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Kapos FP, Craig KD, Anderson SR, Bernardes SF, Hirsh AT, Karos K, Keogh E, Reynolds Losin EA, McParland JL, Moore DJ, Ashton-James CE. Social Determinants and Consequences of Pain: Toward Multilevel, Intersectional, and Life Course Perspectives. THE JOURNAL OF PAIN 2024:104608. [PMID: 38897311 DOI: 10.1016/j.jpain.2024.104608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 06/07/2024] [Accepted: 06/10/2024] [Indexed: 06/21/2024]
Abstract
Despite wide endorsement of a biopsychosocial framework for pain, social aspects of pain remain rarely addressed in the context of pain prevention and management. In this review, we aim to 1) examine the broad scope of social determinants and consequences of pain and their interactions across multiple levels of organization, and 2) provide a framework synthesizing existing concepts and potential areas for future work on social aspects of pain, drawing upon socioecological, intersectional, and life course approaches. Integrating interdisciplinary theory and evidence, we outline pathways through which multilevel social factors and pain may affect each other over time. We also provide a brief summary of intrapersonal aspects of pain, which are thought to operate at the interface between individuals and the social context. Progressing from micro- to macrolevel factors, we illustrate how social determinants of pain can directly or indirectly contribute to pain experiences, expression, risk, prognosis, and impact across populations. We consider 1) at the interpersonal level, the roles of social comparison, social relatedness, social support, social exclusion, empathy, and interpersonal conflict; 2) at the group or community level, the roles of intimacy groups, task groups, social categories, and loose associations; and 3) at the societal level, the roles of political, economic, and cultural systems, as well as their policies and practices. We present examples of multilevel consequences of pain across these levels and discuss opportunities to reduce the burden and inequities of pain by expanding multilevel social approaches in pain research and practice. PERSPECTIVE: Despite wide endorsement of a biopsychosocial framework for pain, social aspects of pain are often unclearly defined, hindering their use in pain prevention, management, and research. We summarize the scope of social aspects of pain and provide a framework synthesizing existing concepts and potential areas for future work.
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Affiliation(s)
- Flavia P Kapos
- Center for Child Health, Behavior and Development, Seattle Children's Research Institute, Seattle, Washington; Department of Orthopaedic Surgery & Duke Clinical Research Institute, Duke University Schoool of Medicine, Durham, North Carolina.
| | - Kenneth D Craig
- Department of Psychology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Steven R Anderson
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Stanford, California
| | - Sónia F Bernardes
- Centre for Social Research and Intervention, Iscte-Lisbon University Institute, Lisbon, Portugal
| | - Adam T Hirsh
- Department of Psychology, Indiana University Indianapolis, Indianapolis, Indiana
| | - Kai Karos
- Experimental Health Psychology, Department of Clinical Psychological Science, Faculty of Psychology and Neuroscience, Maastricht University, Maastricht, the Netherlands
| | - Edmund Keogh
- Department of Psychology & Centre for Pain Research, University of Bath, Bath, United Kingdom
| | | | - Joanna L McParland
- Department of Psychology, Glasgow Caledonian University, Glasgow, United Kingdom
| | - David J Moore
- School of Psychology, Liverpool John Moores University, Liverpool, United Kingdom
| | - Claire E Ashton-James
- Pain Management Research Institute, Kolling Institute, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Yadav UN, Smith M, Agostino J, Sinka V, Williamson L, Wyber R, Butler DC, Belfrage M, Freeman K, Passey M, Walke E, Hammond B, Lovett R, Douglas KA. Understanding the implementation of health checks in the prevention and early detection of chronic diseases among Aboriginal and Torres Strait Islander people in Australia: a realist review protocol. BMJ Open 2023; 13:e071234. [PMID: 37344121 DOI: 10.1136/bmjopen-2022-071234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/23/2023] Open
Abstract
INTRODUCTION Chronic disease remains the leading cause of morbidity and mortality among Aboriginal and Torres Strait Islander peoples in Australia. Regular structured, comprehensive health assessments are available to Aboriginal and Torres Strait Islander people as annual health checks funded through the Medicare Benefits Schedule. This realist review aims to identify context-specific enablers and tensions and contribute to developing an evidence framework to guide the implementation of health checks in the prevention and early detection of chronic diseases for Aboriginal and Torres Strait Islander people. METHODS AND ANALYSIS The review will involve the following steps: (1) Aboriginal and Torres Strait Islander engagement and research governance; (2) defining the scope of the review; (3) search strategy; (4) screening, study selection and appraisal; (5) data extraction and organisation of evidence; (6) data synthesis and drawing conclusions. This realist review will follow the Realist and MEta-narrative Evidence Syntheses: Evolving Standards guidance and will be reported as set up by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols statement. The realist programme theory will be developed through a literature review using multiple database searches from 1 November 1999 to 31 June 2022, limited to the English language, and stakeholder consultation, which will be refined throughout the review process. The study findings will be reported by applying the context-mechanism-outcome configuration to gain a deeper understanding of context and underlying mechanisms that influence the implementation of health checks in the prevention and early detection of chronic diseases among Aboriginal and Torres Strait Islander people in Australia. ETHICS AND DISSEMINATION Ethical approval is not required as this review will be using secondary data. Findings will be published in a peer-reviewed journal and presented at scientific conferences. SYSTEMATIC REVIEW REGISTRATION The review protocol has been registered on the international prospective register of systematic reviews: CRD42022326697.
