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Carlson M, Redvers N. Indigenous Peoples and Cultural Safety in Public Health. Am J Public Health 2023; 113:1059-1063. [PMID: 37535896 PMCID: PMC10484130 DOI: 10.2105/ajph.2023.307363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Affiliation(s)
- Megan Carlson
- Megan Carlson is with the Department of Population Health, School of Medicine and Health Sciences, University of North Dakota, Grand Forks. Nicole Redvers is with the Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
| | - Nicole Redvers
- Megan Carlson is with the Department of Population Health, School of Medicine and Health Sciences, University of North Dakota, Grand Forks. Nicole Redvers is with the Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
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Shahram SZ. Five ways 'health scholars' are complicit in upholding health inequities, and how to stop. Int J Equity Health 2023; 22:15. [PMID: 36658523 PMCID: PMC9851581 DOI: 10.1186/s12939-022-01763-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Accepted: 09/16/2022] [Indexed: 01/20/2023] Open
Abstract
Health scholars have been enthusiastic in critique of health inequities, but comparatively silent on the ways in which our own institutions, and our actions within them, recreate and retrench systems of oppression. The behaviour of health scholars within academic institutions have far reaching influences on the health-related workforce, the nature of evidence, and the policy solutions within our collective imaginations. Progress on health equity requires moving beyond platitudes like 'equity, diversity and inclusion' statements and trainings towards actually being and doing differently within our day-to-day practices. Applying complex systems change theory to identify, examine and shift mental models, or habits of thought (and action), that are keeping us stuck in our efforts to advance health equity is a promising approach. This paper introduces five common mental models that are preventing meaningful equity-oriented systems transformation within academia and offers ideas for shifting them towards progressively more productive, and authentic, actions by health scholars to advance health equity across systems.
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Affiliation(s)
- Sana Z. Shahram
- grid.17091.3e0000 0001 2288 9830School of Nursing, Faculty of Health & Social Development, The University of British Columbia, Okanagan Campus Syilx Okanagan Nation Territory 1147 Research Road, V1V 1V7, P. 250 807 8685 Kelowna, BC Canada ,grid.143640.40000 0004 1936 9465Canadian Institute for Substance Use Research, University of Victoria, Victoria, Canada
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Giorgi EM, Drescher MJ, Winkelmann ZK, Eberman LE. Validation of a Script to Facilitate Social Determinant of Health Conversations with Adolescent Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph192214810. [PMID: 36429530 PMCID: PMC9690555 DOI: 10.3390/ijerph192214810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 11/03/2022] [Accepted: 11/09/2022] [Indexed: 05/13/2023]
Abstract
Current social determinants of health (SDOH) tools exist to assess patient exposure; however, healthcare providers for the adolescent population are unsure of how to integrate SDOH knowledge into clinical practice. The purpose of this study was to validate a focused history script designed to facilitate SDOH conversations between clinicians and adolescents through the use of the Delphi method. Six individuals (1 clinician, 5 educators/researchers) participated as expert panelists. Panelists provided critical feedback on the script for rounds 1 and 2. For rounds 3-7, panelists received an electronic questionnaire asking them to indicate agreement on a 6-point Likert scale (1 = strongly disagree, 6 = strongly agree). We defined consensus as mean item agreement ≥ 5.0 and percent agreement ≥ 80%. In round 7, panelists rated overall script level of agreement. After seven rounds of feedback, the focused history script achieved content validity with 100% of panelists agreeing on the final 40-item script. A focused history script for the SDOH was content validated to aid conversations between healthcare providers and adolescent patients on factors that affect their life, school, and play. Addressing social determinants of health with adolescent patients will improve cultural proficiency and family-centered care delivered by school healthcare professionals.
