Democracies: Challenges to Societal Health: Volume 19

My introduction to political sociology and particularly to the concept of democracy and its practical implication for societies started during my student years when I was a member of student chapter of the pro-democracy Solidarity Movement in Poland in 1980–1981. Participation in the Solidarity Movement taught me the unforgettable lesson about the power of individuals united by a common goal of building democratic society. I was able to witness how united citizens' concern about the future of their country could overpower totalitarian regimes (i.e., communist regimes), initiate their breakdown and, by voting and political participation, encourage policy makers and political figures to focus on betterment of societal living conditions. I also realize that democratization is a long process that starts with democratic political changes and democratic elections but it takes decades for their institutionalization and development, and it takes even longer to improve quality of people's lives in democratizing countries. Development of democracy requires experience, knowledge, and skills of domestic politicians and the existence of certain economic, political, and cultural structures conducive to democratic growth.

In democratic societies people can impact policy making and in theory can direct societal development. Hence, due to active public participation in the decision-making process, it might be easier to solve societal problems in democratic countries. Nonetheless, democracies are not free from social ills nor are nondemocracies. Though the benefits outweigh the costs of democratic changes, the costs should not be forgotten. Especially when we consider the impact of democracy and development on population health, the costs are significant though limitedly discussed.

The costs in societal health are especially visible among poverty-driven populations of democratic and nondemocratic countries. Poverty, in general, limits access to medical care and modern medical treatment. Poverty is also one of the most influential separators of society separating social strata in terms of their differentiated access to health-care facilities and modern medical treatments. Democracies by being more likely supported by international networks that help to open access to medical care, including international medical services, ease the struggle against poverty and unhealthy living conditions, but democracies are still unable to eliminate them.

Since many Afghans, especially in rural areas, favor traditional, customary, and tribal laws over national laws, they tend to disregard the constitution and national governmental structure under the new democracy that gives girls and women protection. These laws allow girls to attend school, and ban child marriage; therefore, the problems related to these practices should be decreasing. However, since many in the more rural areas of Afghanistan do not honor the regulations, laws, and rulings of the national government, serious problems still exist for girls and women. Those to be addressed in this chapter are high rates of illiteracy, child marriage, obstetrical fistulas, poor health, domestic violence, and self-immolation.

There is a need for rigorous research documenting the important role of school nurses in facilitating positive health outcomes among students. Poorly managed care can affect student absenteeism rates, which are associated with academic performance and school funding, and students in underresourced schools are at particularly higher risk of suffering chronic conditions (e.g., asthma, diabetes) that necessitate proper care and management. The San Jose Unified School District (SJUSD) Nurse Demonstration Project was developed as a five-year endeavor to expand school nursing and formally link school nurses to a school-based health clinic. The initiative provides for full-time school nurses at four elementary and middle schools in SJUSD, and a nurse practitioner at School Health Clinics of Santa Clara County. The objectives are to: (1) improve access to primary care and prevention services, specifically asthma and chronic condition management and (2) facilitate the establishment of a medical home for students. Evaluation of the project employs a mixed methods research design, including a logic model, an intervention and control study design (comparing outcome measures in the four demonstration schools with five “control” schools), parent, teacher, and school administrator feedback, systematic nurse reports, and quantitative analysis of school health and administrative data, including health conditions and absenteeism information. Key findings in Phase I of the project are discussed, including improvement in screening and referrals, follow-up care among students with asthma, and mean days absent due to illness. With increasing budget cuts to public schools, documenting the impact of full-time school nurses will remain crucial in leveraging support and resources for school health services. Findings of this project indicate that school nurses provide valuable services and could be a major player in providing and coordinating effective management and prevention of chronic disease among children.

So far only minimal efforts have been made to directly integrate health concerns with priorities of the processes of global economic development. Nonetheless, there is search for new models to provide sufficient medical care and to encumber global threats, soaring medical costs, technological costs, poverty, and disease. Using example of health conditions and health policies implemented in countries of Southeast Asia in comparison to Eastern Europe, the chapter emphasizes success achieved and in the process of achievement in provision of health care to societies in these countries.

After 1945 all countries of the communist Eastern Europe implemented a uniform model of health-care system and health policies called socialist Health Services that provided universal, free of charge health care to all citizens. The initial model underwent many reforms with the largest change taking place during the country's democratization and transition to a market economy system after 1989. The processes of the democratization of the political life and economic changes included privatization of the health-care and medical services. In addition to state hospitals, medical care was provided by private doctors and these services were fully paid for by patients. The private medical care was greatly available but was not controlled by the state until a few years later when the state developed networks of state-regulated services, including public and independent health-care centers. Among other changes of the recent decades was establishment of accreditation system in Polish medical institutions implemented in Poland after 1997. As of 2011 there are 98 accredited Polish hospitals. The prevailing mix-health-care system (private and public) is divided by differences in quality of services, with much higher quality medical services being offered by private clinics than by state-sponsored hospitals.

Natural disasters have an enormous impact on the lives and well-being of people in many parts of the world. When a disaster occurs, it causes massive damage to people's livelihoods. Although a household is automatically disrupted after experiencing a natural disaster (floods, earthquakes, mudslides, etc.), the accessibility of food commodities is often the most negatively impacted. Since pre-disaster periods are already challenging in the context of providing sufficient food within poverty-stricken areas, natural disasters leave a trail of vulnerable and disadvantaged people who cannot acquire an adequate amount of nutritious food necessary for survival. The inability to maintain consumption levels exposes households to food insecurities – insecurities experienced particularly by women, who head households. Women are more susceptible to food scarcity and lose the ability to sustain their families’ livelihood due to the loss of seeds, livestock, and food, in general. Natural cataclysms, however, not only hamper access to nutritious food, but also considerably affect women's and children's health conditions. In countries like Tajikistan, there is a small body of research that assesses the impact of hazardous events on women's and children's health and nutrition in the aftermath of disasters. This study seeks to provide insights into the access of balanced diets to families in post-disaster situations and analyzes how disasters impact the health of affected people.