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Affiliation(s)
- Uday Narayan Yadav
- National Centre for Aborginal and Torres Strait Islander Wellbeing Research, Australian National University, Canberra, Australian Capital Territory, Australia
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Matthew Smith
- Australian National University Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Jason Agostino
- Australian National University Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
- National Aboriginal Community Controlled Health Organisation, Canberra, Australian Capital Territory, Australia
| | - Victoria Sinka
- Centre for Kidney Research, Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Leonie Williamson
- National Centre for Aborginal and Torres Strait Islander Wellbeing Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Rosemary Wyber
- National Centre for Aborginal and Torres Strait Islander Wellbeing Research, Australian National University, Canberra, Australian Capital Territory, Australia
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Danielle C Butler
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
- The Institute for Urban Indigenous Health, Windsor, Queensland, Australia
| | - Mary Belfrage
- Royal Australian College of General Practitioners, Aboriginal & Torres Strait Islander Health, Melbourne, Victoria, Australia
| | - Kate Freeman
- Royal Australian College of General Practitioners, Aboriginal & Torres Strait Islander Health, Melbourne, Victoria, Australia
| | - Megan Passey
- University Centre for Rural Health, University of Sydney, Lismore, New South Wales, Australia
| | - Emma Walke
- University Centre for Rural Health, University of Sydney, Lismore, New South Wales, Australia
| | - Belinda Hammond
- Royal Australian College of General Practitioners, Aboriginal & Torres Strait Islander Health, Melbourne, Victoria, Australia
| | - Raymond Lovett
- National Centre for Aborginal and Torres Strait Islander Wellbeing Research, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Kirsty A Douglas
- Australian National University Medical School, Australian National University, Canberra, Australian Capital Territory, Australia
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3
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Wien S, Miller AL, Kramer MR. Structural racism theory, measurement, and methods: A scoping review. Front Public Health 2023; 11:1069476. [PMID: 36875414 PMCID: PMC9978828 DOI: 10.3389/fpubh.2023.1069476] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 01/30/2023] [Indexed: 02/18/2023] Open
Abstract
Introduction Epidemiologic and public health interest in structural racism has grown dramatically, producing both increasingly sophisticated questions, methods, and findings, coupled with concerns of atheoretical and ahistorical approaches that often leave the actual production of health or disease ambiguous. This trajectory raises concerns as investigators adopt the term "structural racism" without engaging with theories and scholars with a long history in this area. This scoping review aims to build upon recent work by identifying current themes about the incorporation of structural racism into (social) epidemiologic research and practice with respect to theory, measurement, and practices and methods for trainees and public health researchers who are not already deeply grounded in this work. Methods This review uses methodological framework and includes peer-review articles written in English published between January 2000-August 2022. Results A search of Google Scholar, manual collection, and referenced lists identified a total of 235 articles; 138 met the inclusion criteria after duplicates were removed. Results were extracted by, and organized into, three broad sections: theory, construct measurement, and study practice and methods, with several themes summarized in each section. Discussion This review concludes with a summary of recommendations derived from our scoping review and a call to action echoing previous literature to resist an uncritical and superficial adoption of "structural racism" without attention to already existing scholarship and recommendations put forth by experts in the field.
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Affiliation(s)
- Simone Wien
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, United States
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4
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Vásquez-Vera H, León-Gómez BB, Borrell C, Jacques-Aviñó C, López MJ, Medina-Perucha L, Pasarin M, Sánchez-Ledesma E, Pérez K. Inequities in the distribution of COVID-19: an adaptation of WHO's conceptual framework. GACETA SANITARIA 2021; 36:488-492. [PMID: 34823902 PMCID: PMC8526437 DOI: 10.1016/j.gaceta.2021.10.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/28/2021] [Accepted: 10/02/2021] [Indexed: 12/02/2022]
Abstract
The COVID-19 pandemic currently affects populations worldwide. Although everyone is susceptible to the virus, there are numerous accounts of the pandemic having a greater impact on lower socioeconomic groups and minorities, which is a ubiquitous phenomenon. It is essential for public health administrations and governments to uncover and understanding these inequities to develop proper intersectoral policies to tackle this crisis. Therefore, developing a conceptual framework on this topic, describing the social mechanisms that explain the unjust distribution of the incidence and mortality of COVID-19, is a key task. The aim of this paper is to adapt the framework on social determinants of health from the World Health Organization to the specifics of COVID-19 pandemic. Thus, it identifies and explains the structural and intermediate determinants involved in this pandemic, and adds some new elements (such as the role of the oppression systems and communication) which may help to understand, and ultimately tackle, social inequities in COVID-19 distribution.
