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Rubio-Valera M, Marqués-Ercilla S, Peñarrubia-María MT, Urbanos-Garrido RM, Borrell C, Bosch J, Sánchez-Viñas A, Aznar-Lou I. Who Suffers From Pharmaceutical Poverty and What Are Their Needs? Evidence From a Spanish Region. Front Pharmacol 2021; 12:617687. [PMID: 33959003 PMCID: PMC8093809 DOI: 10.3389/fphar.2021.617687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 02/08/2021] [Indexed: 11/18/2022] Open
Abstract
Background: Pharmaceutical poverty occurs when a patient cannot afford the cost of prescribed medication and/or medical products. Nonprofit organizations are covering the cost of medication to those patients in some contexts. The aim of the study was to describe the population of beneficiaries of the PB, a nongovernmental organization based on the primary healthcare system, which provides free-of-charge access to medicines and their utilization pattern of medicines and healthcare products. Methods: This was an observational study using PB beneficiary data collected between November 2017 and December 2018 in Catalonia. The Catalan Health Service provided information from the general population. A descriptive analysis of the beneficiaries' characteristics was conducted and compared to the general population. Results: The beneficiaries (N = 1,206) were mainly adults with a low level of education, unemployed, with functional disability, and with ≥1 child. Compared with the general population, the beneficiaries were older, had a lower level of education, showed a higher prevalence of functional disability, were less likely to be Spanish, and were more likely to be divorced and unemployed. The beneficiaries were polymedicated, and most were using medication related to the nervous (79%), musculoskeletal (68%), and cardiovascular system (56%) and alimentary tract and metabolism (68%). Almost 19% of beneficiaries used healthcare products. Female beneficiaries were older and more likely to be divorced or widowed, employed, and with children. Compared to men, women were more likely to use medicines for pain and mental disorders. The pediatric group used medications for severe, chronic conditions (heart diseases, autoimmune diseases, conduct disorders, and attention deficit hyperactivity disorder). Conclusion: Patients with severe, chronic, and disabling conditions are affected by pharmaceutical poverty. While the system of copayment remains unchanged, family physicians and pediatricians should explore economic barriers to treatment and direct their patients to resources that help to cover the cost of treatment.
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Affiliation(s)
- Maria Rubio-Valera
- Research and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- The Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Silvia Marqués-Ercilla
- Centre d’Atenció Primària Bartomeu Fabrés Anglada, Direcció d'Atenció Primària Costa de Ponent, Institut Català de la Salut, Gavà, Spain
- Unitat de Suport a la Recerca Costa de Ponent, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Cornellà de Llobregat, Spain
| | - M Teresa Peñarrubia-María
- The Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Centre d’Atenció Primària Bartomeu Fabrés Anglada, Direcció d'Atenció Primària Costa de Ponent, Institut Català de la Salut, Gavà, Spain
- Unitat de Suport a la Recerca Costa de Ponent, Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Cornellà de Llobregat, Spain
| | - Rosa M. Urbanos-Garrido
- Department of Applied Economics, Public Economics and Political Economy, The Complutense University of Madrid, Madrid, Spain
| | - Carme Borrell
- The Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Agència de Salut Pública de Barcelona, Barcelona, Spain
| | | | - Alba Sánchez-Viñas
- Research and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- The Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Ignacio Aznar-Lou
- Research and Teaching Unit, Parc Sanitari Sant Joan de Déu, Sant Boi de Llobregat, Spain
- The Biomedical Research Centre Network for Epidemiology and Public Health (CIBERESP), Madrid, Spain
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Shantz E, Elliott SJ. From social determinants to social epigenetics: Health geographies of chronic disease. Health Place 2021; 69:102561. [PMID: 33761408 DOI: 10.1016/j.healthplace.2021.102561] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 01/25/2021] [Accepted: 03/09/2021] [Indexed: 01/11/2023]
Abstract
Social epigenetics explores relationships between social factors and health inequities embodied at the molecular level. Through modulating gene expression, epigenetic changes resulting from human-environment interactions may play a role in shaping health trajectories. This paper applies a health geography lens to explore the potential and support for conducting social epigenetic studies of chronic diseases with complex and dynamic etiologies. In so doing, we argue that social epigenetics presents a novel space for investigations of health and disease that is transdisciplinary and builds upon new understandings of bodies and place-based experiences. Given gender disparities in chronic diseases, we adopt a feminist perspective that cogitates the transactive relationships between gender and health/ill-health as mediated by biosocial processes at a variety of scales. Looking forward to the practical undertaking of social epigenetic studies, we assess existing theoretical and methodological support as well as insights to be gained. Reflecting upon the central tenets of health geography, we propose a unique positionality for health geographers to drive this field forward.
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Affiliation(s)
- Emily Shantz
- Department of Geography & Environmental Management, Faculty of Environment, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada.
| | - Susan J Elliott
- Department of Geography & Environmental Management, Faculty of Environment, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada
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Thomson K, Moffat M, Arisa O, Jesurasa A, Richmond C, Odeniyi A, Bambra C, Rankin J, Brown H, Bishop J, Wing S, McNaughton A, Heslehurst N. Socioeconomic inequalities and adverse pregnancy outcomes in the UK and Republic of Ireland: a systematic review and meta-analysis. BMJ Open 2021; 11:e042753. [PMID: 33722867 PMCID: PMC7959237 DOI: 10.1136/bmjopen-2020-042753] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE There has been an unprecedented rise in infant mortality associated with deprivation in recent years in the United Kingdom (UK) and Republic of Ireland. A healthy pregnancy can have significant impacts on the life chances of children. The objective of this review was to understand the association between individual-level and household-level measures of socioeconomic status and adverse pregnancy outcomes. DESIGN Systematic review and meta-analysis. DATA SOURCES Nine databases were searched (Medline, Embase, Scopus, ASSIA, CINAHL, PsycINFO, BNI, MIDRIS and Google Scholar) for articles published between 1999 and August 2019. Grey literature searches were also assessed. STUDY SELECTION CRITERIA Studies reporting associations between individual-level or household socioeconomic factors on pregnancy outcomes in the UK or Ireland. RESULTS Among the 82 353 search results, 53 821 titles were identified and 35 unique studies met the eligibility criteria. Outcomes reported were neonatal, perinatal and maternal mortality, preterm birth, birth weight and mode of delivery. Pooled effect sizes were calculated using random-effects meta-analysis. There were significantly increased odds of women from lower levels of occupation/social classes compared with the highest level having stillbirth (OR 1.40, 95% CI 1.23 to 1.59, I298.62%), neonatal mortality (OR 1.39, 95% CI 1.22 to 1.57, I297.09%), perinatal mortality (OR 1.39, 95% CI 1.23 to 1.57, I298.69%), preterm birth (OR 1.41, 95% CI 1.33 to 1.50, I270.97%) and low birth weight (OR 1.40, 95% CI 1.19 to 1.61, I299.85%). Limitations relate to available data, unmeasured confounders and the small number of studies for some outcomes. CONCLUSIONS This review identified consistent evidence that lower occupational status, especially manual occupations and unemployment, were significantly associated with increased risk of multiple adverse pregnancy outcomes. Strategies to improve pregnancy outcomes should incorporate approaches that address wider determinants of health to provide women and families with the best chances of having a healthy pregnancy and baby and to decrease pregnancy-related health inequalities in the general population. PROSPERO REGISTRATION NUMBER PROSPERO CRD42019140893.
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Affiliation(s)
- Katie Thomson
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Malcolm Moffat
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Oluwatomi Arisa
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | | | - Catherine Richmond
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Adefisayo Odeniyi
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Clare Bambra
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Fuse, The Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Judith Rankin
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Fuse, The Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Heather Brown
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Fuse, The Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Julie Bishop
- Health Improvement Division, Public Health Wales, Cardiff, UK
| | - Susan Wing
- Health Improvement Division, Public Health Wales, Cardiff, UK
| | - Amy McNaughton
- Health Improvement Division, Public Health Wales, Cardiff, UK
| | - Nicola Heslehurst
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
- Fuse, The Centre for Translational Research in Public Health, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
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104
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Tang S, Gong Y, Liu M, Yang D, Tang K. Do Drug Accessibility and OOP Burden Affect Health-Related Quality of Life of Patients With Chronic Diseases? - EQ-5D-5L Evaluation Evidence From Five Districts in China. Front Public Health 2021; 9:656104. [PMID: 33791272 PMCID: PMC8006263 DOI: 10.3389/fpubh.2021.656104] [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: 01/20/2021] [Accepted: 02/19/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: The dependence of patients with chronic diseases on drugs may affect their health-related quality of life (HRQoL). This study aims to assess the relationship between the direct economic burden caused by out-of-pocket (OOP) payments, drug accessibility, sociodemographic characteristics, and health-related quality of life. Methods: 1,055 patients with chronic diseases from Gansu, Hebei, Sichuan, Zhejiang, and Tianjin were investigated. Data collection included basic conditions and economic and health insurance conditions of patients with chronic diseases. The CLAD and Tobit regression models were used to analyze and compare the health-related quality of life and influencing factors of patients with chronic diseases in five districts. Differentiated analysis was conducted through sub-sample regression to explore the variable health effects of patients with single and multiple diseases. Results: A total of 1,055 patients with chronic diseases participated in the study, 54.4% of whom were women. The overall average utility score was 0.727, of which Sichuan Province was the highest with 0.751. Participants reported the highest proportion of pain/discomfort problems, while patients reported the least problems with self-care. The improvement of drug accessibility and the reduction of the burden of out-of-pocket expenses have significant positive effects on HRQoL. Various sociodemographic factors such as age and gender also have significant impact on HRQoL of patients with chronic diseases. HRQoL of patients with multiple chronic diseases is more affected by various influencing factors than that of patients with single disease. Conclusion: In order to improve the quality of life of patients with chronic diseases, it is of great importance to ensure the accessibility of drugs and reduce patients' medication burden. Future focus should shift from preventing and controlling chronic diseases as individual diseases to meeting the comprehensive health needs of people suffering from multiple diseases.
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Affiliation(s)
- Shaoliang Tang
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Ying Gong
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Meixian Liu
- School of Health Economics and Management, Nanjing University of Chinese Medicine, Nanjing, China
| | - Duoer Yang
- Nanjing Stomatological Hospital, Nanjing Stomatological Hospital, Medical School of Nanjing University, Nanjing, China
| | - Kean Tang
- Faculty of Science, Lund University, Lund, Sweden
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105
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Measuring health inequalities: a systematic review of widely used indicators and topics. Int J Equity Health 2021; 20:73. [PMID: 33691701 PMCID: PMC7945367 DOI: 10.1186/s12939-021-01397-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/28/2021] [Indexed: 11/22/2022] Open
Abstract
Background According to many conceptual frameworks, the first step in the monitoring cycle of health inequalities is the selection of relevant topics and indicators. However, some difficulties may arise during this selection process due to a high variety of contextual factors that may influence this step. In order to help accomplish this task successfully, a comprehensive review of the most common topics and indicators for measuring and monitoring health inequalities in countries/regions with similar socioeconomic and political status as Catalonia was performed. Methods We describe the processes and criteria used for selecting health indicators from reports, studies, and databases focusing on health inequalities. We also describe how they were grouped into well-known health topics. The topics were filtered and ranked by the number of indicators they accounted for. Results We found 691 indicators used in the study of health inequalities. The indicators were grouped into 120 topics, 34 of which were selected for having five indicators or more. Most commonly found topics in the list include “Life expectancy”, “Infant mortality”, “Obesity and overweight (BMI)”, “Mortality rate”, “Regular smokers/tobacco consumption”, “Self-perceived health”, “Unemployment”, “Mental well-being”, “Cardiovascular disease/hypertension”, “Socioeconomic status (SES)/material deprivation”. Conclusions A wide variety of indicators and topics for the study of health inequalities exist across different countries and organisations, although there are some clear commonalities. Reviewing the use of health indicators is a key step to know the current state of the study of health inequalities and may show how to lead the way in understanding how to overcome them.
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106
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Porroche-Escudero A, Popay J, Ward F, Ahmed S, Akeju D, Cloke J, Gabbay M, Hassan S, Khan K, Khedmati-Morasae E. From fringe to centre-stage: experiences of mainstreaming health equity in a health research collaboration. Health Res Policy Syst 2021; 19:28. [PMID: 33658047 PMCID: PMC7928171 DOI: 10.1186/s12961-020-00648-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 10/19/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Action to address the structural determinants of health inequalities is prioritized in high-level initiatives such as the United Nations Sustainable Development Goals and many national health strategies. Yet, the focus of much local policy and practice is on behaviour change. Research shows that whilst lifestyle approaches can improve population health, at best they fail to reduce health inequalities because they fail to address upstream structural determinants of behaviour and health outcomes. In health research, most efforts have been directed at three streams of work: understanding causal pathways; evaluating the equity impact of national policy; and developing and evaluating lifestyle/behavioural approaches to health improvement. As a result, there is a dearth of research on effective interventions to reduce health inequalities that can be developed and implemented at a local level. OBJECTIVE To describe an initiative that aimed to mainstream a focus on health equity in a large-scale research collaboration in the United Kingdom and to assess the impact on organizational culture, research processes and individual research practice. METHODS The study used multiple qualitative methods including semi-structured interviews, focus groups and workshops (n = 131 respondents including Public Advisers, university, National Health Service (NHS), and local and document review. RESULTS utilizing Extended Normalization Process Theory (ENPT) and gender mainstreaming theory, the evaluation illuminated (i) the processes developed by Collaboration for Leadership in Applied Health Research and Care North West Coast to integrate ways of thinking and acting to tackle the upstream social determinants of health inequities (i.e. to mainstream a health equity focus) and (ii) the factors that promoted or frustrated these efforts. CONCLUSIONS Findings highlight the role of contextual factors and processes aimed at developing and implementing a robust strategy for mainstreaming health equity as building blocks for transformative change in applied health research.
