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Fernandez B, Gaitonde R. Non-communicable diseases and its risk factors among the transgender population in Kerala: a cross-sectional study. Int J Equity Health 2024; 23:107. [PMID: 38789986 PMCID: PMC11127387 DOI: 10.1186/s12939-024-02167-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 03/28/2024] [Indexed: 05/26/2024] Open
Abstract
BACKGROUND Non-communicable diseases (NCDs) are high on the priority list of the Kerala government, and exploring the extent to which transgender and gender diverse (TGD) community members benefit from the services of national programmes for NCDs can provide valuable insights on improving the inclusivity of the health system as it moves towards Universal Health Coverage. This study was conducted to explore the prevalence of NCD risk factors as well as facilitators and barriers to NCD management among the TGD population in Kerala. METHODS A multiple methods study, including a cross-sectional survey of 120 self-identifying TGD people that included an adaptation of the WHO STEPS questionnaire, as well as in-depth interviews with thirteen individuals, was conducted in three districts of Kerala to explore the barriers and facilitators to NCD prevention and management. RESULTS The results are presented using the key dimensions emerging out of the Diederichsen framework. A range of discrimination faced by TGD people in Kerala traps them in situations of low educational outcomes with consequent disadvantages in the job market when they search for livelihoods. This results in a large proportion of our sample living away from families (69 percent), and finding themselves in precarious jobs including sex work (only 33 percent had a regular job), with all these aforementioned factors converging to marginalise their social position. This social position leads to differential risk exposures such as increased exposure to modifiable risk factors like alcohol (40 percent were current alcohol users) and tobacco use (40.8 percent currently used tobacco) and ultimately metabolic risk factors too (30 and 18 percent were hypertensive and diabetic respectively). Due to their differential vulnerabilities such as the discrimination that TGD people are subjected to (41.7 percent had faced discrimination at a healthcare centre in the past one year), those with higher exposure to risk factors often find it hard to bring about behavioural modifications and are often not able to access the services they require. CONCLUSIONS The disadvantaged social position of TGD people and associated structural issues result in exacerbated biological risks, including those for NCDs. Ignoring these social determinants while designing health programmes is likely to lead to sub-optimal outcomes.
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Affiliation(s)
- Bhavya Fernandez
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India.
| | - Rakhal Gaitonde
- Achutha Menon Centre for Health Science Studies, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, Kerala, India
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Mrejen M, Nunes L, Giacomin K. Socioeconomic inequalities in health and healthcare utilization among the elderly in Brazil: results from the 2019 National Health Survey. Public Health 2024; 226:165-172. [PMID: 38071949 DOI: 10.1016/j.puhe.2023.11.015] [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: 08/18/2023] [Revised: 10/26/2023] [Accepted: 11/08/2023] [Indexed: 01/15/2024]
Abstract
OBJECTIVES To assess socioeconomic-related inequalities in health and healthcare utilization among the elderly in Brazil. STUDY DESIGN Cross-sectional nationally representative household-based survey. METHODS We evaluated the Brazilian National Health Survey data collected in 2019. We computed the prevalence of measures of health conditions and healthcare utilization by age-bracket and markers of socioeconomic status-income, educational attainment, and race/ethnicity-among individuals aged 60 or older. We further employed logistic regression models, adjusted for a wide set of covariates, to estimate the relationship between socioeconomic status and those outcomes. RESULTS Higher-income and more educated individuals exhibit better health conditions compared to their lower-income and less-educated counterparts within each age bracket. Results from regression models showed strong associations with income and educational attainment for most health conditions: health status, physical activity, difficulties with activities of daily living and instrumental activities of daily living, and depression. For most conditions, weaker or no associations with race/ethnicity were found. Individuals in the highest income quintile and that completed higher education also had higher odds of having consulted a physician, while high-income individuals had lower odds of having received emergency care at home. CONCLUSIONS The findings of this study highlight the significant socioeconomic inequalities in the health of the elderly population in Brazil. The substantial and pervasive nature of these inequalities stresses the need for action to address them.
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Affiliation(s)
- M Mrejen
- Instituto de Estudos para Políticas de Saúde (IEPS), São Paulo, SP, Brazil.
| | - L Nunes
- Insper, São Paulo, SP, Brazil
| | - K Giacomin
- NESPE, FIOCRUZ/UFMG, Belo Horizonte, MG, Brazil
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Parkinson J, Clark K, McIntosh T. The Collaborative Service Design Playbook to plan, design, and implement sustainable health services for impact. Health Mark Q 2024; 41:11-32. [PMID: 37195673 DOI: 10.1080/07359683.2023.2211853] [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] [Indexed: 05/18/2023]
Abstract
This paper sets out the Collaborative Service Design Playbook, to guide planning, design, and implementation of co-created health services. Successful health service development and implementation is best guided by theoretically informed approaches; however, organisations often lack design and implementation know-how and have difficulty applying it. This study seeks to improve health service design and potential for scale-up by proposing a tool to guide an end-to-end process, drawing together service design, co-design, and implementation science; and exploring the tool's feasibility to establish a sustainable service solution developed with participants and experts that is scalable and sustainable. The Collaborative Service Design Playbook phases include, (1) Define the opportunity and initiatives, (2) Design the concept and prototype, (3) Deliver to scale and evaluate; and (4) Optimise to transform and sustain. This paper has implications for health marketing through providing an end-to-end approach with phased guidance for health service development, implementation, and scale up.
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Affiliation(s)
- Joy Parkinson
- Australian eHealth Research Centre, CSIRO, Griffith Business School, Griffith University, Brisbane, Australia
| | - Kristen Clark
- Diabetes Queensland, Health and Wellbeing Queensland, Brisbane, Australia
| | - Tegan McIntosh
- Diabetes Queensland, Institute for Urban Indigenous Health, Brisbane, Australia
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Allen B, Neill DB, Schell RC, Ahern J, Hallowell BD, Krieger M, Jent VA, Goedel WC, Cartus AR, Yedinak JL, Pratty C, Marshall BDL, Cerdá M. Translating Predictive Analytics for Public Health Practice: A Case Study of Overdose Prevention in Rhode Island. Am J Epidemiol 2023; 192:1659-1668. [PMID: 37204178 PMCID: PMC10558193 DOI: 10.1093/aje/kwad119] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 03/09/2023] [Accepted: 05/15/2023] [Indexed: 05/20/2023] Open
Abstract
Prior applications of machine learning to population health have relied on conventional model assessment criteria, limiting the utility of models as decision support tools for public health practitioners. To facilitate practitioners' use of machine learning as a decision support tool for area-level intervention, we developed and applied 4 practice-based predictive model evaluation criteria (implementation capacity, preventive potential, health equity, and jurisdictional practicalities). We used a case study of overdose prevention in Rhode Island to illustrate how these criteria could inform public health practice and health equity promotion. We used Rhode Island overdose mortality records from January 2016-June 2020 (n = 1,408) and neighborhood-level US Census data. We employed 2 disparate machine learning models, Gaussian process and random forest, to illustrate the comparative utility of our criteria to guide interventions. Our models predicted 7.5%-36.4% of overdose deaths during the test period, illustrating the preventive potential of overdose interventions assuming 5%-20% statewide implementation capacities for neighborhood-level resource deployment. We describe the health equity implications of use of predictive modeling to guide interventions along the lines of urbanicity, racial/ethnic composition, and poverty. We then discuss considerations to complement predictive model evaluation criteria and inform the prevention and mitigation of spatially dynamic public health problems across the breadth of practice. This article is part of a Special Collection on Mental Health.
