1
|
Timilsina A, Neupane P, Pandey J, Subedi A, Thapa S. Exploring the healthcare access challenges faced by visually impaired young women in Nepal: Navigating sexual harassment and stigma within healthcare settings. DIALOGUES IN HEALTH 2024; 4:100171. [PMID: 38516223 PMCID: PMC10953973 DOI: 10.1016/j.dialog.2024.100171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/25/2024] [Accepted: 01/25/2024] [Indexed: 03/23/2024]
Abstract
Introduction Despite global progress in gender equality, still not every woman has access to safe and the highest quality health care. Visually impaired young adult women represent one of the most vulnerable groups with a poorer ability to access necessary healthcare services. This study aims to explore and comprehend the experiences of visually impaired young adult women in accessing healthcare services in Nepal. Methods A descriptive phenomenological study was conducted among 16 visually impaired women aged 20 to 35 years who had utilized healthcare services within the past 12 months. Face-to-face, in-depth interviews were conducted for data collection, and thematic analysis was conducted for data analysis. Results Our study revealed a range of challenges faced by visually impaired young women that impeded their healthcare-seeking. These challenges included sexual harassment by male healthcare providers, disability-related stigma, financial difficulties, limited autonomy in decision-making, and a lack of disability-friendly healthcare facilities and services. Particularly, experiencing sexual harassment from male healthcare providers, coupled with underlying disability-related stigma, profoundly influenced the avoidance of healthcare. To navigate these challenges, some women sought support by having family members or friends accompany them or by requesting to be seen by a female healthcare provider. Nevertheless, financial dependence on families and women lacking employment and income led to a feeling of burden on the family, contributing to a reluctance among women to seek expensive healthcare. Social organization-based, collaborative efforts and peer support networks played a significant role in breaking down barriers and improving overall healthcare experiences. Conclusions While integrating disability-friendly healthcare services and infrastructure is essential, fostering attitudinal and behavioral change-particularly among male healthcare providers-is more important to ensure safety for young women in healthcare settings. The implementation of anti-sexual harassment policies is imperative to ensure a safe and respectful environment. Community mobilizing and peer group-based programs can be tested for increasing visually impaired women's utilization of relevant healthcare services.
Collapse
Affiliation(s)
- Amit Timilsina
- Department of Gender Studies, Tribhuvan University, Kathmandu, Nepal
- Department of Public Health, University of Southern Denmark, Esbjerg, Denmark
| | - Pabitra Neupane
- Department of Gender Studies, Tribhuvan University, Kathmandu, Nepal
| | | | - Aastha Subedi
- Central Department of Public Health, Tribhuvan University, Kathmandu, Nepal
| | - Subash Thapa
- Rural Health Research Institute, Charles Sturt University, Orange, New South Wales 2800, Australia
| |
Collapse
|
2
|
Borboudaki L, Linardakis M, Tsiligianni I, Philalithis A. Utilization of Health Care Services and Accessibility Challenges among Adults Aged 50+ before and after Austerity Measures across 27 European Countries: Secular Trends in the SHARE Study from 2004/05 to 2019/20. Healthcare (Basel) 2024; 12:928. [PMID: 38727485 PMCID: PMC11083176 DOI: 10.3390/healthcare12090928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/20/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
This study aimed to assess and compare the utilization of preventive and other health services and the cost or availability in different regions of Europe, before and during the economic crisis. The data used in the study were obtained from Wave 8 of the Survey of Health, Ageing and Retirement in Europe (2019/2020) and Wave 1 data (2004/5), with a sample size of 46,106 individuals aged ≥50 across 27 countries, adjusted to represent a population of N = 180,886,962. Composite scores were derived for preventive health services utilization (PHSU), health care services utilization (HCSU), and lack of accessibility/availability in health care services (LAAHCS). Southern countries had lower utilization of preventive services and higher utilization of other health services compared to northern countries, with a significant lack of convergence. Moreover, the utilization of preventive health services decreased, whereas the utilization of secondary care services increased during the austerity period. Southern European countries had a significantly higher prevalence of lack of accessibility. An increase in the frequency of lack of accessibility/availability in health care services was observed from 2004/5 to 2019/20. In conclusion, our findings suggest that health inequalities increase during crisis periods. Therefore, policy interventions could prioritize accessibility and expand health coverage and prevention services.
Collapse
Affiliation(s)
- Lena Borboudaki
- Department of Social Medicine, School of Medicine, University of Crete, 71500 Heraklion, Greece; (M.L.); (I.T.); (A.P.)
| | | | | | | |
Collapse
|
3
|
Askarzade E, Abolghasem Gorji H, Arabloo J. The Role of Supplementary Insurance in Achieving Universal Health Coverage: A Comprehensive Review. Med J Islam Repub Iran 2024; 38:28. [PMID: 38783981 PMCID: PMC11114190 DOI: 10.47176/mjiri.38.28] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Indexed: 05/25/2024] Open
Abstract
Background The gradual movement towards universal health coverage (UHC) is an important issue in many countries. The aim of this study is to identify the role of supplementary health insurance in achieving universal coverage. Methods This comprehensive review study was conducted to identify the role of supplementary health insurance in achieving universal health coverage. 4894 articles were found in the search in databases (Scopus, PubMed, and Web Science), and finally42 articles were selected. Considering the criteria of titles and abstracts, the reviewed articles were assessed, and a thematic analysis approach was used to analyze the collected data. Results The review showed 52 Sub dimensions in 7 dimensions. Policymakers can draw on international experiences to ensure that private health insurance contributes to achieving universal health coverage by Providing clarity within the national health financing policy framework regarding the role of private health insurance. Enhancing understanding of how supplementary health insurance impacts the performance of the healthcare system. They are improving oversight of private health insurance, regulating financial protection and consumer support, and implementing thorough market surveillance and proper allocation of health subsidies between the private and public sectors. Conclusion Supplementary insurance holds promise as a complementary tool in achieving universal health coverage. Addressing gaps in primary insurance and providing additional financial protection can contribute to enhanced access, improved quality of care, and reduced financial barriers to healthcare services. However, careful attention must be given to affordability, equity, regulation, and coordination with primary insurance schemes to ensure its effective implementation and prevent unintended consequences.
Collapse
Affiliation(s)
- Elahe Askarzade
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Hasan Abolghasem Gorji
- Department of Health Services Management, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
| | - Jalal Arabloo
- Health Management and Economics Research Center, Health Management Research Institute, Iran University of Medical Sciences, Tehran, Iran
| |
Collapse
|
4
|
Nymberg P, Milos Nymberg V, Calling S, Engström G, Svensson P, Elf J, Zöller B. Association between changed self-rated health and the risk of venous thromboembolism in Malmö Preventive Program: a cohort study. J Thromb Thrombolysis 2024; 57:497-502. [PMID: 38265738 PMCID: PMC10961270 DOI: 10.1007/s11239-023-02933-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/07/2023] [Indexed: 01/25/2024]
Abstract
Poor self-rated health (SRH) is associated with incident arterial cardiovascular disease in both sexes. Studies on the association between SRH and incident venous thromboembolism (VTE) show divergent results in women and no association in men. This study focuses on the association between change in SRH and incident VTE in a cohort of 11,558 men and 6682 women who underwent a baseline examination and assessment of SRH between 1974 and 1992 and a re-examination in 2002-2006. To investigate if changes in SRH over time affect the risk of incident VTE in men and women. During a follow-up time from the re-examination of more than 16 years, there was a lower risk for incident VTE among women if SRH changed from poor at baseline to very good/excellent (HR 0.46, 95% CI 0.28; 0.74) at the re-examination. Stable good SRH (good to very good/excellent at the re-examination, HR 0.60, 95% CI 0.42; 0.89), or change from good SRH at baseline into poor/fair at the re-examination (HR 0.68, 95% CI 0.51; 0.90) were all significantly associated with a reduced risk for VTE. All comparisons were done with the group with stable poor SRH. This pattern was not found among men. Regardless of a decreased or increased SRH during life, having an SRH of very good/excellent at any time point seems to be associated with a decreased risk of VTE among women.
Collapse
Affiliation(s)
- Peter Nymberg
- School of Health and Welfare, Halmstad University, Halmstad, Sweden.
| | - Veronica Milos Nymberg
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Region Skåne, Sweden
| | - Susanna Calling
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Region Skåne, Sweden
| | - Gunnar Engström
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Region Skåne, Sweden
| | - Peter Svensson
- Center for Thrombosis and Haemostasis, Department of Haematology, Skåne University Hospital, Malmö, Sweden
| | - Johan Elf
- Center for Thrombosis and Haemostasis, Department of Haematology, Skåne University Hospital, Malmö, Sweden
| | - Bengt Zöller
- Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Region Skåne, Sweden
| |
Collapse
|
5
|
Lin L, Zai X. Assessing the impact of public insurance on healthcare utilization and mortality: A nationwide study in China. SSM Popul Health 2024; 25:101615. [PMID: 38322784 PMCID: PMC10844660 DOI: 10.1016/j.ssmph.2024.101615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Revised: 12/29/2023] [Accepted: 01/24/2024] [Indexed: 02/08/2024] Open
Abstract
We investigate the effects of a significant health insurance expansion in rural China known as the New Cooperative Medical Scheme (NCMS). Our analysis is based on a nationwide dataset spanning from 2004 to 2011. We find that the NCMS effectively increases healthcare utilization, particularly inpatient admissions, and reduces the incidence for infectious diseases. In addition to the increased healthcare utilization, the reduction in the incidence for infectious diseases can be attributed to improved health knowledge and health behavior, both of which are associated with the expansion of insurance coverage. Our findings affirm the importance of insurance coverage in safeguarding low-income individuals from the adverse health consequences linked to infectious diseases.
Collapse
Affiliation(s)
- Lin Lin
- School of Public Management, East China Normal University, Shanghai, China
| | - Xianhua Zai
- Department of Labor Demography, Max Planck Institute for Demographic Research, Rostock, Germany
- Max Planck – University of Helsinki Center for Social Inequalities in Population Health, Rostock, Germany and Helsinki, Finland
| |
Collapse
|
6
|
Godoy-Bermúdez A, Rojo-Gallego-Burin A, Delgado-Márquez L, Martín-Martín JJ, Sánchez-Martínez MT, López del Amo-González MP. Variation in perceived health across gender, working status, educational level, and regional health care expenditure in Spain (2014-2017). PLoS One 2023; 18:e0269613. [PMID: 37450459 PMCID: PMC10348579 DOI: 10.1371/journal.pone.0269613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 06/21/2023] [Indexed: 07/15/2023] Open
Abstract
A gender perspective was used to analyze whether and how education, unemployment, and per capita public health expenditure were associated with perceived health among the Spanish population between the years 2014 and 2017. Using multilevel methodologies (looking at year, individual, and region) and linear and logistic specifications, we analyzed longitudinal microdata files from the Survey on Living Conditions. The results suggest that women with lower educational levels tend to report worse health than their more educated counterparts. On the other hand, women's bad health was not associated with unemployment, unlike men's. Regional per capita public health expenditure was not associated with perceived health in either men or women.
