of race, class, and/or
gender may impact
the response to a
global event.
Does not explain
how social attitudes
and issues of race,
class, and/or gender
may impact the
response to a global
event.
Explains how social
attitudes and issues of
race, class, and/or
gender may impact
the response to a
global event, but omits
key information or
critical aspects.
Explains how
social attitudes and
issues of race,
class, and/or
gender may impact
the response to a
global event.
Explains how social
attitudes and issues of
race, class, and/or gender
may impact the response
to a global event, providing
real-world examples that
add clarity and insight.
Explain the role of
international and
altruistic
organizations in
providing health
care services during
a global event.
Does not explain the
role of international
and/or altruistic
organizations in
providing health
care services during
a global event.
Explains the role of
either international or
altruistic organizations
in providing health
care services during a
global event, or the
explanation lacks key
elements.
Explains the role of
international and
altruistic
organizations in
providing health
care services
during a global
event.
Explains the role of
international and altruistic
organizations in providing
health care services during
a global event, and
considers how
professional nursing can
play a greater part within
the organizations.
Explain the role of
the professional
nurse in providing
health care services
related to global
events.
Does not explain the
role of the
professional nurse
in providing health
care services.
Explains the role of
the professional nurse
in providing health
care services, but
does not relate the
explanation to global
events; or the
explanation is missing
key elements.
Explains the role of
the professional
nurse in providing
health care
services related to
global events.
Explains the role of the
professional nurse in
providing health care
services related to global
events, addresses scope
of practice when working
outside the area of license,
and explores the
contribution of nursing to
positive outcomes.
Describe barriers to
health care services
during a global
event.
Does not identify
barriers to health ...
My topic is Global sexual violence Those is my search (The .docxhallettfaustina
My topic is:
Global sexual violence
Those is my search (
The United Nations Children ’s Fund (UNICEF) published a global child abuse research report on the 4th, pointing out that about 10% of girls under the age of 20 have been sexually assaulted or other compulsive sexual behaviors; more than half of children between the ages of 2-14 are often suffered Parents or guardians beaten; and about 20% of the murder victims worldwide are teenagers and children under 20 years old.
The vast majority of violent incidents come from people who interact daily with children, such as family members, peers, and partners. On the whole, the proportion of wars that harm children is not large; but in the context of armed conflicts and other humanitarian crises, domestic violence suffered by women and children will grow significantly.
Sexual violence is a serious public health problem, which can have a long or short profound impact on physical and mental health. For example, it may affect the ability to reproduce and increase fertility, increase the risk of sexually transmitted diseases, and may lead to suicide or self-mutilation. And other behaviors. During or after sexual violence, the victim's killing due to honorary murder is also part of sexual violence. Although women are the main victims of sexual violence, people of any age and gender may be harmed by sexual violence.)
Based on the 4+ academic articles identified in the "Literature Review" assignment, students will write an annotated bibliography that provides an outline of each article. An annotated bibliography provides a summary of an academic paper and relates the paper to one's own research topic.
For this assignment, you will write an annotated bibliography for
each
article you found during your literature search assignment. If any of those articles were
not
academic (i.e. published in an peer-reviewed scientific journal), you must find a replacement article that is academic.
Guidelines
Your annotated bibliography should include the following:
An introduction paragraph that tells your reader (a) your topic and focus of your research and (b) the general context of your topic.
Each annotation should include:
A full citation of the paper in APA style
Three paragraphs that summarizes, analyzes, and applies the source
The first paragraph
summarizes
the source by...
providing context of the source
outlining the thesis (main point) of the source
indicating the main finding of the paper
The second paragraph
analyzes
the source by explaining the benefits and limitations of the research
The third paragraph
applies
the source by explaining how the source's ideas, research, and information can be applied to your topic of study
Grading:
Below Sufficient (2-point)
Sufficient (4-points)
Above Sufficient (6-points)
Examples
Here's an example annotated bibliography from a student in a previous class who received full credit for this assignment.
Below, an exa.
Vikram Sarabhai was an Indian scientist who made significant contributions to India's nuclear and space programs. He founded several research institutions, including the Physical Research Laboratory and Indian Space Research Organisation. Under his leadership, India launched its first satellite and took initial steps towards developing nuclear power. Sarabhai played a pivotal role in establishing India as a leader in space research despite his early death at age 52. He received several prestigious awards for his scientific achievements and leadership.
CLASS ASSIGNMENTS (Choose OneWriting Project, Discussion Grou.docxbartholomeocoombs
CLASS ASSIGNMENTS (Choose One:
Writing Project, Discussion Group or Couple Enrichment):
Option #1:
WRITING
PROJECT
(Choose 1 out of the following 7 Topics)
:
Paper
heading
should include:
Student Name;
Student ID #;
and Section 001.
Pages must be:
typed and double-spaced:
12 point font;
1” margins.
It should be a minimum of 6 pages and is due on
March 30th
.
HARD COPY ONLY.
Choose 1 of the following 7 topics. Your paper should be divided into 2 sections.
Section 1: (2 -3 pages)
- “What Do You Think” - asks
you
to reflect and discuss the topic area.
Section 2: (3-4 pages)
– “What Does Research Tell Us” – asks you to discuss
your review
of the
literature, with appropriate references and bibliography, on the topic area.
PLEASE use the following headings within your paper:
Section 1: What Do You Think?
Section 2: What Does Research Tell Us?
1.
TOPIC 1
·
Section 1: What Do You Think?
:
Do you think that sex or violence on television influences how promiscuous or violent our society becomes? Do you think the sexual stereotypes in commercials and advertisements shape our attitudes toward gender relations? How do you think you have been influenced by the media?
·
Section 2: What Does Research Tell Us?
:
Discuss what research has revealed regarding the impact of sexually violent and degrading media on the attitudes and behaviors of men and women. What effect, if any, does this “exposure” have on intimate relationships?
2.
TOPIC 2
·
Section 1: What Do You Think?
:
Describe your ideal marriage/cohabitating partner and their characteristics (e.g. appearance, personality, and occupation). What circumstances or conflicts (if any) would lead you to consider a separation or divorce (e.g. infidelity, refusal to have children, disease, or cross-dressing)?
·
Section 2: What Does Research Tell Us?
:
After a review of the literature, discuss the factors that determine with whom we fall in love; and the principle factors involved in keeping a relationship strong.
3.
TOPIC 3
·
Section 1: What Do You Think?
:
Imagine that you have always been attracted emotionally and sexually to your own sex and that your family has rather traditional religious and conservative views. Would you tell your family about your attraction? If you were to disclose your sexual orientation to your family, how would you do it? What do you think their response would be?
·
Section 2: What Does Research Tell Us?
:
From your research, what are the steps that people can take to communicate to others about their sexual orientation? What is the process of “coming out”? Briefly discuss the social and psychological effects on people who are unable to disclose their sexual orientation or introduce a lifetime partner to family and friends.
4.
TOPIC 4:
·
Section 1: What Do You Think?
:
Both men and women may sometimes give unclear signals about whether they are willing to engage in sexual contact when they are in a potent.
Long-Term Care TodayDemographics and epidemiological transitions.docxSHIVA101531
Long-Term Care Today
Demographics and epidemiological transitions result in dramatic changes in the health needs of individuals throughout the globe. In recent times, there has been increase in the prevalence of long-term disability in the population—causing increasing need for long-term care services. In addition, the present developing world is experiencing an increase in the demand for long-term care services at a cost much lower than industrialized countries.
Prepare a report in a 3- to 4-page Microsoft Word document comparing the US long-term care system with the long-term care system of a developing country. Research Scholarly Library and the Internet to find relevant content.
Include the following information in your report:
· What are the chronic illness trends of each country?
· What is the incidence and prevalence of elderly consumers of long-term care in the United States as compared to your chosen developing country?
· How does each country expect these numbers to change in the next ten years?
· What are the main characteristics of the elderly population in both the countries? Is there any difference in the long-term health care needs of consumers in both the countries? Provide a rationale for your answer.
· Who are the institutional and non institutional caregivers in both the countries? Support your answer with relevant examples. Explain the factors that affect care giving in each country.
· Is there any difference in the status of quality of care of the elderly consumers in the United States as compared to the developing country?
· Is there any difference in the health care cost provided in the United States as compared to the developing country? Define any social support that may exist to cover health care in both countries.
Support your responses with examples.
Cite any sources in APA format.
15 INTERVIEW QUESTIONS
1. How do you feel about yourself? She cross that one
2. What are your experiences on your everyday interactions with the normal members of the society?
3. What are your everyday experiences with the deaf colleagues in the society?
4. What are your experiences with your family members?
5. How do you relate to your wife? (Married male adults) OR, how do you relate to your husband? (married female adults?)
6. need Q
7. How often do you interact with the members of the society that are not deaf?
8. How do you communicate with members of the society who do not know sign language?
9. What do you do if you encounter an individual who does not know how to communicate in sign language?
10. What was your experience when you were young?
11. How did you feel when you were with your peers when you were little?
12. How did you feel when your peers could not understand your situation when you were little?
13. What was your experience in your family during young age?
14. In case you were discriminated by your peers, how did you feel?
15. Do you remember any one time when you felt low self-esteem due to the treatment that you ...
DIRECTIONSIn this assignment, you will be exploring actual and p.docxlynettearnold46882
The document provides directions for completing an assignment on assessing children's functional health patterns. Students are instructed to:
1) Complete a functional health pattern assessment worksheet for toddlers, preschool-aged, and school-aged children.
2) Discuss Erikson's stages of child development as they relate to each age group.
3) Answer two short answer questions comparing assessments across age groups and how nurses approach children versus adults.
Guidelines are provided on what to include in the assessment for each functional health pattern. A rubric is also included to evaluate students' responses.
Why does teen pregnancy and sexually transmitted diseases remain hig.docxvelmakostizy
Why does teen pregnancy and sexually transmitted diseases remain high in the U.S.
What can healthcare providers do that decrease the rate of teen pregnancy and STD’s in the US?
* These questions should be researched and incorporated in the body of the paper and answered.
This is my introduction already done.
Adolescent Sex
Teen pregnancy and sexually transmitted diseases continue to be an important healthcare issue in the 20
th
century.
Although teen pregnancy rates have dropped there are still concerns and healthcare problems that are associated with teen pregnancy.
Often times they are afraid to discuss sex with their parents and deny will deny being sexually active at all.
There are problems that manifest with
adolescent pregnancy for the mother and often times the infants as well.
The high school drop out rate among pregnant high school students is approximated at about
70 percent and is cited as the number reason teens drop out prior to graduation
.
There is also an estimated $7 billion revenue cost associated with teen pregnancy in the United States alone.
[KD2]
The risk of young people engaging in early sexual intercourse is largely due to the lack of sexual education, peer pressure and social influences.
Chlamydial infection, gonorrhea, HIV/AIDS, primary and secondary syphilis, and hepatitis B virus infection are amid the highest reported STDs with chlamydia noted as the most dominate which is likely due to the fact that there is more vigorous testing.
Some of the other noted STDs are genital herpes, trichomoniasis, Chancroid, and HPV.
Often times and without any signs or symptoms present more than one pathogen is involved with sexually transmitted diseases. Typically the only environments in which there remain viable pathogens is the bodily fluids from the genitourinary tract requiring there to be intimate contact for them to be acquired.
Although it affects men and women chlamydia is predominately seen in young women and is the most common nationally known sexually transmitted disease in the U.S.
Bodily fluids from the genitourinary tract are typically the environments in which there remain viable pathogens, so intimate contact is generally required to obtain STDs.
Chlamydia infections are asymptomatic in most women and can be transmitted during childbirth with the
potential of a newborn developing pneumonia as a complication.
If it is not treated
chlamydia can spread to the uterus and fallopian tube creating further health problems and permanent damage to the reproductive system.
Teaching abstinence is the most affective way to prevent pregnancy and STDs but sexuality and curiosity of sex begins at a young age and exploration into sexuality is a natural part of personal development.
I feel it is our
[KD3]
role and responsibility as healthcare providers to provide adolescents and teens with the information and risk factors involved with having sex.
They need to be educated on contraceptives, pregnancy and S.
$60.00 Due 1213Theory Application PaperThe paper will co.docxaryan532920
$60.00 Due 12/13
Theory Application Paper
The paper will comprise of cited research on the effectiveness of the model(s) or theories related to your identified issue of HIV among homeless youth, a gap analysis, and a proposed intervention that would help fill the gap.
Guidelines for Submission: Submit a 10 page word document that uses 11-pt Times New Roman font with 1 inch margins. Utilize at least 10 references to support your claims. All citations and other formatting conventions should follow the most current version of AMA style.
TOPIC: HIV Among Homeless Youth in the US
Your paper needs to include the following:
· Introduction –Compete- see pages 4-5
1 Briefly review the chosen issue or behavior.
○ Explain the history, public health implication, affected population, and economic and/or social consequences.
○ State why the issue you chosen is an important one to address.
○ Explain how addressing this issue might lead to better conditions.
· Theories, Models, and Gap Analysis
1 Describe the different social and behavioral health models that people in the field have used to address this behavior/issue.
○ Identify a gap that still exists despite the current efforts in the field. What could be done to address the gap? What behavioral change must occur?
○ Support all claims with relevant and reputable resources and examples. You may want to reference the work done in your research summaries.
· Intervention
1 Propose a behavioral intervention that would help to fill the gap you have described above. This does not need to be an original intervention, you may choose an intervention that has already been proposed. The purpose is to propose an intervention that would best fill the gap you have identified.
■ You are not expected to provide an in depth proposal with all the details of the intervention.
■ For example: An intervention for school aged children who smoke may be an after school program to enhance positive interaction among peers.
○ Explain how your intervention utilizes the chosen theory/model. What specific components of the theory/model are being used in your intervention?
○ Support your proposed intervention with evidence from the literature. Reference the work completed in your research summaries.
○ Make a table/visual/figure that illustrates the relationship between your theory/model and the proposed intervention. This visual should show which components of the theory/model are being used and where in the intervention.
Conclusion
○ Summarize the major concepts from this paper.
○ How does your intervention achieve the desired behavioral change?
○ What limitations are there to your proposed plan?
○ Discuss potential next steps.
RUBIC:
Excellent
Satisfactory
Needs Improvement
Not Evident
Introduction
Meets the
“Satisfactory” criteria and explains how addressing this issue might lead to better conditions
Succinctly identifies chosen issue/behavior, explains the history, pub ...
Global Events Scoring GuideCRITERIA NON-PERFORMANCE BASIC .docxwhittemorelucilla
Global Events Scoring Guide
CRITERIA NON-PERFORMANCE BASIC PROFICIENT DISTINGUISHED
Explain the
response to a global
event at the local
and national levels.
Does not explain the
response to a global
event at the local or
the national level.
Explains the response
to a global event at
either the local or the
national level, but not
both; or the
explanation does not
fully address the
response.
Explains the
response to a
global event at the
local and national
levels.
Explains the response to a
global event at the local
and national levels, and
describes how the
response impacted
outcomes.
Explain how social
attitudes and issues
of race, class, and/or
gender may impact
the response to a
global event.
Does not explain
how social attitudes
and issues of race,
class, and/or gender
may impact the
response to a global
event.
Explains how social
attitudes and issues of
race, class, and/or
gender may impact
the response to a
global event, but omits
key information or
critical aspects.
Explains how
social attitudes and
issues of race,
class, and/or
gender may impact
the response to a
global event.
Explains how social
attitudes and issues of
race, class, and/or gender
may impact the response
to a global event, providing
real-world examples that
add clarity and insight.
Explain the role of
international and
altruistic
organizations in
providing health
care services during
a global event.
Does not explain the
role of international
and/or altruistic
organizations in
providing health
care services during
a global event.
Explains the role of
either international or
altruistic organizations
in providing health
care services during a
global event, or the
explanation lacks key
elements.
Explains the role of
international and
altruistic
organizations in
providing health
care services
during a global
event.
Explains the role of
international and altruistic
organizations in providing
health care services during
a global event, and
considers how
professional nursing can
play a greater part within
the organizations.
Explain the role of
the professional
nurse in providing
health care services
related to global
events.
Does not explain the
role of the
professional nurse
in providing health
care services.
Explains the role of
the professional nurse
in providing health
care services, but
does not relate the
explanation to global
events; or the
explanation is missing
key elements.
Explains the role of
the professional
nurse in providing
health care
services related to
global events.
Explains the role of the
professional nurse in
providing health care
services related to global
events, addresses scope
of practice when working
outside the area of license,
and explores the
contribution of nursing to
positive outcomes.
Describe barriers to
health care services
during a global
event.
Does not identify
barriers to health ...
My topic is Global sexual violence Those is my search (The .docxhallettfaustina
My topic is:
Global sexual violence
Those is my search (
The United Nations Children ’s Fund (UNICEF) published a global child abuse research report on the 4th, pointing out that about 10% of girls under the age of 20 have been sexually assaulted or other compulsive sexual behaviors; more than half of children between the ages of 2-14 are often suffered Parents or guardians beaten; and about 20% of the murder victims worldwide are teenagers and children under 20 years old.
The vast majority of violent incidents come from people who interact daily with children, such as family members, peers, and partners. On the whole, the proportion of wars that harm children is not large; but in the context of armed conflicts and other humanitarian crises, domestic violence suffered by women and children will grow significantly.
Sexual violence is a serious public health problem, which can have a long or short profound impact on physical and mental health. For example, it may affect the ability to reproduce and increase fertility, increase the risk of sexually transmitted diseases, and may lead to suicide or self-mutilation. And other behaviors. During or after sexual violence, the victim's killing due to honorary murder is also part of sexual violence. Although women are the main victims of sexual violence, people of any age and gender may be harmed by sexual violence.)
Based on the 4+ academic articles identified in the "Literature Review" assignment, students will write an annotated bibliography that provides an outline of each article. An annotated bibliography provides a summary of an academic paper and relates the paper to one's own research topic.
For this assignment, you will write an annotated bibliography for
each
article you found during your literature search assignment. If any of those articles were
not
academic (i.e. published in an peer-reviewed scientific journal), you must find a replacement article that is academic.
Guidelines
Your annotated bibliography should include the following:
An introduction paragraph that tells your reader (a) your topic and focus of your research and (b) the general context of your topic.
Each annotation should include:
A full citation of the paper in APA style
Three paragraphs that summarizes, analyzes, and applies the source
The first paragraph
summarizes
the source by...
providing context of the source
outlining the thesis (main point) of the source
indicating the main finding of the paper
The second paragraph
analyzes
the source by explaining the benefits and limitations of the research
The third paragraph
applies
the source by explaining how the source's ideas, research, and information can be applied to your topic of study
Grading:
Below Sufficient (2-point)
Sufficient (4-points)
Above Sufficient (6-points)
Examples
Here's an example annotated bibliography from a student in a previous class who received full credit for this assignment.
Below, an exa.
Vikram Sarabhai was an Indian scientist who made significant contributions to India's nuclear and space programs. He founded several research institutions, including the Physical Research Laboratory and Indian Space Research Organisation. Under his leadership, India launched its first satellite and took initial steps towards developing nuclear power. Sarabhai played a pivotal role in establishing India as a leader in space research despite his early death at age 52. He received several prestigious awards for his scientific achievements and leadership.
CLASS ASSIGNMENTS (Choose OneWriting Project, Discussion Grou.docxbartholomeocoombs
CLASS ASSIGNMENTS (Choose One:
Writing Project, Discussion Group or Couple Enrichment):
Option #1:
WRITING
PROJECT
(Choose 1 out of the following 7 Topics)
:
Paper
heading
should include:
Student Name;
Student ID #;
and Section 001.
Pages must be:
typed and double-spaced:
12 point font;
1” margins.
It should be a minimum of 6 pages and is due on
March 30th
.
HARD COPY ONLY.
Choose 1 of the following 7 topics. Your paper should be divided into 2 sections.
Section 1: (2 -3 pages)
- “What Do You Think” - asks
you
to reflect and discuss the topic area.
Section 2: (3-4 pages)
– “What Does Research Tell Us” – asks you to discuss
your review
of the
literature, with appropriate references and bibliography, on the topic area.
PLEASE use the following headings within your paper:
Section 1: What Do You Think?
Section 2: What Does Research Tell Us?
1.
TOPIC 1
·
Section 1: What Do You Think?
:
Do you think that sex or violence on television influences how promiscuous or violent our society becomes? Do you think the sexual stereotypes in commercials and advertisements shape our attitudes toward gender relations? How do you think you have been influenced by the media?
·
Section 2: What Does Research Tell Us?
:
Discuss what research has revealed regarding the impact of sexually violent and degrading media on the attitudes and behaviors of men and women. What effect, if any, does this “exposure” have on intimate relationships?
2.
TOPIC 2
·
Section 1: What Do You Think?
:
Describe your ideal marriage/cohabitating partner and their characteristics (e.g. appearance, personality, and occupation). What circumstances or conflicts (if any) would lead you to consider a separation or divorce (e.g. infidelity, refusal to have children, disease, or cross-dressing)?
·
Section 2: What Does Research Tell Us?
:
After a review of the literature, discuss the factors that determine with whom we fall in love; and the principle factors involved in keeping a relationship strong.
3.
TOPIC 3
·
Section 1: What Do You Think?
:
Imagine that you have always been attracted emotionally and sexually to your own sex and that your family has rather traditional religious and conservative views. Would you tell your family about your attraction? If you were to disclose your sexual orientation to your family, how would you do it? What do you think their response would be?
·
Section 2: What Does Research Tell Us?
:
From your research, what are the steps that people can take to communicate to others about their sexual orientation? What is the process of “coming out”? Briefly discuss the social and psychological effects on people who are unable to disclose their sexual orientation or introduce a lifetime partner to family and friends.
4.
TOPIC 4:
·
Section 1: What Do You Think?
:
Both men and women may sometimes give unclear signals about whether they are willing to engage in sexual contact when they are in a potent.
Note this is not my case scenario at all. it is just how i want mamit657720
The document discusses a mental health assessment of a 16-year-old boy named Shawn who was brought to an outpatient clinic by his mother. The practitioner must work to engage Shawn in the assessment since he did not want to be there. The assessment aims to understand the chief complaint, make a diagnosis, identify the cause of issues, and develop a treatment plan while also assessing risk of suicide or homicide. The practitioner maintained good eye contact and listened well to Shawn. Areas for improvement include exploring why Shawn does not like school, obtaining more information about Shawn's relationship with his mother, and using open-ended questions.