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Affiliation(s)
- Bennett Allen
- Correspondence to Dr. Bennett Allen, Center for Opioid Epidemiology and Policy, Grossman School of Medicine, New York University, 180 Madison Avenue, 4th Floor, Room 4-15, New York, NY 10016 (e-mail: )
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Honeycutt AA, Yarnoff B, Tayebali Z, Glasgow L, Hacker K. Using the Prevention Impacts Simulation Model to Estimate Long-Term Impacts of Multisector Community Partnerships' Efforts to Address Social Determinants of Health. Prev Chronic Dis 2023; 20:E62. [PMID: 37471635 PMCID: PMC10364837 DOI: 10.5888/pcd20.220327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/22/2023] Open
Abstract
Public health plays a key role in addressing social determinants of health (SDOH) through multisector community partnerships (MCPs), which contribute to community changes that promote healthy living; however, little is known about the longer-term impact of MCP-driven interventions. We used the Prevention Impacts Simulation Model (PRISM) in a rapid evaluation to better understand the implementation and potential impact of MCPs' SDOH initiatives. Results suggest that, if sustained, initiatives implemented by the 27 included MCPs may prevent 880 premature deaths and avert $125.7 million in medical costs over 20 years. As a validated model that estimates impact by using available implementation data, PRISM is a useful tool for evaluating SDOH initiatives.
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Affiliation(s)
- Amanda A Honeycutt
- RTI International, 3040 E Cornwallis Rd, Research Triangle Park, NC 27709
| | | | - Zohra Tayebali
- RTI International, Research Triangle Park, North Carolina
| | | | - Karen Hacker
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
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Hastings K, Marquina C, Morton J, Abushanab D, Berkovic D, Talic S, Zomer E, Liew D, Ademi Z. Projected New-Onset Cardiovascular Disease by Socioeconomic Group in Australia. PHARMACOECONOMICS 2022; 40:449-460. [PMID: 35037191 PMCID: PMC8761535 DOI: 10.1007/s40273-021-01127-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/05/2021] [Indexed: 05/22/2023]
Abstract
BACKGROUND Socioeconomic status has an important effect on cardiovascular disease (CVD). Data on the economic implications of CVD by socioeconomic status are needed to inform healthcare planning. OBJECTIVES The aim of this study was to project new-onset CVD and related health economic outcomes in Australia by socioeconomic status from 2021 to 2030. METHODS A dynamic population model was built to project annual new-onset CVD by socioeconomic quintile in Australians aged 40-79 years from 2021 to 2030. Cardiovascular risk was estimated using the Pooled Cohort Equation (PCE) from Australian-specific data, stratified for each socioeconomic quintile. The model projected years of life lived, quality- adjusted life-years (QALYs), acute healthcare medical costs, and productivity losses due to new-onset CVD. All outcomes were discounted by 5% annually. RESULTS PCE estimates showed that 8.4% of people in the most disadvantaged quintile were at high risk of CVD, compared with 3.7% in the least disadvantaged quintile (p < 0.001). From 2021 to 2030, the model projected 32% more cardiovascular events in the most disadvantaged quintile compared with the least disadvantaged (127,070 in SE 1 vs. 96,222 in SE 5). Acute healthcare costs in the most disadvantaged quintile were Australian dollars (AU$) 183 million higher than the least disadvantaged, and the difference in productivity costs was AU$959 million. Removing the equity gap (by applying the cardiovascular risk from the least disadvantaged quintile to the whole population) would prevent 114,822 cardiovascular events and save AU$704 million of healthcare costs and AU$3844 million of lost earnings over the next 10 years. CONCLUSION Our results highlight the pressing need to implement primary prevention interventions to reduce cardiovascular health inequity. This model provides a platform to incorporate socioeconomic status into health economic models by estimating which interventions are likely to yield more benefits in each socioeconomic quintile.
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Affiliation(s)
- Kaitlyn Hastings
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Clara Marquina
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Jedidiah Morton
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
- Diabetes and Population Health, Baker Heart and Diabetes Institute, Melbourne, Australia
| | - Dina Abushanab
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | | | - Stella Talic
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Zanfina Ademi
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia.
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Nacht CL, Kelly MM, Edmonson MB, Sklansky DJ, Shadman KA, Kind AJH, Zhao Q, Barreda CB, Coller RJ. Association Between Neighborhood Disadvantage and Pediatric Readmissions. Matern Child Health J 2022; 26:31-41. [PMID: 35013884 PMCID: PMC8982848 DOI: 10.1007/s10995-021-03310-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/23/2021] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Although individual-level social determinants of health (SDH) are known to influence 30-day readmission risk, contextual-level associations with readmission are poorly understood among children. This study explores associations between neighborhood disadvantage measured by Area Deprivation Index (ADI) and pediatric 30-day readmissions. METHODS This retrospective cohort study included discharges of patients aged < 20 years from Maryland's 2013-2016 all-payer dataset. The ADI, which quantifies 17 indicators of neighborhood socioeconomic disadvantage within census block groups, is used as a proxy for contextual-level SDH. Readmissions were identified with the 30-day Pediatric All-Condition Readmissions measure. Associations between ADI and readmission were identified with generalized estimating equations adjusted for patient demographics and clinical severity (Chronic Condition Indicator [CCI], Pediatric Medical Complexity Algorithm [PMCA], Index Hospital All Patients Refined Diagnosis Related Groups [APR-DRG]), and hospital discharge volume. RESULTS Discharges (n = 138,998) were mostly female (52.7%), publicly insured (55.1%), urban-dwelling (93.0%), with low clinical severity levels (0-1 CCIs [82.3%], minor APR-DRG severity [48.4%]). Overall readmission rate was 4.0%. Compared to the least disadvantaged ADI quartile, readmissions for the most disadvantaged quartile were significantly more likely (aOR 1.19, 95% CI 1.09-1.30). After adjustment, readmissions were associated with public insurance and indicators of medical complexity (higher number of CCIs, complex-chronic disease PMCA, and APR-DRG severity). CONCLUSION In this all-payer, statewide sample, living in the most socioeconomically disadvantaged neighborhoods independently predicted pediatric readmission. While the relative magnitude of neighborhood disadvantage was modest compared to medical complexity, disadvantage is modifiable and thus represents an important consideration for prevention and risk stratification efforts.
