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Horváth K, Túri G, Kaposvári C, Cseh B, Dózsa CL. Challenges and opportunities for improvement in the management and financing system of Health Promotion Offices in Hungary. Front Public Health 2023; 11:1219186. [PMID: 37965520 PMCID: PMC10641462 DOI: 10.3389/fpubh.2023.1219186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
Background One hundred ten Health Promotion Offices (HPOs) have started operating in Hungary in response to public health challenges. Many of them have been active for almost 10 years, yet their operational experience has not been evaluated. The specific objectives of our study were: (1) to describe the current operational and funding system of HPOs, (2) to identify challenges related to the current management and funding practices, and (3) to formulate recommendations for improvement based on gathered experience and international experience. Design In order to gain a deeper insight into the operational experience of HPOs, an online survey was conducted with the professional or economic managers of HPOs. A scoping review was carried out to gather international experiences about best practices to formulate recommendations for improvement in developing the operational and financing scheme for HPOs. Results We found that current HPO network in Hungary faces three main challenges: a deficient management system, inflexible financing scheme, and unequal ability to purchase or provide services for the population. Conclusions Based on the survey complemented by international experiences, we propose the overhaul of the professional management system and switching toa combination of fixed and performance-based financing scheme for the HPOs in Hungary.
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Affiliation(s)
- Krisztián Horváth
- Department of Public Health, Semmelweis University, Budapest, Hungary
- Med-Econ Human Services Ltd., Budapest, Hungary
- Synthesis Health Research Foundation, Budapest, Hungary
| | - Gergo Túri
- Med-Econ Human Services Ltd., Budapest, Hungary
- Synthesis Health Research Foundation, Budapest, Hungary
| | - Csilla Kaposvári
- Med-Econ Human Services Ltd., Budapest, Hungary
- Synthesis Health Research Foundation, Budapest, Hungary
- Faculty of Health Sciences, Doctoral School, University of Pécs, Pécs, Hungary
| | - Borbála Cseh
- Med-Econ Human Services Ltd., Budapest, Hungary
- Doctoral School of Medical Sciences, Semmelweis University, Budapest, Hungary
| | - Csaba László Dózsa
- Med-Econ Human Services Ltd., Budapest, Hungary
- Department of Theoretical Health Sciences, Faculty of Health Sciences, University of Miskolc, Miskolc, Hungary
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Hübelová D, Caha J, Janošíková L, Kozumplíková A. A holistic model of health inequalities for health policy and state administration: a case study in the regions of the Czech Republic. Int J Equity Health 2023; 22:183. [PMID: 37670373 PMCID: PMC10481637 DOI: 10.1186/s12939-023-01996-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 08/23/2023] [Indexed: 09/07/2023] Open
Abstract
BACKGROUND Health inequities exist within and between societies at different hierarchical levels. Despite overall improvements in health status in European Union countries, disparities persist among socially, economically, and societally disadvantaged individuals. This study aims to develop a holistic model of health determinants, examining the complex relationship between various determinants of health inequalities and their association with health condition. METHODS Health inequalities and conditions were assessed at the territorial level of Local Administrative Units (LAU1) in the Czech Republic. A dataset of 57 indicators was created, categorized into seven determinants of health and one health condition category. The necessary data were obtained from publicly available databases. Comparisons were made between 2001-2003 and 2016-2019. Various methods were employed, including composite indicator creation, correlation analysis, the Wilcoxon test, aggregate index calculation, cluster analysis, and data visualization using the LISA method. RESULTS The correlation matrix revealed strong relationships between health inequality categories in both periods. The most significant associations were observed between Economic status and social protection and Education in the first period. However, dependencies weakened in the later period, approaching values of approximately 0.50. The Wilcoxon test confirmed variations in determinant values over time, except for three specific determinants. Data visualization identified persistently adverse or worsening health inequalities in specific LAU1, focusing on categories such as Economic status and social protection, Education, Demographic situation, Environmental status, Individual living status, and Road safety and crime. The health condition indices showed no significant change over time, while the aggregate index of health inequalities improved with widened differences. CONCLUSION Spatial inequalities in health persist in the Czech Republic, influenced by economic, social, demographic, and environmental factors, as well as local healthcare accessibility. Both inner and outer peripheries exhibit poor health outcomes, challenging the assumption that urban areas fare better. The combination of poverty and vulnerabilities exacerbates these inequalities. Despite the low rates of social exclusion and poverty, regional health inequalities persist in the long term. Effectively addressing health inequalities requires interdisciplinary collaboration and evidence-based policy interventions. Efforts should focus on creating supportive social and physical environments, strengthening the healthcare system, and fostering cooperation with non-medical disciplines.
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Affiliation(s)
- Dana Hübelová
- Department of Social Studies, Mendel University in Brno, Zemedelska 1, Brno, 613 00, Czech Republic
| | - Jan Caha
- Department of Regional Development, Mendel University in Brno, Zemedelska 1, Brno, 613 00, Czech Republic
| | - Lenka Janošíková
- Department of Regional Development, Mendel University in Brno, Zemedelska 1, Brno, 613 00, Czech Republic
| | - Alice Kozumplíková
- Department of Social Studies, Mendel University in Brno, Zemedelska 1, Brno, 613 00, Czech Republic.