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Affiliation(s)
- Hugo Vásquez-Vera
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | | | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Constanza Jacques-Aviñó
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain; Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès (Barcelona), Spain
| | - María José López
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Laura Medina-Perucha
- Fundació Institut Universitari per a la recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Barcelona, Spain
| | - Maribel Pasarin
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
| | - Esther Sánchez-Ledesma
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain
| | - Katherine Pérez
- Agència de Salut Pública de Barcelona, Barcelona, Spain; Institut d'Investigació Biomèdica Sant Pau, Barcelona, Spain; CIBER de Epidemiología y Salud Pública (CIBERESP), Spain
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5
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Bergen N, Ruckert A, Abebe L, Asfaw S, Kiros G, Mamo A, Morankar S, Kulkarni MA, Labonté R. Characterizing 'health equity' as a national health sector priority for maternal, newborn, and child health in Ethiopia. Glob Health Action 2021; 14:1853386. [PMID: 33380284 PMCID: PMC7782227 DOI: 10.1080/16549716.2020.1853386] [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] [Indexed: 11/21/2022] Open
Abstract
Background: The pursuit of health equity is a priority in Ethiopia, especially with regards to maternal, newborn, and child health (MNCH). To date, there has been little characterization of the ‘problem’ of health inequity, and the normative assumptions implicit in the representation of the problem. Yet, such insights have implications for shaping the framing, incentivization, and implementation of health policies and their wider impact. Objective: In this article, we characterize how health (in)equity is represented as a policy issue, how this representation came about, and the underlying assumptions. Methods: We draw from Bacchi’s ‘what is the problem represented to be’ approach to explore how national-level actors in the health sector constitute the problem. The data for our analysis encompass 23 key informant interviews with national health sector actors working in leadership positions on MNCH in Ethiopia, and six policy documents. Findings were derived from thematic and content analysis. Results: Health inequity is a normalized and inevitable concern that is regarded as actionable (can be altered) but not fully resolvable (can never be fully achieved). Operationally, health equity is viewed as a technocratic matter, reflected in the widespread use of metrics to motivate and measure progress. These representations are shaped by Ethiopia’s rapid expansion of health services into rural areas during the 2000s leading to the positive international attention and funding the country received for improved MNCH indicators. Expanding the coverage and efficiency of health service provision, especially in rural areas, is associated with economic productivity. Conclusion: The metrication of health equity may detract from the fairness, justice, and morality underpinnings of the concept. The findings of this study point to the implications of global pressures in terms of maximizing health investments, and call into question how social, political, and economic determinants of health are addressed through broader development agendas.
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Affiliation(s)
- Nicole Bergen
- Faculty of Health Sciences, Interdisciplinary School of Health Sciences, University of Ottawa , Ottawa, Canada
| | - Arne Ruckert
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa , Ottawa, Canada
| | - Lakew Abebe
- Faculty of Public Health, Institute of Health, Department of Health, Behavior and Society, Jimma University , Jimma, Ethiopia
| | - Shifera Asfaw
- Faculty of Public Health, Institute of Health, Department of Health, Behavior and Society, Jimma University , Jimma, Ethiopia
| | - Getachew Kiros
- Faculty of Health Sciences, School of Nursing, University of Ottawa , Ottawa, Canada
| | - Abebe Mamo
- Faculty of Public Health, Institute of Health, Department of Health, Behavior and Society, Jimma University , Jimma, Ethiopia
| | - Sudhakar Morankar
- Faculty of Public Health, Institute of Health, Department of Health, Behavior and Society, Jimma University , Jimma, Ethiopia
| | - Manisha A Kulkarni
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa , Ottawa, Canada
| | - Ronald Labonté
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa , Ottawa, Canada
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6
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Mahabir DF, O'Campo P, Lofters A, Shankardass K, Salmon C, Muntaner C. Classism and Everyday Racism as Experienced by Racialized Health Care Users: A Concept Mapping Study. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2021; 51:350-363. [PMID: 33949220 PMCID: PMC8204040 DOI: 10.1177/00207314211014782] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
In Toronto, Canada, 51.5 % of the population are members of racialized groups. Systemic
labor market racism has resulted in an overrepresentation of racialized groups in
low-income and precarious jobs, a racialization of poverty, and poor health. Yet, the
health care system is structured around a model of service delivery and policies that fail
to consider unequal power social relations or racism. This study examines how racialized
health care users experience classism and everyday racism in the health care setting and
whether these experiences differ within stratifications such as social class, gender, and
immigration status. A concept mapping design was used to identify mechanisms of classism
and everyday racism. For the rating activity, 41 participants identified as racialized
health care users. The data analysis was completed using concept systems software.
Racialized health care users reported “race”/ethnic-based discrimination as moderate to
high and socioeconomic position-/social class-based discrimination as moderate in
importance for the challenges experienced when receiving health care; differences within
stratifications were also identified. To improve access to services and quality of care,
antiracist policies that focus on unequal power social relations and a broader systems
thinking are needed to address institutional racism within the health care system.