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Affiliation(s)
- Carrie L. Nacht
- University of Wisconsin School of Medicine and Public Health, Department of Pediatrics, Madison, Wisconsin
| | - Michelle M. Kelly
- University of Wisconsin School of Medicine and Public Health, Department of Pediatrics, Madison, Wisconsin
| | - M Bruce Edmonson
- University of Wisconsin School of Medicine and Public Health, Department of Pediatrics, Madison, Wisconsin
| | - Daniel J. Sklansky
- University of Wisconsin School of Medicine and Public Health, Department of Pediatrics, Madison, Wisconsin
| | - Kristin A. Shadman
- University of Wisconsin School of Medicine and Public Health, Department of Pediatrics, Madison, Wisconsin
| | - Amy J. H. Kind
- Madison VA Hospital Geriatrics Research Education and Clinical Center (GRECC),University of Wisconsin School of Medicine and Public Health, Department of Medicine
| | - Qianqian Zhao
- University of Wisconsin School of Medicine and Public Health, Department of Biostatistics and Medical Informatics, Madison, Wisconsin
| | - Christina B. Barreda
- University of Wisconsin School of Medicine and Public Health, Department of Pediatrics, Madison, Wisconsin
| | - Ryan J. Coller
- University of Wisconsin School of Medicine and Public Health, Department of Pediatrics, Madison, Wisconsin
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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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Kasabji F, Alrajo A, Vincze F, Kőrösi L, Ádány R, Sándor J. Self-Declared Roma Ethnicity and Health Insurance Expenditures: A Nationwide Cross-Sectional Investigation at the General Medical Practice Level in Hungary. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238998. [PMID: 33287122 PMCID: PMC7730532 DOI: 10.3390/ijerph17238998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/29/2020] [Accepted: 12/01/2020] [Indexed: 11/29/2022]
Abstract
The inevitable rising costs of health care and the accompanying risk of increasing inequalities raise concerns. In order to make tailored policies and interventions that can reduce this risk, it is necessary to investigate whether vulnerable groups (such as Roma, the largest ethnic minority in Europe) are being left out of access to medical advances. Objectives: The study aimed to describe the association between general medical practice (GMP) level of average per capita expenditure of the National Health Insurance Fund (NHIF), and the proportion of Roma people receiving GMP in Hungary, controlled for other socioeconomic and structural factors. Methods: A cross-sectional study that included all GMPs providing care for adults in Hungary (N = 4818) was conducted for the period 2012–2016. GMP specific data on health expenditures and structural indicators (GMP list size, providing care for adults only or children also, type and geographical location of settlement, age of GP, vacancy) for secondary analysis were obtained from the NHIF. Data for the socioeconomic variables were from the last census. Age and sex standardized specific socioeconomic status indicators (standardized relative education, srEDU; standardized relative employment, srEMP; relative housing density, rHD; relative Roma proportion based on self-reported data, rRP) and average per capita health expenditure (standardized relative health expenditure, srEXP) were computed. Multivariate linear regression model was applied to evaluate the relationship of socioeconomic and structural indicators with srEXP. Results: The srEDU had significant positive (b = 0.199, 95% CI: 0.128; 0.271) and the srEMP had significant negative (b = −0.282, 95% CI: −0.359; −0.204) effect on srEXP. GP age > 65 (b = −0.026, 95% CI: −0.036; −0.016), list size <800 (b = −0.043, 95% CI: −0.066; −0.020) and 800–1200 (b = −0.018, 95% CI: −0.031; −0.004]), had significant negative association with srEXP, and GMP providing adults only (b = 0.016, 95% CI: 0.001;0.032) had a positive effect. There was also significant expenditure variability across counties. However, rRP proved not to be a significant influencing factor (b = 0.002, 95% CI: −0.001; 0.005). Conclusion: As was expected, lower education, employment, and small practice size were associated with lower NHIF expenditures in Hungary, while the share of self-reported Roma did not significantly affect health expenditures according to our GMP level study. These findings do not suggest the necessity for Roma specific indicators elaborating health policy to control for the risk of widening inequalities imposed by rising health expenses.
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Affiliation(s)
- Feras Kasabji
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Hungary; (F.K.); (A.A.); (F.V.); (R.Á.)
- Doctoral School of Health Sciences, University of Debrecen, H-4012 Debrecen, Hungary
| | - Alaa Alrajo
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Hungary; (F.K.); (A.A.); (F.V.); (R.Á.)
| | - Ferenc Vincze
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Hungary; (F.K.); (A.A.); (F.V.); (R.Á.)
- Doctoral School of Health Sciences, University of Debrecen, H-4012 Debrecen, Hungary
| | - László Kőrösi
- Department of Financing, National Health Insurance Fund, H-1139 Budapest, Hungary;
| | - Róza Ádány
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Hungary; (F.K.); (A.A.); (F.V.); (R.Á.)
| | - János Sándor
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, H-4012 Debrecen, Hungary; (F.K.); (A.A.); (F.V.); (R.Á.)
- Correspondence:
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van Roode T, Pauly BM, Marcellus L, Strosher HW, Shahram S, Dang P, Kent A, MacDonald M. Values are not enough: qualitative study identifying critical elements for prioritization of health equity in health systems. Int J Equity Health 2020; 19:162. [PMID: 32933539 PMCID: PMC7493313 DOI: 10.1186/s12939-020-01276-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 09/02/2020] [Indexed: 11/10/2022] Open
Abstract
Background Health system policies and programs that reduce health inequities and improve health outcomes are essential to address unjust social gradients in health. Prioritization of health equity is fundamental to addressing health inequities but challenging to enact in health systems. Strategies are needed to support effective prioritization of health equity. Methods Following provincial policy recommendations to apply a health equity lens in all public health programs, we examined health equity prioritization within British Columbia health authorities during early implementation. We conducted semi-structured qualitative interviews and focus groups with 55 senior executives, public health directors, regional directors, and medical health officers from six health authorities and the Ministry of Health. We used an inductive constant comparative approach to analysis guided by complexity theory to determine critical elements for prioritization. Results We identified seven critical elements necessary for two fundamental shifts within health systems. 1) Prioritization through informal organization includes creating a systems value for health equity and engaging health equity champions. 2) Prioritization through formal organization requires explicit naming of health equity as a priority, designating resources for health equity, requiring health equity in decision making, building capacity and competency, and coordinating a comprehensive approach across levels of the health system and government. Conclusions Although creating a shared value for health equity is essential, health equity - underpinned by social justice - needs to be embedded at the structural level to support effective prioritization. Prioritization within government and ministries is necessary to facilitate prioritization at other levels. All levels within health systems should be accountable for explicitly including health equity in strategic plans and goals. Dedicated resources are needed for health equity initiatives including adequate resourcing of public health infrastructure, training, and hiring of staff with equity expertise to develop competencies and system capacity.
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Affiliation(s)
- Thea van Roode
- Canadian Institute for Substance Use Research, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada.
| | - Bernadette M Pauly
- Canadian Institute for Substance Use Research, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada.,School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, Canada
| | - Lenora Marcellus
- School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, Canada
| | - Heather Wilson Strosher
- Canadian Institute for Substance Use Research, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada
| | - Sana Shahram
- Faculty of Health and Social Development, University of British Columbia, 1147 Research Road, Okanagan, Kelowna, BC, V1V 1V7, Canada
| | - Phuc Dang
- Canadian Institute for Substance Use Research, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada
| | - Alex Kent
- Canadian Institute for Substance Use Research, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada
| | - Marjorie MacDonald
- Canadian Institute for Substance Use Research, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, V8W 2Y2, Canada.,School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, Canada
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11
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Hamal M, Dieleman M, De Brouwere V, de Cock Buning T. Social determinants of maternal health: a scoping review of factors influencing maternal mortality and maternal health service use in India. Public Health Rev 2020; 41:13. [PMID: 32514389 PMCID: PMC7265229 DOI: 10.1186/s40985-020-00125-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 04/07/2020] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Maternal health remains a major public health problem in India, with large inter- and intra-state inequities in maternal health service use and maternal deaths. The Commission on Social Determinants of Health provides a framework to identify structural and intermediary factors of health inequities, including maternal health, and understand their mechanism of influence, which might be important in addressing maternal health inequities in India. Our review aims to map and summarize the evidence on social determinants influencing maternal health in India and understand their mechanisms of influence by using a maternal health-specific social determinants framework. METHODS A scoping review was conducted of peer-reviewed journal articles in two databases (PubMed and Science Direct) on quantitative and qualitative studies conducted in India after 2000. We also searched for articles in a search engine (Google Scholar). Forty-one studies that met the study objectives were included: 25 identified through databases and search engines and 16 through reference check. RESULTS Economic status, caste/ethnicity, education, gender, religion, and culture were the most important structural factors of maternal health service use and maternal mortality in India. Place of residence, maternal age at childbirth, parity and women's exposure to mass media, and maternal health messages were the major intermediary factors. The structural factors influenced the intermediary factors (either independently or in association with other factors) that contributed to the use of maternal health service or caused maternal deaths. The health system emerged as a crucial and independent intermediary factor of influence on maternal health in India. Issues of power were observed in broader social contexts and in the relationships of health workers which led to differential access to maternal healthcare for women from different socioeconomic groups. CONCLUSION The model integrates existing information from quantitative and qualitative studies and provides a more comprehensive picture of structural and intermediary factors of maternal health service use and maternal mortality in India and their mechanisms of influence. Given the limitations of this study, we indicate the areas for further research pertaining to the framework and maternal health.