PERSONAL HEALTH AND WELLNESS........ DISCUSSION BOARD DUE THURSDAY.docxbartholomeocoombs
PERSONAL HEALTH AND WELLNESS........ DISCUSSION BOARD DUE THURSDAY
Healthy vs. Unhealthy Relationships
Consider this scenario: Carrie has been dating John for three years. In the first year of their relationship, they were blissful and happy. Spending almost every day together, they often talked about marriage. Carrie was so happy that she started eating healthier and exercising on a regular basis. By the end of the first year, the novelty of the relationship wore off, and John paid less attention to Carrie. She became more anxious and often questioned their commitment to each other, and her exercise routine decreased. As the couple rounded the third year, John hit Carrie during an argument after she dropped a fork on the floor. John was apologetic and promised it would never happen again. Since she still loved him, she agreed to forgive him and try and make the relationship work. How might this relationship affect personal health and wellness for either partner?
There are many types of relationships. Sibling-to-sibling, parent-to-child, colleague-to-colleague, to name a few. Within these various relationships, the dynamics can range from healthy to unhealthy and can affect personal health and wellness in various ways. People often have difficulty recognizing whether a relationship is healthy or unhealthy. This could lead to some unanticipated consequences. Think about what constitutes healthy and unhealthy relationships and how they can impact personal health and wellness.
To prepare
for this Discussion:
Review Chapter 5 in
Health: The Basics, 10
th
edition
.. Pay particular attention to what constitutes a healthy and unhealthy relationship.
Review Chapter 4 in
Health: The Basics, 10
th
edition
.. Focus on the intimate partner and interpersonal violence. Consider how you might prevent a violent or unhealthy relationship.
Review the multimedia piece “Dimensions of Health Wheel.” Pay particular attention to the impact relationships have on the dimensions of health for this week.
With these thoughts in mind:
By Day 4, post
an example of a healthy or unhealthy relationship. Then describe two factors that might contribute to a healthy or unhealthy relationship. Finally explain two ways a healthy or unhealthy relationship might impact personal health and wellness.
____________________________________________________________________________
PERSONAL HEALTH AND WELLNESS .... ASSIGNMENT DUE SUNDAY
Application: Personal Relationships and Spiritual Health
Personal relationships can be rewarding and, at times, challenging. Think back to this week’s Discussion and what constitutes a healthy or unhealthy relationship. Consider your own relationships and think about how they impact your personal health and wellness.
In addition to considering your relationships, think about your spiritual health. Spiritual health is characterized by subscribing to a way of life or “a belief in a supreme being or a specified way of living prescribed by a particular r.
Thanks for your work. Your submission contains an overview of the .docxtodd191
Thanks for your work. Your submission contains an overview of the simulation scenario that you worked on, and you have identified the intent of the scenario. You have also properly identified three elements from the PMBOK Guide that relate to the simulation. Also, you have properly documented your lessons learned and described your experience using the simulation tool. Please note, however, you were supposed to ‘capture a screen image of the confirmation page showing your total score for the scenario”. You have not provided this screenshot so I have not graded your work yet. “1” is not your grade and is only a placeholder for my own references. Please provide the screenshot for me to be able to finalize your grade. - You could have done a better job of identifying three elements from the PMBOK Guide that relate to the simulation by dedicating a section of your work and by describing these processes in more depth. For example, you could have chosen schedule management as a practice and highlight some of the main considerations in performing the simulation from the schedule management perspective. In the corresponding section of your work, you have not cited or directed incorporated any content from the PMBOK Guide. - I recommend not to cite a reference in the conclusion section. You could have done so by using and referencing it in previous sections. Please refrain from introducing a new concept or offering a statement that has not already been presented in the material leading up to the conclusion section. The general rule is that the main body of your narrative should include all the main arguments and key statements. The conclusion, on the other hand, should summarize main points made in the main body of your writing and creatively restate the ideas already presented. The conclusion is not intended to include new ideas and key points.
Soria 1
Victoria Soria
Dean Winther
English 101
31 March 2020
The Impact of Poverty on Education in America
Opening
Poverty is an element of sociological and economic total measure of an individual’s experience and social-economic position compared to others. Social-economic status is commonly broken down into three levels, these include low, middle and high class. When placing families in one of these classes, any of the three variables are likely to be assessed: occupation, education and income. Poverty is classified under low income and involves limited resources to meet basic needs. The level of poverty is approximately 15%, implying that about 1 in every 6 Americans are living in poverty. This slater translates that 1 in every 5 children in the United States is living in poverty. Further, it has been noted that 30% of children raised below poverty lines barely complete their high school education. In that light, children are one of the most hit by the implication of poverty and this is evidenced in their poor cognition and overall educational development.
Social-economic difference and education
Among o.
The document discusses leadership styles and behavioral perspectives in public health. It provides examples of leaders who used situational and emotional intelligence-based approaches to address health crises. These included "barefoot doctors" in early 20th century China who connected with rural communities, and a leader who established clinics in Burma for displaced populations. The document presents an assignment to analyze a public health leadership event through the lenses of various leadership theories.
SLA Default Written Assignment Grading Rubric 2013-2014 .docxbudabrooks46239
SLA Default Written Assignment Grading Rubric 2013-2014
Grading Rubric,
Written Assignments
2013-2014
Value for column and grade equivalent
Criteria F(0) F (11) D (13) C (15) B (17) A (20)
Writing Skills:
Grammar, spelling and
syntax are correct. Length
meets requirements for the
assignment.
No submission Significant number of
errors in grammar,
spelling and/or syntax per
page. Indicates a
significant lack of
proofreading effort. Does
not adhere to length
requirements.
Many errors in grammar,
spelling and/or syntax on
most pages. Some minor
effort at proofreading,
insufficient. Does not
adhere to length
requirements.
Rare errors in grammar,
spelling and/or syntax;
for example - fewer than
two per page. Overall,
some effort at
proofreading; meets
length requirements.
No obvious errors in
grammar, spelling and/or
syntax; for example-fewer
than one minor error per
page; meets length
requirements.
Essentially, no errors in
grammar, spelling or
syntax throughout the
entire document; meets
length requirements.
Development: Core theme
or thesis statement is
present along with
coherent, coordinated,
supported arguments
No submission 1) Paper has no
theme/thesis statement; 2)
Lacks identifiable
arguments and/or ideas
1) Paper’s core
theme/thesis statement is
difficult to identify; 2)
Rudimentary
development of
arguments and/or ideas
1) Paper is organized
around a core
theme/thesis statement; 2)
Identifiable development
of arguments and/or ideas
1) Paper is focused on a well
developed theme/thesis
statement; 2) Ideas and
arguments are clear and well
defined
1) Paper's theme/thesis
statement is completely
developed 2) the arguments
and ideas are clear, well
defined and comprehensive
Content: Paper contains
the appropriate quality and
quantity of well thought
out ideas to support and
address the topic as
required.
No submission Paper lacks the most
basic quality and quantity
of ideas to support and
address the topic as
required.
Paper contains poorly
developed ideas that
inconsistently support and
address the topic as
required.
Paper contains the
minimum quality and
quantity of ideas that
support the topic as
required.
Paper contains the
appropriate quality and
quantity of ideas to support
and address fully the topic as
required.
Paper contains high quality
ideas that are skillfully
used to support the topic
completely as required.
Conclusion: Paper
contains a well-developed
summary or conclusion
that builds on the
theme/thesis and the ideas
or arguments presented.
No submission Paper lacks a
summary/conclusion
drawn from stated ideas.
Paper has incorrect and/or
incomplete
summary/conclusion.
Paper has an adequate
summary/conclusion.
Paper has a convincing and
inclusive
summary/conclusion.
Paper has a cogent,
in.
Qualitative Article Review and CritiqueIn approximately 7-10 pjanekahananbw
Qualitative Article Review and Critique
In approximately 7-10 pages (including title page and references), address the following questions.
Title
After reading the entire article, do you think the title adequately describes the study? Does the title catch your attention? Please explain.
Abstract
Does the abstract contain the recommended content (see “Abstract,” pp. 314, in Yegidis et al.)? How difficult do you think it is to summarize so much information in 150–250 words? Please explain.
Introduction
Why did the authors conduct this study and write this article? What was the problem of interest or concern? Be specific. Use quotes and paraphrases with citations.What audience might be interested in this study?
Do you feel the problem is significant enough to warrant a journal article? Did you have a “so what” reaction? If so, why do you think it was accepted for publication? Please justify your position.
To what extent does the literature presented in the introduction help you understand the problem? How does the literature reviewed put the problem in context? Be specific.
Does the researcher indicate how this research is different from and/or similar to earlier ones reported in the literature? Summarize what this article intends to add to the knowledge base.
Do the authors state their research questions and/or hypotheses? What are the hypotheses or focused research questions?
Methods
What specific qualitative method is used? How does aqualitative research design correspond with the research questions? Can you determine whether the design was appropriate?
To what extent can the design answer the research questions? Elaborate.
What were the key concepts being explored in the study? What measures or observations were used in the research? Explain why you do, or do not, think that the methods used to collect the data are described clearly enough to allow for replication. Be specific and please elaborate.
How was research reactivity and bias managed in the study?
Explain whether or not information was provided concerning the credibility and trustworthiness of the measures or observations. Was this information adequate? Be specific.
What strategies were used to establish credibility?
Was there evidence of an audit trail and/or peer consultation on the project?
Sample
How were the participants recruited or selected for the study? What sampling strategy was used? Did the author(s) offer any justification for the sample size? Are you satisfied with the information reported about the sample? What questions might you have about the sample that were not addressed? Please be sure to provide an explanation for all of your answers.
Are the demographics of the participants (e.g., background characteristics such as age, race, etc.) described in sufficient detail? If so, how is the presentation of this descriptive data useful in evaluating the research? If not, please explain how that may affec ...
May Alice Randall wrote an article for The New.docxwrite5
Randall wrote an article noting that many black communities view overweight women as more beautiful. This perspective emphasizes the need for healthcare professionals to consider diverse cultural beliefs that impact patients' health. When building health histories, nurses must be aware of socioeconomic, spiritual, lifestyle, and other cultural factors that are relevant to patients' backgrounds in order to be sensitive and gather accurate information.
Case Study The Corning Journey to Performance Excellence Part 1 a.docxdrennanmicah
Case Study: The Corning Journey to Performance Excellence Part 1 and 2.
This week we have learned that performance excellence, sometimes referred to as business excellence, refers to increasing the consumer’s perception of value and a focused responsibility on the part of organizational members to quickly identify and correct problems. Operational/Performance excellence includes a series of intangible assets that will allow companies to continuously improve in areas of performance and quality that create a competitive advantage for organizations. This supports the theory that while the consumer may play a part in identifying quality issues, the organizational stakeholder has a responsibility for quality and is an important factor in performance and operational excellence. This is also aligned with the concept that all stakeholders share in the benefits of business and performance excellence.
This case study is an examination of the renewal of quality at Corning in the decade since 2002. It is a story of quality, innovation, operating excellence, and renewal, but above all, it is a story of leadership. The great companies overcome the obstacles, and the poor companies fall by the wayside.
Review the Case Study: The Corning Journey to Performance Excellence Part 1 and 2. (http://asq.org/knowledge-center/case-studies-corning.html)
Through research from sources provided in the course and from academic and scholarly resources outside of the course, evaluate and discuss the following elements:
1. Discuss the impact of leadership on improving and increasing the quality and performance excellence at Corning.
2. What elements of the Corning case study do you feel could be applied in your current or a former organization where you are or have been a member?
3. Discuss how Corning’s strategies meet the standards of continual improvement for performance excellence (Evans, 2017, pg. 33).
The paper should contain the following APA formatted elements:
1. Title Page.
2. Abstract.
3. Body of the essay (Your researched response).
4. Conclusion.
5. References Section.
The requirements below must be met for your paper to be accepted and graded:
1. Write a response between 750 – 1000 words for the body of the essay (The title page, abstract, conclusion and References section are not counted toward the word requirement.) (approximately 4-6 pages) using Microsoft Word in APA style.
2. Address all three elements fully.
3. Use font size 12 and 1” margins.
4. Use at least three references from outside the course material (You may use the academic resources included in the Week 8 Bibliography.) one reference must be from EBSCOhost. The course textbook and lectures can be used, but are not counted toward the five reference requirement.
5. References must come from sources such as, academic and scholarly journals and essays found in EBSCOhost, CNN, online newspapers such as, The Wall Street Journal, government websites, etc. Sources such as, Wikis, Yah.
2
Running head: PTSD
PTSD
9
Post-Traumatic Stress Disorder
Amber Hope
Argosy University
Post-Traumatic Stress Disorder
Strengths and Weaknesses of the Articles
Adamsons, K., & Johnson, S. (2013). An updated and expanded meta-analysis of nonresident fathering and child well-being. Journal of Family Psychology, 27(4),, 589.
The discussion of the article is conclusive despite its major focus on the topic. The article talks about the relationship between fathering and child well-being as a factor associated with the development of depression. When a child does not have a strong relationship with the father, it becomes easy for them to become depressed. However, the article is general and does not provide specific reasons to the development of depression on a child. The article lacks significant data regarding depression. Despite the above factor, it presents adequate data regarding the relationship between a father and a child in the process of growth and development.
Anderson, D., Cesur, R., & Tekin, E. (2015). Youth depression and future criminal behavior. Economic Inquiry, 53(1),, 294-317.
The weakness of the article is that it brings out criminal behavior as an outcome of youth depression. It is not all the time that depression may cause criminality among individuals. Some people who are depressed may visit rehabilitation centers. The strength of the article is that depression among youths may motivate them to commit future crimes. This is because they may find possible ways of eliminating it in their lives. Criminality may serve as the alternative for rehabilitation for those youths who do not like to be in places with specific policies, rules, and standards. Therefore, the article argues that it is likely that individuals may commit crimes due to depression.
Bargai, N., Ben-Shakhar, G., & Shalev, A. (2007). Posttraumatic stress disorder and depression in battered women: The mediating role of learned helplessness. Journal of Family Violence, 22, 267-275.
Depression is a mild form of Posttraumatic stress disorder. It brings out women as individuals who are affected by depression the most. However, the strength of the article is that women are the ones contributing to their personal depression and PTSD levels. This is because they have all the help they need but may choose to ignore it. The weakness is that it talks of women as the main reason but focuses on their self-help. Women are seen as the ones to tackle their issue. It does not focus on motivation from other individuals in the society to assist them in handling their depressive situation.
Baumeister, R., Vohs, K., Aaker, J., & Garbinsky, E. (2013). Some key differences between a happy life and a meaningful life. The Journal of Positive Psychology, 8(6),, 505-516.
Depression is the centerpiece of sadness among individuals. The article strengths focuses on the differences between people who live happy and meaningful l.
Teen Suicide Case Study Essay
Health Care Proposal Essay
Reserch Proposal Example
A Modest Proposal Summary
Research Proposal
Project Proposal Example
Project Proposal Essay
Sample Proposal Letter Essay
Crime Research Proposal
Investment Proposal Essay example
CASE STUDY PRESENTATIONPaper Submission RequirementsPapers s.docxwendolynhalbert
CASE STUDY PRESENTATION:
Paper Submission Requirements:
Papers should be typed, double-spaced, with 12-pt font and 1-inch
margins, and should conform to APA (American Psychological Association) Style, 6th Edition. Proper spelling, grammar, and punctuation are expected
This activity is designed for students to comprehensively
understand how to complete an interview, write up findings, and present information to the class.
Each student will be required to interview a child and/or parent between the ages of 2-18 years
of age. After completing interview, the student is required to write up a biopsychosocial report
based on interview (minimum of 5 pages) and create a 10-15 minutes powerpoint presentation
regarding client.
Case Study assignment is worth 30 points and is
due on February 3,2018.
Each student needs to submit the Biopsychosocial report, Powerpoint presentation, and
Informed Consent signed on the scheduled due date.
1. Biopsychosocial – should consist of the following sections in report: presenting problem, history of
problem, developmental/medical history, family history, educational/social history, special
considerations, mental status and client’s strengths, clinical findings, diagnostic impressions, and
tentative treatment recommendations.
(15 points)
2. Powerpoint presentation – should consist of the following sections for the presentation: demographic
information, presenting problem, developmental/medical, family history, educational/social history,
diagnosis, differential diagnosis, treatment, medication (if applicable), diversity issues, and ethical issues. (15 points)
Must include and will be graded on below.
Biopsychosocial
Report (15 pts)
Discussed presenting and history of problem
Developmental/Medical History reported
Family History is discussed
Educational/Social History reported
Special Considerations discussed
Mental Status and Client’s strengths reported
Clinical Findings is appropriate to history of problem
Diagnoses is appropriate to history of problem
Treatment recommendation is appropriate for diagnosis
Written clearly and concisely
No or few errors in grammar
No or few errors in punctuation
Provided adequate demographic information about the client
Maintained confidentiality of client’s name and characteristics
Discusses presenting problem in presentation
Developmental/Medical history discussed
Family History presented
Educational/Social History discussed
Drew correct conclusions relating to clinical diagnoses and
differential diagnoses of client
Treatment and Medication recommendation were appropriate for
diagnoses
Discussed diversity issues relating to client and therapist
Ethical issues relating working with client was reported
Presented information clearly and concisely
Student was able to answer questions about the presentation and
defend diagnoses
PHIL 101 Essay Grading Rubric
Student’s Name: Professor:
...
Reply 1 Effects of Illness on Womens RelationshipsIn addition.docxcarlt4
Reply 1 Effects of Illness on Women's Relationships
In addition to affecting the lives of those who are ill, illnesses may also profoundly affect the spouses or partners who care for those who are ill. Anxiety and depression may increase as caregivers adjust to new realities and expectations. On the other hand, intimacy and closeness may increase as partners solidify their relationships in the face of illness. Though every relationship is unique, there are some trends that can be seen across relationships when, for instance, in a heterosexual relationship the man is the caregiver, and alternatively when the women is the caregiver. Lesbian relationships, too, are impacted when one partner is ill, sometimes in similar patterns to heterosexual relationships, and sometimes in different ways.
To prepare for this Discussion, consider how illness might affect a life partner relationship under these different relationship configurations.
Women's Health
Reply 1– Effects of Illness on Women’s Relationships
In a relationship, when one becomes very ill and requires a caregiver, it can significantly impact the relationship. In some instances, it can make the relationship stronger, however, there are many challenges from the perspective of both male and female. Alexander and Wilz (2010) state that family caregivers have to develop coping skills to deal with issues that could arise daily. Taking care of someone poses different challenges, resulting in different types of stressors so caregivers need to be conscientious of those challenges to be prepared to deal with them when they come up. Additionally, being a caregiver for a loved one can be very taxing and cumbersome, resulting in decreased mental and physical health (Alexander & Wilz, 2010).
Fekete et al. (2007) states that emotional support has a significant influence on an individual with a chronic illness. Emotional support provides a more positive outlook for an individual, which, can impact their mental state and also influence their health (Fekete et al., 2007). Additionally, caregivers or spouses of individuals with chronic illnesses are more susceptible to health implications and psychological stress, resulting from lifestyles changes, assuming the responsibilities of their loved one, limited time for social events, and most importantly, lack of self-care (Fekete et al., 2007). Fekete et al. (2007) also states that women and men differ on how they support each other and how they interpret that support.
According to Umberson et al. (2016), various factors should be considered in thinking about how individuals interpret and respond to relationships. Social contexts influence the way in which men and women deal with illness. For example, men are typically encouraged to be strong, independent, and inattentive regarding physical illness or pain, therefore men are more likely to avoid accepting or looking for help whereas women are perceived to be delicate and feeble (Umberson et al., 2016)..
Explanatory Essay. College essay: An explanatory essayMari Howard
Narrative Essay: Explanatory essay example. Explanatory Essay Writing Guide - ensayoX. 023 Explanatory Essay Example Expository Samples Prompts 7th Grade .... School essay: Explanatory essay introduction. Explanatory Essay Example — Recent Posts. How to Write an Explanatory Essay and Get Maximum Grade. 003 Explanatory Essay Examples Example Sample Expository Framework L .... College essay: An explanatory essay. 23 Writing Explanatory Essays | Thoughtful Learning K-12. How to Write an Explanatory Essay | Full Guide by HandMadeWriting. Explanatory Essay Samples.
Narrative Essay: Explanatory essay example. Explanatory Essay Writing Guide - ensayoX. 023 Explanatory Essay Example Expository Samples Prompts 7th Grade .... School essay: Explanatory essay introduction. Explanatory Essay Example — Recent Posts. How to Write an Explanatory Essay and Get Maximum Grade. 003 Explanatory Essay Examples Example Sample Expository Framework L .... College essay: An explanatory essay. 23 Writing Explanatory Essays | Thoughtful Learning K-12. How to Write an Explanatory Essay | Full Guide by HandMadeWriting. Explanatory Essay Samples.
Introduction Ideally, program andor policy interventio.docxMargenePurnell14
Introduction Ideally, program and/or policy interventions must seek to address an identified challenge/gap in a given sector/segment of society (McDavid & Hawthorn, 2013). To enable stakeholders make informed decisions on what program/policy choices to make there is the need for information and such information can be gathered through a process known as evaluation – the outcome of an evaluation process creates/provides information and this information influences policy choices and/or programmatic interventions (McDavid & Hawthorn, 2013). In this post, I briefly describe the Mentoring Gang Involved-Youth Project with is being implemented by Roca Inc, a Massachusetts-based nonprofit working with young male adults from Boston, Chelsea, and Springfield Massachusetts. I also explain the type of evaluation employed in evaluating the Project and the kind of data used for the evaluation and I indicate whether comparisons were used. Description of the project According to the Justice Center: Council of State Governments (2012), the Mentoring-gang Involved-Youth Project, targets young male adults between the ages of 17 and 24 who are suffering from substance abuse and are in detention. The primary objective of the Project is to reduce incarceration rates and enhance the ability of participants to retain employment (Roca, 2016). Under the Project, it is recognized that participants lack healthy relationships that will help them say away from criminal and/or antisocial behavior hence under the program three types of mentoring support are offered (Justice Center: Council of State Governments, 2012). The Justice Center: Council of State Governments (2012) informs its readers that mentoring support, under the Project, extends to supporting participants get jobs and remain employed. The project proceeds under the philosophy that keeping participants occurred by positive activities steers them away from antisocial criminal behavior (Justice Center: Council of State Governments, 2012). Some of the mentors under the Project have served jail time and successfully reintegrated into the community and are deemed to be role models hence using them to mentor participants is seen as offering participants with real life examples of persons who were just like them and have managed to emancipate themselves from the hands of criminal/antisocial conduct and are living better lives. Cognitive-restructuring is the objective of the Project and it seeks to achieve this through skills development and behavioral change for/of participants (Roca, 2016). Where this Project successfully restructures the cognitive behavior of participants and they acquire skills and get employment, their economic situation will change and this will translate into economic development. According to Roca (2016) the Project runs for four years - the first two years focus on inculcating into participants behavioral change whilst the remaining period focuses on sustaining the positive ch.
