1
|
Broadbent P, Walsh D, Katikireddi SV, Gallagher C, Dundas R, McCartney G. Is Austerity Responsible for the Stalled Mortality Trends Across Many High-Income Countries? A Systematic Review. INTERNATIONAL JOURNAL OF SOCIAL DETERMINANTS OF HEALTH AND HEALTH SERVICES 2024:27551938241255041. [PMID: 38767141 DOI: 10.1177/27551938241255041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
This article systematically reviews evidence evaluating whether macroeconomic austerity policies impact mortality, reviewing high-income country data compiled through systematic searches of nine databases and gray literature using pre-specified methods (PROSPERO registration: CRD42020226609). Eligible studies were quantitatively assessed to determine austerity's impact on mortality. Two reviewers independently assessed eligibility and risk of bias using ROBINS-I. Synthesis without meta-analysis was conducted due to heterogeneity. Certainty of evidence was assessed using the GRADE framework. Of 5,720 studies screened, seven were included, with harmful effects of austerity policies demonstrated in six, and no effect in one. Consistent harmful impacts of austerity were demonstrated for all-cause mortality, life expectancy, and cause-specific mortality across studies and different austerity measures. Excess mortality was higher in countries with greater exposure to austerity. Certainty of evidence was low. Risk of bias was moderate to critical. A typical austerity dose was associated with 74,090 [-40,632, 188,792] and 115,385 [26,324, 204,446] additional deaths per year. Austerity policies are consistently associated with adverse mortality outcomes, but the magnitude of this effect remains uncertain and may depend on how austerity is implemented (e.g., balance between public spending reductions or tax rises, and distributional consequences). Policymakers should be aware of potential harmful health effects of austerity policies.
Collapse
Affiliation(s)
- Philip Broadbent
- University of Glasgow MRC/CSO Social and Public Health Sciences Unit, Glasgow, UK
| | - David Walsh
- University of Glasgow School of Health and Wellbeing, Glasgow, UK
| | | | | | - Ruth Dundas
- University of Glasgow MRC/CSO Social and Public Health Sciences Unit, Glasgow, UK
| | - Gerry McCartney
- University of Glasgow College of Social Sciences, Glasgow, UK
| |
Collapse
|
2
|
Carrilero N, García-Altés A. Health inequalities in childhood diseases: temporal trends in the inter-crisis period. Int J Equity Health 2024; 23:76. [PMID: 38632575 PMCID: PMC11025183 DOI: 10.1186/s12939-024-02169-5] [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: 06/26/2023] [Accepted: 04/02/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Since 2008, children in Catalonia (Spain) have suffered a period of great economic deprivation. This situation has generated broad-ranging health inequalities in a variety of diseases. It is not known how these inequalities have changed over time. The aim of the present study is to determine trends in inequalities over this period in ten relevant diseases in children according to sex and age. METHODS A retrospective cross-sectional population-based study of all children under 15 years old resident in Catalonia during the 2014-2021 period (over 1.2 million children/year) and of their diagnoses registered by the Catalan Health System. Health inequalities were estimated by calculating the relative index of inequality and time trends using logistic regression models. Interaction terms were added to test for the effects of sex on time trends. RESULTS Increasing significant temporal trends in inequalities were shown for both sexes in almost all the diseases or adverse events studied (asthma, injuries, poisoning, congenital anomalies, overweight and obesity), in mood disorders in boys, and in adverse birth outcomes in girls. Adjustment and anxiety and mood disorders in girls showed a decreasing temporal trend in inequalities. More than half of the diseases and adverse events studied experienced significant annual increases in inequality. Poisoning stood out with an average annual increase of 8.65% [4.30, 13.00], p ≤ 0.001 in boys and 8.64% [5.76, 11.52], p ≤ 0.001) in girls, followed by obesity with increases of 5.52% [4.15, 6.90], p = < 0.001 in boys and 4.89% [4.26, 5.51], p ≤ 0.001) in girls. CONCLUSIONS Our results suggest that inequalities persist and have increased since 2014. Policy makers should turn their attention to how interventions to reduce Health inequalities are designed, and who benefits from them.
Collapse
Affiliation(s)
- Neus Carrilero
- Agència de Qualitat I Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain.
- Department of Medicine and Life Sciences (MELIS-UPF), Pompeu Fabra University, Barcelona, Spain.
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS) , Barcelona, Spain.
- Research Group on Primary and Community Care in Barcelona (APICBA), Hospital del Mar Research Institute, Barcelona, Spain.
