Theory as a Bridge between the Personal and the Public Essay Example for Free

Theory as a Bridge between the Personal and the Public Essay In his seminal work called â€Å"Sociological Imagination†, C. Wright Mills attempts to shed light on the processes and patterns through which individual troubles and public issues are closely related. For Mill, sociological analysis is the key to understanding the dialectics between personal troubles and public issues. II. What Constitutes the Sociological Analysis? The epistemological premise of sociological enquiry is based on its ability to understand the concrete nature of personal troubles in the abstract nature of public issues. In other words, sociological analysis in its ontological position is an abstraction of the overarching phenomena. According to Mill, sociological imagination is constituted by the ability to see through the core of the social and the soul of the personal and the complex interactions between them, while without being blinded by any. Based on this idea, Mills (2000) points out that â€Å"the most fruitful distinction with which the sociological imagination works is between ‘the personal troubles of the milieu’ and ‘the public issues of social structure†. As an individual, one would experience his/her problems as personal but such problems still may well derived from the general problems from within the society. Therefore, sociological imagination has to give its due to both the larger social forces and the individuals and groups. It is the mutually interactionist nature of both social forces and individuals that matters. Behaviors are not only shaped by the social forces, but also individual actions too influence the course societal dynamics. III. Conclusion Sociological imagination is always interactive. It demands a balance of approach in looking at the specific problems of individuals as they often closely assembled to the wider social context. On the other hand, the social context too is necessarily linked to the actions and behaviors of individuals and groups. Reference Mills, C. W. (2000). The Sociological Imagination. 40th Ed. New York: Oxford.

Obesity in African American Culture Essay Example for Free

Obesity in African American Culture Essay Obesity has more that just a physical effect on the body. Obesity also greatly affects the mental and emotional part of the body as well. Although you cannot directly correlate metal and emotional health to obesity, you can see that its effects do in fact play a role in the mental and emotional health of an obese person. While the effects of obesity do indeed reach out to all races, it is easy to see that mental and emotional problems from obesity in the African American culture are present in the culture. Depression, anxiety, and discrimination, are all results that are caused by obesity in the African American community. Many people are familiar with depression, whether it be a friend or family member that went through it or that they themselves went though it. â€Å"Depression is a state of low mood and aversion to activity that can have a negative effect on a persons thoughts, behavior, feelings, world view and physical well-being† (Salmans 1997). African American obesity has a close tie with depression in African American people. When people are self-conscious about their weight they may think that people look down on them for this. This would cause them to think less of themselves or believe that others are better then them. In turn it can cause the obese African American to have a bad view of themselves, other people, and the world in general. This is exactly what depression is. You can see that depression can be caused by obesity in the African American culture. Anxiety is another emotional distress many people are familiar with. Anxiety is know as, â€Å"the displeasing feeling of fear and concern† (Davison 2008). Many people have felt the effects of anxiety in their own lives, whether it is before an important test, a speech in front of many people, or the big gam; many people feel anxiety. Looking only at anxiety caused by obesity in African American people is a different situation. Anxiety or nervousness before a big event is common and in many ways healthy because it motivates us to do the very best we can. Anxiety in African Americans because of obesity is not healthy; in fact it can be dangerous and destructive. By feeling displeased and concerned about their weight African Americans can struggle all through out life to over come these feelings. It could limit their goals and overall make them settle for less then they really can do. Anxiety do to obesity in the African American community is not a healthy and can severely constrain someone’s life. Discrimination in the African American community has always been a problem through out history. Slavery is a very obvious product of discrimination. Taking a more specific look at discrimination of the African American community because of obesity is a different situation. When people discriminate African Americans because of their weight it seriously prohibits their chances of succeeding in life. It could be in the work place or at school. By placing these barriers we are limiting the ability of the African American community and hurting their chances of having a successful and meaningful life. These mental and emotional effects of obesity in the African American community are unfair and wrong. People should not be judged on their weight. Davison, Gerald C. (2008). Abnormal Psychology. Toronto: Veronica Visentin. p. 154. ISBN 978-0-470-84072-6. Salmans, Sandra (1997). Depression: Questions You Have – Answers You Need. Peoples Medical Society. ISBN 978-1-882606-14-6.

Public Health Expenditure And Health

Public Health Expenditure And Health Using a utility maximization approach as developed by Grossman, the results revealed that health expenditure does not affect health outcomes in Kenya. The factors that affect health outcomes include: distance to nearest health facility (5km or more) and other household income. This implies that increasing public health expenditure does not lead to reduced maternal mortality rates. Since the other determinants (access to medical facility and other household income) significantly affect the health outcomes, the government needs to put measures in place to ensure that women can easily access health facilities and sensitize them to ensure that they deliver in health facilities and attend antenatal care. This study did not include some important variables that affect maternal mortality rates like the impact of cultural practices such as female genital mutilation (FGM), preference of certain types of health care providers (including traditional and herbal medicine) and earlier marriages. Therefore we suggest that in future, studies in this field should give attention to these variables. CHAPTER ONE: INTRODUCTION 1.1 Background information Health is the extent to which an individual or group is able to cope with the interpersonal, social, biological, and physical environments (World Bank, 2004). Health is therefore a resource for everyday life, not the objective of living. It is a positive concept embracing social and personal resources as well as physical and psychological capacities. Health financing is a key input in the provision of quality healthcare. Governments have always had a prominent role in overcoming public health risks and this is a major area of concern in less developed countries like Kenya (Scott, 2001). The provision of good health satisfies one of the basic human needs and contributes significantly to maintaining and enhancing the productivity of the people (Owino, 1997). Public expenditure on health services therefore is a key investment in human capital and plays a catalytic role in the growth of the economy by enabling people to achieve their full potential and lead productive lives. In recognition of the importance of human health, one of the Kenya governments major goals since independence has been to achieve adequate and good-quality health care for all citizens (GOK, 1965). To address health outcomes in developing countries such as Kenya, UNICEF advocates for increased public expenditure on health (UNICEF, 2006). Therefore, many countries in developing countries have increased their health expenditure over time. For example, to achieve better health outcomes, Kenya has increased its health expenditure from Kshs. 11.9 billion in 2000 