Collapse
|
7
|
Alamnia TT, Sargent GM, Kelly M. Patterns of Non-Communicable Disease, Multimorbidity, and Population Awareness in Bahir Dar, Northwest Ethiopia: A Cross-Sectional Study. Int J Gen Med 2023; 16:3013-3031. [PMID: 37465551 PMCID: PMC10351527 DOI: 10.2147/ijgm.s421749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 07/04/2023] [Indexed: 07/20/2023] Open
Abstract
Objective Ethiopia, like other developing countries, is going through an epidemiological transition, and high rates of non-communicable diseases (NCDs) are having a significant impact on the health system; however, there is limited evidence about community level NCD prevalence, multimorbidity, and population awareness that could inform targeted interventions and policy responses. This study aimed to identify factors associated with NCD prevalence, multimorbidity, and population awareness of NCDs in Bahir Dar, Northwest Ethiopia. Methods A community-based cross-sectional survey was conducted with 417 randomly sampled adults. We performed descriptive and logistic regression analyses to evaluate associations between NCD prevalence (cardiovascular diseases, diabetes, cancer, chronic respiratory diseases, chronic kidney disease, and hypertension) multimorbidity (2 or more NCDs) and demographic, socioeconomic, individual risk factors, anthropometrics, knowledge, and attitude. Results This study reveals that 24% of participating adults have an NCD, and 8% have multimorbidity. One-third (34.5%) have some NCD knowledge, and 75% consider NCDs more dangerous than communicable diseases. We find low NCD prevalence in participants: younger than 40 years of age (AOR 0.17, 95% CI 0.07 to 0.39); with normal body mass index (AOR 0.27, 0.10 to 0.77) and; with a family history of NCD (AOR 7.7, 4.2 to 14.1). Multimorbidity is lower in young adults (AOR 0.08, 0.03 to 0.26). NCD knowledge is higher in men (AOR 1.76, 1.06 to 2.93) and employed adults (AOR 2.91, 1.52 to 5.57), and NCD attitude in normal-weight adults (AOR 3.23, 1.42 to 7.39). Conclusion This study reveals a high prevalence of NCD and overall low NCD awareness in the population. Age above 40 years, family history of NCD, and weight in the obese category are significant predictors of NCD prevalence. These findings can help health professionals, health offices, and concerned stakeholders to plan targeted health interventions to reduce NCDs in the population.
Collapse
Affiliation(s)
- Tilahun Tewabe Alamnia
- College of Medical and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Ginny M Sargent
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Matthew Kelly
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| |
Collapse
|
8
|
Endalamaw A, Erku D, Khatri RB, Nigatu F, Wolka E, Zewdie A, Assefa Y. Successes, weaknesses, and recommendations to strengthen primary health care: a scoping review. Arch Public Health 2023; 81:100. [PMID: 37268966 DOI: 10.1186/s13690-023-01116-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 05/23/2023] [Indexed: 06/04/2023] Open
Abstract
BACKGROUND Primary health care (PHC) is a roadmap for achieving universal health coverage (UHC). There were several fragmented and inconclusive pieces of evidence needed to be synthesized. Hence, we synthesized evidence to fully understand the successes, weaknesses, effective strategies, and barriers of PHC. METHODS We followed the PRISMA extension for scoping reviews checklist. Qualitative, quantitative, or mixed-approach studies were included. The result synthesis is in a realistic approach with identifying which strategies and challenges existed at which country, in what context and why it happens. RESULTS A total of 10,556 articles were found. Of these, 134 articles were included for the final synthesis. Most studies (86 articles) were quantitative followed by qualitative (26 articles), and others (16 review and 6 mixed methods). Countries sought varying degrees of success and weakness. Strengths of PHC include less costly community health workers services, increased health care coverage and improved health outcomes. Declined continuity of care, less comprehensive in specialized care settings and ineffective reform were weaknesses in some countries. There were effective strategies: leadership, financial system, 'Diagonal investment', adequate health workforce, expanding PHC institutions, after-hour services, telephone appointment, contracting with non-governmental partners, a 'Scheduling Model', a strong referral system and measurement tools. On the other hand, high health care cost, client's bad perception of health care, inadequate health workers, language problem and lack of quality of circle were barriers. CONCLUSIONS There was heterogeneous progress towards PHC vision. A country with a higher UHC effective service coverage index does not reflect its effectiveness in all aspects of PHC. Continuing monitoring and evaluation of PHC system, subsidies to the poor, and training and recruiting an adequate health workforce will keep PHC progress on track. The results of this review can be used as a guide for future research in selecting exploratory and outcome parameters.
Collapse
Affiliation(s)
- Aklilu Endalamaw
- School of Public Health, The University of Queensland, Brisbane, Australia.
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Daniel Erku
- School of Public Health, The University of Queensland, Brisbane, Australia
- Centre for Applied Health Economics, School of Medicine, Griffith University, Brisbane, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Resham B Khatri
- School of Public Health, The University of Queensland, Brisbane, Australia
- Health Social Science and Development Research Institute, Kathmandu, Nepal
| | - Frehiwot Nigatu
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia
| | - Eskinder Wolka
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia
| | - Anteneh Zewdie
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, Australia
| |
Collapse
|
9
|
G C S, Adhikari N. Decomposing inequality in Maternal and Child Health (MCH) services in Nepal. BMC Public Health 2023; 23:995. [PMID: 37248553 DOI: 10.1186/s12889-023-15906-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 05/16/2023] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND About 75.5% of women in Nepal's urban areas receive at least four ANC visits, compared to 61.7% of women in the country's rural areas. Similarly, just 34% of women in the lowest wealth quintile give birth in a medical facility compared to 90% of women in the richest group. As a result of this inequality, the poor in emerging nations suffer since those who are better off can make greater use of the healthcare than those who are less fortunate. This study aims to examine and decompose the contributions of various socioeconomic factors towards MCH service inequality in Nepal in the years 2011 and 2016. METHODS Inequality in MCH services was estimated using concentration curves and their corresponding indices using data from Nepal Demographic Health Survey (NDHS) 2011 and 2016. We examined the inequality across three MCH service outcomes: less than 4 ANC visits, no postnatal checkups within 2 months of delivery and no SBA delivery and decomposed them across observed characteristics of the mothers aged between 15 and 49. Furthermore, Oaxaca-blinder decomposition approach was used to measure and decompose the inequality differential between two time periods. RESULTS Inequality in MCH services was prevalent for all 3 MCH outcomes in 2011 and 2016, respectively. However, the concentration indices for <4 ANC visits, no SBA delivery, and no postnatal checkups within 2 months of birth increased from -0.2184, -0.1643, and -0.1284 to -0.1871, -0.0504, and -0.0218 correspondingly, showing the decrease in MCH services inequality over two time periods. Wealth index, women's literacy, place of living, mother's employment status, and problem of distance to reach nearest health facility were the main contributors. CONCLUSION We find that MCH services are clearly biased towards the women with higher living standards. National policies should focus on empowering women through education and employment, along with the creation of health facilities and improved educational institutions, in order to address inequalities in living standards, women's education levels, and the problem of distance. Leveraging these factors can reduce inequality in MCH services.
Collapse
Affiliation(s)
- Shreezal G C
- Central Department of Economics, Tribhuvan University, Kirtipur, 44600, Kathmandu, Nepal.
| | - Naveen Adhikari
- Central Department of Economics, Tribhuvan University, Kirtipur, 44600, Kathmandu, Nepal
| |
Collapse
|
10
|
Long Q, Jiang H. Qualitative research in health: value and visibility. THE LANCET REGIONAL HEALTH. WESTERN PACIFIC 2023; 34:100790. [PMID: 37283968 PMCID: PMC10240377 DOI: 10.1016/j.lanwpc.2023.100790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 04/27/2023] [Indexed: 06/08/2023]
Affiliation(s)
- Qian Long
- Global Health Research Center, Duke Kunshan University, No.8 Duke Avenue, Kunshan, Jiangsu, China
| | - Hong Jiang
- School of Public Health, Key Lab of Health Technology Assessment (National Health Commission of the People's Republic of China), Fudan University, Mailbox 175, 138 Yixueyuan Road, Shanghai, 200032, China
| |
Collapse
|
11
|
Coube M, Nikoloski Z, Mrejen M, Mossialos E. Inequalities in unmet need for health care services and medications in Brazil: a decomposition analysis. LANCET REGIONAL HEALTH. AMERICAS 2023; 19:100426. [PMID: 36950032 PMCID: PMC10025415 DOI: 10.1016/j.lana.2022.100426] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Revised: 09/16/2022] [Accepted: 12/21/2022] [Indexed: 06/18/2023]
Abstract
Background Unmet need is a metric used to assess the performance of health care systems throughout the world. One of the primary objectives of the Brazilian health care system is to identify ways to improve the health outcomes of all citizens. To accomplish this challenging goal, the health care system in Brazil will need to identify and eliminate barriers and provide timely and adequate access to health care services to all. Methods This study assessed the performance of the Brazilian health care system by focusing on the unmet need for health care services and medications. We evaluated the Brazilian National Health Survey data collected in 2013 and 2019 to determine the magnitude of socioeconomic-related inequalities associated with unmet health care needs. Primary contributing factors were identified via decomposition analysis of the calculated concentration indices (CInds). Findings Despite the availability of universal health care, 3.8% and 7.5% of the population in Brazil reported unmet needs for health care services and medications, respectively in the 2019 survey. Although the overall unmet need for medications remained unchanged between 2013 and 2019, CInd analysis revealed significant pro-poor inequalities with respect to unmet needs for both health care services and medications. The overall magnitude of these inequalities was higher in the poorer regions of the country. The use of private health insurance as well as individual health and socioeconomic status contributed significantly to the inequalities associated with unmet needs for health care services and medication throughout Brazil. Interpretations Policy interventions should focus on improving access to health care services, extending coverage to include pharmaceuticals, and targeting both financial and non-financial barriers to obtaining care, particularly those experienced by the poor and vulnerable populations in Brazil. Funding None.
Collapse
Affiliation(s)
- Maíra Coube
- Fundação Getúlio Vargas, São Paulo, Brazil
- Instituto de Estudos para Políticas de Saúde (IEPS), São Paulo, Brazil
| | - Zlatko Nikoloski
- Department of Health Policy, London School of Economics and Political Science, London, WC2A 2AE, United Kingdom
| | - Matías Mrejen
- Instituto de Estudos para Políticas de Saúde (IEPS), São Paulo, Brazil
| | - Elias Mossialos
- Department of Health Policy, London School of Economics and Political Science, London, WC2A 2AE, United Kingdom
| |
Collapse
|
12
|
Pinilla JP, Román Brugnoli JA, Leyton Legües D, Vergara del Solar A. My Home Quarantine on an App: A Qualitative Visual Analysis of Changes in Family Routines During the COVID-19 Pandemic in Chile. QUALITATIVE SOCIOLOGY 2023; 46:1-24. [PMID: 36846825 PMCID: PMC9944783 DOI: 10.1007/s11133-023-09531-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/24/2023] [Indexed: 06/18/2023]
Abstract
This article presents original findings from a longitudinal qualitative study on changes in individual and family life associated with safety and health measures implemented during the COVID-19 pandemic in three regions of Chile. We developed a methodological approach based on multimodal diaries in a mobile application, in which participants submitted photographs and texts to express changes in their daily lives under residential confinement. Content and semiotic visual analyses show a significant loss in instances of collective recreation, partially compensated through new personal and productive activities performed at home. Our results suggest that modal diaries serve as potential tools to capture people's perceptions and meanings as their lives go through exceptional and traumatic times. We assert that using digital and mobile technologies in qualitative studies could allow subjects to actively participate in the co-construction of fieldwork and produce quality knowledge from their situated perspectives. Supplementary Information The online version contains supplementary material available at 10.1007/s11133-023-09531-z.