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Affiliation(s)
| | - Jennie Popay
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Fiona Ward
- ARC NWC, Division of Health Research, Lancaster University, Lancaster, UK
| | - Saiqa Ahmed
- ARC NWC, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Dorkas Akeju
- ARC NWC, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Jane Cloke
- ARC NWC, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Mark Gabbay
- ARC NWC, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Shaima Hassan
- ARC NWC, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Koser Khan
- ARC NWC, Division of Health Research, Lancaster University, Lancaster, UK
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107
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Guest Editorial: Hearing Care for All-An Opportunity to Globally Unite to Address Inequities in Hearing Health. Ear Hear 2021; 42:487-491. [PMID: 33657575 DOI: 10.1097/aud.0000000000001047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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108
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Wang A, Kho AN, Black B, French DD. Determining the feasibility of an index of the social determinants of health using data from public sources. Inform Health Soc Care 2021; 46:205-217. [PMID: 33632053 DOI: 10.1080/17538157.2021.1880413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Examining the feasibility of developing an index measure for the social determinants of health using public data is needed. We examined these characteristics at the ZIP code in California and New York using public data extracted from the US Census, American Community Survey, the USDA Food Research Access Atlas, and the Dartmouth Atlas. We conducted a retrospective study from 2000 to 2017. The main outcome was a novel index measure representing six domains (economic stability, neighborhood and physical environment, education, community and social context, food access, and health care) and encompassing 13 items. The index measure at the ZIP code was created using principal component analysis, normalized to "0" worse and "1" better in California (ZIP codes n = 1,447 to 1,515) and New York (ZIP codes n = 1,211 to 1,298). We assessed the reliability and conducted a nonparametric comparison to the Robert Wood Johnson Foundation County Health Rankings, Area Deprivation Index, Social Deprivation Index, and GINI Index. These measures shared similarities and differences with the novel measure. Mapping of this novel measure showed regional variation. As a result, developing a universal social determinants of health measure is feasible and more research is needed to link it to health outcomes.
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Affiliation(s)
- Andrew Wang
- Institute for Public Health and Medicine, Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Institute for Public Health and Medicine, Center for Health Information Partnerships, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Abel N Kho
- Institute for Public Health and Medicine, Center for Health Information Partnerships, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | - Bernard Black
- Pritzker School of Law, Northwestern University, Chicago, Illinois, USA.,Kellogg School of Management, Northwestern University, Chicago, Illinois, USA
| | - Dustin D French
- Institute for Public Health and Medicine, Center for Health Services and Outcomes Research, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,Department of Ophthalmology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA.,U.S. Department of Veterans Affairs, Health Services Research and Development, Hines, Illinois, USA
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109
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Brazil N. The multidimensional clustering of health and its ecological risk factors. Soc Sci Med 2021; 295:113772. [PMID: 33637329 DOI: 10.1016/j.socscimed.2021.113772] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 02/07/2021] [Accepted: 02/09/2021] [Indexed: 01/03/2023]
Abstract
A diverse set of research has examined the ways in which population-level health and its ecological risk factors are embedded within self-reinforcing structures. Syndemic theory, for example, focuses on the co-occurrence of multiple diseases, whereas the spatial diffusion literature highlights the concentration of poor health among communities sharing geographic boundaries. This study combines these related but disciplinarily-isolated perspectives to examine the clustering of population-level health and its determinants across four dimensions: co-occurrence, spatial, temporal, and social network. Using data on U.S. county-level health outcomes and health factors from the Robert Wood Johnson Foundation's County Health Rankings, this study estimates associations between health outcomes within communities and the co-occurrence of community-level factors theorized to influence ecological health. Not only do health outcomes and their ecological risk factors cluster within counties, but also between geographically adjacent counties and counties connected via migration network pathways. Moreover, the self-reinforcing structures uncovered across the co-occurrence, spatial and network dimensions persist over time, and this clustering has consequences on county health and well-being. Rather than adopting the perspective that either health and its community-level factors should be broadly targeted and detached from local context or communities are different, have unique needs and thus should be treated in isolation, the approach advanced in this study identifies shared vulnerabilities in a way that allows for the development of knowledge networks between communities dealing with similar issues.
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Affiliation(s)
- Noli Brazil
- University of California, Davis, Department of Human Ecology, One Shields Ave, Davis, CA, 95616, USA.
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110
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Sulley S, Bayssie M. Social Determinants of Health: An Evaluation of Risk Factors Associated With Inpatient Presentations in the United States. Cureus 2021; 13:e13287. [PMID: 33728220 PMCID: PMC7955789 DOI: 10.7759/cureus.13287] [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] [Indexed: 11/07/2022] Open
Abstract
Social Determinants of Health (SDoH) are socioeconomic indicators that directly or indirectly impact individual and community health outcomes. The distribution of most of these indicators within communities can be traced to public policies. These public policies often lead to diverse inequities with varying impacts on communities across the country. The inequities that arise because of specific public policies can be associated with increased risk factors and poor health outcomes among communities at high risk for these indicators. This study examined inpatient hospitalization and SDoH indicators that put individuals at risk of poor health outcomes. We utilized the National Inpatient Sample (NIS) databases 2012-2014 and 2016-2017 through the Healthcare Cost and Utilization Project (HCUP). The NIS datasets are de-identified to ensure patients' privacy. The HCUP-NIS dataset is a well-established sizable all-payer inpatient dataset for national estimates. It includes primary, secondary inpatient diagnoses as well as demographic information. SDoH indicators were identified using the International Classification of Diseases (ICD), versions 9 and 10 diagnosis codes. The relationship between SDoH indicators such as housing, psychosocial, healthcare access, upbringing, unemployment, social factors, gender, race, income, region, payer, age group, mortality, and severity was evaluated in a regression analysis. A total of 3,002,557 (2012-2014) and 1,254,899 (2016-2017) cases were included in this study. Mental diseases (p < 0.001) were high between 2012-2014 (OR 18.8, 95% CI 18.20-19.42) and 2016-2017 (OR 4.11, 95% CI 3.99-4.23). Native Americans had odds of presentation (p < 0.001) with SDoH indicator between 2012-2014 (OR 1.15, 95% CI 1.12-1.18) and 2016-2017 (OR 1.75, 95% CI 1.70-1.79). The odds of presentation among long income group were high compared to other income categories (p < 0.001) between 2012-2014 (OR 1.15, 95% CI 1.15-1.16) and 2016-2017 (OR 1.26, 95% CI 1.28-1.32). In conclusion, disparities, severity, and mortality risk at presentation were high among minority communities, males, and low-income demographics across all regions of United States
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Affiliation(s)
- Saanie Sulley
- Health Informatics, National Healthy Start Association, Washington DC, USA
| | - Mathios Bayssie
- Emergency Medicine, Southern Tennessee Regional Health System, Nashville, USA
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111
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Nobles J, Summerbell C, Brown T, Jago R, Moore T. A secondary analysis of the childhood obesity prevention Cochrane Review through a wider determinants of health lens: implications for research funders, researchers, policymakers and practitioners. Int J Behav Nutr Phys Act 2021; 18:22. [PMID: 33563281 PMCID: PMC7874658 DOI: 10.1186/s12966-021-01082-2] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/06/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Randomised controlled trials (RCTs) are often regarded as the gold standard of evidence, and subsequently go on to inform policymaking. Cochrane Reviews synthesise this type of evidence to create recommendations for practice, policy, and future research. Here, we critically appraise the RCTs included in the childhood obesity prevention Cochrane Review to understand the focus of these interventions when examined through a wider determinants of health (WDoH) lens. METHODS We conducted a secondary analysis of the interventions included in the Cochrane Review on "Interventions for Preventing Obesity in Children", published since 1993. All 153 RCTs were independently coded by two authors against the WDoH model using an adaptive framework synthesis approach. We used aspects of the Action Mapping Tool from Public Health England to facilitate our coding and to visualise our findings against the 226 perceived causes of obesity. RESULTS The proportion of interventions which targeted downstream (e.g. individual and family behaviours) as opposed to upstream (e.g. infrastructure, environmental, policy) determinants has not changed over time (from 1993 to 2015), with most intervention efforts (57.9%) aiming to change individual lifestyle factors via education-based approaches. Almost half of the interventions (45%) targeted two or more levels of the WDoH. Where interventions targeted some of the wider determinants, this was often achieved via upskilling teachers to deliver educational content to children. No notable difference in design or implementation was observed between interventions targeting children of varying ages (0-5 years, 6-12 years, 13-18 years). CONCLUSIONS This study highlights that interventions, evaluated via RCTs, have persisted to focus on downstream, individualistic determinants of obesity over the last 25 years, despite the step change in our understanding of its complex aetiology. We hope that the findings from our analysis will challenge research funders, researchers, policymakers and practitioners to reflect upon, and critique, the evidence-based paradigm in which we operate, and call for a shift in focus of new evidence which better accounts for the complexity of obesity.
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Affiliation(s)
- James Nobles
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol National Health Service Foundation Trust, Bristol, UK.
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Carolyn Summerbell
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
- Fuse, NIHR Centre for Translational Research in Public Health, Newcastle upon Tyne, UK
- The NIHR ARC North East & North Cumbria (NIHR ARC NENC), Newcastle upon Tyne, UK
| | - Tamara Brown
- Cochrane Vascular, The Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Russell Jago
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol National Health Service Foundation Trust, Bristol, UK
- Centre for Exercise, Nutrition and Health Sciences, School for Policy Studies, University of Bristol, Bristol, UK
| | - Theresa Moore
- The National Institute for Health Research Applied Research Collaboration West (NIHR ARC West) at University Hospitals Bristol National Health Service Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Methods Support Unit, Editorial and Methods Department, Cochrane, London, UK
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112
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Border Environmental Justice PPGIS: Community-Based Mapping and Public Participation in Eastern Tijuana, México. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031349. [PMID: 33540887 PMCID: PMC7908571 DOI: 10.3390/ijerph18031349] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 11/24/2022]
Abstract
Community mapping projects have been studied as important contributions to the field of environmental justice and Public Participation Geographic Information Systems (PPGIS). As a collaborative project between the Colectivo Salud y Justicia Ambiental and Red de Ciudadanos por el Mejoramiento de las Comunidades (RECIMEC), the “Mapeo Comunitario de la Zona Alamar” was created as a mechanism for community participation in the urban planning process in Tijuana, México. This paper outlines the project’s community mapping process, including planning, data collection, priority identification, and data submission. Results from this community mapping project are analyzed including the (1) particular environmental risks and goods in this border region, (2) the influence that the project data had on the urban planning process, and (3) the impact that the community mapping process had on community organizing capacity. Our findings point to particular environmental challenges in this border city including clandestine trash dumps, and contaminated water runoff points. The mapping project influenced the land use planning process by identifying the key environmental risks and goods to prioritize in the zoning and ground truthing urban planning data. The community mapping project also had a key impact on community organizing through the fomenting of knowledge and relationships between community members and government representatives at the city’s urban planning agency.
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Enang O, Omoronyia O, Asibong U, Ayuk A, Nwafor K, Legogie A. A case-control study of pattern and determinants of quality of life of patients with diabetes in a developing country. J Egypt Public Health Assoc 2021; 96:2. [PMID: 33507391 PMCID: PMC7843869 DOI: 10.1186/s42506-020-00061-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 11/04/2020] [Indexed: 01/15/2023]
Abstract
Background Globally, diabetes is a leading cause of impairment of quality of life. In the sub-Saharan African region, there is a need for studies that provide more valid assessment of effect of diabetes on quality of life (QoL). This study aimed at assessing quality of life among patients with diabetes attending a tertiary health service in Nigeria. Methods The study design was a case-control. Diabetic cases were randomly recruited from the University of Calabar Teaching Hospital, while non-diabetic controls were civil servants and retirees. The validated and pretested WHOQoL-BREF instrument was used to assess quality of life, with higher scores indicating higher quality of life. Results Three hundred and thirty subjects were studied, with mean ages of males and females of 55.2 ± 4.8 and 51.8 ± 6.3 years, respectively. The mean total QoL score was 75.77 ± 11.2, with no significant difference between males and females. Among male and female cases, the mean score of the physical health domain was significantly lower for cases compared with controls (p = 0.05). Male cases compared with controls had higher scores for the environment domain (p < 0.05). Older age and higher systemic blood pressure were associated with lower QoL scores for both sexes (p < 0.05). Unmarried status, obesity, and poor glycemic control (HbA1c > 7%) were associated with lower QoL scores (p < 0.05). Fasting blood sugar (FBS) level and lipid profile were not significantly correlated with QoL score in both sexes (p > 0.05). Conclusion Diabetes contributes to low quality of life among males and females, with significant differences in the affected domains. Diabetes care providers should identify affected domains during clinic consultation, in order to improve provision of more effective care.
