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Shaw J, Glover W. The Political Economy of Digital Health Equity: Structural Analysis. J Med Internet Res 2024; 26:e46971. [PMID: 38530341 PMCID: PMC11005444 DOI: 10.2196/46971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/30/2023] [Accepted: 02/27/2024] [Indexed: 03/27/2024] Open
Abstract
Digital technologies have produced many innovations in care delivery and enabled continuity of care for many people when in-person care was impossible. However, a growing body of research suggests that digital health can also exacerbate health inequities for those excluded from its benefits for reasons of cost, digital literacy, and structural discrimination related to characteristics such as age, race, ethnicity, and socioeconomic status. In this paper, we draw on a political economy perspective to examine structural barriers to progress in advancing digital health equity at the policy level. Considering the incentive structures and investments of powerful actors in the field, we outline how characteristics of neoliberal capitalism in Western contexts produce and sustain digital health inequities by describing 6 structural challenges to the effort to promote health equity through digital health, as follows: (1) the revenue-first incentives of technology corporations, (2) the influence of venture capital, (3) inequitable access to the internet and digital devices, (4) underinvestment in digital health literacy, (5) uncertainty about future reimbursement of digital health, and (6) justified mistrust of digital health. Building on these important challenges, we propose future immediate and long-term directions for work to support meaningful change for digital health equity.
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Affiliation(s)
- James Shaw
- Department of Physical Therapy, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Joint Centre for Bioethics, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Wiljeana Glover
- Technology, Operations, and Information Management Division, Babson College, Wellesley, MA, United States
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Berkowitz SA. Multisector Collaboration vs. Social Democracy for Addressing Social Determinants of Health. Milbank Q 2023. [PMID: 38156764 DOI: 10.1111/1468-0009.12685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/13/2023] [Accepted: 12/08/2023] [Indexed: 01/03/2024] Open
Abstract
Policy Points Multisector collaboration, the dominant approach for responding to health harms created by adverse social conditions, involves collaboration among health care insurers, health care systems, and social services organizations. Social democracy, an underused alternative, seeks to use government policy to shape the civil (e.g., civil rights), political (e.g., voting rights), and economic (e.g., labor market institutions, property rights, and the tax-and-transfer system) institutions that produce health. Multisector collaboration may not achieve its goals, both because the collaborations are difficult to accomplish and because it does not seek to transform social conditions, only to mitigate their harms. Social democracy requires political contestation but has greater potential to improve population health and health equity.
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Timpson K, McCartney G, Walsh D, Chabanis B. What is missing from how we measure and understand the experience of poverty and deprivation in population health analyses? Eur J Public Health 2023; 33:974-980. [PMID: 37862435 PMCID: PMC10710332 DOI: 10.1093/eurpub/ckad174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2023] Open
Abstract
BACKGROUND Explaining why some populations are healthier than others is a core task of epidemiology. Socioeconomic position (SEP), encompassing a broad range of exposures relating to economic circumstances, social class and deprivation, is an important explanation, but lacks a comprehensive framework for understanding the range of relevant exposures it encompasses. METHODS We reviewed existing literature on experiential accounts of poverty through database searching and the identification of relevant material by experts. We mapped relevant concepts into a complex systems diagram. We developed this diagram through a process of consultation with academic experts and experts with direct experience of poverty. Finally, we categorized concepts on the basis of whether they have previously been measured, their importance to the causal flow of the diagram, and their importance to those consulted, creating a list of priorities for future measurement. RESULTS There are a great many aspects of SEP which are not frequently measured or used in epidemiological research and, for some of these, work is needed to better conceptualize and develop measures. Potentially important missing aspects include stigma, social class processes, access to education, sense of lost potential, neighbourhoods, fairness and justice, emotional labour, masking poverty, being (in)visible, costs, and experiences of power. CONCLUSIONS Analyses seeking to understand the extent to which SEP exposures explain differences in the health of populations are likely to benefit from a comprehensive understanding of the range and inter-relationships between different aspects of SEP. More research to better conceptualize and measure these aspects is now needed.
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Affiliation(s)
| | - Gerry McCartney
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK
| | - David Walsh
- Glasgow Centre for Population Health, Glasgow, UK
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Ralston R, Godziewski C, Brooks E. Reconceptualising the commercial determinants of health: bringing institutions in. BMJ Glob Health 2023; 8:e013698. [PMID: 38016709 PMCID: PMC10685945 DOI: 10.1136/bmjgh-2023-013698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Accepted: 11/01/2023] [Indexed: 11/30/2023] Open
Abstract
The concept of the 'commercial determinants of health' (CDOH) has been developed by public health researchers as a way to describe the political economy of corporations and the impact of their practices on health, social inequalities and climate change. In this analysis, we assess the conceptual work that has developed this field and the influence of the more established 'social determinants of health' models. We highlight the dominance of epidemiologic and biomedical concepts on understandings of structure and agency in the CDOH literature and argue that the terminology of 'risk factors', 'drivers' and 'pathways' reflects an agent-centred approach. We suggest that, as a result, there is a tendency to overlook the importance of political institutions in shaping the exercise of corporate power. Our analysis seeks to 'bring institutions in' to CDOH research, using the empirical cases of Health in All Policies and Better Regulation in the European Union to highlight how institutional contexts shape political legitimacy and accountability, and in turn the strategies of corporate actors. Institutionalist approaches, we argue, have the potential to develop and expand understandings of CDOH by opening the black box between agency and structure.