Collapse
Affiliation(s)
- Juan Pablo Pinilla
- School of Sociology, Faculty of Social Sciences, University of Valparaíso, El Litre 1028, Valparaíso, Chile
| | - José Antonio Román Brugnoli
- Department of Social Work, Faculty of Humanities and Social Communication Technologies, Institutional Programme for the Promotion of Research, Development and Innovation (PIDi), Metropolitan Technological University, Dieciocho 390, Santiago, Chile
| | - Daniela Leyton Legües
- Department of Sociology and Anthropology, Faculty of Social Sciences, University of Concepción, Víctor Lamas 1290, Concepción, Chile
| | - Ana Vergara del Solar
- School of Psychology, Faculty of Humanities, University of Santiago of Chile, 3650 Santiago, Chile
| |
Collapse
|
13
|
Mohammed AK, Munsamy AJ. Ophthalmic services utilisation and associated factors in the Ashanti region, Ghana. Ghana Med J 2023; 57:58-65. [PMID: 37576369 PMCID: PMC10416273 DOI: 10.4314/gmj.v57i1.9] [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: 08/15/2023] Open
Abstract
Objective This survey determined the utilisation of eye care services and associated factors among adults in the Ashanti region of Ghana. Design A population-based cross-sectional descriptive study. Method Data for this study was collected from 1615 randomly selected individuals in the Ashanti region of Ghana, using a structured, pretested interviewer-guided questionnaire. Information regarding the accessibility and determinants of, and barriers to, eye care services was based on self-reports, using the WHO Eye Care Services Assessment Questionnaire. Inferential analyses were performed using the chi-square test for statistical significance, set at p=0.05. Setting Ashanti Region, Ghana. Participants One thousand six hundred and fifteen randomly selected adults. Results Public eye care facilities were used by 58.2% of the participants for their last eye exam. Of the participants, 47.0% had travelled less than five kilometres for their last eye exam. Waiting time and service cost were participants' most frequently cited challenges in seeking care. No need felt (40.1%), self-medication (37.7%) and cost (22.2%) were the most frequently mentioned barriers to seeking ophthalmic services. Conclusion The major challenges encountered in seeking eye care services were waiting time and cost of service. Major barriers to ophthalmic services utilisation were no need felt, self-medication and cost. Factors such as cost, lack of felt need and self-medication, which serve as barriers to utilising eye care services, should be addressed by stake-holders through eye health education and promotion. Funding None declared.
Collapse
Affiliation(s)
- Abdul-Kabir Mohammed
- Discipline of Optometry, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
- Department of Optometry and Visual Science, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Alvin J Munsamy
- Discipline of Optometry, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
14
|
de Siqueira Filha NT, Li J, Phillips-Howard PA, Quayyum Z, Kibuchi E, Mithu MIH, Vidyasagaran A, Sai V, Manzoor F, Karuga R, Awal A, Chumo I, Rao V, Mberu B, Smith J, Saidu S, Tolhurst R, Mazumdar S, Rosu L, Garimella S, Elsey H. The economics of healthcare access: a scoping review on the economic impact of healthcare access for vulnerable urban populations in low- and middle-income countries. Int J Equity Health 2022; 21:191. [PMID: 36585704 PMCID: PMC9805259 DOI: 10.1186/s12939-022-01804-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 12/08/2022] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The growing urban population imposes additional challenges for health systems in low- and middle-income countries (LMICs). We explored the economic burden and inequities in healthcare utilisation across slum, non-slum and levels of wealth among urban residents in LMICs. METHODS This scoping review presents a narrative synthesis and descriptive analysis of studies conducted in urban areas of LMICs. We categorised studies as conducted only in slums, city-wide studies with measures of wealth and conducted in both slums and non-slums settlements. We estimated the mean costs of accessing healthcare, the incidence of catastrophic health expenditures (CHE) and the progressiveness and equity of health expenditures. The definitions of slums used in the studies were mapped against the 2018 UN-Habitat definition. We developed an evidence map to identify research gaps on the economics of healthcare access in LMICs. RESULTS We identified 64 studies for inclusion, the majority of which were from South-East Asia (59%) and classified as city-wide (58%). We found severe economic burden across health conditions, wealth quintiles and study types. Compared with city-wide studies, slum studies reported higher direct costs of accessing health care for acute conditions and lower costs for chronic and unspecified health conditions. Healthcare expenditures for chronic conditions were highest amongst the richest wealth quintiles for slum studies and more equally distributed across all wealth quintiles for city-wide studies. The incidence of CHE was similar across all wealth quintiles in slum studies and concentrated among the poorest residents in city-wide studies. None of the definitions of slums used covered all characteristics proposed by UN-Habitat. The evidence map showed that city-wide studies, studies conducted in India and studies on unspecified health conditions dominated the current evidence on the economics of healthcare access. Most of the evidence was classified as poor quality. CONCLUSIONS Our findings indicated that city-wide and slums residents have different expenditure patterns when accessing healthcare. Financial protection schemes must consider the complexity of healthcare provision in the urban context. Further research is needed to understand the causes of inequities in healthcare expenditure in rapidly expanding and evolving cities in LMICs.
Collapse
Affiliation(s)
| | - Jinshuo Li
- Department of Health Sciences, University of York, York, UK
| | | | - Zahidul Quayyum
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Eliud Kibuchi
- MRC/CSO Social &, University of Glasgow, Public Health Sciences Unit, Glasgow, UK
| | | | | | - Varun Sai
- The George Institute for Global Health, New Delhi, India
| | - Farzana Manzoor
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | | | - Abdul Awal
- James P Grant School of Public Health, BRAC University, Dhaka, Bangladesh
| | - Ivy Chumo
- African Population and Health Research Center, Nairobi, Kenya
| | - Vinodkumar Rao
- The Society for Promotion of Area Resource Centres, Mumbai, India
| | - Blessing Mberu
- African Population and Health Research Center, Nairobi, Kenya
| | - John Smith
- COMAHS: University of Sierra Leone, Freetown, Sierra Leone
| | - Samuel Saidu
- COMAHS: University of Sierra Leone, Freetown, Sierra Leone
| | - Rachel Tolhurst
- Liverpool School of Tropical Medicine, Department of International Public Health, Liverpool, UK
| | - Sumit Mazumdar
- University of York, Centre for Health Economics, York, UK
| | - Laura Rosu
- Liverpool School of Tropical Medicine, Department of Clinical Sciences, Liverpool, UK
| | | | - Helen Elsey
- Department of Health Sciences, University of York, York, UK
| |
Collapse
|
15
|
The Prevalence of HIV Infection in Minority Indigenous Populations of the South-East Asia and Western Pacific Regions: A Systematic Review and Meta-analysis. AIDS Behav 2022; 27:2226-2242. [PMID: 36543946 PMCID: PMC9771782 DOI: 10.1007/s10461-022-03954-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2022] [Indexed: 12/24/2022]
Abstract
A random effects meta-analysis was used to estimate the pooled prevalence of HIV infection within minority indigenous populations of the South-East Asia (SEAR) and Western Pacific Regions (WPR). Sub-group analyses were conducted, and the sources of heterogeneity explored through meta-regression. The majority of studies were undertaken in high HIV risk subpopulations. There was a paucity of data for many countries with data from China representing 70% of the comparative studies. Within minority indigenous populations the pooled prevalence of HIV infection was 13.7% (95% CI 8.9, 19) and 8.4% (95% CI 6.3, 10.7) among other populations. The prevalence differential between populations was significant in the WPR (adjusted odds ratio 1.1, 95% CI 1.0, 1.2). Across both regions, in contrast to other populations, minority indigenous did not experience any significant reduction in HIV prevalence over the years of data collection. There was large heterogeneity in the prevalence of HIV across studies.
Collapse
|
16
|
Munro J, Katmo ETR, Wetipo M. Hospital Births and Frontier Obstetrics in Urban West Papua. THE ASIA PACIFIC JOURNAL OF ANTHROPOLOGY 2022. [DOI: 10.1080/14442213.2022.2115121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
17
|
Arriaza A, Hambidge KM, Krebs NF, Garcés A, Channon AA. The trend in mean height of Guatemalan women born between 1945 and 1995: a century behind. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2022; 41:43. [PMID: 36109796 PMCID: PMC9476692 DOI: 10.1186/s41043-022-00324-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 09/07/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Adult height is a cumulative indicator of living standards with mean height increasing with a greater socio-economic level. Guatemalan adult women have the lowest mean height worldwide. The country's population is ethnically divided between indigenous and non-indigenous groups. This study aims to identify trends in the mean height for indigenous and non-indigenous adult women born between 1945 and 1995 in Guatemala and the association with individual, household and environmental factors. METHODS We used pooled data of adult women from five Demographic and Health Surveys. Mixed-effects multilevel linear regression models estimate the mean height associated with the explanatory variables. Mean height was modelled as a function of birth year cohort, wealth, education, geo-administrative regions and elevation. RESULTS The mean height increased 0.021 cm per year on average. The annual increase for indigenous women was 0.027 cm, while 0.017 cm for non-indigenous women. Height is associated with household wealth and women's education level. We found an interaction effect between ethnicity and household wealth, with indigenous women at the lowest quintile 0.867 cm shorter than the corresponding non-indigenous group. Height is associated with the geo-administrative region, those women in western regions being shorter than those in the metropolis. Mean height is reduced 0.980 cm for each 1000 m increase in elevation. CONCLUSIONS Guatemalan women have grown only 1 cm over half century, a slow improvement between 1945 and 1995, a period characterised by political instability and civil war. There are persistent inequalities in women's height associated with socio-economic status, education and attributes of the geographical context. These aspects need to be considered when implementing strategies to encourage growth. Further research is required to understand the evolution of adult height and the standard of living in post-war Guatemala.
Collapse
Affiliation(s)
- Astrid Arriaza
- Institute of Nutrition of Central America and Panama, Calzada Roosevelt, 6-25, Zona 11, Guatemala City, 01011 Guatemala
| | - K. Michael Hambidge
- University of Colorado School of Medicine, 12700 East 19th Avenue, Box C225, Aurora, CO 80045 USA
| | - Nancy F. Krebs
- University of Colorado School of Medicine, 12700 East 19th Avenue, Box C225, Aurora, CO 80045 USA
| | - Ana Garcés
- Institute of Nutrition of Central America and Panama, Calzada Roosevelt, 6-25, Zona 11, Guatemala City, 01011 Guatemala
| | - Andrew Amos Channon
- Centre for Global Health and Policy, University of Southampton, Southampton, UK
| |
Collapse
|
18
|
Xu R, Yue W, Wei F, Yang G, Chen Y, Pan K. Inequality of public facilities between urban and rural areas and its driving factors in ten cities of China. Sci Rep 2022; 12:13244. [PMID: 35918427 PMCID: PMC9344805 DOI: 10.1038/s41598-022-17569-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 07/27/2022] [Indexed: 11/09/2022] Open
Abstract
Urban development continues to face the dilemma of spatial inequality of public facilities, particularly educational and medical facilities. Identifying inequalities in various types of public facilities and their driving mechanisms is crucial in reducing social inequality. However, information on this topic is limited. This study took 10 typical cities in China as cases. We used the methods of the Gini coefficient and hedonic price model as bases in evaluating the equality of nine types of education and medical facilities, focusing on the differences between urban and rural areas. Moreover, we further analyzed the driving factors of facility equality. Results showed that equality of public facilities in urban areas was significantly higher than that in rural areas. Primary schools, middle schools, and health service centers were relatively equal, and kindergartens and pharmacies were unequal only in rural areas. However, the equality of facilities with large-size or commercial attributes was not optimistic. Furthermore, there remained a significant gap among counties (or districts), which was mainly driven by population, economy, and building density in the form of logarithm and logarithmic linear models. Our research contributes to an in-depth understanding of the inequality of public facilities and further supports decision-making to improve social equality.
Collapse
Affiliation(s)
- Ronghua Xu
- Department of Land Management, Zhejiang University, Zijingang Campus, 866 Yuhangtang Road, Hangzhou, 310058, Zhejiang, People's Republic of China
| | - Wenze Yue
- Department of Land Management, Zhejiang University, Zijingang Campus, 866 Yuhangtang Road, Hangzhou, 310058, Zhejiang, People's Republic of China.
| | - Feiyang Wei
- School of Design and Environment, National University of Singapore, Singapore, 117566, Singapore
| | - Guofu Yang
- Artistic Design & Creation School, Zhejiang University City College, Hangzhou, 310015, People's Republic of China
| | - Yi Chen
- College of Life Sciences, Zhejiang University, Hangzhou, 310058, People's Republic of China
| | - Kaixuan Pan
- Institute of Environmental Science, Leiden University, Einsteinweg 2, 2333 CC, Leiden, The Netherlands
| |
Collapse
|
19
|
Bullied Because of Their Teeth: Evidence from a Longitudinal Study on the Impact of Oral Health on Bullying Victimization among Australian Indigenous Children. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19094995. [PMID: 35564388 PMCID: PMC9101169 DOI: 10.3390/ijerph19094995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 04/07/2022] [Accepted: 04/15/2022] [Indexed: 02/01/2023]
Abstract
Making life better for Indigenous peoples is a global priority. Although bullying and oral health have always been a topic of concern, there is limited information regarding the impact of this problem on the general population, with no evidence in this regard among the Australian Indigenous population. Thus, we aimed to quantify the relationship between bullying victimization and oral health problems by remoteness among 766 Australian Indigenous children aged between 10−15-years using data from the LSIC study. Bivariate and multilevel mixed-effect logistic regression analyses were employed. Findings indicated children self-reported bullying more than parents reported their children were being bullied (44% vs. 33.6%), with a higher percentage from rural/remote areas than urban areas. Parents reported that oral health problems increased the probability (OR 2.20, p < 0.05) of being bullied, in Indigenous children living in urban areas. Racial discrimination, lower level of parental education and poor child oral hygiene increase the risk of bullying victimization. Parental happiness with life and a safe community were associated with a lower risk of bullying. Dental problems are linked with Australian Indigenous children experiencing bullying victimization. Cultural resilience and eliminating discrimination may be two modifiable paths to ameliorating health issues associated with bullying in the Australian Indigenous community.
