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Ning C, Pei H, Huang Y, Li S, Shao Y. Does the Healthy China 2030 Policy Improve People's Health? Empirical Evidence Based on the Difference-in-Differences Approach. Risk Manag Healthc Policy 2024; 17:65-77. [PMID: 38204928 PMCID: PMC10778192 DOI: 10.2147/rmhp.s439581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
Background The Healthy China 2030 (HC2030) policy is currently recognized as China's most significant and influential national health policy. However, despite its implementation in 2016, the policy's impact has yet to be comprehensively evaluated, particularly in relation to its effectiveness in enhancing population health and promoting public health equity. Methods We utilized the Difference-in-Differences (DiD) method to evaluate the impact of the HC2030. Our analysis utilized a panel dataset derived from five longitudinal surveys conducted by the China Family Panel Studies (CFPS). Results The implementation of HC2030 has improved the overall health status of residents, particularly in urban areas and the western and eastern regions. Mechanistic analysis has further unveiled that the policy's beneficial impact on health outcomes is attributed to a rise in physical activity frequency and the betterment of mental health. Additionally, female, married, and medically insured individuals have demonstrated a significant positive impact of the policy on their health outcomes. Conclusion Although the HC2030 appears to have effectively improved overall population health, it needs to promote equity in public health adequately. The study suggests adjustments are needed to address the unequal distribution of health outcomes between urban and rural areas and among different regions.
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Affiliation(s)
- Chuanlin Ning
- School of Media and Communication, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Huacheng Pei
- School of Finance, Shanghai University of Finance and Economics, Shanghai, People’s Republic of China
| | - Youjia Huang
- School of Media and Communication, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Sichen Li
- School of Media and Communication, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
| | - Yiling Shao
- School of Media and Communication, Shanghai Jiao Tong University, Shanghai, People’s Republic of China
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Dunn JR, Halapy E, Moineddin R, Young M. Short-term impact of a neighbourhood-based intervention on mental health and self-rated health in Hamilton, Ontario, Canada. Health Place 2023; 83:103052. [PMID: 37459666 DOI: 10.1016/j.healthplace.2023.103052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 09/24/2023]
Abstract
The Hamilton Neighbourhoods Study aimed to measure the short-term impact of a neighbourhood-based intervention known as the City of Hamilton's Neighbourhood Action Strategy on health and neighbourhood outcomes. A quasi-experimental study with 881 intervention participants across six targeted neighbourhoods and 173 control participants was conducted to investigate changes in self-rated health and mental health from baseline to follow-up. There was evidence of small improvements in mental health in two neighbourhoods, but there was no change in self-rated health. Place-based interventions aimed at high poverty neighbourhoods may have only modest impacts on health in the short-term.
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Affiliation(s)
- James R Dunn
- Department of Health, Aging & Society, McMaster University, Canada; MAP Centre for Urban Health Solutions, St. Michael's Hospital, Canada.
| | - Erika Halapy
- Department of Health, Aging & Society, McMaster University, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Canada
| | - Marisa Young
- Department of Sociology, McMaster University, Canada
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Valdebenito R, Angelini F, Schmitt C, Baeza F, Cortinez-O'Ryan A, González F, Vives-Vergara A. [Developing tools to study the health impact of urban transformations in high vulnerability contexts: the RUCAS study]. CAD SAUDE PUBLICA 2023; 39:e00148322. [PMID: 37132718 DOI: 10.1590/0102-311xes148322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 03/02/2023] [Indexed: 05/04/2023] Open
Abstract
This article describes the design and characteristics of a questionnaire and an intradomiciliary observation tool developed to assess the housing-neighborhood-health relationship both cross-sectionally and longitudinally in the context of urban transformations carried out in populations of high socio-territorial vulnerability. The instruments were developed for the multi-method longitudinal study RUCAS (Urban Regeneration, Quality of Life and Health), a natural experiment aiming to assess the quality of life and health impact of a comprehensive Urban Regeneration Program in two social housing complexes in Chile. The design of the instruments followed four main stages: (1) narrative review of the literature to define the dimensions of the study, and of existing measurement instruments to identify appropriate items for measuring them; (2) content validation with experts; (3) pre-test; and (4) pilot study. The resulting questionnaire, composed of 262 items, considers the different stages of the life course and gender issues. The intradomiciliary observation tool (77 items) is applied by the interviewer. The instruments assess (i) characteristics of the current residential situation that are known to affect health and will be intervened by the program; (ii) dimensions of health potentially affected by the residential situation and/or by the intervention within the time frame of the study (4 years); (iii) other health and health-related conditions that are relevant, even if changes will not be modified within the time frame of the study; and (iv) relevant socioeconomic, occupational and demographic dimensions. The instruments have shown to be capable of addressing the multidimensionality of urban transformation processes in contexts of urban poverty in formal housing.