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Affiliation(s)
- Rob Ralston
- Global Health Policy Unit, School of Social & Political Science, The University of Edinburgh, Edinburgh, UK
- SPECTRUM Consortium (Shaping Public Health Policies to Reduce Inequalities and Harm), London, UK
| | | | - Eleanor Brooks
- Global Health Policy Unit, School of Social & Political Science, The University of Edinburgh, Edinburgh, UK
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Nambiar D, Bestman A, Srivastava S, Marten R, Yangchen S, Buse K. How to Build Healthy Societies: A Thematic Analysis of Relevant Conceptual Frameworks. Int J Health Policy Manag 2023; 12:7451. [PMID: 38618791 PMCID: PMC10699821 DOI: 10.34172/ijhpm.2023.7451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 10/16/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND As the Sustainable Development Goals deadline of 2030 draws near, greater attention is being given to health beyond the health sector, in other words, to the creation of healthy societies. However, action and reform in this area has not kept pace, in part due to a focus on narrower interventions and the lack of upstream action on health inequity. With an aim to guide action and political engagement for reform, we conducted a thematic analysis of concepts seeking to arrive at healthy societies. METHODS This paper drew on a qualitative thematic analysis of a purposive sample of 68 documents including political declarations, reports, peer reviewed literature and guidance published since 1974. Three independent reviewers extracted data to identify, discuss and critique public policy levers and 'enablers' of healthy societies, the "how." RESULTS The first lever concerned regulatory and fiscal measures. The second was intersectoral action. The final lever a shift in the global consensus around what signifies societal transformation and outcomes. The three enablers covered political leadership and accountability, popular mobilization and the generation and use of knowledge. CONCLUSION Documents focused largely on technical rather than political solutions. Even as the importance of political leadership was recognized, analysis of power was limited. Rights-based approaches were generally neglected as was assessing what worked or did not work to pull the levers or invest in the enablers. Frameworks typically failed to acknowledge or challenge prevailing ideologies, and did not seek to identify ways to hold or governments or corporations accountable for failures. Finally, ideas and approaches seem to recur again over the decades, without adding further nuance or analysis. This suggests a need for more upstream, critical and radical approaches to achieve healthy societies.
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Affiliation(s)
- Devaki Nambiar
- The George Institute for Global Health, New Delhi, India
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
- Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Amy Bestman
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | | | - Robert Marten
- The Alliance for Health Policy and Systems Research, World Health Organization (WHO), Geneva, Switzerland
| | - Sonam Yangchen
- The Alliance for Health Policy and Systems Research, World Health Organization (WHO), Geneva, Switzerland
| | - Kent Buse
- The George Institute for Global Health, Imperial College London, London, UK
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Costa N, Blyth FM, Parambath S, Huckel Schneider C. What's the low back pain problem represented to be? An analysis of discourse of the Australian policy directives. Disabil Rehabil 2023; 45:3312-3322. [PMID: 36150033 DOI: 10.1080/09638288.2022.2125085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/09/2022] [Accepted: 09/10/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE Low back pain (LBP) directives provide information about how LBP should be managed, communicated and navigated in complex health systems, making them an important form of policy. This study aimed to examine how LBP is problematised (represented) in Australian directives. MATERIALS AND METHODS We employed an analysis of discourse of LBP directives drawing on Bacchi's "What's the problem represented to be?" policy problematisation approach. RESULTS Our analysis suggests that LBP is problematised as a symptom that tends to improve when individuals take responsibility for themselves, but may require care at times. The way in which LBP is represented in the directives excludes important aspects, such as the uncertainties of scientific knowledge, paradigms other than (post)positivist, multimorbidity, social and structural determinants of health. CONCLUSION LBP directives may benefit from problematisations of LBP that consider the ongoing nature of LBP and broader contextual factors that impact on both LBP outcomes and care, beyond individual responsibility. Consideration of a wider range of paradigms and expanded evidence base may also be beneficial, as these are likely to enable individuals, clinicians and the Australian healthcare system to address LBP while dealing with its complexities, enabling real-world changes to lessen the LBP burden.IMPLICATIONS FOR REHABILITATIONHealthcare professionals who work with people who experience low back pain (LBP) may benefit from critically reflecting about discourses embedded in policy directives.Healthcare professionals may consider engaging in policy changes processes to expand the discourses on which LBP policy directives rely.Healthcare professionals' ability to enact policy recommendations may be enhanced by consideration of the fluctuating nature of LBP, uncertainties, multimorbidity and determinants of health.