to Kshs. 20 billion in 2004 representing a 30% increase as shown in Figure 1.1 (GOK, 2007). But more resources alone may not necessarily lead to better health outcomes because health care expenditure is only one of the many factors that contribute to health outcomes, considering the fact that these resources may be channeled to various projects that may not directly influence health outcomes. The link between government health expenditures and health outcomes may therefore not necessarily be present. First, an increase in public health expenditures may result in a decrease in private health expenditures; a household may dive rt its funds towards other uses once the government increases its provision of basic health care. Second, the incremental government expenditures may be employed on the intensive rather than the extensive margin. An example of intensive expenditures would be if expensive and low productivity inputs are bought with marginal funds in which case the impact of these expenditures on health outcomes may be small. Third, even if extra funds are applied extensively to health care (e.g. more staff at hospitals, adequate stocking of medications), but complementary services, both inside and outside the health sector, are not there (e.g. lack of roads or transportation to hospitals and clinics, subsidized prices for medication, etc.) the impact of extra government health expenditures may be little or none (Wagstaff, 2002a). In addition to health expenditure, Kenya also joined hands with other one hundred and eighty eight countries in a global effort to improve health outcome and reaffirmed its commitment to the united Nations Millennium Development goals (MDGs). Three of these millennium development goals are directly related to health. These are to (i) reduce child mortality, (ii) Improve maternal health and (iii) combat HIV/AIDS, malaria and other diseases. Despite these global and local interventions in health, performance of Kenyas health sector in terms of maternal mortality has remained as high as four hundred and eighty eight maternal deaths per 100,000 live births in 2008/9, an increase from four hundred and fourteen per 100,000 live births in 2003, five hundred and ninety per 100,000 in 1998 (KDHS, 2008-09). Figure 1.2. Most maternal deaths are due to causes directly related to pregnancy and childbirth, unsafe abortion and obstetric complications such as severe bleeding, infection, hypertensive disorders, and obstructed labor (KDHS, 2008-09). Improving maternal health being one of the eight Millennium Development Goals (MDGs) adopted at the 2000 Millennium Summit, and with only three years left until the 2015 deadline to achieve the MDGs, closer examination of maternal mortality levels is needed to inform planning of reproductive health programmes and to guide advocacy efforts and research at the national level. These estimates a re also needed at the international level, to inform decision-making concerning funding support for the achievement of this goal. Therefore this study focuses on the relationship between health expenditure and health outcomes in Kenya more particularly, how public health expenditure impacts on maternal mortality rates and other determinants of health outcomes. Figure 1.1 Public Health expenditure trends in Kenya Source: Kenya Demographic Health Survey 2008/09 Figure 1.2 Trends in maternal mortality: 1990-2008 Source: Kenya Demographic Health Survey 2008/09 1.1.2 Public Health expenditure in Kenya Adequate resources are critical to sustainable provision of health services. The government remains the major financier of health care, meeting nearly half of the national health recurrent expenditure. The Kenya policy framework of 1994 identified several methods of health services financing, including taxation, user fees, donor funds, and health insurance. These methods have evolved into important mechanisms for funding health services in the country. The GOK funds the health sector through budgetary allocations to the MOH. However, tax revenues are unreliable sources of health finance, because of macroeconomic conditions such as poor growth, national debt, and inflation, which often affect health allocations. The government therefore works closely with development partners to raise money for the health sector. Donor contributions to the health sector have been on the increase, rising from eight percent of the health budget in 1994-95 to sixteen percent in the fiscal 2001/2002. In some years, donor contributions accounted for over ninety percent of the development budget of the MOH (Ministry of Health, 2006). According to the 2001-2002 national health accounts (NHA), as cited by Wamai (2009) Kenya spends 5.1% of its GDP on health. He cited that the health budget had grown significantly from Ksh15.2 billion in Fiscal 2001/02 to Ksh34.4 billion in Fiscal 2008/09. He added that the proportion of overall government expenditure that the government spent on health declined over the same period from 9% to 7.9% in Fiscal 2006/07. In 1992 a cost-sharing system was introduced to leverage more resources for health services (Collins et al, 1996). Revenue from the cost-sharing system increased exponentially from Ksh60 million in Fiscal 1992/93 to over Ksh1, 468 million in Fiscal 2005/06. However, the revenues overall share of total health expenditure for Fiscal 2005/06 was just 6.4% of the MOHs total spending (MOH, 2007). Figure 1.3: Overview of Kenyas health budget, FY2002 2008 ( US$ million) Source: Health Policy Initiative analysis of Ministry of medical services, 2008 Figure 1.4: Absolute value of Total Health Expenditure (THE) by financing source 2001-2010 Source: Kenya National Health Accounts 2009/10 Reviews of public expenditures and budgets in Kenya show that total health spending constitutes about eight percent of the total government expenditure and that recurrent expenditures have been consistently higher than the development expenditures, both in absolute terms, and as a percentage of the GDP. Government financing of health expenditure is about sixty percent of what is required to provide minimum health services, implying that healthcare delivery in Kenya is under-funded (KHDR, 1999). This is accentuated by inefficiency of the system, including lack of cost-effectiveness in service delivery. However, preliminary information from Kenyas national health accounts shows that the financial contributions of households (out of pocket expenses) exceed those of the government. (Collins et al. 1996) The per capita expenditure therefore falls short of the Government of Kenyas commitment to spend fifteen percent of its total budget on health, as agreed in the Abuja Declaration. The under-financing of the health sector has thus reduced its ability to ensure an adequate level of service provision to the population (Collins et al. 1996). The national health concern therefore is the extent to which additional health expenditure on specific care programmes like maternal health will promote /increase benefits of the patients through improved outcomes in health (decline in maternal mortality rates). 1.1.3 Maternal healthcare in Kenya Improving maternal health is one of the eight Millennium Development Goals (MDGs) adopted at the 2000 Millennium Summit. The two targets for assessing progress in improving maternal health are reducing the maternal mortality ratio (MMR) by three quarters between 1990 and 2015, and achieving universal access to reproductive health by 2015. With only three years left until the 2015 deadline to achieve the MDGs, closer examination of maternal mortality levels is needed to inform planning of reproductive health programmes and to guide advocacy efforts and research at the national level. These estimates are also needed at the international level, to inform decision-making concerning funding support for the achievement of this goal. Good maternal health is crucial for the welfare of the whole household, especially children who are dependent on their mothers to provide food and care. Prevention of the death of a mother is the single most important intervention for the health of a child. Women are intensely vulnerable to the effects of costs incurred during childbirth. User fees can be especially high for emergency or technological procedures such as caesarean section, sometimes reaching catastrophic amounts, which push families into poverty (Graham and Newell, 1999). Many women often leave the hospital before