- Network for Research On Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain.
| | - Anna García-Altés
- Agència de Qualitat I Avaluació Sanitàries de Catalunya (AQuAS), Barcelona, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
- Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| |
Collapse
|
3
|
Novillo-Del-Álamo B, Martínez-Varea A, Nieto-Tous M, Morales-Roselló J. Deprived areas and adverse perinatal outcome: a systematic review. Arch Gynecol Obstet 2024; 309:1205-1218. [PMID: 38063892 DOI: 10.1007/s00404-023-07300-5] [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: 05/11/2023] [Accepted: 11/10/2023] [Indexed: 02/25/2024]
Abstract
PURPOSE This systematic review aimed to assess if women living in deprived areas have worse perinatal outcomes than those residing in high-income areas. METHODS Datasets of PubMed, ScienceDirect, CENTRAL, Embase, and Google Scholar were searched for studies comparing perinatal outcomes (preterm birth, small-for-gestational age, and stillbirth) in deprived and non-deprive areas. RESULTS A total of 46 studies were included. The systematic review of the literature revealed a higher risk for adverse perinatal outcomes such as preterm birth, small for gestational age, and stillbirth in deprived areas. CONCLUSION Deprived areas are associated with adverse perinatal outcomes. More multifactorial studies are needed to assess the weight of each factor that composes the socioeconomic gradient of health in adverse perinatal outcomes.
Collapse
Affiliation(s)
- Blanca Novillo-Del-Álamo
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - Alicia Martínez-Varea
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain.
| | - Mar Nieto-Tous
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
| | - José Morales-Roselló
- Department of Obstetrics and Gynaecology, La Fe University and Polytechnic Hospital, Avenida Fernando Abril Martorell 106, 46026, Valencia, Spain
| |
Collapse
|
4
|
Pickett KE, Wilkinson RG. The health costs of political failure. BMJ 2024; 384:q379. [PMID: 38350693 DOI: 10.1136/bmj.q379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
|
5
|
Barnish MS, Tan SY, Robinson S, Taeihagh A, Melendez-Torres GJ. A realist synthesis to develop an explanatory model of how policy instruments impact child and maternal health outcomes. Soc Sci Med 2023; 339:116402. [PMID: 38000341 DOI: 10.1016/j.socscimed.2023.116402] [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: 01/26/2023] [Revised: 10/23/2023] [Accepted: 11/06/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Child and maternal health, a key marker of overall health system performance, is a policy priority area by the World Health Organization and the United Nations, including the Sustainable Development Goals. Previous realist work has linked child and maternal health outcomes to globalization, political tradition, and the welfare state. It is important to explore the role of other key policy-related factors. This paper presents a realist synthesis, categorising policy instruments according to the established NATO model, to develop an explanatory model of how policy instruments impact child and maternal health outcomes. METHODS A systematic literature search was conducted to identify studies assessing the relationships between policy instruments and child and maternal health outcomes. Data were analysed using a realist framework. The first stage of the realist analysis process was to generate micro-theoretical initial programme theories for use in the theory adjudication process. Proposed theories were then adjudicated iteratively to produce a set of final programme theories. FINDINGS From a total of 43,415 unique records, 632 records proceeded to full-text screening and 138 papers were included in the review. Evidence from 132 studies was available to address this research question. Studies were published from 1995 to 2021; 76% assessed a single country, and 81% analysed data at the ecological level. Eighty-eight initial candidate programme theories were generated. Following theory adjudication, five final programme theories were supported. According to the NATO model, these were related to treasure, organisation, authority-treasure, and treasure-organisation instrument types. CONCLUSIONS This paper presents a realist synthesis to develop an explanatory model of how policy instruments impact child and maternal health outcomes from a large, systematically identified international body of evidence. Five final programme theories were supported, showing how policy instruments play an important yet context-dependent role in influencing child and maternal health outcomes.
Collapse
Affiliation(s)
- Maxwell S Barnish
- Peninsula Technology Assessment Group (PenTAG), Department of Public Health and Sport Sciences, University of Exeter Medical School, United Kingdom.