INTRO TO PUBLIC ADMINISTRATIONCase Study 11 Who Brought Bern.docxMargenePurnell14
INTRO TO PUBLIC ADMINISTRATION
Case Study 11: Who Brought Bernadine Healy Down? Case Study 11: Who Brought Bernadine Healy Down? Questions for Case study 11 1.Identify and discuss the public service culture present in the case and explain why Wise argue that public service motivation is found more in the government than in private sector. 2.Discuss if the Healy’s motivation for accepting the Red Cross presidency is in line with the public service motives? 3.Discuss what the case study indicates about the modern complexities of professional personnel in the public setting? 4.Does the Wise reading offer some specific answers to contemporary problems of public personnel motivation? If so, how?
.
Introduction
GDD’s Results
Candidate’s Results
GDD/ Candidates Comparison
Recommendation
Purpose:
In the first assignment, students are given a scenario about Global Delivery Direct (GDD), a Norfolk, England medium-sized global delivery company that was started in 1968 by four college friends. . The purpose of this exercise is to see if you can identify the GDD leader in the potential candidates that will be hired to lead the new boutique services department.
Outcome Met by Completing This Assignment
use leadership theories, assessment tools, and an understanding of the role of ethics, values, and attitudes to evaluate and enhance personal leadership skills
Background:
Andrew Rockfish and the other owners have been looking for a competitive edge in the North American market that will translate well to the other divisions. A recent meeting of the owners resulted in the decision to target business organizations with custom services. The decision stems from recent feedback from customers that revealed that for GDD to anticipate the needs of their clients, suppliers and service vendors, the company needed to decrease the turnaround time in delivery and mailing of small packages and letters. Rockfish has decided to offer “boutique” services to its business customers. Catering to businesses will allow GDD to provide personal services that Fed Ex and UPS cannot offer. Customizing the services will allow GDD to increase prices while creating a new niche in the market. It was decided that the initial roll out of this idea would start in the US where an imminent threat from competition lies. Rockfish was on board with this idea and began a campaign among the rest of the company to find ideas that would help to encourage the new ‘Business First” strategic plan.
In response, a sales manager from the mid-west sales team brought this idea from their brainstorming session for Rockfish’s consideration. The sales manager proposed creating several mobile packing stores to bring customer service to businesses directly. GDD would not just pick up and deliver but they would also package. This model could be viewed as an UPS store on wheels. The team got the idea from a local delivery service that started a similar business as a Mail Store on Wheels and it seemed to be doing well. The mail company has five “Mail on Wheels” trucks and focuses on taking small business, not individuals away from the three local UPS and Kinko stores. After a financial review of the company, Rockfish decided to buy the business.
The mail business was started by a young entrepreneur, Adrian Cheng, who ran the business with the philosophy that “customers always get the best of our time and service”. Personal service, friendliness, and as much time as it takes to make the customer happy, was part of the mission statement. Employees were casually dressed and had no deadlines except those given by the customer. Cheng had about 45 employees and ran both.
IntroductionDefine the individual client or community populati.docxMargenePurnell14
Introduction
Define the individual client or community population.
This should be about 1-2 paragraphs that identify the client (or the organization).
In this section, for an A paper
, you will address the following elements:
Introduces the client or community population for whom the treatment or service plan is being developed,
Include cultural or diversity issues; also
Include the role of the social worker in supporting the client or population.
Include at least one reference that defines the importance of cultural sensitivity and the role of the social worker working with a client or organization.
Identified Issue/Situation
Describe the situation to be addressed that was identified by the client or the organization
In this section, for an A paper
, you will address the following elements:
Define the identifying issue, situation, or problem in a way that reflects client or community agency,
Discuss the cultural or diversity issues inherent in the client or community situation, and Reflects the interaction between the social worker and the client or community.
Include supporting literature from the course text or other related source.
Problem Statement
How did the client or the organization state the problem?
This should correspond to the Problem statement on the ASI Treatment Plan Template
Goals/Objectives to be Achieved
This should correspond to the Goals section of the ASI Treatment Plan Template.
In this section, for an A paper
, you will address the following elements:
Creates clearly defined objectives and goals with measurable outcomes that reflect the interaction between the social worker and the client or community.
Include literature that discusses how to define objectives and goals with measurable outcomes.
State the goals in measurable terms.
For example, “The client states a desire to quit smoking.” Or “The client states a desire to exercise more often.”
Measurable Goals
For example, the client who wants to quit smoking.
Measurable goals might be: To obtain a prescription for a nicotine patch by XXX date; to go for 3 days without a cigarette starting on XXX DATE; to call a hypnotherapist and find out about how to use hypnotherapy for changing cravings to smoke.”
Each goal should have a target completion date.
Interventions
Describe what the counselor will do to assist the client with achieving the defined goals.
Participation in Treatment Planning Process
What actions will the client (or organization) do to be involved in the plan of action?
Participation of Others in Goals and Plans
Who will the client (or organization) use to support their goals?
Indicators of Successful Completion
How will the client and counselor (or organization and manager) know that successful completion has occurred?
Parallels between Individual Treatment Plans
and Organizational Plans
Describe how an organizational plan would be the same or different from an individual treatment plan.
This is to .
Introduction to Public SpeakingWeek 6 AssignmentIn.docxMargenePurnell14
Introduction to Public Speaking
Week 6 Assignment
Informative Speech
It’s time to take what you've learned from all of your prior presentations and add an element of research to create your Informative Speech. You have to be cautious when choosing an Informative topic, as it’s easy to confuse the Informative Speech and a Persuasive Speech as the same thing. However an Informative Speech JUST provides information. The most basic informative speech is the kind that teaches us (much in the way the Demonstration Speech taught us) something detailed about a topic with which we are already familiar. For instance, we know George Washington was our first President, but a lot of people don't know much about his life prior to the military or serving in office. That would make for an interesting Informative Speech.
With an informative Speech, you’ll want to establish credibility by referencing and citing your materials. For example: "In the July 13, 2007 edition of the New York Times, John Smith said that George Washington suffered from depression as a young boy." It is critical that you discuss where you found your information in order to maintain your credibility.
A few parameters:
1. Your speech should be 5-10 minutes in length.
2. Feel free to incorporate visual aids. This is not mandatory, but it makes for a better presentation, as we learned last week.
3. Cite a minimum of two different sources for your materials. Do NOT use Wikipedia as a source. Please copy and paste these sources into the ‘comments’ area when submitting or submit as a paper. I will evaluate your sources.
4. Be sure to have a good introduction, a body that contains at least three main points (with appropriate supporting evidence) and a conclusion that appropriately wraps everything up.
As always, you may draft your speech word for word, but be very careful not to simply read from your paper! We want eye contact and emotion! Good luck with this assignment and have fun!
.
Introduction about topic Intelligence phaseWhat is the .docxMargenePurnell14
Introduction about topic
Intelligence phase
:
What is the problem (opportunity)
Classify the problem (opportunity)
structurt ,unstructuer ,semi structur
i think our search structure
Decompose the problem (opportunity).
The effects of noise on student performance
The effects of temprutur on student performance
The effects of light on student performance
.
Introduction A short summary is provided on the case subject and.docxMargenePurnell14
Introduction
A short summary is provided on the case subject and discuss Effat University ICT infrastructure sustainability in 3 pillars (Planet, People, and Profit).
Analysis
(due April 16)
Study the ICT infrastructure of Effat University and provide an analysis of its performance in terms of Green Measures of Performance (Green MoPs).
.
Introduction Illiteracy is the inability to read and write a.docxMargenePurnell14
Introduction
Illiteracy is the inability to read and write at an adequate level of proficiency that is critical for communication. Illiterate adults are unable to use printed and written information to function in the society so as to achieve one’s goals and also to develop one’s potential.
According to an international nonprofit ProLiteracy in 2003, there are 36 million adults in the United States alone. This potential includes a broad range of information-processing skills that one can use daily in school and at the community as a whole. Adult illiteracy has become a societal problem because illiterate people can never fully utilize writing and reading skills to make use of their fully potential in the world. The thesis statement of adult illiteracy involves reasons why it identified as a societal problem; the solutions proposed to solve this problem and the statistical information of adult literacy as the global societal problem.
Different types of society exist. These types of illiteracy are technological illiteracy, mathematical illiteracy, visual illiteracy, school illiteracy, community illiteracy and personal illiteracy. All these types of illiteracy are caused by various reasons. These reasons are summarized in the following discussion.
Causes of Adult Illiteracy
People are usually mistaken about illiteracy. School illiteracy is overvalued to the extent that many adults have started to believe the act of reading and writing are the only important things in school. It is this type of reasoning that make many adults less interested in wanting to gain more knowledge and see things beyond the negative images. This has become one of the main reasons why adult illiteracy has increased in the world over the last few years.
Another reason for adult illiteracy is the misuse of groups. Some people tend to agree with the argument that can make one believe that he or she is weak as a reader and he or she won’t be able to achieve literacy even after finishing school. This type of thinking lowers someone’s self-esteem and self-confidence meaning that the person will not bother to seek literacy help. People’s reading attitude are influential in literacy behaviors. According to McKenna in 2001, reading attitudes are influenced by factors such as a person’s social experiences with reading, one’s personal experiences, the cultural norms about reading, cultural norms and the learner’s preferences about reading. Attitude is associated with unwillingness to read. Every learning experience that a child has in school will at some point determine how that child will determine to learn. The learners who have had negative experiences in school will come to view school and learning in total as a bad experience that. This disengagement spreads over to adults. An adult learner who has negative perceptions about school would not want to be associated with it. These learners never get interested in educational process because they don’t see it as valuabl.
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Similar to Critical Review Grading RubricKINE 3353 Health and the Huma
Note this is not my case scenario at all. it is just how i want mamit657720
The document discusses a mental health assessment of a 16-year-old boy named Shawn who was brought to an outpatient clinic by his mother. The practitioner must work to engage Shawn in the assessment since he did not want to be there. The assessment aims to understand the chief complaint, make a diagnosis, identify the cause of issues, and develop a treatment plan while also assessing risk of suicide or homicide. The practitioner maintained good eye contact and listened well to Shawn. Areas for improvement include exploring why Shawn does not like school, obtaining more information about Shawn's relationship with his mother, and using open-ended questions.
PERSONAL HEALTH AND WELLNESS........ DISCUSSION BOARD DUE THURSDAY.docxbartholomeocoombs
PERSONAL HEALTH AND WELLNESS........ DISCUSSION BOARD DUE THURSDAY
Healthy vs. Unhealthy Relationships
Consider this scenario: Carrie has been dating John for three years. In the first year of their relationship, they were blissful and happy. Spending almost every day together, they often talked about marriage. Carrie was so happy that she started eating healthier and exercising on a regular basis. By the end of the first year, the novelty of the relationship wore off, and John paid less attention to Carrie. She became more anxious and often questioned their commitment to each other, and her exercise routine decreased. As the couple rounded the third year, John hit Carrie during an argument after she dropped a fork on the floor. John was apologetic and promised it would never happen again. Since she still loved him, she agreed to forgive him and try and make the relationship work. How might this relationship affect personal health and wellness for either partner?
There are many types of relationships. Sibling-to-sibling, parent-to-child, colleague-to-colleague, to name a few. Within these various relationships, the dynamics can range from healthy to unhealthy and can affect personal health and wellness in various ways. People often have difficulty recognizing whether a relationship is healthy or unhealthy. This could lead to some unanticipated consequences. Think about what constitutes healthy and unhealthy relationships and how they can impact personal health and wellness.
To prepare
for this Discussion:
Review Chapter 5 in
Health: The Basics, 10
th
edition
.. Pay particular attention to what constitutes a healthy and unhealthy relationship.
Review Chapter 4 in
Health: The Basics, 10
th
edition
.. Focus on the intimate partner and interpersonal violence. Consider how you might prevent a violent or unhealthy relationship.
Review the multimedia piece “Dimensions of Health Wheel.” Pay particular attention to the impact relationships have on the dimensions of health for this week.
With these thoughts in mind:
By Day 4, post
an example of a healthy or unhealthy relationship. Then describe two factors that might contribute to a healthy or unhealthy relationship. Finally explain two ways a healthy or unhealthy relationship might impact personal health and wellness.
____________________________________________________________________________
PERSONAL HEALTH AND WELLNESS .... ASSIGNMENT DUE SUNDAY
Application: Personal Relationships and Spiritual Health
Personal relationships can be rewarding and, at times, challenging. Think back to this week’s Discussion and what constitutes a healthy or unhealthy relationship. Consider your own relationships and think about how they impact your personal health and wellness.
In addition to considering your relationships, think about your spiritual health. Spiritual health is characterized by subscribing to a way of life or “a belief in a supreme being or a specified way of living prescribed by a particular r.
Thanks for your work. Your submission contains an overview of the .docxtodd191
Thanks for your work. Your submission contains an overview of the simulation scenario that you worked on, and you have identified the intent of the scenario. You have also properly identified three elements from the PMBOK Guide that relate to the simulation. Also, you have properly documented your lessons learned and described your experience using the simulation tool. Please note, however, you were supposed to ‘capture a screen image of the confirmation page showing your total score for the scenario”. You have not provided this screenshot so I have not graded your work yet. “1” is not your grade and is only a placeholder for my own references. Please provide the screenshot for me to be able to finalize your grade. - You could have done a better job of identifying three elements from the PMBOK Guide that relate to the simulation by dedicating a section of your work and by describing these processes in more depth. For example, you could have chosen schedule management as a practice and highlight some of the main considerations in performing the simulation from the schedule management perspective. In the corresponding section of your work, you have not cited or directed incorporated any content from the PMBOK Guide. - I recommend not to cite a reference in the conclusion section. You could have done so by using and referencing it in previous sections. Please refrain from introducing a new concept or offering a statement that has not already been presented in the material leading up to the conclusion section. The general rule is that the main body of your narrative should include all the main arguments and key statements. The conclusion, on the other hand, should summarize main points made in the main body of your writing and creatively restate the ideas already presented. The conclusion is not intended to include new ideas and key points.
Soria 1
Victoria Soria
Dean Winther
English 101
31 March 2020
The Impact of Poverty on Education in America
Opening
Poverty is an element of sociological and economic total measure of an individual’s experience and social-economic position compared to others. Social-economic status is commonly broken down into three levels, these include low, middle and high class. When placing families in one of these classes, any of the three variables are likely to be assessed: occupation, education and income. Poverty is classified under low income and involves limited resources to meet basic needs. The level of poverty is approximately 15%, implying that about 1 in every 6 Americans are living in poverty. This slater translates that 1 in every 5 children in the United States is living in poverty. Further, it has been noted that 30% of children raised below poverty lines barely complete their high school education. In that light, children are one of the most hit by the implication of poverty and this is evidenced in their poor cognition and overall educational development.
Social-economic difference and education
Among o.
The document discusses leadership styles and behavioral perspectives in public health. It provides examples of leaders who used situational and emotional intelligence-based approaches to address health crises. These included "barefoot doctors" in early 20th century China who connected with rural communities, and a leader who established clinics in Burma for displaced populations. The document presents an assignment to analyze a public health leadership event through the lenses of various leadership theories.
SLA Default Written Assignment Grading Rubric 2013-2014 .docxbudabrooks46239
SLA Default Written Assignment Grading Rubric 2013-2014
Grading Rubric,
Written Assignments
2013-2014
Value for column and grade equivalent
Criteria F(0) F (11) D (13) C (15) B (17) A (20)
Writing Skills:
Grammar, spelling and
syntax are correct. Length
meets requirements for the
assignment.
No submission Significant number of
errors in grammar,
spelling and/or syntax per
page. Indicates a
significant lack of
proofreading effort. Does
not adhere to length
requirements.
Many errors in grammar,
spelling and/or syntax on
most pages. Some minor
effort at proofreading,
insufficient. Does not
adhere to length
requirements.
Rare errors in grammar,
spelling and/or syntax;
for example - fewer than
two per page. Overall,
some effort at
proofreading; meets
length requirements.
No obvious errors in
grammar, spelling and/or
syntax; for example-fewer
than one minor error per
page; meets length
requirements.
Essentially, no errors in
grammar, spelling or
syntax throughout the
entire document; meets
length requirements.
Development: Core theme
or thesis statement is
present along with
coherent, coordinated,
supported arguments
No submission 1) Paper has no
theme/thesis statement; 2)
Lacks identifiable
arguments and/or ideas
1) Paper’s core
theme/thesis statement is
difficult to identify; 2)
Rudimentary
development of
arguments and/or ideas
1) Paper is organized
around a core
theme/thesis statement; 2)
Identifiable development
of arguments and/or ideas
1) Paper is focused on a well
developed theme/thesis
statement; 2) Ideas and
arguments are clear and well
defined
1) Paper's theme/thesis
statement is completely
developed 2) the arguments
and ideas are clear, well
defined and comprehensive
Content: Paper contains
the appropriate quality and
quantity of well thought
out ideas to support and
address the topic as
required.
No submission Paper lacks the most
basic quality and quantity
of ideas to support and
address the topic as
required.
Paper contains poorly
developed ideas that
inconsistently support and
address the topic as
required.
Paper contains the
minimum quality and
quantity of ideas that
support the topic as
required.
Paper contains the
appropriate quality and
quantity of ideas to support
and address fully the topic as
required.
Paper contains high quality
ideas that are skillfully
used to support the topic
completely as required.
Conclusion: Paper
contains a well-developed
summary or conclusion
that builds on the
theme/thesis and the ideas
or arguments presented.
No submission Paper lacks a
summary/conclusion
drawn from stated ideas.
Paper has incorrect and/or
incomplete
summary/conclusion.
Paper has an adequate
summary/conclusion.
Paper has a convincing and
inclusive
summary/conclusion.
Paper has a cogent,
in.
Qualitative Article Review and CritiqueIn approximately 7-10 pjanekahananbw
Qualitative Article Review and Critique
In approximately 7-10 pages (including title page and references), address the following questions.
Title
After reading the entire article, do you think the title adequately describes the study? Does the title catch your attention? Please explain.
Abstract
Does the abstract contain the recommended content (see “Abstract,” pp. 314, in Yegidis et al.)? How difficult do you think it is to summarize so much information in 150–250 words? Please explain.
Introduction
Why did the authors conduct this study and write this article? What was the problem of interest or concern? Be specific. Use quotes and paraphrases with citations.What audience might be interested in this study?
Do you feel the problem is significant enough to warrant a journal article? Did you have a “so what” reaction? If so, why do you think it was accepted for publication? Please justify your position.
To what extent does the literature presented in the introduction help you understand the problem? How does the literature reviewed put the problem in context? Be specific.
Does the researcher indicate how this research is different from and/or similar to earlier ones reported in the literature? Summarize what this article intends to add to the knowledge base.
Do the authors state their research questions and/or hypotheses? What are the hypotheses or focused research questions?
Methods
What specific qualitative method is used? How does aqualitative research design correspond with the research questions? Can you determine whether the design was appropriate?
To what extent can the design answer the research questions? Elaborate.
What were the key concepts being explored in the study? What measures or observations were used in the research? Explain why you do, or do not, think that the methods used to collect the data are described clearly enough to allow for replication. Be specific and please elaborate.
How was research reactivity and bias managed in the study?
Explain whether or not information was provided concerning the credibility and trustworthiness of the measures or observations. Was this information adequate? Be specific.
What strategies were used to establish credibility?
Was there evidence of an audit trail and/or peer consultation on the project?
Sample
How were the participants recruited or selected for the study? What sampling strategy was used? Did the author(s) offer any justification for the sample size? Are you satisfied with the information reported about the sample? What questions might you have about the sample that were not addressed? Please be sure to provide an explanation for all of your answers.
Are the demographics of the participants (e.g., background characteristics such as age, race, etc.) described in sufficient detail? If so, how is the presentation of this descriptive data useful in evaluating the research? If not, please explain how that may affec ...
May Alice Randall wrote an article for The New.docxwrite5
Randall wrote an article noting that many black communities view overweight women as more beautiful. This perspective emphasizes the need for healthcare professionals to consider diverse cultural beliefs that impact patients' health. When building health histories, nurses must be aware of socioeconomic, spiritual, lifestyle, and other cultural factors that are relevant to patients' backgrounds in order to be sensitive and gather accurate information.
Case Study The Corning Journey to Performance Excellence Part 1 a.docxdrennanmicah
Case Study: The Corning Journey to Performance Excellence Part 1 and 2.
This week we have learned that performance excellence, sometimes referred to as business excellence, refers to increasing the consumer’s perception of value and a focused responsibility on the part of organizational members to quickly identify and correct problems. Operational/Performance excellence includes a series of intangible assets that will allow companies to continuously improve in areas of performance and quality that create a competitive advantage for organizations. This supports the theory that while the consumer may play a part in identifying quality issues, the organizational stakeholder has a responsibility for quality and is an important factor in performance and operational excellence. This is also aligned with the concept that all stakeholders share in the benefits of business and performance excellence.
This case study is an examination of the renewal of quality at Corning in the decade since 2002. It is a story of quality, innovation, operating excellence, and renewal, but above all, it is a story of leadership. The great companies overcome the obstacles, and the poor companies fall by the wayside.
Review the Case Study: The Corning Journey to Performance Excellence Part 1 and 2. (http://asq.org/knowledge-center/case-studies-corning.html)
Through research from sources provided in the course and from academic and scholarly resources outside of the course, evaluate and discuss the following elements:
1. Discuss the impact of leadership on improving and increasing the quality and performance excellence at Corning.
2. What elements of the Corning case study do you feel could be applied in your current or a former organization where you are or have been a member?
3. Discuss how Corning’s strategies meet the standards of continual improvement for performance excellence (Evans, 2017, pg. 33).
The paper should contain the following APA formatted elements:
1. Title Page.
2. Abstract.
3. Body of the essay (Your researched response).
4. Conclusion.
5. References Section.
The requirements below must be met for your paper to be accepted and graded:
1. Write a response between 750 – 1000 words for the body of the essay (The title page, abstract, conclusion and References section are not counted toward the word requirement.) (approximately 4-6 pages) using Microsoft Word in APA style.
2. Address all three elements fully.
3. Use font size 12 and 1” margins.
4. Use at least three references from outside the course material (You may use the academic resources included in the Week 8 Bibliography.) one reference must be from EBSCOhost. The course textbook and lectures can be used, but are not counted toward the five reference requirement.
5. References must come from sources such as, academic and scholarly journals and essays found in EBSCOhost, CNN, online newspapers such as, The Wall Street Journal, government websites, etc. Sources such as, Wikis, Yah.