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Affiliation(s)
- Mukesh Hamal
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
- Maternal and Reproductive Health, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- ISGlobal, Barcelona Centre for International Health Research (CRESIB), Hospital Clínic-Universitat de Barcelona, Barcelona, Spain
| | - Marjolein Dieleman
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
- KIT Health, PO Box 95001, 1090 HA Amsterdam, The Netherlands
| | - Vincent De Brouwere
- Maternal and Reproductive Health, Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Tjard de Cock Buning
- Athena Institute for Research on Innovation and Communication in Health and Life Sciences, VU University, De Boelelaan 1085, 1081 HV Amsterdam, The Netherlands
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Pauly B, Urbanoski K, Hartney E, Shahram S, Marcellus L, Wallace B, Macdonald M, Hancock T. What Is Missing from "Patient-Oriented Research?" A View from Public Health Systems and Services. ACTA ACUST UNITED AC 2020; 15:10-19. [PMID: 32077841 PMCID: PMC7020799 DOI: 10.12927/hcpol.2019.26075] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Patient-oriented research (POR) aims to increase patient engagement in health research to improve health research and health services. In Canada, the Strategies for Patient-Oriented Research (SPOR) framework provides guidance for conducting POR. We critically review the SPOR framework through the lens of public health systems and services research. The SPOR framework is primarily focused on engaging individual patients in health research without attention to broader structural forces that shape health and participation in healthcare systems. Shifting from patient to public involvement and from patient to community engagement and being explicit about the range of health research that SPOR encompasses would enhance the framework and strengthen the potential of SPOR to improve health systems through health protection, promotion and prevention of disease and injury.
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Affiliation(s)
- Bernadette Pauly
- Professor, School of Nursing and Scientist, Canadian Institute for Substance Use Research, University of Victoria, Victoria, BC
| | - Karen Urbanoski
- Assistant Professor, School of Public Health and Social Policy, University of Victoria, Scientist, Canadian Institute for Substance Use Research, Victoria, BC
| | - Elizabeth Hartney
- Professor, School of Leadership Studies, Royal Roads University, Victoria, BC
| | - Sana Shahram
- Adjunct Professor, School of Public Health & Social Policy, University of Victoria, Victoria, BC, Assistant Professor, Nursing, University of British Columbia, Okanagan, Kelowna, BC
| | - Lenora Marcellus
- Associate Professor, School of Nursing, University of Victoria, Victoria, BC
| | - Bruce Wallace
- Associate Professor, School of Social Work, University of Victoria, Scientist, Canadian Institute for Substance Use Research, Victoria, BC
| | | | - Trevor Hancock
- Retired Professor and Senior Scholar, School of Public Health and Social Policy, University of Victoria, Victoria, BC
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Prescott C, Shahram SZ, Ogilvie G, Hassam N, Franks AS, Pauly B. Applying a health equity tool to assess a public health nursing guideline for practice in sexually transmitted infection assessment in British Columbia. Canadian Journal of Public Health 2020; 111:610-616. [PMID: 32086774 DOI: 10.17269/s41997-019-00285-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 12/10/2019] [Indexed: 11/17/2022]
Abstract
SETTING There is a multitude of health equity tools but little guidance on how to effectively use these tools in public health nursing practice. In BC, public health nurses who are certified in sexually transmitted infection care utilize guidelines authorized by the nursing regulatory body. INTERVENTION As part of the Equity Lens in Public Health (ELPH) research project, an assessment of the nursing guideline, Sexually Transmitted Infection (STI) Assessment Decision Support Tool, was undertaken using the Assessing Equity in Clinical Practice Guidelines health equity assessment tool. The chosen tool is intended for use by health care providers, is broadly applicable to clinical practice guidelines, can be used retrospectively, and falls within the category of equity checklists and audits. OUTCOMES Overall, the tool was useful in assessing the inclusion and omission of an equity focus in the guideline. However, there were several challenges: the identification of an appropriate health equity tool; the absence of an evaluation of the chosen tool; the tool's focus on chronic disease versus communicable disease; and the difficulty of obtaining client perspectives. IMPLICATIONS For an improved equity lens in the STI Assessment Decision Support Tool, future revisions should be equity focused and include perspectives from affected populations, an emphasis on the determinants of health that perpetuate inequities for populations who experience a disproportionate burden of STI, information on provincially available resources, and service delivery models that improve timely and equitable access to treatment and care.
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Affiliation(s)
- Cheryl Prescott
- Sexual Health and Blood Borne Infections, Population Public Health, Fraser Health Authority, 400 - 13450 - 102nd Avenue, Surrey, BC, V3T 0H1, Canada
| | - Sana Z Shahram
- Canadian Institute for Substance Use Research (CISUR), University of Victoria, Victoria, BC, Canada.
| | - Gina Ogilvie
- Faculty of Medicine, University of British Columbia, British Columbia Centre for Disease Control, British Columbia Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Noorjean Hassam
- British Columbia Centre for Disease Control, Provincial Health Services Authority, Vancouver, BC, Canada
| | | | - Bernie Pauly
- Canadian Institute for Substance Use Research (CISUR), University of Victoria, Victoria, BC, Canada
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Williams KM, Taylor RD, Painter T, Jeffries WL, Prather C, Spikes P, Mulatu MS, Henny K, Hoyte T, Flores SA. Learning by Doing: Lessons From the Care and Prevention in the United States Demonstration Project. Public Health Rep 2019; 133:18S-27S. [PMID: 30457953 PMCID: PMC6262517 DOI: 10.1177/0033354918803611] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Kim M Williams
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Prevention Research Branch, Atlanta, GA, USA
| | - Raekiela D Taylor
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Prevention Research Branch, Atlanta, GA, USA
| | - Thomas Painter
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Prevention Research Branch, Atlanta, GA, USA
| | - William L Jeffries
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Prevention Research Branch, Atlanta, GA, USA
| | - Cynthia Prather
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Prevention Research Branch, Atlanta, GA, USA
| | - Pilgrim Spikes
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Prevention Research Branch, Atlanta, GA, USA
| | - Mesfin S Mulatu
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Prevention Research Branch, Atlanta, GA, USA
| | - Kirk Henny
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Prevention Research Branch, Atlanta, GA, USA
| | - Tamika Hoyte
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Prevention Research Branch, Atlanta, GA, USA
| | - Stephen A Flores
- 1 Division of HIV/AIDS Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Prevention Research Branch, Atlanta, GA, USA
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Feigin E, Ronen O. Making rural health care better: How to attract interns to rural hospital. Aust J Rural Health 2019; 27:139-145. [PMID: 30942515 DOI: 10.1111/ajr.12502] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Revised: 01/17/2019] [Accepted: 01/27/2019] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE We examined the factors that influence medical school graduates' choices for the place of internship, so that they can guide policy-makers to attract interns to rural hospitals. DESIGN A national survey. SETTING Rural and metropoles of Israel. PARTICIPANTS Three-hundred-and-thirty-nine interns who did their internships during the years 2016-2018. MAIN OUTCOME MEASURE The participants completed a web survey. We used the results of this survey to deduce which factors were influential in helping the interns choose a hospital for their year of internship. RESULTS We received 339 questionnaires from medical school graduates of years 2015-2017. We found that the most influential factors in attracting interns to rural hospital internships are the availability of desired residency and exposure to a rural curriculum in medical school. This far outweighed any economic or life quality incentives. In addition, we found that the exposure to rural hospitals during the medical school years increases the likelihood of choosing an internship in a rural hospital. CONCLUSIONS The most important factor for choosing a hospital for internship is the availability of lucrative residencies. Thus, we believe the best way to attract good interns would be to make the desired residency positions available for them. Furthermore, it might be more successful to target either students who have studied in a university affiliated with rural hospital rotations or graduates of universities outside of the country.