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Ohno M, Dzurova D, Smejkal P. Health inequalities in post-COVID-19 outcomes among adults aged 50+ in Europe: has COVID-19 exposed divide between postcommunist countries and Western Europe? J Epidemiol Community Health 2023; 77:601-608. [PMID: 37423747 PMCID: PMC10423549 DOI: 10.1136/jech-2023-220771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 06/10/2023] [Indexed: 07/11/2023]
Abstract
BACKGROUND COVID-19 affected people and countries disproportionately and continues to impact the health of people. The aim is to investigate protective health and socio-geographical factors for post-COVID-19 conditions in adults aged 50 years and older in Europe. METHODS Using longitudinal data from the Survey of Health, Ageing and Retirement in Europe, collected from June to August 2021, protective factors against post-COVID-19 condition among 1909 respondents who self-reported a positive COVID-19 test result were investigated using multiple logistic regression models. RESULTS Male adults living outside of Czechia, Poland, Hungary and Slovakia (Visegrad group, V4), who received the COVID-19 vaccination, tertiary or higher education, had a healthy weight (body mass index, BMI 18.5-24.9 kg/m2) and no underlying health condition/s, showed protective effects against post-COVID-19 condition. Health inequalities associated with BMI were observed in education attainment and comorbidities, with higher BMI having lower education attainment and higher comorbidities. Health inequality was particularly evident in individuals in V4 with higher obesity prevalence and lower attainment of higher education than those living in other regions in the study. CONCLUSION Our study suggests that healthy weight and higher education attainment are predictors associated with a lower incidence of post-COVID-19 condition. Health inequality associated with education attainment was particularly relevant in V4. Our results highlight health inequality in which BMI was associated with comorbidities and educational attainment. To reduce obesity prevalence among older people with lower education, raising awareness about the risks of obesity and providing assistance in maintaining a healthy weight are needed.
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Affiliation(s)
- Maika Ohno
- Research Centre on Health, Quality of Life and Lifestyle in a Geodemographic and Socioeconomic Context (GeoQol), Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague, Czech Republic
| | - Dagmar Dzurova
- Research Centre on Health, Quality of Life and Lifestyle in a Geodemographic and Socioeconomic Context (GeoQol), Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague, Czech Republic
| | - Petr Smejkal
- Infectious Disease and Infection Control, IKEM Hospital, Prague, Czech Republic
- Hospitalist and Infection Control, Mount Desert Island Hospital, Bar Harbor, Maine, USA
- 1st Medical Faculty, Institute of Hygiene and Epidemiology, Charles University, Prague, Czech Republic
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Ji J, Yang Y, Chen Z, Zhang W, Jiang S, Shen X, Zhang J, Lin L, Qu M, Wang Y, Gao X. How education level affects postoperative rehabilitation and follow-up: a single-center experience. BMC Urol 2023; 23:123. [PMID: 37464331 DOI: 10.1186/s12894-023-01282-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 06/28/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Radical prostatectomy remains the fundamental treatment for prostate cancer, and improving patients' compliance with postoperative follow-ups is essential for improving patients' quality of life. This study investigates the effect of education levels on patients' recovery and follow-up after radical prostatectomy. METHODS Data from 1,112 patients undergoing radical prostatectomy between 2011 and 2020 were collected using medical records, and "pc-follow" systems were used to collect patients' baseline information, education level, pathological information, number of outpatient visits, the time interval between each visit, and PSA test data. RESULTS Regarding postoperative outpatient data, there was no difference in the number of outpatient visits among the different education level groups in Shanghai (P = 0.063). A significant difference was found in the interval between outpatient visits among the groups (P < 0.001). Furthermore, significant differences were detected in the number and duration of outpatient clinic visits among the education level groups in all patients (P = 0.016, P = 0.0027). By contrast, no significant difference was found in the recovery time of urinary continence between all patients and those in Shanghai, grouped according to education level (P = 0.082, P = 0.68). For all patients and patients in the Shanghai area, the number of PSA follow-ups increased gradually with an increasing level of education (P < 0.001, P = 0.0029). CONCLUSIONS Education level affected the number of postoperative clinic visits, compliance, and the number of PSA tests. However, no significant effect on the recovery of urinary continence was found. Further, clinicians must increase their focus on patients with low education levels to achieve equitable access to health services for all patients.
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Affiliation(s)
- Jin Ji
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
- Department of Urology, Naval Medical Center, Naval Medical University, Shanghai, China
| | - Yuchen Yang
- Nursing Department, Naval Hospital of Eastern Theater Command, PLA, Zhoushan, China
| | - Zeyu Chen
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
- Department of Urology, The Second Affiliated Hospital of Soochow University, Jiangsu, China
| | - Wenhui Zhang
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
| | - Shaoqin Jiang
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
- Department of Urology, Fujian Union Hospital, Fujian Medical University, Fuzhou, Fujian, China
| | - Xianqi Shen
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
| | - Jili Zhang
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
| | - Lu Lin
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
| | - Min Qu
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
| | - Yan Wang
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China
| | - Xu Gao
- Department of Urology, Changhai Hospital, Navy Medical University (Second Military Medical University), 168 Changhai Road, Shanghai, 200433, P. R. China.