| | - Si Ying Tan
- Alexandra Research Centre for Healthcare in the Virtual Environment (ARCHIVE), Alexandra Hospital, National University Health System, Singapore
| | - Sophie Robinson
- Peninsula Technology Assessment Group (PenTAG), Department of Public Health and Sport Sciences, University of Exeter Medical School, United Kingdom
| | - Araz Taeihagh
- Lee Kuan Yew School of Public Policy, National University of Singapore, Singapore
| | - G J Melendez-Torres
- Peninsula Technology Assessment Group (PenTAG), Department of Public Health and Sport Sciences, University of Exeter Medical School, United Kingdom
| |
Collapse
|
6
|
Doetsch JN, Almendra R, Severo M, Leão T, Teixeira R, Marques S, Pilot E, Krafft T, Barros H. The influence of the Great Recession on perinatal health-an ecological study on the trend changes and regional differences in Portugal. THE LANCET REGIONAL HEALTH. EUROPE 2023; 34:100735. [PMID: 37927436 PMCID: PMC10625015 DOI: 10.1016/j.lanepe.2023.100735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 11/07/2023]
Abstract
Background Few studies examine the relationship between socioeconomic factors and trends in mortality in high-income European countries. Due to the lack of regional-level data, most recent studies on social inequality in Portugal do not investigate regional differences. This study analyses time trends and regional disparities in the evolution of perinatal mortality (PMR) and infant mortality (IMR) associated with demographic and socioeconomic indicators following Portugal's 2008 economic and financial crisis. Methods Associations were assessed using generalised linear models. A Poisson joinpoint regression model was applied to identify relevant PMR and IMR changes between 2000 and 2018. Country regional disparities were analysed using Mixed Effect Multilevel models. Findings IMR and PMR significantly decreased in the pre-crisis period but not in the post-crisis period. The significant differences between regions in IMR and PMR in 2000 were followed by a different evolution of regional IMR after 2008. PMR and IMR were not significantly associated with socioeconomic indicators. A significant positive association with maternal age at first birth was identified. Interpretation Results confirm the influence of the crisis on PMR and IMR trends in Portugal, taking into account recurring associations between macroeconomic cycles, variations in mortality trends, macroeconomic volatility, and stagnation of IMR and PMR. Regional inequalities confirm the internal variability of the crisis influence and persistent spatial inequalities affecting IMR patterns. Funding FCT, under the Institute of Public Health of the University of Porto (ISPUP)-EPIUnit (UIDB/04750/2020) and ITR (LA/P/0064/2020), Maastricht University's external PhD programme under the Care and Public Health Research Institute (CAPHRI), and the RECAP preterm project (grant agreement no 733280).
Collapse
Affiliation(s)
- Julia Nadine Doetsch
- EPIUnit – Instituto de Saúde Pública da Universidade do Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Ricardo Almendra
- Department of Geography and Tourism, CEGOT-Centre of Studies on Geography and Spatial Planning, University of Coimbra, Portugal
| | - Milton Severo
- EPIUnit – Instituto de Saúde Pública da Universidade do Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Portugal
| | - Teresa Leão
- EPIUnit – Instituto de Saúde Pública da Universidade do Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Faculdade de Medicina, Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Universidade do Porto (FMUP), Porto, Portugal
| | - Raquel Teixeira
- EPIUnit – Instituto de Saúde Pública da Universidade do Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - Sandra Marques
- EPIUnit – Instituto de Saúde Pública da Universidade do Porto, Portugal
- ICNOVA, FCSH, Universidade Nova de Lisboa, Portugal
| | - Eva Pilot
- Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Thomas Krafft
- Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute, Maastricht University, Maastricht, the Netherlands
| | - Henrique Barros
- EPIUnit – Instituto de Saúde Pública da Universidade do Porto, Portugal
- Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
- Faculdade de Medicina, Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Universidade do Porto (FMUP), Porto, Portugal
| |
Collapse
|
7
|
Doetsch JN, Almendra R, Severo M, Leão T, Pilot E, Krafft T, Barros H. 2008 economic crisis impact on perinatal and infant mortality in Southern European countries. J Epidemiol Community Health 2023; 77:305-314. [PMID: 36813545 DOI: 10.1136/jech-2022-219639] [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: 08/02/2022] [Accepted: 02/05/2023] [Indexed: 02/24/2023]
Abstract
INTRODUCTION The study of crisis events provides important lessons to prepare for upcoming events. The Great Recession's impact on perinatal health in Europe can provide relevant insights into the healthcare and social protection systems' response to the protection of the health of the most vulnerable groups. OBJECTIVE To assess time trends and international disparities in perinatal mortality rates (PMR) and infant mortality rates (IMR), following the Great Recession, and their association with socioeconomic indicators in Portugal, Greece, Italy and Spain. METHODS Associations were assessed through generalised linear models for all four countries. A Poisson joinpoint regression model was applied to explore PMR and IMR trend changes between 2000 and 2018. Country disparities were analysed using mixed-effects multilevel models. RESULTS IMR and PMR have decreased overall in the four selected countries between 2000 and 2018. Still, whereas in Spain, Italy and Portugal the decreasing pace was attenuated after 2009, in Greece a positive trend was found after the 2008 crisis. IMR and PMR were significantly associated with socioeconomic indicators in all four countries. National disparities in the evolution of IMR and PMR were significantly associated with most socioeconomic indicators between 2000 and 2018. CONCLUSION Our results confirm the impact of the Great Recession on PMR and IMR trends in all four countries, taking recurring associations between macroeconomic cycles, variations in mortality trends, macroeconomic volatility and stagnation of IMR and PMR into account. The association with socioeconomic indicators stresses the need to strengthen social protection and healthcare systems to better protect the population's health from the earliest days.