2
Running head: PTSD
PTSD
9
Post-Traumatic Stress Disorder
Amber Hope
Argosy University
Post-Traumatic Stress Disorder
Strengths and Weaknesses of the Articles
Adamsons, K., & Johnson, S. (2013). An updated and expanded meta-analysis of nonresident fathering and child well-being. Journal of Family Psychology, 27(4),, 589.
The discussion of the article is conclusive despite its major focus on the topic. The article talks about the relationship between fathering and child well-being as a factor associated with the development of depression. When a child does not have a strong relationship with the father, it becomes easy for them to become depressed. However, the article is general and does not provide specific reasons to the development of depression on a child. The article lacks significant data regarding depression. Despite the above factor, it presents adequate data regarding the relationship between a father and a child in the process of growth and development.
Anderson, D., Cesur, R., & Tekin, E. (2015). Youth depression and future criminal behavior. Economic Inquiry, 53(1),, 294-317.
The weakness of the article is that it brings out criminal behavior as an outcome of youth depression. It is not all the time that depression may cause criminality among individuals. Some people who are depressed may visit rehabilitation centers. The strength of the article is that depression among youths may motivate them to commit future crimes. This is because they may find possible ways of eliminating it in their lives. Criminality may serve as the alternative for rehabilitation for those youths who do not like to be in places with specific policies, rules, and standards. Therefore, the article argues that it is likely that individuals may commit crimes due to depression.
Bargai, N., Ben-Shakhar, G., & Shalev, A. (2007). Posttraumatic stress disorder and depression in battered women: The mediating role of learned helplessness. Journal of Family Violence, 22, 267-275.
Depression is a mild form of Posttraumatic stress disorder. It brings out women as individuals who are affected by depression the most. However, the strength of the article is that women are the ones contributing to their personal depression and PTSD levels. This is because they have all the help they need but may choose to ignore it. The weakness is that it talks of women as the main reason but focuses on their self-help. Women are seen as the ones to tackle their issue. It does not focus on motivation from other individuals in the society to assist them in handling their depressive situation.
Baumeister, R., Vohs, K., Aaker, J., & Garbinsky, E. (2013). Some key differences between a happy life and a meaningful life. The Journal of Positive Psychology, 8(6),, 505-516.
Depression is the centerpiece of sadness among individuals. The article strengths focuses on the differences between people who live happy and meaningful l.
Teen Suicide Case Study Essay
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CASE STUDY PRESENTATIONPaper Submission RequirementsPapers s.docxwendolynhalbert
CASE STUDY PRESENTATION:
Paper Submission Requirements:
Papers should be typed, double-spaced, with 12-pt font and 1-inch
margins, and should conform to APA (American Psychological Association) Style, 6th Edition. Proper spelling, grammar, and punctuation are expected
This activity is designed for students to comprehensively
understand how to complete an interview, write up findings, and present information to the class.
Each student will be required to interview a child and/or parent between the ages of 2-18 years
of age. After completing interview, the student is required to write up a biopsychosocial report
based on interview (minimum of 5 pages) and create a 10-15 minutes powerpoint presentation
regarding client.
Case Study assignment is worth 30 points and is
due on February 3,2018.
Each student needs to submit the Biopsychosocial report, Powerpoint presentation, and
Informed Consent signed on the scheduled due date.
1. Biopsychosocial – should consist of the following sections in report: presenting problem, history of
problem, developmental/medical history, family history, educational/social history, special
considerations, mental status and client’s strengths, clinical findings, diagnostic impressions, and
tentative treatment recommendations.
(15 points)
2. Powerpoint presentation – should consist of the following sections for the presentation: demographic
information, presenting problem, developmental/medical, family history, educational/social history,
diagnosis, differential diagnosis, treatment, medication (if applicable), diversity issues, and ethical issues. (15 points)
Must include and will be graded on below.
Biopsychosocial
Report (15 pts)
Discussed presenting and history of problem
Developmental/Medical History reported
Family History is discussed
Educational/Social History reported
Special Considerations discussed
Mental Status and Client’s strengths reported
Clinical Findings is appropriate to history of problem
Diagnoses is appropriate to history of problem
Treatment recommendation is appropriate for diagnosis
Written clearly and concisely
No or few errors in grammar
No or few errors in punctuation
Provided adequate demographic information about the client
Maintained confidentiality of client’s name and characteristics
Discusses presenting problem in presentation
Developmental/Medical history discussed
Family History presented
Educational/Social History discussed
Drew correct conclusions relating to clinical diagnoses and
differential diagnoses of client
Treatment and Medication recommendation were appropriate for
diagnoses
Discussed diversity issues relating to client and therapist
Ethical issues relating working with client was reported
Presented information clearly and concisely
Student was able to answer questions about the presentation and
defend diagnoses
PHIL 101 Essay Grading Rubric
Student’s Name: Professor:
...
Reply 1 Effects of Illness on Womens RelationshipsIn addition.docxcarlt4
Reply 1 Effects of Illness on Women's Relationships
In addition to affecting the lives of those who are ill, illnesses may also profoundly affect the spouses or partners who care for those who are ill. Anxiety and depression may increase as caregivers adjust to new realities and expectations. On the other hand, intimacy and closeness may increase as partners solidify their relationships in the face of illness. Though every relationship is unique, there are some trends that can be seen across relationships when, for instance, in a heterosexual relationship the man is the caregiver, and alternatively when the women is the caregiver. Lesbian relationships, too, are impacted when one partner is ill, sometimes in similar patterns to heterosexual relationships, and sometimes in different ways.
To prepare for this Discussion, consider how illness might affect a life partner relationship under these different relationship configurations.
Women's Health
Reply 1– Effects of Illness on Women’s Relationships
In a relationship, when one becomes very ill and requires a caregiver, it can significantly impact the relationship. In some instances, it can make the relationship stronger, however, there are many challenges from the perspective of both male and female. Alexander and Wilz (2010) state that family caregivers have to develop coping skills to deal with issues that could arise daily. Taking care of someone poses different challenges, resulting in different types of stressors so caregivers need to be conscientious of those challenges to be prepared to deal with them when they come up. Additionally, being a caregiver for a loved one can be very taxing and cumbersome, resulting in decreased mental and physical health (Alexander & Wilz, 2010).
Fekete et al. (2007) states that emotional support has a significant influence on an individual with a chronic illness. Emotional support provides a more positive outlook for an individual, which, can impact their mental state and also influence their health (Fekete et al., 2007). Additionally, caregivers or spouses of individuals with chronic illnesses are more susceptible to health implications and psychological stress, resulting from lifestyles changes, assuming the responsibilities of their loved one, limited time for social events, and most importantly, lack of self-care (Fekete et al., 2007). Fekete et al. (2007) also states that women and men differ on how they support each other and how they interpret that support.
According to Umberson et al. (2016), various factors should be considered in thinking about how individuals interpret and respond to relationships. Social contexts influence the way in which men and women deal with illness. For example, men are typically encouraged to be strong, independent, and inattentive regarding physical illness or pain, therefore men are more likely to avoid accepting or looking for help whereas women are perceived to be delicate and feeble (Umberson et al., 2016)..
Explanatory Essay. College essay: An explanatory essayMari Howard
Narrative Essay: Explanatory essay example. Explanatory Essay Writing Guide - ensayoX. 023 Explanatory Essay Example Expository Samples Prompts 7th Grade .... School essay: Explanatory essay introduction. Explanatory Essay Example — Recent Posts. How to Write an Explanatory Essay and Get Maximum Grade. 003 Explanatory Essay Examples Example Sample Expository Framework L .... College essay: An explanatory essay. 23 Writing Explanatory Essays | Thoughtful Learning K-12. How to Write an Explanatory Essay | Full Guide by HandMadeWriting. Explanatory Essay Samples.
Narrative Essay: Explanatory essay example. Explanatory Essay Writing Guide - ensayoX. 023 Explanatory Essay Example Expository Samples Prompts 7th Grade .... School essay: Explanatory essay introduction. Explanatory Essay Example — Recent Posts. How to Write an Explanatory Essay and Get Maximum Grade. 003 Explanatory Essay Examples Example Sample Expository Framework L .... College essay: An explanatory essay. 23 Writing Explanatory Essays | Thoughtful Learning K-12. How to Write an Explanatory Essay | Full Guide by HandMadeWriting. Explanatory Essay Samples.
Similar to Critical Review Grading RubricKINE 3353 Health and the Huma (14)
Introduction Ideally, program andor policy interventio.docxMargenePurnell14
Introduction Ideally, program and/or policy interventions must seek to address an identified challenge/gap in a given sector/segment of society (McDavid & Hawthorn, 2013). To enable stakeholders make informed decisions on what program/policy choices to make there is the need for information and such information can be gathered through a process known as evaluation – the outcome of an evaluation process creates/provides information and this information influences policy choices and/or programmatic interventions (McDavid & Hawthorn, 2013). In this post, I briefly describe the Mentoring Gang Involved-Youth Project with is being implemented by Roca Inc, a Massachusetts-based nonprofit working with young male adults from Boston, Chelsea, and Springfield Massachusetts. I also explain the type of evaluation employed in evaluating the Project and the kind of data used for the evaluation and I indicate whether comparisons were used. Description of the project According to the Justice Center: Council of State Governments (2012), the Mentoring-gang Involved-Youth Project, targets young male adults between the ages of 17 and 24 who are suffering from substance abuse and are in detention. The primary objective of the Project is to reduce incarceration rates and enhance the ability of participants to retain employment (Roca, 2016). Under the Project, it is recognized that participants lack healthy relationships that will help them say away from criminal and/or antisocial behavior hence under the program three types of mentoring support are offered (Justice Center: Council of State Governments, 2012). The Justice Center: Council of State Governments (2012) informs its readers that mentoring support, under the Project, extends to supporting participants get jobs and remain employed. The project proceeds under the philosophy that keeping participants occurred by positive activities steers them away from antisocial criminal behavior (Justice Center: Council of State Governments, 2012). Some of the mentors under the Project have served jail time and successfully reintegrated into the community and are deemed to be role models hence using them to mentor participants is seen as offering participants with real life examples of persons who were just like them and have managed to emancipate themselves from the hands of criminal/antisocial conduct and are living better lives. Cognitive-restructuring is the objective of the Project and it seeks to achieve this through skills development and behavioral change for/of participants (Roca, 2016). Where this Project successfully restructures the cognitive behavior of participants and they acquire skills and get employment, their economic situation will change and this will translate into economic development. According to Roca (2016) the Project runs for four years - the first two years focus on inculcating into participants behavioral change whilst the remaining period focuses on sustaining the positive ch.
INTRO TO PUBLIC ADMINISTRATIONCase Study 11 Who Brought Bern.docxMargenePurnell14
INTRO TO PUBLIC ADMINISTRATION
Case Study 11: Who Brought Bernadine Healy Down? Case Study 11: Who Brought Bernadine Healy Down? Questions for Case study 11 1.Identify and discuss the public service culture present in the case and explain why Wise argue that public service motivation is found more in the government than in private sector. 2.Discuss if the Healy’s motivation for accepting the Red Cross presidency is in line with the public service motives? 3.Discuss what the case study indicates about the modern complexities of professional personnel in the public setting? 4.Does the Wise reading offer some specific answers to contemporary problems of public personnel motivation? If so, how?
.
Introduction
GDD’s Results
Candidate’s Results
GDD/ Candidates Comparison
Recommendation
Purpose:
In the first assignment, students are given a scenario about Global Delivery Direct (GDD), a Norfolk, England medium-sized global delivery company that was started in 1968 by four college friends. . The purpose of this exercise is to see if you can identify the GDD leader in the potential candidates that will be hired to lead the new boutique services department.
Outcome Met by Completing This Assignment
use leadership theories, assessment tools, and an understanding of the role of ethics, values, and attitudes to evaluate and enhance personal leadership skills
Background:
Andrew Rockfish and the other owners have been looking for a competitive edge in the North American market that will translate well to the other divisions. A recent meeting of the owners resulted in the decision to target business organizations with custom services. The decision stems from recent feedback from customers that revealed that for GDD to anticipate the needs of their clients, suppliers and service vendors, the company needed to decrease the turnaround time in delivery and mailing of small packages and letters. Rockfish has decided to offer “boutique” services to its business customers. Catering to businesses will allow GDD to provide personal services that Fed Ex and UPS cannot offer. Customizing the services will allow GDD to increase prices while creating a new niche in the market. It was decided that the initial roll out of this idea would start in the US where an imminent threat from competition lies. Rockfish was on board with this idea and began a campaign among the rest of the company to find ideas that would help to encourage the new ‘Business First” strategic plan.
In response, a sales manager from the mid-west sales team brought this idea from their brainstorming session for Rockfish’s consideration. The sales manager proposed creating several mobile packing stores to bring customer service to businesses directly. GDD would not just pick up and deliver but they would also package. This model could be viewed as an UPS store on wheels. The team got the idea from a local delivery service that started a similar business as a Mail Store on Wheels and it seemed to be doing well. The mail company has five “Mail on Wheels” trucks and focuses on taking small business, not individuals away from the three local UPS and Kinko stores. After a financial review of the company, Rockfish decided to buy the business.
The mail business was started by a young entrepreneur, Adrian Cheng, who ran the business with the philosophy that “customers always get the best of our time and service”. Personal service, friendliness, and as much time as it takes to make the customer happy, was part of the mission statement. Employees were casually dressed and had no deadlines except those given by the customer. Cheng had about 45 employees and ran both.
IntroductionDefine the individual client or community populati.docxMargenePurnell14
Introduction
Define the individual client or community population.
This should be about 1-2 paragraphs that identify the client (or the organization).
In this section, for an A paper
, you will address the following elements:
Introduces the client or community population for whom the treatment or service plan is being developed,
Include cultural or diversity issues; also
Include the role of the social worker in supporting the client or population.
Include at least one reference that defines the importance of cultural sensitivity and the role of the social worker working with a client or organization.
Identified Issue/Situation
Describe the situation to be addressed that was identified by the client or the organization
In this section, for an A paper
, you will address the following elements:
Define the identifying issue, situation, or problem in a way that reflects client or community agency,
Discuss the cultural or diversity issues inherent in the client or community situation, and Reflects the interaction between the social worker and the client or community.
Include supporting literature from the course text or other related source.
Problem Statement
How did the client or the organization state the problem?
This should correspond to the Problem statement on the ASI Treatment Plan Template
Goals/Objectives to be Achieved
This should correspond to the Goals section of the ASI Treatment Plan Template.
In this section, for an A paper
, you will address the following elements:
Creates clearly defined objectives and goals with measurable outcomes that reflect the interaction between the social worker and the client or community.
Include literature that discusses how to define objectives and goals with measurable outcomes.
State the goals in measurable terms.
For example, “The client states a desire to quit smoking.” Or “The client states a desire to exercise more often.”
Measurable Goals
For example, the client who wants to quit smoking.
Measurable goals might be: To obtain a prescription for a nicotine patch by XXX date; to go for 3 days without a cigarette starting on XXX DATE; to call a hypnotherapist and find out about how to use hypnotherapy for changing cravings to smoke.”
Each goal should have a target completion date.
Interventions
Describe what the counselor will do to assist the client with achieving the defined goals.
Participation in Treatment Planning Process
What actions will the client (or organization) do to be involved in the plan of action?
Participation of Others in Goals and Plans
Who will the client (or organization) use to support their goals?
Indicators of Successful Completion
How will the client and counselor (or organization and manager) know that successful completion has occurred?
Parallels between Individual Treatment Plans
and Organizational Plans
Describe how an organizational plan would be the same or different from an individual treatment plan.
This is to .
Introduction to Public SpeakingWeek 6 AssignmentIn.docxMargenePurnell14
Introduction to Public Speaking
Week 6 Assignment
Informative Speech
It’s time to take what you've learned from all of your prior presentations and add an element of research to create your Informative Speech. You have to be cautious when choosing an Informative topic, as it’s easy to confuse the Informative Speech and a Persuasive Speech as the same thing. However an Informative Speech JUST provides information. The most basic informative speech is the kind that teaches us (much in the way the Demonstration Speech taught us) something detailed about a topic with which we are already familiar. For instance, we know George Washington was our first President, but a lot of people don't know much about his life prior to the military or serving in office. That would make for an interesting Informative Speech.
With an informative Speech, you’ll want to establish credibility by referencing and citing your materials. For example: "In the July 13, 2007 edition of the New York Times, John Smith said that George Washington suffered from depression as a young boy." It is critical that you discuss where you found your information in order to maintain your credibility.
A few parameters:
1. Your speech should be 5-10 minutes in length.
2. Feel free to incorporate visual aids. This is not mandatory, but it makes for a better presentation, as we learned last week.
3. Cite a minimum of two different sources for your materials. Do NOT use Wikipedia as a source. Please copy and paste these sources into the ‘comments’ area when submitting or submit as a paper. I will evaluate your sources.
4. Be sure to have a good introduction, a body that contains at least three main points (with appropriate supporting evidence) and a conclusion that appropriately wraps everything up.
As always, you may draft your speech word for word, but be very careful not to simply read from your paper! We want eye contact and emotion! Good luck with this assignment and have fun!
.
Introduction about topic Intelligence phaseWhat is the .docxMargenePurnell14
Introduction about topic
Intelligence phase
:
What is the problem (opportunity)
Classify the problem (opportunity)
structurt ,unstructuer ,semi structur
i think our search structure
Decompose the problem (opportunity).
The effects of noise on student performance
The effects of temprutur on student performance
The effects of light on student performance
.
Introduction A short summary is provided on the case subject and.docxMargenePurnell14
Introduction
A short summary is provided on the case subject and discuss Effat University ICT infrastructure sustainability in 3 pillars (Planet, People, and Profit).
Analysis
(due April 16)
Study the ICT infrastructure of Effat University and provide an analysis of its performance in terms of Green Measures of Performance (Green MoPs).
.
Introduction Illiteracy is the inability to read and write a.docxMargenePurnell14
Introduction
Illiteracy is the inability to read and write at an adequate level of proficiency that is critical for communication. Illiterate adults are unable to use printed and written information to function in the society so as to achieve one’s goals and also to develop one’s potential.
According to an international nonprofit ProLiteracy in 2003, there are 36 million adults in the United States alone. This potential includes a broad range of information-processing skills that one can use daily in school and at the community as a whole. Adult illiteracy has become a societal problem because illiterate people can never fully utilize writing and reading skills to make use of their fully potential in the world. The thesis statement of adult illiteracy involves reasons why it identified as a societal problem; the solutions proposed to solve this problem and the statistical information of adult literacy as the global societal problem.
Different types of society exist. These types of illiteracy are technological illiteracy, mathematical illiteracy, visual illiteracy, school illiteracy, community illiteracy and personal illiteracy. All these types of illiteracy are caused by various reasons. These reasons are summarized in the following discussion.
Causes of Adult Illiteracy
People are usually mistaken about illiteracy. School illiteracy is overvalued to the extent that many adults have started to believe the act of reading and writing are the only important things in school. It is this type of reasoning that make many adults less interested in wanting to gain more knowledge and see things beyond the negative images. This has become one of the main reasons why adult illiteracy has increased in the world over the last few years.
Another reason for adult illiteracy is the misuse of groups. Some people tend to agree with the argument that can make one believe that he or she is weak as a reader and he or she won’t be able to achieve literacy even after finishing school. This type of thinking lowers someone’s self-esteem and self-confidence meaning that the person will not bother to seek literacy help. People’s reading attitude are influential in literacy behaviors. According to McKenna in 2001, reading attitudes are influenced by factors such as a person’s social experiences with reading, one’s personal experiences, the cultural norms about reading, cultural norms and the learner’s preferences about reading. Attitude is associated with unwillingness to read. Every learning experience that a child has in school will at some point determine how that child will determine to learn. The learners who have had negative experiences in school will come to view school and learning in total as a bad experience that. This disengagement spreads over to adults. An adult learner who has negative perceptions about school would not want to be associated with it. These learners never get interested in educational process because they don’t see it as valuabl.
Intro to Quality Management Week 3Air Bag Recall.docxMargenePurnell14
Intro to Quality Management Week 3
Air Bag Recall
Assignment
Review the article “Blow Out” from this week’s reading assignment. This article pertains to the recall of air bag products. Assume you are the manager for a large automotive company that will be using air bags in your products. What risk assessment tools will you use in order to ensure that the product being installed into your vehicles meets safety standards in order to avoid a recall? Use your course materials and outside research to generate a solid analysis on why these methods would be helpful. Your analysis should be supported by research.
Directions for obtaining the file: Login to the Grantham University library by clicking on the Resources tab from the main page. You will then log into EBSCOHost. Once you have accessed the database, simply copy and paste the title of the article and press enter to search and you should now have the file accessible to review.
The requirements below must be met for your paper to be accepted and graded:
•Write between 750 – 1,250 words (approximately 3 – 5 pages) using Microsoft Word in APA style, see example below.
•Use font size 12 and 1” margins.
•Include cover page and reference page.
•At least 80% of your paper must be original content/writing.
•No more than 20% of your content/information may come from references.
•Use at least three references from outside the course material, one reference must be from EBSCOhost. Text book, lectures, and other materials in the course may be used, but are not counted toward the three reference requirement.
•Cite all reference material (data, dates, graphs, quotes, paraphrased words, values, etc.) in the paper and list on a reference page in APA style.
Article
Section:
Features
Business: Cars
Keywords: Safety; Automotive industry; Driving; Accidents; Brain; Congress; Design; Regulations; Vehicles; Weight; Fariello; Cars
Air bags are meant to save lives. Now a massive recall shows how they sometimes can turn deadly
Forensic Investigator Sal Fariello, whose job is to deconstruct car crashes, has witnessed a catalog of carnage caused by air bags over the past two decades. In his collection, there is a photo of a woman who has been horribly scarred by an inflating air bag. There's an X-ray of a driver's broken wrists snapped in the "fling zone" of an air bag that mashed both arms from a 10-and-2 position into the car's roof. He can cite numerous drivers who suffered torn aortas or lacerated brain stems, all the result of being "punched" by an air bag inflating at 200 m.p.h. (322 km/h). "What's sitting in the front of the steering wheel is an explosive device," explains Fariello, the author of Airbag Injuries: Causation & Federal Regulation. "Nasty, unexpected events can occur."
None have been nastier than the injuries and deaths caused by exploding inflators in air bags made by automotive supplier Takata Corp., based in Tokyo. Its air bags have .
Intro to Quality Management Week 3Air Bag RecallAssignment.docxMargenePurnell14
Intro to Quality Management Week 3
Air Bag Recall
Assignment
Review the article “Blow Out” from this week’s reading assignment. This article pertains to the recall of air bag products. Assume you are the manager for a large automotive company that will be using air bags in your products. What risk assessment tools will you use in order to ensure that the product being installed into your vehicles meets safety standards in order to avoid a recall? Use your course materials and outside research to generate a solid analysis on why these methods would be helpful. Your analysis should be supported by research.
