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Dunn JR, Park GR, Brydon R, Wolfson M, Veall M, Rolheiser L, Siddiqi A, Ross NA. Income inequality and population health: a political-economic research agenda. J Epidemiol Community Health 2022; 76:jech-2022-219252. [PMID: 35676074 DOI: 10.1136/jech-2022-219252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 05/28/2022] [Indexed: 11/03/2022]
Abstract
There is more than 30 years of research on relationships between income inequality and population health. In this article, we propose a research agenda with five recommendations for future research to refine existing knowledge and examine new questions. First, we recommend that future research prioritise analyses with broader time horizons, exploring multiple temporal aspects of the relationship. Second, we recommend expanding research on the effect of public expenditures on the inequality-health relationship. Third, we introduce a new area of inquiry focused on interactions between social mobility, income inequality and population health. Fourth, we argue the need to examine new perspectives on 21st century capitalism, specifically the population health impacts of inequality in income from capital (especially housing), in contrast to inequality in income from labour. Finally, we propose that this research broaden beyond all-cause mortality, to cause-specific mortality, avoidable mortality and subcategories thereof. We believe that such a research agenda is important for policy to respond to the changes following the COVID-19 pandemic.
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Affiliation(s)
- James R Dunn
- Department of Health, Aging and Society, McMaster University Faculty of Social Sciences, Hamilton, Ontario, Canada
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
| | - Gum-Ryeong Park
- Department of Health, Aging & Society, McMaster University, Hamilton, Ontario, Canada
- Department of Health Care Policy Research, Korea Institute for Health and Social Affairs, Sejong, Republic of Korea
| | - Robbie Brydon
- Department of Health, Aging & Society, McMaster University, Hamilton, Ontario, Canada
| | - Michael Wolfson
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Michael Veall
- Department of Economics, McMaster University, Hamilton, Ontario, Canada
| | - Lyndsey Rolheiser
- Center for Real Estate and Urban Economic Studies, University of Connecticut School of Business, Storrs, Connecticut, USA
| | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Nancy A Ross
- Department of Geography, McGill University, Montreal, Quebec, Canada
- Public Health Sciences, Queen's University, Kingston, Ontario, Canada
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Affiliation(s)
- Nicholas Freudenberg
- The author is with the Graduate School of Public Health and Health Policy, City University of New York, New York, NY
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Lasco G, Gregory Yu V. Medical populism and the politics of dengue epidemics in the Global South. Glob Public Health 2021; 17:1795-1808. [PMID: 34375166 DOI: 10.1080/17441692.2021.1965181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
With millions of cases and thousands of deaths every year in Asia and Latin America, dengue fever continues to be of global public health significance. This article uses the concept of 'medical populism' to analyse the political construction of the 2019 dengue epidemics in Bangladesh, the Philippines, and Honduras. Through this framework, we examine the narratives of these outbreaks by reconstructing how political actors simplified the discourse, spectacularised the crises, offered multiple knowledge claims, and forged divisions between the people and 'dangerous others'. Taken together, our case studies, obtained through government, journalistic, and scholarly sources, illuminate the role of medical populists (who are almost always politicians) in defining and responding to public health emergencies, underscoring the performative dimension of disease outbreaks. By detracting attention from less spectacular but more substantive policies and programs, these 'performances' of health crises perpetuate health inequities, especially in fragile democracies like the aforementioned Global South countries. We conclude by reflecting on the implications of medical populism to public health, health communications, and the inevitable recurrence of epidemics.