Collapse
|
20
|
Bauknecht J, Merkel S. Differences in self-reported health between low- and high-income older persons in 2002 and 2018. A cohort study based on the European Social Survey. HEALTH POLICY OPEN 2022. [DOI: 10.1016/j.hpopen.2022.100070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
|
21
|
Mukherjee M, Awasthi P. Involuntary Cultural Change and Mental Health Status Among Indigenous Groups: A Synthesis of Existing Literature. Community Ment Health J 2022; 58:222-230. [PMID: 33721141 DOI: 10.1007/s10597-021-00813-w] [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: 08/19/2020] [Accepted: 03/05/2021] [Indexed: 10/21/2022]
Abstract
Indigenous groups throughout the world have experienced social exclusion and have been subjected to marginalization. Globalization has resulted in significant changes in traditional lifestyles and developmental programs have not been successful in integrating Indigenous people into communities with non-Indigenous people. Although there is substantial research on acculturation and adaptation within the field of cross-cultural psychology, there are few narrative reviews of this literature. The present paper provides such a review and examines the mental health concerns of Indigenous groups undergoing acculturation. We address the consequences of involuntary cultural change and review studies that have been conducted on mental health issues, psychosomatic symptoms, substance use, and suicidality in Indigenous groups. We conclude by offering suggestions to mitigate mental health problems. Directions for future research on the acculturation of Indigenous groups are also provided.
Collapse
Affiliation(s)
- Madhurima Mukherjee
- Department of Psychology, Banaras Hindu University, Varanasi, 221005, India.
| | - Purnima Awasthi
- Department of Psychology, Banaras Hindu University, Varanasi, 221005, India
| |
Collapse
|
22
|
Trends in absolute and relative educational inequalities in health during times of labour market restructuring in coastal areas: The HUNT Study, Norway. Soc Sci Med 2021; 292:114541. [PMID: 34799180 DOI: 10.1016/j.socscimed.2021.114541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 10/04/2021] [Accepted: 11/04/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Restructuring labour markets offers natural population-level experiments of great social epidemiological interest. Many coastal areas have endured substantial restructuring of their local labour markets following declines in small-scale fishing and transitions to new employment opportunities. It is unknown how educational inequalities in health have developed in formerly fishery-dependent communities during such restructuring. In this study, we compare trends in social inequalities in health in Norwegian coastal areas with adjacent geographical areas between 1984 and 2019. METHODS We used cross-sectional population-based data from the Trøndelag Health Study (HUNT), collected four times: HUNT1 (1984-86), HUNT2 (1995-97), HUNT3 (2006-08) and HUNT4 (2017-19). Adults above 30 years of age were included. Using Poisson regression, we calculated absolute and relative educational inequalities in self-rated health, using slope (SII) and relative (RII) indices of inequality. RESULTS Trends in absolute and relative inequalities in rural coastal health were generally more favourable than in adjacent geographical areas. We found a statistically significant trend of declining relative educational inequalities in self-rated health in the rural coastal population from HUNT1 to HUNT4. Absolute inequalities overall increased from HUNT1 to HUNT4, although a declining trend followed HUNT2. Nonetheless, the rural coastal population exhibited the highest prevalence of poor self-rated health across the four decades. CONCLUSIONS Although absolute educational inequalities in self-rated health widened in all geographical areas, the smallest increase was in rural coastal areas. Relative educational inequalities narrowed in this rural coastal population. Considering the concurrent processes of large-scale investments in the Norwegian public sector and welfare schemes, increased fishing fleet safety, and employment opportunities in aquaculture, our findings do not suggest that potential positive effects on public health of this restructuring have benefitted inhabitants with higher educational attainment more than inhabitants with lower educational attainment in this rural coastal population.
Collapse
|
23
|
Lopes de Oliveira T, Oliveira RVCD, Griep RH, Moreno AB, Almeida MDCCD, Almquist YB, Fonseca MDJMD. Brazilian Longitudinal Study of Adult Health (ELSA-Brasil) participant's profile regarding self-rated health: a multiple correspondence analysis. BMC Public Health 2021; 21:1761. [PMID: 34579683 PMCID: PMC8474707 DOI: 10.1186/s12889-021-11760-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 09/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Self-rated health (SRH) - one of the most common health indicators used to verify health conditions - can be influenced by several types of socioeconomic conditions, thereby reflecting health inequalities. This study aimed to evaluate the participant profiles regarding the association between self-rated health and social and occupational characteristics of the Brazilian Longitudinal Study of Adult Health (ELSA-Brasil). METHODS Cross-sectional design, including 11,305 individuals. Self-rated health was categorized as good, fair, and poor. The relationship between socio-demographic, psychosocial work environment, health-related variables, and self-rated health was analyzed by multiple correspondence analysis (stratified by age: up to 49 years old and 50 years old or more). RESULTS For both age strata, group composition was influenced by socioeconomic conditions. Poor SRH was related to lower socioeconomic conditions, being women, black self-declared race/ethnicity, being non-married/non-united, low decision authority, low skill discretion, and obesity. CONCLUSION To promote health, interventions should focus on reducing existing socioeconomic, race, and gender inequalities in Brazil.
Collapse
Affiliation(s)
- Thaís Lopes de Oliveira
- Department of Epidemiology and Quantitative Methods in health. National School of Public Health, Oswaldo Cruz Foundation, 1480, Manguinhos, Rio de Janeiro, RJ, 21041-210, Brazil
| | | | - Rosane Harter Griep
- Laboratory of Health and Environment Education, Oswaldo Cruz Institute, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Arlinda B Moreno
- Department of Epidemiology and Quantitative Methods in health. National School of Public Health, Oswaldo Cruz Foundation, 1480, Manguinhos, Rio de Janeiro, RJ, 21041-210, Brazil
| | | | - Ylva Brännström Almquist
- Department of Public Health Sciences, Centre for Health Equity Studies (CHESS), Stockholm University, Stockholm, Sweden
| | - Maria de Jesus Mendes da Fonseca
- Department of Epidemiology and Quantitative Methods in health. National School of Public Health, Oswaldo Cruz Foundation, 1480, Manguinhos, Rio de Janeiro, RJ, 21041-210, Brazil.
| |
Collapse
|
24
|
Denhard L, Kaviany P, Chicumbe S, Muianga C, Laisse G, Aune K, Sheffel A. How prepared is Mozambique to treat COVID-19 patients? A new approach for estimating oxygen service availability, oxygen treatment capacity, and population access to oxygen-ready treatment facilities. Int J Equity Health 2021; 20:90. [PMID: 33823863 PMCID: PMC8022128 DOI: 10.1186/s12939-021-01403-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/07/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND This study aims to assess the COVID-19 response preparedness of the Mozambican health system by 1) determining the location of oxygen-ready public health facilities, 2) estimating the oxygen treatment capacity, and 3) determining the population coverage of oxygen-ready health facilities in Mozambique. METHODS This analysis utilizes information on the availability of oxygen sources and delivery apparatuses to determine if a health facility is ready to deliver oxygen therapy to patients in need, and estimates how many patients can be treated with continuous oxygen flow for a 7-day period based on the available oxygen equipment at health facilities. Using GIS mapping software, the study team modeled varying travel times to oxygen-ready facilities to estimate the proportion of the population with access to care. RESULTS 0.4% of all health facilities in Mozambique are prepared to deliver oxygen therapy to patients, for a cumulative total of 283.9 to 406.0 patients-weeks given the existing national capacity, under varying assumptions including ability to divert oxygen from a single source to multiple patients. 35% of the population in Mozambique has adequate access within one-hour driving time of an oxygen-ready health facility. This varies widely by region; 89.1% of the population of Maputo City was captured by the one-hour driving time network, as compared ot 4.4% of the population of Niassa province. CONCLUSIONS The Mozambican health system faces the dual challenges of under-resourced health facilities and low geographic accessibility to healthcare as it prepares to confront the COVID-19 pandemic. This analysis also illustrates the disparity between provinces in preparedness to deliver oxygen therapy to patient, with Cabo Delgado and Nampula being particularly under-resourced.
Collapse
Affiliation(s)
- Langan Denhard
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - Parisa Kaviany
- Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Sérgio Chicumbe
- Programa de Sistemas de Saúde, Instituto Nacional de Saúde, Maputo, Mozambique
| | | | | | - Kyle Aune
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Ashley Sheffel
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
25
|
Bartoll-Roca X, Palència L, Gotsens M, Borrell C. Socioeconomic inequalities in self-assessed health and mental health in Barcelona, 2001-2016. GACETA SANITARIA 2021; 36:452-458. [PMID: 33771401 DOI: 10.1016/j.gaceta.2021.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 02/13/2021] [Accepted: 02/15/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Previous research has found persistent socioeconomic inequalities in health outcomes at the national level, with different patterns after the economic crisis. However, inequalities in urban areas are also important. This study analyses socioeconomic inequalities in self-assessed health and mental health in the city of Barcelona. METHOD Repeated cross-sectional design using quinquennial data from the Barcelona Health Surveys carried out in 2001, 2006, 2011 and 2016 for the population older than 22 years. Robust Poisson regressions models were used to compute socioeconomic gradients and relative (RII) and slope indexes of inequality (SII) by occupational social class, with stratification by sex. RII and SII were also obtained with further adjustment by employment situation. RESULTS A consistent socioeconomic gradient was found for all years except for 2011. Relative and absolute inequalities followed a V-shape, showing a drop during the economic crisis but widening thereafter to recover pre-crisis figures for self-assessed health and widening for mental health, in both relative and absolute terms in 2016. Adjustment for employment situation reduces inequalities but a large part of these inequalities remains, with variability across years. CONCLUSIONS The lasting effects of the 2008 economic crisis and the austerity programmes imposed since then may have contributed to the persistence of socioeconomic inequalities in self-assessed health and the widening of those for mental health.
Collapse
Affiliation(s)
- Xavier Bartoll-Roca
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain.
| | - Laia Palència
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Mercè Gotsens
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| |
Collapse
|
26
|
Moyano M, Lobato RM, Ventsislavova P, Trujillo HM. Social inclusion level of Spanish and foreign adolescents: Proposal for an evaluation instrument. CURRENT PSYCHOLOGY 2020; 41:6880-6893. [PMID: 33230381 PMCID: PMC7673581 DOI: 10.1007/s12144-020-01201-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 11/26/2022]
Abstract
Social exclusion is one of the most complex and sensitive social problems nowadays. Of all social groups, adolescents are among the most vulnerable to social exclusion, which can interfere with their social development. Consequently, the evaluation of this construct in adolescents is an important matter. The aim of this investigation was to develop the Social Inclusion for Adolescents Scale (SIAS). Firstly, five psychosocial factors were proposed, which potentially contribute to social inclusion: (1) covered needs, (2) self-efficacy, (3) social support, (4) job training, and (5) social integration. From these five factors, a set of items was created and reduced using qualitative evaluations. The final set of items was used in three studies, with a Spanish population (N = 1540) and a foreign population (N = 460), to test the psychometric properties of the scale, its dimensional structure, the measurement invariance between Spanish and foreign people, the reliability of the instrument and the evidence of the validity of its measurements. The results indicate that this scale is psychometrically reliable enough to assess social inclusion in adolescents. Supplementary Information The online version contains supplementary material available at 10.1007/s12144-020-01201-5.