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Affiliation(s)
- Eugene Feigin
- Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
| | - Ohad Ronen
- Department of Otolaryngology - Head and Neck Surgery, Galilee Medical Center affiliated with Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
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Woldemichael A, Takian A, Akbari Sari A, Olyaeemanesh A. Inequalities in healthcare resources and outcomes threatening sustainable health development in Ethiopia: panel data analysis. BMJ Open 2019; 9:e022923. [PMID: 30705237 PMCID: PMC6359736 DOI: 10.1136/bmjopen-2018-022923] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 11/15/2018] [Accepted: 11/19/2018] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To measure inequalities in the distributions of selected healthcare resources and outcomes in Ethiopia from 2000 to 2015. DESIGN A panel data analysis was performed to measure inequalities in distribution of healthcare workforce, infrastructure, outcomes and finance, using secondary data. SETTING The study was conducted across 11 regions in Ethiopia. PARTICIPANTS Regional population and selected healthcare workforce. OUTCOMES MEASURED Aggregate Theil and Gini indices, changes in inequalities and elasticity of healthcare resources. RESULTS Despite marked inequality reductions over a 16 year period, the Theil and Gini indices for the healthcare resources distributions remained high. Among the healthcare workforce distributions, the Gini index (GI) was lowest for nurses plus midwives (GI=0.428, 95% CI 0.393 to 0.463) and highest for specialist doctors (SPDs) (GI=0.704, 95% CI 0.652 to 0.756). Inter-region inequality was the highest for SPDs (95.0%) and the lowest for health officers (53.8%). The GIs for hospital beds, hospitals and health centres (HCs) were 0.592(95% CI 0.563 to 0.621), 0.460(95% CI 0.404 to 0.517) and 0.409(95% CI 0.380 to 0.439), respectively. The interaction term was highest for HC distributions (47.7%). Outpatient department visit per capita (GI=0.349, 95% CI 0.321 to 0.377) and fully immunised children (GI=0.307, 95% CI 0.269 to 0.345) showed inequalities; inequality in the under 5 years of age mortality rate increased overtime (P=0.048). Overall, GI for government health expenditure (GHE) was 0.596(95% CI 0.544 to 0.648), and the estimated relative GHE share of the healthcare workforce and infrastructure distributions were 46.5% and 53.5%, respectively. The marginal changes in the healthcare resources distributions were towards the advantaged populations. CONCLUSION This study revealed high inequalities in healthcare resources in favour of the advantaged populations which can hinder equal access to healthcare and the achievements of healthcare outcomes. The government should strengthen monitoring mechanisms to address inequalities based on the national healthcare standards.
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Affiliation(s)
- Abraha Woldemichael
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Science, Tehran, Iran (the Islamic Republic of)
- School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
| | - Amirhossein Takian
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Science, Tehran, Iran (the Islamic Republic of)
- Department of Global Health and Public Policy, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
- Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Ali Akbari Sari
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Science, Tehran, Iran (the Islamic Republic of)
| | - Alireza Olyaeemanesh
- Department of Health Management and Economics, School of Public Health, Tehran University of Medical Science, Tehran, Iran (the Islamic Republic of)
- Health Equity Research Centre (HERC), Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
- National Institute for Health Research, Tehran, Iran (the Islamic Republic of)
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Healthy Ageing and Health Equity: Broader Determinants of Health with a Spotlight on Climate Change. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/978-3-319-96529-1_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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Critical considerations for the practical utility of health equity tools: a concept mapping study. Int J Equity Health 2018; 17:48. [PMID: 29688855 PMCID: PMC5914026 DOI: 10.1186/s12939-018-0764-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 04/12/2018] [Indexed: 12/03/2022] Open
Abstract
Background Promoting health equity within health systems is a priority and challenge worldwide. Health equity tools have been identified as one strategy for integrating health equity considerations into health systems. Although there has been a proliferation of health equity tools, there has been limited attention to evaluating these tools for their practicality and thus their likelihood for uptake. Methods Within the context of a large program of research, the Equity Lens in Public Health (ELPH), we conducted a concept mapping study to identify key elements and themes related to public health leaders and practitioners’ views about what makes a health equity tool practical and useful. Concept mapping is a participatory mixed-method approach to generating ideas and concepts to address a common concern. Participants brainstormed responses to the prompt “To be useful, a health equity tool should…” After participants sorted responses into groups based on similarity and rated them for importance and feasibility, the statements were analyzed using multidimensional scaling, then grouped using cluster analysis. Pattern matching graphs were constructed to illustrate the relationship between the importance and feasibility of statements, and go-zone maps were created to guide subsequent action. Results The process resulted in 67 unique statements that were grouped into six clusters: 1) Evaluation for Improvement; 2) User Friendliness; 3) Explicit Theoretical Background; 4) Templates and Tools 5) Equity Competencies; and 6) Nothing about Me without Me- Client Engaged. The result was a set of concepts and themes describing participants’ views of the practicality and usefulness of health equity tools. Conclusions These thematic clusters highlight the importance of user friendliness and having user guides, templates and resources to enhance use of equity tools. Furthermore, participants’ indicated that practicality was not enough for a tool to be useful. In addition to practical characteristics of the tool, a useful tool is one that encourages and supports the development of practitioner competencies to engage in equity work including critical reflections on power and institutional culture as well as strategies for the involvement of community members impacted by health inequities in program planning and delivery. The results of this study will be used to inform the development of practical criteria to assess health equity tools for application in public health.
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Dalazen CE, Carli ADD, Bomfim RA. Fatores associados às necessidades de tratamento odontológico em idosos brasileiros: uma análise multinível. CIENCIA & SAUDE COLETIVA 2018; 23:1119-1130. [DOI: 10.1590/1413-81232018234.27462015] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 06/22/2016] [Indexed: 11/21/2022] Open
Abstract
Resumo Este estudo teve como objetivos estimar a prevalência da necessidade de prótese e tratamento dental em idosos brasileiros, e verificar a associação entre essas necessidades e fatores contextuais e individuais. Realizou-se estudo com dados (n = 7.619) da Pesquisa Nacional de Saúde Bucal – SB Brasil 2010. Modelos de regressão logística multinível foram utilizados para estimar odds ratio e intervalos de 95% de confiança entre as necessidades de tratamento e as variáveis contextuais (Índice de Desenvolvimento Humano Municipal, Coeficiente de Gini e cobertura de saúde bucal na Estratégia de Saúde da Família) e individuais (sexo, renda, escolaridade e cor da pele). Para a necessidade de tratamento dental, ser homem, apresentar menor escolaridade, menor renda, cor da pele autorrelatada como não branca e residir em municípios com menor IDH -M foram fatores que aumentaram as chances de os indivíduos necessitarem de tratamento; para a necessidade de prótese, a cor da pele autorreferida como não branca, menor renda e menor escolaridade também aumentaram as chances dos idosos necessitarem de prótese. Os resultados indicaram associação entre as necessidades de tratamento e determinantes individuais e contextuais.