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Affiliation(s)
| | | | | | | | - Christina Salmon
- 518773Knowledge Translation Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Carles Muntaner
- 7938University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, 7938University of Toronto, ON, Canada
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7
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Structural determination and social practice: towards a new understanding of ‘structure’ in health inequality research. SOCIAL THEORY & HEALTH 2021. [DOI: 10.1057/s41285-021-00163-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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8
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Borras AM. Toward an Intersectional Approach to Health Justice. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2020; 51:206-225. [PMID: 33356774 DOI: 10.1177/0020731420981857] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Despite unprecedented global wealth creation, health inequity-the unjust health inequality between classes and groups among and within countries-persists, reviving the relevance of social justice as a lens to understand and as an instrument to intervene in these issues. However, the theoretical aspects and polysemous character of social justice as applied in the field of public health are often assumed rather than explicitly explained. An intersectional justice approach to understanding health inequality, inequity, and injustice might be useful. It argues that preexisting class-, race/ethnicity-, and gender-based health injustice and the socially differentiated impacts of the COVID-19 pandemic are shaped, interconnectedly, by economic maldistribution, cultural misrecognition, and political misrepresentation. Pursuing health justice requires analyses, strategies, and interventions that integrate the economic, cultural, and political spheres of redistribution, recognition, and representation, respectively. Such an intersectional approach to health justice is even more relevant and compelling in light of the COVID-19 pandemic. This article is broadly about class, race/ethnicity, and gender political economy of public health-but with a narrower focus on maldistribution, misrecognition, and misrepresentation, shaping social and health injustices.
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Affiliation(s)
- Arnel M Borras
- School of Health Policy and Management, 56014York University, Toronto, Ontario, Canada
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9
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Hamelin AM, Caux C, Désy M, Guichard A, Ouédraogo S, Tremblay MC, Vissandjée B, Godard B. Developing the culture of ethics in population health intervention research in Canada. Glob Health Promot 2020; 27:69-77. [PMID: 32400273 DOI: 10.1177/1757975920913547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Population health intervention research (PHIR) is a particular field of health research that aims to generate knowledge that contributes to the sustainable improvement of population health by enabling the implementation of cross-sectoral solutions adapted to social realities. Despite the ethical issues that necessarily raise its social agenda, the ethics of PHIR is still not very formalized. Unresolved ethical challenges may limit its focus on health equity. This contribution aims to highlight some of these issues and calls on researchers to develop a culture of ethics in PHIR. Three complementary ways are proposed: to build an ethical concept specific to this field, to promote a shared space for critical reflection on PHIR ethics, and to develop the ethical competence in PHIR for which a preliminary framework is proposed.
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Affiliation(s)
| | | | - Michel Désy
- Institut national de santé publique du Québec, Montreal, Canada
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10
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Ziersch A, Freeman T, Javanparast S, Mackean T, Baum F. Regional primary health care organisations and migrant and refugee health: the importance of prioritisation, funding, collaboration and engagement. Aust N Z J Public Health 2020; 44:152-159. [DOI: 10.1111/1753-6405.12965] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 11/01/2019] [Accepted: 12/01/2019] [Indexed: 12/29/2022] Open
Affiliation(s)
- Anna Ziersch
- Southgate Institute for Health, Society and EquityFlinders University South Australia
| | - Toby Freeman
- Southgate Institute for Health, Society and EquityFlinders University South Australia
| | - Sara Javanparast
- Southgate Institute for Health, Society and EquityFlinders University South Australia
| | - Tamara Mackean
- Southgate Institute for Health, Society and EquityFlinders University South Australia
| | - Fran Baum
- Southgate Institute for Health, Society and EquityFlinders University South Australia
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11
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Choi YJ, Jeon MS. How Business Interests and Government Inaction Led to the Humidifier Disinfectant Disaster in South Korea: Implications for Better Risk Governance. RISK ANALYSIS : AN OFFICIAL PUBLICATION OF THE SOCIETY FOR RISK ANALYSIS 2020; 40:240-253. [PMID: 31536155 DOI: 10.1111/risa.13400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 08/13/2019] [Accepted: 08/13/2019] [Indexed: 06/10/2023]
Abstract
Humidifier sterilizers were regarded as innovative and health-promoting products; they were widespread in South Korea until 2011. However, hospitals reported mysterious deaths, and a legal investigation in April 2016 found that hundreds of people have died due to use of the sterilizing disinfectant. This article takes up that topic, discussing the government's role in dealing with the risk regarding the humidifier disinfectant. We pay particular attention to the unequal nature of the uncertainty produced by the distorted socioeconomic structure. Through in-depth interviews with key informants and an examination of relevant documents from the government, civic groups, and newspapers, we find that the government had increasingly acknowledged the risk, yet their inaction failed to stop the high number of casualties, and they have only recently responded proactively. The uncertainty of the risk was unevenly distributed between companies, the government, experts, and citizens. We argue that the proactive and transparent role of the government with the precautionary principle could fix the unequal structure of knowledge production and preserve public health.