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Affiliation(s)
- Gideon Lasco
- Development Studies Program, Ateneo de Manila University, Quezon City, Philippines.,Department of Anthropology, University of the Philippines Diliman, Quezon City, Philippines
| | - Vincen Gregory Yu
- Development Studies Program, Ateneo de Manila University, Quezon City, Philippines
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Plamondon KM, Brisbois B, Dubent L, Larson CP. Assessing how global health partnerships function: an equity-informed critical interpretive synthesis. Global Health 2021; 17:73. [PMID: 34215301 PMCID: PMC8254362 DOI: 10.1186/s12992-021-00726-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 06/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background Global health partnerships (GHPs) are situated in complex political and economic relationships and involve partners with different needs and interests (e.g., government agencies, non-governmental organizations, corporations, universities, professional associations, philanthropic organizations and communities). As part of a mixed methods study designed to develop an equity-sensitive tool to support more equity-centred North-South GHPs, this critical interpretive synthesis examined reported assessments of GHPs. Results We examined 30 peer-reviewed articles for power dynamics, equity and inequities, and contradictions or challenges encountered in North-South partnerships. Among articles reviewed, authors most often situated GHPs around a topical focus on research, capacity-building, clinical, or health services issues, with the ‘work’ of the partnership aiming to foster skills or respond to community needs. The specific features of GHPs that were assessed varied widely, with consistently-reported elements including the early phases of partnering; governance issues; the day-to-day work of partnerships; the performance, impacts and benefits of GHPs; and issues of inclusion. Articles shared a general interest in partnering processes and often touched briefly on issues of equity; but they rarely accounted for the complexity of sociopolitical and historical contexts shaping issues of equity in GHPs. Further, assessments of GHPs were often reported without inclusion of voices from all partners or named beneficiaries. GHPs were frequently portrayed as inherently beneficial for Southern partners, without attention to power dynamics and inequities (North-South, South-South). Though historical and political dynamics of the Global North and South were inconsistently examined as influential forces in GHPs, such dynamics were frequently portrayed as complex and characterized by asymmetries in power and resources. Generally, assessments of GHPs paid little attention to the macroeconomic forces in the power and resource dynamics of GHPs highlights the importance of considering the broader political. Our findings suggest that GHPs can serve to entrench both inequitable relationships and unfair distributions of power, resources, and wealth within and between countries (and partners) if inequitable power relationships are left unmitigated. Conclusions We argue that specific practices could enhance GHPs’ contributions to equity, both in their processes and outcomes. Enhancing partnering practices to focus on inclusion, responsiveness to North-South and South-South inequities, and recognition of GHPs as situated in a broader (and inequitable) political economy. A relational and equity-centred approach to assessing GHPs would place social justice, humility and mutual benefits as central practices—that is, regular, routine things that partners involved in partnering do intentionally to make GHPs function well. Practicing equity in GHPs requires continuous efforts to explicitly acknowledge and examine the equity implications of all aspects of partnering. Supplementary Information The online version contains supplementary material available at 10.1186/s12992-021-00726-z.
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Affiliation(s)
- Katrina M Plamondon
- Michael Smith Foundation for Health Research Scholar, School of Nursing, Faculty of Health & Social Development, University of British Columbia, 1147 Research Road, Kelowna, BC, V1V 1V7, Canada.
| | - Ben Brisbois
- School of Health Sciences, University of Northern British Columbia, 3333 University Way, Prince George, BC, V2N 4Z9, Canada
| | - Leslie Dubent
- Canadian Coalition for Global Health Research, 46 Cremona Crescent, Nepean, ON, K2G 1A1, Canada
| | - Charles P Larson
- Faculty of Medicine and Health Sciences, School of Population and Global Health, McGill University, 772 Sherbrooke Street West, Montreal, QC, H3A 1G1, Canada
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Abstract
The COVID-19 pandemic has produced mass market failure in global private health, particularly in tertiary care. Low-and-middle income countries (LMICs) dependent on private providers as a consequence of neglect of national health systems or imposed conditionalities under neoliberal governance were particularly effected. When beds were most needed for the treatment of acute COVID-19 cases, private providers suffered a liquidity crisis, itself propelled by the primary effects of lockdowns, government regulations and patient deferrals, and the secondary economic impacts of the pandemic. This led to a private sector response—involving, variously, hospital closures, furloughing of staff, refusals of treatment, and attempts to profit by gouging patients. A crisis in state and government relations has multiplied across LMICs. Amid widespread national governance failures—either crisis bound or historic—with regards to poorly resourced public health services and burgeoning private health—governments have responded with increasing legal and financial interventions into national health markets. In contrast, multilateral governance has been path dependent with regard to ongoing commitments to privately provided health. Indeed, the global financial institutions appear to be using the COVID crisis as a means to recommit to the roll out of markets in global health, this involving the further scaling back of the state.