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Szőllősi GJ, Boruzs K, Karcagi-Kováts A, Kalas N, Bányai G, Bíró K. Investigation of the relationship between incidence of mental disorders and economic growth among the Visegrad countries. Front Public Health 2022; 10:982716. [PMID: 36159231 PMCID: PMC9490257 DOI: 10.3389/fpubh.2022.982716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 08/18/2022] [Indexed: 01/25/2023] Open
Abstract
Prevention and care for mental disorders represent an important public health task in achieving global development goals. Proper access to adequate healthcare and social services is an important step related to care for mental disorders, which is presumably strongly related to economic growth. The main aim of the study was to investigate the relationship between the economic growth and the incidence of mental disorders in the V4 countries. An ecological correlation study was conducted regarding the four Visegrad countries. Indicators were derived from the World Health Organization (WHO) 'Health for All' (HFA) online database and Penn World Table version 10. The incidence of mental disorders increased in the V4 countries throughout the years between 2000-2018 except in Hungary, where a decreasing trend was observed. The prevalence of mental disorders increased in all countries as well, but it stagnated in Hungary. At the same time standardized death rate due to mental disorders increased in all Visegrad countries. According to the Hungarian data, while the prevalence of the disease did not change remarkably, the incidence decreased and the mortality increased as well as the prescription of drugs used in the treatment of mental disorders. This could indicate a serious hidden morbidity.
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Affiliation(s)
- Gergő József Szőllősi
- Faculty of Health Sciences, University of Debrecen, Debrecen, Hungary,*Correspondence: Gergő József Szőllősi
| | - Klára Boruzs
- Faculty of Economics and Business, Institute of Health Economics and Management, University of Debrecen, Debrecen, Hungary
| | - Andrea Karcagi-Kováts
- Faculty of Economics and Business, Department of Environmental Economics, University of Debrecen, Debrecen, Hungary
| | - Nándor Kalas
- Doctoral School of Health Sciences, University of Debrecen, Debrecen, Hungary
| | - Gábor Bányai
- Faculty of Economics and Business, Institute of Health Economics and Management, University of Debrecen, Debrecen, Hungary
| | - Klára Bíró
- Faculty of Economics and Business, Institute of Health Economics and Management, University of Debrecen, Debrecen, Hungary
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Bányai G, Dombrádi V, Katona C, Boruzs K, Dezső G, Nagy A, Bíró K. Preference for patient-centered communication among the citizens of the Visegrad countries. PATIENT EDUCATION AND COUNSELING 2021; 104:3086-3092. [PMID: 33958254 DOI: 10.1016/j.pec.2021.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 03/31/2021] [Accepted: 04/10/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES The aim of the study was to investigate and compare the preferences that citizens of four Visegrad countries hold concerning the communication between patient and provider. METHODS The patient-practitioner orientation scale was used on a general population in our research, which consists of the Sharing and Caring subscales and assesses patient-centered or doctor-centered orientation toward communication. The statistical analysis included 4000 respondents of citizens from the Czech Republic, Slovakia, Poland and Hungary. When comparing the various demographic data and the four countries with each other univariate and multivariate logistic regressions were performed. RESULTS Being female, middle aged, having a higher education and a poor health status were associated with significantly higher Sharing and Caring scores. Also, Hungarian citizens had a significantly higher Caring score compared to the other three countries. CONCLUSIONS Key demographic variables were identified that affect how citizens perceive the communication between patient and provider. With the exception of Caring among Hungarian citizens, no differences were observed among the Visegrad countries. PRACTICE IMPLICATIONS These findings have potential implications for understanding the preferences of the citizens and thus better promote a more patient-centered communication.
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Affiliation(s)
- Gábor Bányai
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Viktor Dombrádi
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Cintia Katona
- Department of Behavioural Sciences, Faculty of Medicine, University of Debrecen, Hungary
| | - Klára Boruzs
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Gréta Dezső
- Department of Behavioural Sciences, Faculty of Medicine, University of Debrecen, Hungary
| | - Attila Nagy
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Klára Bíró
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary.
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Hübelová D, Kuncová M, Vojáčková H, Coufalová J, Kozumplíková A, Lategan FS, Chromková Manea BE. Inequalities in Health: Methodological Approaches to Spatial Differentiation. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312275. [PMID: 34886004 PMCID: PMC8656580 DOI: 10.3390/ijerph182312275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 11/07/2021] [Accepted: 11/18/2021] [Indexed: 11/23/2022]
Abstract
The prevalence of inequalities in the general health position of communities can be assessed by using selected determinants. The aims of this article are three-fold: (1) to apply a comprehensive approach to the assessment of inequalities in the general health position of communities, (2) to determine the spatial differentiation of determinants, and (3) to present selected assessment methods and their impact on the results. To present a quantitative assessment of these inequalities in health status in communities, a composite indicator (Health Index) was developed. This Health Index is composed of 8 areas of evaluation and 60 indicators which include, amongst others, determinants of health status and healthcare at district level (LAU 1) in the Czech Republic. The data are evaluated using multicriteria decision-making methods (the WSA and TOPSIS methods). Findings suggest that, when all eight domains are assigned the same weight of one, the spatial differentiation among the districts is similar when using both methods. If different weightings are assigned to the districts, changes occur in both the index values and the rankings of the analyzed districts. For example, the allocation of weightings in both methods results in a rearrangement of the ranking of districts for which the Health Index is around the average.