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Affiliation(s)
- Young Jun Choi
- Department of Public Administration, Yonsei University, Yonsei-ro 50, Seoul, South Korea
| | - Mi Sun Jeon
- Department of Public Administration, Yonsei University, Yonsei-ro 50, Seoul, South Korea
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12
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Explaining mental health recovery in the context of structural disadvantage: the unrealised potential of critical realism. SOCIAL THEORY & HEALTH 2019. [DOI: 10.1057/s41285-019-00122-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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13
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Tulier ME, Reid C, Mujahid MS, Allen AM. "Clear action requires clear thinking": A systematic review of gentrification and health research in the United States. Health Place 2019; 59:102173. [PMID: 31357049 PMCID: PMC6868313 DOI: 10.1016/j.healthplace.2019.102173] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/13/2019] [Accepted: 07/18/2019] [Indexed: 12/28/2022]
Abstract
Gentrification is a process in which formerly declining, under-resourced, neighborhoods experience reinvestment and in-migration of increasingly affluent new residents, with understudied implications for individual health and health-protective community resources for low-income and minority residents. Increased attention on urban health inequities have propelled research on the relationship between gentrification and health. Yet, there are significant challenges inherent in the study of gentrification given its non-linear process occurring at multiple levels and via various mechanisms in a complex web of urban systems. How then have empirical studies addressed questions regarding the relationship between gentrification and health and wellness from a conceptual and methodological standpoint? Applying key search terms to PubMed and Web of Science, we identified 546 papers published in the United States. This review is guided by three foundational premises informing the inclusion and exclusion of articles. These include: 1. a clear definition of gentrification and explicit health outcome; 2. identification of a specific geographic context (United States) in which gentrification occurs, and 3. use of a social determinants of health framework to identify potential health outcomes of interest. 17 papers met our inclusion criteria. Through systematic content analysis using MaxQDA software, we evaluated the included studies using three critical frames: 1. conceptualization of gentrification; 2. mechanisms linking gentrification and health; and 3. spatio-temporal considerations. Based on this analysis, we identify the strengths and limitations of existing research, and offer three methodological approaches to strengthen the current literature on gentrification and health. We recommend that future studies: 1. explicitly identify the mechanisms and levels at which processes can occur and systems are organized; 2. incorporate space and time into the analytical strategy and 3. articulate an epistemological standpoint driven by their conceptualization of the exposure and identification of the relevant mechanism and outcome of interest.
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Affiliation(s)
- Melody Esther Tulier
- Center for Interdisciplinary Research on AIDS (CIRA), Yale University, 60 College St.New Haven, CT, 06520-8034, USA.
| | - Carolina Reid
- Department of City and Regional Planning, University of California, Berkeley, 312 Wurster Hall #1850, Berkeley, CA, 94720-1820, USA
| | - Mahasin S Mujahid
- University of California, Berkeley School of Public Health Division of Epidemiology, Haviland Hall, 2121 Berkeley Way, Berkeley, CA, 94720-7360, USA
| | - Amani M Allen
- University of California, Berkeley School of Public Health Division of Epidemiology, Haviland Hall, 2121 Berkeley Way, Berkeley, CA, 94720-7360, USA; University of California, Berkeley School of Public Health Division of Community Health Sciences, 2121 Berkeley Way, MC #5302, Berkeley, CA, 94720-7360, USA
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14
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Muntaner C, Augustinavicius J. Intersectionality: A Scientific Realist Critique. THE AMERICAN JOURNAL OF BIOETHICS : AJOB 2019; 19:39-41. [PMID: 31543026 DOI: 10.1080/15265161.2018.1557296] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
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15
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Axelsson Fisk S, Mulinari S, Wemrell M, Leckie G, Perez Vicente R, Merlo J. Chronic Obstructive Pulmonary Disease in Sweden: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy. SSM Popul Health 2018; 4:334-346. [PMID: 29854918 PMCID: PMC5976844 DOI: 10.1016/j.ssmph.2018.03.005] [Citation(s) in RCA: 65] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 03/09/2018] [Accepted: 03/12/2018] [Indexed: 12/13/2022] Open
Abstract
Socioeconomic, ethnic and gender disparities in Chronic Obstructive Pulmonary Disease (COPD) risk are well established but no studies have applied multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) within an intersectional framework to study this outcome. We study individuals at the first level of analysis and combinations of multiple social and demographic categorizations (i.e., intersectional strata) at the second level of analysis. Here we used MAIHDA to assess to what extent individual differences in the propensity of developing COPD are at the intersectional strata level. We also used MAIHDA to determine the degree of similarity in COPD incidence of individuals in the same intersectional stratum. This leads to an improved understanding of risk heterogeneity and of the social dynamics driving socioeconomic and demographic disparities in COPD incidence. Using data from 2,445,501 residents in Sweden aged 45–65, we constructed 96 intersectional strata combining categories of age, gender, income, education, civil- and migration status. The incidences of COPD ranged from 0.02% for young, native males with high income and high education who cohabited to 0.98% for older native females with low income and low education who lived alone. We calculated the intra-class correlation coefficient (ICC) that informs on the discriminatory accuracy of the categorizations. In a model that conflated additive and interaction effects, the ICC was good (20.0%). In contrast, in a model that measured only interaction effects, the ICC was poor (1.1%) suggesting that most of the observed differences in COPD incidence across strata are due to the main effects of the categories used to construct the intersectional matrix while only a minor share of the differences are attributable to intersectional interactions. We found conclusive interaction effects. The intersectional MAIHDA approach offers improved information to guide public health policies in COPD prevention, and such policies should adopt an intersectional perspective. We use multilevel analysis of individual heterogeneity and discriminatory accuracy. There is a clear difference in COPD incidence between intersectional strata. Intersectionality improves mapping of socioeconomic differences in COPD incidence. Preventive measures should be based on intersectional rather than classic analyses.