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Affiliation(s)
- Emily M. Giorgi
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, IN 47803, USA
- Correspondence: ; Tel.: +1-916-822-1338
| | - Matthew J. Drescher
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, IN 47803, USA
| | - Zachary K. Winkelmann
- Department of Exercise Science, University of South Carolina, Columbia, SC 29208, USA
| | - Lindsey E. Eberman
- Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute, IN 47803, USA
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Gerlach AJ, McFadden A. Re-Envisioning an Early Years System of Care towards Equity in Canada: A Critical, Rapid Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159594. [PMID: 35954949 PMCID: PMC9368147 DOI: 10.3390/ijerph19159594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 07/22/2022] [Accepted: 07/29/2022] [Indexed: 02/04/2023]
Abstract
Background: Many children in high-income countries, including Canada, experience unjust and preventable health inequities as a result of social and structural forces that are beyond their families’ immediate environment and control. In this context, early years programs, as a key population health initiative, have the potential to play a critical role in fostering family and child wellbeing. Methods: Informed by intersectionality, this rapid literature review captured a broad range of international, transdisciplinary literature in order to identify promising approaches for orienting early years systems of care towards equity in Canada. Results: Findings point to the need for a comprehensive, integrated and socially responsive early years system that has top-down political vision, leadership and accountability and bottom-up community-driven tailoring with an explicit focus on health promotion and maternal, family and community wellness using relational approaches. Conclusions: Advancing child health equity in wealthy countries requires structural government-level changes that support cross-ministerial and intersectoral alliances. Employing intersectionality in this rapid review promotes contextualized and nuanced understandings of what is needed in order to advance a responsive, comprehensive and quality early years system of equity-oriented care. Further research is needed to prevent child health inequities that are disproportionally experienced by Indigenous and racialized children in wealthy countries such as Canada. olicy and research recommendations that have relevance for high-income countries in diverse global contexts are discussed.
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Affiliation(s)
- Alison Jayne Gerlach
- School of Child and Youth Care, Faculty of Human and Social Development, University of Victoria, Victoria, BC V8W 2Y2, Canada
- Correspondence:
| | - Alysha McFadden
- School of Nursing, University of British Columbia, Vancouver, BC V6T 2B5, Canada
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Dawson P, Auvray B, Jaye C, Gauld R, Hay-Smith J. Social determinants and inequitable maternal and perinatal outcomes in Aotearoa New Zealand. WOMEN'S HEALTH (LONDON, ENGLAND) 2022; 18:17455065221075913. [PMID: 35109729 PMCID: PMC8819758 DOI: 10.1177/17455065221075913] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Aotearoa New Zealand has demonstrable maternal and perinatal health inequity.
We examined the relationships between adverse outcomes in a total population
sample of births and a range of social determinant variables representing
barriers to equity. Methods: Using the Statistics New Zealand Integrated Data Infrastructure suite of
linked administrative data sets, adverse maternal and perinatal outcomes
(mortality and severe morbidity) were linked to socio-economic and health
variables for 97% of births in New Zealand between 2003 and 2018 (~970,000
births). Variables included housing, economic, health, crime and family
circumstances. Logistic regression examined the relationships between
adverse outcomes and social determinants, adjusting for demographics
(socio-economic deprivation, education, parity, age, rural/urban residence
and ethnicity). Results: Māori (adjusted odds ratio = 1.21, 95% confidence interval = 1.18–1.23) and
Asian women (adjusted odds ratio 1.39, 95% confidence interval = 1.36–1.43)
had poorer maternal or perinatal outcomes compared to New Zealand
European/European women. High use of emergency department (adjusted odds
ratio = 2.68, 95% confidence interval = 2.53–2.84), disability (adjusted
odds ratio = 1.98, 95% confidence interval = 1.83–2.14) and lack of
engagement with maternity care (adjusted odds ratio = 1.89, 95% confidence
interval = 1.84–1.95) had the strongest relationship with poor outcomes. Conclusion: Maternal health inequity was strongly associated with a range of
socio-economic and health determinants. While some of these factors can be
targeted for interventions, the study highlights larger structural and
systemic issues that affect maternal and perinatal health.