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Affiliation(s)
- Dana Hübelová
- Department of Social Studies, Faculty of Regional Development and International Studies, Mendel University in Brno, 613 00 Brno, Czech Republic;
- Correspondence: (D.H.); (A.K.); Tel.: +420-545-136-282 (D.H. & A.K.)
| | - Martina Kuncová
- Department of Economic Studies, College of Polytechnics Jihlava, 586 01 Jihlava, Czech Republic;
| | - Hana Vojáčková
- Department of Technical Studies, College of Polytechnics Jihlava, 586 01 Jihlava, Czech Republic;
| | - Jitka Coufalová
- Department of Development, City Municipality of Břeclav, 690 02 Břeclav, Czech Republic;
| | - Alice Kozumplíková
- Department of Environmental Studies, Faculty of Regional Development and International Studies, Mendel University in Brno, 613 00 Brno, Czech Republic
- Correspondence: (D.H.); (A.K.); Tel.: +420-545-136-282 (D.H. & A.K.)
| | - Francois Stefanus Lategan
- Department of Regional and Business Economics, Faculty of Regional Development and International Studies, Mendel University in Brno, 613 00 Brno, Czech Republic;
| | - Beatrice-Elena Chromková Manea
- Department of Social Studies, Faculty of Regional Development and International Studies, Mendel University in Brno, 613 00 Brno, Czech Republic;
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Boruzs K, Fekete Z, Dombrádi V, Bányai G, Nagy A, Horne R, Bíró K. Differences in Beliefs About Cholesterol-Lowering Medications Among the Visegrad Group Countries: A Cross-Sectional Study. Front Public Health 2021; 9:645043. [PMID: 33996721 PMCID: PMC8119757 DOI: 10.3389/fpubh.2021.645043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/05/2021] [Indexed: 11/13/2022] Open
Abstract
Background: New cholesterol guidelines highlight more personalized risk assessments and new cholesterol-lowering drugs for people at the highest risk for cardiovascular disease. Adherence due to fear of and lack of trust in medications prevents treatment to provide better health outcomes. Objectives: The aim of our study was to investigate the possible differences in the beliefs about the necessity and concerns regarding lipid-lowering drugs among the Visegrad Group countries. Methods: The Beliefs About Medicines Questionnaire (BMQ-Specific) was used in our research. The responses of 205 Hungarian, 200 Slovak, 235 Czech, and 200 Polish participants, all taking cholesterol-lowering medications, were compared to each other. Results: Hungarian participants' belief in the necessity of cholesterol-lowering drugs was significantly lower compared to the Slovak (P = 0.001), Czech (P = 0.037), and Polish (P < 0.001) participants. While no difference was observed between the Czech and Slovak responses (P = 0.154), both the Czech (P < 0.001) and Slovak (P = 0.006) respondents' belief regarding necessity was lower than that of the Polish. Regarding concerns, the only significant difference was observed between the Czech and the Polish respondents (P = 0.011). Conclusions: While the beliefs about benefits (necessity) are most prominent among the Polish participants, except in comparison to Czech responses, the Visegrad Group countries do not differ considerably regarding their beliefs about the fear (concerns) of the treatment.
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Affiliation(s)
- Klára Boruzs
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Zita Fekete
- Department of Behavioural Sciences, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Viktor Dombrádi
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Gábor Bányai
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Attila Nagy
- Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Robert Horne
- School of Pharmacy, University College London, London, United Kingdom
| | - Klára Bíró
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
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Investigating the Geographic Disparities of Amenable Mortality and Related Ambulance Services in Hungary. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031065. [PMID: 33504113 PMCID: PMC7908127 DOI: 10.3390/ijerph18031065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 01/21/2021] [Accepted: 01/22/2021] [Indexed: 11/29/2022]
Abstract
The aim of this study was to investigate how amenable mortality and related ambulance services differ on a county level in Hungary. The differences in mortality rates and ambulance services could identify counties where stronger ambulance services are needed. The datasets for 2018 consisted of county level aggregated data of citizens between the ages 15–64. The study examined how both the mortality rates and the ambulance rescue deliveries differ from the national average. The analyses were narrowed down to disease groups, such as acute myocardial infarction, hemorrhagic and ischemic stroke. Inequalities were identified regarding the distribution of number of ambulance deliveries, several counties had rates more than double that of the national average. For both mortality and ambulance services some of the counties had significantly better results and others had significantly worse compared to the national average. In Borsod-Abaúj-Zemplén county’s case, hemorrhagic stroke mortality was significantly higher (1.73 [1.35–2.11]), while ambulance deliveries were significantly lower (0.58 [0.40–0.76]) compared to the national average. The research has shown that regarding the investigated mortality rates and ambulance services there are considerable differences between the counties in Hungary. In this regard policy makers should implement policies to tackle these discrepancies.