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Affiliation(s)
- Sten Axelsson Fisk
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Sweden
| | - Shai Mulinari
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Sweden
| | - Maria Wemrell
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Sweden
| | - George Leckie
- Centre for Multilevel Modelling, University of Bristol, UK
| | | | - Juan Merlo
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Sweden.,Center for Primary Health Research, Region Skåne, Malmö, Sweden
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MacVicar S, Berrang-Ford L, Harper S, Steele V, Lwasa S, Bambaiha DN, Twesigomwe S, Asaasira G, Ross N. How seasonality and weather affect perinatal health: Comparing the experiences of indigenous and non-indigenous mothers in Kanungu District, Uganda. Soc Sci Med 2017. [DOI: 10.1016/j.socscimed.2017.06.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Muntaner C, Mahabir DF. Just Say No to the TPP: A Democratic Setback for American and Asian Public Health Comment on "The Trans-Pacific Partnership: Is It Everything We Feared for Health?". Int J Health Policy Manag 2017; 6:419-421. [PMID: 28812839 PMCID: PMC5505113 DOI: 10.15171/ijhpm.2016.145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Accepted: 10/31/2016] [Indexed: 11/20/2022] Open
Abstract
The article by Labonté, Schram, and Ruckert is a significant and timely analysis of the Trans-Pacific Partnership (TPP) policy and the severe threats to public health that it implies for 12 Pacific Rim populations from the Americas and Asia (Australia, Brunei, Canada, Chile, Japan, Malaysia, Mexico, New Zealand, Peru, Singapore, United States, and Vietnam). With careful and analytic precision the authors convincingly unearth many aspects of this piece of legislation that undermine the public health achievements of most countries involved in the TTP. Our comments complement their policy analysis with the aim of providing a positive heuristic tool to assist in the understanding of the TPP, and other upcoming treaties like the even more encompassing Transatlantic Trade and Investment Partnership (TTIP), and in so doing motivate the public health community to oppose the implementation of the relevant provisions of the agreements. The aims of this commentary on the study of Labonté et al are to show that an understanding of the health effects of the TPP is incomplete without a political analysis of policy formation, and that realist methods can be useful to uncover the mechanisms underlying TPP’s political and policy processes.
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Affiliation(s)
- Carles Muntaner
- Bloomberg Faculty of Nursing University of Toronto, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,School of Medicine, University of Toronto, Toronto, ON, Canada
| | - Deb Finn Mahabir
- Bloomberg Faculty of Nursing University of Toronto, Toronto, ON, Canada
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Muntaner C, Davis O, McIsaack K, Kokkinen L, Shankardass K, O’Campo P. Retrenched Welfare Regimes Still Lessen Social Class Inequalities in Health. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2017. [DOI: 10.1177/0020731417712509] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article builds on recent work that has explored how welfare regimes moderate social class inequalities in health. It extends research to date by using longitudinal data from the EU-SILC (2003–2010) and examines how the relationship between social class and self-reported health and chronic conditions varies across 23 countries, which are split into five welfare regimes (Nordic, Anglo-Saxon, Eastern, Southern, and Continental). Our analysis finds that health across all classes was only worse in Eastern Europe (compared with the Nordic countries). In contrast, we find evidence that the social class gradient in both measures of health was significantly wider in the Anglo-Saxon and Southern regimes. We suggest that this evidence supports the notion that welfare regimes continue to explain differences in health according to social class location. We therefore argue that although downward pressures from globalization and neoliberalism have blurred welfare regime typologies, the Nordic model may continue to have an important mediating effect on class-based inequalities in health.