Collapse
Affiliation(s)
- Manuel Moyano
- Department of Psychology, University of Cordoba, Cordoba, Spain
| | - Roberto M. Lobato
- Research & Projects Department, Euro-Arab Foundation for Higher Studies, C/ San Jerónimo, 27, 18001 Granada, Spain
| | - Petya Ventsislavova
- Department of Psychology, Nottingham Trent University, Nottingham, Great Britain
| | - Humberto M. Trujillo
- Department of Methodology for Behavioral Sciences, University of Granada, Granada, Spain
| |
Collapse
|
27
|
Stone B, Sambo J, Sawadogo-Lewis T, Roberton T. When it rains, it pours: detecting seasonal patterns in utilization of maternal healthcare in Mozambique using routine data. BMC Health Serv Res 2020; 20:950. [PMID: 33059682 PMCID: PMC7559485 DOI: 10.1186/s12913-020-05807-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 10/07/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Climatic conditions and seasonal trends can affect population health, but typically, we consider the effect of climate on the epidemiology of communicable diseases. However, climate can also have an effect on access to care, particularly in remote rural areas of low- and middle-income countries. In this study, we investigate associations between the rainy season and the utilization of maternal health services in Mozambique. METHODS We examined patterns in the number of women receiving antenatal care (ANC) and delivering at a health facility for 2012-2019, using data from Mozambique's Health Management Information Systems. We investigated the association between seasonality (rainfall) and maternal health service utilization (ANC and institutional delivery) at national and provincial level. We fit a negative binomial regression model for institutional delivery and used it to estimate the yearly reduction in institutional deliveries due to the rainy season, with other factors held constant. We used the Lives Saved Tool (LiST) to model increases in mortality due to this estimated decrease in institutional delivery associated with the rainy season. RESULTS In our national analysis, the rate of ANC visits was 1% lower during the rainy season, adjusting for year and province (IRR = 0.99, 95% CI: 0.96-1.03). The rate of institutional deliveries was 6% lower during the rainy season than the dry season, after adjusting for time and province (IRR = 0.94, 95% CI: 0.92-0.96). In provincial analyses, all provinces except for Maputo-Cidade, Maputo-Province, Nampula, and Niassa showed a statistically significantly lower rate of institutional deliveries in the rainy season. None were statistically significantly lower for ANC. We estimate that, due to reductions in institutional delivery attributable only to the rainy season, there were 74 additional maternal deaths and 726 additional deaths of children under the age of 1 month in 2021, that would not have died if the mothers had instead delivered at a facility. CONCLUSION Fewer women deliver at a health facility during the rainy season in Mozambique than during the dry season. Barriers to receiving care during pregnancy and childbirth must be addressed using a multisectoral approach, considering the impact of geographical inequities.
Collapse
Affiliation(s)
- Briana Stone
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Júlia Sambo
- Instituto Nacional de Saúde, Ministério da Saúde, Maputo, Mozambique
| | | | - Timothy Roberton
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|
28
|
Roxo L, Bambra C, Perelman J. Gender Equality and Gender Inequalities in Self-Reported Health: A Longitudinal Study of 27 European Countries 2004 to 2016. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2020; 51:146-154. [PMID: 33019863 PMCID: PMC8114429 DOI: 10.1177/0020731420960344] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Significant gender-based health inequalities have been observed across Europe, with women reporting worse health than men. Still, there has been little examination of how the gender–health gap has changed over time, and how it has been shaped by societal gender equality. We used data from the Statistics on Income and Living Conditions Eurostat database (EU-SILC), involving 2,931,081 participants aged 25–64, for 27 European countries. Logistic regressions were performed to model the association between self-reported bad health and gender, in general and over time. Analyses were stratified by employment, education, and clusters of countries according to levels of Gender Equality Index (GEI). Adjusting for age, year, and country, bad health was 17% more likely among women, but this disadvantage ceased after accounting for education and employment. Gender–health inequalities were larger among countries with higher GEI scores and among low-educated groups. The gender–health gap did not reduce significantly between 2004 and 2016, in general and within subgroups. Although societies are becoming more equal, persistent inequalities in employment and income still lead to sustained health differences between men and women.
Collapse
Affiliation(s)
- Luis Roxo
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Clare Bambra
- Faculty of Medical Sciences, Institute for Population Health Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Julian Perelman
- NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisbon, Portugal.,Public Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa, Lisboa, Portugal
| |
Collapse
|
29
|
Elran-Barak R, Mozeikov M. One Month into the Reinforcement of Social Distancing due to the COVID-19 Outbreak: Subjective Health, Health Behaviors, and Loneliness among People with Chronic Medical Conditions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E5403. [PMID: 32727103 PMCID: PMC7432045 DOI: 10.3390/ijerph17155403] [Citation(s) in RCA: 67] [Impact Index Per Article: 16.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 07/15/2020] [Accepted: 07/24/2020] [Indexed: 12/15/2022]
Abstract
We sought to examine how the near-lockdown measures, announced by the Israeli government in an effort to contain the COVID-19 outbreak, impacted the self-rated health (SRH), health behaviors, and loneliness of people with chronic illnesses. An online cross-sectional survey was carried out about one month (April 20-22, 2020) after the Israeli government reinforced the severe social distancing regulations, among a convenience sample of 315 participants (60% women) with chronic conditions (27% metabolic, 17% cardiovascular, 21% cancer/autoimmune, 18% orthopedic/pain, 12% mental-health). Results suggested that about half of the participants reported a decline in physical or mental SRH, and as many as two-thirds reported feeling lonely. A significant deterioration in health behaviors was reported, including a decrease in vegetable consumption (p = 0.008) and physical activity (p < 0.001), an increase in time spent on social media (p < 0.001), and a perception among about half of the participants that they were eating more than before. Ordinal regression suggested that a decline in general SRH was linked with female gender (p = 0.016), lack of higher education (p = 0.015), crowded housing conditions (p = 0.001), longer illness duration (p = 0.010), and loneliness (p = 0.008). Findings highlight the important role of loneliness in SRH during the COVID-19 lockdown period. Future studies are warranted to clarify the long-term effects of social-distancing and loneliness on people with chronic illnesses.
Collapse
Affiliation(s)
- Roni Elran-Barak
- School of Public Health, Faculty of Social Welfare and Health Sciences, University of Haifa, Haifa 3498838, Israel;
| | | |
Collapse
|
30
|
Mahumud RA, Alam K, Keramat SA, Renzaho AMN, Hossain MG, Haque R, Ormsby GM, Dunn J, Gow J. Wealth stratified inequalities in service utilisation of breast cancer screening across the geographical regions: a pooled decomposition analysis. ACTA ACUST UNITED AC 2020; 78:32. [PMID: 32528677 PMCID: PMC7285540 DOI: 10.1186/s13690-020-00410-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 03/18/2020] [Indexed: 11/10/2022]
Abstract
Background Breast cancer is the most commonly occurring cancer among women in low-resourced countries. Reduction of its impacts is achievable with regular screening and early detection. The main aim of the study was to examine the role of wealth stratified inequality in the utilisation breast cancer screening (BCS) services and identified potential factors contribute to the observed inequalities. Methods A population-based cross-sectional multi-country analysis was used to study the utilisation of BCS services. Regression-based decomposition analyses were applied to examine the magnitude of the impact of inequalities on the utilisation of BCS services and to identify potential factors contributing to these outcomes. Observations from 140,974 women aged greater than or equal to 40 years were used in the analysis from 14 low-resource countries from the latest available national-level Demographic and Health Surveys (2008-09 to 2016). Results The population-weighted mean utilisation of BCS services was low at 15.41% (95% CI: 15.22, 15.60), varying from 80.82% in European countries to 25.26% in South American countries, 16.95% in North American countries, 15.06% in Asia and 13.84% in African countries. Women with higher socioeconomic status (SES) had higher utilisation of BCS services (15%) than those with lower SES (9%). A high degree of inequality in accessing and the use of BCS services existed in all study countries across geographical areas. Older women, access to limited mass media communication, being insured, rurality and low wealth score were found to be significantly associated with lower utilisation of BCS services. Together they explained approximately 60% in the total inequality in utilisation of BCS services. Conclusions The level of wealth relates to the inequality in accessing BCS amongst reproductive women in these 14 low-resource countries. The findings may assist policymakers to develop risk-pooling financial mechanisms and design strategies to increase community awareness of BCS services. These strategies may contribute to reducing inequalities associated with achieving higher rates of the utilisation of BCS services.
Collapse
Affiliation(s)
- Rashidul Alam Mahumud
- School of Social Sciences and Psychology, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia.,Translational Health Research Institute (THRI), Western Sydney University, Sydney, NSW Australia.,Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, QLD 4350 Australia.,School of Commerce, University of Southern Queensland, Toowoomba, QLD 4350 Australia.,Health Economics and Financing Research, International Centre for Diarrhoeal Disease Research, Dhaka, 1212 Bangladesh
| | - Khorshed Alam
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, QLD 4350 Australia.,School of Commerce, University of Southern Queensland, Toowoomba, QLD 4350 Australia
| | - Syed Afroz Keramat
- Department of Economics, American International University-Bangladesh (AIUB), Dhaka, 1212 Bangladesh
| | - Andre M N Renzaho
- School of Social Sciences and Psychology, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751 Australia.,Translational Health Research Institute (THRI), Western Sydney University, Sydney, NSW Australia
| | - Md Golam Hossain
- Health and Epidemiological Research Group, Department of Statistics, University of Rajshahi, Rajshahi, 6205 Bangladesh
| | - Rezwanul Haque
- Department of Economics, American International University-Bangladesh (AIUB), Dhaka, 1212 Bangladesh
| | - Gail M Ormsby
- Professional Studies, Faculty of Business, Education, Law and Arts, University of southern Queensland, Toowoomba, QLD 4350 Australia
| | - Jeff Dunn
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, QLD 4350 Australia.,Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD 4006 Australia.,Prostate Cancer Research Foundation of Australia, St Leonards, NSW 2065 Australia
| | - Jeff Gow
- Health Economics and Policy Research, Centre for Health, Informatics and Economic Research, University of Southern Queensland, Toowoomba, QLD 4350 Australia.,School of Commerce, University of Southern Queensland, Toowoomba, QLD 4350 Australia.,School of Accounting, Economics and Finance, University of KwaZulu-Natal, Durban, 4000 South Africa
| |
Collapse
|
31
|
NENA E, FASOULAKIS Z, TRYPSIANIS G, CONSTANTINIDIS T, KONTOMANOLIS E. Attitudes and thoughts of medical practitioners towards their profession in the era of financial crisis in Greece. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2020; 61:E60-E65. [PMID: 32490270 PMCID: PMC7225647 DOI: 10.15167/2421-4248/jpmh2020.61.1.839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Accepted: 12/17/2019] [Indexed: 11/16/2022]
Abstract
Introduction The financial crisis which started in Greece about 10 years ago has affected the income of citizens, their quality of life, as well as social and occupational relationships. Aim of the present study was to assess the attitudes towards working conditions and personal life and to explore quality of life, as well as disorders in physical condition, sleep, mood and their predictors, among doctors working or being trained in a tertiary hospital of NE Greece. Methods Included were 133 medical students and doctors of all ranks (61.7% males) practicing medicine in a university tertiary hospital in Greece. All of them answered a 31-item questionnaire regarding their working conditions, and personal life, daytime activities and sleeping habits. Results In general, the majority reported dissatisfaction with the work environment, the salary and they rated their quality of life worse than that of the general population. Weekly workload exceeded 60 hours for the majority. No difference between sexes was revealed, with the exception of use of energy drinks which was more prevalent in males (70.7% vs. 51%, p = 0.022). Comparison between ranks revealed that medical students performed better in everyday activities and socialization, although prevalence of reported fatigue was higher in them. Finally, it was demonstrated that surgeons used more frequently medication to achieve sleep promotion (80.4% vs. 36%, p < 0.001) and daily energy (78.4% vs. 44%, p < 0.001). Conclusions An overall dissatisfaction regarding workload, salary and quality of life is recorded among doctors of a tertiary hospital in Greece, with different coping strategies among subgroups.
