In this paper, we examine how economic, social and political forces impact on NCDs in Khayelitsha (a predominantly low income area in Cape Town, South Africa) through their shaping of the built environment. The paper draws on literature reviews and ethnographic fieldwork undertaken in Khayelitsha. The three main pathways through which the built environment of the area impacts on NCDs are through a complex food environment in which it is difficult to achieve food security, an environment that is not conducive to safe physical activity, and high levels of depression and stress (linked to, amongst other factors, poverty, crime and fear of crime). All of these factors are at least partially linked to the isolated, segregated and monofunctional nature of Khayelitsha. The paper highlights that in order to effectively address urban health challenges, we need to understand how economic, social and political forces impact on NCDs through the way they shape built environments.

ObjectivesUsing the nexus between food consumption, food security and obesity, this paper addresses the complexity of health behavior decision-making moments that reflect relational social dynamics in context-specific dialogues, often in choice-constrained conditions.MethodsA pragmatic review of literature regarding social determinants of health in relation to food consumption, food security and obesity was used to advance this theoretical model.Results and discussionWe suggest that health choice, such as food consumption, is based on more than the capacity and volition of individuals to make “healthy” choices, but is dialogic and adaptive. In terms of food consumption, there will always be choice-constrained conditions, along a continuum representing factors over which the individual has little or no control, to those for which they have greater agency. These range from food store geographies and inventories and food availability, logistical considerations such as transportation, food distribution, the structure of equity in food systems, state and non-government food and nutrition programs, to factors where the individual exercises a greater degree of autonomy, such as sociocultural foodways, family and neighborhood shopping strategies, and personal and family food preferences. At any given food decision-making moment, many factors of the continuum are present consciously or unconsciously when the individual makes a decision. These health behavior decision-making moments are mutable, whether from an individual perspective, or within a broader social or policy context. We review the construct of “choice set”, the confluence of factors that are temporally weighted by the differentiated and relationally-contextualized importance of certain factors over others in that moment. The choice transition represents an essential shift of the choice set based on the conscious and unconscious weighting of accumulated evidence, such that people can project certain outcomes. Policies and interventions should avoid dichotomies of “good and bad” food choices or health behaviors, but focus on those issues that contribute to the weightedness of factors influencing food choice behavior at a given decision-making moment and within a given choice set.

Using intercept surveys, we explored demographic and socioeconomic factors associated with food purchasing characteristics of supermarket shoppers and the perceptions of their neighborhood food environment in urban Cape Town. Shoppers (N = 422) aged ≥18 years, categorized by their residential socioeconomic areas (SEAs), participated in a survey after shopping in supermarkets located in different SEAs. A subpopulation, out-shoppers (persons shopping outside their residential SEA), and in-shoppers (persons residing and shopping in the same residential area) were also explored. Fruits and vegetables (F&V) were more likely to be perceived to be of poor quality and healthy food not too expensive by shoppers from low- (OR = 6.36, 95% CI = 2.69, 15.03, p < 0.0001), middle-SEAs (OR = 3.42, 95% CI = 1.45, 8.04, p < 0.001) compared to the high-SEA shoppers. Low SEA shoppers bought F&V less frequently than high- and middle-SEA shoppers. Purchase of sugar-sweetened beverages (SSBs) and snacks were frequent and similar across SEAs. Food quality was important to out-shoppers who were less likely to walk to shop, more likely to be employed and perceived the quality of F&V in their neighborhood to be poor. Food purchasing characteristics are influenced by SEAs, with lack of mobility and food choice key issues for low-SEA shoppers.

