Teaching poverty and health: importing transformative learning into the structures and paradigms of medical education

Background: As a paradigm of education that emphasizes equity and social justice, transformative education aims to improve societal structures by inspiring learners to become agents of social change. In an attempt to contribute to transformative education, the University of Toronto MD program implemented a workshop on poverty and health that included tutors with lived experience of poverty. This research aimed to examine how tutors, as members of a group that faces structural oppression, understood their participation in the workshop. Methods: This research drew on qualitative case study methodology and interview data, using the concept of transformative education to direct data analysis and interpretation. Results: Our findings centred around two broad themes: misalignments between transformative learning and the structures of medical education; and unintended consequences of transformative education within the dominant paradigms of medical education. These misalignments and unintended consequences provided insight into how courses operating within the structures, hierarchies and paradigms of medical education may be limited in their potential to contribute to transformative education. Conclusions: To be truly transformative, medical education must be willing to try to modify structures that reinforce oppression rather than integrating marginalized persons into educational processes that maintain social inequity.

Impact of selected social welfare programs on poverty alleviation and health outcomes in Pakistan

The purpose of this paper is to review and analyse poverty alleviation and health outcomes through the effectiveness of two major programs launched by the government to uplift social welfare in Pakistan (Benazir Income Support Program (BISP) and the Sehat Sahulat Program (SSP). We also aim to explore the link between poverty and health in light of the BISP and SSP. Secondary data is utilized to carry out this study, where qualitative data is gathered from the beneficiaries’ interviews while quantitative data is based upon the poverty line. Through this study, we can conclude an overall positive impact of the BISP and SSP on two components of the Human Development Indicator (HDI) concerning poverty and health: standards of living and life expectancy. Although positive conclusions have been brought about by BISP such as a reduction in wasting (girls) and increased food consumption, it fails to substantially cover health and may even be ineffective if individuals face external shocks such as dangerous illnesses. Such findings strengthen the importance of the SSP as a social welfare program alongside the BISP to secure far more wholesome and successful outcomes. By exploring the interchangeable link between poverty and health and connecting it to these programs, we further assert the complimentary nature of the BISP and SSP and base our evaluation on it.

Energy poverty and its relationship with health: empirical evidence on the dynamics of energy poverty and poor health in Australia

Does poor health increase the likelihood of energy poverty or vice versa creating a vicious poverty trap? We use data from the Household, Income and Labour Dynamics of Australia (HILDA) survey from 2005–2018 to explore if these two processes are dynamically related across a number of subjective and objective measures of physical and mental health as well as subjective and objective measures of energy poverty. We employ univariate dynamic models, introduce controls for initial conditions, and explore inter-dependence between energy poverty and health using a dynamic bivariate probit model. Our results show that controlling for initial conditions impacts on the magnitude and significance of the lagged coefficients. We only find cross-dependency effects between energy poverty and health for subjective measures of energy poverty. This suggests that individuals’ feelings about being in energy poverty may impact on their health leading to poor health/energy poverty traps. Targeting individuals in financial stress/debt may be one way to reduce these poor health/energy poverty traps.

Play of children living with HIV/AIDS in a low-resourced setting: Perspectives of caregivers

Background Although play is viewed as a childhood occupation that is spontaneous, it can be limited in children with HIV/AIDS. This study explored the perspectives of caregivers from Zimbabwe on the play of children with HIV/AIDS. Methodology A descriptive qualitative research approach was used to explore the perceptions of caregivers on play of children living with HIV/AIDS. Fifteen caregivers of children aged 4–9 years diagnosed with HIV/AIDS were purposively sampled. Two interviews were carried out with each of the caregivers. Findings were analysed thematically. Findings Four major themes were generated from the study: ‘Ubuntu is no more’, ‘Survival is primary (chikuru kurarama)’, ‘Play affirms that my child is still like other children’ and ‘More is required for this child’. Although issues of survival were paramount, caregivers were able to highlight the importance of play in affirming childhood, identifying the specific needs for play of children with HIV/AIDS. Conclusion and Significance Play, like all other human occupation, is contextually situated. Poverty and health status are key in shaping how families prioritise play. However, the ability to play for a child with HIV/AIDS also seems to mitigate stigma and may disrupt the ‘HIV is death’ narrative.

COVID-19 as Eco-Pandemic Injustice: Opportunities for Collective and Antiracist Approaches to Environmental Health

The COVID-19 pandemic has coincided with a powerful upsurge in antiracist activism in the United States, linking many forms and consequences of racism to public and environmental health. This commentary develops the concept of eco-pandemic injustice to explain interrelationships between the pandemic and socioecological systems, demonstrating how COVID-19 both reveals and deepens structural inequalities that form along lines of environmental health. Using Pellow’s critical environmental justice theory, we examine how the crisis has made more visible and exacerbated links between racism, poverty, and health while providing opportunities to enact change through collective embodied health movements. We describe new collaborations and the potential for meaningful opportunities at the intersections between health, antiracist, environmental, and political movements that are advocating for the types of transformational change described by critical environmental justice.