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Purpose – The purpose of this chapter is to provide a comprehensive overview of the substance use disparities among American Indian/Alaska Native (AI/AN) youth, the contributing factors to these disparities, proven and promising approaches through strengths-based methods, barriers to implementation of prevention and treatment efforts, and future recommendations for effective programs and research.

Approach – We have conducted a thorough literature review of relevant research studies, as well as a review of government, tribal, and community-based curricula and resources. This review of programs is not exhaustive but provides several examples of best practices in the field and suggestions for future directions.

Social implications – We strongly advocate that to accurately explore the true etiology of substance abuse and to respond to the concerns that AI/AN have prioritized, it is necessary to utilize a strengths-based approach and draw upon traditional AI/AN perspectives and values, and active community participation in the process. More specifically, prevention and treatment programs should use methods that incorporate elders or intergenerational approaches; foster individual and family skills-building; promote traditional healing methods to recognize and treat historical, cultural, and intergenerational and personal trauma; focus on early intervention; and tailor efforts to each Native nation or community.

Value – Ultimately, to reduce substance abuse disparities in AI/AN youth, we must find better ways to merge traditional Native practices with western behavioral health to ensure cultural competency, as well as to develop mechanisms to effect system- and policy-level changes that reduce barriers to care and promote the well-being of AI/AN youth, families, and communities.

The incipient HIV/AIDS epidemic in Chile poses challenges for responsiveness of the Chilean national health care system, Fondo Nacional de Salud (FONASA) (National Health Funds), especially given the sociocultural forces for inertia in FONASA. Thus, the issue is what is the nature of the forces for change. A grounded theory approach was applied to interview data from two qualitative studies, one with HIV/AIDS advocates and activists as interviewees and the other with Chilean low-income women. The stories of their experiences with and perceptions of FONASA revealed major issues facing FONASA, including quality of care and ethics. Ways in which these issues are being addressed by the activists result in constructed environmental dynamism. A conceptual model of the forces for change was developed including actors, strategies, and targets of change that constitutes organizational environmental dynamism. The construct of environmental dynamism has international applicability, particularly to governmental health systems, which are influenced by strong sociocultural forces.

The authors have previously validated a design of the health-care supply chain which treats patients as inventory without loss of respect for the patients. This work continues examination of patients as inventory while addressing the dual objectives of reducing redundancy in services and creating greater efficiency in the health-care supply chain. Historical data is used to forecast health care needs in light of the increasingly specialized health-care professionals, which have resulted in much more flexible and expensive supply chains. The lack of common data storage, or electronic medical records (EMRs), has created a need for redundancy (or rework) in medical testing. The use of EMR will also enhance our ability to forecast needs in the future. We perform simulations using SigmaFlow software to address our goals relative to the resource constraints, monetary constraints, and the overall culture of the medical supply chain. The simulation outcomes lead us to recommendations for data warehousing as well as providing mechanisms, like inventory postponement strategies, to establish structures for more efficiency, and reduced flexibility in the supply chains.

Adopting an intra-organizational viewpoint is essential to grasp legal intermediation. To deepen our understanding of such phenomena, this chapter proposes a qualitative and “multi-level” approach drawing on insights from the neo-institutional literature, policy ethnography analysis and the research on legal intermediaries. Such a perspective is particularly suited to capture the complexity and the depth of institutional change. Using the 12-hour work legal mechanism of derogation in the context of French public hospitals as an example, this chapter highlights how both macro-level actors (actors of a “reform network”), and micro-level ones (hospital directors) contribute to the shaping and framing of legality in French public hospitals. Results show that variation in how those actors use law depends on the local configuration. Second, results demonstrate that the legal games they play are not merely based on symbolic and superficial compliance with the law, but also on outright manipulations and conscious rule-breaking.

Identities provide a human link between macro-level mechanisms and microfoundations of institutions. Yet, as the literature on identity within the microfoundations of institutions has developed, scholars have begun to shift their understanding of “who” populates the microfoundations of institutions. This chapter offers a historical review of this niche, but growing, area of research. More specifically, the author identifies and discusses three phases of research on identity within the microfoundations of institutions, their ontological and epistemological assumptions, and their implications for the area. To conclude, the author reflects on the possible theoretical avenues for future research on identities within the microfoundations of institutions.

Traditional African Health Systems (TAHS) is one of the earliest systems of health care known to humankind. It remains a sustainable practice in many indigenous cultures and in Africa accounts for the great majority of cures for illnesses despite the advent of Western Medicine. This chapter explores the concept of TAHS and the specialisations that constitute it. It looks at relational and contextual factors in the practitioners of TAHS within the continent that explain its viability. There are resources and knowledge passed on from generation to generation which make African Traditional Medicines a force to be reckoned with.

The authors look at the specific system of health education contained in the health-related adages which foster wisdom with respect to prevention, diagnosis, and treatment of ailments. Situating education in its cultural context is one of the factors that has promoted TAHS. The authors compare some of these factors with Western Medicine and outline the benefits of encouraging mutuality rather than the dominance of one over the other. TAHS will definitely be a practice in the future and prospects have to include continued research in the areas of pharmacognosy, medical ethics, responsible health care, and education.

Food system channels are proposed to be major components of the larger food system which influence health and illness.

Food system channels are defined, discussed in relationship to other food system components, considered in terms of historical food system changes, examined in relationship to wellbeing and disease, and proposed to have useful applications.

Food system channels are broad, organized, and integrated pathways through which foods and nutrients pass. Channels are larger in scale and scope than previously described food system structures like chains, stages, sectors, networks, and others. Four major types of contemporary Western food system channels differ in their underlying values and health impacts. (1) Industrialized food channels are based on profit as an economic value, which contributes to a diversity of inexpensive foods and chronic diseases. (2) Emergency food channels are based on altruism as a moral value, and try to overcome gaps in industrialized channels to prevent diseases of poverty. (3) Alternative food channels are based on justice and environmentalism as ethical values, and seek to promote wellness and sustainability. (4) Subsistence food channels are based on self-sufficiency as a traditional value, and seek self-reliance to avoid hunger and illness. Historical socioeconomic development of agricultural and industrial transitions led to shifts in food system channels that shaped dietary, nutritional, epidemiological, and mortality transitions.

Food system channels provide varying amounts of calories and types of nutrients that shape wellbeing and diseases. Sociologists and others may benefit from examining food system channels and considering their role in health and illness.

Based on ethnographic data and a textual analysis, this chapter highlights the process of “therapization” of Buddhism in Western countries, with a specific emphasis on Tibetan Buddhism in France. Referring to the paradigm of “political economy of health”, as developed in recent medical anthropology, it attempts to explore the relationships between two concepts – economics and health – that had previously been considered separately, in the context of Western Buddhism. Further, this chapter's aim is to expose a potential application of theoretical economic models in an anthropological approach of Buddhist diffusion and appropriation in the West.