Abstract Objective: To identify factors associated with food purchasing decisions and expenditure of South African supermarket shoppers across income levels. Design: Intercept surveys were conducted, grocery receipts collated and expenditure coded into categories, with each category calculated as percentage of the total expenditure. In-supermarket food quality audit and shelf space measurements of foods such as fruits and vegetables (F&V) (healthy foods), snacks and sugar-sweetened beverages (SSB) (unhealthy foods) were also assessed. Shoppers and supermarkets were classified by high-, middle- and low-income socio-economic areas (SEA) of residential area and location, respectively. Shoppers were also classified as “out-shoppers” (persons shopping outside their residential SEA) and “in-shoppers” (persons shopping in their residential SEA). Data were analysed using descriptive analysis and ANOVA. Setting: Supermarkets located in different SEA in urban Cape Town. Participants: Three hundred ninety-five shoppers from eleven purposively selected supermarkets. Results: Shelf space ratio of total healthy foods v. unhealthy foods in all the supermarkets was low, with supermarkets located in high SEA having the lowest ratio but better quality of fresh F&V. The share expenditure on SSB and snacks was higher than F&V in all SEA. Food secure shoppers spent more on food, but food items purchased frequently did not differ from the food insecure shoppers. Socio-economic status and food security were associated with greater expenditure on food items in supermarkets but not with overall healthier food purchases. Conclusion: Urban supermarket shoppers in South Africa spent substantially more on unhealthy food items, which were also allocated greater shelf space, compared with healthier foods.

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RESUMENObjetivos Este artículo busca mostrar el desarrollo de un Modelo de Interlocución sobre el desempeño local del sistema de salud en La Guajira, entre 2005 y 2007, con el fin de generar condiciones para la participación social y el mejor desempeño del sistema conforme a las condiciones, necesidades y expectativas locales. Métodos El desarrollo del Modelo se hizo mediante técnicas etnográficas, en la primera y segunda fase de la investigación, y técnicas participativas, en la tercera. La metodología buscaba recoger la información que permitiera escoger las estrategias de intervención para mejorar las habilidades y capacidades para la participación de los usuarios y que sugiriera la creación de espacios de confianza para la interlocución entre los actores y la negociación de acciones de mejoramiento para el sistema. Con base en la etnografía del sistema y del usuario, se diseñaron estrategias de intervención que incluyen materiales impresos pedagógicos y tres módulos en forma de talleres participativos. Se probó el Modelo en cuatro localidades de La Guajira, en donde al final se crearon Mesas de Trabajo en Salud con participación de usuarios y decisores institucionales. Resultados Se constató que se puede lograr que los usuarios participen como ciudadanos informados y consumidores críticos, fortaleciendo sus habilidades de interlocución, ampliando sus conocimientos, generando léxicos y significados compartidos con los actores institucionales, y utilizando los dispositivos locales y redes sociales de participación. Conclusión Es indispensable encontrar estrategias efectivas para motivar una mayor participación de las instituciones, especialmente de las Entidades Promotoras de Salud y Aseguradoras del Régimen Subsidiado.Palabras Clave: Participación Comunitaria, planificación social, controles informales de la sociedad, calidad de la atención de salud, sistemas de salud (fuente: DeCS, BIREME).Rev. salud pública. 9 (3):

Comprender el significado del capital social de la diabetes tipo 2 según género, dentro un contexto urbano colombiano. Investigación cualitativa del interaccionismo simbólico. 25 mujeres y 16 hombres, diabéticos, familiares, vecinos y personal asistencial participaron en seis grupos focales. Emergieron 850 códigos que se integraron en un set de 142 códigos de códigos para el ego, el alter y alter ego. Tres categorías y veinte subcategorías fueron identificadas para el diseño del "paradigma de la codificación". El significado no es igual para hombres y mujeres. Los vínculos sociales de las redes sociales, creados cotidianamente por la confianza y la solidaridad para el cuidado, son valorados de manera diferente, debido a experiencias y hechos sociales resultantes de la autoconfianza, la autoeficacia para el apoyo social principalmente y, la autoestima frente al manejo y control de la enfermedad. Los recursos sociales de un individuo son reificados para el manejo y cuidado de la enfermedad como estrategia para disminuir las inequidades en salud

The provisions regarding native peoples in the 1991 Colombian constitution codify native identities that until now, were more fluid and locally‐based. This essay reflects upon what ethnic difference means to the various indigenous participants in the Colombian constitutional dialogue, through the interpretation of educational materials developed by major indigenous organizations to inform and promote discussion at the grassroots. In particular, we are concerned with native contributions to the creation of Indigenous Territorial Entities and the extent to which essentialized definitions of ethnicity are successful in promoting an indigenous identity on the national level. The relative success of two national‐level indigenous organizations is assessed and compared.