Directions for obtaining the file: Login to the Grantham University library by clicking on the Resources tab from the main page. You will then log into EBSCOHost. Once you have accessed the database, simply copy and paste the title of the article and press enter to search and you should now have the file accessible to review.
The requirements below must be met for your paper to be accepted and graded:
•Write between 750 – 1,250 words (approximately 3 – 5 pages) using Microsoft Word in APA style, see example below.
•Use font size 12 and 1” margins.
•Include cover page and reference page.
•At least 80% of your paper must be original content/writing.
•No more than 20% of your content/information may come from references.
•Use at least three references from outside the course material, one reference must be from EBSCOhost. Text book, lectures, and other materials in the course may be used, but are not counted toward the three reference requirement.
•Cite all reference material (data, dates, graphs, quotes, paraphrased words, values, etc.) in the paper and list on a reference page in APA style.
Article
Section:
Features
Business: Cars
Keywords: Safety; Automotive industry; Driving; Accidents; Brain; Congress; Design; Regulations; Vehicles; Weight; Fariello; Cars
Air bags are meant to save lives. Now a massive recall shows how they sometimes can turn deadly
Forensic Investigator Sal Fariello, whose job is to deconstruct car crashes, has witnessed a catalog of carnage caused by air bags over the past two decades. In his collection, there is a photo of a woman who has been horribly scarred by an inflating air bag. There's an X-ray of a driver's broken wrists snapped in the "fling zone" of an air bag that mashed both arms from a 10-and-2 position into the car's roof. He can cite numerous drivers who suffered torn aortas or lacerated brain stems, all the result of being "punched" by an air bag inflating at 200 m.p.h. (322 km/h). "What's sitting in the front of the steering wheel is an explosive device," explains Fariello, the author of Airbag Injuries: Causation & Federal Regulation. "Nasty, unexpected events can occur."
None have been nastier than the injuries and deaths caused by exploding inflators in air bags made by automotive supplier Takata Corp., based in Tokyo. Its air bags have been blamed for killing five motorists in.
INTERVIEW WITH AMERICAN INDIAN COMMUNITY PRACTITIONERSResourcesD.docxMargenePurnell14
INTERVIEW WITH AMERICAN INDIAN COMMUNITY PRACTITIONERS
Resources
Discussion Participation Scoring Guide
.
Interview With American Indian Community Practitioners
Interview with Betty Laverdure
LAUNCH INTERVIEW
|
Transcript
Interviews With American Indian Community Practitioners
Interview with Denise Levy
LAUNCH INTERVIEW
|
Transcript
Values, communication, beliefs, economics, clothing, assumptions, and interpretation are all part of cultural dynamics. Understanding this, review the interviews with American Indian community practitioners. Listen for their expectations toward culturally appropriate ways in which to communicate and work with tribal communities.
Provide a synopsis of the interviews and address the following questions.
How do cultural dynamics impact collaboration?
What are the cultural dynamics at play?
How will you use the information to better understand working with American Indian communities?
.
Interview Each team member should interview an educator about his.docxMargenePurnell14
Interview:
Each team member should interview an educator about his or her philosophy of education.
Consider
the following questions regarding the challenges facing education today:
Where do they think education is headed in the future?
How have their own life experiences shaped their current philosophy regarding education?
Ask 6 questions including the two above.
.
IntroductionRisk management is critical to protect organization.docxMargenePurnell14
Introduction
:
Risk management is critical to protect organizational assets and to ensure compliance with laws and regulations. Many individuals and departments in organizations are involved in risk management; this is especially true when creating a risk management plan.
You, as an employee of YieldMore, are asked to create a risk management plan for the organization.
Scenario
:
In order to help protect the company and ensure it maintains compliance with laws and regulations, senior management at YieldMore has decided to develop a formal risk management plan.
As an employee of YieldMore, your team has been given the task of creating a risk management plan for the organization.
Tasks
:
You will initiate a kick-off meeting to discuss YieldMore’s risk management plan with your team.
Review the responsibilities associated with your assigned role.
Explain the specific responsibilities of your assigned role within the project.
Explain your role and the roles of the other team members to senior management.
.
Interview two different individuals regarding their positions in soc.docxMargenePurnell14
Interview two different individuals regarding their positions in society. Analyze their responses regarding:
Identify each person’s class, race, and gender.
What role has class, race, and gender played in their lives? How do you see these stratifiers as playing a role, even if the interviewee is unaware of it?
Apply one of the sociological perspectives (structural-functional, social-conflict, or symbolic-interaction) to the individuals’ lives. Why did you choose this particular perspective? How does it explain each person’s life and life choices?
What are some the benefits and limitations to using interview as a research methodology?
Analyze each person’s components of culture (language, symbols, material objects, and behaviors) and relate them to his/her stratified position in society.
Please post your completed paper in the
M5: Assignment 1 Dropbox
.
Assignment 1 Grading Criteria
Maximum Points
Described each person’s class, race, and gender.
40
Evaluated the role of social stratification.
.
Internet ExerciseVisit the homepage of Microsoft at www.micros.docxMargenePurnell14
Internet Exercise
Visit the homepage of Microsoft at www.microsoft.com. Access the annual report for 2012. Find the footnotes to the statements and read the disclosures in the note titled Contingencies. Regarding the events described, do you think Microsoft is providing adequate disclosure to its stockholders?
.
Interpersonal Violence Against Women, The Role of Men by Martin Schw.docxMargenePurnell14
Interpersonal Violence Against Women, The Role of Men by Martin Schwartz and Walter DeKeseredy.
Respond to questions 1-3 at the end of the reading.
1- How is ininate partner violence a "male" issue?
2- how dose a patriarchal society perpetuate violence against women?
3- what type of programming and interventions are necessary to stop violence against women?
.
Internet of Vehicles-ProjectIntroduction - what you plan t.docxMargenePurnell14
Internet of Vehicles-Project
Introduction - what you plan to accomplish and why, include an overview of the situation or
organization and what the situation/problem is that you intend to improve - usually 1-2 pages) Cite and support all content appropriately
o
Methodology is a research paper about Action Research, 2-3 pages (include reasons and justification for approach), minimum of five (5) professional references
Reserved for hifsa shaukat
.
Interview an ELL instructor from a Title I school about how assessme.docxMargenePurnell14
Interview an ELL instructor from a Title I school about how assessment is used for placement. You may interview one of the instructors that you have observed during your observations for this course. Inquire also about how placement is determined for both special education and gifted ELLs. Your questions might include (but should not be limited to) the following:
What are the indicators of exceptionality a classroom teacher should look for when a student also has a language barrier?
How can informal as well as formal assessment results factor into placement?
What role do parents and teachers have in placement?
What are some primary factors that are exhibited in underachievement that may not necessarily signal special education needs?
How are changes among individual ELL proficiency levels over the course of the school year accounted for?
How are diagnostic, formative, and summative assessments integrated for ELLs in mainstream classrooms?
What are the benefits of the SIOP protocol for native English speakers as well as those for whom English is an additional language?
Consolidate your findings in a 750-word essay, supporting your findings with at least three current sources from your readings and the GCU Library to support your reasoning.
.
INTERNATIONAL JOURNAL OF INFORMATION SECURITY SCIENCE Walid.docxMargenePurnell14
This document provides an overview of standards for information security risk management, highlighting challenges in implementing assessments and drivers for adopting standards. It analyzes frameworks including ISO 27001, ISO 27002, ISO 27005, ITIL, COBIT, Risk IT, Basel II, PCI DSS, and OCTAVE. While these frameworks provide guidance, there is no single best solution, and organizations face challenges selecting and properly implementing a framework given their unique needs and resources. The document concludes more research is needed to guide selection of the most appropriate framework.
International Finance Please respond to the followingBased on.docxMargenePurnell14
"International Finance"
Please respond to the following:
Based on the lecture and Webtext materials, address the following:
The IMF and World Bank are the world’s two leading lending institutions, but much of their monetary assistance disappears once it enters the banking systems of developing countries. Cite concrete evidence that supports the assertion that much assistance to developing countries is simply stolen by officials. Determine other main factors that account for the misuse of these funds.
.
The simplified electron and muon model, Oscillating Spacetime: The Foundation...RitikBhardwaj56
Discover the Simplified Electron and Muon Model: A New Wave-Based Approach to Understanding Particles delves into a groundbreaking theory that presents electrons and muons as rotating soliton waves within oscillating spacetime. Geared towards students, researchers, and science buffs, this book breaks down complex ideas into simple explanations. It covers topics such as electron waves, temporal dynamics, and the implications of this model on particle physics. With clear illustrations and easy-to-follow explanations, readers will gain a new outlook on the universe's fundamental nature.
How to Manage Your Lost Opportunities in Odoo 17 CRMCeline George
Odoo 17 CRM allows us to track why we lose sales opportunities with "Lost Reasons." This helps analyze our sales process and identify areas for improvement. Here's how to configure lost reasons in Odoo 17 CRM
A Strategic Approach: GenAI in EducationPeter Windle
Artificial Intelligence (AI) technologies such as Generative AI, Image Generators and Large Language Models have had a dramatic impact on teaching, learning and assessment over the past 18 months. The most immediate threat AI posed was to Academic Integrity with Higher Education Institutes (HEIs) focusing their efforts on combating the use of GenAI in assessment. Guidelines were developed for staff and students, policies put in place too. Innovative educators have forged paths in the use of Generative AI for teaching, learning and assessments leading to pockets of transformation springing up across HEIs, often with little or no top-down guidance, support or direction.
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A review of the growth of the Israel Genealogy Research Association Database Collection for the last 12 months. Our collection is now passed the 3 million mark and still growing. See which archives have contributed the most. See the different types of records we have, and which years have had records added. You can also see what we have for the future.
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This slide is special for master students (MIBS & MIFB) in UUM. Also useful for readers who are interested in the topic of contemporary Islamic banking.
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Critical Review Grading RubricKINE 3353 Health and the Huma
1. Critical Review Grading Rubric
KINE 3353: Health and the Human Condition in the Global
Community
Fall 2020
Criteria
Ratings
Overview of the chapter
2 pts
Excellent
Reflects a full understanding of all key concepts and discusses
main arguments. Takes about 1/3 of the page. Ends with a
strong thesis that acknowledges both strengths and limitations.
1 pts
Satisfactory
Reflects a moderate understanding of all key concepts and
arguments. Takes about 1/3 of the page. Thesis does not
acknowledge both strengths and limitations.
0 pts
Needs Improvement
Overview is either too long or too short and does not accurately
summarize the text. Does not end with a thesis statement or
does not acknowledge either strengths or weaknesses.
Evaluation of Strengths & Weaknesses
2 pts
Excellent
Critically evaluates the text’s arguments and assumptions,
discussing its strengths and weaknesses using appropriate
evidence and examples. Synthesizes information and does not
merely list. About 1/3rd of a page.
1 pts
Satisfactory
2. Adequately evaluates the arguments made. Discusses strengths
and weaknesses but does not synthesize the information (instead
listing) and provides adequate examples. About 1/3rd of a page.
0 pts
Needs Improvement
Does not evaluate either the strengths or weaknesses of the text.
Too long or too short.
Conclusion: General Impressions or Recommendations
2 pts
Excellent
Discusses the text’s contribution to public health and any
recommendations for improvement. Proficiently supports
recommendations made and closing arguments.
1 pts
Satisfactory
Concludes with only either public health contributions or
recommendations. Adequately supports recommendations for
improvement and closing arguments.
0 pts
Needs Improvement
Does not discuss the text’s contribution to public health nor
makes any recommendations for improvement.
Two Key Questions
2 pts
Excellent
At least two thoughtful questions are posed which provoke
further thought AND at least one relevant external source is
cited.
1 pts
Satisfactory
Only one thoughtful question is posed which provokes further
thought, no external sources are cited, or one external source is
cited with no questions posed.
0 pts
Needs Improvement
No questions are posed nor are any external sources cited.
3. Writing, Grammar & APA Format
2 pts
Excellent
Written in APA style using Zotero, in 11-point Times New
Roman font, one-inch margins, double-spaced, and paginated
with no errors. No spelling or grammar mistakes. 1 page or
more.
1 pts
Satisfactory
Written in APA style using Zotero, in 11-point Times New
Roman font, one-inch margins, double-spaced, and paginated
with a few errors. A few spelling or grammar mistakes. 1 page
or more.
0 pts
Needs Improvement
Not written in APA style, in 11-point Times New Roman font,
one-inch margins, double-spaced, and paginated or with many
errors. Does not use Zotero. Many spelling or grammar
mistakes. Less than 1 page. An assignment with 30% or more in
Unicheck will automatically receive a grade of zero.
1
Chapter 5: Education and Empowerment.
Chapter 5 addresses various aspects of health and how
inequality plays out. In chapter five, the focus is on Education
and Empowerment across multiple subjects. The author seeks to
4. deconstruct and demystify education's perception regarding its
roles, gender perspectives, and relation to health and well -
being. The chapter is structured on how education creates
empowerment through the concept of gender, empowerment,
health, and addressing the several forms of inequality. The
author understands the structural myths that have overtaken
gender-based education inequalities and how misconceptions
override education regarding better pay and wealth
accumulation. The chapter is structured in terms of health,
gender, education, fertility reduction, especially in developing
countries, and child survival (Marmot, 2019). Education and
empowerment are closely interrelated. According to the author,
an educated child enhances its survival, improved health and
awareness, and self-protection initiatives. Marmot also proposes
the measures of addressing structural inequality, with the
Finland model being proposed.
The author has a clear outline, structure, and model of
addressing education-based misconceptions attached to gender
and its roles regarding the chapter's strengths. Marmot's
pertinent question is on the importance of education to parents,
children, and society concerning their health. Thus, the article
uses typical case studies in Finland to benchmark the
understanding of inequality methods and strategies. The author
also creates an objective approach to how education is related to
health, gender, and inequality across different aspects of
society. Marmot's chapter on education and empowerment has
an insightful, simple, and detailed assessment of various factors
associated with education and health. Education is viewed as a
tool that is more than just improved pay. The author appreciates
its role concerning awareness of risk factors, gender biases, and
inequalities.
However, the chapter has shortcomings regarding the
complexity of the correlation between education and health in
terms of gender. There is no clear clarity on which models the
author uses in comparing Finland's approach to addressing
5. inequality to any other specific country. Thus, the vagueness
creates confusion in connecting the variables. The weakness is
also in the more extended similarities of the issues discussed
through a language that is not smoothly comprehensive in most
aspects (Marmot, 2019). These components create a lack of
clarity, and the readers might lose track of what is expected of
them by the author (Wiggins, 2012)There is a thin line between
the chapter objectives and the prolonged narratives in the book's
chapter. These negative attributes constitute weaknesses,
characterized by vague reference to claims and concepts that the
author seeks to pass across. Two questions that I believe should
be considered for further studies are 1. How is education
creating health-related empowerment in developing countries
during global pandemics such as coronavirus? 2.How make
differences in educational curriculum and models impact health
inequalities among developed countries?
A reflective conclusion is that it forms the benchmark on the
argument between education's roles about empowering people
about their health status and well-being. The author has the
masteries of various case studies on the correlation between
these concepts, which underline their relevance in the modern
health setup. The gap in understanding education and its
implications on health and empowerment is addressed
throughout the chapter. Therefore, a recommendation on the
role of education on cultural empowerment should be
undertaken to achieve the desired outcomes.
References
Marmot Michael. (2019). The Health Gap: The Challenge of an
Unequal World. Bloomsbury Publishing.
Wiggins, N. (2012). Popular education for health promotion and
community empowerment: A review of the literature. Health
6. Promotion International, 27(3), 356–371.
https://doi.org/10.1093/heapro/dar046
THE HEALTH GAP
THE HEALTH GAP
The Challenge of an Unequal World
MICHAEL MARMOT
7. For Alexi, Andre, Daniel and Deborah
CONTENTS
Introduction
1. The Organisation of Misery
2. Whose Responsibility?
3. Fair Society, Healthy Lives
4. Equity from the Start
5. Education and Empowerment
6. Working to Live
7. Do Not Go Gentle
8. Building Resilient Communities
9. Fair Societies
10. Living Fairly in the World
11. The Organisation of Hope
Notes
Acknowledgements
Index
A Note on the Author
By the Same Author
Introduction
Why treat people and send them back to the conditions that
made them
8. sick?
The woman looked the very picture of misery. Her gait almost
apologetic, she approached the doctor and sat down, huddling
into the chair.
The dreariness of the outpatients clinic, unloved and uncared
for, could not
have helped. It certainly did nothing for my mood.
‘When were you last time completely well?’ asked the
psychiatrist in a
thick middle-European accent. Psychiatrists are supposed to
have middle-
European accents. Even in Australia, this one did.
‘Oh doctor,’ said the patient, ‘my husband is drinking again and
beating
me, my son is back in prison, my teenage daughter is pregnant,
and I cry
most days, have no energy, difficulty sleeping. I feel life is not
worth
living.’
It was hardly surprising that she was depressed. My mood
dipped further.
As a medical student in the 1960s I was sitting in Psychiatry
Outpatients at
Royal Prince Alfred Hospital, a teaching hospital of the
University of
Sydney.
The psychiatrist told the woman to stop taking the blue pills and
try these
red pills. He wrote out an appointment for a month’s time and,
still a picture
of misery, she was gone. That’s it? No more? To incredulous
9. medical
students he explained that there was very little else he could do.
The idea that she was suffering from red-pill deficiency was not
compelling. It seemed startlingly obvious that her depression
was related to
her life circumstances. The psychiatrist might have been correct
that there
was little that he personally could do. Although, as I will show
you, I have
come to question that. To me, that should not imply that there
was nothing
that could be done. ‘We’ should be paying attention to the
causes of her
depression. The question of who ‘we’ should be, and what we
could do,
explains why I discarded my flirtation with psychiatry and
pursued a career
researching the social causes of ill-health and, latterly,
advocating action.
This book is the result of the journey that began in that dreary
outpatients
clinic all those years ago.
And it was not just a question of mental illness. The conditions
of
people’s lives could lead to physical illness as well. The inner -
city teaching
hospital where I trained in Sydney served a large immigrant
population, at
that time from Greece, Yugoslavia and southern Italy. Members
of this
population, with very little English to explain their symptoms,
10. would come
into the Accident and Emergency Department with a pain in the
belly. As
young doctors we were told to give them some antacids and
send them
home. I found this absurd. People would come in with problems
in their
lives and we would treat them with a bottle of white mixture.
We needed
the tools, I thought, to deal with the problems in their lives.
A respected senior colleague put it to me that there is continuity
in the
life of the mind. Perhaps it is not surprising that stressful
circumstances
should cause mental illness, he said, but it is inherently unlikely
that stress
in life could cause physical ill-health. He was wrong, of course.
I did not
have the evidence to contradict him at the time, but I do now.
The evidence
linking the life of the mind with avoidable ill-health will run
right through
this book. Death, for example, is rather physical, it is not just in
the mind.
We know that people with mental ill-health have life expectancy
between
ten and twenty years shorter than people with no mental
illness.1 Whatever
is going on in the mind is having a profound effect on people’s
risk of
physical illness and their risk of death, as well as on mental
illness. And
what goes on in the mind is profoundly influenced by the
conditions in
which people are born, grow, live, work and age, and by the
11. inequities in
power, money and resources that influence these conditions of
daily life. A
major part of this book is examining how that works and what
we can do
about it.
The more I thought about it at the time, the more I thought that
medicine
was failed prevention. By that I mean most of medicine, not just
pain in the
belly in marginal groups or depression in women suffering
domestic
violence. Surgery seems a rather crude approach to cancer.
Lung cancer is
almost entirely preventable – by eliminating smoking. I didn’t
know it at
the time, but about a third of cancers can be prevented by diet.
Heart
disease – surely we would want to prevent that, rather than
simply wait for
the heart attack and treat. Stroke ought to be preventable by diet
and
treating high blood pressure. We need surgery for trauma, of
course, but
could we not take steps to reduce the risk of trauma? That said,
having had
a bad bicycle accident, I am very grateful for high-quality
surgical care, free
at the point of use (thank you, National Health Service).
As for prevention, it seemed to me then, and I have evidence
now, that
12. taking control of your life and exercising, eating and drinking
sensibly,
having time off on happy holidays, was all very well if you
were
comfortably off financially and socially (and going to the
private clinics,
not the public hospital where I was then working). Were we
going to tell the
woman in Psychiatry Outpatients that she should stop smoking
and, as soon
as her husband stopped beating her, she should make sure that
he and she
had five fruit and vegetables a day (we did know about healthy
eating then,
even if we didn’t have the ‘five a day’ slogan)? Were we going
to tell the
immigrant with a marginal, lonely existence to stop eating fish
and chips
and take out membership in a gym? And for those who assert
that health is
a matter of personal responsibility, should we tell the depressed
woman to
pull her socks up and sort herself out?
The thought then occurred that a preponderance of the patients I
was
seeing were disadvantaged socially. Not in desperate poverty:
the husband
of the depressed woman was working; the migrants, like
probably most
migrants, were working hard to get a toehold in society. But
they were at
the lower end of the social scale. In fact, all the things that
happened to the
depressed woman – domestic violence, son in prison, teenage
daughter
13. pregnant – are more common in people at that end of the scale. I
was seeing
social disadvantage in action; not poverty so much as low social
status
leading to life problems that were leading to ill-health.
She had an illness. The fire was raging. Treating her with pills
might help
put out the fire. Should we not be in the business of fi re
prevention as well?
Why treat people and send them back to the conditions that
made them
sick? And that, I told myself, entails dealing with the conditions
that make
people sick, not simply prescribing pills or, if interested in
prevention,
telling people to behave better. At that time, and since, I have
never met a
patient who lost weight because the doctor told her to.
As doctors we are trained to treat the sick. Of course; but if
behaviour,
and health, are linked to people’s social conditions, I asked
myself whose
job it should be to improve social conditions. Shouldn’t the
doctor, or at
least this doctor, be involved? I became a doctor because I
wanted to help
people be healthier. If simply treating them when they got sick
was, at best,
a temporary remedy, then the doctor should be involved in
improving the
conditions that made them sick.
14. I had a cause. I still do.
It was not a cause, though, that many of my seniors in medicine
were
prepared to endorse. They were too busy putting out fires to
expend effort
improving the conditions that promoted these fires.
While thinking these thoughts and working as a junior doctor in
the
respiratory medicine ward, I had a Russian patient with
tuberculosis. When
I ‘presented’ the patient to my seniors, I didn’t start with his
medical history
but, I now blush to recall, said that Mr X, a Russian, was like a
character
out of Dostoevsky. He had stubbed his toe on the highway of
life (cringe).