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Affiliation(s)
- Ofem Enang
- Department of Internal Medicine, University of Calabar, Calabar, Nigeria
| | - Ogban Omoronyia
- Department of Community Medicine, University of Calabar, Calabar, Nigeria.
| | - Udeme Asibong
- Department of Family Medicine, University of Calabar, Calabar, Nigeria
| | - Agam Ayuk
- Department of Family Medicine, University of Calabar, Calabar, Nigeria
| | - Kenneth Nwafor
- Department of Family Medicine, University of Calabar, Calabar, Nigeria
| | - Annette Legogie
- Department of Family Medicine, University of Calabar, Calabar, Nigeria
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Mathiesen AS, Rothmann MJ, Zoffmann V, Jakobsen JC, Gluud C, Lindschou J, Due-Christensen M, Rasmussen B, Marqvorsen E, Thomsen T. Self-determination theory interventions versus usual care in people with diabetes: a protocol for a systematic review with meta-analysis and trial sequential analysis. Syst Rev 2021; 10:12. [PMID: 33413645 PMCID: PMC7791693 DOI: 10.1186/s13643-020-01566-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 12/17/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Existing self-management and behavioural interventions for diabetes vary widely in their content, and their sustained long-term effectiveness is uncertain. Autonomy supporting interventions may be a prerequisite to achieve 'real life' patient engagement and more long-term improvement through shared decision-making and collaborative goal setting. Autonomy supportive interventions aim to promote that the person with diabetes' motivation is autonomous meaning that the person strives for goals they themselves truly believe in and value. This is the goal of self-determination theory and guided self-determination interventions. Self-determination theory has been reviewed but without assessing both benefits and harms and accounting for the risk of random errors using trial sequential analysis. The guided self-determination has not yet been systematically reviewed. The aim of this protocol is to investigate the benefits and harms of self-determination theory-based interventions versus usual care in adults with diabetes. METHODS/DESIGN We will conduct the systematic review following The Cochrane Collaboration guidelines. This protocol is reported according to the PRISMA checklist. A comprehensive search will be undertaken in the CENTRAL, MEDLINE, EMBASE, LILACS, PsycINFO, SCI-EXPANDED, CINAHL, SSCI, CPCI-S and CPCI-SSH to identify relevant trials. We will include randomised clinical trials assessing interventions theoretically based on guided self-determination or self-determination theory provided face-to-face or digitally by any healthcare professional in any setting. The primary outcomes will be quality of life, mortality, and serious adverse events. The secondary will be diabetes distress, depressive symptoms and adverse events not considered serious. Exploratory outcomes will be glycated haemoglobin and motivation. Outcomes will be assessed at the end of the intervention and at maximum follow-up. The analyses will be performed using Stata version 16 and trial sequential analysis. Two authors will independently screen, extract data from and perform risk of bias assessment of included studies using the Cochrane risk of bias tool. Certainty of the evidence will be assessed by GRADE. DISCUSSION Self-determination theory interventions aim to promote a more autonomous patient engagement and are commonly used. It is therefore needed to evaluate the benefit and harms according to existing trials. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42020181144.
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Affiliation(s)
- Anne Sophie Mathiesen
- Department of Endocrinology, Center for Cancer and Organ Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark.
| | - Mette Juel Rothmann
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Melbourne, Australia
| | - Vibeke Zoffmann
- The Research Unit Women's and Children's Health, The Julie Marie Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
- Sector of Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen, Denmark
- Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen, Denmark
| | - Jane Lindschou
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen, Denmark
| | - Mette Due-Christensen
- Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
- Steno Diabetes Center Copenhagen, The Capital Region of Denmark, Copenhagen, Denmark
| | - Bodil Rasmussen
- Steno Diabetes Center Odense, Odense University Hospital, Odense, Denmark
- School of Nursing and Midwifery, Faculty of Health, Deakin University, Melbourne, Australia
- Sector of Health Services Research, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Emilie Marqvorsen
- The Research Unit Women's and Children's Health, The Julie Marie Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thordis Thomsen
- Department of Anaesthesiology, Herlev University Hospital, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Peris E, Fenech B. Associations and effect modification between transportation noise, self-reported response to noise and the wider determinants of health: A narrative synthesis of the literature. THE SCIENCE OF THE TOTAL ENVIRONMENT 2020; 748:141040. [PMID: 33113703 DOI: 10.1016/j.scitotenv.2020.141040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Revised: 07/03/2020] [Accepted: 07/16/2020] [Indexed: 06/11/2023]
Abstract
Noise and health guidance to date have focused on the direct links between noise and health outcomes such as annoyance, sleep disturbance, cardiovascular and metabolic disease, and cognitive impairment in schoolchildren. However, noise is a psychosocial stressor, and there are individual studies showing that exposure to noise or the self-reported responses to noise may affect health through interactions with the wider determinants of health and well-being including physical activity, use of green spaces and social interactions. Despite this emerging evidence concerning potential impacts of noise on the wider determinants of health, literature in the field remains dispersed and unsynthesised. This study seeks to synthetize evidence on different relationships between transportation noise, self-reported responses to noise and the wider determinants of health using a systematic review methodology. The search was conducted in Medline, PsycINFO, PubMed, and Scopus on articles published from 2000 to 2017. This led to the review of 76 papers which satisfied the inclusion criteria. Despite strong heterogeneity in the studies' methodologies and indicators used, there is some evidence that noise exposure and responses to noise such as annoyance and disturbance are associated with people's lifestyle, recreational activities as well as the local economy of the neighbourhood. On the other hand, there are some wider determinants of health, mainly those related to the built and natural environment, which modify the relationship between noise exposure and self-reported responses to noise. In particular, greenness, having access to quiet areas, and covering noise sources either visually or acoustically with natural features seems to decrease people's negative responses to noise. Results indicate that transportation noise has the potential to affect health through various pathways, and a holistic approach is needed to capture all the effects.
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Affiliation(s)
- Eulalia Peris
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, UK
| | - Benjamin Fenech
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, UK.
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Estecha Querol S, Clarke P, Sattler ELP, Halford JCG, Gabbay M. Non-visible disease, the hidden disruptive experiences of chronic illness in adversity. Int J Qual Stud Health Well-being 2020; 15:1857579. [PMID: 33287691 PMCID: PMC7733900 DOI: 10.1080/17482631.2020.1857579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Objective: This study's principal aim was to describe the lived reality for people with cardiovascular disease (CVD) and other chronic health conditions, who live in economically deprived neighbourhoods in a city in North West England. Methodology: This is a qualitative, exploratory study based on in-depth, semi-structured interviews with participants experiencing compromised cardiovascular health, conducted in August 2017. The study sample comprised 14 adults (3 females) aged 54 to 76. Thematic analysis was used for data analysis, and the biographical disruption concept was used as theoretical reference to explore the results. Wider health inequalities literature supplemented the individual experiences of chronic illness. Results: Four main themes were developed from the data: (1) chronic illness as a disruptive experience; (2) struggling for money; (3) lifestyle and health risks; and (4) reflections on current inequalities. The varied nature of participants' narratives about their chronic illness indicated that the experience of biographical disruption depends on the wider socioeconomic and cultural factors of the individual. Discussion: This study suggests that biographical disruption theory combined with health inequalities contexts highlights the role of hidden suffering and enhances the understanding of chronic illness experiences and thus informs clinical management, service and public health planning.
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Affiliation(s)
- Sara Estecha Querol
- Institute of Population Health, University of Liverpool , Liverpool, UK.,Academic Unit of Primary Care, Warwick Medical School, University of Warwick , Coventry, UK
| | - Pam Clarke
- Institute of Population Health, University of Liverpool , Liverpool, UK
| | - Elisabeth Lilian Pia Sattler
- Department of Foods and Nutrition and Department of Clinical and Administrative Pharmacy, University of Georgia , Athens, GA, USA
| | - Jason C G Halford
- Institute of Population Health, University of Liverpool , Liverpool, UK.,School of Psychology, University of Leeds , Leeds, UK
| | - Mark Gabbay
- Institute of Population Health, University of Liverpool , Liverpool, UK
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Retour à l’emploi après cancer du sein : apports de la recherche collaborative en santé au travail et d’une charte de partenariat entre acteurs concernés. ARCH MAL PROF ENVIRO 2020. [DOI: 10.1016/j.admp.2020.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Allen LN, Smith RW, Simmons-Jones F, Roberts N, Honney R, Currie J. Addressing social determinants of noncommunicable diseases in primary care: a systematic review. Bull World Health Organ 2020; 98:754-765B. [PMID: 33177772 PMCID: PMC7607469 DOI: 10.2471/blt.19.248278] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Revised: 03/16/2020] [Accepted: 04/10/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To explore how primary care organizations assess and subsequently act upon the social determinants of noncommunicable diseases in their local populations. METHODS For this systematic review we searched the online databases of PubMed®, MEDLINE®, Embase® and the Health Management Information Consortium from inception to 28 June 2019, along with hand-searching of references. Studies of any design that examined a primary care organization assessing social determinants of noncommunicable diseases were included. For quality assessment we used Cochrane's tool for assessing risk of bias in non-randomized studies of interventions. We used narrative data synthesis to appraise the extent to which the assessments gathered data on the domains of the World Health Organization social determinants of health framework. FINDINGS We identified 666 studies of which 17 were included in the review. All studies used descriptive study designs. Clinic-based and household surveys and interviews were more commonly used to assess local social determinants than population-level data. We found no examples of organizations that assessed sociopolitical drivers of noncommunicable diseases; all focused on sociodemographic factors or circumstances of daily living. Nevertheless, the resulting actions to address social determinants ranged from individual-level interventions to population-wide measures and introducing representation of primary care organizations on system-level policy and planning committees. CONCLUSION Our findings may help policy-makers to consider suitable approaches for assessing and addressing social determinants of health in their domestic context. More rigorous observational and experimental evidence is needed to ascertain whether measuring social determinants leads to interventions which mitigate unmet social needs and reduce health disparities.
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Affiliation(s)
- Luke N Allen
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Rd, Oxford OX2 6GG, England
| | - Robert W Smith
- Nuffield Department of Population Health, University of Oxford, Oxford, England
| | | | - Nia Roberts
- Bodleian Health Care Libraries, University of Oxford, Oxford, England
| | - Rory Honney
- Primary Care and Population Sciences Unit, University of Southampton, Southampton, England
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Low back pain and the social determinants of health: a systematic review and narrative synthesis. Pain 2020; 161:2476-2493. [DOI: 10.1097/j.pain.0000000000001944] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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Key elements of a successful integrated community-based approach aimed at reducing socioeconomic health inequalities in the Netherlands: A qualitative study. PLoS One 2020; 15:e0240757. [PMID: 33079952 PMCID: PMC7575081 DOI: 10.1371/journal.pone.0240757] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 10/02/2020] [Indexed: 02/08/2023] Open
Abstract
Background Since 2010, the Zwolle Healthy City approach, an integrated community-based approach, has been implemented in the Dutch municipality of Zwolle. This approach is proven successful in reducing health inequalities. However, the key elements of this approach are not clear. The current study aimed to identify key elements of this successful local community-based approach, according to the perspectives of various stakeholders. Methods Semi-structured interviews were carried out with 29 professionals who were involved in the approach in the period 2010–2018 and have occupations at the strategic (n = 4), tactical (n = 17) and operational level (n = 8). Data was analyzed using the thematic analysis approach. Results We identified nine perceived key elements that contributed to the success of the approach aimed at reducing socioeconomic health inequalities. The respondents indicated the following key elements: (1) collaboration between a variety of local organizations that want to have impact on the health of citizens; (2) support for the approach on the strategic, tactical and operational level of involved organizations; (3) proper communication and coordination, both for the network and within the organizations; (4) embeddedness in organizations’ policies and processes and (5) collaboration with private organizations is of added value, although there is no “one size fits all”. Other key elements are (6) collaboration with citizens, (7) profiling the approach like a brand and (8) moving along with and taking advantage of opportunities. Finally, (9) continuous monitoring and evaluating goals and processes, and learning from the results, is important. Conclusion Nine key elements were identified that, according to various stakeholders, contributed to the success of the Zwolle Healthy City approach. These insights are important to further strengthen the Zwolle Healthy City approach but may also help and inspire other local integrated community-based approaches aimed at reducing socioeconomic health inequalities, to improve and adapt the approach within their specific local and dynamic context.