Collapse
Affiliation(s)
- Julia Nadine Doetsch
- Unidade de Investigação em Epidemiologia (EPIUnit), Instituto de Saúde Pública da Universidade do Porto (ISPUP), Porto, Portugal .,Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University, Maastricht, Netherlands.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal
| | - Ricardo Almendra
- CEGOT-Centre of Studies on Geography and Spatial Planning, Department of Geography and Tourism, University of Coimbra, Coimbra, Portugal
| | - Milton Severo
- Unidade de Investigação em Epidemiologia (EPIUnit), Instituto de Saúde Pública da Universidade do Porto (ISPUP), Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal.,Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Porto, Portugal
| | - Teresa Leão
- Unidade de Investigação em Epidemiologia (EPIUnit), Instituto de Saúde Pública da Universidade do Porto (ISPUP), Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal.,Predictive Medicine and Public Health Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto (FMUP), Porto, Portugal
| | - Eva Pilot
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University (UM), Maastricht, Netherlands
| | - Thomas Krafft
- Department of Health, Ethics and Society, Faculty of Health, Medicine and Life Sciences (FHML), Maastricht University (UM), Maastricht, Netherlands
| | - Henrique Barros
- Unidade de Investigação em Epidemiologia (EPIUnit), Instituto de Saúde Pública da Universidade do Porto (ISPUP), Porto, Portugal.,Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Universidade do Porto, Porto, Portugal.,Predictive Medicine and Public Health Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto (FMUP), Porto, Portugal
| |
Collapse
|
8
|
Lee AR, Kingdon CC, Davie M, Hawcutt D, Sinha IP. Child poverty and health inequalities in the UK: a guide for paediatricians. Arch Dis Child 2023; 108:94-101. [PMID: 35680401 DOI: 10.1136/archdischild-2021-323671] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 05/12/2022] [Indexed: 01/24/2023]
Abstract
One in three children in the UK lives in relative poverty. There are clear and consistent links between child poverty and paediatric morbidity and mortality. In this review, we discuss drivers for family poverty in the UK, and how this leads to poor child health outcomes. We present a framework for healthcare professionals and institutions to consider interventions and strategies relating to socioeconomic health inequalities. We will focus on approaches to mitigate the effects of child poverty on children using our services at a local level and outline the importance of healthcare workers advocating for structural and high-level policy change to address the deep-rooted societal problems that cause child poverty.
Collapse
Affiliation(s)
- Alice R Lee
- Lab to Life Child Health Applied Data Centre, Department of Innovation, Alder Hey Children's NHS Foundation Trust, Liverpool, UK.,University of Liverpool, Liverpool, UK
| | | | - Max Davie
- Community Paediatrics, Mary Sheridan Centre, Evelina London Children's Hospital, London, UK
| | - Daniel Hawcutt
- National Institute for Health Research, Alder Hey Clinical Research Facility, Alder Hey Children's Hospital, Liverpool, UK.,Department of Women's and Children's Health, University of Liverpool, Liverpool, UK
| | - Ian P Sinha
- Lab to Life Child Health Applied Data Centre, Department of Innovation, Alder Hey Children's NHS Foundation Trust, Liverpool, UK .,University of Liverpool, Liverpool, UK
| |
Collapse
|
9
|
Doetsch JN, Schlösser C, Barros H, Shaw D, Krafft T, Pilot E. A scoping review on the impact of austerity on healthcare access in the European Union: rethinking austerity for the most vulnerable. Int J Equity Health 2023; 22:3. [PMID: 36604705 PMCID: PMC9815671 DOI: 10.1186/s12939-022-01806-1] [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: 07/30/2022] [Accepted: 12/13/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND There is consensus that the 2008 financial and economic crisis and related austerity measures adversely impacted access to healthcare. In light of the growing debt caused by the COVID-19 crisis, it is uncertain whether a period of austerity will return. OBJECTIVE This study aims to provide a structured overview of the impact of austerity policies in the EU-28 zone, applied in response to the Great Recession, on access to health care for the adult population, using the five access dimensions by Levesque et al. (2013). METHODS This study followed the PRISMA extension for Scoping Reviews guideline. Medline (PubMed) and Web of Science were searched between February 2021 and June 2021. Primary studies in the English language published after the 1st of January 2008 reporting on the possible change in access to the healthcare system for the adult population induced by austerity in an EU28 country were included. RESULTS The final search strategy resulted in 525 articles, of which 75 studies were reviewed for full-text analysis, and a total of 21 studies were included. Results revealed that austerity policy has been primarily associated with a reduction in access to healthcare, described through four main categories: i) Increase in rates of reported unmet needs (86%); ii) Affordability (38%); iii) Appropriateness (38%); iv) and Availability and Accommodation (19%). Vulnerable populations were more affected by austerity measures than the general population when specific safeguards were not in place. The main affected adult vulnerable population groups were: patients with chronic diseases, elderly people, (undocumented) migrants, unemployed, economically inactive people and individuals with lower levels of education or socioeconomic status. CONCLUSION Austerity measures have led to a deterioration in access to healthcare in the vast majority of the countries studied in the EU-28 zone. Findings should prompt policymakers to rethink the fiscal agenda across all policies in times of economic crisis and focus on the needs of the most vulnerable populations from the health perspective.