He had been a gambler down on his luck, an alcoholic, unlucky
in love, and
now, as if in a Russian novel, had developed TB.
A few days later the consultant chest physician drew me aside
and said: I
have just the career for you, it’s called epidemiology. (Anything
to get me
out of his hair.) He said that doctors, anthropologist s and
statisticians all
work together to figure out why people have different rates of
illness
depending on where and how they live. I was dispatched with a
fellowship
to the University of California Berkeley to do a PhD in
epidemiology with
Leonard Syme.
15. The idea that one could actually study how social conditions
affected
health and disease was a revelation. Walking round the hospital
wards, I had
been saying to myself that if social conditions caused physical
and mental
illness, then perhaps the rate of illness of a society could tell us
something
about that society. I know, it sounds obvious, but I was trained
in medicine,
not in thinking. It meant that the term ‘healthy society’ could do
double
duty. A healthy society surely would be one that worked well to
meet the
needs of its citizens, and hence would be one where health was
better.
In Spanish they say Salud (health); in German prosit (may it be
good for
you); in Russian Vashe zdorov’ye (for your health); in Hebrew
L’Chayyim
(to life); in Maori Mauri ora (to life). In English when we are
not saying
Cheers, Bottoms up or Here’s lookin’ at you kid, commonly we
say: Good
health. People value health. Even when they get together for
something not
favourable to health, alcohol, people remember to wish each
other good
health. Health is important to all of us.
But other things take priority.
16. I asked some people in a poor part of London, forty or so years
after the
experiences in Sydney, what was on their mind. They talked
about the
importance of family and friendships; concern for their children
– safe
places to play, good schools, not getting into trouble with
unsuitable
friends; having enough money to feed the family and to heat the
home, and
perhaps for the occasional indulgence; having adequate housing;
living in a
neighbourhood with green space, good public transport, shops
and
amenities, and freedom from crime; having reliable and
interesting work,
without fear of losing their job; older people not being thrown
on the
scrapheap. Actually, had I asked people in a well-heeled part of
London, the
answers would have been little different.
Then I asked what they thought about health. I was told that in
poor
countries, ill-health is the result of unsanitary living conditions
and lack of
health care. In rich countries, now that we all have clean water
and safe
toilets, they told me that ill-health is the result of difficulty
getting to see the
doctor and our own indulgent behaviour, we dreadful feckless
drinkers,
smokers and overweight sloths (I am translating slightly), or
just plain bad
luck in the genetic lottery.
17. My point in writing this book is that my informants were not
wrong
about what is important for health, just too limited. The
depressed woman
in outpatients, the migrants with pain in the belly, the Russian
with TB –
they are the rule, not the exception. We now know that the
things that really
matter to us in our lives, minute to minute, day to day and year
to year, have
a profound impact on our health. The conditions in which
people lead their
lives, all the things my London informants told me were on
their minds, are
the main influences on their health.
The central issue is that good conditions of daily life, the things
that
really count, are unequally distributed, much more so than is
good for
anything, whether for our children’s future, for a just society,
for the
economy and, crucially, for health. The result of unequal
distribution of life
chances is that health is unequally distributed. If you are born
in the most
fortunate circumstances you can expect to have your healthy life
extended
by nineteen years or more, compared with being born into
disadvantage.
Being at the wrong end of inequality is disempowering, it
deprives people
of control over their lives. Their health is damaged as a result.
And the
effect is graded – the greater the disadvantage the worse the
health.
18. Finding this out has been not only wonderfully interesting,
thrilling even,
but it turns out that the evidence provides us with answers. How
to improve
the conditions of our lives and improve health is the substance
of the
chapters that follow. The knowledge that we can make a
difference is
inspiring. The argument that we should make a difference I find
utterly
convincing.
My Damascus moment may have been in Sydney, but the
journey of
compiling the evidence began in Berkeley. As Len Syme, still in
Berkeley,
puts it, they sent me off from Sydney because I was asking too
many
awkward questions and thought that Berkeley, soon after its
experiences of
the student rebellions of the 1960s, was a better place to ask
awkward
questions. A great place, actually!
Syme, in Berkeley, shocked me by saying: just because you
have a
medical degree it doesn’t mean that you can understand health.
If you want
to understand why health is distributed the way it is, you have
to understand
society. I have been trying ever since.
An American colleague enjoys scrambled eggs for breakfast. He
19. studies the
impact of stress on health but he doesn’t rule out the importance
of fatty
diet, so limits his egg indulgence to Sunday mornings. One day
he opened
his carton of eggs and found a printed insert, a bit like a box of
pills. Poor
desperate souls, we addictive readers, we’ll even read package
inserts in
egg cartons. On the insert he was intrigued to discover that
Marmot’s study
of Japanese migrants in California, reported in the 1970s,
proved that
cholesterol was not bad for the heart. Stress was important, not
diet.
Not quite.
I am, of course, delighted that academics in Massachusetts can
learn
about my research over breakfast simply by reading what’s in
the egg
carton. I would be even more pleased if the advertising
copywriter had got
it right. Admittedly, it is just a tad complicated; it entails the
ability to hold
two ideas in your head at the same time – but writers of egg-
carton inserts
should be able to manage that.
As Japanese migrate across the Pacific, their rate of heart
disease goes up
and their rate of stroke goes down.2 Would I like to work on
this for my
Berkeley PhD? Would I! It was a brilliant natural experiment. If
you were
20. trying to sort out genetic and environmental contributions to
disease, here
were people with, presumably, the same genetic endowment
living in
different environments. Japanese in Hawaii had higher rates of
heart disease
than those in Japan, Japanese in California higher rates than
those in
Hawaii, and white Americans higher rates still.
This was terrific. You couldn’t have designed a better
experiment to test
the impact on health of ‘environment’, broadly conceived. Most
likely, the
changing rates of disease are telling us something about culture
and way of
life, linked to the environment. Simple hypothesis:
Americanisation leads to
heart disease, or Japanese culture protects from heart disease.
But what does
that mean in practice?
Conventional wisdom at the time was, and still is, that fatty
diets are the
culprit. Indeed, I have chaired committees saying just that.3
Japanese-
Americans had diets that were somewhat Americanised, with
higher levels
of fat than a traditional Japanese diet, and as a result had higher
levels of
plasma cholesterol than did Japanese in Japan.4 Diet and high
levels of
cholesterol were likely to be playing a part in the higher rate of
21. heart
disease. What’s more, the higher the level of plasma
cholesterol, the higher
is the risk of heart disease. So much for the egg-package insert.
It missed
idea one. It grieves me to say it, but conventional wisdom is not
always
wrong.
Now for idea two. Japanese-Americans may be taller, fatter and
more
partial to hamburgers than Japanese in the old country, but their
approach to
family and friends resembles the more close-knit culture of
Japan more than
it does the more socially and geographically mobile culture of
the US.
That’s interesting, but is it important for health? A Japanese-
American
social scientist with the very Japanese-American name of Scott
Matsumoto
had speculated that the cohesive nature of Japanese culture was
a powerful
mechanism for reducing stress.5 Such a diminution could
protect from heart
disease. I particularly liked the idea of turning the study of
stress on its
head. Not looking at how being under pressure messes up the
heart and
blood vessels, but how people’s social relationships were
positive and
supportive. We humans gossip and schmooze; apes groom. If,
whether
human or non-human primate, we support each other it changes
hormonal
profiles and may lower risk of heart attacks.
22. If this were true, I thought, then perhaps the Japanese in Hawaii
had more
opportunity to maintain their culture than the Japanese in
California – hence
the lower rate of heart disease in Hawaii. It seemed a reasonable
speculation, but I had no test for it.
I had the data to test the hypothesis much more directly among
the
California Japanese. Men who were more involved with
Japanese culture
and had cohesive social relations should have lower rates of
heart disease
than those who were more acculturated – had adopted more of
the
American way of life. That is what I found. And this research
result,
perhaps, is where the egg cartons got their ‘news’. The apparent
protection
from heart disease among the California men who were more
‘Japanese’
culturally and socially could not be explained by dietary
patterns, nor by
smoking, nor by blood pressure levels, nor by obesity. The
culture effect
was not a proxy for the usual suspects of diet and smoking.6
Two ideas then: conventional wisdom is correct, smoking and
diet are
important causes of heart disease; and, while correct,
conventional wisdom
is also limited – other things are going on. In the case of
Japanese-
23. Americans, it was the protective effect of being culturally
Japanese.
Everything I will show you in this book conforms to that simple
proposition – conventional wisdom is correct, but limited, when
it comes to
causes of disease. In rich countries, for example, we understand
a good deal
about why one individual gets sick and another does not: their
habits of
smoking, diet, drinking alcohol, physical inactivity, in addition
to genetic
makeup – we could call that conventional wisdom. But being
emotionally
abused by your spouse, having family troubles, being unlucky in
love,
being marginal in society, can all increase risk of disease; just
as living in
supportive, cohesive social groups can be protective. If we want
to
understand why health and disease are distributed the way they
are, we have
to understand these social causes; all the more so if we want to
do
something about it.
The British Civil Service changed my life. Not very romantic, a
bit like
being inspired by a chartered accountant. The measured pace
and careful
rhythms of Her Majesty’s loyal servants had a profound effect
on
everything I did subsequently. Well, not quite the conservatism
of the actual
practices of the civil service, but the drama of the patter ns of
health that we
24. found there. Inequality is central.
The civil service seems the very antithesis of dramatic. Please
bear with
me. You have been, let’s say, invited to a meeting with a top-
grade civil
servant. It is a trial by hierarchy. You arrive at the building and
someone is
watching the door – he is part of the office support grades, as is
the person
who checks your bag and lets you through the security gate. A
clerical
assistant checks your name and calls up to the office on the fifth
floor. A
higher-grade clerical person comes to escort you upstairs, where
a low-
grade executive officer greets you. Two technical people, a
doctor and a
statistician, who will be joining the meeting, are already
waiting. Then the
great man’s, or woman’s, high-flying junior administrator says
that Richard,
or Fiona, will be ready shortly. Finally you are ushered in to the
real deal
where studied informality is now the rule. In the last ten
minutes you have
completed a journey up the civil service ranking ladder – takes
some people
a lifetime: office support grades, through clerical assistants,
clerical
officers, executive grades, professionals, junior administrators
to, at the
pinnacle, senior administrators. So far so boring: little different
25. from a
private insurance company.
The striking thing about this procession up the bureaucratic
ladder is that
health maps on to it, remarkably closely. Those at the bottom,
the men at
the door, have the worst health, on average. And so it goes.
Each person we
meet has worse health, and shorter life expectancy, than the
next one a little
higher up the ladder, but better health than the one lower down.
Health is
correlated with seniority. In our first study, 1978–1984, of
mortality of civil
servants (the Whitehall Study), who were all men unfortunately,
men at the
bottom had a mortality rate four times higher than the men at
the top – they
were four times more likely to die in a specific period of time.
In between
top and bottom, health improved steadily with rank.7 This
linking of social
position with health – higher rank, better health – I call the
social gradient
in health. Investigating the causes of the gradient, teasing out
the policy
implications of such health inequalities, and advocating for
change, have
been at the centre of my activities since.
I arrived at Whitehall through a slightly circuitous route,
intellectual as
well as geographic.
You couldn’t be interested in public health, or even just
26. interested, and
not be aware that people in poor countries have high rates of
illness and die
younger compared with those in rich countries. Poverty
damages health.
What about poverty in rich countries? It was a niche interest in
the US of
the 1970s. After all, the USA thought of itself as a classless
society, so there
could not be differences between social classes in rates of
health and
disease, right? Wrong – a piece of conventional wisdom that
was
completely wrong. The actual truth was handed around almost
like
Samizdat literature in the former Soviet Union in the form of a
small
number of papers, one of which was written by Len Syme and
my colleague
Lisa Berkman, now at Harvard.8 People with social
disadvantage did suffer
worse health in the USA. It was, though, far from a mainstream
preoccupation. Race and ethnicity were dominant concerns.
Class and
health was not a serious subject for study. Inequality and health
was
completely off the agenda, bar a few trailblazers, writing about
the evils of
capitalism.9
If there was a country on the planet that was aware of social
class
distinctions and had a tradition of studying social class
27. differences in health,
it was the United Kingdom. And if there was a place in Britain
that excelled
at social stratification it was the British Civil Service,
familiarly known as
Whitehall.
From Berkeley, then, I came home. It had taken a while. Born in
North
London, I went to Australia with my family when I was four
years old and,
after a few years playing cricket in the street and declaiming in
the school
debating team, studied medicine in Sydney, then went off to
Berkeley.
Donald Reid, Professor of Epidemiology at the London School
of Hygiene
and Tropical Medicine, offered me a job with the
encouragement that if I
wanted a position of low pay, limited opportunities for research
in different
places (such as Hawaii, for example), low research funding, but
high
intellectual activity, London was the place for me. How could I
turn down
such an attractive offer? Donald Reid said he was worried about
me in
‘Lotus Land’, i.e. Berkeley. It was too much fun. He was a
Scottish
Presbyterian and thought a bit of hard living would be good for
me. London
provided it. The British economy in 1976 had just been bailed
out by the
IMF. A sense of doom prevailed, and the Labour government,
staggering its
way to a dismal end, was cutting public expenditure like there
28. was no
tomorrow. We wondered if that might well be the case. But,
after being in
London for about six months (I had arrived at end October
1976), I saw the
sun come out, people shed their woolly sweaters, the roads
dried out, the
flowers bloomed, I stopped writing daily letters to friends back
in
California, and started to enjoy what Donald Reid promised. It
was
privilege, not hard living.
At first experience, London’s Whitehall was as much of a
culture shock
as San Francisco’s Japantown. Whitehall is home to the British
Civil
Service, and it looks it. To the east, in ‘the City’, financial
giants now flaunt
their hubris in soaring glass constructions, reaching for the
skies, like their
occupants. Whitehall’s buildings, heavy and stolid, proclaim
stability. Even
in the newer buildings, the corridors of power feel as though
unchanged
from the days of Empire. It is certainly a place to study class
distinctions,
but not poverty. There are no poor in Whitehall.
The Whitehall Study, a screening study of 17,000 men, had been
set up
by Professors Donald Reid and, another great teacher of mine,
Geoffrey
29. Rose. Why civil servants? A little more culture shock. Donald
Reid had
lunch at the Athenaeum Club with one of his friends who was
the chief
doctor for the Civil Service, and the study was born. Athenaeum
Club?
Think Gentlemen’s Club, with a classical façade and an
Athenian-style
frieze at the front, in a lovely setting not far from the Royal
Parks in
London, a stuffy dining room and overpadded armchairs.
Twice is a coincidence, three times a trend. In the 1970s I had
done only
two big studies, Japanese migrants and now Whitehall civil
servants, and
both had flown in the face of conventional wisdom. At the time,
everyone
‘knew’ that people in top jobs had a high risk of heart attacks
because of the
stress they were under. Sir William Osler, great medical teacher
from Johns
Hopkins University and the University of Oxford, had, around
1920,
described heart disease as being more common in men in high-
status
occupations. Osler fuelled the speculation that it was the stress
of these jobs
that was killing people.
We found the opposite. High-grade men had lower risk of dying
from
heart attacks, and most other causes of death, than everyone
below them,
and as I described earlier, it was a social gradient, progressively
higher
30. mortality going hand in hand with progressively lower grade of
employment.
Further, conventional explanations did not work. True, smoking
was
more common as one descended the social ladder, but plasma
cholesterol
was marginally higher in the high grades, and the social
gradient in obesity
and high blood pressure was modest. Together, these
conventional risk
factors accounted for about a third of the social gradient in
mortality.10
Something else had to be going on. In that sense, it was similar
to my
studies of Japanese-Americans. The conventional risk factors
mattered, but
something else accounted for the different risks of disease
between social
groups. In the Japanese case we thought it was the stress-
reducing effects of
traditional Japanese culture.
You may think: stress in the civil service? Surely not! My
colleagues
Tores Theorell in Stockholm and Robert Karasek, the man who
was eating
eggs in Massachusetts, had elaborated a theory of work stress. It
was not
high demand that was stressful, but a combination of high
demand and low
control.11 To describe it as a Eureka moment goes too far, but
it did provide
a potential explanation of the Whitehall findings. Whoever
31. spread the
rumour that it is more stressful at the top? People up there have
more
psychological demands, but they also have more control.
Control over your life loomed large as a hypothesis for why, in
rich
countries, people in higher social positions should have better
health.
I have written about the Whitehall Studies at length in a
previous book,
Status Syndrome, and will not rehearse all the evidence here.12
More recent
evidence will make its way into chapters of this book. Suffice it
to say that
the social gradient that we found in the Whitehall studies has
been found in
British national data, and now all over the world. There is much
effort
going into understanding it. In this respect, if no other, British
civil servants
do still lead the world!
More than that, some social scientists from Oxford beat a path
to my
door. They said that they had a view of how work, not just in
the civil
service but more generally, should be classified into
hierarchies. They
thought that the span of control was central: higher status, more
control.13
The second Whitehall Study showed that span of control was
important for
health.14 They loved it: evidence that their theorising was
important for
32. people’s lives.
At the start of this section, I went a bit over the top and said
Whitehall
changed my life. The social gradient and ‘control’ certainly
changed my
approach to health and inequalities in health. It says we should
focus not
only on poverty but on the whole of society. Poverty is bad for
health.
There are good reasons for wanting to do something to reduce
poverty, and
among them is the harm it does to health. The gradient, though,
is different.
All the way, from top to bottom of society, the lower you are
the worse your
health. The gradient includes all of us below the topmost 1 per
cent. You are
thinking, perhaps, that we will always need people to watch the
doors and
staff the front desk, to serve the great man. Hierarchies are
inevitable. Does
that not mean that health inequalities, the social gradient in
health, are
inevitable?
Read on. The evidence shows that there is a great deal that we
can do to
reduce the social gradient in health, but it will take committed
social action,
and political will. But before we get to that, we will need to
consider the
huge amount of work that has been done in connecting our
understanding of
33. these social determinants of health in rich countries to the
global picture of
health and health inequalities.
A remarkable thing happened in 2012. According to the World
Health
Organization (WHO), life expectancy in the world was seventy,
a biblical
three score years and ten. Regrettably, that statistic is nearly
totally useless.
It tells us that China and other countries with life expectancy
greater than
seventy are balanced by India and other countries, mainly in
Africa, with
life expectancy less than seventy. The more relevant figure is
the spread of
thirty-eight years: from life expectancy of forty-six in Sierra
Leone to
eighty-four in Japan – in Japanese women it is eighty-six.
My first experiences of life expectancy at the wrong end of the
scale
were in New Guinea and Nepal. To be sure, there was little
medical care
available in remote villages, but one could hardly start there in
looking for
causes of ill-health. Dirty water and inadequate nutrition
seemed a much
better place to start. In the lowlands of New Guinea,
particularly, malaria
was also a problem, but prevention with impregnated bed nets
and mosquito
control, even then, seemed better options than waiting for
people to get sick
and then treating them. In the highlands, everyone had a cough,
mostly
34. because of open fires inside their huts to keep warm in the
chilly highland
nights. Safe cooking stoves would make a difference.
In the early 1970s it seemed a bit hopeless to think that health
could
improve in such unpromising circumstances. Not so. In Nepal,
life
expectancy improved by about twenty years, to sixty-nine,
between 1980
and 2012. This is astonishing. Let us assume that the figures are
more or
less correct. Twenty years of improvement in thirty years means
two-thirds
of a year of improvement for every calendar year. That is
sixteen hours of
improvement every twenty-four hours. In rich countries, now,
the rate of
improvement is only(!) about six to seven hours every twenty-
four hours.
My point is twofold. First, there are huge differences in health
and life
expectancy across the world, not just Sierra Leone and Japan
but every
shade of light and dark in between. Second, health can improve
really
quickly. Such rapid improvement fuels what I call my evidence-
based
optimism.
Some time around 2008, I gave a lecture in San Francisco. After
it, a friend
35. said to me: ‘I have heard you lecture many times, but that is the
first time
I’ve seen you wagging your finger. There is something else
going on. Not
just scientific evidence but an urgency, a demand for action.’
He was right. I had been studying social causes of ill -health,
having a
fascinating time doing research and writing papers, but
underneath there
was a low, insistent rumble: it is not right that social conditions
should be so
unequally distributed across the world, and between social
groups within
countries. It means that much of the inequality in health that we
see is
unfair. The rumble grew louder. Research is immensely
rewarding, but
shouldn’t we, and that includes me, be trying to do something
about it?
At the end of every scientific paper there is a familiar coda:
more
research is needed, more research is needed. What, I wondered,
if we added
a new coda: more action is needed. It need not be discordant
with the first.
Around this time, the turn of the millennium, Professor Jeffrey
Sachs,
now at Columbia University, and a great advocate for
development aimed at
the world’s poor, had led a Commission on Macroeconomics
and Health
(CMH) set up by the World Health Organization. The CMH
concluded that
36. there should be major investment, globally, aimed at reducing
killing
diseases. The resultant improvement in health would lead to
economic
growth.
My thought was that investment in reducing the global burden
of
tuberculosis, HIV/AIDS and malaria had to be applauded. Much
better than
global expenditure on armaments, for example. If arguing that
disease
control would lead to economic growth helped get action, well
done. There
is a ‘however’, however. From my standpoint, they got it upside
down.
Health should not be a means to the end of a stronger economy.
Surely the
higher goal should be health and well-being. We want better
economic and
social conditions in order to achieve greater health and well-
being for the
population.
As an idealistic young student, I did not decide to study
medicine out of a
wish to further economic growth. I studied it because I wanted
to help
individuals get healthier. I went into public health, and social
determinants
of health, because I wanted to help societies become healthier. I
discussed
this with the economist and philosopher Amartya Sen, then of
37. Cambridge,
England, now of Cambridge, Mass., and suggested we get a
group together
to say that it was important to improve social conditions to
improve health.
Not to criticise the CMH, but to say that we needed action,
globally, on the
social determinants of health. Amartya Sen agreed.
One thing led to another, and in 2005 the Director-General of
WHO, J.
W. Lee, set up the Commission on Social Determinants of
Health (CSDH),
with me as chair and Amartya Sen as a distinguished member.
We had
consultations before the Commission started properly. One
prestigious
academic said that he had served on commissions where the
report was
essentially written before the commission met. He said that
would not be
true here, because: ‘Michael doesn’t know enough.’
Absolutely right. I ran the CSDH as a mutual learning exercise.
I learned
from the former heads of government, government ministers,
academics
and representatives of civil society who made up the global
commission,
and we all learned from global knowledge networks that we set
up. The
learning that came from the CSDH, and two subsequent
exercises that I will
mention below, informs this book.