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Liu T, Dutton DJ. With great inequality comes great responsibility: the role of government spending on population health in the presence of changing income distributions. Canadian Journal of Public Health 2020; 112:199-209. [PMID: 32959327 DOI: 10.17269/s41997-020-00407-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Accepted: 08/19/2020] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To determine the association between provincial government health and social spending and population health outcomes in Canada, separately for men and women, and account for the potential role of income inequality in modifying the association. METHODS We used data for nine Canadian provinces, 1981 to 2017. Health outcomes and demographic data are from Statistics Canada; provincial spending data are from provincial public accounts. We model the ratio of social-to-health spending ("the ratio") on potentially avoidable mortality (PAM), life expectancy (LE), potential years of life lost (PYLL), infant mortality, and low birth weight baby incidence. We interact the ratio with the Gini coefficient to allow for income inequality modification. RESULTS When the Gini coefficient is equal to its average (0.294), the ratio is associated with desirable health outcomes for adult men and women. For example, among women, a 1% increase in the ratio is associated with a 0.04% decrease in PAM, a 0.05% decrease in PYLL, and a 0.002% increase in LE. When the Gini coefficient is 0.02 higher than average, the relationship between the ratio and outcomes is twice as strong as when the Gini is at its average, other than for PAM for women. Infant-related outcomes do not have a statistically significant association with the ratio. CONCLUSION Overall, outcomes for men and women have similar associations with the ratio. Inequality increases the return to social spending, implying that those who benefit the most from social spending reap higher benefits during periods of higher inequality.
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Affiliation(s)
- Tong Liu
- Department of Community Health & Epidemiology, Dalhousie University, 100 Tucker Park Road, Saint John, NB, E2K 5E2, Canada
| | - Daniel J Dutton
- Department of Community Health & Epidemiology, Dalhousie University, 100 Tucker Park Road, Saint John, NB, E2K 5E2, Canada.
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Varbanova V, Beutels P. Recent quantitative research on determinants of health in high income countries: A scoping review. PLoS One 2020; 15:e0239031. [PMID: 32941493 PMCID: PMC7498048 DOI: 10.1371/journal.pone.0239031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Accepted: 08/28/2020] [Indexed: 01/21/2023] Open
Abstract
Background Identifying determinants of health and understanding their role in health production constitutes an important research theme. We aimed to document the state of recent multi-country research on this theme in the literature. Methods We followed the PRISMA-ScR guidelines to systematically identify, triage and review literature (January 2013—July 2019). We searched for studies that performed cross-national statistical analyses aiming to evaluate the impact of one or more aggregate level determinants on one or more general population health outcomes in high-income countries. To assess in which combinations and to what extent individual (or thematically linked) determinants had been studied together, we performed multidimensional scaling and cluster analysis. Results Sixty studies were selected, out of an original yield of 3686. Life-expectancy and overall mortality were the most widely used population health indicators, while determinants came from the areas of healthcare, culture, politics, socio-economics, environment, labor, fertility, demographics, life-style, and psychology. The family of regression models was the predominant statistical approach. Results from our multidimensional scaling showed that a relatively tight core of determinants have received much attention, as main covariates of interest or controls, whereas the majority of other determinants were studied in very limited contexts. We consider findings from these studies regarding the importance of any given health determinant inconclusive at present. Across a multitude of model specifications, different country samples, and varying time periods, effects fluctuated between statistically significant and not significant, and between beneficial and detrimental to health. Conclusions We conclude that efforts to understand the underlying mechanisms of population health are far from settled, and the present state of research on the topic leaves much to be desired. It is essential that future research considers multiple factors simultaneously and takes advantage of more sophisticated methodology with regards to quantifying health as well as analyzing determinants’ influence.
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Affiliation(s)
- Vladimira Varbanova
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
- * E-mail:
| | - Philippe Beutels
- Centre for Health Economics Research and Modelling Infectious Diseases, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
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Nickel S, von dem Knesebeck O. Do multiple community-based interventions on health promotion tackle health inequalities? Int J Equity Health 2020; 19:157. [PMID: 32912257 PMCID: PMC7488049 DOI: 10.1186/s12939-020-01271-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 08/25/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Previous systematic reviews of the impact of multi-component community-based health promotion interventions on reducing health inequalities by socio-economic status (SES) were restricted to physical activity and smoking behavior, and revealed limited and rather disillusioning evidence. Therefore, we conducted a comprehensive review worldwide to close this gap, including a wide range of health outcomes. METHODS The Pubmed and PsycINFO databases were screened for relevant articles published between January 1999 and August 2019, revealing 87 potentially eligible publications out of 2876 hits. In addition, three studies out of a prior review on the effectiveness of community-based interventions were reanalyzed under the new research question. After a systematic review process, 23 papers met the inclusion criteria and were included in the synthesis. RESULTS More than half (56.5%) of the studies reported improvements of socially disadvantaged communities overall (i.e. reduced inequalities at the area level) in at least one health behavior and/or health status outcome. Amongst the remaining studies we found some beneficial effects in the most deprived sub-groups of residents (8.2%) and studies with no differences between intervention and control areas (34.8%). There was no evidence that any program under review resulted in an increase in health disparity. CONCLUSIONS Our results confirm that community-based interventions may be reducing absolute health inequalities of deprived and disadvantaged populations, but their potential so far is not fully realized. For the future, greater attention should be paid to inequalities between sub-groups within communities when analyzing changes in health inequality over time.
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Affiliation(s)
- Stefan Nickel
- University Medical Center Hamburg-Eppendorf, Institute of Medical Sociology, Martinistraße 52, D-20246, Hamburg, Germany.
| | - Olaf von dem Knesebeck
- University Medical Center Hamburg-Eppendorf, Institute of Medical Sociology, Martinistraße 52, D-20246, Hamburg, Germany
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Drokow EK, Zi L, Han Q, Effah CY, Agboyibor C, Sasu E, Akpabla GS, Foli F, Sun K. Awareness of Cervical Cancer and Attitude Toward Human Papillomavirus and Its Vaccine Among Ghanaians. Front Oncol 2020; 10:1651. [PMID: 33014828 PMCID: PMC7506130 DOI: 10.3389/fonc.2020.01651] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/28/2020] [Indexed: 12/16/2022] Open
Abstract
Background: Cervical cancer (CC) is the fourth most commonly diagnosed cancer among women. Ghana is a low-middle- income country with annual diagnosed cases of 3,151 and 2,119 deaths. The high prevalence rate of cervical cancer in Ghana is mainly due to ineffective preventive measures and insufficient knowledge about the disease. Therefore, our objective was to evaluate the level of knowledge and awareness of cervical cancer and attitude toward human papillomavirus and its vaccine among Ghanaians. Methods: This descriptive cross-sectional survey on the awareness of cervical cancer and attitude toward human papillomavirus and its vaccine was carried out from March 2019 to February 2020. SPSS v. 23.0 was used in the data analysis. The participants' demographic characteristics, knowledge of cervical carcinoma, human papillomavirus vaccine and HPV, and the likelihood to be vaccinated were represented as percentages and frequencies. The difference between males and females was assessed using the chi-square test. The logistic regression analysis was used to evaluate the relationship of possible related indicators with the willingness to receive the HPV vaccine. A p < 0.05 was considered statistically significant. Results: A total of 1,376 participants were involved in the final analysis. Among the 1,376 participants involved in this survey, 1,240 participants (90.1%) representing 456 males (33.1%) and 784 females (57.0%) were aware of the terminology “cervical cancer” with a significant p = 0.001. When stratified by gender, women had significantly greater knowledge, compared to men in terms of “cervical cancer being common in middle age (35–50) females” (75.5 vs. 67.5%, respectively, p ≤ 0.001). When stratified by gender, women had significantly greater knowledge of human papillomavirus (54.5 vs. 43.6%, respectively, p < 0.001) and the human papillomavirus vaccine (39.3 vs. 33.1%, respectively, p = 0.019) compared to men. Conclusion: Majority of the respondents had poor knowledge regarding cervical cancer risk factors, symptoms, HPV, and its vaccine. Hence, this indicates a wakeup call for government to increase the awareness and knowledge level via the media and health professionals.
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Affiliation(s)
- Emmanuel Kwateng Drokow
- Department of Radiation Oncology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital Henan, Zhengzhou, China
| | - Liu Zi
- Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qian Han
- Department of Radiation Oncology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital Henan, Zhengzhou, China
| | | | - Clement Agboyibor
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, China
| | - Evans Sasu
- Department of Radiotherapy, National Centre for Radiotherapy and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | | | - Francis Foli
- Department of Internal Medicine, Seventh-Day Adventist Hospital, Takoradi, Ghana
| | - Kai Sun
- Department of Haematology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital Henan, Zhengzhou, China
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The mediating role of unhealthy behaviors and body mass index in the relationship between high job strain and self-rated poor health among lower educated workers. Int Arch Occup Environ Health 2020; 94:95-105. [PMID: 32889612 PMCID: PMC7826307 DOI: 10.1007/s00420-020-01565-y] [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: 02/27/2020] [Accepted: 08/25/2020] [Indexed: 12/02/2022]
Abstract
Objectives The objective of this study is to examine the mediating role of unhealthy behaviors and body mass index (BMI) in the relationship between high job strain and self-rated poor health in workers with a low education. Methods A total of 8369 low educated workers, who participated in the Lifelines cohort study during the period 2012–2017, were included. Self-reported job strain, health behaviors (smoking, physical activity, and fruit and vegetable consumption), and BMI were assessed at baseline, and self-rated health after 2 years. To assess mediation by the health behaviors and BMI, structural equation modeling with logistic and multinomial regression analyses were performed. Results Workers with high job strain had a higher odds of poor health (OR 1.34; 95% CI 1.13–1.60) compared to those with low job strain. Workers with high job strain were more likely to have a lack of physical activity (OR 1.14; 95% CI 1.01–1.28), but were not more likely to smoke, to be overweight or obese, or to have a low fruit or vegetable consumption. Workers who smoke, have a lack of physical activity or are overweight or obese are more likely to report poor health (OR 1.37; 95% CI 1.16–1.60, OR 1.25; 95% CI 1.08–1.43, OR 1.37; 95% CI 1.16–1.61, OR 2.25; 95% CI 1.86–2.72). Indirect (mediating) effects of unhealthy behaviors and BMI in the relationship between high job strain and poor health were small and not statistically significant. Conclusions No mediating effects of unhealthy behaviors or BMI were found in the relationship between high job strain and self-rated poor health among workers with a low educational level.
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Regmi K, Mudyarabikwa O. A systematic review of the factors - barriers and enablers - affecting the implementation of clinical commissioning policy to reduce health inequalities in the National Health Service (NHS), UK. Public Health 2020; 186:271-282. [PMID: 32871449 DOI: 10.1016/j.puhe.2020.07.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 07/15/2020] [Accepted: 07/19/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the present study is two-fold. First, it attempts to identify the barriers and enablers of implementing clinical commissioning policy. Second, it synthesises how these barriers and enablers affect the success of National Health Service (NHS) efforts to reduce health inequalities in the UK. METHODS A systematic review was conducted. We searched large biomedical bibliographic databases, namely MEDLINE, EMBASE, CINAHL, Allied & Complementary Medicine, DH-DATA, Global Health and CINAHL for primary studies, conducted in the UK, that assessed the factors - barriers and enablers related to health inequalities, published from 2010 onwards and in English, and reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We used Joanna Briggs Institute (JBI) Critical Appraisal and Mixed Methods Appraisal tools to assess the methodological qualities, and synthesised by performing thematic analysis. Two reviewers independently screened the articles and extracted data. RESULTS We included six primary studies (including a total of 1155 participants) in the final review. The studies reported two broad categories, under four separate themes: (1) the agenda of health inequalities has not been given priority; (2) there was very little evidence for reducing health inequalities through the clinical commissioning (CC) process; (3) CC was positively associated with the restructuring of NHS; and (4) CC brings better collaboration and engagement, which led to some improvements in health services access, utilisation and delivery at the local level. CONCLUSION This study provides useful factors - barriers and enablers - to implement and deliver clinical commissioning policy in improving health and well-being. These factors could be assessed in future to develop objective measures and interventions to establish the link between commissioning and health inequalities.
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Affiliation(s)
- K Regmi
- Institute for Health Research, Faculty of Health and Social Sciences, University of Bedfordshire, University Square, Luton, Bedfordshire, LU1 3JU, United Kingdom; Centre for Medical Education, School of Medicine, University of Dundee, Dundee, DD2 4BF, United Kingdom.
| | - O Mudyarabikwa
- Faculty of Health and Life Sciences, Coventry University, Richard Crossman Building, Room RC145, Priory Street, Coventry, CV1 5FB, United Kingdom.
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Iroz-Elardo N, Schoner J, Fox EH, Brookes A, Frank LD. Active travel and social justice: Addressing disparities and promoting health equity through a novel approach to Regional Transportation Planning. Soc Sci Med 2020; 261:113211. [PMID: 32745821 PMCID: PMC7939113 DOI: 10.1016/j.socscimed.2020.113211] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 06/15/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022]
Abstract
Public health impacts of transportation policies and infrastructure investment are becoming better understood, particularly for those associated with physical activity. Yet health impacts are not routinely evaluated within the context of the development of a Regional Transportation Plan (RTP) and subsequent programming and investment processes. This is particularly concerning because the spatial distribution of planned transportation infrastructure potentially has significant health equity implications for vulnerable populations at greater risk of chronic disease. This study discusses the application of the National Public Health Assessment Model (NPHAM) - a new approach that expands several scenario planning tools to include health - for the San Joaquin Council of Governments 2018 RTP. It demonstrates how quantifying health impacts at a finer spatial scale (census block groups) helps assess the extent to which RTP strategies are likely to benefit or harm health. It further enables a spatial form of health equity analysis that can help planners understand where infrastructure is most needed to meet social equity goals. To the knowledge of the authors, this is the first example of a quantified, health equity analysis of transport physical activity and a health outcome - body mass index - associated with an RTP; it demonstrates significant advancement in transportation planning practice and policy.