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Affiliation(s)
- Nathalia Costa
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Fiona M Blyth
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- ARC Centre of Excellence in Population Aging Research (CEPAR), University of Sydney, Sydney, Australia
| | - Sarika Parambath
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Carmen Huckel Schneider
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Heller JC, Fleming PJ, Petteway RJ, Givens M, Pollack Porter KM. Power Up: A Call for Public Health to Recognize, Analyze, and Shift the Balance in Power Relations to Advance Health and Racial Equity. Am J Public Health 2023; 113:1079-1082. [PMID: 37535894 PMCID: PMC10484127 DOI: 10.2105/ajph.2023.307380] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2023] [Indexed: 08/05/2023]
Affiliation(s)
- Jonathan C Heller
- Jonathan C. Heller is with the University of Wisconsin Population Health Institute, Madison, WI, and the National Collaborating Centre for Determinants of Health, Saint Francis Xavier University, Antigonish, Nova Scotia, Canada. Paul J. Fleming is with the University of Michigan School of Public Health, Ann Arbor, MI. Ryan J. Petteway is with the Oregon Health and Science University‒Portland State University School of Public Health, Portland, OR. Marjory Givens is with the University of Wisconsin Population Health Institute. Keshia M. Pollack Porter is with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Paul J Fleming
- Jonathan C. Heller is with the University of Wisconsin Population Health Institute, Madison, WI, and the National Collaborating Centre for Determinants of Health, Saint Francis Xavier University, Antigonish, Nova Scotia, Canada. Paul J. Fleming is with the University of Michigan School of Public Health, Ann Arbor, MI. Ryan J. Petteway is with the Oregon Health and Science University‒Portland State University School of Public Health, Portland, OR. Marjory Givens is with the University of Wisconsin Population Health Institute. Keshia M. Pollack Porter is with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Ryan J Petteway
- Jonathan C. Heller is with the University of Wisconsin Population Health Institute, Madison, WI, and the National Collaborating Centre for Determinants of Health, Saint Francis Xavier University, Antigonish, Nova Scotia, Canada. Paul J. Fleming is with the University of Michigan School of Public Health, Ann Arbor, MI. Ryan J. Petteway is with the Oregon Health and Science University‒Portland State University School of Public Health, Portland, OR. Marjory Givens is with the University of Wisconsin Population Health Institute. Keshia M. Pollack Porter is with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Marjory Givens
- Jonathan C. Heller is with the University of Wisconsin Population Health Institute, Madison, WI, and the National Collaborating Centre for Determinants of Health, Saint Francis Xavier University, Antigonish, Nova Scotia, Canada. Paul J. Fleming is with the University of Michigan School of Public Health, Ann Arbor, MI. Ryan J. Petteway is with the Oregon Health and Science University‒Portland State University School of Public Health, Portland, OR. Marjory Givens is with the University of Wisconsin Population Health Institute. Keshia M. Pollack Porter is with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Keshia M Pollack Porter
- Jonathan C. Heller is with the University of Wisconsin Population Health Institute, Madison, WI, and the National Collaborating Centre for Determinants of Health, Saint Francis Xavier University, Antigonish, Nova Scotia, Canada. Paul J. Fleming is with the University of Michigan School of Public Health, Ann Arbor, MI. Ryan J. Petteway is with the Oregon Health and Science University‒Portland State University School of Public Health, Portland, OR. Marjory Givens is with the University of Wisconsin Population Health Institute. Keshia M. Pollack Porter is with the Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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Baum F, Friel S, Liberman J, de Leeuw E, Smith JA, Herriot M, Williams C. Why action on the commercial determinants of health is vital. Health Promot J Austr 2023; 34:725-727. [PMID: 37130652 DOI: 10.1002/hpja.737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2023] [Indexed: 05/04/2023] Open
Affiliation(s)
- Fran Baum
- The Stretton Institute, The University of Adelaide, Adelaide, Australia
| | - Sharon Friel
- School of Regulation and Global Governance, The Australian National University, Canberra, Australia
| | - Jonathan Liberman
- Law and Global Health, The University of Melbourne, Melbourne, Australia
| | - Evelyne de Leeuw
- HUE (Healthy Urban Environments) Collaboratory, Maridulu Budyari Gumal, Sydney, Australia
| | - James A Smith
- Rural and Remote Health, College of Public Health and Medicine, Flinders University, Darwin, Australia
| | | | - Carmel Williams
- Centre for Health in All Policies Research Translation, SAHMRI and University of Adelaide, Adelaide, Australia
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Wood B, Lacy-Nichols J, Sacks G. Taking on the Corporate Determinants of Ill-health and Health Inequity: A Scoping Review of Actions to Address Excessive Corporate Power to Protect and Promote the Public's Health. Int J Health Policy Manag 2023; 12:7304. [PMID: 38618808 PMCID: PMC10590241 DOI: 10.34172/ijhpm.2023.7304] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Accepted: 08/18/2023] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND In many sectors of the economy, for-profit business corporations hold excessive power relative to some governments and civil society. These power imbalances have been recognised as important contributors to many pressing and complex societal challenges, including unhealthy diets, climate change, and widening socio-economic inequalities, and thus pose a major barrier to efforts to improve public health and health equity. In this paper, we reviewed potential actions for addressing excessive corporate power. METHODS We conducted a scoping review of diverse literature (using Scopus, Web of Science, HeinOnline, and EBSCO databases), along with expanded searches, to identify state and collective actions with the potential to address excessive corporate power. Actions were thematically classified into overarching strategic objectives, guided by Meagher's '3Ds' heuristic, which classifies actions to curb corporate power into three groups: dispersion, democratisation, and dissolution. Based on the actions identified, we proposed two additional strategic objectives: reform and democratise the global governance of corporations, and strengthen countervailing power structures. RESULTS We identified 178 documents that collectively cover a broad range of actions to address excessive corporate power. In total, 18 interrelated strategies were identified, along with several examples in which aspects of these strategies have been implemented. CONCLUSION The proposed framework sheds light on how a diverse set of strategies and actions that seek to address excessive corporate power can work synergistically to change the regulatory context in which corporations operate, so that broader societal goals, including health and equity, are given much greater prominence and consideration vis-à-vis powerful corporate interests.
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Affiliation(s)
- Benjamin Wood
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Jennifer Lacy-Nichols
- Centre for Health Policy, The University of Melbourne School of Population and Global Health, Melbourne, VIC, Australia
| | - Gary Sacks
- Global Centre for Preventive Health and Nutrition (GLOBE), Institute for Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia
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Lewis CL, Yan A, Williams MY, Apen LV, Crawford CL, Morse L, Valdez AM, Alexander GR, Grant E, Valderama-Wallace C, Beatty D. Health equity: A concept analysis. Nurs Outlook 2023; 71:102032. [PMID: 37683597 DOI: 10.1016/j.outlook.2023.102032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Revised: 07/28/2023] [Accepted: 08/09/2023] [Indexed: 09/10/2023]
Abstract
BACKGROUND Although health equity is critically important for healthcare delivery, there are inconsistencies in its definitions or lack of definitions. PURPOSE Develop a comprehensive understanding of health equity to guide nursing practice and healthcare policy. METHOD Walker and Avant's concept analysis method was used to establish defining attributes, antecedents, consequences, and empirical referents of health equity. FINDINGS Health equity defining attributes are grounded in ethical principles, the absence of unfair and avoidable differences, and fair and just opportunities to attain a person's full health potential. Health equity antecedents are categorized into environmental; financial or economic; law, politics, and policy; societal and structural; research; and digital and technology. DISCUSSION Health equity's antecedents are useful to distinguish health disparities from health outcomes resulting from individual preferences. To achieve health equity, organizations need to focus on addressing the antecedents.