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Suarez-Balcazar Y, Mirza M, Errisuriz VL, Zeng W, Brown JP, Vanegas S, Heydarian N, Parra-Medina D, Morales P, Torres H, Magaña S. Impact of COVID-19 on the Mental Health and Well-Being of Latinx Caregivers of Children with Intellectual and Developmental Disabilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7971. [PMID: 34360263 PMCID: PMC8345447 DOI: 10.3390/ijerph18157971] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/17/2021] [Accepted: 07/25/2021] [Indexed: 01/20/2023]
Abstract
The COVID-19 pandemic has impacted the entire world in unprecedented ways. However, populations that have had a history of marginalization have experienced a more profound impact. One such group is Latinx families of children with intellectual and developmental disabilities (IDD) in the Unites States. In this study, we used a mixed methods approach to explore the impact of the pandemic on the mental health and well-being of Latinx caregivers of children with IDD. Specifically, we (1) identified which social determinants of health are correlated with maternal caregivers perceived general health, mental health, and well-being; (2) explored the impact of the pandemic on families' overall eating and physical activity routines; and (3) identified emergent themes from caregivers' experiences during the pandemic. Thirty-seven Latinx caregivers participated in three interviews in which several validated instruments were administered. The results indicated that perceived social support, annual family income, food security, and receipt of financial benefits were correlated with fewer depressive symptoms. Annual family income was also significantly correlated with perceived general health. Most caregivers reported that the pandemic had placed a strain on their economic situation; increased their isolation; and disrupted their child's therapeutic supports, online education, eating routines, and engagement in physical activity. Meanwhile, some caregivers reported positive changes as a result of the pandemic. Implications for future research and practice are discussed.
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Affiliation(s)
- Yolanda Suarez-Balcazar
- Department of Occupational Therapy, University of Illinois Chicago, 1919 West Taylor, Chicago, IL 60612, USA; (M.M.); (J.P.B.)
| | - Mansha Mirza
- Department of Occupational Therapy, University of Illinois Chicago, 1919 West Taylor, Chicago, IL 60612, USA; (M.M.); (J.P.B.)
| | - Vanessa L. Errisuriz
- Latino Research Institute, University of Texas at Austin, 210 W. 24th St., Austin, TX 78712, USA; (V.L.E.); (D.P.-M.)
| | - Weiwen Zeng
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd., Austin, TX 78712, USA; (W.Z.); (N.H.); (P.M.); (H.T.); (S.M.)
| | - Jasmine P. Brown
- Department of Occupational Therapy, University of Illinois Chicago, 1919 West Taylor, Chicago, IL 60612, USA; (M.M.); (J.P.B.)
| | - Sandra Vanegas
- School of Social Work, Texas State University, Encino Hall, 712 North Commanche St., San Marcos, TX 78666, USA;
| | - Nazanin Heydarian
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd., Austin, TX 78712, USA; (W.Z.); (N.H.); (P.M.); (H.T.); (S.M.)
| | - Deborah Parra-Medina
- Latino Research Institute, University of Texas at Austin, 210 W. 24th St., Austin, TX 78712, USA; (V.L.E.); (D.P.-M.)
| | - Paula Morales
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd., Austin, TX 78712, USA; (W.Z.); (N.H.); (P.M.); (H.T.); (S.M.)
| | - Hilda Torres
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd., Austin, TX 78712, USA; (W.Z.); (N.H.); (P.M.); (H.T.); (S.M.)
| | - Sandy Magaña
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd., Austin, TX 78712, USA; (W.Z.); (N.H.); (P.M.); (H.T.); (S.M.)