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Affiliation(s)
- Roxana Valdebenito
- Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Flavia Angelini
- Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Cristian Schmitt
- Escuela de Arquitectura, Pontificia Universidad Católica de Chile, Santiago, Chile
- Instituto de Geografía, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Fernando Baeza
- Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile
- Departamento de Educación Física, Deportes y Recreación, Universidad de la Frontera, Temuco, Chile
| | - Andrea Cortinez-O'Ryan
- Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile
- Facultad de Arquitectura, Artes y Diseño, Universidad Católica de Temuco, Temuco, Chile
| | - Francisca González
- Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Alejandra Vives-Vergara
- Departamento de Salud Pública, Pontificia Universidad Católica de Chile, Santiago, Chile
- Centro de Desarrollo Urbano Sustentable, Pontificia Universidad Católica de Chile, Santiago, Chile
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Baeza F, Vives Vergara A, González F, Orlando L, Valdebenito R, Cortinez-O’Ryan A, Slesinski C, Diez Roux AV. The Regeneración Urbana, Calidad de Vida y Salud - RUCAS project: a Chilean multi-methods study to evaluate the impact of urban regeneration on resident health and wellbeing. BMC Public Health 2021; 21:728. [PMID: 33858373 PMCID: PMC8047526 DOI: 10.1186/s12889-021-10739-3] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 03/30/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The available evidence of the health effects of urban regeneration is scarce In Latin America, and there are no studies focused on formal housing that longitudinally evaluate the impact of housing and neighborhood interventions on health. The "Regeneración Urbana, Calidad de Vida y Salud" (Urban Regeneration, Quality of Life, and Health) or RUCAS project is a longitudinal, multi-method study that will evaluate the impact of an intervention focused on dwellings, built environment and community on the health and wellbeing of the population in two social housing neighborhoods in Chile. METHODS RUCAS consists of a longitudinal study where inhabitants exposed and unexposed to the intervention will be compared over time within the study neighborhoods (cohorts), capitalizing on interventions as a natural experiment. Researchers have developed a specific conceptual framework and identified potential causal mechanisms. Proximal and more distal intervention effects will be measured with five instruments, implemented pre- and post-interventions between 2018 and 2021: a household survey, an observation tool to evaluate dwelling conditions, hygrochrons for measuring temperature and humidity inside dwellings, systematic observation of recreational areas, and qualitative interviews. Survey baseline data (956 households, 3130 individuals) is presented to describe sociodemographics, housing and health characteristics of both cohorts, noting that neighborhoods studied show worse conditions than the Chilean population. DISCUSSION RUCAS' design allows for a comprehensive evaluation of the effects that the intervention could have on various dimensions of health and health determinants. RUCAS will face some challenges, like changes in the intervention process due to adjustments of the master plan, exogenous factors -including COVID-19 pandemic and associated lockdowns- and lost to follow-up. Given the stepped wedge design, that the study capitalizes on within household changes over time, the possibility of adjusting data collection process and complementarity of methods, RUCAS has the flexibility to adapt to these circumstances. Also, RUCAS' outreach and retention strategy has led to high retention rates. RUCAS will provide evidence to inform regeneration processes, highlighting the need to consider potential health effects of regeneration in designing such interventions and, more broadly, health as a key priority in urban and housing policies.
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Affiliation(s)
- Fernando Baeza
- Department of Public Health, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077 Santiago, Chile
- Institute of Geography, Pontificia Universidad Católica de Chile, Vicuña Mackenna 4860, 7820436 Santiago, Chile
| | - Alejandra Vives Vergara
- Department of Public Health, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077 Santiago, Chile
- Centre for Sustainable Urban Development (CEDEUS), Los Navegantes 1963, 7520246 Santiago, Chile
| | - Francisca González
- Department of Public Health, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077 Santiago, Chile
| | - Laura Orlando
- Department of Public Health, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077 Santiago, Chile
| | - Roxana Valdebenito
- Department of Public Health, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077 Santiago, Chile
| | - Andrea Cortinez-O’Ryan
- Department of Public Health, Pontificia Universidad Católica de Chile, Diagonal Paraguay 362, 8330077 Santiago, Chile
- Department of Physical Education, Sports and Recreation, Universidad de La Frontera, Moneda 673, 8320216 Santiago, Chile
| | - Claire Slesinski
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3215 Market St, Philadelphia, PA 19104 USA
| | - Ana V. Diez Roux
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, 3215 Market St, Philadelphia, PA 19104 USA
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Gao W, Tu R, Li H, Fang Y, Que Q. In the Subtropical Monsoon Climate High-Density City, What Features of the Neighborhood Environment Matter Most for Public Health? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17249566. [PMID: 33371262 PMCID: PMC7767275 DOI: 10.3390/ijerph17249566] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 12/10/2020] [Accepted: 12/18/2020] [Indexed: 12/27/2022]
Abstract