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Affiliation(s)
- Chrystal L Lewis
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA.
| | - Alice Yan
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA
| | - Michelle Y Williams
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA; Division of Primary Care and Population Health and Nursing Research Section, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA
| | - Lynette V Apen
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA
| | - Cecelia L Crawford
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA
| | - Lisa Morse
- Department of Research and Health Equity, Stanford Health Care, Menlo Park, CA
| | - Anna M Valdez
- Department of Nursing, Sonoma State University, Rohnert Park, CA
| | - G Rumay Alexander
- School of Nursing, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | | | - Dale Beatty
- Executive Administration, Stanford Health Care, Palo Alto, CA
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Harris P. Health Policy Analysis Requires Attending to Institutions Comment on "Modelling the Health Policy Process: One Size Fits All or Horses for Courses?". Int J Health Policy Manag 2023; 12:8085. [PMID: 38618811 PMCID: PMC10590235 DOI: 10.34172/ijhpm.2023.8085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 07/24/2023] [Indexed: 04/16/2024] Open
Abstract
Powell and Manion present an important review of reviews about health and policy research. They zero in on theories of the policy process as the most likely to unearth what is really going on in health policy. Here I contend that their analysis insufficiently attends to institutions. Powell and Manion situate 'institutions' (with 'Ideas' and 'Interests') as a 'health policy process models' that 'tend to' list factors rather than connect them. Rather, I show how there is a rich history of considering institutions in the political science literature that is under considered by Powell and Manion. By necessity for a Public Health audience I quickly pull back the covers on 'rigour' and 'causation' to demonstrate what is 'fit for purpose' in rigorous institution focussed policy analysis. I conclude by arguing how institutionally focussed public health policy analysis is vital for understanding and addressing heath inequities. That focus necessitates research that provides better, explicit, conceptualisations of power in health policy: especially drawing out the roles played by structure and agency. I offer some recent examples.
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Affiliation(s)
- Patrick Harris
- Centre for Health Equity, Training, Research & Evaluation (CHETRE), Part of the UNSW Sydney Research Centre for Primary Health Care & Equity, A Unit of Population Health, South Western Sydney Local Health District, NSW Health, Ingham Institute, Liverpool, NSW, Australia
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Schultz S, Zorbas C, Peeters A, Yoong S, Backholer K. Strengthening local government policies to address health inequities: perspectives from Australian local government stakeholders. Int J Equity Health 2023; 22:119. [PMID: 37344850 DOI: 10.1186/s12939-023-01925-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 05/30/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND With their close connection to community and increasing preventive health remit, local governments are well positioned to implement policies and programs to address health inequities. Nevertheless, there is a lack of evidence of equity-focused policy action in this sector. We aimed to understand how local government representatives approach equity in the development and implementation of health and wellbeing policies and programs, and to identify potential enablers for strengthening an equity focus. METHODS We conducted semi-structured interviews (June 2022-January 2023) with 29 health directorate representatives from 21 local governments in Victoria, Australia. Representatives were recruited from urban, regional and rural local government areas, with varying levels of socioeconomic position. Data was analysed inductively using Braun and Clarke's reflexive thematic analysis, informed by social determinants of health theory and a public policy decision making framework. RESULTS Local governments approach health equity in different ways including focusing on priority populations, disadvantaged geographic areas, or by targeting the upstream determinants of health, such as housing and employment. Enabling factors for more equity-oriented local government policy action included those internal to local governments: (i) having a clear conceptualisation of equity, (ii) fostering a strong equity-centric culture, and (iii) developing organisational-wide competency in health equity. External factors related to key stakeholder groups that support and/or influence local governments included: (iv) strong support from community, (v) state government leadership and legislation, and (vi) supportive local partners, networks and NGO's. CONCLUSIONS Local governments have a responsibility to implement policies and programs that improve health and reduce health inequities. Local government's capacity to leverage resources, structures, processes and relationships, internally and across sectors and community, will be key to strengthening equity-oriented local government health policies and programs.
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Affiliation(s)
- Sally Schultz
- Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia.
| | - Christina Zorbas
- Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Anna Peeters
- Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Serene Yoong
- Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
| | - Kathryn Backholer
- Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, VIC, 3125, Australia
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Simon J, Parisi S, Wabnitz K, Simmenroth A, Schwienhorst-Stich EM. Ten characteristics of high-quality planetary health education-Results from a qualitative study with educators, students as educators and study deans at medical schools in Germany. Front Public Health 2023; 11:1143751. [PMID: 37181714 PMCID: PMC10166869 DOI: 10.3389/fpubh.2023.1143751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 03/07/2023] [Indexed: 05/16/2023] Open
Abstract
Aim The climate and ecological crises are considered fundamental threats to human health. Healthcare workers in general and doctors in particular can contribute as change agents in mitigation and adaptation. Planetary health education (PHE) aims to harness this potential. This study explores perspectives among stakeholders involved in PHE at German medical schools on the characteristics of high-quality PHE and compares them to existing PHE frameworks. Methods In 2021, we conducted a qualitative interview study with stakeholders from German medical schools involved in PHE. Three different groups were eligible: faculty members, medical students actively involved in PHE, and study deans of medical schools. Recruitment was performed through national PHE networks and snowball sampling. Thematic qualitative text analysis according to Kuckartz was used for the analysis. Results were systematically compared to three existing PHE frameworks. Results A total of 20 participants (13 female) from 15 different medical schools were interviewed. Participants covered a wide range of professional backgrounds and experience in PHE education. The analysis revealed ten key themes: (1) Complexity and systems thinking, (2) inter- and transdisciplinarity, (3) ethical dimension, (4) responsibility of health professionals, (5) transformative competencies including practical skills, (6) space for reflection and resilience building, (7) special role of students, (8) need for curricular integration, (9) innovative and proven didactic methods, and (10) education as a driver of innovation. Six of our themes showed substantial overlap with existing PHE frameworks. Two of our themes were only mentioned in one of the frameworks, and two others were not explicitly mentioned. Few important elements of the frameworks did not emerge from our data. Conclusions In the light of increased attention regarding the connections of the climate and ecological crises and health, our results can be useful for anyone working toward the integration of planetary health into medical schools' and any health professions' curricula and should be considered when designing and implementing new educational activities.