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Affiliation(s)
- C. Muntaner
- Bloomberg Faculty of Nursing and Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - O. Davis
- School of Social Policy, Sociology and Social Research, University of Kent, UK
| | - K. McIsaack
- Nova Scotia Health Authority, Research Services, Nova Scotia, Canada
| | - L. Kokkinen
- Centre of Expertise for the Development of Work and Organizations, Finnish Institute of Occupational Health, Tampere and Helsinki, Finland
| | - K. Shankardass
- Department of Health Sciences, Wilfrid Laurier University, Waterloo, Ontario, Canada
- Centre for Urban Health Solutions, The Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - P. O’Campo
- Centre for Urban Health Solutions, The Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Toronto, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Wemrell M, Mulinari S, Merlo J. An intersectional approach to multilevel analysis of individual heterogeneity (MAIH) and discriminatory accuracy. Soc Sci Med 2017; 178:217-219. [PMID: 28274599 DOI: 10.1016/j.socscimed.2017.02.040] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 02/28/2017] [Indexed: 12/14/2022]
Affiliation(s)
- Maria Wemrell
- Unit of Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden.
| | - Shai Mulinari
- Unit of Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden; Department of Sociology, Faculty of Social Sciences, Lund University, Lund, Sweden
| | - Juan Merlo
- Unit of Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden; Center for Primary Health Research, Region Skåne, Malmö, Sweden
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Wemrell M, Mulinari S, Merlo J. Intersectionality and risk for ischemic heart disease in Sweden: Categorical and anti-categorical approaches. Soc Sci Med 2017; 177:213-222. [PMID: 28189024 DOI: 10.1016/j.socscimed.2017.01.050] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 01/17/2017] [Accepted: 01/23/2017] [Indexed: 12/13/2022]
Abstract
Intersectionality theory can contribute to epidemiology and public health by furthering understanding of power dynamics driving production of health disparities, and increasing knowledge about heterogeneities within, and overlap between, social categories. Drawing on McCall, we relate the first of these potential contributions to categorical intersectionality and the second to anti-categorical intersectionality. Both approaches are used in study of risk of ischemic heart disease (IHD), based on register data on 3.6 million adults residing in Sweden by 2010, followed for three years. Categorical intersectionality is here coupled with between-group differences in average risk calculation, as we use intersectional categorizations while estimating odds ratios through logistic regressions. The anti-categorical approach is operationalized through measurement of discriminatory accuracy (DA), i.e., capacity to accurately categorize individuals with or without a certain outcome, through computation of the area under the curve (AUC). Our results show substantial differences in average risk between intersectional groupings. The DA of social categorizations is found to be low, however, due to outcome variability within and overlap between categories. We argue that measures of DA should be used for proper interpretation of differences in average risk between social (or any other) categories. Tension between average between-group risk and the DA of categorizations, which can be related to categorical and anti-categorical intersectional analyses, should be made explicit and discussed to a larger degree in epidemiology and public health.
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Affiliation(s)
- Maria Wemrell
- Unit of Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden.
| | - Shai Mulinari
- Unit of Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden; Department of Sociology, Faculty of Social Sciences, Lund University, Lund, Sweden
| | - Juan Merlo
- Unit of Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden; Center for Primary Health Research, Region Skåne, Malmö, Sweden
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De Kock C, Decorte T, Vanderplasschen W, Derluyn I, Sacco M. Studying ethnicity, problem substance use and treatment: From epidemiology to social change. DRUGS: EDUCATION, PREVENTION AND POLICY 2017. [DOI: 10.1080/09687637.2016.1239696] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Charlotte De Kock
- Department of Criminology Penal Law and Social Law, Institute for Social Drug Research (ISD),
| | - Tom Decorte
- Department of Criminology Penal Law and Social Law, Institute for Social Drug Research (ISD),
| | | | - Ilse Derluyn
- Department of Social Work and social pedagogy, Ghent University, Ghent, Belgium, and
| | - Muriel Sacco
- Institut de sociologie, GERME, Université Libre de Bruxelles, Brussels, Belgium
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Crammond BR, Carey G. What do we mean by ‘structure’ when we talk about structural influences on the social determinants of health inequalities? SOCIAL THEORY & HEALTH 2016. [DOI: 10.1057/s41285-016-0020-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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23
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Ferre JC. Economic Inequalities in Latin America at the Base of Adverse Health Indicators. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2016; 46:501-22. [DOI: 10.1177/0020731416653428] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
There is increasing evidence supporting the existence of a link between income inequalities and health outcomes. The main purpose of this article is to test whether economic inequalities are associated with poor population health in Latin American countries. Multi-country data from 1970 to 2012 were used to assess this question. The results show that the Gini coefficient has a strong correlation with health outcomes. Moreover, multiple linear regression analysis using fixed effects shows that after controlling for gross national income per capita, literacy rate, and health expenditure, the Gini coefficient is independently negatively associated with health outcomes. In Latin American countries, for every percentage point increase in the Gini coefficient, the infant mortality rate grows by 0.467 deaths per 1,000 live births, holding all other variables constant. Additionally, an ordinary least squares estimation model suggests that countries that do not use International Monetary Fund loans perform better on health outcomes. These findings should alert policymakers, elected officials, and the public of the need to fight income inequalities and rethink the role of international financial institutions that dictate state policies.