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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: 10] [Impact Index Per Article: 3.3] [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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Olstad DL, Kirkpatrick SI. Planting seeds of change: reconceptualizing what people eat as eating practices and patterns. Int J Behav Nutr Phys Act 2021; 18:32. [PMID: 33663528 PMCID: PMC7934561 DOI: 10.1186/s12966-021-01102-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 02/18/2021] [Indexed: 12/15/2022] Open
Abstract
Language focused on individual dietary behaviors, or alternatively, lifestyle choices or decisions, suggests that what people eat and drink is primarily a choice that comes down to free will. Referring to and intervening upon food consumption as though it were a freely chosen behavior has an inherently logical appeal due to its simplicity and easily defined targets of intervention. However, despite decades of behavioral interventions, population-level patterns of food consumption remain suboptimal. This debate paper interrogates the manner in which language frames how problems related to poor diet quality are understood and addressed within society. We argue that referring to food consumption as a behavior conveys the idea that it is primarily a freely chosen act that can be ameliorated through imploring and educating individuals to make better selections. Leveraging practice theory, we subsequently propose that using the alternative language of eating practices and patterns better conveys the socially situated nature of food consumption. This language may therefore point to novel avenues for intervention beyond educating and motivating individuals to eat more healthfully, to instead focus on creating supportive contexts that enable sustained positive dietary change. Clearly, shifting discourse will not on its own transform the science and practice of nutrition. Nevertheless, the seeds of change may lie in aligning our terminology, and thus, our framing, with desired solutions.
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Affiliation(s)
- Dana Lee Olstad
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, T2N 4Z6, Canada.
| | - Sharon I Kirkpatrick
- School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada
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Amri MM, Jessiman-Perreault G, Siddiqi A, O’Campo P, Enright T, Di Ruggiero E. Scoping review of the World Health Organization's underlying equity discourses: apparent ambiguities, inadequacy, and contradictions. Int J Equity Health 2021; 20:70. [PMID: 33658033 PMCID: PMC7931570 DOI: 10.1186/s12939-021-01400-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Given the heightened rhetorical prominence the World Health Organization has afforded to equity in the past half-century, it is important to better understand how equity has been referred to and its conceptual underpinning, which may have broader global implications. ELIGIBILITY CRITERIA Articles were included if they met inclusion criteria - chiefly the explicit discussion of the WHO's concept of health equity, for example in terms of conceptualization and/or definitions. Articles which mentioned health equity in the context of WHO's programs, policies, and so on, but did not discuss its conceptualization or definition were excluded. SOURCES OF EVIDENCE We focused on peer-reviewed literature by scanning Ovid MEDLINE and SCOPUS databases, and supplementing by hand-search. RESULTS Results demonstrate the WHO has held - and continues to hold - ambiguous, inadequate, and contradictory views of equity that are rooted in different theories of social justice. CONCLUSIONS Moving forward, the WHO should revaluate its conceptualization of equity and normative position, and align its work with Amartya Sen's Capabilities Approach, as it best encapsulates the broader views of the organization. Further empirical research is needed to assess the WHO interpretations and approaches to equity.