they are well enough for discharge because they cannot pay for the care they have received. User charges add to the costs of transport and companion time, which can be substantial for those living far from facilities. The time spent looking for cash can also delay access to emergency life-saving care in facilities (Kunst and Houweling, 2001). In sub-Saharan Africa, one in sixteen women die in pregnancy or childbirth (WHO, 2001). An estimated ten to twenty million women develop physical or mental disabilities every year as a result of complications or poor management (Ashford, 2006). The long-term consequences are not only physical, but are also psychological, social, and economic. Despite the commitment expressed with the Millennium initiative, maternal health has not been given financial priority internationally. Safe motherhood programmes compete for funding with other priorities such as tuberculosis, malaria and HIV/AIDS. 1.2 Statement of the problem In Kenya, as in most Sub-Saharan African countries, health care expenditure has steadily increased over time, therefore making its containment a major issue for successive governments. The existence of a large public deficit and the need to reduce it drastically to comply with the requirements of the AU has added importance to controlling health care expenditure. Financing health care has remained a challenge to the Government of Kenya for a long time. There seems to be very low investment in health by the government, and inappropriate allocation of resources within the government health budget. In Kenya, health is a basic human right and therefore the health situation in Kenya remains a significant concern for the policy makers. The cost of health care, especially maternal health is a heavy burden on households. While health financing has undergone numerous reforms, more changes are needed to ease the burden of maternal health care costs on households in a bid to increase utilization and subsequently improve the health status of the population. In Kenya, like in most developing countries, maternal health care program encompass a medical condition that is regularly associated with death. The maternal mortality rates are very high. The major concern in this study is therefore the change in patient improvement due to additional expenditure on maternal health care (reduced maternal mortality rates). It analyzes whether increasing health care expenditure towards maternal health care program will reduce the maternal mortality rates. 1.3 Objectives of the study The broad objective of this study is to analyze the relationship between health care expenditure and maternal health outcomes in Kenya. The specific objectives of this study are: To identify the determinants of maternal health in Kenya. To investigate the relationship between government expenditure on maternal health care and maternal health outcomes To make policy recommendations based on study findings 1.4 Significance of the study A key factor that has contributed to the declining health outcomes has been the decline in annual real per capita government budget to the health sector. As noted earlier, the actual expenditures fall below budgetary allocations. With respect to this, policy makers are highly interested in the relationship between expenditure on public health and the resultant health outcomes/benefits. The issue is whether extra spending on maternal health leads to better maternal health outcomes. From a policy perspective, this study can help set priorities on resource allocations across specific program of care. For instance it can help the government to know whether additional expenditure on maternal health care will reduce maternal mortality rates in the country. The government is able to set its priorities right whether to invest more on these specific care programme or to reduce its expenditure given the severe budgetary constraints. It also gives policy makers some guidance on appropriate cost containment measures that will help improve health system performance in Kenya. It is also very useful at the international level, to inform decision-making concerning funding support for the achievement of the fifth millennium development goal. This study also adds to the existing literature on the relationship between health care expenditure and health outcomes, determinants of health outcomes and how health outcomes can be improved. CHAPTER TWO: LITERATURE REVIEW 2.1 THEORETICAL FRAMEWORK Healthcare is an intermediate good that has no intrinsic value in itself but has value in its contribution (along with other inputs such as environmental and social factors) towards production of health itself. Health, or in general, health status, refers to measures of the physical and emotional well-being of an individual or a defined population. The quantity of healthcare product produced by a healthcare firm is referred to as its output. The ultimate output of the health sector is health. Healthcare therefore can be viewed as any other good or service in which each individual maximizes utility subject to a budget constraint. The basic economic theory of production provides a basis on the linkage of health expenditure and health outcomes. The theory suggests that there are many ways inputs can be used in various proportions to produce outputs (Wolfe, 2002). Inputs refer to the resources needed to carry out a process or provide a service. Inputs required in healthcare are usually financial, physical structures such as buildings, supplies and equipment, personnel, and clients while output refers to the direct result of the interaction of inputs and processes in the system; the types and quantities of goods and services produced by an activity, project or program. The use of inputs in healthcare leads to outcomes. (Cremieux et al. 1999). Health production theory highlights the manner in which health care as an input is related to health as an output. In this theory, health is the output measured in terms of improved health status such as reduced mortality, morbidity or achieving health related millennium development goals while inputs consist of the number of trained health professionals, the number of school years completed, residential place, the proportion of GDP spent on health and the government health expenditure in the health sector (Desai, 1998). Health production theory utilizes the health production function which is the change in health status affected as an approximate matter by changes in the consumption of various health services effective in improving health. The production function summarizes the relationship between inputs and outputs with health status being the dependent variable (function of healthcare) dependent on populations social and environmental factors, policy variables and country specific effects inclusive of biological endowment, and lifestyle. Many studies on this subject have adopted Grossmans (1972) model of health production which views each individual as both a producer and a consumer of health. It regards health as a commodity which the individual will wish to consume and maximize, subject to his/her budget constraints, in conjunction with a number of endogenous and exogenous variables which have an impact on individuals health. Within this model, income and educational level play an important role as explanatory variables. In Grossmans model, he regards health care as both a consumption good that provides direct satisfaction and utility, and as an investment good, it provides satisfaction to individuals indirectly through reduction in sick days, increased wages and increased productivity. In this case, health can be viewed as a stock which degrades over time if there are no investments in the individual health, and that health is taken as a sort of capital. Investing in health may seem costly as individuals must trade off resources and time that may be devoted to health, unlike other goals. These factors are also used in determining the optimal level of health that is needed by an individual. The model therefore makes predictions on the likely effects of health care price changes and other goods, outcomes in labor market such as technological changes, wages and employment. In the Grossman model, at the optimal level, health investment occurs where the marginal cost of health capital is equal to the marginal benefit. Over time, health is likely to depreciate at a certain rate which may be denoted by ÃŽÂ ´. The consumer faces