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Affiliation(s)
- Johanna Simon
- Department of General Practice/Family Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Sandra Parisi
- Department of General Practice/Family Medicine, University Hospital Würzburg, Würzburg, Germany
| | | | - Anne Simmenroth
- Department of General Practice/Family Medicine, University Hospital Würzburg, Würzburg, Germany
| | - Eva-Maria Schwienhorst-Stich
- Department of General Practice/Family Medicine, University Hospital Würzburg, Würzburg, Germany
- Teaching Clinic of the Faculty of Medicine and Institute of Medical Teaching and Medical Education Research, University Hospital Würzburg, Würzburg, Germany
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Friel S, Collin J, Daube M, Depoux A, Freudenberg N, Gilmore AB, Johns P, Laar A, Marten R, McKee M, Mialon M. Commercial determinants of health: future directions. Lancet 2023; 401:1229-1240. [PMID: 36966784 DOI: 10.1016/s0140-6736(23)00011-9] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 09/06/2022] [Accepted: 12/23/2022] [Indexed: 04/07/2023]
Abstract
This paper is about the future role of the commercial sector in global health and health equity. The discussion is not about the overthrow of capitalism nor a full-throated embrace of corporate partnerships. No single solution can eradicate the harms from the commercial determinants of health-the business models, practices, and products of market actors that damage health equity and human and planetary health and wellbeing. But evidence shows that progressive economic models, international frameworks, government regulation, compliance mechanisms for commercial entities, regenerative business types and models that incorporate health, social, and environmental goals, and strategic civil society mobilisation together offer possibilities of systemic, transformative change, reduce those harms arising from commercial forces, and foster human and planetary wellbeing. In our view, the most basic public health question is not whether the world has the resources or will to take such actions, but whether humanity can survive if society fails to make this effort.
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Affiliation(s)
- Sharon Friel
- Menzies Centre for Health Governance, School of Regulation and Global Governance, The Australian National University, Acton, ACT, Australia.
| | - Jeff Collin
- School of Political and Social Science, University of Edinburgh, Edinburgh, UK
| | - Mike Daube
- Faculty of Health Sciences, Curtin University, Perth, WA, Australia
| | - Anneliese Depoux
- Virchow-Villermé Public Health Centre, University of Paris, Paris, France
| | - Nicholas Freudenberg
- School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Anna B Gilmore
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
| | - Paula Johns
- ACT Health Promotion, Rio de Janeiro, Brazil
| | - Amos Laar
- School of Public Health, University of Ghana, Legon, Ghana
| | - Robert Marten
- Alliance for Health Policy and Systems Research, World Health Organization, Geneva, Switzerland
| | - Martin McKee
- London School of Hygiene & Tropical Medicine, London, UK
| | - Melissa Mialon
- Trinity Business School, Trinity College Dublin, Dublin, Ireland
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15
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Fisher M, Harris P, Freeman T, George E, Baum F. Universal and Targeted Policy for Health Equity in the Neoliberal Era; A Response to the Recent Commentaries. Int J Health Policy Manag 2023; 12:7998. [PMID: 37579414 PMCID: PMC10461898 DOI: 10.34172/ijhpm.2023.7998] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Accepted: 03/01/2023] [Indexed: 08/16/2023] Open
Affiliation(s)
- Matthew Fisher
- Stretton Health Equity, University of Adelaide, Adelaide, SA, Australia
| | - Patrick Harris
- Centre for Health Equity Training, Research and Evaluation, University of New South Wales, Sydney, NSW, Australia
| | - Toby Freeman
- Stretton Health Equity, University of Adelaide, Adelaide, SA, Australia
| | - Emma George
- School of Allied Health Science and Practice, University of Adelaide, Adelaide, SA, Australia
| | - Fran Baum
- Stretton Health Equity, University of Adelaide, Adelaide, SA, Australia
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16
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How gender is socially constructed in policy making processes: a case study of the Adolescent and Youth Health Policy in South Africa. Int J Equity Health 2023; 22:36. [PMID: 36829217 PMCID: PMC9955531 DOI: 10.1186/s12939-022-01819-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 12/22/2022] [Indexed: 02/26/2023] Open
Abstract
BACKGROUND Gender equality remains an outstanding global priority, more than 25 years after the landmark Beijing Platform for Action. The disconnect between global health policy intentions and implementation is shaped by several conceptual, pragmatic and political factors, both globally and in South Africa. Actor narratives and different framings of gender and gender equality are one part of the contested nature of gender policy processes and their implementation challenges. The main aim of this paper is to foreground the range of policy actors, describe their narratives and different framings of gender, as part exploring the social construction of gender in policy processes, using the Adolescent Youth Health Policy (AYHP) as a case study. METHODS A case study design was undertaken, with conceptual underpinnings combined from gender studies, sociology and health policy analysis. Through purposive sampling, a range of actors were selected, including AYHP authors from government and academia, members of the AYHP Advisory Panel, youth representatives from the National Department of Health Adolescent and Youth Advisory Panel, as well as adolescent and youth health and gender policy actors, in government, academia and civil society. Qualitative data was collected via in-depth, semi-structured interviews with 30 policy actors between 2019 and 2021. Thematic data analysis was used, as well as triangulation across both respondents, and the document analysis of the AYHP. RESULTS Despite gender power relations and more gender-transformative approaches being discussed during the policy making process, these were not reflected in the final policy. Interviews revealed an interrelated constellation of diverse and juxtaposed actor gender narratives, ranging from framing gender as equating girls and women, gender as inclusion, gender as instrumental, gender as women's rights and empowerment and gender as power relations. Some of these narrative framings were dominant in the policy making process and were consequently included in the final policy document, unlike other narratives. The way gender is framed in policy processes is shaped by actor narratives, and these diverse and contested discursive constructions were shaped by the dynamic interactions with the South Africa context, and processes of the Adolescent Youth Health Policy. These varied actor narratives were further contextualised in terms of reflections of what is needed going forward to advance gender equality in adolescent and youth health policy and programming. This includes prioritising gender and intersectionality on the national agenda, implementing more gender-transformative programmes, as well as having the commitments and capabilities to take the work forward. CONCLUSIONS The constellation of actors' gender narratives reveals overlapping and contested framings of gender and what is required to advance gender equality. Understanding actor narratives in policy processes contributes to bridging the disconnect between policy commitments and reality in advancing the gender equality agenda.