Domestic violence is one of the crimes against women which is linked to their disadvantageous position in the society. Internationally, one in three women have been beaten or abused by a member of her own family.

Though violence against women in the family is a global phenomenon, yet its ramifications are more complex and its intensity much greater in India. The status of women fits into a vicious circle of mutually reinforcing gender inequalities and patriarchal practices in Rajasthan.

The present study was conducted in two villages near Pilani, Rajasthan during January–June 2009. Main objectives of the study were to explore the incidence, type, and cause of violence among women and to examine the awareness level of “Prevention of Domestic Violence Act 2005.” Simple random sampling technique was used. Respondents were married women within the age group of 15–50 years. A total of 150 women were interviewed.

A statistically significant relationship was found between violence and women's age, caste, structure of family, literacy level of women, husband's level of education, and husband's alcohol consumption. Not a single case of violence was reported to the police.

Violence against women remains a significant barrier to securing human-centered development goals. Domestic violence in particular has limited options in almost every sphere of women's lives and in most community space. It also compromises the healthy development and well-being of their children and families. Yet, domestic violence is widespread in all regions, classes, and cultures. Wife beating is the most common form of family violence, and it poses a threat to the quality of women's lives in nearly every culture and society (Penn & Nardos, 2003). Victims of violence are often silent because they are helpless. Social and legal barriers continue to make it difficult to collect accurate data and sufficient evidence for domestic violence. In patriarchal societies in Asia, such as Sri Lanka, women face many difficulties due to domestic violence. This chapter identifies diverse problems and harassment faced by women in their domestic life in Kandy District in rural Sri Lanka. It focuses on problems women face in their youth, married life, and, in some cases, divorce. The qualitative study focuses on understanding the nature of the problem, the reason for domestic violence, and providing some conclusion from the material gathered from the study.

Although gender dimensions have been widely discussed in social research, many disaster relief and recovery programs still ignore gender needs and gender discrepancies. Specially, in a disaster situation, certain cultures and governments have a lack of mind-set and skills to focus on women's needs adequately although it requires much more investigation. During natural disasters, females face unprecedented challenges than men, because they are vulnerable and marginalized – socially, culturally, economically, and politically. To overcome these challenges, it is strongly suggested that a multifaceted decision-making process is practiced.

This chapter explains challenges for women in a natural disaster situation and discusses how to overcome difficulties and rebuild livelihoods of a vulnerable population in Sri Lankan society. The 2004 tsunami claimed over 40,000 lives, displaced about 1.0 million from their homes, and caused severe damage to the physical infrastructure and the damage estimated was well over US $1.5 billion. As the female population face unprecedented challenges, it is suggested that gender needs and gender discrepancies require thorough investigation. This chapter presents a study based on needs assessment carried out in tsunami impact communities in East and South Sri Lanka in 2005 and outlines the lessons learned on how women and men operate and anticipate post-disaster relief and recovery. Using participatory mapping methodology (e.g., narratives, ethnographic observations, community mappings, key informant interviews, focus group interviews, and other qualitative methods) this study suggests effective techniques to incorporate gender needs in a natural disaster situation.

This study reveals that despite the negative effects of migration, the Tanzanian government has not done enough to address migration-related health issues. This is owing to inadequate data or information about effects of migration in the country. Dodoma region, the focus of this study, is selected for its migration-inducing factors as they relate to the declining health status of its inhabitants. Harsh climatic conditions causing irregular and inadequate rainfall and prolonged drought have led to a severe decline of the health of the poor. The region is entirely dependent on subsistence agriculture and livestock production. The small-scale production is locally practiced at household level. Extreme poverty motivates rural people to migrate to cities with the main migrant groups being middle school (about 13 to 15 years old) and high school dropouts (15 to 18 years old), and youth including young parents (18 to 35 years old). The rural-urban migration conjoined with harsh climatic conditions significantly downsizes local population, available agricultural labor force, and further endangers food security. More importantly, however, due to exposure to HIV in the cities, most migrants who are unable to find city jobs return home terminally ill with HIV/AIDS, which further adds to impoverishment of rural families and to downsizing of rural population.

Nepal has made progress in raising the living standards of its people over the last 50 years, and yet the country's human development, especially the development of women remains among the lowest in the world. Development outcomes have varied inequitably manifesting themselves in gender, caste, ethnic, and geographic disparities. Women cut across all these categories and within any one group remain the most marginalized sections of the society. Women find themselves in a vicious circle that drives the discrimination against their gender. With low status, they lack the decision-making power to control access to health care and other resources, which perpetuates the low status, with no obvious place to break into the circle.

Three important lessons can be drawn from the health situation in developing and democratizing world. First lesson is that the societal health does not occur in the vacuum of societal life or social structures, but it simultaneously inspires development of all major spheres of political, economic, and cultural life of society. Second, health policy transpires simultaneously in all major social institutions, including economy, political institutions, and culture. Furthermore, because all social institutions are interconnected, the initiation of health reforms causes enormous, multilevel changes in all social strata and affects the performance of all essential institutions. Third, according to the World Health Organization, health is considered an integral part of human security, human rights, and peace. Consequently, societal health is determined and depends on the fullest cooperation of governments, world-scale communities, and local health care providers.