an interest rate which may also be denoted by r. By adding these variables, the health capital marginal cost can be calculated as under: ÃŽÂ ´ In this case the health capital marginal benefit is the rate of return from this capital in both non market and market sectors. In this model, the health stock at optimal level can be caused by factors such as education, wages and age. The theory further advocates that investing in health should be combined with other factors which are crucial in order to produce new health, which in the long run may offset the process of deterioration in the stock of health. Medical scientists could argue that only effective medical care should be universally available (OHE, 1979). The government therefore may resort to explicit rationing which is not only to set limits on total expenditure for care, but also to develop mechanisms to arrive at more rational decisions as to relative investments in different disease specific programmes, and the establishment of certain minimal uniform standards. This rationing does not guarantee mothers to equal access to appropriate maternal/medical care. Treatment is still within the postulate that the doctor will do his best with the resources available to him but there is no such constraint on those resources as government decides (OHE, 1979). This study looks at maternal health as the output of an aggregate production which utilizes variables such as public health expenditure, access to government medical services and household incomes as the inputs. The assumption is that for reasons associated with diminishing returns and the adverse effects of certain variables after an initial positive outcome, the relationship is expected to be nonlinear (Nixon and Ulman, 2006). 2.2 EMPIRICAL LITERATURE Health status are commonly measured using four major indicators, maternal mortality, mortality rate in infants, mortality rate for under five and life expectancy at birth (Akinkugbe et al. 2009); (Gupta et al. 1999); (Wang,2002); (Imam et al. 2003). Other measures of health outcomes/status used include preference of cancer or circulatory diseases, disability adjusted life years, quality adjusted life years, fertility indicators and achievement of other health related millennium development goals. Similarly, government health expenditure, GDP per capita, female literacy, number of physicians, immunization coverage, urbanization and calorie intake among others are some of the most used explanatory variables (Wolfe, 1986); (Wang, 2002); (Or, 2000b); (Caldwell, 1990) and (Filmer et al. 1999). Most studies have used cross-sectional analysis (Bokhari et al.2007); (Imam et al. 2003); (Anyanwu et al. 2008); (Gani et al. 2009); (Wang, 2002); (Nixon and Ulman, 2006) and (Martin et al. 2009). Some have used panel data (Gupta et al. 1999) and (Or, 2000b), while Akinkugbe et al. (2009) used time series analysis to estimate the relationship between the public health expenditure and health outcomes. To solve the problem of autocorrelation in cross sectional analysis, heteroskedasticity test was done, corrected standard errors for panel data analysis while augmented Dickey Fuller tests were used to test for stationarity in all studies using time series data. All studies reviewed used health expenditure as one of the explanatory variables except Wang, (2002) who looked at it in a different perspective. According to him, demand for electricity, access to piped water and sanitation and female education increases health expenditure but it does not increase public health expenditure in improving health outcomes. Most studies indicated that public spending contributes significantly to health status improvements (Filmer et al. 1999); (Abel Smith, 1963); (Kiymaz et al. 2006); (Ester et al. 2011); (Gakunju, 2003); (Bokhari et al.2006); (Anyanwu et al. 2005); (Cremieux et al. 1999); (Nixon and Ulman, 2006) and (Blendon et al. 2006). For example, Filmer et al. (1999) used data from the early 1990s and estimated multivariate regression model of child mortality on per capita income, government health expenditure and other controls. They found that there was significant correlation between child mortality and income per capita. Some studies however indicated that public health expenditure alone as a determinant of health is inadequate (Ogbu and Gallagher, 1992); (Castrol-leal et al. 1999); (Gupta et al. 2003); (Anderson and Frogner, 2005); (Hitris and Posnet, 1992); (Caldwell, 1986); (Dor et al. 2007) and (Cochrane et al. 1978). In estimations, different methods were used by different authors. Generally two main methods were used: generalized least squares and the ordinary least squares. However, other methods have also been used. For example, Bokhari et al. (2006) and Gupta et al. (1999) used two stage least squares because of the instrumental variables used to address the problem of reverse causality and measurement errors in the variables. Anyanwu et al. (2005) used Robust Ordinary Least Squares as the baseline specification and robust two stage least squares to control for endogeneity and reverse causality. Bhalotra (2007) used the linear probability model. Particularly, Flippi et al (2006) took a broader perspective on maternal health and drew attention to the economic and social vulnerability of pregnant women. They called for action to reduce maternal mortality rates by channeling more resources towards maternal healthcare, improving on human resources and information. They used maternal mortality ratio (by cause) as the major indicator and recommended that research is needed on how to finance health services and ensure equitable access to generate more evidence. While examining the association of the socio-demographic characteristics of women and the unobserved hospital factors in Kenya, Magadi et al. (2001) used multilevel logistic regression. The results showed that the probability of maternal mortality depends on both observed factors that are associated with a particular woman and unobserved factors peculiar to the admitting hospital. The individual characteristics observed to have a significant association with maternal mortality include maternal age, antenatal clinic attendance and educational attainment. The hospital variation was observed to be stronger for women with least favorable socio-demographic characteristics. For example, the risk of maternal death at high-risk hospitals for women aged thirty five years and above, who had low levels of education, and did not attend antenatal care is about two hundred and eighty deaths per a thousand admissions. The risk for similar women at low-risk hospitals is about four deaths per a thous and admissions. In a study carried out on health care services and sources of revenue in six countries from Western Europe and North America, Abel Smith (1963) found that health care expenditure was associated with reduced life expectancy and increased mortality rates. In a similar study carried out in the year 1967 involving twenty nine countries he found that the level of national income was associated with improved health status and that the demand for healthcare increased in countries with declining mortality. Abel Smiths studies laid down foundation for the development of methodologies for tracking health expenditures in both private and public sectors. While investigating the factors that are associated with infant mortality in Sub-Saharan Africa, Ester et al. (2011) carried out an ecological multi-group study using a bi-variate and multi-variate analysis with infant mortality rate as the dependent variable. They used a linear regression model between infant mortality rate and the correlated indicators (social security expenditure and government expenditure per-capita on health). This study revealed, in the multi-variate analysis, three factors associated with the IMR: a higher social security expenditure on health as a percentage of the general government expenditure on health, a higher per-capita government expenditure on health and a higher number of children under five years of age with diarrhea receiving oral dehydration therapy indicated a lower IMR. During the examination of the effectiveness of public social spending on education and health care in several African countries, Castro-Leal et al. (1999) reviewed the benefit incidence of government spending in Cote divoire, Guinea, Kenya, Madagascar, South Africa and Tanzania. Their study found that public expenditures on health