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Affiliation(s)
- Nicole Iroz-Elardo
- Urban Design 4 Health, Inc., 24 Jackie Circle East, Rochester, NY, 14612, USA; University of Arizona, School of Landscape Architecture and Planning, 1040 N. Olive Rd, Tucson, AZ, 85719, USA(1).
| | - Jessica Schoner
- Urban Design 4 Health, Inc., 24 Jackie Circle East, Rochester, NY, 14612, USA; Toole Design Group, 212 3rd Ave N #352, Minneapolis, MN, 55401, USA(1).
| | - Eric H Fox
- Urban Design 4 Health, Inc., 24 Jackie Circle East, Rochester, NY, 14612, USA.
| | - Allen Brookes
- U.S. Environmental Protection Agency, 200 SW 35th St, Corvallis, OR, 97333, USA.
| | - Lawrence D Frank
- Urban Design 4 Health, Inc., 24 Jackie Circle East, Rochester, NY, 14612, USA.
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Verschuuren M, van Oers H. Population health monitoring: an essential public health field in motion. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2020; 63:1134-1142. [PMID: 32857173 DOI: 10.1007/s00103-020-03205-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Population health monitoring, the regular and institutionalized production and dissemination of information and knowledge about the health status of a population, is an essential element of public health. Nevertheless, while epidemiology and biostatistics, for example, are well-recognized disciplines, this does not (yet) apply to population health monitoring. Over the past decade, however, it has matured as a distinct field of expertise. OBJECTIVES This paper presents a comprehensive model for population health monitoring and describes its current status as a field of expertise. It concludes with an overview of the most important developments that are likely to shape the health information systems and population health monitoring practices of the future. RESULTS AND CONCLUSIONS Combining the information pyramid (an application of the data-information-knowledge-wisdom hierarchy), describing outputs, and a so-called monitoring chain, describing activities, results in a comprehensive model for population health monitoring. The steps of the activity chain can be viewed as a stairway by which the information pyramid is climbed, reaching evidence-informed policymaking at the top. Population health monitoring has several inherent strengths, such as its high societal relevance; its integrative, comprehensive, and structured approach; and the fact that it makes use of routinely collected data. In practice, however, secondary use of routine data is often hampered by technical, motivational, economic, political, ethical, and legal barriers. Important developments that will shape health information systems and population health monitoring practices of the future include digitalization and data-driven technology, citizen science, and the growing need for intersectoral approaches. Population health monitoring practice will need to adapt in order to counteract the risks and reap the benefits that these developments hold.
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Affiliation(s)
- Marieke Verschuuren
- Independent public health consultant, Kovelaarstraat 32, 3582GP, Utrecht, The Netherlands.
| | - Hans van Oers
- National Institute of Public Health and the Environment, Bilthoven, The Netherlands.,Tilburg University, Tilburg, The Netherlands
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Martinez-Cardoso A, Jang W, Baig AA. Moving Diabetes Upstream: the Social Determinants of Diabetes Management and Control Among Immigrants in the US. Curr Diab Rep 2020; 20:48. [PMID: 32857197 PMCID: PMC9328159 DOI: 10.1007/s11892-020-01332-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
PURPOSE OF REVIEW Relative to the US-born population, immigrants are less likely to successfully manage and control their diabetes, leading to a host of diabetes-related complications. This review draws on the social determinants of health framework (SDoH) to summarize the multilevel factors that shape diabetes care and management among immigrants in the USA. RECENT FINDINGS While the diabetes literature is replete with research on individual-level risk factors and health behaviors, empirical literature linking the SDoH to diabetes management among immigrants is limited. However, housing precarity, food insecurity, poverty, uninsurance and underinsurance, and limited support for immigrants in healthcare systems are consistently shown to deter diabetes management and care. Immigrants with diabetes face a multitude of structural constraints to managing their diabetes. More research that theorizes the role of SDoH in diabetes management along with empirical qualitative and quantitative studies are needed. Interventions to address diabetes also require a more upstream approach in order to mitigate the drivers of diabetes disparities among immigrants.
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Affiliation(s)
- Aresha Martinez-Cardoso
- Department of Public Health Sciences, University of Chicago, 5841 South Maryland Ave, MC 2000, Chicago, IL, 60637, USA.
| | - Woorin Jang
- The College, University of Chicago, Chicago, IL, USA
| | - Arshiya A Baig
- Department of Medicine, University of Chicago, Chicago, IL, USA
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Feldman SS, Davlyatov G, Hall AG. Toward Understanding the Value of Missing Social Determinants of Health Data in Care Transition Planning. Appl Clin Inform 2020; 11:556-563. [PMID: 32851616 DOI: 10.1055/s-0040-1715650] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Social determinants of health play an important role in the likelihood of readmission and therefore should be considered in care transition planning. Unfortunately, some social determinants that can be of value to care transition planners are missing in the electronic health record. Rather than trying to understand the value of data that are missing, decision makers often exclude these data. This exclusion can lead to failure to design appropriate care transition programs, leading to readmissions. OBJECTIVES This article examines the value of missing social determinants data to emergency department (ED) revisits, and subsequent readmissions. METHODS A deidentified data set of 123,697 people (18+ years), with at least one ED visit in 2017 at the University of Alabama at Birmingham Medical Center was used. The dependent variable was all-cause 30-day revisits (yes/no), while the independent variables were missing/nonmissing status of the social determinants of health measures. Logistic regression was used to test the relationship between likelihood of revisits and social determinants of health variables. Moreover, relative weight analysis was used to identify relative importance of the independent variables. RESULTS Twelve social determinants were found to be most often missing. Of those 12, only "lives with" (alone or with family/friends) had higher odds of ED revisits. However, relative logistic weight analysis suggested that "pain score" and "activities of daily living" (ADL) accounted for almost 50% of the relevance for ED revisits when compared among all 12 variables. CONCLUSION In the process of care transition planning, data that are documented are factored into the care transition plan. One of the most common challenges in health services practice is to understand the value of missing data in effective program planning. This study suggests that the data that are not documented (i.e., missing) could play an important role in care transition planning as a mechanism to reduce ED revisits and eventual readmission rates.
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Affiliation(s)
- Sue S Feldman
- University of Alabama at Birmingham, Birmingham, Alabama, United States
| | | | - Allyson G Hall
- University of Alabama at Birmingham, Birmingham, Alabama, United States
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131
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Huys N, Van Stappen V, Shadid S, De Craemer M, Androutsos O, Wikström K, Makrilakis K, Moreno LA, Iotova V, Tankova T, Nánási A, Manios Y, Cardon G. Effectiveness of a family-, school- and community-based intervention on physical activity and its correlates in Belgian families with an increased risk for type 2 diabetes mellitus: the Feel4Diabetes-study. BMC Public Health 2020; 20:1231. [PMID: 32787943 PMCID: PMC7425007 DOI: 10.1186/s12889-020-09336-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 08/03/2020] [Indexed: 11/23/2022] Open
Abstract
Background The study aimed to investigate the effectiveness of the European Feel4Diabetes intervention, promoting a healthy lifestyle, on physical activity and its correlates among families at risk for type 2 diabetes mellitus (based on the Finnish Diabetes Risk Score) in Belgium. Methods The Feel4Diabetes intervention involved three components: family, school and community component, with the family component consisting of 6 counseling sessions for families at risk. Main outcomes were objectively measured physical activity levels and its subjectively measured correlates. The final sample consisted of 454 parents (mean age 39.4 years; 72.0% women) and 444 children (mean age 8.0 years; 50.1% girls). Multilevel repeated measures analyses were performed to assess intervention effectiveness after 1 year. Results In parents, there was no significant intervention effect. In children, there were only significant negative effects for moderate to vigorous physical activity (p = 0.05; ηp2 = 0.008) and steps (p = 0.03; ηp2 = 0.006%) on weekdays, with physical activity decreasing (more) in the intervention group. Conclusions The F4D-intervention lacks effectiveness on high-risk families’ physical activity and its correlates in Belgium. This could partially be explained by low attendance rates and a large drop-out. To reach vulnerable populations, future interventions should invest in more appropriate recruitment (e.g. more face-to-face contact) and more bottom-up development of the intervention (i.e. co-creation of the intervention with the target group). Trial registration The Feel4Diabetes-study was prospectively registered at clinicaltrials.gov as NCT02393872 on 20 March 2015.
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Affiliation(s)
- Nele Huys
- Department of Movement and Sport Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium.
| | - Vicky Van Stappen
- Department of Movement and Sport Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium
| | - Samyah Shadid
- Department of Endocrinology and Metabolic Diseases, Ghent University Hospital, Corneel Heymanslaan, 10, Ghent, Belgium
| | - Marieke De Craemer
- Department of Rehabilitation Sciences, Ghent University, Corneel Heysmanslaan, 10, Ghent, Belgium.,Research Foundation Flanders, Egmontstraat 5, Brussels, Belgium
| | - Odysseas Androutsos
- Department of Nutrition and Dietetics, School of Health Sciences & Education, Harokopio University, El. Venizelou 70, Kallithea, Athens, Greece
| | - Katja Wikström
- Department of Public Health Solutions, National Institute for Health and Welfare, Mannerheimintie, 166, Helsinki, Finland
| | - Konstantinos Makrilakis
- First Department of Propaedeutic Internal Medicine, National and Kapodistrian University of Athens, 75 Mikras Asias str, Athens, Greece
| | - Luis A Moreno
- Growth, Exercise, Nutrition and Development (GENUD) Research Group, Instituto Agroalimentario de Aragón (IA2), Instituto de Investigación Sanitaria Aragón (IIS Aragón), University of Zaragoza, Calle Pedro Cerbuna, 12, Zaragoza, Spain
| | - Violeta Iotova
- Department of Paediatrics, Medical University of Varna, 55 Marin Drinov str, Varna, Bulgaria
| | - Tsvetalina Tankova
- Clinical Center of Endocrinology, Medical University of Sofia, Boulevard "Akademik Ivan Evstratiev Geshov, 15, Sofia, Bulgaria
| | - Anna Nánási
- Department of Family and Occupational Medicine, University of Debrecen, Egyeterm tér 1, Debrecen, Hungary
| | - Yannis Manios
- Department of Nutrition and Dietetics, School of Health Sciences & Education, Harokopio University, El. Venizelou 70, Kallithea, Athens, Greece
| | - Greet Cardon
- Department of Movement and Sport Sciences, Ghent University, Watersportlaan 2, 9000, Ghent, Belgium
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South E, Lorenc T. Use and value of systematic reviews in English local authority public health: a qualitative study. BMC Public Health 2020; 20:1100. [PMID: 32660533 PMCID: PMC7359488 DOI: 10.1186/s12889-020-09223-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 07/06/2020] [Indexed: 02/06/2023] Open
Abstract
Background Responsibility for public health in England transferred from the National Health Service to local authorities in 2013, representing a different decision-making environment. Systematic reviews are considered the gold standard of evidence for clinical decision-making but little is known about their use in local government public health. This study aimed to explore the extent to which public health decision-makers in local authorities engage with systematic reviews and how they do so. Methods Semi-structured interviews were conducted with senior public health practitioners (n = 14) in Yorkshire and the Humber local authorities. Sampling was purposive and involved contacting Directors of Public Health directly and snowballing through key contacts. Face-to-face or telephone interviews were digitally recorded, transcribed verbatim and analysed using the Framework Method. Results Public health practitioners described using systematic reviews directly in decision-making and engaging with them more widely in a range of ways, often through a personal commitment to professional development. They saw themselves as having a role to advocate for the use of rigorous evidence, including systematic reviews, in the wider local authority. Systematic reviews were highly valued in principle and public health practitioners had relevant skills to find and appraise them. However, the extent of use varied by individual and local authority and was limited by the complexity of decision-making and various barriers. Barriers included that there were a limited number of systematic reviews available on certain public health topics, such as the wider determinants of health, and that the narrow focus of reviews was not reflective of complex public health decisions facing local authorities. Reviews were used alongside a range of other evidence types, including grey literature. The source of evidence was often considered an indicator of quality, with specific organisations, such as Public Health England, NICE and Cochrane, particularly trusted. Conclusions Research use varies and should be considered within the specific decision-making and political context. There is a need for systematic reviews to be more reflective of the decisions facing local authority public health teams.
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Affiliation(s)
- Emily South
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK.
| | - Theo Lorenc
- Centre for Reviews and Dissemination, University of York, York, YO10 5DD, UK
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Disaster Literacy and Public Health: A Systematic Review and Integration of Definitions and Models. Disaster Med Public Health Prep 2020; 15:518-527. [PMID: 32618555 DOI: 10.1017/dmp.2020.100] [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: 01/04/2023]
Abstract
OBJECTIVE The aim of this study is to develop an integrated definition and a conceptual model covering the dimensions of disaster literacy. METHODS A systematic literature review was conducted to identify the definitions and conceptual frameworks of disaster literacy. The content analysis of definitions and conceptual frameworks were conducted to identify the central dimensions of disaster literacy and to develop an integrated model. RESULTS In this study, 8 disaster literacy definitions and 4 conceptual model studies related to disasters were found. In line with these studies, a comprehensive definition of disaster literacy was presented. In addition, based on content analysis, a 16-matrix integrative conceptual model of the mitigation, preparedness, response and recovery dimensions of disaster literacy, and the access, understanding, appraisal, and application areas of disaster information processing were developed. CONCLUSIONS In this study, a comprehensive definition and conceptual framework of disaster literacy were presented in an integrated model. By using this model, practices that are special to the phases of a disaster can be identified and supported in society. In addition, the model can contribute to empirical studies by providing the basis for the development of tools to measure disaster literacy.