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Monitoring socioeconomic inequalities in health in Hong Kong: insights and lessons from the UK and Australia. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 31:100636. [PMID: 36879790 PMCID: PMC9985041 DOI: 10.1016/j.lanwpc.2022.100636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Revised: 10/13/2022] [Accepted: 10/20/2022] [Indexed: 11/13/2022]
Abstract
In many developed countries such as the UK and Australia, addressing socioeconomic inequalities in health is a priority in their policy agenda, with well-established practices and authorities to collect and link selected health and social indicators for long-term monitoring. Nonetheless, the monitoring of socioeconomic inequalities in health in Hong Kong remains in a piecemeal manner. Also, the common international practice to monitor inequalities at area level appears to be unsuitable in Hong Kong due to its small, compact, and highly interconnected built environment that limits the variation of neighbourhood deprivation level. To enhance inequality monitoring in Hong Kong, we aim to draw reference and lesson from the UK and Australia to explore the feasible steps forward regarding collection of health indicators and contextually appropriate equity stratifiers with strong implication on policy actions, and discuss potential strategies to promote the public awareness and motivations for a more comprehensive inequality monitoring system.
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18
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Richard Z, Chabrol F, Gautier L, Zinszer K, Ridde V. Considering social inequalities in health in COVID-19 response: insights from a French case study. Health Promot Int 2023; 38:6974796. [PMID: 36617297 DOI: 10.1093/heapro/daac173] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
The COVID-19 pandemic highlighted the impact of social inequalities in health (SIH). Various studies have shown significant inequalities in mortality and morbidity associated with COVID-19 and the influence of social determinants of health. The objective of this qualitative case study was to analyze the consideration of SIH in the design of two key COVID-19 prevention and control interventions in France: testing and contact tracing. Interviews were conducted with 36 key informants involved in the design of the intervention and/or the government response to the pandemic as well as relevant documents (n = 15) were reviewed. We applied data triangulation and a hybrid deductive and inductive analysis to analyze the data. Findings revealed the divergent understandings and perspectives about SIH, as well as the challenges associated with consideration for these at the beginning stages of the pandemic. Despite a shared concern for SIH between the participants, an epidemiological frame of reference dominated the design of the intervention. It resulted in a model in which consideration for SIH appeared as a complement, with a clinical goal of the intervention: breaking the chain of COVID-19 transmission. Although the COVID-19 health crisis highlighted the importance of SIH, it did not appear to be an opportunity to further their consideration in response efforts. This article provides original insights into consideration for SIH in the design of testing and contact-tracing interventions based upon a qualitative investigation.
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Affiliation(s)
- Zoé Richard
- Université Paris Cité, IRD, INSERM, Ceped, F-75006 Paris, France
| | - Fanny Chabrol
- Université Paris Cité, IRD, INSERM, Ceped, F-75006 Paris, France
| | - Lara Gautier
- École de Santé Publique de l'Université de Montréal (ESPUM), Montréal, Québec, Canada
- Centre de Recherche en Santé Publique (CReSP), Université de Montréal et CIUSSS du Centre-Sud-de-l'île-de-Montréal, Montréal, Québec, Canada
| | - Kate Zinszer
- École de Santé Publique de l'Université de Montréal (ESPUM), Montréal, Québec, Canada
- Centre de Recherche en Santé Publique (CReSP), Université de Montréal et CIUSSS du Centre-Sud-de-l'île-de-Montréal, Montréal, Québec, Canada
| | - Valéry Ridde
- Université Paris Cité, IRD, INSERM, Ceped, F-75006 Paris, France
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Whitley E, McCartney G, Bartley M, Benzeval M. Examining the impact of different social class mechanisms on health inequalities: A cross-sectional analysis of an all-age UK household panel study. Soc Sci Med 2022; 312:115383. [PMID: 36155357 DOI: 10.1016/j.socscimed.2022.115383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/24/2022] [Accepted: 09/16/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Socioeconomic inequalities are well established across health, morbidity and mortality measures. Social class theory describes how social groups relate, interact and accrue advantages/disadvantages relative to one another, with different theorists emphasising different dimensions. In the context of health inequalities, different social class measures are used interchangeably to rank population groups in terms of health rather than directly exploring the role of social class in creating inequalities. We aim to better understand how four distinct social class mechanisms explain differences in a range of self-reported and biological health outcomes. METHODS We use data from the UK Household Longitudinal Study, a representative population survey of UK adults, to identify measures pertaining to Early years, Bourdieusian, Marxist, and Weberian social class mechanisms. Using logistic and least-squares regression we consider the relative extent to which these mechanisms explain differences in health (Self-reported health, SF12 Physical (PCS) and Mental (MCS) Component Scores, General Health Questionnaire; N = 21,446) and allostatic load, a biomarker-based measure of cumulative stress (N = 5003). RESULTS Respondents with higher social position according to all social class measures had better self-rated, physical and mental health, and lower allostatic load. Associations with Marxist social class were among the strongest (e.g. Relative Index of Inequality for very good/excellent self-rated health comparing highest versus lowest Marxist social class: 4.96 (4.45, 5.52), with the Weberian measure also strongly associated with self-rated (4.35 (3.90, 4.85)) and physical health (Slope Index of Inequality for SF12-PCS: 7.94 (7.39, 8.48)). Health outcome associations with Bourdieusian and Marxist measures were generally stronger for women and older respondents, and physical health associations with all measures were stronger among those aged 50+ years. CONCLUSIONS The impact of social class on health is multi-faceted. Policies to reduce health inequalities should focus more on unequal capital ownership, economic democracy and educational inequalities, reflecting Marxist and Weberian mechanisms.