were not sufficient especially on the poor to reduce mortality rates. On the other hand, Gupta et al. (2003) used cross-country data for over seventy developing countries to assess the relationship between public spending on health care and the health status of the poor. Their findings confirmed that the poor have significantly worse health status than the rich. The results however suggested that increased public spending alone will not be sufficient to significantly improve health status. Another study carried out on the health effects of per capita income and public expenditure on social services in Kenya, proved that per capita income had been very influential in determining health status. The study found that expenditures on education and health care improved health status at a great margin. It further established that per capita income was significantly linked to the levels of mortalities, and that some of the negative trends in health status could have been attributed to unfavorable growth and insufficient social spending on health (Manyala, 2000). In his findings income elasticities were all statistically significant, current income had the expected effect on life expectancy but not on infant mortality. He further found that if mothers are malnourished and are in poor state of health, their infant will inherit part of this poor health, and therefore will be at greater risk of mortality relative to infants of healthy mother. A comparative study by Wagstaff (2002a) that focused on forty two developing countries used child mortality due to malnutrition and diarrhea as the health outcomes/indicators. Wagstaff (2002b) treated government health expenditure as an exogenous variable and found that it did have a statistically significant (negative) coefficient. The study used a simple stylized theoretical model rationalizing the health-income relationship and found that public spending on health care had a larger impact on child mortality among the poor than among the non-poor population. In his study on health and schooling investments in Africa, Schultz (1999) found that health status rose with increased public spending on health services. He also argued that the health status will tend to decline with a rise in relative prices of health inputs such as salaries of medical personnel, cost of drugs and other medical supplies, relative to prices of nutrients that help fight infections and disease. He also found that levels of education were correlated with lower mortality rates. The relationship between mothers education and mortality rate was stronger than the fathers. He recommended that an additional year of schooling to the mother especially in low-income countries was associated with a five to ten percent reduction in mortality rates. On his analysis of the factors determining health status in Kenya, Gakunju (2003) found that government expenditure on public health was noteworthy in shaping individual health status. He also found that government health expenditure influences health status with over a long time. This actually implies that the government investment and spending in the health sector have had a major effect on the health of the people. He also acknowledged a number of factors as being important in resolving the health problem Kenya such as: Per capita income, individual access to doctors, HIV/AIDs prevalence, literacy level for women, Child immunization coverage and spending/investment by the government in the health sector. His study majorly used the central government e

Name: Abraham Yeh :: English Literature

Title of Presentation: How Marvell has used language to show his concerns in the poem, â€Å"To His Coy Mistress† and how it makes it a makes it a memorable one. â€Å"To His Coy Mistress† is a love poem written by Andrew Marvell to his mistress to accept his love proposal. Throughout the poem, he shows his concern about how time is running out between the two of them by the use of convincing and persuasive words. I the first two line of the poem, â€Å"Had we but world enough and time, This coyness, Lady were no crime† ,He says this to explain to the mistress that if they did have time, he wouldn’t care about her shyness and by the use of words like â€Å"had† and â€Å"enough† show clearly that they do not have time. In the next two lines, â€Å"We should sit down and think which way to walk, and pass our long love’s day† which is related to the first two sentences explains that they would sit down and think where to walk to and have a nice day if they had time. â€Å"Thou by the Indians Ganges’ side Shouldst rubies find: I by the tide of Humber would complain†. He tells her this to show his love to her to mean that if they were far apart, he would complain. â€Å"I would love you ten years before the flood: And you should, if you please, refuse till the conversion of the Jews† is said by the persona probably to show her how long he has loved her and that they will have a never ending love. Also in this statement, â€Å"till the conversion of the Jews† which might never happen, is said to show that he will love her forever. He goes on to exaggerate that the love he has for her will slowly but surely grow larger then an empire by saying, â€Å"My vegetable love should grow vaster than empires, and more slowly. By the tone of the persona in this statement, it shows a bit of confidence and boldness. In the next line, â€Å"An hundred years should go to praise thine eyes, and on thy forehead gaze. Two hundred to adore each breast: But thirty thousand to the rest. An age at least to every part." Over here, he uses erotic and passionate words to show to the mistress how much he adores her body. There is a bit of lust and obsession. He also uses the word â€Å"gaze† to show her that he would never be tired of looking at her body and he also relates it to time.

High Altitude Climbing :: essays research papers fc

High altitude climbing is a very dangerous sport, well, we won’t call it a sport, it is more like a profession for highly skilled individuals. High altitude climbing is when mountain climbers decide that they want to climb higher  Ã‚  Ã‚  Ã‚  Ã‚  and more difficult mountains. To do this they need the right training and also need to know the effects of high altitude climbing to their bodies.   Ã‚  Ã‚  Ã‚  Ã‚  The body attempts to maintain a state of homeostasis or balance to ensure the optimal operating environment for its complex chemical systems. Any change from this homeostasis is a change away from the best possible operating environment. The body attempts to correct this imbalance. One such imbalance is the effect of increasing altitude on the body's ability to provide adequate oxygen to be utilized in cellular respiration. With an increase in elevation, a typical occurrence when climbing mountains, the body is forced to respond in various ways to the changes in external environment. Foremost of these changes is the diminished ability to obtain oxygen from the atmosphere. If the adaptive responses to this stressor are inadequate the performance of body systems may decline dramatically. If prolonged the results can be serious or even fatal.   Ã‚  Ã‚  Ã‚  Ã‚  In looking at the effect of altitude on body functioning we first must understand what occurs in the external environment at higher elevations and then observe the important changes that occur in the internal environment of the body in response. In discussing altitude change and its effect on the body mountaineers generally define altitude according to the scale of high (8,000 - 12,000 feet), very high (12,000 - 18,000 feet), and extremely high (18,000+ feet), (Hubble, 1995).   Ã‚  Ã‚  Ã‚  Ã‚  A common misperception of the change in external environment with increased altitude is that there is decreased oxygen. This is not correct as the concentration of oxygen at sea level is about 21% and stays relatively unchanged until over 50,000 feet (Johnson, 1988). What is really happening is that the atmospheric pressure is decreasing and subsequently the amount of oxygen available in a single breath of air is significantly less. At sea level the barometric pressure averages 760 mmHg while at 12,000 feet it is only 483 mmHg. This decrease in total atmospheric pressure means that there are 40% fewer oxygen molecules per breath at this altitude compared to sea level (Princeton, 1995). The pulmonary surface and the thickness of the alveolar membranes are not directly affected by a change in altitude.