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Conceptualization of Roma in Policy Documents Related to Social Inclusion and Health in the Czech Republic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217739. [PMID: 33105901 PMCID: PMC7660212 DOI: 10.3390/ijerph17217739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 11/16/2022]
Abstract
In the Czech Republic, a number of strategy papers and policy documents are guiding the direction of Roma inclusion, including in the area of health. The conceptualization of Roma and how mainstream political and public discourse operate with the term “Roma” contribute to a mistakenly homogenous and harmful image of Roma that conforms to negative stereotypes. The aim of our study was to examine the conceptualization of Roma in policy documents related to social inclusion and health in the Czech Republic. Relevant political, strategic and project documents were selected for analysis. Emphasis is placed in them on individual responsibility in relation to health, while structural conditions and discrimination are mentioned less often. Roma are described in relation to health primarily as people who should be educated. More emphasis is placed on the economic benefits of eliminating health inequalities than on citizens’ rights and the importance of inclusion. When “participation” or “empowerment” is mentioned, it is done vaguely, usually in addition to references to completely non-participatory practices. The majority is the primary actor in the field of eliminating health inequalities, as it defines the “path” that Roma need to be shown or determines what is needed to “stimulate” citizens. Although the political discourse concerning Roma has shifted more towards human rights, equity and combating discrimination in the Czech Republic, subtle forms of anti-Gypsyism still seem to be present.
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Palència L, Ferrando J, Marí-Dell'Olmo M, Gotsens M, Morrison J, Dzurova D, Lustigova M, Costa C, Rodríguez-Sanz M, Bosakova L, Santana P, Borrell C. Socio-economic inequalities on cancer mortality in nine European areas: The effect of the last economic recession. Cancer Epidemiol 2020; 69:101827. [PMID: 33038640 DOI: 10.1016/j.canep.2020.101827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 09/10/2020] [Accepted: 09/13/2020] [Indexed: 01/02/2023]
Abstract
BACKGROUND The effect of inequalities aggravated by economic recessions in the mortality rates of certain diseases has been previously described. In this study, we analyzed the relationship between socio-economic deprivation and cancer mortality. We focused on lung, colon, prostate, and breast cancers in nine European urban areas over three periods: two before (2000-2003 and 2004-2008) and one after (2009-2014) the onset of the 2008 financial crisis. METHODS This is an ecological study of trends. The units of analysis were small areas within nine European urban areas. We used a composite deprivation index as a socio-economic indicator. As a mortality indicator, we used the smoothed standardized mortality ratio, calculated using the hierarchical Bayesian model proposed by Besag, York and Mollié. To analyze the evolution of socio-economic inequalities, we fitted an ecological regression model that included the socio-economic indicator, the period of time, and the interaction between these terms. RESULTS In men, socio-economic inequalities in all-cancer and lung cancer mortality were observed in most of the cities studied, but did not increase after the onset of the economic crisis. In women, only two cities (Stockholm and London) showed socio-economic inequalities in all-cancer and lung cancer mortality; there was also no increase in inequalities. CONCLUSIONS Our results did not validate our hypothesis that inequalities increase in times of crisis. However, they emphasize the importance of socio-economic measurements for understanding mortality inequalities, and can be used to inform prevention strategies and help plan local health programs aimed at reducing health inequalities.
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Affiliation(s)
- Laia Palència
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.
| | | | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.
| | - Mercè Gotsens
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
| | - Joana Morrison
- Institute of Health Equity at the Research Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Dagmar Dzurova
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague, Czechia
| | - Michala Lustigova
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, Prague, Czechia
| | - Claudia Costa
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, Coimbra, Portugal
| | - Maica Rodríguez-Sanz
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain
| | - Lucia Bosakova
- Department of Health Psychology and Research Methodology, Medical Faculty, P. J. Safarik University in Kosice, Kosice, Slovak Republic; Olomouc University Social Health Institute (OUSHI), Palacky University in Olomouc, Olomouc, Czech Republic
| | - Paula Santana
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, Coimbra, Portugal
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain; Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain; Universitat Pompeu Fabra, Barcelona, Spain
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12
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Health inequalities in Eastern Europe. Does the role of the welfare regime differ from Western Europe? Soc Sci Med 2020; 267:113357. [PMID: 32980174 DOI: 10.1016/j.socscimed.2020.113357] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 08/14/2020] [Accepted: 09/04/2020] [Indexed: 11/22/2022]
Abstract
When we study the impact of social policy on health inequalities, we find that most research is based on Western European countries. This study expands the geographical focus by including post-communist countries from Eastern Europe, Russia, and the Caucasus. The 2008/2009 round of the European Values Study (EVS) provides a unique opportunity for this analysis since it covers 23 post-communist countries and 20 Western European countries. The study uses multilevel cross-sectional analyses to examine the moderating role of welfare regimes on socioeconomic health inequalities. Many reviews claim that the results for welfare systems and health inequalities are inconsistent. However, since the studies selected for the reviews are mainly focused on Western Europe-only a few include Central Eastern European countries-we still need to find out how welfare regimes in post-communist countries moderate the link between socioeconomic status and health. A cluster analysis based on 13 social and economic indicators generates 4 welfare clusters within the post-communist countries which are used for further analyses. Regarding the achievements of the communist countries in compulsory secondary education, the expectation is that the educational health inequalities differ between Eastern and Western Europe. The multilevel analyses confirm that social gradients in health related to education and income exist in both Western and Eastern Europe. However, while income-related health inequalities are similar, educational health inequalities are most pronounced in the welfare cluster of the EU Member States of Central and Eastern Europe.