Collapse
Affiliation(s)
- E. NENA
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace Alexandroupolis, Greece
- Correspondence: Evangelia Nena, Laboratory of Hygiene and Environmental Protection Medical School, Democritus University of Thrace, University Campus, Dragana 68100, Alexandroupolis, Greece - Tel. +30 2551030638 - E-mail:
| | - Z. FASOULAKIS
- Department of Obstetrics and Gynecology, Medical School, Democritus University of Thrace Alexandroupolis, Greece
| | - G. TRYPSIANIS
- Laboratory of Medical Statistics, Medical School, Democritus University of Thrace, Alexandroupolis, Greece
| | - T.C. CONSTANTINIDIS
- Laboratory of Hygiene and Environmental Protection, Medical School, Democritus University of Thrace Alexandroupolis, Greece
| | - E. KONTOMANOLIS
- Department of Obstetrics and Gynecology, Medical School, Democritus University of Thrace Alexandroupolis, Greece
| |
Collapse
|
32
|
Bayesian analysis of Turkish Income and Living Conditions data, using clustered longitudinal ordinal modelling with Bridge distributed random effects. STAT MODEL 2020. [DOI: 10.1177/1471082x20920122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article is motivated by the panel surveys, called Statistics on Income and Living Conditions (SILC), conducted annually on (randomly selected) country representative households to monitor EU 2020 aims on poverty reduction. We particularly consider the surveys conducted in Turkey within the scope of integration to the EU. Our main interests are on health aspects of economic and living conditions. The outcome is self-reported health that is clustered longitudinal ordinal, since repeated measures of it are nested within individuals and individuals are nested within families. Economic and living conditions have been measured through a number of individual- and family-level explanatory variables. The questions of interest are on the marginal relationships between the outcome and covariates that we address using a polytomous logistic regression with Bridge distributed random effects. This choice of distribution allows us to directly obtain marginal inferences in the presence of random effects. Widely used Normal distribution is also considered as the random effects distribution. Samples from the joint posterior densities of parameters and random effects are drawn using Markov Chain Monte Carlo. Interesting findings from the public health point of view are that differences were found between the subgroups of employment status, income level and panel year in terms of odds of reporting better health.
Collapse
|
33
|
Zhou Y, Guo Y, Liu Y. Health, income and poverty: evidence from China's rural household survey. Int J Equity Health 2020; 19:36. [PMID: 32178686 PMCID: PMC7076955 DOI: 10.1186/s12939-020-1121-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 01/01/2020] [Indexed: 11/30/2022] Open
Abstract
Background Understanding the health status of the poor households and the influence of unhealthy on their income can provide some vital insights into the effectiveness and appropriateness of poverty reduction solutions. Methods Based on a nationwide cross-sectional survey of 29,712 rural poor households, this study systematically investigated the causes of poverty and health status of Chinese rural poor households, and revealed the relationship between health, income and poverty. Results The health status of the rural poor in China is not optimistic, with 51.63% attributing their poverty to the illness of household members. NCDs are the biggest health threat to the rural poor in China. Over 60% of all the households have at least one patient and more than a quarter of the households with patients cannot afford expensive medical expenses. Although 98% of all the households participate in China’s a rural health insurance system - the New Rural Cooperative Medical Scheme - 16% are still unable to bear their medical expenses after reimbursement from the scheme. Further, high altitude, ill-health and low-income are interlinked and mutually reinforcing. The per capita net income of poor households was inversely proportional to the altitude of their places of residence, family aging and unhealthy status, but was positively correlated with the number of workforces in their families. Conclusions Poverty due to illness is one of the root causes of rural poverty in China. With the backward medical infrastructure in high altitude areas, people are more prone to fall into the vicious circle of poverty-unhealthy-low income-poverty. The establishment of effective long-term mechanism of disease prevention and intervention is an important prerequisite to enhance the endogenous development power of the poor and reduce poverty.
Collapse
Affiliation(s)
- Yang Zhou
- Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101, China. .,Key Laboratory of Regional Sustainable Development Modeling, Chinese Academy of Sciences, Beijing, 100101, China. .,University of Chinese Academy of Sciences, Beijing, 100049, China.
| | - Yuanzhi Guo
- Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101, China.,Key Laboratory of Regional Sustainable Development Modeling, Chinese Academy of Sciences, Beijing, 100101, China
| | - Yansui Liu
- Institute of Geographic Sciences and Natural Resources Research, Chinese Academy of Sciences, Beijing, 100101, China.,Key Laboratory of Regional Sustainable Development Modeling, Chinese Academy of Sciences, Beijing, 100101, China.,University of Chinese Academy of Sciences, Beijing, 100049, China
| |
Collapse
|
34
|
Gomez-Baya D, Salinas-Perez JA, Rodero-Cosano ML, Alvarez-Galvez J. Socioeconomic Inequalities in Health Through Lifestyles: Analysing Gender and Age Differences in Andalusia, Spain. J Community Health 2020; 45:836-845. [PMID: 32103379 DOI: 10.1007/s10900-020-00800-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This research aims to analyse the association between socioeconomic status (SES) and self-rated health (SRH) through its relationship with lifestyle factors, as well as examining these effects stratified by gender and age groups. A cross-sectional study was performed with a representative sample from Andalusia (Southern Spain) composed of 1200 adults. The study analysed several variables related to lifestyle (healthy diet, physical activity and tobacco and alcohol consumption) and SES (education and income), along with SRH. The joint effects of SRH and the set of variables were studied by using a hierarchical linear regression analysis. Later a path analysis was carried out to test the impact of gender and age group on these associations. The results show that a better SRH was reported by men with lower age, higher SES, more frequent physical activity, healthy diet, and lower alcohol use compared with their counterparts. Income was directly related to better SRH through more physical activity, a healthier diet and less alcohol consumption. SES had a greater positive relationship with women's health than with men's health. In addition, a greater explained variance in SRH was observed in older women based on SES and lifestyle factors. Our findings provide some cross-sectional evidence of the social inequalities in health mediated through lifestyle factors, with gender and age differences. Therefore, socioeconomic inequalities should be addressed by public and social policies considering the gender and age gaps.
Collapse
Affiliation(s)
- Diego Gomez-Baya
- Department of Social, Developmental and Educational Psychology, Universidad de Huelva, Avda. Fuerzas Armadas s/n., 21007, Huelva, Spain.
| | - Jose A Salinas-Perez
- Department of Quantitative Methods, Universidad Loyola Andalucía, Seville, Spain.,Centre for Mental Health Research, Research School of Population Health, College of Health & Medicine, Australian National University, Canberra, Australia
| | | | - Javier Alvarez-Galvez
- Department of Biomedicine, Biotechnology and Public Health, University of Cadiz, Cádiz, Spain
| |
Collapse
|
35
|
Self-Reported General Health, Overall and Work-Related Stress, Loneliness, and Sleeping Problems in 335,625 Swedish Adults from 2000 to 2016. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020511. [PMID: 31947519 PMCID: PMC7014157 DOI: 10.3390/ijerph17020511] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 01/07/2020] [Accepted: 01/10/2020] [Indexed: 11/17/2022]
Abstract
The prevalence of poor health, in particular stress-related mental ill-health, is increasing over time and birth cohorts. As rapid societal changes have occurred in the last decade and still are occurring, there is an interest in investigating the trends in health-related factors. The aim of the present study was to investigate trends in self-reported general health, overall stress, work-related stress, feelings of loneliness, and sleeping problems in 335,625 Swedish adults across categories of gender, geographic regions, length of education, and age from 2000 to 2016. On population level, sleeping problems and poor general health have increased markedly and significantly, while experiences of work stress decreased between 2000 and 2016 (p < 0.05). Overall stress and level of loneliness were unchanged (p > 0.05). The risk of having ≥3 symptoms (any of poor or very poor general health, often or very often perceived overall stress, loneliness, or sleeping problems) has increased significantly from 2000 to 2016 (ß = 1034 (1027–1040)). This increase was significantly higher in young (ß = 1052 (1038–1065)) and individuals with lower education (ß = 1056 (1037–1076)) compared to older and high length of education.
Collapse
|
36
|
Wachtler B, Hoebel J, Lampert T. Trends in socioeconomic inequalities in self-rated health in Germany: a time-trend analysis of repeated cross-sectional health surveys between 2003 and 2012. BMJ Open 2019; 9:e030216. [PMID: 31562151 PMCID: PMC6773326 DOI: 10.1136/bmjopen-2019-030216] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 07/16/2019] [Accepted: 08/30/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES This study assessed the extent of educational and income inequalities in self-rated health (SRH) in the German adult population between 2003 and 2012 and how these inequalities changed over time. DESIGN Repeated cross-sectional health interview surveys conducted in 2003, 2009, 2010 and 2012. SETTING AND PARTICIPANTS The study population was the German adult population aged 25-69, living in private households in Germany. In total 54 197 randomly selected participants (2003: 6890; 2009: 16 418; 2010: 17 145; 2012: 13 744) were included. MAIN OUTCOME MEASURES SRH was assessed with one single question. Five answer categories were dichotomised into good ('very good' and 'good') versus poor ('moderate', 'poor', 'very poor') SRH. To estimate the extent of the correlation between absolute and relative inequalities in SRH on the one hand, and income and education on the other; slope indices of inequality (SII) and relative indices of inequality (RII) were estimated using linear probability and log-binomial regression models. RESULTS There were considerable and persisting educational and income inequalities in SRH in every survey year. Absolute educational inequalities were largely stable (2003: SII=0.25, 95% CI 0.21 to 0.30; 2012: 0.29, 95% CI 0.25 to 0.33; p trend=0.359). Similarly, absolute income inequalities were stable (2003: SII=0.22, 95% CI 0.17 to 0.27; 2012: SII=0.26, 95% CI 0.22 to 0.30; p trend=0.168). RII by education (2003: 2.53, 95% CI 2.11 to 3.03; 2012: 2.72, 95% CI 2.36 to 3.13; p trend=0.531) and income (2003: 2.09. 95% CI 1.75 to 2.49; 2012: 2.53, 95% CI 2.19 to 2.92; p trend=0.051) were equally stable over the same period. CONCLUSIONS We found considerable and persisting absolute and relative socioeconomic inequalities in SRH in the German adult population between 2003 and 2012, with those in lower socioeconomic position reporting poorer SRH. These findings should be a concern for both public health professionals and political decision makers.
Collapse
Affiliation(s)
- Benjamin Wachtler
- Department of Epidemiology and Health Monitoring, Robert Koch Institut, Berlin, Germany
| | - Jens Hoebel
- Department of Epidemiology and Health Monitoring, Robert Koch Institut, Berlin, Germany
| | - Thomas Lampert
- Department of Epidemiology and Health Monitoring, Robert Koch Institut, Berlin, Germany
| |
Collapse
|
37
|
Maina J, Ouma PO, Macharia PM, Alegana VA, Mitto B, Fall IS, Noor AM, Snow RW, Okiro EA. A spatial database of health facilities managed by the public health sector in sub Saharan Africa. Sci Data 2019; 6:134. [PMID: 31346183 PMCID: PMC6658526 DOI: 10.1038/s41597-019-0142-2] [Citation(s) in RCA: 91] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 06/25/2019] [Indexed: 01/08/2023] Open
Abstract
Health facilities form a central component of health systems, providing curative and preventative services and structured to allow referral through a pyramid of increasingly complex service provision. Access to health care is a complex and multidimensional concept, however, in its most narrow sense, it refers to geographic availability. Linking health facilities to populations has been a traditional per capita index of heath care coverage, however, with locations of health facilities and higher resolution population data, Geographic Information Systems allow for a more refined metric of health access, define geographic inequalities in service provision and inform planning. Maximizing the value of spatial heath access requires a complete census of providers and their locations. To-date there has not been a single, geo-referenced and comprehensive public health facility database for sub-Saharan Africa. We have assembled national master health facility lists from a variety of government and non-government sources from 50 countries and islands in sub Saharan Africa and used multiple geocoding methods to provide a comprehensive spatial inventory of 98,745 public health facilities.