Urbanization and climate change have been rapidly occurring globally. Evidence-based healthy city development is required to improve living quality and mitigate the adverse impact of the outdoor neighborhood environment on public health. Taking Guangzhou as an example to explore the association of neighborhood environment and public health and preferably to offer some implications for better future city development, we measured ten environmental factors (temperature (T), wind-chill index (WCI), thermal stress index (HSI), relative humidity (RH), average wind speed (AWS), negative oxygen ions (NOI), PM2.5, luminous flux (LF), and illuminance (I)) in four seasons in four typical neighborhoods, and the SF-36 health scale was employed to assess the physical and mental health of neighborhood residents in nine subscales (health transition(HT), physiological functions (PF), general health status (GH), physical pain (BP), physiological functions (RP), energy vitality (VT), mental health (MH), social function (SF), and emotional functions (RE)). The linear mixed model was used in an analysis of variance. We ranked the different environmental factors in relation to aspects of health and weighted them accordingly. Generally, the thermal environment had the greatest impact on both physical and mental health and the atmospheric environment and wind environment had the least impact on physical health and mental health, respectively. In addition, the physical health of the resident was more greatly affected by the environment than mental health. According to the results, we make a number of strategic suggestions for the renewal of the outdoor neighborhood environment in subtropical monsoon climate high-density cities and provide a theoretical basis for improving public health through landscape architecture at the neighborhood scale.
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Nickel S, von dem Knesebeck O. Do multiple community-based interventions on health promotion tackle health inequalities? Int J Equity Health 2020; 19:157. [PMID: 32912257 PMCID: PMC7488049 DOI: 10.1186/s12939-020-01271-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 08/25/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Previous systematic reviews of the impact of multi-component community-based health promotion interventions on reducing health inequalities by socio-economic status (SES) were restricted to physical activity and smoking behavior, and revealed limited and rather disillusioning evidence. Therefore, we conducted a comprehensive review worldwide to close this gap, including a wide range of health outcomes. METHODS The Pubmed and PsycINFO databases were screened for relevant articles published between January 1999 and August 2019, revealing 87 potentially eligible publications out of 2876 hits. In addition, three studies out of a prior review on the effectiveness of community-based interventions were reanalyzed under the new research question. After a systematic review process, 23 papers met the inclusion criteria and were included in the synthesis. RESULTS More than half (56.5%) of the studies reported improvements of socially disadvantaged communities overall (i.e. reduced inequalities at the area level) in at least one health behavior and/or health status outcome. Amongst the remaining studies we found some beneficial effects in the most deprived sub-groups of residents (8.2%) and studies with no differences between intervention and control areas (34.8%). There was no evidence that any program under review resulted in an increase in health disparity. CONCLUSIONS Our results confirm that community-based interventions may be reducing absolute health inequalities of deprived and disadvantaged populations, but their potential so far is not fully realized. For the future, greater attention should be paid to inequalities between sub-groups within communities when analyzing changes in health inequality over time.
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Affiliation(s)
- Stefan Nickel
- University Medical Center Hamburg-Eppendorf, Institute of Medical Sociology, Martinistraße 52, D-20246, Hamburg, Germany.
| | - Olaf von dem Knesebeck
- University Medical Center Hamburg-Eppendorf, Institute of Medical Sociology, Martinistraße 52, D-20246, Hamburg, Germany
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Lund R, Christensen U, Mathisen J, Sørensen KS, Srivarathan A, Molbo D, Halby K, Kristiansen M. Health, well-being and social relations in a changing neighbourhood: protocol for a prospective, multimethods study of the consequences of large structural changes in an ethnic diverse social housing area in Denmark. BMJ Open 2019; 9:e030936. [PMID: 31221894 PMCID: PMC6588977 DOI: 10.1136/bmjopen-2019-030936] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Residential areas constitute an important arena for health, well-being and social relations. Structural interventions such as demolition and area renewal have been used to reduce inequality in health and well-being in disadvantaged areas. However, the effects of larger structural interventions are inconclusive. In a longitudinal perspective, this study aims to analyse how large-scale structural changes in an ethnic diverse social housing area are associated with the residents' health, well-being and social relations. METHODS AND ANALYSIS In this multimethods study, we examine this aim among middle-aged and older residents in a multiethnic social housing area in a Danish municipality by the inclusion of comprehensive survey (in 2018, 2019 and 2020), register (yearly 2015-2025) and qualitative (2018-2020) data. Municipal Health Profile survey data from 2017 and 2021 will be used for comparison. The area will undergo large structural changes in the built environment during 2018-2021. A 'natural experiment' (n=6000) compares differences in health and social outcomes across the study period between the study area and a similar neighbouring area not undergoing structural changes. Through user engagement in the design of the study, throughout the different phases of the study and in the two co-created interventions embedded in the study design, a focus on empowerment and recognition of the resources and perspectives of residents are encouraged. ETHICS AND DISSEMINATION The study is registered in the University of Copenhagen's record of biobanks and research projects containing personal data and will be conducted in accordance with the principles of the Helsinki Declaration. Residential and municipal representatives and local non-governmental organisations are engaged in the design and execution of the study to ensure the usefulness, reflexive interpretation of data, and relevance of interventions. Results will be published in international peer-reviewed scientific journals, presented at conferences and as short reports through the use of both written and visual outputs.