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Affiliation(s)
- Michelle M. Amri
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8 Canada
- Takemi Program in International Health, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue, Bldg. 1, Boston, MA 02115-6021 USA
- School of Public Health and Social Policy, Human and Social Development Building, University of Victoria, 3800 Finnerty Road, Victoria, British Columbia V8P 5C2 Canada
| | | | - Arjumand Siddiqi
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8 Canada
- Gillings School of Global Public Health, University of North Carolina - Chapel Hill, Chapel Hill, USA
| | - Patricia O’Campo
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8 Canada
- Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, Toronto, Ontario M5B 1T8 Canada
| | - Theresa Enright
- Department of Political Science, University of Toronto, 100 St George Street, Toronto, Ontario M5S 3G3 Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario M5T 1P8 Canada
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Fry D. Language and framing as determinants of the predominance of behavioural health promotion: an Australian view. Health Promot Int 2021; 35:624-631. [PMID: 31056706 DOI: 10.1093/heapro/daz039] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The language used in health promotion warrants attention as it shapes how health promotion is understood, constraining or opening up possibilities for action. The 2016 Shanghai Declaration and the 1986 Ottawa Charter for Health Promotion call for comprehensive approaches which include policy and environmental changes. Yet many health promotion programmes in Australia continue to focus on informational and/or behavioural strategies, and there is a contemporary tendency for such programmes to be described as 'sending messages'. This paper uses frame analysis to discuss the role of language, and specifically language that frames health promotion as sending messages, in contributing to and reinforcing the predominance of informational and/or behavioural strategies. It argues such 'message' language helps to set a pattern in which informational and/or behavioural strategies are assumed to be the primary goal and extent of health promotion; rather than one component of a comprehensive, multi-strategic approach. It discusses how frames can be 'taken for granted' and ways in which such frames can be challenged and broadened. It argues that the message frame and associated behavioural framings set narrow boundaries for health promotion, contributing to the continuation of health inequities. These frames can also displace the language of the Ottawa Charter, which has capacity to reframe health issues socio-ecologically and include collective strategies. The paper concludes that a first step (of the many needed) towards applying the Charter's approach and multi-level, multi-strategic framework is to use the innovative vocabulary it offers. The words matter.
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Affiliation(s)
- Denise Fry
- Community Health Services, Sydney Local Health District, Level 9 South, King George V Building Missenden Road, Camperdown, NSW 2050, Australia
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11
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Svobodova I, Filakovska Bobakova D, Bosakova L, Dankulincova Veselska Z. How to improve access to health care for Roma living in social exclusion: a concept mapping study. Int J Equity Health 2021; 20:61. [PMID: 33579295 PMCID: PMC7881662 DOI: 10.1186/s12939-021-01396-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Accepted: 01/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background Half of the people living in social exclusion in the Czech Republic are of Roma origin. The worse health of Roma could be partly explained by numerous barriers to accessing health care. Therefore, our study aimed to explore the perceptions of various stakeholders and experts who may have an impact on the inclusion of Roma and/or their access to health care on how to improve health care access for Roma living in social exclusion in the Czech Republic. Methods We conducted a concept mapping study and obtained data from 32 participants from health and social services, policymakers and others who were involved in different study phases (brainstorming, sorting, rating, interpretation). Results Out of 64 proposed measures sorted into six distinct clusters, 20 were rated as the most urgent and the most feasible and should be implemented with a priority to improve access to health care for Roma living in social exclusion. The proposed measures covered various topics, such as education and awareness of the target group as well as education and supervision of helping professionals, strengthening capacities and streamlining the health care system, health promotion and associated services and increasing the local and financial accessibility of health care. Overall, measures concerning the education and supervision of helping professionals were rated as both the most urgent and the most feasible. Individual priority measures targeted, for example, the health needs assessment of Roma living in social exclusion to set up interventions or to include topics such as participation, empowerment, cultural competence and communication training in the curricula of health care and helping professionals in postgraduate and continuing studies. Conclusions Stakeholders proposed a set of relevant and acceptable measures that may help improve access to health care for Roma living in social exclusion. The way they rated the proposed measures reflects both the current unfavourable mainstream and public discourse concerning Roma living in social exclusion and the most acute policy issues identified by several European and national bodies. Supplementary Information The online version contains supplementary material available at 10.1186/s12939-021-01396-4.
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Affiliation(s)
- Ivana Svobodova
- Palacky University in Olomouc, Olomouc University Social Health Institute, Olomouc, Czech Republic.