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Affiliation(s)
- Juan Cruz Ferre
- Cátedra de Farmacología Aplicada, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, Buenos Aires, Argentina
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Muntaner C, Ng E, Chung H, Prins SJ. Two decades of Neo-Marxist class analysis and health inequalities: A critical reconstruction. SOCIAL THEORY & HEALTH 2015; 13:267-287. [PMID: 26345311 PMCID: PMC4547054 DOI: 10.1057/sth.2015.17] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Most population health researchers conceptualize social class as a set of attributes and material conditions of life of individuals. The empiricist tradition of 'class as an individual attribute' equates class to an 'observation', precluding the investigation of unobservable social mechanisms. Another consequence of this view of social class is that it cannot be conceptualized, measured, or intervened upon at the meso- or macro levels, being reduced to a personal attribute. Thus, population health disciplines marginalize rich traditions in Marxist theory whereby 'class' is understood as a 'hidden' social mechanism such as exploitation. Yet Neo-Marxist social class has been used over the last two decades in population health research as a way of understanding how health inequalities are produced. The Neo-Marxist approach views social class in terms of class relations that give persons control over productive assets and the labour power of others (property and managerial relations). We critically appraise the contribution of the Neo-Marxist approach during the last two decades and suggest realist amendments to understand class effects on the social determinants of health and health outcomes. We argue that when social class is viewed as a social causal mechanism it can inform social change to reduce health inequalities.
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Affiliation(s)
- Carles Muntaner
- Bloomberg School of Nursing, Dalla Lana School of Public Health, University of Toronto , 155 College Street, Suite 386, Toronto, Ontario, Canada M5T 1P8 ; Department of Public Health Sciences, Korea University , Suite 365, Hana Science Building, 145 Anam-Ro, Seongbuk-Gu, Seoul, 136-713 Republic of Korea . E-mail:
| | - Edwin Ng
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute , 209 Victoria Street, 3rd Floor, Toronto, Ontario, Canada M5B 1C6. E-mail:
| | - Haejoo Chung
- Department of Public Health Sciences, Korea University , Suite 365, Hana Science Building, 145 Anam-Ro, Seongbuk-Gu, Seoul, 136-713 Republic of Korea . E-mail:
| | - Seth J Prins
- Department of Epidemiology, Columbia University, Mailman School of Public Health , 722 West 168th Street, Suite #720C, New York, NY 10032, USA . E-mail:
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Kokkinen L, Muntaner C, Kouvonen A, Koskinen A, Varje P, Väänänen A. Welfare state retrenchment and increasing mental health inequality by educational credentials in Finland: a multicohort study. BMJ Open 2015; 5:e007297. [PMID: 26041491 PMCID: PMC4458631 DOI: 10.1136/bmjopen-2014-007297] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Epidemiological studies have shown an association between educational credentials and mental disorders, but have not offered any explanation for the varying strength of this association in different historical contexts. In this study, we investigate the education-specific trends in hospitalisation due to psychiatric disorders in Finnish working-age men and women between 1976 and 2010, and offer a welfare state explanation for the secular trends found. SETTING Population-based setting with a 25% random sample of the population aged 30-65 years in 7 independent consecutive cohorts (1976-1980, 1981-1985, 1986-1990, 1991-1995, 1996-2000, 2001-2005, 2006-2010). PARTICIPANTS Participants were randomly selected from the Statistics Finland population database (n=2,865,746). These data were linked to diagnosis-specific records on hospitalisations, drawn from the National Hospital Discharge Registry using personal identification numbers. Employment rates by educational credentials were drawn from the Statistics Finland employment database. PRIMARY AND SECONDARY OUTCOME MEASURES Hospitalisation and employment. RESULTS We found an increasing trend in psychiatric hospitalisation rates among the population with only an elementary school education, and a decreasing trend in those with higher educational credentials. The employment rate of the population with only an elementary school education decreased more than that of those with higher educational credentials. CONCLUSIONS We propose that restricted employment opportunities are the main mechanism behind the increased educational inequality in hospitalisation for psychiatric disorders, while several secondary mechanisms (lack of outpatient healthcare services, welfare cuts, decreased alcohol duty) further accelerated the diverging long-term trends. All of these inequality-increasing mechanisms were activated by welfare state retrenchment, which included the liberalisation of financial markets and labour markets, severe austerity measures and narrowing down of public sector employment commitment.
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Affiliation(s)
- Lauri Kokkinen
- Centre of Expertise for the Development of Work and Organizations, Finnish Institute of Occupational Health, Tampere and Helsinki, Finland
| | - Carles Muntaner
- Bloomberg Faculty of Nursing, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Anne Kouvonen
- Department of Social Research, University of Helsinki, Helsinki, Finland
- UKCRC Centre of Excellence for Public Health, Queen's University Belfast, Belfast, UK
- Faculty in Wroclaw, University of Social Sciences and Humanities, Poland
| | - Aki Koskinen
- Centre of Expertise for the Development of Work and Organizations, Finnish Institute of Occupational Health, Tampere and Helsinki, Finland
| | - Pekka Varje
- Centre of Expertise for the Development of Work and Organizations, Finnish Institute of Occupational Health, Tampere and Helsinki, Finland
| | - Ari Väänänen
- Centre of Expertise for the Development of Work and Organizations, Finnish Institute of Occupational Health, Tampere and Helsinki, Finland
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