Collapse
Affiliation(s)
- Joseph Maina
- Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya
| | - Paul O Ouma
- Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya
| | - Peter M Macharia
- Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya
| | - Victor A Alegana
- Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya
- Geography and Environmental Science, University of Southampton, Southampton, UK
- Faculty of Science and Technology, Lancaster University, LA1 4YR, UK
| | - Benard Mitto
- Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya
| | - Ibrahima Socé Fall
- World Health Organization, Regional Office for Africa, Brazzaville, Congo
| | - Abdisalan M Noor
- Global Malaria Programme, World Health Organization, Geneva, Switzerland
| | - Robert W Snow
- Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK
| | - Emelda A Okiro
- Population Health Unit, Kenya Medical Research Institute - Wellcome Trust Research Programme, P.O. Box 43640-00100, Nairobi, Kenya.
| |
Collapse
|
38
|
Kirk N, Fritzell S, Burström B. How Did Employment and Financial Strain Affect the Self-rated Health of Lone Mothers Around the Time of the Economic Crisis? A Cross-sectional Comparison of the United Kingdom and Sweden. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2019; 49:773-798. [PMID: 31299875 DOI: 10.1177/0020731419861864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Lone mothers face higher risk of poor self-rated health (SRH) than coupled mothers, partly explained by financial strain, non-employment, and welfare context. Comparing the United Kingdom and Sweden, we sought to determine how the economic crisis of 2008 affected the inequality in lone and coupled mothers SRH and what socioeconomic factors impacted this. Survey data was divided into periods corresponding to before, during, and after the economic crisis. Logistic regression was used to evaluate the impact of socioeconomic factors. Financial strain explained 70%–80% of the excess risk for poor health among Swedish lone mothers and 40% of those in the United Kingdom. Controlling for background and socioeconomic factors eliminated the health inequality among Swedish mothers. In the United Kingdom this inequality remained and may reflect the impact of social mechanisms such as stigma. Converse to what was expected, we did not observe significant variation over time in factors affecting SRH, nor did we find conclusive evidence of the impact of the economic crisis on the SRH of lone mothers. Factors that may account for these counterintuitive results, including retrenchment of the Swedish welfare state, economic lag, and reduction in overall inequality in health, are discussed.
Collapse
Affiliation(s)
- Nina Kirk
- 1 Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Sara Fritzell
- 1 Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - Bo Burström
- 1 Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| |
Collapse
|
39
|
Single transitions and persistence of unemployment are associated with poor health outcomes. BMC Public Health 2019; 19:740. [PMID: 31196081 PMCID: PMC6567908 DOI: 10.1186/s12889-019-7059-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2018] [Accepted: 05/29/2019] [Indexed: 12/23/2022] Open
Abstract
Background Although job loss has been associated with decline in health, the effect of long term unemployment is less clear and under-researched. Furthermore, the impact of an economic recession on this relationship is unclear. We investigated the associations of single transitions and persistence of unemployment with health. We subsequently examined whether these associations are affected by the latest recession, which began in 2008. Methods In total, 57,911 participants from the Dutch Health Interview Survey who belonged to the labour force between 2004 and 2014 were included. Based on longitudinal tax registration data, single employment transitions between time point 1 (t1) and time point 2 (t2) and persistent unemployment (i.e. number of years individuals were unemployed) between t1 and time point 5 (t5) were defined. General and mental health, smoking and obesity were assessed at respectively time point 3 (t3) and time point 6 (t6). Logistic regression models were performed and interactions with recession indicators (year, annual gross domestic product estimates and regional unemployment rates) were tested. Results Compared with individuals who stayed employed at t1 and t2, the likelihood of poor mental health at the subsequent year was significantly higher in those who became unemployed at t2. Persistent unemployment was associated with poor mental health, especially for those who were persistently unemployed for 5 years. Similar patterns, although less pronounced for smoking, were found for general health and obesity. Indicators of the economic recession did not modify these associations. Conclusions Single transitions into unemployment and persistent unemployment are associated with poor mental and general health, obesity, and to a lesser extend smoking. Our study suggests that re-employment might be an important strategy to improve health of unemployed individuals. The relatively extensive Dutch social security system may explain that the economic recession did not modify these associations.
Collapse
|
40
|
A Scoping Review of the Health of East and Southeast Asian Female Marriage Migrants. J Immigr Minor Health 2019; 22:182-211. [PMID: 31152303 DOI: 10.1007/s10903-019-00901-w] [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] [Indexed: 10/26/2022]
Abstract
The number of female marriage migrants in East and Southeast Asia has grown significantly over the past three decades. However, little is known about the health of this population. Following Arksey and O'Malley's (Int J Soc Res Methodol 8(1):19-32, 2005) framework, a scoping review of English language research databases was used to synthesize knowledge on the health of Asian marriage migrants. This will be used to inform recommendations for health care practice and research. Fifty-five eligible studies were included and presented using five identified categories-mental health, women's health and maternal-child health, public health, general well-being, and social challenges. Overall, studies consistently document that marriage migrants experience worse health outcomes, multiple barriers to health care services, and multilevel social challenges compared with the native population in the receiving countries.
Collapse
|
41
|
Mazeikaite G, O'Donoghue C, Sologon DM. The Great Recession, financial strain and self-assessed health in Ireland. THE EUROPEAN JOURNAL OF HEALTH ECONOMICS : HEPAC : HEALTH ECONOMICS IN PREVENTION AND CARE 2019; 20:579-596. [PMID: 30564918 PMCID: PMC6517350 DOI: 10.1007/s10198-018-1019-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 12/04/2018] [Indexed: 06/09/2023]
Abstract
In this paper, we study the effects of the 2008 economic crisis on general health in one of the most severely affected EU economies-Ireland. We examine the relationship between compositional changes in demographic and socio-economic factors, such as education, income, and financial strain, and changes in the prevalence of poor self-assessed health over a 5-year period (2008-2013). We apply a generalised Oaxaca-Blinder decomposition approach for non-linear regression models proposed by Fairlie (1999, 2005). Results show that the increased financial strain explained the largest part of the increase in poor health in the Irish population and different sub-groups. Changes in the economic activity status and population structure also had a significant positive effect. The expansion of education had a significant negative effect, preventing further increases in poor health. Wealthier and better educated individuals experienced larger relative increases in poor health, which led to reduced socio-economic health inequalities.
Collapse
Affiliation(s)
- Gintare Mazeikaite
- Luxembourg Institute of Socio-Economic Research (LISER), Esch-Sur-Alzette, Luxembourg.
- Maastricht University/UNU-MERIT, Maastricht, Netherlands.
| | | | - Denisa M Sologon
- Luxembourg Institute of Socio-Economic Research (LISER), Esch-Sur-Alzette, Luxembourg
| |
Collapse
|
42
|
Saez M, Vidiella-Martin J, Casasnovas GL. Impact of the great recession on self-perceived health in Spain: a longitudinal study with individual data. BMJ Open 2019; 9:e023258. [PMID: 30782700 PMCID: PMC6361339 DOI: 10.1136/bmjopen-2018-023258] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 08/10/2018] [Accepted: 09/27/2018] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES Our objective in this study is to evaluate the impact the Great Recession (2008-2014) had on self-perceived health in Spain. DESIGN We use a longitudinal database (four waves of the Bank of Spain's Survey of Household Finances (2005, 2008, 2011 and 2014)) with repeated observations of the same individuals before and after the Great Recession. INTERVENTIONS We consider the Great Recession in a natural experiment and we introduce it as an explanatory variable in a mixed logistic regression model in which we explain the probability of a subject declaring poor health (fair, bad and very bad). In the model we control for both observed and unobserved confounders at both individual and family level. RESULTS We find an average downward trend in self-perceived health during the most severe period of the Great Recession (2009-2011). However, the fact that the adjusted measures are less volatile than the crude ones shows that variation in health status can be captured by either demographic or socioeconomic controls. In fact, there are significant differences in the impact the economic crisis had on health in terms of gender and age group. In particular, the (adjusted) risk of declaring poor health increases after the crisis began but only in those families in which the reference person is a woman younger than 45 years of age or a man aged 75 years or older. CONCLUSIONS Given our results, we discuss the link between financial wealth and self-rated health and how policy-makers could address the health inequalities that arise from adverse economic and financial shocks.
Collapse
Affiliation(s)
- Marc Saez
- Research Group on Statistics, Econometrics and Health (GRECS), University of Girona, Girona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Center for Research in Health and Economics (CRES), Universitat Pompeu Fabra, Barcelona, Spain
| | - Joaquim Vidiella-Martin
- Erasmus School of Economics, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Tinbergen Institute, Amsterdam, The Netherlands
| | - Guillem López Casasnovas
- Center for Research in Health and Economics (CRES), Universitat Pompeu Fabra, Barcelona, Spain
- Department of Economics and Business, Department of Economics and Business, Barcelona, Spain
- Barcelona Graduate School (BGSE), Universitat Pompeu Fabra, Barcelona, Spain
| |
Collapse
|
43
|
Brzezinski M. What accounts for the rise of low self-rated health during the recent economic crisis in Europe? Int J Equity Health 2019; 18:21. [PMID: 30691481 PMCID: PMC6350338 DOI: 10.1186/s12939-019-0926-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 01/21/2019] [Indexed: 11/11/2022] Open
Abstract
Background A growing literature investigates health effects of the recent economic crisis. This study examines how different economic mechanisms affected low self-rated health (SRH) in Europe over the crisis period (2008–2011). We measure changes in low SRH over 2008–2011 and analyze how they are accounted for by changes in household income levels and income distribution (income poverty, income inequality), labour market developments (increasing unemployment, falling employment, changes in labour market inactivity), and non-income poverty (material deprivation). Methods We use balanced panel data for 2008–2011 covering 26 European countries and 43,456 participants. The data come from longitudinal 2011 European Union Statistics on Income and Living Conditions (EU-SILC) database. Increases in low SRH incidence over time are decomposed into the contributions of changes in the distribution of covariates and changes in returns to the covariates. Main covariates include household income and its distribution, labour market developments, and non-income poverty (material deprivation). The decompositions are performed using a detailed non-linear multivariate regression-based decomposition methodology. Results Low SRH incidence increased in Europe during the crisis by almost 2 percentage points, and by 3.7 percentage points in case of the Baltic countries. Decomposition analysis shows that: 1) decreasing household incomes and changing income distribution had no impact on low SRH incidence, 2) rise of material deprivation accounts for a significant portion (12%) of the overall growth in low SRH rates (27% for the Baltic countries), 3) decreasing levels of full-time and part-time employment as well as transitions to unemployment, economic inactivity, disability, or retirement account jointly for about 21% of the rise in low SRH in Europe (73% for Baltic countries). Conclusion Together, the recession-related economic factors account for about 33% of the increase in low SRH incidence in Europe during the crisis, and for about 100% of the increase in the Baltic countries. Public health policy during recessions should focus also on reducing material deprivation through free or subsidized access to public services, public housing, and other means. Electronic supplementary material The online version of this article (10.1186/s12939-019-0926-1) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Michal Brzezinski
- Faculty of Economic Sciences, University of Warsaw, Dluga 44/50, 00-241, Warsaw, Poland.
| |
Collapse
|
44
|
Jiang J, Wang P. Health status in a transitional society: urban-rural disparities from a dynamic perspective in China. Popul Health Metr 2018; 16:22. [PMID: 30591053 PMCID: PMC6307183 DOI: 10.1186/s12963-018-0179-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 12/09/2018] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND The phenomenon of urban-rural segmentation has emerged and is remarkable, and the health disparities between rural and urban China should be stressed. METHODS Based on data from the Chinese General Social Survey from 2005 to 2013, this study not only explored the net age, period, and cohort effects of self-rated health, but compared these effects between rural and urban China from a dynamic perspective through hierarchical age-period-cohort-cross-classified random effects model. RESULTS Urban-rural disparities, as well as work status and gender disparities in health increased with age, in line with the cumulative advantage/disadvantage effects theory, while marital status disparities in health declining with age was in line with the age-as-leveler effects theory. The war cohort, famine cohort, later cultural revolution cohort, and early reform cohort had poorer health than did those in the early China cohort, economic recovery cohort, and later reform cohort. The economic crisis period, war cohort, baby boomer, and early cultural revolution cohort encountered larger urban-rural health disparities, while the early China cohort and early reform cohort experienced smaller urban-rural disparities in health. CONCLUSIONS Population health is closely related to social context and health care development. It is necessary to keep economic development stable and boost medical technology improvements and the construction of the health care system.