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13
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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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14
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Bíró K, Dombrádi V, Fekete Z, Bányai G, Boruzs K, Nagy A, Ádány R. Investigating the knowledge of and public attitudes towards genetic testing within the Visegrad countries: a cross-sectional study. BMC Public Health 2020; 20:1380. [PMID: 32912246 PMCID: PMC7488256 DOI: 10.1186/s12889-020-09473-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 08/30/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Previous studies have investigated various factors that can determine the attitudes of the citizens considering genetic testing. However, none of them investigated how these attitudes may differ between the Visegrad countries. METHODS In this cross-sectional study a questionnaire developed by Dutch researchers was translated and used in Hungary, Slovakia, Czechia and Poland. In each country 1000 adult citizens were asked on the topics of personal benefits regarding genetic tests, genetic determinism, and finally, the availability and usage of genetic testing. Multivariate robust regression model was created including several possible influencing factors (such as age, sex, education, marital status, religiousness, and having a genetic test within the nuclear family) to identify the possible differences between the four countries. RESULTS The Hungarian citizens had the most positive opinion on the personal benefits of genetic testing followed by the Czech, Slovak and Polish. All differences were significant in this regard. Considering genetic determinism, the Slovak citizens had a significantly firmer belief in this issue compared to the Hungarians. No other significant differences were observed in this domain. On the topic of the availability and use of genetic testing the Hungarian citizens had the most accepting opinion among the four countries, followed by the Czech citizens. In this domain the Polish and Slovak answers did not differ significantly from each other. CONCLUSIONS Significant differences were observed even when considering various confounding effects. As the underlying reasons for these discrepancies are unknown, future studies should investigate this enigma among the four countries.
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Affiliation(s)
- Klára Bíró
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Viktor Dombrádi
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Zita Fekete
- Department of Behavioural Sciences, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Gábor Bányai
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Klára Boruzs
- Department of Health Systems Management and Quality Management for Health Care, Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Attila Nagy
- Faculty of Public Health, University of Debrecen, Debrecen, Hungary
| | - Róza Ádány
- MTA-DE Public Health Research Group, University of Debrecen, Debrecen, Hungary
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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15
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Bosakova L, Madarasova Geckova A, van Dijk JP, Reijneveld SA. School is (not) calling: the associations of gender, family affluence, disruptions in the social context and learning difficulties with school satisfaction among adolescents in Slovakia. Int J Public Health 2020; 65:1413-1421. [PMID: 32894334 DOI: 10.1007/s00038-020-01474-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 08/25/2020] [Accepted: 08/28/2020] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES Education is an important tool to reduce health inequalities. Several factors influence the educational trajectory of children, with school satisfaction being one of them. The aim was to explore how learning difficulties, a disrupted social context and family affluence relate to school satisfaction. METHODS We used data from the 2018 Slovak cross-sectional Health Behaviour in School-aged Children-study (age 15 years; N = 913; 50.3% boys). School satisfaction was categorized as liking school and caring about education (satisfied), disliking school but caring about education or vice versa (inconsistent), and disliking school and not caring about education (indifferent). We explored the association of learning difficulties, disrupted social context and family affluence with school satisfaction using multinomial logistic regression. RESULTS Boys, and children having learning difficulties, or disruption in the social context and living in low affluence family were significantly less likely to be satisfied at school. CONCLUSIONS The key is to create a stimulating and encouraging environment at school, where children successfully learn functional literacy and feel well. The more satisfaction pupils get from school, the more likely is a favourable educational trajectory for them.
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Affiliation(s)
- Lucia Bosakova
- Department of Health Psychology and Research Methodology, Medical Faculty, P.J. Safarik University in Kosice, Kosice, Slovakia. .,Olomouc University Society and Health Institute, Palacky University in Olomouc, Olomouc, Czech Republic. .,Graduate School Kosice Institute for Society and Health, Medical Faculty, P.J. Safarik University in Kosice, Kosice, Slovakia. .,Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Andrea Madarasova Geckova
- Department of Health Psychology and Research Methodology, Medical Faculty, P.J. Safarik University in Kosice, Kosice, Slovakia.,Olomouc University Society and Health Institute, Palacky University in Olomouc, Olomouc, Czech Republic.,Graduate School Kosice Institute for Society and Health, Medical Faculty, P.J. Safarik University in Kosice, Kosice, Slovakia.,Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Jitse P van Dijk
- Olomouc University Society and Health Institute, Palacky University in Olomouc, Olomouc, Czech Republic.,Graduate School Kosice Institute for Society and Health, Medical Faculty, P.J. Safarik University in Kosice, Kosice, Slovakia.,Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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16
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Kubák M, Gavurová B, Kulhánek A. Spatial analysis of alcohol-related mortality in Slovakia. Cent Eur J Public Health 2020; 27 Suppl:S48-S54. [PMID: 31901192 DOI: 10.21101/cejph.a5766] [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] [Received: 03/22/2019] [Accepted: 01/03/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The aim of our study was to investigate the relationship between alcohol-related mortality in Slovak regions, as represented by Nomenclature of Territorial Units for Statistics (NUTS) III level. METHODS We used data from mortality reports spanning 1996-2017 in the Slovak Republic. Data was provided by the National Health Information Centre in Slovakia. We applied two-dimensional correspondence analysis where the dimensions are regions and selected alcohol-related deaths diagnoses are classified by the International Classification of Diseases. RESULTS Analysis revealed a relationship between the Prešov region and diagnoses I42 - Cardiomyopathy and K29 - Alcoholic gastritis. Furthermore, the Banská Bystrica and Žilina regions correspond to G31 - Degeneration of nervous system due to alcohol and K86 - Alcohol-induced chronic pancreatitis. In the case of K70 - Alcoholic liver disease - the Banská Bystrica, Trenčín and Nitra regions are identified as regions which have an intermediate relationship with this diagnosis. The Trnava region corresponds to F10 - Acute alcohol intoxication. The Trenčín and Nitra regions correspond closely to G62 - Alcoholic polyneuropathy. Perfect correspondence can be seen between the Košice region and K73 - Chronic hepatitis, not elsewhere classified. K74 - Fibrosis and cirrhosis of liver diagnosis also corresponds with the Košice region. CONCLUSIONS The results of this analysis provide valuable insights for national and regional health policymakers in the process of preparing high-quality health regional plans, as well as retrospectively assessing the success of existing health policies and interventions in this area. Facts presented in the study justify the need for specialised health care, which is part of the process of building an Integrated Health Care Centre in Slovakia.