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134
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Simpson J, Brown H, Bell Z, Albani V, Bambra C. Investigating the relationship between changes in social security benefits and mental health: a protocol for a systematic review. BMJ Open 2020; 10:e035993. [PMID: 32595158 PMCID: PMC7322275 DOI: 10.1136/bmjopen-2019-035993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Poor mental health is one of the greatest causes of disability in the world. Evidence increasingly shows that population mental health may be influenced by national social security policies. This systematic review aims to establish the relationship between social security and mental health in order to help inform recommendations for policy-makers, practitioners and future research. METHODS AND ANALYSIS A systematic review of quantitative observational studies investigating mental health outcomes related to changes in social security policies will be conducted. Six major databases, including Medline, PsychInfo, Embase, Cumulative Index to Nursing and Allied Health Literature, Applied Social Sciences Index Abstracts and Scopus, as well as Research Papers in Economics will be searched from January 1979 to April 2020. The electronic database searches will be supplemented by reference and citation searches as well as hand-searching of key journals. The outcomes of interest are objective or subjective mental health outcomes, including stress, anxiety, depression, self-reported mental health scores, subjective well-being and suicide. Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the quality of the studies will be assessed by the validity assessment framework designed for appraising econometric studies. A narrative synthesis will be conducted for all included studies. If data permit, study findings will be synthesised by conducting a meta-analysis. ETHICS AND DISSEMINATION As it will be a systematic review, without primary data collection, there will be no requirement for ethical approval. Findings will be disseminated through peer-reviewed publications and in various media, for example, conferences or symposia. PROSPERO REGISTRATION NUMBER CRD42019154733.
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Affiliation(s)
- Julija Simpson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Heather Brown
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Zoe Bell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Viviana Albani
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Clare Bambra
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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135
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Pineo H. Towards healthy urbanism: inclusive, equitable and sustainable (THRIVES) – an urban design and planning framework from theory to praxis. ACTA ACUST UNITED AC 2020. [DOI: 10.1080/23748834.2020.1769527] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Helen Pineo
- Institute for Environmental Design and Engineering, Bartlett School of Environment, Energy and Resources, University College London, London, UK
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136
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Falahat K, Baradaran Eftekhari M, Ebadifar A, Eltemasi M, Sobhani Z, Ghalenoee E, Habibi E. Knowledge production in Iranian social determinants of health research centers: Toward health equity. Med J Islam Repub Iran 2020; 34:58. [PMID: 32934947 PMCID: PMC7481857 DOI: 10.34171/mjiri.34.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Indexed: 11/21/2022] Open
Abstract
Background: As the partner country of the WHO Commission on Social Determinants of Health (SDH), Iran has expanded the knowledge based on the social determinants of health- as one of commission recommendations- by establishing SDH research centers to collect evidence and design responses to the existing health equity gap. Considering the importance of the role assigned to these research centers, this study aimed to present the knowledge production of SDH research centers and determine their status in Iran's health research system (HRS). Methods: In this cross sectional study, research performance of SDH research centers was assessed based on international research indicators and compared with national medical research centers and HRS knowledge production. Then, SDH research centers were scored and ranked based on the research indicators. Results: Out of 37 approved SDH research centers, the knowledge performance of 33 research centers was reviewed. The total number of academic members was 334. The number of these centers' indexed published articles and the proportion of published articles per academic member have been doubled from 483 and 1.44 in 2015 to 984 and 2.94 in 2017. In this period, the number of citations of the past 5-year publications was 4355 according to Scopus database. The proportions of these centers' high-quality publication (Q1) and international collaborations per published articles were 14.8 and 8.25. In ranking, the first to third ranks were occupied by SDH research centers of Kermanshah, Kurdistan, and Qazvin Universities of Medical Sciences. Conclusion: Although knowledge production seems desirable in mentioned research centers, it is essential to create a virtual research network to increase intersectoral collaboration and develop strategies to solve the puzzle of gathering evidence on the social determinants affecting health inequities.
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Affiliation(s)
- Katayoun Falahat
- Deputy for Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | | | - Asghar Ebadifar
- Deputy for Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
- Dentofacial Deformities Research Center, Research Institute of Dental Sciences, Department of Orthodontics, Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Masoumeh Eltemasi
- Deputy for Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Zahra Sobhani
- Deputy for Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Elham Ghalenoee
- Deputy for Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
| | - Elham Habibi
- Deputy for Research and Technology, Ministry of Health and Medical Education, Tehran, Iran
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137
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Albright JN, Hurd NM. Marginalized Identities, Trump-Related Distress, and the Mental Health of Underrepresented College Students. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 65:381-396. [PMID: 31829453 DOI: 10.1002/ajcp.12407] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The current study sought to determine whether holding targeted marginalized identities was associated with greater experiences of distress related to Trump's presidency and whether participants' level of Trump-related distress predicted decrements in mental health. Participants in the current longitudinal study included 338 underrepresented college students attending a predominantly White institution. Results indicated that individuals who held targeted marginalized identities reported greater Trump-related distress compared to their non-targeted counterparts, and that holding multiple targeted marginalized identities was associated with greater levels of Trump-related distress. Findings also indicated that Trump-related distress was associated with increases (relative to previous trajectories) in anxious but not depressive symptoms. Overall, our results suggest that a shift in sociopolitical circumstances that promulgates bigotry may be harmful to those who possess targeted marginalized identities.
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Affiliation(s)
| | - Noelle M Hurd
- Department of Psychology, University of Virginia, Charlottesville, VA, USA
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138
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Kearns A, Ghosh S, Mason P, Egan M. Urban regeneration and mental health: Investigating the effects of an area-based intervention using a modified intention to treat analysis with alternative outcome measures. Health Place 2020; 61:102262. [PMID: 32329728 DOI: 10.1016/j.healthplace.2019.102262] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 11/19/2019] [Accepted: 11/26/2019] [Indexed: 11/16/2022]
Abstract
A quasi-experimental study of the mental health impacts of regeneration was carried out across fifteen communities in Glasgow, UK, grouped into five and then four types of intervention area. Regression modelling was undertaken to examine the effects of living in each type of area upon mental health (MCS-12 and SF-12 MH) and mental wellbeing (WEMWBS). Living in regeneration areas had no impacts on mental health or wellbeing, possibly due to incomplete implementation. Positive impacts from living in areas of housing improvement were not evident separately for areas of high-rise housing. Areas surrounding regeneration areas exhibited gains in mental health and wellbeing, contrary to notions of negative spillover. Moving between areas had negative effects, especially for those moving beyond the study areas. Changes in mental wellbeing appear less substantial compared with changes in mental health.
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Affiliation(s)
- Ade Kearns
- Urban Studies, School of Social and Political Sciences, University of Glasgow, 25 Bute Gardens, Glasgow, G12 0NU, UK.
| | - Seemanti Ghosh
- Urban Studies, School of Social and Political Sciences, University of Glasgow, 25 Bute Gardens, Glasgow, G12 0NU, UK.
| | - Phil Mason
- School of Education, Room 7/403, Urban Big Data Centre, 7 Lilybank Gardens, Glasgow, G12 8RZ, UK.
| | - Matt Egan
- Faculty of Public Health & Policy, London School of Hygiene & Tropical Medicine, Room 146, LSHTM, 15-17, Tavistock Place, London, WC1H 9SH, UK.
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139
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Wang E, Glazer KB, Howell EA, Janevic TM. Social Determinants of Pregnancy-Related Mortality and Morbidity in the United States: A Systematic Review. Obstet Gynecol 2020; 135:896-915. [PMID: 32168209 PMCID: PMC7104722 DOI: 10.1097/aog.0000000000003762] [Citation(s) in RCA: 185] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To synthesize the literature on associations between social determinants of health and pregnancy-related mortality and morbidity in the United States and to highlight opportunities for intervention and future research. DATA SOURCES We performed a systematic search using Ovid MEDLINE, CINAHL, Popline, Scopus, and ClinicalTrials.gov (1990-2018) using MeSH terms related to maternal mortality, morbidity, and social determinants of health, and limited to the United States. METHODS OF STUDY SELECTION Selection criteria included studies examining associations between social determinants and adverse maternal outcomes including pregnancy-related death, severe maternal morbidity, and emergency hospitalizations or readmissions. Using Covidence, three authors screened abstracts and two screened full articles for inclusion. TABULATION, INTEGRATION, AND RESULTS Two authors extracted data from each article and the data were analyzed using a descriptive approach. A total of 83 studies met inclusion criteria and were analyzed. Seventy-eight of 83 studies examined socioeconomic position or individual factors as predictors, demonstrating evidence of associations between minority race and ethnicity (58/67 studies with positive findings), public or no insurance coverage (21/30), and lower education levels (8/12), and increased incidence of maternal death and severe maternal morbidity. Only 2 of 83 studies investigated associations between these outcomes and socioeconomic, political, and cultural context (eg, public policy), and 20 of 83 studies investigated material and physical circumstances (eg, neighborhood environment, segregation), limiting the diversity of social determinants of health studied as well as evaluation of such evidence. CONCLUSION Empirical studies provide evidence for the role of race and ethnicity, insurance, and education in pregnancy-related mortality and severe maternal morbidity risk, although many other important social determinants, including mechanisms of effect, remain to be studied in greater depth. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42018102415.
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Affiliation(s)
- Eileen Wang
- Department of Medical Education, Icahn School of Medicine at Mount Sinai
| | - Kimberly B. Glazer
- Blavatnik Family Women’s Health Institute, Icahn School of Medicine at Mount Sinai; Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Elizabeth A. Howell
- Blavatnik Family Women’s Health Institute, Icahn School of Medicine at Mount Sinai; Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Obstetrics, Gynecology, and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Teresa M. Janevic
- Blavatnik Family Women’s Health Institute, Icahn School of Medicine at Mount Sinai; Department of Population Health Science & Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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140
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Nicholas K, Bentley M, Terán E, Thompson A. Water Security in the Galápagos: Socioecological Determinants and Health Implications. ECOHEALTH 2020; 17:111-124. [PMID: 31811596 PMCID: PMC8697564 DOI: 10.1007/s10393-019-01456-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 11/05/2019] [Indexed: 06/10/2023]
Abstract
Water security is strongly associated with important health outcomes and has many socioecological determinants. Several studies have documented the social determinants of water security and impacts of water security on health, independently. Yet few have examined both components in one setting. Using data from Ecuador's nationally representative health survey (ENSANUT-ECU), we proposed a new methodological framework for assessing water security in the Galápagos and assessed the relationship between socioecological indicators and water security among 2701 individuals in 693 households. We then tested the link between water security and childhood stunting using multilevel mixed effects logistic regressions controlling for household clustering. We found that being higher income in rural settings is significantly protective of water quality (OR 7.35) and increasing household size is associated with reduced water access (OR 0.44). We found no impact of water insecurity on childhood stunting. We observed a marked divergence in water security between islands and discussed potential underlying structural determinants. Understanding the structural predictors of water security and health is a necessary step in improving local health outcomes in the Galápagos. The social and physical factors leading to this water security environment may also be shared by similar locations, broadening the application of these findings.
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Affiliation(s)
- Khristopher Nicholas
- Department of Nutrition, UNC Chapel Hill, Chapel Hill, NC, USA.