macbeth :: essays research papers

Shakespeare draws an amazing psychological portrait of a man who became a villain by means of ambition, desire and an imbalance of good and evil. â€Å"Macbeth† is a play composed of the disintegration of a noble man’s world. The play begins by offering the audience Macbeth, a war hero, with a high regard from Duncan, the king of Scotland. By the end of the play Macbeth transforms into a universally despised man without a place in the social community. Shakespeare draws an amazing face of a man made to be a villain by ambition, desire and an imbalance of good and evil.   Ã‚  Ã‚  Ã‚  Ã‚  Macbeth, unhappy and unsatisfied with his social position, caused his feelings to snowball into the ambition that led him to the murder of Duncan.   Ã‚  Ã‚  Ã‚  Ã‚  Ã¢â‚¬Å"I have no spur To prick the sides of my intent, but only Vaulting ambition, which O’erleaps itself And falls on th’other† (Act 1 sc. 7 pg 41) By using an aside, Shakespeare allows Macbeth to reveal his ambitions. And uses Macbeth’s ambition to create irony, in that his ambition was what brought him to power, yet it also leads him to his tragic downfall. Ambition is what allowed Macbeth to become more powerful, and helps him to overcome obstacles and come closer to his final goals. It is this ambition that is the direct cause of the tragic incident of Duncan’s death.   Ã‚  Ã‚  Ã‚  Ã‚  The encounter with the three witches summons Macbeth’s innermost imaginative desires, eventually pointing him in the direction of Duncan’s murder.   Ã‚  Ã‚  Ã‚  Ã‚  Ã¢â‚¬Å"Art thou not fatal vision, sensible To feeling as to sight? Or art thou but A dagger of the mind, a false creation Proceeding from the heat-oppressed brain?† (Act 2 sc. 1 pg 53)  Ã‚  Ã‚  Ã‚  Ã‚   Here Macbeth’s imagination precedes his rational thought, he is stolen in the grip of his fantastical imagination. It is as if the dagger is actually pulling him towards his desires to murder Duncan, rather than being persuaded by an actual inner passion for that motive. Shakespeare uses this scene to demonstrate to the audience that Macbeth’s conscious act of knowing that his desires are immoral and still acting upon them proves him quite the villain. This symbolism brings the audience to savor the play’s hidden meanings and also allows for leeway in the interpretation of the plot.   Ã‚  Ã‚  Ã‚  Ã‚  Macbeth’s inability to balance the forces of good and evil cause him to reach an insecure state of mind, causing him to make many malicious decisions.   Ã‚  Ã‚  Ã‚  Ã‚  Ã¢â‚¬Å"But let the fame of things disjoint, both the worlds suffer,

A Walk in the Night by Alex La Guma Essay

Born in 1925 Cape Town, Alex La Guma is a writer, a leader of the South African Coloured People’s organization and a Defendant in the Treason Trial. Graduated High school and then joined the Young Communist League in 1947. He then became a member of the Communist Party a year later. He wrote for the new age from 1955. He wrote many articles for fighting talk in which he captured the atmosphere of the trial proceedings. He was placed under 24 hour house arrest in 1962, and was detained again in 1963. In 1966, he eaves Africa and wrote novels and short stories and received the 1969 Lotus Prize for Literature. In 1972, he edited the Apartheid: A collection of writings on South African Racism by South Africans. He was considered one of the most South African’s major twentieth century writers. A walk in the Night was his first book based on a nature of District sex, Cape Town. La Guma was an important political figure as well. Being charged with treason, banned, house arrest ed and eventually forced into exile, he was chief representative of the African National Congress (ANC) in the Caribbean at the time of his death in 1985. South Africa is a country blessed with an abundance of natural resources including fertile farmlands and unique mineral resources. South African mines are world leaders in the production of diamonds and gold as well as strategic metals such as platinum. It was colonized by the English and Dutch in the seventieth century. The English domination of the Dutch descendants resulted in the Dutch establishing the new colonies of Orange Free State ad Transual. The diamonds in these lands around 1900 resulted in an English invasion which sparked the Boer War. Until the 1940’s, an uneasy power sharing between the two groups held sway when the Afrikaner National Party was able to gain a strong majority. Strategists in the National party  invented apartheid as a meaning to cement their control over the economic and social system. The aim of the apartheid was to maintain while domination while extending racial separation. Beginning in the 1960’s, a plan of Grand Apartheid was executed, emphasizing territorial separation and police repression. The Enactment of Apartheid law in 1948, racial discrimination was institutionalized. Race laws touched every aspect of social life, including a prohibition between marriage, between non-whites and whites, and the sanctioning of â€Å"whites only† jobs. The Population Registration Act required that all South Africans are racially classified into one of three categories: white, black (African), and or Coloured (mixed decent). In 1951, the Bonto Authorities Act established a basis for ethnic government in African reserves known as homelands. The homelands were independent states to which each African was assigned by the government. All of the political rights, including voting was held by an African who was restricted to the designated homeland. The idea was that they would be citizens of homeland and lose their citizenship in South Africa and any right involvement with the South African parliament. The homeland administration refused the nominal independence, maintaining pressure for political rights within the country as a whole. Nevertheless, Africans living in the homelands needed passports to enter South Africa. So they were basically considered aliens in their own country. Alex la Guma, very first novel presents the struggle against oppression by a group of characters in Cape Town’s toughest district and the moral dissolution of a young man who is unjustly fired from his job. Being published in 1962, La Guma has a high reputation that is based on his vivid style, his Coloured dialogue, and his ability to present sympatically and realistically people living under sordid and oppressive circumstances. This book reflects the plight of the South Africans and American blacks, a plight which has â€Å"symptoms† racism, segregation, and injustice. The novel depicts on a conflict between two main races; whites and blacks in 1950’s South Africa respectively. Being set in Cape Town in District Six, in one night in the late 1950’s, the time setting represents Apartheid in South Africa and depicts the abusive attitudes and methods of white South Africans against  their black compatriots. With the obnoxious system going on, there are ha rsh attitudes which the black community has to endure and on the hand it is a little opportunity given to blacks to lead normal lives. Michael Adonis and Willie boy are two main characters and they are set as the epitome of the unfortunate black youth; unemployed, apparently uneducated, and exposed at any moment to the abusive methods of police. Both of them try to find their way out to freedom but can’t they are stuck in delinquency. In the book, there are a lot of negative images of the Negro represented in the perception of the whites. Whites feel that they have the right to treat the blacks in any type of way they want regardless of what anybody says. Whites being the oppressor and the blacks being