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Pauly BM, Shahram SZ, Dang PTH, Marcellus L, MacDonald M. Health Equity Talk: Understandings of Health Equity among Health Leaders. AIMS Public Health 2017; 4:490-512. [PMID: 30155500 PMCID: PMC6111274 DOI: 10.3934/publichealth.2017.5.490] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 11/08/2017] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Reducing health inequities is a stated goal of health systems worldwide. There is widespread commitment to health equity among public health leaders and calls for reorientation of health systems towards health equity. As part of the Equity Lens in Public Health (ELPH) program of research, public health decision makers and researchers in British Columbia collaborated to study the application of a health equity lens in a time of health system renewal. We drew on intersectionality, complexity and critical social justice theories to understand how participants construct health equity and apply a health equity lens as part of public health renewal. METHODS 15 focus groups and 16 individual semi-structured qualitative interviews were conducted with 55 health system leaders. Data were analyzed using constant comparative analysis to explore how health equity was constructed in relation to understandings and actions. RESULTS Four main themes were identified in terms of how health care leaders construct health equity and actions to reduce health inequities: (1) population health, (2) determinants of health, and (3) accessibility and (4) challenges of health equity talk. The first three aspects of health equity talk reflect different understandings of health equity rooted in vulnerability (individual versus structural), determinants of health (material versus social determinants), and appropriate health system responses (targeted versus universal responses). Participants identified that talking about health equity in the health care system, either inside or outside of public health, is a 'challenging conversation' because health equity is understood in diverse ways and there is little guidance available to apply a health equity lens. CONCLUSIONS These findings reflect the importance of creating a shared understanding of health equity within public health systems, and providing guidance and clarity as to the meaning and application of a health equity lens. A health equity lens for public health should capture both the production and distribution of health inequities and link to social justice to inform action.
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Affiliation(s)
- Bernadette M. Pauly
- Centre for Addictions Research of BC, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, Canada
- School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, Canada
| | - Sana Z. Shahram
- Centre for Addictions Research of BC, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, Canada
| | - Phuc T. H. Dang
- Centre for Addictions Research of BC, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, Canada
| | - Lenora Marcellus
- School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, Canada
| | - Marjorie MacDonald
- Centre for Addictions Research of BC, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, Canada
- School of Nursing, University of Victoria, PO Box 1700 STN CSC, Victoria, BC, Canada
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Sadana R, Blas E, Budhwani S, Koller T, Paraje G. Healthy Ageing: Raising Awareness of Inequalities, Determinants, and What Could Be Done to Improve Health Equity. THE GERONTOLOGIST 2017; 56 Suppl 2:S178-93. [PMID: 26994259 DOI: 10.1093/geront/gnw034] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY Social and scientific discourses on healthy ageing and on health equity are increasingly available, yet from a global perspective limited conceptual and analytical work connecting both has been published. This review was done to inform the WHO World Report on Ageing and Health and to inform and encourage further work addressing both healthy aging and equity. DESIGN AND METHODS We conducted an extensive literature review on the overlap between both topics, privileging publications from 2005 onward, from low-, middle-, and high-income countries. We also reviewed evidence generated around the WHO Commission on Social Determinants of Health, applicable to ageing and health across the life course. RESULTS Based on data from 194 countries, we highlight differences in older adults' health and consider three issues: First, multilevel factors that contribute to differences in healthy ageing, across contexts; second, policies or potential entry points for action that could serve to reduce unfair differences (health inequities); and third, new research areas to address the cause of persistent inequities and gaps in evidence on what can be done to increase healthy ageing and health equity. IMPLICATIONS Each of these areas warrant in depth analysis and synthesis, whereas this article presents an overview for further consideration and action.
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Affiliation(s)
- Ritu Sadana
- Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland.
| | - Erik Blas
- International Public Health and Development, Copenhagen, Denmark
| | - Suman Budhwani
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Theadora Koller
- Gender, Equity and Human Rights Team, World Health Organization, Geneva, Switzerland
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Psychosocial Mechanisms Linking the Social Environment to Mental Health in African Americans. PLoS One 2016; 11:e0154035. [PMID: 27119366 PMCID: PMC4847864 DOI: 10.1371/journal.pone.0154035] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Accepted: 04/07/2016] [Indexed: 11/30/2022] Open
Abstract
Resource-poor social environments predict poor health, but the mechanisms and processes linking the social environment to psychological health and well-being remain unclear. This study explored psychosocial mediators of the association between the social environment and mental health in African American adults. African American men and women (n = 1467) completed questionnaires on the social environment, psychosocial factors (stress, depressive symptoms, and racial discrimination), and mental health. Multiple-mediator models were used to assess direct and indirect effects of the social environment on mental health. Low social status in the community (p < .001) and U.S. (p < .001) and low social support (p < .001) were associated with poor mental health. Psychosocial factors significantly jointly mediated the relationship between the social environment and mental health in multiple-mediator models. Low social status and social support were associated with greater perceived stress, depressive symptoms, and perceived racial discrimination, which were associated with poor mental health. Results suggest the relationship between the social environment and mental health is mediated by psychosocial factors and revealed potential mechanisms through which social status and social support influence the mental health of African American men and women. Findings from this study provide insight into the differential effects of stress, depression and discrimination on mental health. Ecological approaches that aim to improve the social environment and psychosocial mediators may enhance health-related quality of life and reduce health disparities in African Americans.
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Moya EM, Chávez-Baray SM, Wood WW, Martinez O. Nuestra Casa: An advocacy initiative to reduce inequalities and tuberculosis along the US-Mexico border. INTERNATIONAL PUBLIC HEALTH JOURNAL 2016; 8:107-119. [PMID: 30245778 PMCID: PMC6150456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The US-Mexico border provides a rich learning environment for professional social workers and at the same time poses some challenges. This article explores some of the unique demographics and social and cultural characteristics in the border region. These characteristics have implications for social work teaching, research, policy and practice. The study of borders includes exploring social disparities and inequalities. Health risks and diseases travel fluidly between borders and kill indiscriminately. The US-Mexico border is at high-risk of elevated tuberculosis (TB) and HIV incidence due to socio-economic stress, rapid and dynamic population growth, mobility and migration, and the hybridization of cultures. Every minute, four people die from TB, and 15 more become infected worldwide. The number of deaths due to tuberculosis is unacceptable given that most cases of TB are preventable. Cross-border cooperation and collaboration among social workers, health professionals and public officials between communities and countries can reduce social injustices to move towards a healthier borderland, as demonstrated in the collaborative prevention of TB. Rather than limiting our work to define social inequalities, we seek to further the conversation and suggest social action to address TB. This article contributes ideas and examples of experiences to encourage innovative, community-academic engaged inter- and multidisciplinary interventions like the Nuestra Casa (Our House) initiative. Nuestra Casa is an advocacy, communication and social mobilization strategy to address TB and HIV health disparities and inequalities in underserved communities, which we argue provides a useful model for combating TB and other inequalities plaguing the US-Mexico borderland.
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Affiliation(s)
- Eva M Moya
- The University of Texas at El Paso College of Health Sciences Department of Social Work, El Paso, Texas, United States of America
| | - Silvia M. Chávez-Baray
- The University of Texas at El Paso College of Health Sciences Department of Social Work, El Paso, Texas, United States of America
| | - William W. Wood
- University of Wisconsin-Milwaukee Department of Anthropology, Milwaukee, Wisconsin, United States of America
| | - Omar Martinez
- School of Social Work, College of Public Health, Temple University, Philadelphia, Pennsylvania, United States of America
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Akinboro O, Ottenbacher A, Martin M, Harrison R, James T, Martin E, Murdoch J, Linnear K, Cardarelli K. Racial and Ethnic Disparities in Health and Health Care: an Assessment and Analysis of the Awareness and Perceptions of Public Health Workers Implementing a Statewide Community Transformation Grant in Texas. J Racial Ethn Health Disparities 2016; 3:46-54. [PMID: 26896104 DOI: 10.1007/s40615-015-0111-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 03/31/2015] [Accepted: 04/06/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Little is known about the awareness of public health professionals regarding racial and ethnic disparities in health in the United States of America (USA). Our study objective was to assess the awareness and perceptions of a group of public health workers in Texas regarding racial health disparities and their chief contributing causes. METHODS We surveyed public health professionals working on a statewide grant in Texas, who were participants at health disparities' training workshops. Multivariable logistic regression was employed in examining the association between the participants' characteristics and their perceptions of the social determinants of health as principal causes of health disparities. RESULTS There were 106 respondents, of whom 38 and 35 % worked in health departments and non-profit organizations, respectively. The racial/ethnic groups with the highest incidence of HIV/AIDS and hypertension were correctly identified by 63 and 50 % of respondents, respectively, but only 17, and 32 % were knowledgeable regarding diabetes and cancer, respectively. Seventy-one percent of respondents perceived that health disparities are driven by the major axes of the social determinants of health. Exposure to information about racial/ethnic health disparities within the prior year was associated with a higher odds of perceiving that social determinants of health were causes of health disparities (OR 9.62; 95 % CI 2.77, 33.41). CONCLUSION Among public health workers, recent exposure to information regarding health disparities may be associated with their perceptions of health disparities. Further research is needed to investigate the impact of such exposure on their long-term perception of disparities, as well as the equity of services and programs they administer.