- Carolina Population Center, 123 W Franklin St, Chapel Hill, NC, 27516, USA.
| | - Margaret Bentley
- Department of Nutrition, UNC Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, 123 W Franklin St, Chapel Hill, NC, 27516, USA
| | - Enrique Terán
- Colegio de Ciencias de la Salud, Universidad San Francisco de Quito, Quito, Ecuador
- Galápagos Science Center, San Cristóbal Island, Galápagos Archipelago, Ecuador
| | - Amanda Thompson
- Department of Nutrition, UNC Chapel Hill, Chapel Hill, NC, USA
- Department of Anthropology, UNC Chapel Hill, Chapel Hill, NC, USA
- Carolina Population Center, 123 W Franklin St, Chapel Hill, NC, 27516, USA
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141
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Limb ES, Procter DS, Cooper AR, Page AS, Nightingale CM, Ram B, Shankar A, Clary C, Lewis D, Cummins S, Ellaway A, Giles-Corti B, Whincup PH, Rudnicka AR, Cook DG, Owen CG. The effect of moving to East Village, the former London 2012 Olympic and Paralympic Games Athletes' Village, on mode of travel (ENABLE London study, a natural experiment). Int J Behav Nutr Phys Act 2020; 17:15. [PMID: 32041612 PMCID: PMC7011441 DOI: 10.1186/s12966-020-0916-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 01/20/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Interventions to encourage active modes of travel (walking, cycling) may improve physical activity levels, but longitudinal evidence is limited and major change in the built environment / travel infrastructure may be needed. East Village (the former London 2012 Olympic Games Athletes Village) has been repurposed on active design principles with improved walkability, open space and public transport and restrictions on residential car parking. We examined the effect of moving to East Village on adult travel patterns. METHODS One thousand two hundred seventy-eight adults (16+ years) seeking to move into social, intermediate, and market-rent East Village accommodation were recruited in 2013-2015, and followed up after 2 years. Individual objective measures of physical activity using accelerometry (ActiGraph GT3X+) and geographic location using GPS travel recorders (QStarz) were time-matched and a validated algorithm assigned four travel modes (walking, cycling, motorised vehicle, train). We examined change in time spent in different travel modes, using multilevel linear regresssion models adjusting for sex, age group, ethnicity, housing group (fixed effects) and household (random effect), comparing those who had moved to East Village at follow-up with those who did not. RESULTS Of 877 adults (69%) followed-up, 578 (66%) provided valid accelerometry and GPS data for at least 1 day (≥540 min) at both time points; half had moved to East Village. Despite no overall effects on physical activity levels, sizeable improvements in walkability and access to public transport in East Village resulted in decreased daily vehicle travel (8.3 mins, 95%CI 2.5,14.0), particularly in the intermediate housing group (9.6 mins, 95%CI 2.2,16.9), and increased underground travel (3.9 mins, 95%CI 1.2,6.5), more so in the market-rent group (11.5 mins, 95%CI 4.4,18.6). However, there were no effects on time spent walking or cycling. CONCLUSION Designing walkable neighbourhoods near high quality public transport and restrictions on car usage, may offer a community-wide strategy shift to sustainable transport modes by increasing public transport use, and reducing motor vehicle travel.
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Affiliation(s)
- Elizabeth S Limb
- Population Health Research Institute, St George's, University of London, London, UK.
| | - Duncan S Procter
- Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Ashley R Cooper
- Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Angie S Page
- Centre for Exercise, Nutrition and Health Sciences, University of Bristol, Bristol, UK.,National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Claire M Nightingale
- Population Health Research Institute, St George's, University of London, London, UK
| | - Bina Ram
- Population Health Research Institute, St George's, University of London, London, UK
| | - Aparna Shankar
- Population Health Research Institute, St George's, University of London, London, UK
| | - Christelle Clary
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Daniel Lewis
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Steven Cummins
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Anne Ellaway
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | - Billie Giles-Corti
- NHMRC Centre of Research Excellence in Healthy Liveable Communities, RMIT University, Melbourne, Australia
| | - Peter H Whincup
- Population Health Research Institute, St George's, University of London, London, UK
| | - Alicja R Rudnicka
- Population Health Research Institute, St George's, University of London, London, UK
| | - Derek G Cook
- Population Health Research Institute, St George's, University of London, London, UK
| | - Christopher G Owen
- Population Health Research Institute, St George's, University of London, London, UK
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142
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Van der Veken K, Lauwerier E, Willems S. "To mean something to someone": sport-for-development as a lever for social inclusion. Int J Equity Health 2020; 19:11. [PMID: 31937308 PMCID: PMC6961252 DOI: 10.1186/s12939-019-1119-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 12/27/2019] [Indexed: 11/13/2022] Open
Abstract
Background Socially excluded groups are at higher risk of low well-being and poor health. The link between social exclusion and health inequities is complex, and not being involved in society makes it difficult to be reached by standard prevention programs. Sport-for-development (SFD) programs are low-threshold and may be promising settings for inclusive actions. We explore the underlying mechanisms through which SFD might have an impact on social inclusion and examine the necessary conditions that work as a catalyst for these underlying mechanisms. Methods A realist evaluation approach was adopted. A non-profit SFD organization in a middle-large city in Flanders, Belgium, formed the setting for a single case study. Document analysis, participatory observations, interviews, and a focus group, were sources for identifying necessary context elements and essential mechanisms through which SFD could promote its participants’ health and wellbeing. Results Among the most efficient mechanisms triggered by the Foundation’s activities are learning by fun, connecting with peers (of whom some serve as role model) and engaging as a volunteer with some responsibilities. Building trust in oneself and in others is a necessary process throughout all these mechanisms. Facilitating context factors include the activities’ accessibility and unconditional approach (creating a sense of safety), the popularity of the first division football team the Foundation is associated with (leading to a sense of belonging), a steady network of social partners and a strongly positive relationship with the SFD coach(es). Conclusions Our findings demonstrate that a SFD setting may be a vehicle for engaging hard-to-reach population groups. It enhances socially vulnerable persons’ sense of competence and connectedness, leading to opportunities to improve life and work skills transferrable outside SFD settings. Based on these findings, suggestions are provided that may enhance the field and help to develop feasible (policy-led) interventions designed to promote social inclusion.
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Affiliation(s)
- Karen Van der Veken
- Department of Public Health & Primary Care, Research group Equity in Health Care, Ghent University, Ghent, Belgium.
| | - Emelien Lauwerier
- Department of Public Health & Primary Care, Research group Equity in Health Care, Ghent University, Ghent, Belgium.,Department of Experimental-Clinical & Health Psychology, Ghent University, Ghent, Belgium
| | - Sara Willems
- Department of Public Health & Primary Care, Research group Equity in Health Care, Ghent University, Ghent, Belgium
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143
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Macintyre AK, Torrens C, Campbell P, Maxwell M, Pollock A, Biggs H, Woodhouse A, Williams JM, McLean J. Socioeconomic inequalities and the equity impact of population-level interventions for adolescent health: an overview of systematic reviews. Public Health 2020; 180:154-162. [PMID: 31923881 DOI: 10.1016/j.puhe.2019.11.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 10/29/2019] [Accepted: 11/12/2019] [Indexed: 01/21/2023]
Abstract
OBJECTIVES Despite robust evidence on health inequalities in adulthood, less attention has been paid to inequalities in adolescence. The aim of this overview was to examine systematic review (SR) evidence on the equity impact of population-level interventions intended to improve health, happiness and wellbeing for adolescents. STUDY DESIGN An overview (review of systematic reviews). METHODS Eleven electronic databases were systematically searched to identify SRs of population-level interventions for adolescent health. A secondary data analysis of socioeconomic inequality was conducted to identify whether SRs reported on primary studies in terms of disadvantage, by measures of socioeconomic status (SES) and by differential effects. RESULTS 35,310 review titles were screened; 566 full texts were retrieved and 140 SRs met the predefined selection criteria. Differential intervention effects were considered in 42/140 (30%) SRs, 18/140 (13%) reported primary studies using an SES measure and 16/140 (11%) explicitly reported differential effects. 15/140 SRs (11%) explicitly focused on socioeconomic inequalities; of these 4/15 reported differential intervention effects in more detail, 7/15 concluded there was insufficient primary evidence to identify the impact of interventions on socioeconomic inequalities and 4/15 planned to examine differential effects by SES, but this was not reported further. CONCLUSIONS Our overview identifies that there is limited SR evidence on the equity impact of population-level interventions for adolescent health. Strengthening the evidence on whether interventions narrow or widen inequalities for adolescents must be a priority for public health research.
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Affiliation(s)
- A K Macintyre
- Centre for Health Policy, University of Strathclyde, Lord Hope Building, 141 St. James Road, Glasgow, G4 0LT, UK.
| | - C Torrens
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow, G4 0BA, UK
| | - P Campbell
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow, G4 0BA, UK
| | - M Maxwell
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Unit 13 Scion House, University of Stirling Innovation Park, Stirling, FK9 4NF, UK
| | - A Pollock
- Nursing, Midwifery and Allied Health Professions Research Unit, Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow, G4 0BA, UK
| | - H Biggs
- Mental Health Foundation, Merchants House, 30 George Square, Glasgow, G2 1EG, UK
| | - A Woodhouse
- Children in Scotland, Level 1, Rosebery House, 9 Haymarket Terrace, Edinburgh, EH12 5EZ, UK
| | - J M Williams
- University of Edinburgh, Room 2.4, Doorway 6, Medical Quad, Teviot Place, Edinburgh, EH8 9AG, UK
| | - J McLean
- Mental Health Foundation, Merchants House, 30 George Square, Glasgow, G2 1EG, UK
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144
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Drokow EK, Zi L, Han Q, Effah CY, Agboyibor C, Sasu E, Akpabla GS, Foli F, Sun K. Awareness of Cervical Cancer and Attitude Toward Human Papillomavirus and Its Vaccine Among Ghanaians. Front Oncol 2020; 10:1651. [PMID: 33014828 DOI: 10.3389/fonc.2020.01651/bibtex] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 07/28/2020] [Indexed: 05/21/2023] Open
Abstract
Background: Cervical cancer (CC) is the fourth most commonly diagnosed cancer among women. Ghana is a low-middle- income country with annual diagnosed cases of 3,151 and 2,119 deaths. The high prevalence rate of cervical cancer in Ghana is mainly due to ineffective preventive measures and insufficient knowledge about the disease. Therefore, our objective was to evaluate the level of knowledge and awareness of cervical cancer and attitude toward human papillomavirus and its vaccine among Ghanaians. Methods: This descriptive cross-sectional survey on the awareness of cervical cancer and attitude toward human papillomavirus and its vaccine was carried out from March 2019 to February 2020. SPSS v. 23.0 was used in the data analysis. The participants' demographic characteristics, knowledge of cervical carcinoma, human papillomavirus vaccine and HPV, and the likelihood to be vaccinated were represented as percentages and frequencies. The difference between males and females was assessed using the chi-square test. The logistic regression analysis was used to evaluate the relationship of possible related indicators with the willingness to receive the HPV vaccine. A p < 0.05 was considered statistically significant. Results: A total of 1,376 participants were involved in the final analysis. Among the 1,376 participants involved in this survey, 1,240 participants (90.1%) representing 456 males (33.1%) and 784 females (57.0%) were aware of the terminology "cervical cancer" with a significant p = 0.001. When stratified by gender, women had significantly greater knowledge, compared to men in terms of "cervical cancer being common in middle age (35-50) females" (75.5 vs. 67.5%, respectively, p ≤ 0.001). When stratified by gender, women had significantly greater knowledge of human papillomavirus (54.5 vs. 43.6%, respectively, p < 0.001) and the human papillomavirus vaccine (39.3 vs. 33.1%, respectively, p = 0.019) compared to men. Conclusion: Majority of the respondents had poor knowledge regarding cervical cancer risk factors, symptoms, HPV, and its vaccine. Hence, this indicates a wakeup call for government to increase the awareness and knowledge level via the media and health professionals.
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Affiliation(s)
- Emmanuel Kwateng Drokow
- Department of Radiation Oncology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital Henan, Zhengzhou, China
| | - Liu Zi
- Department of Radiation Oncology, First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qian Han
- Department of Radiation Oncology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital Henan, Zhengzhou, China
| | | | - Clement Agboyibor
- School of Pharmaceutical Sciences, Zhengzhou University, Zhengzhou, China
| | - Evans Sasu
- Department of Radiotherapy, National Centre for Radiotherapy and Nuclear Medicine, Korle Bu Teaching Hospital, Accra, Ghana
| | | | - Francis Foli
- Department of Internal Medicine, Seventh-Day Adventist Hospital, Takoradi, Ghana
| | - Kai Sun
- Department of Haematology, Zhengzhou University People's Hospital and Henan Provincial People's Hospital Henan, Zhengzhou, China
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145
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Deyra M, Gay C, Gerbaud L, Berland P, Pizon F. Global Health Determinants Perceived and Expressed by Children and Adolescents Between 6 and 17 Years: A Systematic Review of Qualitative Studies. Front Pediatr 2020; 8:115. [PMID: 32309268 PMCID: PMC7145944 DOI: 10.3389/fped.2020.00115] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 03/05/2020] [Indexed: 01/20/2023] Open
Abstract
Aim: To identify the determinants of global health in the literature as perceived and expressed by children and adolescents in order to adapt prevention actions to this young audience. To also question the pertinence of a qualitative approach when interviewing children. Method:Systematic review of the literature from PubMed, Google Scholar, CINAHL, PsycINFO databases. The studies selected used qualitative methods alone for investigating the views of health determinants in children and adolescents. Results:185 articles were read to reach a final selection of 13 articles on global health, excluding studies with children who were ill, studies using quantitative, mixed, or retrospective methodologies, and those dealing exclusively with themes of health. Collecting information from children and adolescents showed the pertinence and effectiveness of qualitative methods. It also appears necessary to explore new paths: improving and adapting the tools and methodological supports used and combining them to enrich repositories. Conclusion:The small amount of qualitative data available with the views of children and adolescents on health determinants requires that new studies with better adapted collection methodologies be set up. To increase pertinence and effectiveness among a young audience, it is necessary, considering the methodologies identified during this literature review, to turn toward a multi-phase method that combines these methods. A methodology in several phases allows each one to use a different approach with young people and to obtain richer and more varied information. A corpus of images appeared as a powerful tool for collection: it facilitates children's capacity for oral expression and places the researcher in a position of listening.