Collapse
Affiliation(s)
- Julia Nadine Doetsch
- grid.5808.50000 0001 1503 7226EPIUnit – Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal ,grid.5808.50000 0001 1503 7226Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal ,grid.5012.60000 0001 0481 6099Department of Health, Ethics & Society, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Clara Schlösser
- grid.5012.60000 0001 0481 6099Department of Health, Ethics & Society, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Henrique Barros
- grid.5808.50000 0001 1503 7226EPIUnit – Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal ,grid.5808.50000 0001 1503 7226Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal ,grid.5808.50000 0001 1503 7226Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina, Universidade do Porto (FMUP), Porto, Portugal
| | - David Shaw
- grid.5012.60000 0001 0481 6099Department of Health, Ethics & Society, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands ,grid.6612.30000 0004 1937 0642Institute for Biomedical Ethics, University of Basel, Basel, Switzerland
| | - Thomas Krafft
- grid.5012.60000 0001 0481 6099Department of Health, Ethics & Society, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| | - Eva Pilot
- grid.5012.60000 0001 0481 6099Department of Health, Ethics & Society, Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands
| |
Collapse
|
10
|
Singh G, Uthayakumar-Cumarasamy A. Cost of living crisis: a UK crisis with global implications - A call to action for paediatricians. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001631. [PMID: 36645799 PMCID: PMC9685256 DOI: 10.1136/bmjpo-2022-001631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 11/04/2022] [Indexed: 11/23/2022] Open
Abstract
The UK's 'cost of living crisis' (COLC) has thrown millions of families into poverty in 2022, delivering an intensifying economic shock that will likely eclipse the financial impact of the global coronavirus pandemic for children, families and communities alike. But what is the relevance for paediatricians? Written by doctors who spend considerable time confronting social problems from clinical, public health and advocacy perspectives, this article aims to untangle the COLC for those working in child health and seeks to stimulate a meaningful conversation about how we might reimagine paediatrics for life in the 21st century.Taking the current crisis as our point of departure, we argue that the UK's COLC can be best understood as a 'crisis of inequality', which has been created through social, economic and political processes that were not inevitable. The health impacts, then, are a matter of health equity and social justice. While the acuity of the crisis unfolding in the UK garners much attention, the implications are global with lessons for paediatricians everywhere. We propose that using a 'social lens' for understanding the true 'causes of the causes' of complex challenges such as COLC is essential for the 21st century paediatrician, as the consequences for child health is deep, wide-ranging and long-lasting. However, the current gap in knowledge, skills and infrastructure in this area leads to disempowerment in the profession.We end with this provocation: What, after all, does it mean to be a paediatrician in a time of economic crisis? We offer thoughts about how paediatrics might respond to social challenges, such as the COLC, acknowledging that organised and concerted action must be taken both inside and outside of health systems if we are to help bring about the changes that our patients and their surrounding communities urgently need.
Collapse
Affiliation(s)
- Guddi Singh
- Centre for Public Policy Research (CPPR), King's College London, London, UK
| | | |
Collapse
|
11
|
Al-shehri H, Dahmash DT, Rochow N, Alturki B, Alrajhi D, Alayed F, Alhazani F, Alsuhibany H, Naser AY. Hospital Admission Profile of Neonates for Conditions Originating in the Perinatal Period in England and Wales Between 1999‒2020: An Ecological Study. Int J Gen Med 2022. [DOI: 10.2147/ijgm.s354847] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
|
12
|
Carrilero N, Dalmau-Bueno A, García-Altés A. Socioeconomic inequalities in 29 childhood diseases: evidence from a 1,500,000 children population retrospective study. BMC Public Health 2021; 21:1150. [PMID: 34130683 PMCID: PMC8205646 DOI: 10.1186/s12889-021-11230-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/07/2021] [Indexed: 11/23/2022] Open
Abstract
Background Socioeconomic position (SEP) powerfully affects health status in the childhood population. However, the knowledge of which diseases are more affected by SEP and whose outcomes could be improved by having a more equitable society remains uncertain on a population basis. Methods We measured socioeconomic and gender inequalities in the pre-COVID-19 era for 29 diseases in the entire childhood population in Catalonia to identify which diseases are most impacted by inequalities. This population-based study included 1,449,816 children under 15 years old from 2014 to 2017 (48.52% girls) and each of their registered diagnoses within the Catalonia National Health System. We calculated frequency measures by SEP and their sex ratios for each disease. We estimated four regression-based inequality measures: slope index of inequality, relative index of inequality (RII), absolute population-attributable fraction, and population-attributable fraction. Results Twenty-five of the 29 diseases examined showed SEP inequalities. The diseases with the greatest inequalities in both sexes were tuberculosis, obesity, adjustment and anxiety disorders, essential hypertension, poisoning, short gestation, low birth weight, foetal growth retardation and intrauterine hypoxia and birth asphyxia and trauma (RII ≥ 2.0); only food allergy showed the opposite pattern (RII < 1.0). Overall, 80,188 (7.80%) of the disease events in boys and 74,921 (8.88%) in girls would be avoided if all children had the same disease rate as those in the medium-high SEP group, with tuberculosis, intrauterine hypoxia and birth asphyxia and trauma, obesity, and short gestation, low birth weight, foetal growth retardation being those that could be reduced the most in relative terms, and dermatitis, injuries, acute bronquitis, and being overweight those that could be reduced the most in absolute terms. Girls present higher RII than boys for respiratory allergy, asthma, dermatitis, being overweight, and obesity (p < 0.05). In contrast, boys showed higher RII compared to girls only in congenital anomalies (p < 0.05). Conclusions Socioeconomic and gender inequalities are widely present in childhood health. This indicates that SEP plays a common role in their development although it varies in magnitude according to each disease. It is also a phenomenon that comprises all SEP groups in society. Action needs to be taken to ensure a fairer start in life in terms of health. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11230-9.