| | - Daniela Filakovska Bobakova
- Palacky University in Olomouc, Olomouc University Social Health Institute, Olomouc, Czech Republic.,Department of Health Psychology and Research Methodology, University of Pavol Jozef Safarik in Kosice, Faculty of Medicine, Kosice, Slovak Republic
| | - Lucia Bosakova
- Palacky University in Olomouc, Olomouc University Social Health Institute, Olomouc, Czech Republic.,Department of Health Psychology and Research Methodology, University of Pavol Jozef Safarik in Kosice, Faculty of Medicine, Kosice, Slovak Republic
| | - Zuzana Dankulincova Veselska
- Department of Health Psychology and Research Methodology, University of Pavol Jozef Safarik in Kosice, Faculty of Medicine, Kosice, Slovak Republic
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Habibzadeh H, Jasemi M, Hosseinzadegan F. Social justice in health system; a neglected component of academic nursing education: a qualitative study. BMC Nurs 2021; 20:16. [PMID: 33435979 PMCID: PMC7802265 DOI: 10.1186/s12912-021-00534-1] [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: 07/04/2020] [Accepted: 01/02/2021] [Indexed: 11/17/2022] Open
Abstract
Background In recent decades, increasing social and health inequalities all over the world has highlighted the importance of social justice as a core nursing value. Therefore, proper education of nursing students is necessary for preparing them to comply with social justice in health systems. This study is aimed to identify the main factors for teaching the concept of social justice in the nursing curriculum. Method This is a qualitative study, in which the conventional content analysis approach was employed to analyze a sample of 13 participants selected using purposive sampling method. Semi-structured interviews were conducted to collect and analyze the data. Results Analysis of the interviews indicated that insufficient education content, incompetency of educators, and inappropriate education approaches made social justice a neglected component in the academic nursing education. These factors were the main sub-categories of the study and showed the negligence of social justice in academic nursing education. Conclusion Research findings revealed the weaknesses in teaching the concept of social justice in the nursing education. Accordingly, it is necessary to modify the content of nursing curriculum and education approaches in order to convey this core value. Since nursing educators act as role models for students, especially in practical and ethical areas, more attention should be paid to competency of nursing educators, specially training in the area of ethical ideology and social justice. Supplementary Information The online version contains supplementary material available at 10.1186/s12912-021-00534-1.
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Affiliation(s)
- Hosein Habibzadeh
- Faculty of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Madineh Jasemi
- Faculty of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
| | - Fariba Hosseinzadegan
- Faculty of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran.
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13
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Ndumbe-Eyoh S. What would it take for health promotion to take structural racism seriously? Glob Health Promot 2020; 27:3-5. [PMID: 33331227 DOI: 10.1177/1757975920972259] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sume Ndumbe-Eyoh
- Senior Knowledge Translation Specialist, National Collaborating Centre for Determinants of Health, Antigonish, NS Canada
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Ndumbe-Eyoh S. ¿Qué se necesita para que la promoción de la salud tome en serio al racismo estructural? Glob Health Promot 2020. [DOI: 10.1177/1757975920972622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Sume Ndumbe-Eyoh
- Senior Knowledge Translation Specialist, National Collaborating Centre for Determinants of Health, Antigonish, NS, Canada
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Ndumbe-Eyoh S. Que faudrait-il pour que la promotion de la santé prenne au sérieux le racisme structurel ? Glob Health Promot 2020. [DOI: 10.1177/1757975920972621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Sume Ndumbe-Eyoh
- Senior Knowledge Translation Specialist, National Collaborating Centre for Determinants of Health, Antigonish, Nova Scotia, Canada
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Suarez-Balcazar Y, Francisco VT, Rubén Chávez N. Applying Community-Based Participatory Approaches to Addressing Health Disparities and Promoting Health Equity. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 66:217-221. [PMID: 33373469 DOI: 10.1002/ajcp.12487] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This special issue highlights work that contributes to our understanding of health disparities and community-based participatory research (CBPR) approaches to promoting health equity across diverse populations and issues that matter to communities. We take on a global perspective, and thus, various efforts across international contexts are illustrated. Articles elucidate a variety of CBPR approaches designed to empower and build capacity among individuals and communities in order to seek changes at the level of community practices, programs, and systems. These articles span across diverse populations-children, youth, and families; adults and older adults; immigrants; refugees; Black people; Latinx people; Native Americans/Indigenous people, the Roma community; Muslim women, and women with disabilities-experiencing inequities of interest to community psychologists and other researchers and practitioners.