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[Health inequalities: new theoretical perspectives]. Salud Colect 2020; 16:e2751. [PMID: 32574463 DOI: 10.18294/sc.2020.2751] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 06/13/2020] [Indexed: 11/24/2022] Open
Abstract
This article, I intend to articulate the theoretical problem of economic and social inequalities with the issue of the social determination of health. Initially, I provide a summary of Rawls' and Sen's theories of justice and equity as an illustration of the dominant perspective in Northern epistemologies. Second, I discuss applications of this theoretical framework in the literature on social inequalities and the social determination of health-illness-care. Thirdly, I present a semantic matrix proposed for the difference-distinction-inequality-inequity-iniquity series to help reduce the existing terminological confusion. Next, I introduce a synthetic theoretical model about the poverty-inequality dyad, referring to the concepts of social resources, health practices, health services, and health situation/conditions. Finally, oriented by an epistemological perspective from the global South, and taking the current Brazilian situation as a case study, I discuss political implications of the complex contemporary conjuncture, pertinent to the hypothesis that a process of transformation of economic inequalities into new forms of social inequities and health iniquities is currently underway.
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Battams S. Neo-Liberalism, Policy Incoherence and Discourse Coalitions Influencing Non-Communicable Disease Strategy Comment on "How Neoliberalism Is Shaping the Supply of Unhealthy Commodities and What This Means for NCD Prevention". Int J Health Policy Manag 2020; 9:116-118. [PMID: 32202094 PMCID: PMC7093044 DOI: 10.15171/ijhpm.2019.95] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Accepted: 10/16/2019] [Indexed: 11/22/2022] Open
Abstract
Lencucha and Thow have highlighted the way in which neo-liberalism is enshrined within institutional mechanisms and conditions the policy environment to shape public policy on non-communicable diseases (NCDs). They critique the strong (but important) focus of public health policy research on corporate interests and influence over NCD policy, and point toward neo-liberal policy paradigms shaping the relationship between the state, market and society as an area for critique and further exploration. They also importantly underline the way in which the neo-liberal policy paradigm shapes the supply of unhealthy goods and argue that health advocates have not engaged enough with supply side issues in critiques of policy debates on NCDs. This is an important consideration especially in the Asia-Pacific where trade and agricultural policies have markedly shaped production and what is being produced within countries. In this commentary, I reflect upon how neoliberalism shapes intersectoral action across trade, development and health within and across institutions. I also consider scope for international civil society to engage in advocacy on NCDs, especially where elusive ‘discourse coalitions’ influenced by neoliberalism may exist, rather than coordinated ‘advocacy coalitions.’
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Affiliation(s)
- Samantha Battams
- Southgate Institute for Health, Society and Equity, Flinders University, SA, Australia
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Edge S, Meyer SB. Pursuing dignified food security through novel collaborative governance initiatives: Perceived benefits, tensions and lessons learned. Soc Sci Med 2019; 232:77-85. [DOI: 10.1016/j.socscimed.2019.04.038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Revised: 04/08/2019] [Accepted: 04/24/2019] [Indexed: 10/26/2022]
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Legge DG. Striving towards integrated people-centred health services: reflections on the Australian experience. Fam Med Community Health 2019; 7:e000056. [PMID: 32148695 PMCID: PMC6910728 DOI: 10.1136/fmch-2018-000056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Revised: 12/30/2018] [Accepted: 01/06/2019] [Indexed: 11/04/2022] Open
Abstract
Health systems around the world are under continuing pressure for reform. Health system reform involves both content and process. Content deals with changes to the structures of the health system; process deals with the strategies of change. In this paper, we reflect on the development of the Australian healthcare system and draw out lessons regarding both structural and developmental principles. We review the historical development and functional performance of a range of 'programmes' which comprise the Australian health system. We use WHO's 2016 'framework on integrated people-centred health services' as a standard against which to evaluate the performance of the different programmes. A model of health system development featuring incremental change, windows of opportunity and policy coherence is used to frame some lessons from the Australian experience regarding reform strategy. Several of the programmes reviewed can be shown to have contributed positively to integrated and people-centred services. However, there have also been significant shortfalls in performance. The successes and the shortfalls of the programmes reviewed reflect both their histories and their contemporary context. Structural principles emerging from this review include the policy leverage available under single payer purchasing and on the other hand the fragmenting effects of privatisation and marketisation. Lessons regarding strategies of reform include cultivating 'reform readiness' across all of the locations and levels where opportunities for change may emerge while cultivating system wide coherence through a shared vision of how the system as a whole should develop.