Collapse
Affiliation(s)
- Neus Carrilero
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Carrer de Roc Boronat, 81-95, 08005, Barcelona, Spain. .,Universitat Pompeu Fabra. Department of Experimental and Health Sciences (DCEXS), Barcelona, Spain. .,Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
| | - Albert Dalmau-Bueno
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Carrer de Roc Boronat, 81-95, 08005, Barcelona, Spain
| | - Anna García-Altés
- Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Carrer de Roc Boronat, 81-95, 08005, Barcelona, Spain.,CIBER de Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| |
Collapse
|
13
|
Erasun D, Alonso-Molero J, Gómez-Acebo I, Dierssen-Sotos T, Llorca J, Schneider J. Low birth weight trends in Organisation for Economic Co-operation and Development countries, 2000-2015: economic, health system and demographic conditionings. BMC Pregnancy Childbirth 2021; 21:13. [PMID: 33407233 PMCID: PMC7789240 DOI: 10.1186/s12884-020-03484-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/08/2020] [Indexed: 03/11/2023] Open
Abstract
Background Low birth weight rates are increasing in both developed and developing countries. Although several maternal factors have been identified as associated with low birth weight, little is known of economic or organization factors influencing this increase. This study aims to ascertain the twenty-first century relationships between the contextual country factors and low birth weight rates. Methods We analyse trends of low birth weight rates in Organisation for Economic Co-operation and Development (OECD) countries. Data from 2000 to 2015 were obtained from the OECD data base. Their relationships with demographic and economic variables, health habits, woman-related preventive measures, health care system organization and funding, health care work force and obstetric care were analysed using random-effects linear regression. Results Low birth weight rates are higher in Southern Europe (7.61%) and lower in Northern Europe (4.68%). Low birth weight rates escalated about 20% in Southern Europe and to less extent in Easter Europe (7%) and Asian/Oceanian countries, while remained stable in America, Central Europe and Northern Europe. Investment in health care, private health system coverage, ratios of paediatricians and obstetricians, average length of admission due to pregnancy or birth and Caesarean section rate were associated with higher low birth weight rates. Factors associated with lower low birth weight rates were health care coverage, public health system coverage, hospitals per million inhabitants, and ratios of health care workers, physicians, midwives and nurses. Conclusions In OECD countries, LBW rates are related to contextual country characteristics such as GDP per capita, which is inversely related to LBW rate. Health care system factors, including health care coverage or investment in public health system, are directly associated with lower LBW rates. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-020-03484-9.
Collapse
Affiliation(s)
- Diego Erasun
- University Hospital Marqués de Valdecilla, Santander, Spain
| | - Jéssica Alonso-Molero
- Department of Preventive Medicine and Public Health, University of Cantabria, Avda. Herrera Oria s/n, 39011, Santander, Spain. .,IDIVAL, Santander, Spain. .,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.