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Affiliation(s)
| | | | - Noé Rubén Chávez
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
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Plamondon KM. A tool to assess alignment between knowledge and action for health equity. BMC Public Health 2020; 20:224. [PMID: 32050946 PMCID: PMC7017559 DOI: 10.1186/s12889-020-8324-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 02/05/2020] [Indexed: 12/02/2022] Open
Abstract
Advancing health equity is a central goal and ethical imperative in public and global health. Though the commitment to health equity in these fields and among the health professions is clear, alignment between good equity intentions and action remains a challenge. This work regularly encounters the same power structures that are known to cause health inequities. Despite consensus about causes, health inequities persist-illustrating an uncomfortable paradox: good intentions and good evidence do not necessarily lead to meaningful action. This article describes a theoretically informed, reflective tool for assessing alignment between knowledge and action for health equity. It is grounded in an assumption that progressively more productive action toward health inequities is justified and desired and an explicit acceptance of the evidence about the socioeconomic, political, and power-related root causes of health inequities. Intentionally simple, the tool presents six possible actions that describe ways in which health equity work could respond to causes of health inequities: discredit, distract, disregard, acknowledge, illuminate, or disrupt. The tool can be used to assess or inform any kind of health equity work, in different settings and at different levels of intervention. It is a practical resource against which practice, policy, or research can be held to account, encouraging steps toward equity- and evidence-informed action. It is meant to complement other tools and training resources to build capacity for allyship, de- colonization, and cultural safety in the field of health equity, ultimately contributing to growing awareness of how to advance meaningful health equity action.
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Affiliation(s)
- Katrina Marie Plamondon
- University of British Columbia, 1147 Research Road, Kelowna, BC, Canada.
- Regional Practice Leader, Research & Knowledge Translation, Research Department, Interior Health, Kelowna, BC, Canada.
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Plamondon KM, Caxaj CS, Graham ID, Bottorff JL. Connecting knowledge with action for health equity: a critical interpretive synthesis of promising practices. Int J Equity Health 2019; 18:202. [PMID: 31878940 PMCID: PMC6933619 DOI: 10.1186/s12939-019-1108-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Accepted: 12/10/2019] [Indexed: 11/12/2022] Open
Abstract
Connecting knowledge with action (KWA) for health equity involves interventions that can redistribute power and resources at local, national, and global levels. Although there is ample and compelling evidence on the nature, distribution, and impact of health inequities, advancing health equity is inhibited by policy arenas shaped by colonial legacies and neoliberal ideology. Effective progress toward health equity requires attention to evidence that can promote the kind of socio-political restructuring needed to address root causes of health inequities. In this critical interpretive synthesis, results of a recent scoping review were broadened to identify evidence-informed promising practices for KWA for health equity. Following screening procedures, 10 literature reviews and 22 research studies were included in the synthesis. Analysis involved repeated readings of these 32 articles to extract descriptive data, assess clarity and quality, and identify promising practices. Four distinct kinds of promising practices for connecting KWA for health equity were identified and included: ways of structuring systems, ways of working together, and ways of doing research and ways of doing knowledge translation. Our synthesis reveals that advancing health equity requires greater awareness, dialogue, and action that aligns with the what is known about the causes of health inequities. By critically reflecting on dominant discourses and assumptions, and mobilizing political will from a more informed and transparent democratic exercise, knowledge to action for health equity can be achieved.