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Affiliation(s)
- Maéliane Deyra
- University of Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Chloé Gay
- University of Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Laurent Gerbaud
- University of Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France.,University of Clermont Auvergne, CHU, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Pauline Berland
- University of Clermont Auvergne, CHU, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
| | - Frank Pizon
- University of Clermont Auvergne, CNRS, SIGMA Clermont, Institut Pascal, Clermont-Ferrand, France
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146
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Besnier E, Thomson K, Stonkute D, Mohammad T, Akhter N, Todd A, Jensen MR, Kilvik A, Bambra C. Which public health interventions are effective in reducing morbidity, mortality and health inequalities from infectious diseases amongst children in low-income and middle-income countries (LMICs): protocol for an umbrella review. BMJ Open 2019; 9:e032981. [PMID: 31888932 PMCID: PMC6937061 DOI: 10.1136/bmjopen-2019-032981] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
INTRODUCTION Despite significant progress in the last few decades, infectious diseases remain a significant threat to children's health in low-income and middle-income countries. Effective means of prevention and control for these diseases exist, making any differences in the burden of these diseases between population groups or countries inequitable. Yet, gaps remain in our knowledge of the effect these public health interventions have on health inequalities in children, especially in low-income and middle-income countries. This umbrella review aims to address some of these gaps by exploring which public health interventions are effective in reducing morbidity, mortality and health inequalities from infectious diseases among children in low-income and middle-income countries. METHODS AND ANALYSIS An umbrella review will be conducted to identify systematic reviews or evidence synthesis of public health interventions that reduce morbidity, mortality and/or health inequalities due to infectious diseases among children (aged under 5 years) in low-income and middle-income countries. The interventions of interest are public health interventions targeting infectious diseases or associated risk factors in children. We will search for reviews reporting health and health inequalities outcomes in and between populations. The literature search will be undertaken using the Cochrane Library, Medline, EMBASE, the CAB Global Health database, Health Evidence, the Campbell Collaboration Library of Systematic Reviews, International Initiative for Impact Evaluation Systematic review repository, Scopus, the Social Sciences Citation Index and PROSPERO. Additionally, a manual search will be performed in Google Scholar and three international organisations websites (UNICEF Office of Research-Innocenti, UNICEF, WHO) to capture grey literature. Data from the records meeting our inclusion/exclusion criteria will be collated using a narrative synthesis approach. ETHICS AND DISSEMINATION This review will exclusively work with anonymous group-level information available from published reviews. No ethical approval was required.The results of the review will be submitted for publication in academic journals and presented at international public health conferences. Additionally, key findings will be summarised for dissemination to a wider policy and general public audience as part of the Centre for Global Health Inequalities Research's policy work. PROSPERO REGISTRATION NUMBER CRD42019141673.
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Affiliation(s)
- Elodie Besnier
- Centre for Global Health Inequalities Research (CHAIN) / Department of Sociology and Political Science, NTNU, Trondheim, Norway
| | - Katie Thomson
- Institute of Health and Society, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Donata Stonkute
- Department of Public Health and Nursing / CHAIN, NTNU, Trondheim, Norway
| | - Talal Mohammad
- Department of Public Health and Nursing / CHAIN, NTNU, Trondheim, Norway
| | - Nasima Akhter
- Department of Anthropology, Durham University, Stockton-on-Tees, UK
| | - Adam Todd
- School of Pharmacy / CHAIN, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | | | - Astrid Kilvik
- Medicine and Health Library, NTNU, Trondheim, Norway
| | - Clare Bambra
- Institute of Health & Society / CHAIN, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
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147
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Namin S, Xu W, Zhou Y, Beyer K. The legacy of the Home Owners' Loan Corporation and the political ecology of urban trees and air pollution in the United States. Soc Sci Med 2019; 246:112758. [PMID: 31884239 DOI: 10.1016/j.socscimed.2019.112758] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/15/2019] [Accepted: 12/19/2019] [Indexed: 10/25/2022]
Abstract
This study examines the persistent impacts of historical racebased discriminatory housing policies on contemporary urban environments in the United States. Specifically, we examine the relationships between Home Owners' Loan Corporation (HOLC) grades assigned to neighborhoods in the 1930s and the current distribution of tree canopy and level of exposure to air pollution hazards. Our results indicate a clear gradient in tree canopy by HOLC grade, with better neighborhood grades associated with significantly higher percentage of tree canopy coverage. The pattern also exists for airborne carcinogens and respiratory hazards, with worse neighborhood grades associated with significantly higher hazards exposure. Our findings indicate that early 20th century discriminatory housing policies exert a contemporary influence on patterns of green space exposure in American cities, with implications for health and health inequities. Our findings suggest that, in order to achieve equitable access to the benefits of urban greenspace, we must acknowledge these historical influences and consider policies and practices that directly counter these influences, for example, through targeted greenspace development in areas historically identified as unfit for investment.
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Affiliation(s)
- S Namin
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA.
| | - W Xu
- Center for Demography of Health and Aging, University of Wisconsin Madison, Madison, WI, USA
| | - Y Zhou
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA
| | - K Beyer
- Institute for Health & Equity, Medical College of Wisconsin, Milwaukee, WI, USA
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148
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Addison M, Kaner E, Johnstone P, Hillier-Brown F, Moffatt S, Russell S, Barr B, Holland P, Salway S, Whitehead M, Bambra C. Equal North: how can we reduce health inequalities in the North of England? A prioritization exercise with researchers, policymakers and practitioners. J Public Health (Oxf) 2019; 41:652-664. [PMID: 30346563 PMCID: PMC6995035 DOI: 10.1093/pubmed/fdy170] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Revised: 08/06/2018] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The Equal North network was developed to take forward the implications of the Due North report of the Independent Inquiry into Health Equity. The aim of this exercise was to identify how to reduce health inequalities in the north of England. METHODS Workshops (15 groups) and a Delphi survey (3 rounds, 368 members) were used to consult expert opinion and achieve consensus. Round 1 answered open questions around priorities for action; Round 2 used a 5-point Likert scale to rate items; Round 3 responses were re-rated alongside a median response to each item. In total, 10 workshops were conducted after the Delphi survey to triangulate the data. RESULTS In Round 1, responses from 253 participants generated 39 items used in Round 2 (rated by 144 participants). Results from Round 3 (76 participants) indicate that poverty/implications of austerity (4.87 m, IQR 0) remained the priority issue, with long-term unemployment (4.8 m, IQR 0) and mental health (4.7 m, IQR 1) second and third priorities. Workshop 3 did not diverge from findings in Round 1. CONCLUSIONS Practice professionals and academics agreed that reducing health inequalities in the North of England requires prioritizing research that tackles structural determinants concerning poverty, the implications of austerity measures and unemployment.
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Affiliation(s)
- M Addison
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle Upon Tyne NE2 4AX, UK
| | - E Kaner
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle Upon Tyne NE2 4AX, UK
| | - P Johnstone
- Public Health England, North of England, Blenheim House, West One, Leeds LS1 4PL, UK
| | - F Hillier-Brown
- Department of Sport and Exercise, Durham University, 42 Old Elvet, Durham DH1 3HN, UK
| | - S Moffatt
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle Upon Tyne NE2 4AX, UK
| | - S Russell
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle Upon Tyne NE2 4AX, UK
| | - B Barr
- Institute of Psychology, Health and Society, Department of Public Health and Policy, University of Liverpool, Whelan Building, The Quadrangle, Liverpool L69 3GB, UK
| | - P Holland
- Lecturer in Public Health, Division of Health Research, Faculty of Health and Medicine, Lancaster University, Furness Building, Lancaster LA1 4YG, UK
| | - S Salway
- Department of Sociological Studies, The University of Sheffield, Elmfield, Northumberland Road, Sheffield S10 2TU, UK
| | - M Whitehead
- Institute of Psychology, Health and Society, Department of Public Health and Policy, University of Liverpool, Whelan Building, The Quadrangle, Liverpool L69 3GB, UK
| | - C Bambra
- Institute of Health and Society, Newcastle University, Baddiley Clark Building, Richardson Road, Newcastle Upon Tyne NE2 4AX, UK
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149
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Naik Y, Baker P, Ismail SA, Tillmann T, Bash K, Quantz D, Hillier-Brown F, Jayatunga W, Kelly G, Black M, Gopfert A, Roderick P, Barr B, Bambra C. Going upstream - an umbrella review of the macroeconomic determinants of health and health inequalities. BMC Public Health 2019; 19:1678. [PMID: 31842835 PMCID: PMC6915896 DOI: 10.1186/s12889-019-7895-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/04/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The social determinants of health have been widely recognised yet there remains a lack of clarity regarding what constitute the macro-economic determinants of health and what can be done to address them. An umbrella review of systematic reviews was conducted to identify the evidence for the health and health inequalities impact of population level macroeconomic factors, strategies, policies and interventions. METHODS Nine databases were searched for systematic reviews meeting the Database of Abstracts of Reviews of Effects (DARE) criteria using a novel conceptual framework. Studies were assessed for quality using a standardised instrument and a narrative overview of the findings is presented. RESULTS The review found a large (n = 62) but low quality systematic review-level evidence base. The results indicated that action to promote employment and improve working conditions can help improve health and reduce gender-based health inequalities. Evidence suggests that market regulation of tobacco, alcohol and food is likely to be effective at improving health and reducing inequalities in health including strong taxation, or restriction of advertising and availability. Privatisation of utilities and alcohol sectors, income inequality, and economic crises are likely to increase health inequalities. Left of centre governments and welfare state generosity may have a positive health impact, but evidence on specific welfare interventions is mixed. Trade and trade policies were found to have a mixed effect. There were no systematic reviews of the health impact of monetary policy or of large economic institutions such as central banks and regulatory organisations. CONCLUSIONS The results of this study provide a simple yet comprehensive framework to support policy-makers and practitioners in addressing the macroeconomic determinants of health. Further research is needed in low and middle income countries and further reviews are needed to summarise evidence in key gaps identified by this review. TRIAL REGISTRATION Protocol for umbrella review prospectively registered with PROSPERO CRD42017068357.
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Affiliation(s)
- Yannish Naik
- Leeds Teaching Hospitals NHS Trust, Beckett St, Leeds, LS9 7TF UK
- University of Liverpool Department of Public Health and Policy, 3rd Floor, Whelan Building, Brownlow Hill, Liverpool, L69 3GB UK
| | - Peter Baker
- Global Health and Development Group, School of Public Health, Imperial College London, St Mary’s Campus, Norfolk Place, London, W2 1PG UK
| | - Sharif A. Ismail
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
- Department of Primary Care and Public Health, Imperial College London, Reynolds Building, St Dunstans Road, London, W6 8RP UK
| | - Taavi Tillmann
- Centre for Global Non-Communicable Diseases, Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH UK
| | - Kristin Bash
- School of Health and Related Research (ScHARR), The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Darryl Quantz
- NW School of Public Health, Health Education England North West, First Floor Regatta Place, Brunswick Business Park, Summers Road, Liverpool, L3 4BL UK
| | - Frances Hillier-Brown
- Department of Sport and Exercise Sciences, Durham University, 42 Old Elvet, Durham, DH1 3HN UK
| | - Wikum Jayatunga
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA UK
| | - Gill Kelly
- Leeds Teaching Hospitals NHS Trust, Beckett St, Leeds, LS9 7TF UK
| | - Michelle Black
- School of Health and Related Research (ScHARR), The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Anya Gopfert
- Junior Doctor and National Medical Director’s Fellow, London, UK
| | - Peter Roderick
- Leeds Teaching Hospitals NHS Trust, Beckett St, Leeds, LS9 7TF UK
| | - Ben Barr
- University of Liverpool Department of Public Health and Policy, 3rd Floor, Whelan Building, Brownlow Hill, Liverpool, L69 3GB UK
| | - Clare Bambra
- Faculty of Medical Sciences, Newcastle University, Sir James Spence Building, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP UK
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150
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Kim D. Bridging the epidemiology-policy divide: A consequential and evidence-based framework to optimize population health. Prev Med 2019; 129:105781. [PMID: 31330155 DOI: 10.1016/j.ypmed.2019.105781] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 05/21/2019] [Accepted: 07/17/2019] [Indexed: 11/27/2022]
Abstract
Epidemiology is the scientific cornerstone of public health. Its traditional role has been to test scientific hypotheses on causal relationships of exposures with health outcomes, the results of which should in turn be synthesized and lead to evidence-based recommendations and the formation of policy. However, the messy truth is that the path from epidemiology to policy is frequently not a perfectly rational, linear one, and the choices of which scientific hypotheses are pursued and the ways in which they are tested, evaluated, and translated into policies do not occur systematically. One avenue for bridging this divide is widespread adoption and implementation of a consequential, evidence-based framework-whereby we can systematically facilitate the translation of epidemiology into policies and interventions to optimize population health. This paper describes the roadmap for a seven-step, outcomes-based consequential approach, that includes priority-setting of problems at both the federal and regional/state levels, and that proposes to strengthen alignment of public and private research funding and journals with these priorities. Over the long term, implementing this framework should help to bridge the divide between epidemiology and policy and optimize the use of increasingly constrained resources to reduce disease burden and promote the nation's health.
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Affiliation(s)
- Daniel Kim
- Department of Health Sciences, Northeastern University, Boston, MA, United States of America.
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