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Affiliation(s)
- Rikke Lund
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Ulla Christensen
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jimmi Mathisen
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Abirami Srivarathan
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - Drude Molbo
- Department of Public Health, Section of Social Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kristian Halby
- Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Maria Kristiansen
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
- Department of Public Health, Section of Health Services Research, University of Copenhagen, Copenhagen, Denmark
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Health Benefits of Physical Activity Related to an Urban Riverside Regeneration. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16030462. [PMID: 30764538 PMCID: PMC6388232 DOI: 10.3390/ijerph16030462] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 01/25/2019] [Accepted: 02/01/2019] [Indexed: 12/20/2022]
Abstract
The promotion of physical activity through better urban design is one pathway by which health and well-being improvements can be achieved. This study aimed to quantify health and health-related economic impacts associated with physical activity in an urban riverside park regeneration project in Barcelona, Spain. We used data from Barcelona local authorities and meta-analysis assessing physical activity and health outcomes to develop and apply the “Blue Active Tool”. We estimated park user health impacts in terms of all-cause mortality, morbidity (ischemic heart disease; ischemic stroke; type 2 diabetes; cancers of the colon and breast; and dementia), disability-adjusted life years (DALYs) and health-related economic impacts. We estimated that 5753 adult users visited the riverside park daily and performed different types of physical activity (walking for leisure or to/from work, cycling, and running). Related to the physical activity conducted on the riverside park, we estimated an annual reduction of 7.3 deaths (95% CI: 5.4; 10.2), and 6.2 cases of diseases (95% CI: 2.0; 11.6). This corresponds to 11.9 DALYs (95% CI: 3.4; 20.5) and an annual health-economic impact of 23.4 million euros (95% CI: 17.2 million; 32.8 million). The urban regeneration intervention of this riverside park provides health and health-related economic benefits to the population using the infrastructure.
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McAllister A, Fritzell S, Almroth M, Harber-Aschan L, Larsson S, Burström B. How do macro-level structural determinants affect inequalities in mental health? - a systematic review of the literature. Int J Equity Health 2018; 17:180. [PMID: 30522502 PMCID: PMC6284306 DOI: 10.1186/s12939-018-0879-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 10/22/2018] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In Europe and elsewhere there is rising concern about inequality in health and increased prevalence of mental ill-health. Structural determinants such as welfare state arrangements may impact on levels of mental health and social inequalities. This systematic review aims to assess the current evidence on whether structural determinants are associated with inequalities in mental health outcomes. METHODS We conducted a systematic review of quantitative studies published between 1996 and 2017 based on search results from the following databases Medline, Embase, PsychInfo, Web of Science, Sociological Abstracts and Eric. Studies were included if they focused on inequalities (measured by socio-economic position and gender), structural determinants (i.e. public policies affecting the whole population) and showed a change or comparison in mental health status in one (or more) of the Organisation for Economic Cooperation and Development (OECD) countries. All studies were assessed for inclusion and study quality by two independent reviewers. Data were extracted and synthesised using narrative analysis. RESULTS Twenty-one articles (17 studies) met the inclusion criteria. Studies were heterogeneous with regards to methodology, mental health outcomes and policy settings. More comprehensive and gender inclusive welfare states (e.g. Nordic welfare states) had better mental health outcomes, especially for women, and less gender-related inequality. Nordic welfare regimes may also decrease inequalities between lone and couple mothers. A strong welfare state does not buffer against socio-economic inequalities in mental health outcomes. Austerity measures tended to worsen mental health and increase inequalities. Area-based initiatives and educational policy are understudied. CONCLUSION Although the literature on structural determinants and inequalities in mental health is limited, our review shows some evidence supporting the causal effects of structural determinants on mental health inequalities. The lack of evidence should not be interpreted as lack of effect. Future studies should apply innovative methods to overcome the inherent methodological challenges in this area, as structural determinants potentially affect both levels of mental health and social inequalities.
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Affiliation(s)
- A. McAllister
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - S. Fritzell
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
- The Public Health Agency of Sweden, Stockholm, Sweden
| | - M. Almroth
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - L. Harber-Aschan
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - S. Larsson
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - B. Burström
- Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
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