Collapse
Affiliation(s)
- Junfeng Jiang
- School of Health Sciences, Wuhan University, Wuhan, China, No.115 Donghu Road, Wuhan City, 430071, China
| | - Peigang Wang
- School of Health Sciences, Wuhan University, Wuhan, China, No.115 Donghu Road, Wuhan City, 430071, China. .,Academy of Humanities and Social Sciences, Wuhan University, Wuhan, China, No.299 Bayi Road, Wuhan City, 430072, China.
| |
Collapse
|
45
|
Heggebø K, Tøge AG, Dahl E, Berg JE. Socioeconomic inequalities in health during the Great Recession: A scoping review of the research literature. Scand J Public Health 2018; 47:635-654. [DOI: 10.1177/1403494818801637] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Aims: The so-called ‘Great Recession’ in Europe triggered widespread concerns about population health, as reflected by an upsurge in empirical research on the health impacts of the economic crisis. A growing body of empirical studies has also been devoted to socioeconomic inequalities in health during the Great Recession. The aim of the current study is to summarise this health inequality literature by means of a scoping review. Methods: We have performed a scoping review of the research literature (English language) published in the years 2012–2017. Only empirical papers with (a) health status measured on the individual level, (b) information on socioeconomic position (i.e. employment status, educational level, income/wealth, and/or occupational class), and (c) data from European countries in both pre- and post-crisis years were considered relevant. In total, 49 empirical studies fulfilled these inclusion criteria. Results: The empirical findings in the 49 included studies predominantly show that socioeconomic inequalities in health either increased or remained stable from pre- to post-crisis years. Two-thirds (65%) of the studies found evidence of either increasing or partially increasing health inequalities. Thus, people in lower socioeconomic strata fared worse overall in terms of health during the Great Recession, compared to people with higher socioeconomic status. Conclusions: The Great Recession in Europe tends to be followed by increasing socioeconomic inequalities in health. Policymakers should take note of this finding. Widening socioeconomic inequalities in health is a major cause of concern, in particular if health deterioration among ‘vulnerable groups’ is caused by accelerating cumulative disadvantages.
Collapse
Affiliation(s)
| | - Anne Grete Tøge
- Work Research Institute (AFI), Oslo Metropolitan University, Norway
| | - Espen Dahl
- Department of Social Work, Child Welfare and Social Policy, Oslo Metropolitan University, Norway
| | - John Erik Berg
- Department of Occupational Therapy, Oslo Metropolitan University, Norway
| |
Collapse
|
46
|
Clause-Verdreau AC, Audureau É, Leplège A, Coste J. Contrasted trends in health-related quality of life across gender, age categories and work status in France, 1995–2016: repeated population-based cross-sectional surveys using the SF-36. J Epidemiol Community Health 2018; 73:65-72. [DOI: 10.1136/jech-2018-210941] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/13/2018] [Accepted: 09/17/2018] [Indexed: 11/03/2022]
Abstract
BackgroundInterest in monitoring health-related quality of life (HRQoL) in general populations has increased in the past 20 years, reinforced by population ageing and repeated economic crises. This study aims to identify temporal trends in HRQoL in France between 1995 and 2016 and to assess disparities according to demographic and socioeconomic characteristics.MethodsData from repeated population-based cross-sectional surveys conducted in 1995, 2003 and 2016 were used. HRQoL was measured using the Medical Outcomes Study 36-item Short Form (SF-36) questionnaire.ResultsA substantial decrease in score was observed between 1995 and 2016 for both genders in almost all subscales of the SF-36, with the largest decrease being in the mental health dimension for men. However, the age group 18–54 years were the most affected with persistent negative or even worsening trends in HRQoL. The largest decreases were among men aged 45–54 years and women aged 35–44 years in most dimensions, and among the age group 18–24 years in vitality. Conversely, an overall improvement was noted among the age group 65–84 years. People in employment were more affected than the unemployed by the decline in several HRQoL dimensions.ConclusionA general decline in HRQoL was found between 1995 and 2016 in the French population, but with wide disparities in trends between age groups. Young and especially middle-aged, employed people exhibited persistent negative and worsening trends. Consistent with evidence from traditional mental health morbidity and mortality indicators, our findings raise questions about the potential influence of macro-socioeconomic factors, especially the 2008 crisis; these observations deserve special attention from health policy-makers.
Collapse
|
47
|
Habibov N, Auchynnikava A, Luo R, Fan L. Effects of the 2008 global financial crisis on population health. Int J Health Plann Manage 2018; 34:e327-e353. [PMID: 30265409 DOI: 10.1002/hpm.2652] [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: 08/10/2018] [Accepted: 08/13/2018] [Indexed: 12/26/2022] Open
Abstract
We compare the transmission channels through which the 2008 global financial crisis affected health. We find that postponing or skipping visits to the doctor after falling ill and stopping buying regular medication had the strongest negative effects on health, followed by a reduced consumption of staple foods, utilities being cut, being forced to move, and having to sell assets. In comparison, experiencing cuts in TV, phone, and internet services, as well as delaying payments for utilities had relatively weaker negative impacts. In contrast, having a household head or household member lose a job also had negative effects on health status, although this effect was relatively lower. Finally, a reduced flow of remittances had the weakest negative effect.
Collapse
Affiliation(s)
| | | | - Rong Luo
- University of Windsor, Ontario, Canada
| | - Lida Fan
- Lakehead University, Thunderbay, Ontario, Canada
| |
Collapse
|
48
|
Chaves C, Castellanos T, Abrams M, Vazquez C. The impact of economic recessions on depression and individual and social well-being: the case of Spain (2006-2013). Soc Psychiatry Psychiatr Epidemiol 2018; 53:977-986. [PMID: 29992341 DOI: 10.1007/s00127-018-1558-2] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 07/02/2018] [Indexed: 11/28/2022]
Abstract
PURPOSE Although there is abundant evidence about the impact of economic crises on depression and other mental health problems, little is known about the protective role of variables linked to positive functioning (i.e., psychological well-being). METHODS We analyzed data from Spain, one of the European countries most affected by the 2008-2013 economic recession, collected in Round 3 (R3, 2006) and Round 6 (R6, 2013) of the European Social Survey interviews. Both surveys included measures of psychological well-being, social well-being and depression. Both samples were nationally representative of the general population (R3: 1877 participants, 49.2% men; R6: 1889 participants, 48.9% men). RESULTS Data from the R6 survey showed that, compared to data gathered in R3 (i.e., before the onset of the recession) Spanish citizens showed significantly less life satisfaction (95% CIs 0.37-0.63), less personal optimism (95% CIs 0.03-0.15), less social optimism (95% CIs 0.75-0.85), and higher levels of depressive symptoms (95% CIs - 0.74 to - 0.19). Structural equation modeling revealed that protective factors for depression changed in both rounds. In R3 (2006), close relationships, social optimism and social trust were significant mediators between well-being and depression. However, social optimism and social trust were no longer significant in R6 (2013), whereas close relationships remained a partial mediator of the effects of psychological well-being on depression. CONCLUSIONS Economic crises are associated with a significant increase in depressive symptoms. Furthermore, financial crises seem to have a corrosive impact on mental health by reducing the mediating effects of positive beliefs regarding the good nature of society.
Collapse
Affiliation(s)
- C Chaves
- Department of Clinical Psychology, School of Psychology, Complutense University of Madrid, 28223, Madrid, Spain.,School of Health Sciences, Francisco de Vitoria University, Madrid, Spain
| | - T Castellanos
- Department of Clinical Psychology, School of Psychology, Complutense University of Madrid, 28223, Madrid, Spain
| | - M Abrams
- Department of Clinical Psychology, School of Psychology, Complutense University of Madrid, 28223, Madrid, Spain
| | - Carmelo Vazquez
- Department of Clinical Psychology, School of Psychology, Complutense University of Madrid, 28223, Madrid, Spain.
| |
Collapse
|
49
|
Flood D, Chary A, Colom A, Rohloff P. Adolescent Rights and the "First 1,000 days" Global Nutrition Movement: A View from Guatemala. Health Hum Rights 2018; 20:295-301. [PMID: 30008571 PMCID: PMC6039738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- David Flood
- Resident physician and health services researcher at Wuqu’ Kawoq’ in Santiago Sacatépquez, Guatemala, and at the University of Minnesota, Minneapolis, Minnesota, USA
| | - Anita Chary
- Resident physician and medical anthropologist at Wuqu’ Kawoq’ in Santiago Sacatépquez, Guatemala, and at Harvard Medical School, Boston, MA, USA
| | - Alejandra Colom
- Associate professor of anthropology at the University del Valle of Guatemala and country director of the Population Council in Gueatemala City, Guatemala
| | - Peter Rohloff
- Practicing internist and pediatrician, assistant professor of medicine at Brigham and Women’s Hospital, Boston, MA, USA, and founder of Wuqu’ Kawoq in Santiago Sacatépquez, Guatemala
| |
Collapse
|
50
|
Reibling N, Beckfield J, Huijts T, Schmidt-Catran A, Thomson KH, Wendt C. Depressed during the depression: has the economic crisis affected mental health inequalities in Europe? Findings from the European Social Survey (2014) special module on the determinants of health. Eur J Public Health 2018; 27:47-54. [PMID: 28355641 DOI: 10.1093/eurpub/ckw225] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Economic crises constitute a shock to societies with potentially harmful effects to the mental health status of the population, including depressive symptoms, and existing health inequalities. Methods With recent data from the European Social Survey (2006–14), this study investigates how the economic recession in Europe starting in 2007 has affected health inequalities in 21 European nations. Depressive feelings were measured with the CES-D eight-item depression scale. We tested for measurement invariance across different socio-economic groups. Results Overall, depressive feelings have decreased between 2006 and 2014 except for Cyprus and Spain. Inequalities between persons whose household income depends mainly on public benefits and those who do not have decreased, while the development of depressive feelings was less favorable among the precariously employed and the inactive than among the persons employed with an unlimited work contract. There are no robust effects of the crisis measure on health inequalities. Conclusion Negative implications for mental health (in terms of depressive feelings) have been limited to some of the most strongly affected countries, while in the majority of Europe persons have felt less depressed over the course of the recession. Health inequalities have persisted in most countries during this time with little influence of the recession. Particular attention should be paid to the mental health of the inactive and the precariously employed.
Collapse
Affiliation(s)
- Nadine Reibling
- University of Siegen, Adolf-Reichwein-Str. 2, Siegen, Germany
| | - Jason Beckfield
- Department of Sociology, Harvard University, 33 Kirkland Street, Cambridge, MA, USA
| | - Tim Huijts
- Wentworth College, University of York, Heslington, York, UK
| | - Alexander Schmidt-Catran
- University of Cologne, Institute of Sociology and Social Psychology, Albertus-Magnus-Platz, Cologne
| | - Katie H Thomson
- Institute of Health and Society, Faculty of Medical Sciences, Newcastle University, The Baddiley-Clark Building, Richardson Road, Newcastle upon Tyne, United Kingdom
| | - Claus Wendt
- University of Siegen, Adolf-Reichwein-Str. 2, Siegen, Germany
| |
Collapse
|