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Affiliation(s)
- David G Legge
- La Trobe China Health Program, La Trobe University, Bundoora, Victoria, Australia
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Battams S, Townsend B. Power asymmetries, policy incoherence and noncommunicable disease control - a qualitative study of policy actor views. CRITICAL PUBLIC HEALTH 2018. [DOI: 10.1080/09581596.2018.1492093] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Samantha Battams
- Southgate Institute for Health, Society and Equity, Flinders University
| | - Belinda Townsend
- School of Regulation and Global Governance, Australian National University, Canberra, Australia
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Was Mackenbach right? Towards a practical political science of redistribution and health inequalities. Health Place 2017; 46:293-299. [PMID: 28689134 DOI: 10.1016/j.healthplace.2017.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 05/27/2017] [Accepted: 06/22/2017] [Indexed: 11/22/2022]
Abstract
In 2010, Mackenbach reflected on England's lack of success in reducing health inequalities between 1997 and 2010, asserting that "it is difficult to imagine a longer window of opportunity for tackling health inequalities"; asking "[i]f this did not work, what will?"; and concluding that reducing health inequalities was not politically feasible at least in that jurisdiction. Exploring the empirics of that observation offers a window into the politics of reducing health inequalities. For purposes of future comparative research, I outline three (not mutually exclusive) perspectives on political feasibility, identify their implications for a political science of health inequalities, and explore what they mean for advocacy in support of reducing those inequalities.
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Arcaya MC, Figueroa JF. Emerging Trends Could Exacerbate Health Inequities In The United States. Health Aff (Millwood) 2017; 36:992-998. [DOI: 10.1377/hlthaff.2017.0011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Mariana C. Arcaya
- Mariana C. Arcaya is an assistant professor of urban planning and public health in the Department of Urban Studies and Planning, Massachusetts Institute of Technology, in Cambridge
| | - José F. Figueroa
- José F. Figueroa is an instructor of medicine at Harvard Medical School and an associate physician in the Department of Medicine, Brigham and Women’s Hospital, in Boston, Massachusetts
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Sparke M. Austerity and the embodiment of neoliberalism as ill-health: Towards a theory of biological sub-citizenship. Soc Sci Med 2016; 187:287-295. [PMID: 28057384 DOI: 10.1016/j.socscimed.2016.12.027] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 12/15/2016] [Accepted: 12/19/2016] [Indexed: 11/16/2022]
Abstract
This article charts the diverse pathways through which austerity and other policy shifts associated with neoliberalism have come to be embodied globally in ill-health. It combines a review of research on these processes of embodiment with the development of a theory of the resulting forms of biological sub-citizenship. This theory builds on other studies that have already sought to complement and complicate the concept of biological citizenship with attention to the globally uneven experience and embodiment of bioinequalities. Focused on the unevenly embodied sequelae of austerity, the proceeding theorization of biological sub-citizenship is developed in three stages of review and conceptualization: 1) Biological sub-citizenship through exclusion and conditionalization; 2) Biological sub-citizenship through extraction and exploitation; and 3) Biological sub-citizenship through financialized experimentation. In conclusion the paper argues that the analysis of biological sub-citizenship needs to remain open-ended and relational in order to contribute to socially-searching work on the social determinants of health.
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Affiliation(s)
- Matthew Sparke
- University of Washington, Box 353550, Seattle, WA 98195, USA.
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Neuwelt PM, Gleeson D, Mannering B. Patently obvious: a public health analysis of pharmaceutical industry statements on the Trans-Pacific Partnership international trade agreement. CRITICAL PUBLIC HEALTH 2015. [DOI: 10.1080/09581596.2015.1022510] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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