oppressed. This comes as a reflection of the attitudes of whites which express the feeling of exclusion, alienation, injustice, oppression, violence, humiliation and anything else that is biased in Apartheid of South Africa. Michael Adonis; a young man who gets off a tram and entering what later becomes the setting of the story: District Six. In the beginning, La Guma gives a strong description of what Michael looks like before telling us that he is an angry man. He is viewed as a young man who is easy to anger but is aware of his right to perform a natural function and is willing to work and does not indulge in theft and thugery as others might peg him for. As well he is a man with violent inclinations who nurses anger at length and is therefore prone to explode. Michael Adonis is a young man who is annoyed because he had lost his job for trying to use the restroom. African right to strike and trade union the white employers managed to secure cheap African Labor. In the novel, it depicts the poverty of the Coloured including the employed one. This was meant to perpetuate the African plight and improve the economic situation of the white employer and employee by guaranteeing them the African cheap labor and eliminating the African potential competition as though black South Africans didn’t share the same citizenship with the white South Africans. After being fired from his job, Michael enters a dirty Portuguese restaurant where he finds Willie boy. Willie boy, being another similar character that La Guma explains how he exposes the evil of apartheid. At the restaurant, he  also meets with three youths who inquire about another character called Foxy. Walking out of the cafà © Michael forgets about Willie boy and went about on his own. The psychological torture that blacks and Coloured in South Africa go through, they resort to alcohol, crime and prostitution. Here the characters are doomed because there is nothing they can do about their predicament. Michael stops at the cafà ©, hoping that by so doing he will purge himself of the shame and humiliation of his encounter with the white oppressors. At the same time he throws his cigarette down the pavement and immediately, there are two slum boys who are wearing ragged shirts and have horny feet scramble over it and the details that are described is important because it tells us about the squalor and it is an indication of juvenile delinquency. In contrast of this young boys, there are two policemen who stopped Michael down the street and demanded to know where he was heading to. They search him irrespectively and Michael goes off once more angry and frustrated. He was already in a state of anger because when talking to Willie boy, Willie boy rambles off about why he doesn’t work for white people. While searching Michael, they think he is bhang (drugs) on him. In this scenario, you can see that this is a clear case of police intimidation and harassment of the inability of a person of Michael’s caliber to have the freedom of walking without being stopped. After being stopped, Adonis enters the pub in District Six where a Jew called Mister Ike and he sells behind the counter. Michael orders wine to soothe his rage. Here you also see that Adonis relies on wine to control his temper which describes him as a volatile and unpredictable man. Leaving the pub, Adonis heads home and passes through dirty slums with narrow alleys. At this tenement he stops to watch a cat struggling with a dead fish. He is a man who hates the squalor but has no choice but to live in it. He meets a young lady name Hazel which is the â€Å"lady of the twilight†. He tried to grab her but fails and is left alone on the steps feeling lonely. Again here, he produces more anger and is feeling malicious. At the same time he encounters Uncle Doughty. During this time he helps the old man into his room, drinks his wine, tortures him to unleash his anger, frustration and loneliness, and then kills him. Doughty represents the whites because of his skin color, we can’t forgive Michael for hitting the poor old man who had done no harm to him. Here this is an example of inhumanity and a victim of dehumanization.  With this going on, Adonis sobers up and realizes what he has done and is feeling guilty. At this moment, he is afraid and bolts out the door being unsure of what to do next. Thoughts run through Adonis mind like â€Å"well, he didn’t have no right living here with us colors.† Adonis is a character who is not aware that skin pigmentation doesn’t matter and he equates color with privilege. Willie boy a character who is presented to us a flighty not too serious youth who does not care for work because he refused to work for whites. Also, he is a young man who loves to play the jukebox. Unlike, Michael Adonis, Willie boy strikes out as a layout. Willie boy does not hesitate to point out that he does not work for any white man and yet still survives. Willie boy visits the cafà © to drink cheap wine on credit and at the cafà © there are black girls who messes with the foreigners, in particular sailors of low breed, bringing to the fore the issues of prostitution. He sees one of the sailors fondling of the girls and him objects â€Å"These Jubas. They just messing our girls†¦I don’t like them messing our girls†¦to hell with them†. While we encounter Willie boy again, he is contemplating on getting a loan from Michael. Meeting Foxy’s group who likes ghosts keep turning up and finds Michael door locked. Willie boy try to see if he is in Doughtry’s room and there he finds the old man dead. At this moment, this is the beginning of his running although he is innocent of the circumstances. Through the realistic mode, the author advances the â€Å"cycle of violence† in South Africa that Willie boy has suffered from. Willie boy was beaten by Miss Gypsy and he has been in that type of violence since childhood. â€Å"His mother beat him at the slightest provocation and he knew that she was wreaking the experience upon him for the beating she received from his father†. Another major character is Constable Raalt. A police officer whose present duty is to patrol District 6. He is a Boer policemen who holds a humiliating estimation of the blacks and considers them primitive. Andries his partner is a man who is full of responsibility but is affected by the white collective unconscious that considers the white race as being the superior. So this makes him worried about the white reputation to be affected by the brutality of the white people like constable Raalt. Raalt drive around in a  police van with Andries and is bragging about the problems he has with his wife. Raalt hides his anger at his wife and it like a hard steel under camouflage paint. A guy who is very annoyed at Andries because he does not have similar marital problems. Constable Raalt is a malicious man who likes contemplating others people pains and he is unstable at home who cannot be stable on the job. Andries, the other driver of Raalt wishes that Raalt would transfer to a white are a to avoid his abuse of power against the Coloured. The violence that characterizes South Africa is shown through the character here. He is depicted as a very ruthless man who represents the South African society of white oppressors. Later on, when Willie Boy dies, he considered himself superior to blacks because of the terms he uses such as bastard. To quote Raalt: â€Å"no hotnot bastard gets away with murder on my patrol†. A close reading of A Walk in the night reveals the abusive methods of constable Raalt on the black citizens. Raalt has no respect for Coloured people and could kill them at will. He terrorizes the life of the