You produce a commission report. Is anyone listening, or will
38. its fate be
that of most such reports – worthy dustiness on shelves? The
CSDH was a
global report. We were concerned with health inequalities
within and
between countries from the poorest to the richest. A
recommendation is
going to look somewhat different in Gujarat and in Glasgow, in
Nigeria and
New York. We made a virtue of necessity and recommended
that countries
set up mechanisms to ‘translate’ our recommendations in a form
suitable for
that country. Brazil set up its own Commission on Social
Determinants of
Health. The CSDH met the Brazilian commission and shared
emerging
findings. Chile got active, as did the Nordic countries.
In the UK, the Labour government, under Prime Minister
Gordon Brown,
invited me to conduct a review of health inequalities in the light
of the
CSDH report. The aim was to translate the CSDH’s
recommendations into a
form suitable for Britain. To inform the review we set up nine
task groups
involving scores of experts who contributed their knowledge in
each of our
key domains. The Marmot Review, as it was known, was
published as Fair
Society, Healthy Lives in 2010.15
More international task groups, more knowledge synthesis,
39. more
deliberation informed the production of the European Review of
Social
Determinants and the Health Divide, which we published in
2014. The
European Review was commissioned by Dr Zsuzsana Jakab, the
Director of
the European Office of WHO. The so-called European Region
contains, in
addition to Europe, all the countries of the former Soviet Union.
It stretches
all the way to the Bering Strait, practically to Alaska. It means
that we are
getting social determinants of health on the agenda in many
countries. The
CSDH report was not forgotten.
Society and health, by its nature, is a highly political issue.
When we
published the CSDH report, one country labelled it ‘ideology
with
evidence’. It was meant as criticism. I took it as praise. We do
have an
ideology, I responded: health inequalities that can be avoided
are unjust – a
case I will make later in the book. Putting them right is a matter
of social
justice, but the evidence really matters.
The Economist weekly newspaper said what it thought of our
commitment. It gave a full two pages to covering the
Commission’s report,
thank you, and ended with: ‘it would be a pity if the new
report’s saner
ideas were obscured by the authors’ quixotic determination to
achieve
40. perfect political, economic and social equity.’16 I particularly
liked
‘quixotic’. In Cervantes’s masterpiece, Don Quixote woke up
one morning
and, imagining himself to be a medieval knight, rushed round
doing
chivalrous deeds – tilting at windmills, slaying wine gourds –
while
everyone chuckled at him. I told the Spanish Minister of Health
– Don
Quixote being part of the Spanish psyche – that the cap, or
rather the tin
helmet, fitted me rather well: a knight idealistic in a faintly
ridiculous way,
wanting to make the world a better place, and no one quite
taking him
seriously. Ah, said the Minister, we need the idealism of Don
Quixote the
dreamer, but we also need the pragmatism of Sancho Panza. I
call that
ideology with evidence.
In presenting the CSDH we made clear that we were driven not
by the
economic case for action, but by the moral case. We even put on
the back
cover: ‘Social injustice is killing on a grand scale.’ That sounds
rather
political. Yet we were criticised for being insufficiently
political in our
analysis.17
Health is political, yes. I have tried, though, to steer clear of
party
politics. As far as is possible I want the evidence to speak for
itself. As
41. societies indulge in the very real debates between the role of the
state and
freedom of the individual, I want to foreground the implications
for health
and health inequity. Since wandering around hospital wards in
Sydney, I
have maintained the view that the scale of health inequalities in
society and
the world tells us a good deal about the quality of our society
and the way
we organise our affairs.
I left clinical medicine because I did not think that the causes of
ill-health
and of social inequalities in health had much to do with what
doctors did.
We had to improve society. I was therefore surprised, to say the
least, to be
invited to be President of the British Medical Association for
the year
2010–11. I thought they had the wrong person.
I had to make a speech when I was installed. I thought that
since there
were a lot of doctors in the audience, I could pick up some
useful advice. I
told the doctors that while doing the work described in this
book, I had
developed three medical conditions. Perhaps they could help.
The first is optimism. I feel unreasonably optimistic all the
time. Despite
all the doomsayers, the people who argue that all has been
42. ruined, I judge
that the evidence shows that things can improve. There must be
some pills I
can take for this condition.
The second, related to the first, is that I have developed
selective
deafness. I don’t hear cynicism. If people say that no one will
ever do things
differently, it won’t happen, people don’t change, and the like,
it bounces
off. I no longer hear it. Realistic yes, but not cynical.
Third, I have developed a watery condition of my eyes. We
were having
a CSDH meeting in Vancouver. At the end of it, Pascoual
Macoumbi,
former PM of Mozambique, who was a member of the CSDH,
said: ‘I
haven’t felt so energised since my country got independence.’
The watery
condition of my eyes developed. When we were in Gujarat, and
saw how
the Self Employed Women’s Association was working with its
members,
the poorest, most marginalised women in India, to triumph over
adversity, I
found my eyes watering. As they did when seeing young people
developing
self-esteem in the slums of Rio, or Maoris finding dignity in
New Zealand.
This watery condition seems to come on not when seeing people
in distress,
so much as when seeing them triumph over difficult conditions.
My purpose in writing this book is to let you know about the
43. evidence of
what we can do to improve people’s lives – be they the poorest
in the world
or the relatively comfortably off. When we launched the CSDH
in Santiago
de Chile, I quoted the Chilean poet Pablo Neruda. Let me do so
now, and
invite you to join me and: ‘Rise up . . . against the organisation
of misery.’
1
The Organisation of Misery
It was the best of times, it was the worst of times, it was the age
of wisdom, it was the age of
foolishness . . . it was the season of Light, it was the season of
Darkness, it was the spring of
hope, it was the winter of despair . . .
Charles Dickens, A Tale of Two Cities
I have a one-track mind. I see everything through the prism of
health. It is
indeed the best of times. Health is improving globally. In many
countries of
the world we are much healthier and living much longer than we
would
have been when Dickens was writing. It is the worst of times.
This
enjoyment of good health is most unequally spread. For some
44. countries
their health is nearly as bad as if they were still languishing in
Dickensian
squalor. Currently in the world the unhealthiest country has a
life
expectancy nearly forty years shorter than the healthiest. That is
the same as
the gap between Dickensian and modern-day London. Within
many
countries, too, inequalities in health are increasing – the health
of the best
off is increasing more rapidly than that of the worst off. The
best and worst
of times coexist.
It is the age of wisdom. Advances in medical science and
knowledge of
public health give us the tools to make dramatic health
advances.1 It is the
age of foolishness – I would have preferred it if Dickens had
written hubris.
Knowledge of medicine and public health is not so much wrong,
as too
limited. Health is too important to be left solely to doctors.
Health is related
not only to access to technical solutions but to the nature of
society. We are
being foolish in ignoring a broader array of evidence, which
shows that the
conditions in which people are born, grow, live, work and age
have
profound influence on health and inequalities in health in
childhood,
working age and older age.
45. It is the spring of hope. We may be foolish to ignore such
knowledge, but
we do now understand how society influences health – my
purpose in
writing this book – and there are inspiring examples from
around the world
of how such understanding is transforming lives and improving
health. It is
the winter of despair. When the 1 per cent and the 99 per cent
have
diverging interests and the head of the US Federal Reserve Bank
says that
inequalities of income and wealth have gone too far,2 when
banks in Europe
and the US have, since 2008, been fined a total of £100 billion
for banking
crimes and misdemeanours which damage their customers’
interests,3 when
rich countries compete to make the most of Africa’s resources,
when people
of ill will misuse race and religion to spread chaos, when in
functioning
democracies people’s faith in their governments is at a low ebb,
and in other
countries governments seem to have little interest in the well-
being of their
populations, then despair may set in.
In this first chapter, I want to show why, in terms of health, it is
the best
and worst of times. Wisdom and foolishness, hope and despair,
will make
their appearance to introduce the topics for the rest of the book.
I am an
evidence-based optimist. Armed with knowledge, we can
46. transform a
season of darkness into one of light. It will take commitment
and political
will, but the knowledge and experience is there that can make a
huge
difference.
A TALE OF TWO CITIES . . . AND THEY ARE BOTH IN
GLASGOW
‘I know you have been contrasting shockingly poor health in
Calton with
the estimable health of Lenzie [areas of Glasgow]. We talk
about it in
Glasgow. Even in the pub. Especially in Calton, as people raise
their glasses
to the memory of drinkers past, so many of them gone. I live in
Lenzie and
drink regularly in the pub with a friend who lives in Calton. We
were
chatting the other night and it turned out that my friend had no
plans for
pension or other retirement arrangements. When I asked him
why not, he
said: “Because I’m fifty-four.”’ So said a Scottish professor to
me at a
meeting.
My response: oh dear! That’s not what I wanted at all. It is
great to have
one’s research discussed, in Scottish pubs, and elsewhere I
hope. I did
publish data on life expectancy in Calton and Lenzie.4 The
47. point was for
discussion to lead to change, not to fatalism.
If a man dies in his prime in Calton, a down-at-heel part of
Glasgow, it
may be a tragedy, but it’s not a surprise. Actually, the question
of what
constitutes his ‘prime’ in Calton is moot. Life expectancy for
men, when I
first looked at figures from 1998–2002, was fifty-four. In
Lenzie, a much
more upmarket place a few kilometres away, ‘in his prime’ has
an
altogether different meaning: life expectancy for men was
eighty-two.5 That
converts to a twenty-eight-year gap in life expectancy in one
Scottish city.
Calton is an unlovely place. Its residents say: ‘Nowhere to
walk, really
bad’, ‘Can’t let granddaughter out’, ‘Side streets, terrible
prostitution’.
There might be a park with some green space but it has
‘prostitutes,
alcoholics and druggies at night’, there is ‘usually a man parked
on a bench
with a bottle’.
Calton is the environment in which Jimmy, a typical resident,
lives. In
truth, Jimmy has always been something of a rascal. He was
born in Calton
in an unstable home, was in trouble in school, and delinquency
problems
led to trouble with the police as a teenager. Jimmy was enrolled
in an
48. apprenticeship but dropped out; he has never had a ‘proper’ job,
but had
short-term temporary manual work. As with his subculture, any
money
Jimmy gets goes into drink and drugs; his diet, if you could call
it that,
consists of pub food, fast food and alcohol. Jimmy has had a
series of short-
term girlfriends, but there is a question of alcohol-fuelled
violent behaviour.
He is known to the police for his various gang-related violent
activities.
It is men like Jimmy who can expect to live shorter lives than
men in
India. Average life expectancy for men in India was sixty-two at
the time
that it was fifty-four for men in Calton. Jimmy’s poor health
prospects will
not be improved by telling the adult Jimmy to pull his socks up
and behave
better. We should have started a bit earlier in his life.
The twenty-eight-year gap in life expectancy in Glasgow was as
big as I
could find anywhere within one city that gathers good data.6
The current
figure is probably closer to twenty years.7 Twenty years is
ridiculously
large. Twenty years is the gap in life expectancy between
women in India
and women in the USA. We can see differences in life
expectancy as big as
twenty years within London, too – even within the London
borough of
Westminster, one of the richest spots on the planet.8 In the US,
49. if I said that
a poor part of the city, in Baltimore or Washington DC for
example, had life
expectancy twenty years shorter than a rich part, many
Americans would
think ‘race’. Perhaps they would be less quick to think ‘race’,
whatever that
means, if they knew that London and Glasgow have a twenty-
year gap in
life expectancy that cannot be attributed to ethnic differences.
We need to
go beyond simple categories such as race and social class to
find out what is
going on.
Perhaps you are thinking: I am not the richest, and I am not the
poorest.
If I were in Glasgow I would be living neither in an elegant
Georgian town
house nor in a tenement. Similarly, in the London borough of
Westminster
where the gap is nearly twenty years I would be neither i n the
fanciest parts
of Mayfair and Knightsbridge nor in the run-down area of
Church Street. If
living in a rich area corresponds with good health, and in a poor
area with
poor health, where do I fit in to all of this, you might ask.
You and I, dear reader, fit right at the heart of all this. If we
live in a
neighbourhood that is somewhere between the humblest and the
most
50. exalted, our life expectancy is somewhere in between the low
level in the
poor areas and the higher prospects in the richer. The richer the
area, the
better is our health, on average, as illustrated in Figure 1.1.9
FIGURE 1.1: ALL THE WAY FROM TOP TO BOTTOM
Here every neighbourhood in England is ranked according to
level of
deprivation. In the top line, each dot represents life expectancy
for one
neighbourhood. Suppose you live in a neighbourhood with
middling levels
of deprivation (or affluence), your life expectancy, on average,
is middling.
If you live in a neighbourhood that is right up there, but not
quite at the
most affluent level, your life expectancy is near the highest.
The link
between deprivation and life expectancy is remarkably graded:
the greater
the deprivation, the shorter your life expectancy.
The social gradient in life expectancy runs all the way from top
to
bottom. It doesn’t just feel better at the top. It is better. At the
top, not only
do you live longer but the quality of life is better – you spend
more years
free from disability, as the bottom line in the graph shows. The
social
gradient in disability-free life expectancy is even steeper than it
is for life
51. expectancy. ‘Disability’ here is quite broadly defined: any
limiting long-
standing illness. Talk about adding insult to injury: the more
deprived
people spend more of their shorter lives with ‘disability’. On
average
people at the top live twelve years of their lives with disability,
people at the
bottom twenty years.
A similar graph could be reproduced in any number of countries
round
the world. The social gradient in health is a widespread
phenomenon.
A decade or so ago, I wrote that if you caught the Washington
Metro from
the southeast of downtown Washington to Montgomery County,
Maryland,
life expectancy rises about a year and a half for each mile
travelled – a
twenty-year gap between ends of the journey.10 Since then,
colleagues in
London have said that if you catch the Jubilee tube line, for
each stop east
from Westminster in central London, life expectancy drops a
year.11
The point of these exercises is to make vivid the social gradient
in health.
Subtle differences in neighbourhood, or more importantly in
other
conditions affecting the people who live there, have grave
import for health
and length of life.
52. The first reaction of most of us to the social gradient in health
is: hey, this
is about me. ‘Health inequalities’ is not only about poor health
for poor
people, it covers gradations in health, wherever we are on the
social ladder.
It is not about ‘them’, the poor, and ‘us’, the non-poor; it is
about all of us
below the very top who have worse health than we could have.
The gradient
involves everyone, rich, poor, and in-between.
A sampling of the popular press demonstrates a huge variability
in
attitudes to the fact that the poor have worse health than
everyone else. For
some, the poor are poor and sick because they are feckless. This
fecklessness extends to not looking after themselves and their
children.
Elsewhere, a more sympathetic view might be that you do care
about the
poor health of the ‘poor’ in your own country or ‘over there’ in
another
country. It is a concern, it says something about your sense of
what you
think a society should be for, but it does not touch you more
than that. The
social gradient in health, though, affects all of us. We are not
just interested,
we are engaged. This is my life and yours. You and I are neither
feckless (I
am making an assumption) nor deserving of sympathy because
of our
poverty, yet all of us below the very top have worse health than
53. those at the
top.
The gradient changes the discussion fundamentally. The
gradient implies
that the central issue is inequality, not simply poverty. As we
will see,
poverty still remains hugely important for health, but relief of
poverty is
conceptually simple, even if politically and practically difficult.
Inequality,
on the other hand, implies that not only is having enough to
make ends meet
important, but so too is what we have relative to others.
Inequality puts us into entirely different terrain. In many
countries,
economic inequality has been seen as a good thing. Loweri ng
taxes on the
rich, for example, a policy that has the clear and predictable
effect of
increasing economic inequality, is justified as being good for
the economy.
Set the wealth producers free and we will all benefit, runs the
argument. But
what if such a policy made health inequality worse? In Britain,
a senior
Labour politician said that he was ‘intensely relaxed’ about how
much the
rich earned.12 Governments of the centre-right and centre-left
have both
contrived to do very little to reduce economic inequality. The
centre-left
wants to reduce poverty; the centre-right appears to believe that
if they get
the incentives right, and the economy grows, poverty will look
54. after itself.
But neither has seen economic inequality as a problem, although
that is now
changing.
We should change our focus. We should focus on the rich, not
only on the
poor. I do not mean social workers calling on the rich to see if
they are
managing their money all right. Of course, we still want to
solve the
problem of poverty and health, but if all of us below the top
have worse
health than those at the top, surely we should aim to improve
everybody’s
health towards the high level of those at the top.
The potential gains are enormous. I once calculated that if
everyone in
England over the age of thirty had the same low mortality as
people with
university education there would be 202,000 fewer deaths
before the age of
seventy-five each year – almost half of the total. This equates to
2.6 million
extra years of life saved each year.13 Health inequalities are not
a footnote
to the health problems we face, they are the major health
problem.
Common sense tells us that if we want to solve a problem we
should
focus on it. I am arguing that the problem of health inequalities
55. within
countries is the social gradient – from top to bottom, the lower
our social
position the worse our health. Focusing on the problem of the
health
gradient implies improving society. But what about the poor at
the bottom
who have the worst health? My answer is that improving
society, improving
everyone’s health up to that of the best off, does not preclude
extra effort on
improving health for the poor. Rather than ‘them’ and ‘us’, we
need to
expend extra effort where it is needed: improve society and
effort
proportional to need. The point is made even more clearly if we
look at a
broader range of countries.
SOCIAL GRADIENTS? FOCUS ON THE RICHEST? DON’T
POOR COUNTRIES HAVE TO WORRY ABOUT POVERTY?
Some health workers in sub-Saharan Africa believe that the
social gradient
in health is an effete concern of rich countries. In the most
deprived parts of
the world, they argue, we should focus on the poorest of the
poor. That is
not what the evidence shows. It is difficult to obtain figures for
inequalities
in adult mortality from most countries – they are simply not
available.
Many countries do have figures for mortality rates of children
under age
five, and those for a few selected countries are shown in Figure
1.2.14
56. FIGURE 1.2: ALL RIGHT FOR THE FEW
These figures reinforce the importance of concentrating not on
the
poorest, but on the richest. We should be asking not only how
can we
improve things for the poor, but how can we get everyone’s
health up to the
standard of the richest? Were we to focus only on the ‘poor’ of
Uganda, we
would miss the fact that the most affluent 20 per cent have a
higher child
mortality than the poorest of Peru. If you are in India, would
you be happy
if only the child mortality rate of the poorest fifth were
reduced? Wouldn’t
you want everyone to have child mortality as low as the top
fifth? For that
matter, surely if you are in the best-off fifth in India you would
want to get
the child mortality of people like you down to the low level of
the top fifth
in Peru, who would want to get theirs as low as the average for
high-income
countries – 7 deaths per 1,000 live births.
In other words, the implications of the gradient in Uganda,
India or Peru
are the same as in Glasgow, London or Baltimore. Yes, it is
important to
improve the lot of the worst off, but the gradient demands that
we improve
conditions, and hence health, for everyone below the top. Not
57. only do we
need to reduce poverty, we need to improve society and have
effort
proportional to need.
You may be thinking that a social gradient in health in Glasgow
and in
India are quite different. Thinking about Jimmy in Calton,
described above,
destitution does not come to mind. He has clean water and
shelter and does
not suffer from malaria, or dysentery. Surely in India it is
different, where
the basics are lacking. The basics are wanting, but in other
respects it is not
so different. Here is Gita.
Gita sells vegetables on the street in Ahmedabad in the state of
Gujarat in
India. She has no formal education, lives in an ‘informal
settlement’ (a slum
made of makeshift housing) and has two children who sit with
her by the
roadside as she sells her vegetables, and an older girl who helps
with the
vegetable trade. To keep her business going Gita takes out
short-term loans,
at 20 per cent a month interest, to buy vegetables from the
middle man in
the wholesale market. Her husband is a migrant worker who is
living in
another state and sends a few rupees back each month. Gita was
just about
58. making her tight budget work, but it was time for her daughter,
aged
fourteen, to marry, and instead of paying off her debts she put
money into a
dowry and a wedding party for her daughter. Some aid workers
are tearing
their hair out at what they see as this ‘irresponsible’ waste of
money, as her
interest payments have gone up.
What links Jimmy and Gita is disempowerment. They simply
have little
control over their lives. This disempowerment is linked to
ranking low in
the social hierarchy. Until they are in a position to take control
of their lives
it is going to be very difficult to improve their health. Yet the
evidence
shows that this is far from hopeless. It is to capture the season
of light that I
have written this book.
In saying at the start that it was the worst of times, I pointed to
two types
of inequality in health. We have just been looking at
inequalities within
countries – the social gradient in health. There is a second type
of
inequality. Figure 1.2 shows big differences between countries
as well as
within them. It implies that poorer countries have worse health.
They do, in
general. To see that that is not the whole story, however, I want
to turn to
the US.
59. RICH COUNTRIES, GOOD HEALTH?
You are a fifteen-year-old boy in the USA. I’ll call you Andy.
You are
secure in the notion that you live in nearly the richest nation on
the planet.
Life will be good. Like all fifteen-year-olds you have many
preoccupations,
some linked to your quick mind and wild enthusiasms, others to
your
growing body and raging hormones. Apart from being a bit
overweight and
prone to the occasional bout of hypochondria – it’s acne not
cancer – health
is not a concern. You live in a rich country and everyone says
that rich
countries have good health because of good medical care and
public health.
Poor countries have poor health because they lack those things.
Anyway,
you think, when a country’s health suffers it is babies and
young children
and older people who die. Fifteen-year-old boys are practically
indestructible. Given what you get up to, that is a welcome
notion. If you
reach the vigorous age of fifteen you can almost guarantee you
will reach
sixty. Reassuring, but not quite right.
Go into a typical American school and count one hundred boys
aged
fifteen. Thirteen of you will fail to reach your sixtieth birthday.
Is thirteen
60. out of a hundred a lot? The US risk is double the Swedish risk,
which is less
than seven. The UK looks more like Sweden, but not quite as
low. Yes,
thirteen out of a hundred is a lot. It may also be the tip of the
iceberg. If so
many young people are dying, there may be a good deal more
that are
suffering non-fatal illnesses and injuries.
You and your family might be shocked to find out that the
survival
chances of a fifteen-year-old boy in the US are about the same
as in Turkey
and Tunisia, Jordan and the Dominican Republic. The US figure
is worse
than Costa Rica, Cuba, Chile, Peru and Slovenia. In fact, in the
US the
likelihood that a fifteen-year-old boy will survive to celebrate
his sixtieth
birthday is lower than in forty-nine other countries. The US
ranks around
fifty on what is called male ‘adult mortality’. There are 194
member states
of the United Nations. Fifty out of 194.15 Not looking good.
