Melbourne School of Population and Global Health - Theses
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ItemMarkers of midlife: interrogating health, illness and ageing in rural Australia( 2007-06)The aim of this thesis is to explore rural women’s midlife experiences and interrogate the roles of health, social and community factors in these. In the cultural imagination, midlife signifies the onset of ageing and is thus framed in a discourse of decline. For women, it is often considered in terms of menopause and the end of fecundity and fertility. I propose that women’s experience of midlife is much broader than this; instead, it is characterised by transformation in multiple domains and health status is important. I suggest that the continuity theory of ageing is useful when conceptualising the life course. The concept of habitus enables exploration of how identity is re/constructed during the ageing process in response to changing bodily circumstances, such as health problems. (For complete abstract open document)
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ItemThe usage of psychotropic medications by family caregivers( 1996-07)This is a randomly selected, cross-sectional, population based study of women caring for family or friends who are elderly or have a long-term illness or disability. The purpose of the study was to investigate the usage of psychotropic medications by carers in order to identify predictors of usage of these medications relating to the caring situation. Data collected in 1993 by the Carers’ Program in the state of Victoria, Australia was used for statistical and qualitative analysis. The data base consisted of 157 carers and 219 non-carers. Women who had the main caring role for a relative or friend with a disability for at least 4 hours per week were selected for the study. Women who were living with a partner or children or both and had the main responsibility for household tasks but were not caring for someone with special needs were selected as the comparison group. Using this group of non-carers allowed direct comparison of carers and non-carers to be made and to identify the difference that the role of caregiving to someone with special needs makes when compared with usual family care responsibilities.
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ItemRace, racism, stress and Indigenous health( 2006)This thesis is a transdisciplinary study aimed at exploring the role of race, racism and stress as determinants of health for indigenous populations and other oppressed ethnoracial groups. Commencing with an analysis of continuing racialisation in health research, it is shown that there is no consistent evidence that oppressed ethnoracial groups, who suffer disproportionately from type 2 diabetes, are especially genetically susceptible to this disease. Continued attribution of ethnoracial differences in health to genetics highlights the need to be attentive to both environmental and genetic risk factors operating within and between ethnoracial groups. This exploration of racialisation is followed by a theoretical examination of racism as a health risk factor. This includes a comprehensive definition of racism, a diagrammatic representation of the aetiological relationship between racism and health and an examination of the dimensions across which perceived racism can be operationalised. An empirical review of 138 quantitative population-based studies of self-reported racism as a determinant of health reveals that self-reported racism is related to ill-health (particularly mental health) for oppressed ethnoracial groups after adjustment for a range of confounders. This review also highlights a number of limitations in this nascent field of research. This thesis then attempts to clarify the plethora of conceptual approaches used in the study of stress and health as a first step towards comprehending how stress interacts with both racism and health. A review of the empirical association between stress and chronic disease for fourth world indigenous populations and African Americans was also conducted. This review, which located 65 studies, found that a range of chronic diseases (especially chronic mental conditions) were associated with psychosocial stress. Utilising the conceptual work on operationalising racism discussed above, an instrument was developed to measure racism and its correlates as experienced by Indigenous Australians. This instrument demonstrated good face, content, psychometric and convergent validity in a pilot study involving 312 Indigenous Australians. The majority of participants in this study (70%) reported some experience of inter-personal racism, with this exposure most commonly reported in employment and public settings, from service providers and from other Indigenous people. Strong and consistent associations were found between racism and chronic stress as well as between racism and depression (CES-D), poor/fair self-assessed health status/poor general mental health (SF-12) and a marker of CVD risk (homocysteine), respectively. There was also evidence that the association between inter-personal racism and poor mental health outcomes was mediated by somatic and inner-directed disempowered reactions to racism as well as by chronic stress and a range of psychosocial characteristics. To conclude this thesis, an examination of approaches to addressing racism for Indigenous Australians is undertaken. The theoretical issues pertinent to the study of anti-racism are discussed along with empirical findings from social psychology on effective approaches to anti-racism. Recommendations for implementing these approaches through institutional and legal policies are also presented. Strategies for engendering political will to combat racism in the current neo-liberal capitalist climate are also briefly considered.