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Affiliation(s)
- Matúš Kubák
- Faculty of Economics, Technical University of Kosice, Kosice, Slovak Republic
| | - Beáta Gavurová
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Adam Kulhánek
- Department of Addictology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
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17
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Hernandez J. Cardiovascular Risk Awareness in the Czech Republic: Can We Implement Effective Measures? Curr Atheroscler Rep 2019; 21:44. [PMID: 31707482 DOI: 10.1007/s11883-019-0805-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Jose Hernandez
- International Clinical Research Center, St. Anne's University Hospital, Brno, Czech Republic.
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18
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Bosakova L, Madarasova Geckova A, van Dijk JP, Reijneveld SA. Increased Employment for Segregated Roma May Improve Their Health: Outcomes of a Public-Private Partnership Project. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16162889. [PMID: 31412549 PMCID: PMC6719200 DOI: 10.3390/ijerph16162889] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Revised: 08/04/2019] [Accepted: 08/07/2019] [Indexed: 12/02/2022]
Abstract
Increasing employment opportunities for segregated Roma might prevent major economic losses and improve their health. Involvement of the private sector in Roma employment, on top of intensified governmental actions, is likely to be a key to sustainable improvement, but evidence on this is scarce. Our aim was to determine the potential outcomes of such a partnership regarding increased employability and the resulting improved well-being and health. We therefore investigated a Roma employment project called Equality of Opportunity, run since 2002 by a private company, U.S. Steel Kosice, in eastern Slovakia. We conducted a multi-perspective qualitative study to obtain the perspectives of key stakeholders on the outcomes of this project. We found that they expected the employability of segregated Roma to increase in particular via improvements in their work ethic and working habits, education, skills acquisition, self-confidence, courage and social inclusion. They further expected as the main health effects of increased employability an improvement in Roma well-being and health via a stable income, better housing, crime reduction, improved hygienic standards, access to prevention and improved mental resilience. Social policies regarding segregated Roma could thus be best directed at increasing employment and at these topics in particular to increase their effects on Roma health.
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Affiliation(s)
- Lucia Bosakova
- Department of Health Psychology, Medical Faculty, P.J. Safarik University in Kosice, Trieda SNP 1, 040 11 Kosice, Slovakia.
- Graduate School Kosice Institute for Society and Health, P.J. Safarik University in Kosice, Trieda SNP 1, 040 11 Kosice, Slovakia.
- Olomouc University Society and Health Institute, Palacky University in Olomouc, Univerzitni 22, 771 11 Olomouc, Czech Republic.
| | - Andrea Madarasova Geckova
- Department of Health Psychology, Medical Faculty, P.J. Safarik University in Kosice, Trieda SNP 1, 040 11 Kosice, Slovakia
- Graduate School Kosice Institute for Society and Health, P.J. Safarik University in Kosice, Trieda SNP 1, 040 11 Kosice, Slovakia
- Olomouc University Society and Health Institute, Palacky University in Olomouc, Univerzitni 22, 771 11 Olomouc, Czech Republic
| | - Jitse P van Dijk
- Graduate School Kosice Institute for Society and Health, P.J. Safarik University in Kosice, Trieda SNP 1, 040 11 Kosice, Slovakia
- Olomouc University Society and Health Institute, Palacky University in Olomouc, Univerzitni 22, 771 11 Olomouc, Czech Republic
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
| | - Sijmen A Reijneveld
- Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Antonius Deusinglaan 1, 9713 AV Groningen, The Netherlands
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19
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Lustigova M, Dzurova D, Costa C, Santana P. Health Disparities in Czechia and Portugal at Country and Municipality Levels. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071139. [PMID: 30934925 PMCID: PMC6480706 DOI: 10.3390/ijerph16071139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 03/22/2019] [Accepted: 03/24/2019] [Indexed: 02/06/2023]
Abstract
This article investigates the health outcomes and determinants between two different European populations, Portuguese and Czech, on two hierarchical levels: country and metropolitan area. At first, the decomposition method of age and cause of death were compared on the country level, and then health was examined based on a factor analysis at the municipality level of Prague and Lisbon. The results clearly indicate problematic diabetes mortality among the Portuguese population, and especially in the Lisbon Metropolitan Area, and confirm the dominant role of circulatory mortality and cancer mortality among Czech, especially the Prague population. The social and economic deprivations were revealed as the major drivers for both metropolitan areas, although with differences between them, requiring interventions that go beyond the health sector.