| | - Inés Gómez-Acebo
- Department of Preventive Medicine and Public Health, University of Cantabria, Avda. Herrera Oria s/n, 39011, Santander, Spain.,IDIVAL, Santander, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Trinidad Dierssen-Sotos
- Department of Preventive Medicine and Public Health, University of Cantabria, Avda. Herrera Oria s/n, 39011, Santander, Spain.,IDIVAL, Santander, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Javier Llorca
- Department of Preventive Medicine and Public Health, University of Cantabria, Avda. Herrera Oria s/n, 39011, Santander, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | | |
Collapse
|
14
|
Varbanova V, Beutels P. Recent quantitative research on determinants of health in high income countries: A scoping review. PLoS One 2020; 15:e0239031. [PMID: 32941493 PMCID: PMC7498048 DOI: 10.1371/journal.pone.0239031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 08/28/2020] [Indexed: 01/21/2023] Open
Abstract
Background Identifying determinants of health and understanding their role in health production constitutes an important research theme. We aimed to document the state of recent multi-country research on this theme in the literature. Methods We followed the PRISMA-ScR guidelines to systematically identify, triage and review literature (January 2013—July 2019). We searched for studies that performed cross-national statistical analyses aiming to evaluate the impact of one or more aggregate level determinants on one or more general population health outcomes in high-income countries. To assess in which combinations and to what extent individual (or thematically linked) determinants had been studied together, we performed multidimensional scaling and cluster analysis. Results Sixty studies were selected, out of an original yield of 3686. Life-expectancy and overall mortality were the most widely used population health indicators, while determinants came from the areas of healthcare, culture, politics, socio-economics, environment, labor, fertility, demographics, life-style, and psychology. The family of regression models was the predominant statistical approach. Results from our multidimensional scaling showed that a relatively tight core of determinants have received much attention, as main covariates of interest or controls, whereas the majority of other determinants were studied in very limited contexts. We consider findings from these studies regarding the importance of any given health determinant inconclusive at present. Across a multitude of model specifications, different country samples, and varying time periods, effects fluctuated between statistically significant and not significant, and between beneficial and detrimental to health. Conclusions We conclude that efforts to understand the underlying mechanisms of population health are far from settled, and the present state of research on the topic leaves much to be desired. It is essential that future research considers multiple factors simultaneously and takes advantage of more sophisticated methodology with regards to quantifying health as well as analyzing determinants’ influence.
Collapse
Affiliation(s)
- Vladimira Varbanova
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
- * E-mail:
| | - Philippe Beutels
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| |
Collapse
|
15
|
Economic Crisis Impact and Social Determinants of Perinatal Outcomes and Infant Mortality in Greece. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186606. [PMID: 32932859 PMCID: PMC7557366 DOI: 10.3390/ijerph17186606] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 09/06/2020] [Accepted: 09/08/2020] [Indexed: 11/16/2022]
Abstract
(1) Background: To explore the effects of the 2008 economic crisis on maternal, perinatal and infant mortality in Greece and the socio-economic determinants associated with them; (2) Methods: The annual rates of stillbirth (SBR), perinatal mortality (PMR), infant mortality (IMR), neonatal mortality (NNMR), post-neonatal mortality (PNMR), low birth weight (LBW), and maternal mortality (MMR) were calculated for the years 2000–2016. Average Annual Percent Changes (AAPC) were calculated by the period before and after 2008. The expected rates of 2009–2016 and the observed-to-expected rate ratios (RR) were calculated. Correlation and multiple linear regression analyses were used to test the impact of socio-economic variables on health outcomes; (3) Results: A reverse in downwards trends of PNM, IMR, and NNMR is observed since 2009. All observed values of 2009–2016 were found significantly higher than the expected ones by 12–34%. All indicators except SBR were found negatively correlated with GDP and DHI. A positive correlation was found between IMR, NNMR, and LBW and long-term unemployment, and no association with public health expenditure; (4) Conclusions: Economic crisis was associated with remarkable adverse effects on perinatal outcomes and infant mortality, mainly determined by long-term unemployment and income reduction. The findings stress a need for interventions to protect maternity and child health during crises.
Collapse
|
16
|
Rajmil L, Hjern A, Spencer N, Taylor-Robinson D, Gunnlaugsson G, Raat H. Austerity policy and child health in European countries: a systematic literature review. BMC Public Health 2020; 20:564. [PMID: 32423441 PMCID: PMC7236143 DOI: 10.1186/s12889-020-08732-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 04/19/2020] [Indexed: 01/17/2023] Open
Abstract
Background To analyse the impact of austerity measures taken by European governments as a response to the 2008 economic and financial crisis on social determinants on child health (SDCH), and child health outcomes (CHO). Methods A systematic literature review was carried out in Medline (Ovid), Embase, Web of Science, PsycInfo, and Sociological abstracts in the last 5 years from European countries. Studies aimed at analysing the Great Recession, governments’ responses to the crisis, and its impact on SDCH were included. A narrative synthesis of the results was carried out. The risk of bias was assessed using the STROBE and EPICURE tools. Results Fourteen studies were included, most of them with a low to intermediate risk of bias (average score 72.1%). Government responses to the crisis varied, although there was general agreement that Greece, Spain, Ireland and the United Kingdom applied higher levels of austerity. High austerity periods, compared to pre-austerity periods were associated with increased material deprivation, child poverty rates, and low birth weight. Increasing child poverty subsequent to austerity measures was associated with deterioration of child health. High austerity was also related to poorer access and quality of services provided to disabled children. An annual reduction of 1% on public health expenditure was associated to 0.5% reduction on Measles-Mumps-Rubella vaccination coverage in Italy. Conclusions Countries that applied high level of austerity showed worse trends on SDCH and CHO, demonstrating the importance that economic policy may have for equity in child health and development. European governments must act urgently and reverse these austerity policy measures that are detrimental to family benefits and child protection.