The US is a
very rich country. Rich countries are supposed to have good
health. What
happened?
I have lost count of the number of Americans who have told me
that they
have the best health care in the world. Let us, for the moment,
assume it is
true. Why, then, would young adults in the US have less chance
of
61. surviving to sixty than young adults in Costa Rica, Cuba or
Slovenia,
let alone Sweden, the UK and most other European countries?
The answer is because medical care, and even public health, has
little to
do with it. The high mortality of young men comes from
homicide, suicide,
car crashes, other accidents, drugs, alcohol and some other
disorders. To
blame homicide or other violent deaths on lack of medical care
is a bit like
blaming broken windows on a lack of suppliers of new window
panes. If
someone heaves a rock through your window, it is quite helpful
to have
someone to call who can come and fix it. It wasn’t difficulty in
finding
someone to call that led to the rock being thrown . . . or not
directly. (There
is a broken windows hypothesis which suggests that if you don’t
fix the
windows it encourages rock throwers.) Could the relatively poor
survival
chances of young men be linked to the nature of society?
For American readers here is a little consolation, albeit not
much for
Russian readers. Russia does dramatically worse. If you are one
of a
hundred fifteen-year-old boys in Russia, look around and take
note: a third
of your group will be gone by the age of sixty. In Russia you
62. simply cannot
assume, as you can in Sweden, that if you are alive and kicking
at fifteen
you will still be breathing at sixty. On this particular health
measure, Russia
would not look out of place in sub-Saharan Africa. Its figure is
the same as
in Guinea-Bissau, and only marginally better than Sierra Leone.
This second type of health inequality – the first is the social
gradient
within countries – is the dramatic variation in health between
countries,
even among relatively rich countries: Sweden, the US and
Russia.
Perhaps you are thinking that Sweden and the US is not a fair
comparison. Perhaps, Sweden being a more homogeneous
country, the
Swedes are genetically programmed to be healthier young adults
than the
ethnically and racially diverse US. Or is it misleading to
compare a country
with a population smaller than New York with the whole of the
US?
What if I told you that twenty years ago, the survival chances of
fifteen-
year-old Swedes were worse than now and looked a lot like that
of
Americans today? Sweden was more homogeneous twenty years
ago than it
is today – there has been a great deal of immigration – so the
homogeneity
explanation does not hold much water. Put simply, if Sweden
could improve
63. its health from a US level of health to a Swedish level, so today
could the
US improve its health to the new Swedish level. After all the
US, too, has
improved over the last twenty years. It just hasn’t caught up.
There is no
good biological reason why you, fifteen-year-old Andy in the
US, should
not have the same health prospects as fifteen-year-old Johan in
Sweden.
Why don’t you, then? Read on.
Obviously, it is not simply about rich and poor countries.
National
income per head is a third higher in the US than in Sweden, but
health is
poorer in the US.16 The US is richer than almost all of the
forty-nine
countries that rank ahead of it in the survival stakes. Russia’s
national
income per head (adjusting for purchasing power) is twenty
times Guinea-
Bissau’s, yet boys in the two countries have the same poor
survival chances.
OK, not simply rich and poor, but we know, don’t we, why
people get
sick and die. Isn’t it lack of health care? And if not that, in poor
countries it
is destitution that leads to death from communicable diseases.
In rich
countries it is smoking, drinking, obesity and general failure to
look after
ourselves that cause diabetes, heart disease and cancer. We will
64. look at
these explanations and see that they are not so much wrong, as
too limited,
and they scarcely apply to the life prospects of fifteen-year-old
boys.
I rather ruled out of hand the idea that differences in medical
care could
explain the differences in survival among fifteen-year-old boys
– broken
windows are not caused by lack of window fixers. Perhaps such
quick
dismissal is inappropriate when it comes to the more robust
gender.
Differences in medical care might provide a readier explanation
for
international differences in fifteen-year-old girls. Women have
to face
something special before they reach sixty: pregnancy and
childbirth. We
visited a boys’ school. Let’s visit a girls’ school.
Go into a school in Sierra Leone, and count twenty-one fifteen-
year-old
girls. One of those twenty-one will die during her childbearing
years of a
cause related to maternity. In Italy, one school would not be
enough. You
would have to count 17,100 fifteen-year-old girls to be fairly
sure than one
would die of a maternal-related cause. I was shocked by the
differences
among boys. I am horrified by the differences among girls.17
My horror comes not just because of the magnitude of the
difference
65. between Sierra Leone and Italy, but because it is all so
unnecessary. This
loss of young lives should not happen. Medical science knows
how to make
pregnancy and childbirth completely safe for the mother. One
maternal
death in all the reproductive years of 17,100 women is as close
as we can
get to completely safe. Conventional explanations suggest that
we know
what to do to prevent this tragedy.
Skilled birth attendants present before, during and after labour
can make
a dramatic difference to survival. Lack of access to health care,
then, is the
beginning of an answer to the differences in risk of maternal
deaths. It is
only the beginning because the obvious question is, why is there
lack of
access? Do countries not know what is needed? Do international
donors not
know what is needed? When I say that conventional
explanations are not
wrong, they are just too limited; this is part of what I mean.
If it were simply a ‘medical care’ issue then the US would have
the
lowest maternal mortality in the world, wouldn’t it? The US
spends more
than any other country on health care. Arguably, it has the best
obstetric
care in the world, but it does not do very well. In the US, you
66. would have to
count 1,800 fifteen-year-old girls to get one maternal death in
their
childbearing years. One in 1,800 is enormously better than one
in twenty-
one in Sierra Leone, but significantly worse than Italy, at one in
17,100. In
fact, sixty-two countries have lower lifetime risks of maternal
deaths than
the US. Let that one sink in a bit. No woman should die during
pregnancy
and childbirth, yet in one of the richest countries in the world,
which spends
the most on medical care, the risk is higher than in sixty-two
other
countries.
It is possible that some countries don’t count maternal deaths
properly
and there may be some error in the calculations. For this
purpose I will
adopt a ‘northern’ bias, cut out the global south, and limit the
comparison to
Europe, by which I mean the fifty-three countries that make up
the
European Region of the World Health Organization, including
all of the
former Soviet Union, Turkey and Israel. Were the US a
European country
then it would have only forty-six countries ranking ahead of it
in lifetime
risk of maternal death. The US would rank forty-seventh among
these
‘European’ countries, and be on a par with Armenia, just ahead
of the
republic of Georgia.
67. Invited to address a meeting of the American Gynecological and
Obstetric Society, I told them this home truth about US
maternal risks
equalling Armenia, congratulated them on being ahead of
Georgia, and said
that I was willing to accept that the US has the best obstetric
care in the
world. I was also willing to guess that if I asked them to jot
down on a piece
of paper which US women died of a maternal-related cause, all
their notes
would say much the same thing: the socially excluded, the very
poor, illegal
immigrants, people with chaotic lives in one form or another.
Some of the
good doctors might have mentioned ‘race’. I take race as a
proxy for other
forms of social exclusion, but I’ll come back to that.
When people get sick they need access to high-quality medical
care.
Medical care saves lives. But it is not the lack of medical care
that causes
illness in the first place. Inequalities in health arise from
inequalities in
society. Social conditions have a determining impact on access
to medical
care, as they do on access to the other aspects of society that
lead to good
health.
I don’t have it in for the US: some of my best friends . . . If you
are a
68. young person in the US, though, it is reasonable to ask why
your prospects
for a healthy life are no better than in Armenia and worse than
in Costa
Rica, Chile or Cuba, quite apart from most high-income
countries.
I assumed that you, Andy, are a typical American fifteen-year-
old. But
there isn’t, is there, a typical fifteen-year-old. There are rich
and poor, urban
and rural, inner-city and suburban, immigrants and descendants
of
immigrants, indigenous and others, different ethnic groups, red
states and
blue states. Often, inequalities in health within countries are as
big as the
differences among countries. We need to get behind the
averages, to unpick
them. In other words, we need to keep both types of inequalities
in focus:
those between countries, and those within countries – the social
gradient.
Before we go on, there is something that may be nagging at you,
as you
read this. How can I make such generalisations? You and I are
unique.
There has never been in the history of the planet another you or
another me.
Even if you have an identical twin, who is the same as you
genetically, the
two of you have somewhat different life experiences that mark
each of you
out as unique. However, if you thought that your uniqueness
meant that we
69. could not make any generalisations about you, I would advise
against going
to the doctor when you get sick. All she could say in that case
would be that
she had never seen another person quite like you; research data
didn’t
apply; treatment was out of the question. Your doctor doesn’t
say that. She
says people with your symptoms and signs have disease of the
heart, or
lungs, or toenails. We have good experience of treating people
like you; we
will therefore recommend the following. It turns out that the
treatment has
more or less the same effect on you as it has, on average, on
other unique
individuals with the same medical condition that you have. You
may be
unique but you share characteristics in common with others of
our species .
. . and other species. Those common characteristics allow us to
learn from
experience.
The same reasoning applies to all the social facts in this book.
Each
American is unique; so is each Swede, and each Russian. Yet
consistently
Russians have higher adult mortality than Americans, who have
higher
mortality than Swedes. They did last year; they did the year
before; and in
all probability they will again next year. Unique as you are,
your shared
experience with your fellow countrymen and women changes
your risk of
70. health and disease, and of life and death; and marks you out as
different, on
average, from people in other countries. Similarly, if you are
rich and in
professional employment, you share characteristics with others
in those
groups that mark you out as different, on average, from people
who are
poor and not employed professionally. Health and disease vary
with these
characteristics of groups, as they do with characteristics of
countries.
MONEY – DOES IT MATTER OR NOT?
In the previous section, when discussing American Andy’s
poorer health
prospects than Swedish Johan’s, I said that it was not about rich
and poor.
The US is richer than almost all of the forty-nine countries that
have lower
chance of death of fifteen-year-old boys. Similarly, I pointed to
Russia’s
‘African’ level of mortality despite having much higher national
income
than Guinea-Bissau. What I did not say is that the 144 countries
with higher
adult mortality than the US are poorer countries.
It is not as contradictory as it sounds. Among poor countries,
higher
national income is associated with better health. Among rich
countries,
71. getting richer does very little for health. Other things are more
important.
Figure 1.3 illustrates these two phenomena, by plotting the span
of
countries’ life expectancy against their national income in
dollars. A dollar
in a poor country can buy much more than a dollar in a rich
country, so
national incomes are adjusted for purchasing power. This
adjustment brings
up the figures for national incomes in poor countries.
If you have little of it, money is crucial to your life and your
health. For
poor countries, small increments in income are associated with
big
increases in life expectancy. It makes sense. A country with a
per capita
national income of less than $1,000 can afford little in the way
of food,
shelter, clean water, sanitation, medical and other services –
relief of what I
have called destitution. With a small increment in income, more
things are
possible.
FIGURE 1.3: RICHER AND HEALTHIER – UP TO A POINT
Even more money, though, does not guarantee good health.
Above a
national income of about $10,000 there is very little relation
between
national income and life expectancy. When describing the fate
of fifteen-
72. year-old American Andy, I pointed out that he does worse than
Swedish
Johan. Here, taking a slightly different measure of health, life
expectancy at
birth, we see that Cuba is doing as well as the USA, and Costa
Rica and
Chile are doing somewhat better, though they all have lower
national
incomes. Russia does remarkably poorly: much lower life
expectancy than
would have been expected from their national income.
The conclusion is that money does matter if you are in a poor
country
and have little of it, less so if your country is relatively well
off. Other
things are important.
NOT JUST INCOME, SOCIETY!
I have three simple ideas that animate this book – only the third
of which
needs some explanation. The first, as I said when comparing
Andy and
Johan, is that there is no good biological reason for most of the
health
inequalities that we see within and between countries. Health
and
inequalities in health can change rapidly. Second, we know
what to do to
make a difference. Arguing for what can be done is the purpose
of this
book. The third relates to the relatively flat part of the curve in
73. Figure 1.3 –
the fact that above a national income of $10,000 there is little
relation
between income and life expectancy.
This third proposition is simply that health is related to how we
organise
our affairs in society. Currently, we measure a society’s success
by an
economic metric – the growth of Gross Domestic Product. There
is
recognition that GDP captures only one aspect of what the good
society
means.18 A measure that gets closer to people’s lives is
happiness or life
satisfaction.19 Health is another. We all value health, probably
more than we
value money. The argument for health as a measure of social
success goes
further. Many of the other things we value are related to health
of
individuals and society: good early child development,
education, good
working conditions, a cohesive society – all are linked to better
health, as
subsequent chapters will show.
I will make the case that our social arrangements are crucial to
the level
of health of our society. The US is doing better than Russia, but
not as well
as Sweden, or forty-eight other countries. My case does not rest
on whether
I personally would rather live in the US or Sweden, UK or
Russia; it rests
on the data. If I say that the US ranks fiftieth, and is therefore
74. doing badly
by its citizens, it is not because I start out liking, or not, the
way the US
does things. My case rests on the data on health. I know Russia
is doing
badly, not because of prior views that I hold, whether about
communism,
post-communism, Putin-ism or some other -ism. I say Russia is
doing badly
by its citizens because its health is disastrously poor. I knew
that
communism in Russia was a disaster in the post-war years
because health
suffered. Post-communism was worse. But we’ll come to that.
So close is the link between the nature of society and health that
you can
use it both ways. By which I mean the level of health, and
magnitude of the
social gradient in health, tell us about how well the society is
doing. And if
you are concerned about improving health, then the conditions
of society
that influence health – its social determinants – loom large.
POVERTY: ABSOLUTE OR RELATIVE?
Two of the ways that societies can affect health are the level of
poverty and
the magnitude of inequalities. They are linked. Absolute
poverty is of clear
importance in explaining the close link between national income
and life
expectancy in the steep part of the curve in Figure 1.3, for
75. countries with
national income less than $10,000 per head, adjusting for
purchasing power.
Degrees of absolute poverty are also likely to be important in
explaining the
gradient in child mortality in India or Uganda, for example. The
higher up
the wealth scale, the more likely that people have the basic
necessities of
life.
Think, though, about the gradient in health in rich countries, the
subway
rides, and Figure 1.1. It is odd to think of people in the middle
of the
distribution as being somewhat in poverty, yet they have worse
health than
those at the top. We need to look for something other than
absolute poverty
to explain their worse health – perhaps relative deprivation, or
being the
wrong side of inequality.
What about poverty in Glasgow? Most people visiting Calton
would have
no hesitation in calling it poor, and yet it is fantastically
wealthy by, for
example, Indian standards. A third of Indians live on $1.25 a
day. No one in
Glasgow lives on so little. Average income per person in India,
adjusting for
purchasing power, is $3,300. That is way below the poverty line
in
Scotland. There are a few rough sleepers in Glasgow, but almost
everyone
has shelter, a toilet, clean water and food. Yet life expectancy
76. for men in
Calton was eight years shorter than the Indian average.
A clear implication of this contrast is that the meaning of
poverty differs
with the context. While $3,300 a year is not considered poor in
India, it
would count as remarkably poor in a high-income country. It is
not simply
the money in your pocket that defines poverty, or determines
health risks.
In the 1980s Amartya Sen and Peter Townsend, two
distinguished social
scientists concerned with poverty, had a vigorous debate as to
which was
more important: absolute or relative poverty. It makes for
amusing reading
as they aimed respectful, elegant, courtly even, academic blows
at each
other. But rereading it now, I am struck by how little difference
there seems
to have been between them.20
Which is more important for health, absolute or relative
poverty? Surely
the answer is both. The people of Calton are deprived relative to
the
standards of the UK, but the absolute amount of money they
have matters
too. It is reasonable to suppose that if they had more money
their lives
would change, and if the community had more cash, conditions
77. in Calton
would also change.
Amartya Sen resolved the debate by saying that relative
inequality with
respect to income translates into absolute inequality in
capabilities: your
freedom to be and to do. It is not only how much money you
have that
matters for your health, but what you can do with what you
have; which, in
turn, will be influenced by where you are.21 If the community
provides
clean water, and sanitation, you don’t need your own money to
ensure these
solutions. If the community provides subsidised public
transport, health
care free at the point of use, and public education, you don’t
need your own
money to access these necessities.
Poverty, then, takes different forms depending on the context.
There is,
though, something that links poverty in countries at all levels of
income and
development, that links Jimmy and Gita. For its 2000–01 World
Development Report, the World Bank interviewed 60,000
people in forty-
seven countries about what relief of poverty meant to them.22
The answers
were: opportunity, empowerment and security. Dignity was
frequently
mentioned. Indeed, dignity has strong claims for considerati on
by those of
us concerned with society and health.23 A similar exercise in
Europe
78. showed that people felt themselves to be poor if they could not
do the
things that were reasonable to expect in society: for example,
entertaining
children’s friends, having a holiday away from home, buying
presents for
people.24 In other words, in Europe the ways of doing without
have
changed – no longer lack of clean water and sanitation, but not
having the
means to participate in society with dignity.
POVERTY? INEQUALITY? EMPOWERMENT? DON’T WE
KNOW THE CAUSES OF ILL HEALTH?
A massive and truly impressive study, the Global Burden of
Disease, looked
at the causes of everything, everywhere.25 I am exaggerating
only slightly.
The study really did look at all diseases in every region of the
world in 2010
and, heroically, came up with estimates of the major causes of
ill-health
globally. The list was, starting at the most important and
working down in
order: high blood pressure, smoking, household air pollution,
low fruit
intake, alcohol use, high body mass index, high fasting plasma
glucose
level, childhood underweight, ambient particulate matter
pollution, physical
inactivity, high sodium intake, low nuts and seeds, iron
deficiency,
79. suboptimal breastfeeding, high total cholesterol, low whole
grains, low
vegetables, low omega-3, drug use, occupational injury,
occupational low
back pain, high processed meat, intimate partner violence, low
fibre, lead,
sanitation, vitamin A deficiency, zinc deficiency and
unimproved water.
Three things strike me about this list. First, where are the
causes of
infectious disease? Sanitation, vitamin A and zinc deficiency
and
unimproved water bring up the rear of the list. Childhood
underweight,
which makes children more vulnerable to infection, comes in at
rank 8,
after high body mass index, i.e. overweight. Today, considering
all
countries, high-, middle- and low-income, the major diseases
affecting
people are similar – so-called non-communicable diseases: heart
disease,
lung disease – note the importance of indoor air pollution, a
cause of
chronic lung disease in low-income countries – cancers,
diabetes. AIDS,
Ebola, TB and malaria remind us that there is still a long
distance to go in
eradicating major infectious disease epidemics. That said,
already in
middle-income countries, and increasingly in low-income
countries, the
causes of suffering and death are similar to those in high-
income countries.
80. Second, the list contains a mix of physiological risk factors:
high blood
pressure, high blood glucose, high total cholesterol; behaviours:
smoking,
diet and alcohol consumption; and environmental exposures: air
pollution,
lead. There is no causal analysis in the sense that diet can cause
high blood
pressure and high plasma cholesterol. Think about tw o ways to
control high
blood pressure: pharmacologically, or through changing diet and
environmental factors. The pharmaceutical industry may not
like me for
saying it, but my preference is for seeing how we could deal
with the causes
of high blood pressure, high cholesterol and high blood sugar,
rather than
simply wait for them to get raised and then treat.
Third, and related to the last point, there is no social analysis.
Overwhelmingly, most of these risk factors are related to
people’s social
circumstances. We might call these the ‘causes of the causes’.
Diet, indoor
air pollution and high blood pressure are potent causes of
disease globally.
We need to ask why, increasingly, these risk factors are linked
to social
disadvantage. Remember the discussion of maternal mortality?
We may call
lack of access to medical care a cause of a mother dying in
childbirth. We
need to look at the causes of lack of access – the causes of the
causes.
81. My argument is that tackling disempowerment is crucial for
improving
health and improving health equity. I think of disempowerment
in three
ways: material, psychosocial and political. If you have too little
money to
feed your children you cannot be empowered. The material
conditions for
well-being are vital. The psychosocial dimension can be
described as
having control over your life. We will look at evidence that
people have
difficulty making the decisions that will improve their health if
they do not
have control over their lives. Further, disempowering people in
this way,
depriving them of control over their lives, is stressful and leads
to greater
risk of mental and physical illness. The political dimension of
empowerment relates to having a voice – for you, your
community and
indeed your country.
My approach to empowerment and the causes of the causes has a
history.
Over a century ago, Robert Tressell, describing the foul living
conditions in
which poor labourers in Britain slept, wrote in The Ragged
Trousered
Philanthropists:
The majority of those who profess to be desirous of preventing
and curing the disease called
consumption (tuberculosis) must be either hypocrites or fools,
for they ridicule the suggestion
82. that it is necessary first to cure and prevent the poverty that
compels badly clothed and half-
starved human beings to sleep in such dens as this.26
Tressell was a novelist and polemicist and not a scientist, but he
is still bang
up to date. Should we, as much of modern medicine tries to do,
at great
expense, look for technical solutions and educate people and
patients about
healthy behaviour? Or should we, in the tradition of Tressell,
seek to create
the conditions for people to lead fulfilling lives, free from
poverty and
drudgery? In my view we should do both.
For an illustration of the potent health effects of
disempowerment we can
return to Glasgow. Sir Harry Burns is a remarkable man. He was
a
practising surgeon in Glasgow. He concluded that treating
people surgically
was too late in the course of their illness. His own clinical
observations led
him to the clear insight that the illnesses he was seeing resulted
from
people’s social conditions. He wanted, then, to treat those
conditions to
prevent illness rather than wait for the illness to occur. We met
in the early
1990s when he made the shift from surgery to public health. His
clinical
insights led him to the view that the way social conditions got
into the body
was through the mind. As I was doing research on how
psychosocial factors
83. affected heart disease we had a great deal to talk about. When
Harry Burns
was appointed Chief Medical Officer of Scotland he brought
these insights
with him – a force for good.
Harry Burns and his colleagues from Glasgow compared
mortality rates
in Glasgow with rates in Manchester and Liverpool in
England.27 All three
cities are post-industrial, in the sense of having lost their heavy
industry,
and have similar levels of poverty and of income inequality.
The causes of
death with the biggest relative excess in Glasgow were: drug-
related
poisonings, deaths associated with alcohol, suicide and
‘external’ causes,
i.e. accidents and violence apart from suicide.
The causes that show the biggest relative excess in Glasgow are
all
psychosocial. Harry Burns says that to understand Scottish, and
in
particular Glaswegian, health disadvantage, you have to
understand that
people feel they have little control over their lives – they are
disempowered.
This will be most evident for the poorest people in Glasgow, but
it will not
be an all-or-nothing phenomenon. It gives us a way to link
poverty and the
gradient. The lower they are in the socio-economic hierarchy