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Affiliation(s)
- Oladimeji Akinboro
- Department of Medicine, Montefiore New Rochelle Hospital, 16 Guion Place, New Rochelle, NY, 10801, USA. .,Formerly at the Center for Community Health, Texas Prevention Institute, University of North Texas Health Science Center, Fort Worth, TX, USA.
| | - Allison Ottenbacher
- Behavioral Research Program, National Cancer Institute, Rockville, MD, USA.,Formerly at the Center for Community Health, Texas Prevention Institute, University of North Texas Health Science Center, Fort Worth, TX, USA
| | | | | | - Thomas James
- 2M Research Services, Cedar Hill, TX, USA.,University of Oklahoma, Norman, OK, USA
| | | | - James Murdoch
- 2M Research Services, Cedar Hill, TX, USA.,University of Texas at Dallas, Dallas, TX, USA
| | - Kim Linnear
- University of North Texas Health Sciences Center, Fort Worth, TX, USA
| | - Kathryn Cardarelli
- University of Kentucky College of Public Health, Lexington, KY, USA.,Formerly at the Center for Community Health, Texas Prevention Institute, University of North Texas Health Science Center, Fort Worth, TX, USA
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Blas E, Ataguba JE, Huda TM, Bao GK, Rasella D, Gerecke MR. The feasibility of measuring and monitoring social determinants of health and the relevance for policy and programme - a qualitative assessment of four countries. Glob Health Action 2016; 9:29002. [PMID: 26853897 PMCID: PMC4744867 DOI: 10.3402/gha.v9.29002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 09/26/2015] [Accepted: 09/26/2015] [Indexed: 11/22/2022] Open
Abstract
Background Since the publication of the reports by the Commission on Social Determinants of Health (CSDH), many research papers have documented inequities, explaining causal pathways in order to inform policy and programmatic decision-making. At the international level, the sustainable development goals (SDGs) reflect an attempt to bring together these themes and the complexities involved in defining a comprehensive development framework. However, to date, much less has been done to address the monitoring challenges, that is, how data generation, analysis and use are to become routine tasks. Objective To test proposed indicators of social determinants of health (SDH), gender, equity, and human rights with respect to their relevance in tracking progress in universal health coverage and population health (level and distribution). Design In an attempt to explore these monitoring challenges, indicators covering a wide range of social determinants were tested in four country case studies (Bangladesh, Brazil, South Africa, and Vietnam) for their technical feasibility, reliability, and validity, and their communicability and usefulness to policy-makers. Twelve thematic domains with 20 core indicators covering different aspects of equity, human rights, gender, and SDH were tested through a review of data sources, descriptive analyses, key informant interviews, and focus group discussions. To test the communicability and usefulness of the domains, domain narratives that explained the causal pathways were presented to policy-makers, managers, the media, and civil society leaders. Results For most countries, monitoring is possible, as some data were available for most of the core indicators. However, a qualitative assessment showed that technical feasibility, reliability, and validity varied across indicators and countries. Producing understandable and useful information proved challenging, and particularly so in translating indicator definitions and data into meaningful lay and managerial narratives, and effectively communicating links to health and ways in which the information could improve decision-making. Conclusions This exercise revealed that for monitoring to produce reliable data collection, analysis, and discourse, it will need to be adapted to each national context and institutionalised into national systems. This will require that capacities and resources for this and subsequent communication of results are increased across countries for both national and international monitoring, including the successful implementation of the SDGs.
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Affiliation(s)
- Erik Blas
- International Public Health Consultant, Copenhagen, Denmark;
| | - John E Ataguba
- Health Economics Unit, School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Tanvir M Huda
- School of Public Health, University of Sydney, Sydney, Australia.,Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh
| | - Giang Kim Bao
- Institute of Preventive Medicine and Public Health, Hanoi Medical University, Hanoi, Vietnam
| | - Davide Rasella
- Institute of Collective Health, Federal University of Bahia, Salvador, Brazil
| | - Megan R Gerecke
- Social Determinants of Health, World Health Organization, Geneva, Switzerland
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26
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Jiao Y, Bower JK, Im W, Basta N, Obrycki J, Al-Hamdan MZ, Wilder A, Bollinger CE, Zhang T, Hatten L, Hatten J, Hood DB. Application of Citizen Science Risk Communication Tools in a Vulnerable Urban Community. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2015; 13:ijerph13010011. [PMID: 26703664 PMCID: PMC4730402 DOI: 10.3390/ijerph13010011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Revised: 10/02/2015] [Accepted: 10/09/2015] [Indexed: 01/08/2023]
Abstract
A public participatory geographical information systems (PPGIS) demographic, environmental, socioeconomic, health status portal was developed for the Stambaugh-Elwood (SE) community in Columbus, OH. We hypothesized that soil at SE residences would have metal concentrations above natural background levels. Three aims were developed that allowed testing of this hypothesis. Aim 1 focused on establishing partnerships between academia, state agencies and communities to assist in the development of a community voice. Aim 2 was to design and conduct soil sampling for residents of the SE community. Aim 3 was to utilize our interactive, customized portal as a risk communication tool by allowing residents to educate themselves as to the potential risks from industrial sources in close proximity to their community. Multiple comparisons of means were used to determine differences in soil element concentration by sampling location at p < 0.05. The results demonstrated that eight metals (As, Cd, Cu, Pb, Mo, Se, Tl, Zn) occurred at statistically-significantly greater levels than natural background levels, but most were below risk-based residential soil screening levels. Results were conveyed to residents via an educational, risk-communication informational card. This study demonstrates that community-led coalitions in collaboration with academic teams and state agencies can effectively address environmental concerns.
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Affiliation(s)
- Yuqin Jiao
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH 43210, USA.
| | - Julie K Bower
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH 43210, USA.
| | - Wansoo Im
- VERTICES, LLC 303 George Street Suite 406, New Brunswick, NJ 08901, USA.
| | - Nicholas Basta
- Environmental Science Graduate Program, School of Environment and Natural Resources, The Ohio State University, Columbus, OH 43210, USA.
| | - John Obrycki
- Environmental Science Graduate Program, School of Environment and Natural Resources, The Ohio State University, Columbus, OH 43210, USA.
| | - Mohammad Z Al-Hamdan
- Universities Space Research Association at NASA Marshall Space Flight Center, Huntsville, AL 35805, USA.
| | - Allison Wilder
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH 43210, USA.
| | - Claire E Bollinger
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH 43210, USA.
| | - Tongwen Zhang
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH 43210, USA.
| | - Luddie Hatten
- Stambaugh-Elwood Citizens for the Environment, LLC Columbus, OH 43207, USA.
| | - Jerrie Hatten
- Stambaugh-Elwood Citizens for the Environment, LLC Columbus, OH 43207, USA.
| | - Darryl B Hood
- Division of Environmental Health Sciences, College of Public Health, The Ohio State University, Columbus, OH 43210, USA.