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Affiliation(s)
- Elise Whitley
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, G3 7HR, UK.
| | - Gerard McCartney
- School of Social and Political Sciences, University of Glasgow, Glasgow, G12 8RT, UK
| | - Mel Bartley
- Institute of Epidemiology & Health, University College London, London, WC1E 7HB, UK
| | - Michaela Benzeval
- Institute for Social and Economic Research, University of Essex, Colchester, CO4 3SQ, UK; Institute of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK
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20
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Friel S. Climate change, society, and health inequities. Med J Aust 2022; 217:466-468. [PMID: 36244044 PMCID: PMC9828533 DOI: 10.5694/mja2.51731] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 07/18/2022] [Accepted: 08/01/2022] [Indexed: 11/08/2022]
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21
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Friel S, Arthur M, Frank N. Power and the planetary health equity crisis. Lancet 2022; 400:1085-1087. [PMID: 35964591 DOI: 10.1016/s0140-6736(22)01544-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 08/01/2022] [Indexed: 01/03/2023]
Affiliation(s)
- Sharon Friel
- Planetary Health Equity Hothouse, School of Regulation and Global Governance, Fellows Road, Australian National University, Canberra 2601, Australia.
| | - Megan Arthur
- Planetary Health Equity Hothouse, School of Regulation and Global Governance, Fellows Road, Australian National University, Canberra 2601, Australia
| | - Nicholas Frank
- Planetary Health Equity Hothouse, School of Regulation and Global Governance, Fellows Road, Australian National University, Canberra 2601, Australia
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22
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Freudenberg N. Integrating Social, Political and Commercial Determinants of Health Frameworks to Advance Public Health in the twenty-first Century. INTERNATIONAL JOURNAL OF HEALTH SERVICES : PLANNING, ADMINISTRATION, EVALUATION 2022; 53:207314221125151. [PMID: 36113468 DOI: 10.1177/00207314221125151] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/18/2024]
Abstract
Existing frameworks seek to elucidate the social, political, and commercial determinants of health in order to inform practice, policy, and research that can improve health and reduce health inequities. Each approach has widened the scope of public health practice and research and identified new partners and targets for intervention. But as the public health crises of the past decade have shown, these frameworks have not yet yielded insights that have enabled the public health profession and movement to prevent or overcome dominant threats to global health and health equity. This report explores the value of an integrated framework that combines insights from previous scholarship and practice using the social, political, and commercial determinants of health. It proposes the questions such an integration would need to answer and suggests processes and tasks that could lead to the creation of a blended framework.
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Affiliation(s)
- Nicholas Freudenberg
- Distinguished Professor of Public Health, 2009City University of New York School of Public Health and Health Policy, New York, NY, USA
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23
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Trowbridge J, Tan JY, Hussain S, Osman AEB, Di Ruggiero E. Examining Intersectoral Action as an Approach to Implementing Multistakeholder Collaborations to Achieve the Sustainable Development Goals. Int J Public Health 2022; 67:1604351. [PMID: 35652124 PMCID: PMC9149775 DOI: 10.3389/ijph.2022.1604351] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 03/31/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives: The Sustainable Development Goals (SDGs) re-orient action towards improving the social and ecological determinants of health and equity. SDG 17 calls for enhanced policy and institutional coherence and strong multi-stakeholder partnerships. Intersectoral action (IA) has a promising history in public health, including health promotion and global health. Some experts see IA as crucial to the SDGs. Yet less is known about how IA is conceptualized and what promising models exist with relevance to the SDGs. We sought to investigate how IA is understood conceptually and empirically. Methods: We conducted a narrative review of global public health and political science literatures and grey literature on the SDGs to identify theoretical models, case studies and reviews of IA research. Results: Multiple competing conceptualizations of IA exist. Research has focused on case studies in high-income countries. More conceptual clarity, analyses of applications in LMICs, and explorations of political and institutional factors affecting IA are needed, as is attention to power dynamics between sectors. Conclusion: IA is required to collaborate on the SDGs and address equity. New models for successful implementation merit exploration.