Collapse
Affiliation(s)
- Luis Rajmil
- Retired, paediatrician and public health and epidemiology specialist, Homer 22 1rst 1, Barcelona, Spain
| | - Anders Hjern
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institutet, SE-106 91, Stockholm, Sweden.
| | - Nick Spencer
- Emeritus Professor of Child Health, Division of Mental Health and Wellbeing, Warwick Medical School University of Warwick, Coventry, CV4 9JD, UK
| | - David Taylor-Robinson
- Clinical Senior Lecturer, Department of Public Health and Policy, Whelan Building University of Liverpool, Liverpool, UK
| | - Geir Gunnlaugsson
- Faculty of Sociology, Anthropology and Folkloristics, University of Iceland, Reykjavik, Iceland
| | - Hein Raat
- Department of Public Health, Erasmus Medical Center, University Medical Center, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| |
Collapse
|
17
|
Tendencia de la mortalidad por edad y sexo en España (1981-2016). Cambios asociados a la crisis económica. GACETA SANITARIA 2020; 34:230-237. [DOI: 10.1016/j.gaceta.2019.03.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Revised: 03/07/2019] [Accepted: 03/14/2019] [Indexed: 11/23/2022]
|
18
|
Terán JM, Juárez S, Bernis C, Bogin B, Varea C. Low birthweight prevalence among Spanish women during the economic crisis: differences by parity. Ann Hum Biol 2020; 47:304-308. [PMID: 32156158 DOI: 10.1080/03014460.2020.1727010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Previous studies have demonstrated a negative, significant impact on birthweight associated with the current economic crisis in Spain, which has also been reported for other European countries. Effects by parity are not known. Our aim is to compare the trends in low birthweight (LBW) by parity in Spain from 1996 to 2016. Using the National Vital Statistics data, joinpoint regression analysis was used to identify the time periods of significant changes in the prevalence of LBW by parity. Adjusted relative risk (RR) of LBW by year of birth was calculated in order to confirm that the time trend differences in LBW by parity were independent of possible confounders. The prevalence of LBW among live births to primiparous increased from 5.12% to 6.87% in 2008 and then stabilised at maximum values, while among live births to multiparous LBW increased from 3.96% to a maximum of 5.20% and then significantly reduced. Trends in adjusted RR of LBW by parity confirm that primiparous and multiparous were affected differently by the economic crisis. Older, nulliparous women may have felt more biosocial pressure to reproduce during the economic crisis, compared to women who were already mothers. This biosocial pressure may have increased the risks for LBW.
Collapse
Affiliation(s)
- José Manuel Terán
- Department of Biology, Faculty of Sciences, Autonomous University of Madrid, Madrid, Spain
| | - Sol Juárez
- Centre for Health Equity Studies (CHESS), Stockholm University/Karolinska Institute, Stockholm, Sweden
| | - Cristina Bernis
- Department of Biology, Faculty of Sciences, Autonomous University of Madrid, Madrid, Spain
| | - Barry Bogin
- School of Sports, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Carlos Varea
- Department of Biology, Faculty of Sciences, Autonomous University of Madrid, Madrid, Spain
| |
Collapse
|
19
|
Sdona E, Briana DD, Malamitsi‐Puchner A. Impact of economic crises on offspring health and the developmental origins of health and disease concept. Acta Paediatr 2020; 109:453-459. [PMID: 31563144 DOI: 10.1111/apa.15040] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 09/16/2019] [Accepted: 09/27/2019] [Indexed: 01/14/2023]
Abstract
There is emerging evidence that economic crises may impact long-term health. Furthermore, adversity experienced by women and their offspring might be transmitted to next generations. The Developmental Origins of Health and Disease (DOHaD) approach emphasises the importance of early life events for the state of health and risk for disease later in life. In this review, we discuss current evidence on the possible impact of economic crises on offspring health through the DOHaD framework and highlight the importance of critical periods of development for future disease risk. Therefore, successful interventions should prioritise strategies that address early life risk factors.
Collapse
Affiliation(s)
- Emmanouela Sdona
- Medical School National and Kapodistrian University of Athens Athens Greece
- Unit of Environmental Epidemiology Institute of Environmental Medicine Karolinska Institute Stockholm Sweden
| | - Despina D. Briana
- Medical School National and Kapodistrian University of Athens Athens Greece
| | | |
Collapse
|
20
|
Malamitsi‐Puchner A, Briana DD. Economic stress and child health-the Greece experience. Acta Paediatr 2019; 108:1740-1741. [PMID: 31378006 DOI: 10.1111/apa.14917] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
| | - Despina D. Briana
- Medical School National and Kapodistrian University of Athens Athens Greece
| |
Collapse
|
21
|
Affiliation(s)
- Lucinda Hiam
- London School of Hygiene and Tropical Medicine, London, UK
| | | |
Collapse
|