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Affiliation(s)
- Katrina M Plamondon
- School of Nursing, The University of British Columbia, 1147 Research Rd., ART 360, Kelowna, BC, V1V 1V7, Canada.
| | | | - Ian D Graham
- School of Epidemiology & Public Health, University of Ottawa, Ottawa, Canada
| | - Joan L Bottorff
- School of Nursing, The University of British Columbia, 1147 Research Rd., ART 360, Kelowna, BC, V1V 1V7, Canada
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Plamondon KM, Bisung E. The CCGHR Principles for Global Health Research: Centering equity in research, knowledge translation, and practice. Soc Sci Med 2019; 239:112530. [PMID: 31539786 DOI: 10.1016/j.socscimed.2019.112530] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 07/24/2019] [Accepted: 08/29/2019] [Indexed: 11/26/2022]
Abstract
Medical geography and global health share a fundamental concern for health equity. Both fields operate within similar multiple intersecting funding, academic, health systems, and development landscapes to produce scholarship. Both reflect complex interactions and partnerships between people, communities and institutions of unequal power. The Canadian Coalition of Global Health Research Principles for Global Health Research evolved from deep concern about the absence of standards for how Canadians engage in this field. They can serve as a broadly relevant framework to guide how to integrate equity considerations into everyday research, knowledge translation, and practice activities. Comprised of six principles (authentic partnering, inclusion, shared benefits, commitment to the future, responsiveness to causes of inequities, and humility), they are an aspirational and reflective frame that can elevate equity as a central procedural goal and outcome. In this commentary, we describe each of the six principles and offer examples of how they are being applied to guide research practices, inform knowledge translation science and build capacity. We invite collective reflection about moving our field toward more meaningful health equity research and action, using the CCGHR Principles for Global Health Research to spark dialogue about how to align our practices with desire for a more equitable world.
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Affiliation(s)
- Katrina M Plamondon
- Faculty of Health & Social Development, School of Nursing, University of British Columbia; and Regional Practice Leader, Research & Knowledge Translation, Interior Health, Canada.
| | - Elijah Bisung
- School of Kinesiology & Health Studies, Queens University, Canada
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Plamondon KM, Pemberton J. Blending integrated knowledge translation with global health governance: an approach for advancing action on a wicked problem. Health Res Policy Syst 2019; 17:24. [PMID: 30832660 PMCID: PMC6399857 DOI: 10.1186/s12961-019-0424-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 02/06/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The persistence of health inequities is a wicked problem for which there is strong evidence of causal roots in the maldistribution of power, resources and money within and between countries. Though the evidence is clear, the solutions are far from straightforward. Integrated knowledge translation (IKT) ought to be well suited for designing evidence-informed solutions, yet current frameworks are limited in their capacity to navigate complexity. Global health governance (GHG) also ought to be well suited to advance action, but a lack of accountability, inclusion and integration of evidence gives rise to politically driven action. Recognising a persistent struggle for meaningful action, we invite contemplation about how blending IKT with GHG could leverage the strengths of both processes to advance health equity. DISCUSSION Action on root causes of health inequities implicates disruption of structures and systems that shape how society is organised. This infinitely complex work demands sophisticated examination of drivers and disrupters of inequities and a vast imagination for who (and what) should be engaged. Yet, underlying tendencies toward reductionism seem to drive superficial responses. Where IKT models lack consideration of issues of power and provide little direction for how to support cohesive efforts toward a common goal, recent calls from the field of GHG may provide insight into these issues. Additionally, though GHG is criticised for its lack of attention to using evidence, IKT offers approaches and strategies for collaborative processes of generating and refining knowledge. Contemplating the inclusion of governance in IKT requires re-examining roles, responsibilities, power and voice in processes of connecting knowledge with action. We argue for expanding IKT models to include GHG as a means of considering the complexity of issues and opening new possibilities for evidence-informed action on wicked problems. CONCLUSION Integrated learning between these two fields, adopting principles of GHG alongside the strategies of IKT, is a promising opportunity to strengthen leadership for health equity action.
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Affiliation(s)
- Katrina Marie Plamondon
- University of British Columbia, 3333 University Way, Kelowna, BC Canada
- Interior Health, 505 Doyle Avenue, Kelowna, BC Canada
| | - Julia Pemberton
- McMaster University, 1280 Main Street West, Hamilton, ON Canada
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