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Affiliation(s)
- Joslyn Trowbridge
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Julia Y. Tan
- Faculty of Arts and Science, University of Toronto, Toronto, ON, Canada
| | - Sameera Hussain
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Ahmed Esawi Babiker Osman
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Erica Di Ruggiero
- Division of Social and Behavioural Health Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- *Correspondence: Erica Di Ruggiero,
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24
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Flavel J, McKee M, Freeman T, Musolino C, van Eyk H, Tesfay FH, Baum F. The need for improved Australian data on social determinants of health inequities. Med J Aust 2022; 216:388-391. [PMID: 35393676 PMCID: PMC9321841 DOI: 10.5694/mja2.51495] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Joanne Flavel
- Stretton Institute, University of Adelaide, Adelaide, SA
| | - Martin McKee
- London School of Hygiene and Tropical Medicine, London, UK
| | - Toby Freeman
- Stretton Institute, University of Adelaide, Adelaide, SA
| | | | - Helen van Eyk
- Stretton Institute, University of Adelaide, Adelaide, SA
| | - Fisaha H Tesfay
- Institute for Health Transformation, Deakin University, Melbourne, VIC
| | - Fran Baum
- Stretton Institute, University of Adelaide, Adelaide, SA
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25
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26
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Martínez-García M, Villegas Camacho JM, Hernández-Lemus E. Connections and Biases in Health Equity and Culture Research: A Semantic Network Analysis. Front Public Health 2022; 10:834172. [PMID: 35425756 PMCID: PMC9002348 DOI: 10.3389/fpubh.2022.834172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/07/2022] [Indexed: 11/27/2022] Open
Abstract
Health equity is a rather complex issue. Social context and economical disparities, are known to be determining factors. Cultural and educational constrains however, are also important contributors to the establishment and development of health inequities. As an important starting point for a comprehensive discussion, a detailed analysis of the literature corpus is thus desirable: we need to recognize what has been done, under what circumstances, even what possible sources of bias exist in our current discussion on this relevant issue. By finding these trends and biases we will be better equipped to modulate them and find avenues that may lead us to a more integrated view of health inequity, potentially enhancing our capabilities to intervene to ameliorate it. In this study, we characterized at a large scale, the social and cultural determinants most frequently reported in current global research of health inequity and the interrelationships among them in different populations under diverse contexts. We used a data/literature mining approach to the current literature followed by a semantic network analysis of the interrelationships discovered. The analyzed structured corpus consisted in circa 950 articles categorized by means of the Medical Subheadings (MeSH) content-descriptor from 2014 to 2021. Further analyses involved systematic searches in the LILACS and DOAJ databases, as additional sources. The use of data analytics techniques allowed us to find a number of non-trivial connections, pointed out to existing biases and under-represented issues and let us discuss what are the most relevant concepts that are (and are not) being discussed in the context of Health Equity and Culture.
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Affiliation(s)
- Mireya Martínez-García
- Department of Immunology, National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico
| | - José Manuel Villegas Camacho
- Clinical Research Division, National Institute of Cardiology Ignacio Chávez, Mexico City, Mexico.,Social Relations Department, Universidad Autónoma Metropolitana, Mexico City, Mexico
| | - Enrique Hernández-Lemus
- Computational Genomics Division, National Institute of Genomic Medicine, Mexico City, Mexico.,Center for Complexity Sciences, Universidad Nacional Autónoma de México, Mexico City, Mexico
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Ridde V, Faye A. Challenges in Implementing the National Health Response to COVID-19 in Senegal. GLOBAL IMPLEMENTATION RESEARCH AND APPLICATIONS 2022; 2:219-233. [PMID: 35967834 PMCID: PMC9361250 DOI: 10.1007/s43477-022-00053-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/26/2022] [Indexed: 04/27/2023]
Abstract
UNLABELLED Since the beginning of the COVID-19 pandemic in Africa, many epidemiological or anthropological studies have been published. However, few studies have yet been conducted to understand the implementation of State interventions to fight the COVID-19 pandemic. In Senegal, the national response plan was planned before the country experienced its first official case of COVID-19 on 2 March 2020. This qualitative study, conducted in March and April 2021, based on 189 interviews, aims to understand how the national response has been implemented in several regions of Senegal. Implementation of the response to the pandemic was favoured by good preparation, capacity to adapt, responsiveness of health actors, and commitment for both the political and religious authorities. The implementation response was confronted by several constraining factors such as the coercive approach, the challenges of coordinating actors, and the lack of intersectoral response. The central level has sometimes used reflexivity processes to adapt its response, but it has remained highly politicized, centralized, directive, and with little involvement of civil society. In Senegal, the response to the pandemic has been implemented in a relatively political and directive, even coercive manner, without necessarily considering prior knowledge and the need to adapt it to local contexts and to involve civil society and community actors in the process. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43477-022-00053-4.
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Affiliation(s)
- Valéry Ridde
- Institute of Health and Development (ISED), Cheikh Anta Diop University, Dakar, Senegal
- Université Paris Cité, IRD, Inserm, Ceped, 75006 Paris, France
| | - Adama Faye
- Institute of Health and Development (ISED), Cheikh Anta Diop University, Dakar, Senegal
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28
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Baum F. How can health promotion contribute to pulling humans back from the brink of disaster? Glob Health Promot 2021; 28:64-72. [PMID: 34711103 DOI: 10.1177/17579759211044074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Health promotion has evolved over the last decades from a primary focus on behaviour change to establishing an ambitious goal of creating healthy, fair and sustainable environments in a manner which realises the rights of all people to health and well-being while protecting the health of our planet and its ecosystems. This paper argues that in order to contribute to this ambitious goal, health promotion must address three key tasks. The first is the need to take planetary health more seriously and move away from reductionist thinking to an approach that sees the planet as a complex system and values more harmony with nature, protects biodiversity and prevents global warming. The second task is to advocate and support governments to govern for health. The key to doing this is putting health and equity before profit, creating healthy urban environments, encouraging participatory decision-making, advocating for healthy economic models and assessing the ways in which corporate determinants of health operate. The third task is to ensure that moves to professionalise health promotion do not come at the expense of health promotion advocacy to powerful people and organisations. Health promotion is well placed to support civil society movements arguing for social and economic change that will benefit health such as the Black Lives Matter and environment movements.
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Affiliation(s)
- Fran Baum
- Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, South Australia, Australia
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