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Trinh-Shevrin C, Kwon SC, Park R, Nadkarni SK, Islam NS. Moving the dial to advance population health equity in New York City Asian American populations. Am J Public Health 2015; 105 Suppl 3:e16-25. [PMID: 25905858 DOI: 10.2105/ajph.2015.302626] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The shift toward a health equity framework for eliminating the health disparities burden of racial/ethnic minority populations has moved away from a disease-focused model to a social determinants framework that aims to achieve the highest attainment of health for all. The New York University Center for the Study of Asian American Health (CSAAH) has identified core themes and strategies for advancing population health equity for Asian American populations in New York City that are rooted in the following: social determinants of health; multisectoral, community-engaged approaches; leveraging community assets; improved disaggregated data collection and access to care; and building sustainability through community leadership and infrastructure-building activities. We describe the strategies CSAAH employed to move the dial on population health equity.
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Affiliation(s)
- Chau Trinh-Shevrin
- All of the authors are with the Center for the Study of Asian American Health, Department of Population Health, NYU School of Medicine, New York, NY
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28
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Szaflarski M. Social determinants of health in epilepsy. Epilepsy Behav 2014; 41:283-9. [PMID: 24998313 DOI: 10.1016/j.yebeh.2014.06.013] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 06/05/2014] [Accepted: 06/07/2014] [Indexed: 10/25/2022]
Abstract
Social factors have been identified as key drivers of epilepsy care, outcomes, and disparities, but there is a limited understanding of what these factors are and how they translate into disparities. This targeted review provides an overview of the social determinants of health framework and applies this perspective to the literature about social and psychosocial factors in epilepsy; a social determinants of health--epilepsy model is proposed. The key social determinants of health in epilepsy include socioeconomic status, race/ethnicity, age, and gender. For example, low socioeconomic status and minority status have been associated with a higher risk of epilepsy, more hospitalizations and emergency room visits (versus neurology services), antiepileptic drug nonadherence, and a lower rate of epilepsy surgery. Such differences in care/treatment and outcomes translate into health disparities, many of which are considered unjust (inequitable) and modifiable through social action. Other social determinants of health include structural and sociocultural contextual conditions (e.g., health economy, policy, and social stigma/discrimination) and mediating mechanisms including material (e.g., housing), behavioral/biological (e.g., adherence), psychosocial (e.g., perceived stigma), and health system (e.g., access) factors. There are complex relationships among social determinants of health in epilepsy, which remain poorly understood and hamper efforts to address and eliminate disparities in epilepsy care and outcomes. Further empirical work grounded in sound theory and robust methodologies is needed to identify points of intervention and design effective and socially acceptable solutions to any pervasive disparities in epilepsy.
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Affiliation(s)
- Magdalena Szaflarski
- Department of Sociology, University of Alabama at Birmingham, HHB 460H, 1720 2nd Ave South, Birmingham, AL 35294-1152, USA.
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29
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Duncan S, Thorne S, Rodney P. Evolving trends in nurse regulation: what are the policy impacts for nursing's social mandate? Nurs Inq 2014; 22:27-38. [DOI: 10.1111/nin.12087] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/03/2014] [Indexed: 11/28/2022]
Affiliation(s)
| | - Sally Thorne
- University of British Columbia; Vancouver BC Canada
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Valdiserri RO. Improving outcomes along the HIV care continuum: paying careful attention to the non-biologic determinants of health. Public Health Rep 2014; 129:319-21. [PMID: 24982533 DOI: 10.1177/003335491412900405] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Ronald O Valdiserri
- Ronald Valdiserri is Deputy Assistant Secretary for Health, Infectious Diseases and Director of the Office of HIV/AIDS and Infectious Disease Policy, U.S. Department of Health and Human Services in Washington, D.C
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31
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Edlin BR, Winkelstein ER. Can hepatitis C be eradicated in the United States? Antiviral Res 2014; 110:79-93. [PMID: 25110202 DOI: 10.1016/j.antiviral.2014.07.015] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 07/18/2014] [Accepted: 07/27/2014] [Indexed: 12/11/2022]
Abstract
The advent of highly effective antiviral regimens will make the eradication of hepatitis C in high-income countries such as the United States technically feasible. But eradicating hepatitis C will require escalating our response to the epidemic in key domains, including surveillance and epidemiology, prevention, screening, care and treatment, policy, research, and advocacy. Surveillance must be nimble enough to quickly assess the magnitude of new transmission patterns as they emerge. Basic prevention strategies - community-based outreach and education, testing and counseling, and access to sterile injection equipment and opioid substitution therapies - must be scaled up and adapted to target groups in which new epidemics are emerging. All adults should be screened for hepatitis C, but special efforts must focus on groups with increased prevalence through community outreach and rapid testing. Government, industry, and payers must work together to assure full access to health services and antiviral drugs for everyone who is infected. Access to the new regimens must not be compromised by excessively high prices or arbitrary payer restrictions. Partnerships must be forged between hepatitis providers and programs that serve people who inject illicit drugs. Healthcare providers and systems, especially primary care practitioners, need education and training in treating hepatitis C and caring for substance-using populations. Services must be provided to the disadvantaged and stigmatized members of society who bear a disproportionate burden of the epidemic. Environments must be created where people who use drugs can receive prevention and treatment services without shame or stigma. Action is needed to end the policy of mass incarceration of people who use drugs, reduce the stigma associated with substance use, support the human rights of people who use drugs, expand social safety net services for the poor and the homeless, remove the legal barriers to hepatitis C prevention, and build public health infrastructure to reach, engage, and serve marginalized populations. Governments must take action to bring about these changes. Public health agencies must work with penal institutions to provide prevention and treatment services, including antiviral therapy, to those in need in jails and prisons or on probation or parole. Research is needed to guide efforts in each of these domains. Strong and sustained political advocacy will be needed to build and sustain support for these measures. Leadership must be provided by physicians, scientists, and the public health community in partnership with community advocates and people living with or at risk for hepatitis C. Eliminating hepatitis C from the United States is possible, but will require a sustained national commitment to reach, test, treat, cure, and prevent every case. With strong political leadership, societal commitment, and community support, hepatitis C can be eradicated in the United States. If this is to happen in our lifetimes, the time for action is now. This article forms part of a symposium in Antiviral Research on "Hepatitis C: next steps toward global eradication."
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Affiliation(s)
- Brian R Edlin
- Weill Cornell Medical College, New York, NY 10065, United States; National Development and Research Institutes, 71 West 23rd St., 4th floor, New York, NY 10010, United States.
| | - Emily R Winkelstein
- National Development and Research Institutes, 71 West 23rd St., 4th floor, New York, NY 10010, United States.
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32
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Taylor LE. Hepatitis C virus infection: from margin to center in rhode island and beyond. RHODE ISLAND MEDICAL JOURNAL (2013) 2014; 97:15-16. [PMID: 24983015 PMCID: PMC4374804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Physicians, Research Scientists and Public Health Experts Collaborate to Combat Rhode Island’s Hepatitis C Epidemic
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Affiliation(s)
- Lynn E Taylor
- Assistant Professor of Medicine, Division of Infectious Diseases, The Warren Alpert Medical School of Brown University
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Dean HD, Williams KM, Fenton KA. From theory to action: applying social determinants of health to public health practice. Public Health Rep 2014; 128 Suppl 3:1-4. [PMID: 24179272 DOI: 10.1177/00333549131286s301] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Affiliation(s)
- Hazel D Dean
- Hazel Dean is the Deputy Director of CDC's NCHHSTP. Kevin Fenton was the Director of CDC's NCHHSTP and is currently Director of Health and Wellbeing at Public Health England in London. Kim Williams is a Behavioral Scientist in the Division of HIV/AIDS Prevention at CDC's NCHHSTP
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