Coloured people everywhere he goes. He went into the Club House with the aim of intimidating and extorting money from the Coloured man, Chips who runs the place. After Willie boy death, we witness two confrontations. The crowds accuses of Constable Raalt of cold blooded murder, but that is all they can do because Raalt is the law. The overbearing Raalt, the law with his gun, has had his taste of blood and does not care. He loads the wounded Willie boy into the back of the can and continues with his patrol. As Willie boy lies at the back of the police van, pain and nausea wracking his body, Andries is anxious to get the boy to the hospital, Raalt does not bother. Raalt was so concerned that he had his partner stop at a convenience store so he can buy some smoke. Here is where Willie boy traces back to his childhood of his bitter purposeless life all mingled up with his present situation and then dies. Another character that is introduce in the story is Joe. Joe is a poor person with hardly anything to eat. Michaels sees Joe and offers him a bob which is slang for beer. Joe turns down the offer and offer Michael some fish that he had picked up off the beach. One thing to understand about Joe is that he is an open handed person with a good heart even though he is poor. Alex la Guma sees him as a clean heart human being. Michael and Joe also have a  conservation about the segregation of beaches. The curse of segregation also inflicted nonwhites on a large scale; districts and even towns were not allowed for nonwhites to go to without having permits. The frequent absence of Jimmy La Guma at home when Alex was a little child, can be paralleled with the description of Joe’s Father for his family. Joe’s father’s description caused Joe to feel miserable and frustrated. However, the specificity of Joe’s peaceful character makes him able to accept his bitter re ality without resorting to violence. The environment of Black district is placed in sharp contrast with the conductive area where the whites live. The black majority live in the ghettos, in squalors, and in bad housing conditions. The contrast in racial desegregation is brought to the fore as the white oppressors segregate themselves from the Coloured people by living in cozy environments. La Guma presents the degrading conditions of the Lorenzo family who live in one room: â€Å"Four of their children lay sleeping in the narrow single bed against the wall on the side of the room. They slept under the one threadbare, worn, sweaty, blanket, and fitted together like parts of a puzzle into the narrow sagging space, two at each end of the bed.† Grace, Franky Lorenzo’s wife had to use â€Å"the tap in the latrine† to get water to make tea for her husband. This underscores the level of realism in South Africa. Also, here we have Franky Lorenzo who expresses his feelings of whites. On pg. 34, he quotes â€Å"They say, mos, it is us poor people’s riches. You got no food in your guts, and you got no food for your children, but you’re rich with them. The rich people got money but they got one, two kids. They got enough to feed ten, twenty children and they only make one or two. We haven’t got even enough for one kid and we make eight, nine-one a year. Jesus.† Being said, he said this because his wife Grace has an unborn child on the way and they cant even afford for the children they already have. He took his anger out on Grace and hurting her because he made it seem like it was her fault she is pregnant. During the pub scene, we are introduced to the taxi driver. A Coloured taxi driver who wants to awaken the consciousness of his community by conveying the idea that the white capitalist system is responsible for racism and  segregation in the country. The taxi driver represents the communist conviction of the author. He cannot explain it well because he is apparently illiterate, but his conviction is deeply rooted in him. When speaking about the violence of the whites against blacks all over the world, he puts the blame on the capitalist system. The last chapter of the novel is a cinematic rendition of what happens all over district 6 concerning the events and characters that are mentioned. Foxy and his gang go on to their mission, a cockroach waits for darkness to eat up the mess in Doughtry’s room and John Abraham tosses over, unable to bear his guilt; Frank Lorenzo snores peacefully as Grace contemplates the future life she is carrying and Joe heads for the sea. It is a sweep at the characters life and their hopes. Since 1948, The Policy of â€Å"Apartheid† of the South African Government has been one of the most publicized racial policies in the world, that both within and without the union just what the policy is all about has led to some confusion, misunderstanding and controversy. These advocates of apartheid see the separate development of the two major racial groups (European and Bantu). Apartheid has come to be a comprehensive social policy and it touches upon every sphere of social life in South Africa: politics, education, economics, religion, and so far on. The 1960 Sharpeville Massacre was the result of a peaceful protest regarding racist South African policies of apartheid. The enforcement of Pass Laws and the reissue of laws that restricted the movement of Black Africans in White areas in South Africa initiated a protest in Sharpeville. Pan African Congressional Leaders assembled close to 5,000 protesters to bring attention to such unfairness. The intent of the protest was for the South African government to rethink their Apartheid policies and abolish such practices. The protest mood was more â€Å"festive than belligerent† as the crowd moved towards the police station. It is here in which the response moved into the realm where the massacre was evident. The police response to the protest became the primary cause of the massacre.  The police assembled and used disproportionate responses to the protest. The use of low flying aircraft to seek to break the crowd up would be one such measure. The police’s response to the stone throwing of the crowds was the use of armored cars and shooting on protesters. Many of the protesters were shot in the back, indicating that they were trying to run away from the police and were still pursued. The reports of men, women, and children running from the police presence â€Å"like rabbits† only feeds the imagery of their being gunned down in such a callous and cruel manner. This brutality is only emphasized by the police commissioner’s statements about what happened in Sharpeville: â€Å"It started when hordes of natives surrounding the police station†¦If they do these things, they must learn their lessons the hard way.† In this statement, one can see the lack of regard for the life of Black South Africans, one in which state sanctioned violence can lead to massacre so easily. The setting of this novel is important because it brings out the social and moral decay of the society. The realistic depiction of gloom, rot, filth, and neglect is a powerful indication of the destructiveness of the Apartheid black environment of District Six, which affects the moods of people’s lives. The characters here are overwhelmed by the environment and are doomed to â€Å"walk the night† in frustration, uncertain of their destination, ambition, destinies, and purposes in life. Blacks of District Six cannot find a way out of their situation except unlawful behavior. Willie boy engages in petty crimes and violent acts in order to survive. Michael was illegitimately dismissed from his job and resorts to the membership of the gang of Foxy, Hendricks and Toyer, who specialize in robbery and petty crimes as well.