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Affiliation(s)
- Michala Lustigova
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, 128 43 Prague, Czech Republic.
| | - Dagmar Dzurova
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, 128 43 Prague, Czech Republic.
| | - Claudia Costa
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal.
| | - Paula Santana
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal.
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20
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Costa C, Santana P, Dimitroulopoulou S, Burstrom B, Borrell C, Schweikart J, Dzurova D, Zangarini N, Katsouyanni K, Deboseree P, Freitas Â, Mitsakou C, Samoli E, Vardoulakis S, Marí Dell'Olmo M, Gotsens M, Lustigova M, Corman D, Costa G. Population Health Inequalities Across and Within European Metropolitan Areas through the Lens of the EURO-HEALTHY Population Health Index. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E836. [PMID: 30866549 PMCID: PMC6427561 DOI: 10.3390/ijerph16050836] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 02/25/2019] [Accepted: 03/02/2019] [Indexed: 12/12/2022]
Abstract
The different geographical contexts seen in European metropolitan areas are reflected in the uneven distribution of health risk factors for the population. Accumulating evidence on multiple health determinants point to the importance of individual, social, economic, physical and built environment features, which can be shaped by the local authorities. The complexity of measuring health, which at the same time underscores the level of intra-urban inequalities, calls for integrated and multidimensional approaches. The aim of this study is to analyse inequalities in health determinants and health outcomes across and within nine metropolitan areas: Athens, Barcelona, Berlin-Brandenburg, Brussels, Lisbon, London, Prague, Stockholm and Turin. We use the EURO-HEALTHY Population Health Index (PHI), a tool that measures health in two components: Health Determinants and Health Outcomes. The application of this tool revealed important inequalities between metropolitan areas: Better scores were found in Northern cities when compared with their Southern and Eastern counterparts in both components. The analysis of geographical patterns within metropolitan areas showed that there are intra-urban inequalities, and, in most cities, they appear to form spatial clusters. Identifying which urban areas are measurably worse off, in either Health Determinants or Health Outcomes, or both, provides a basis for redirecting local action and for ongoing comparisons with other metropolitan areas.
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Affiliation(s)
- Claudia Costa
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal.
| | - Paula Santana
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal.
- Department of Geography and Tourism, University of Coimbra, 3004-530 Coimbra, Portugal.
| | - Sani Dimitroulopoulou
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton OX11 0RQ, Oxon, UK.
| | - Bo Burstrom
- Karolinska Institutet, Department of Public Health Sciences, Division of Social Medicine, 171 77 Stockholm, Sweden.
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain.
- Institut d'Investigació Biomèdica (IIB Sant Pau), 08041 Barcelona, Spain.
- Universitat Pompeu Fabra, 08002 Barcelona, Spain.
| | - Jürgen Schweikart
- Department of Civil Engineering and Geoinformation, Beuth University of Applied Sciences Berlin, 13437 Berlin, Germany.
| | - Dagmar Dzurova
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, 128 43 Prague, Czech Republic.
| | - Nicolás Zangarini
- Department of Public Health and Pediatrics, University of Turin, 10126 Turin, Italy.
| | - Klea Katsouyanni
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 115 27 Athens, Greece.
| | - Patrick Deboseree
- Interface Demography, University of Brussels, 1050 Brussels, Belgium.
| | - Ângela Freitas
- Centre of Studies in Geography and Spatial Planning, University of Coimbra, 3004-530 Coimbra, Portugal.
| | - Christina Mitsakou
- Centre for Radiation, Chemical and Environmental Hazards, Public Health England, Chilton OX11 0RQ, Oxon, UK.
| | - Evangelia Samoli
- Department of Hygiene, Epidemiology and Medical Statistics, University of Athens Medical School, 115 27 Athens, Greece.
| | | | - Marc Marí Dell'Olmo
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain.
- Institut d'Investigació Biomèdica (IIB Sant Pau), 08041 Barcelona, Spain.
| | - Mercè Gotsens
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain.
- CIBER Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain.
- Institut d'Investigació Biomèdica (IIB Sant Pau), 08041 Barcelona, Spain.
- Universitat Pompeu Fabra, 08002 Barcelona, Spain.
| | - Michala Lustigova
- Department of Social Geography and Regional Development, Faculty of Science, Charles University, 128 43 Prague, Czech Republic.
| | - Diana Corman
- The National Board of Health and Welfare, 106 30 Stockholm, Sweden.
| | - Giuseppe Costa
- Medical School of the University of Turin, University of Turin, 10124 Turin, Italy.
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