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Sun W, Wu Y, Wang L, Li X, Guo Q, Hu Z. Associations between environmental perception and self-rated health in the city hierarchy of China: Findings from a national cross-sectional survey. Soc Sci Med 2024; 348:116785. [PMID: 38569281 DOI: 10.1016/j.socscimed.2024.116785] [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: 10/10/2023] [Revised: 01/18/2024] [Accepted: 03/11/2024] [Indexed: 04/05/2024]
Abstract
Identifying environmental determinants of health and clarifying their variations is crucial for health promotion in different cities by providing tailored intervention strategies. Although the association between perceived urban environment and health (e.g., self-rated health) has been repeatedly explored, most studies have focused on cities of a specific size, and it is still unknown whether either significant environment variables or the magnitude of the association would vary across different-sized cities. This study investigated how perceived urban environment variables significantly associated with individuals' self-rated health varied from small cities to mega cities in China, based on a national survey including 5963 valid respondents. The results showed that the relationship between self-rated health and city size was U-shaped, with respondents in medium and large cities reporting a low-level self-rated health. Perceived greenness, public facilities, housing supply, and medical services were positively and significantly associated with self-rated health, with the odds ratio (OR) of 1.37 (95%CI: 1.29-1.46), 1.27 (95%CI: 1.19-1.35), 1.14 (95%CI: 1.09-1.20), and 1.17 (95%CI: 1.10-1.24), respectively. Furthermore, the magnitude of the association was significantly larger in mega cities. These findings provide useful evidence for promoting public health in cities of different sizes for achieving health equity and indicate that smaller cities and their health-supportive environment need further attention.
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Affiliation(s)
- Wenyao Sun
- College of Architecture and Urban Planning, Tongji University, No. 1239 Siping Road, Shanghai, 200092, China.
| | - Ying Wu
- Chinese Academy of Social Sciences, No. 5 Jianguomennei Street, Beijing, 100732, China.
| | - Lan Wang
- College of Architecture and Urban Planning, Tongji University, No. 1239 Siping Road, Shanghai, 200092, China.
| | - Xiaotian Li
- Bureau of Public Works of Shenzhen Municipality, Shenzhen; No. 3, 3rd Floor, Podium 1, Qiaoxiang Village, Xiangmihu Street, Futian District, Shenzhen, 518040, China.
| | - Qiaoni Guo
- College of Architecture and Urban Planning, Tongji University, No. 1239 Siping Road, Shanghai, 200092, China.
| | - Zhanzhan Hu
- College of Architecture and Urban Planning, Tongji University, No. 1239 Siping Road, Shanghai, 200092, China.
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Tucker-Seeley R, Abu-Khalaf M, Bona K, Shastri S, Johnson W, Phillips J, Masood A, Moushey A, Hinyard L. Social Determinants of Health and Cancer Care: An ASCO Policy Statement. JCO Oncol Pract 2024; 20:621-630. [PMID: 38386945 DOI: 10.1200/op.23.00810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 01/10/2024] [Indexed: 02/24/2024] Open
Abstract
ASCO's new policy statement on SDOH supports practices that sustain and advance cancer health equity.
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Affiliation(s)
| | | | | | | | | | | | - Azam Masood
- American Society of Clinical Oncology, Alexandria, VA
| | - Allyn Moushey
- American Society of Clinical Oncology, Alexandria, VA
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3
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Benebo FO, Lukic M, Jakobsen MD, Braaten TB. The role of lifestyle factors in the association between education and self-reported fibromyalgia: a mediation analysis. BMC Womens Health 2024; 24:244. [PMID: 38632566 PMCID: PMC11022321 DOI: 10.1186/s12905-024-03060-9] [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: 08/09/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Socioeconomic status as measured by education, income, or occupation, has been associated with fibromyalgia but the underlying mechanism and the role of lifestyle factors are unclear. Thus, we examine the role of modifiable lifestyle factors (body mass index, physical activity, alcohol consumption and smoking) in the association between education and self-reported fibromyalgia. METHODS We used data from 74,157 participants in the population-based prospective Norwegian Women and Cancer (NOWAC) study. Socioeconomic position, operationalized as years of educational attainment, and lifestyle factors were assessed via self-reported questionnaires. Multiple mediation analysis was used to decompose total effects into direct and indirect effects. Estimates were reported as hazard ratios (HRs) with 95% confidence intervals (CIs). RESULTS The cumulative incidence of fibromyalgia was 3.2% after a median follow up time of 13 years. Fibromyalgia was inversely associated with years of educational attainment for ≤ 9 years (HR = 2.56; 95% CI 2.32-2.91) and for 10-12 years (HR = 1.84; 95% CI 1.72-2.02), compared with ≥ 13 years of education. Overall, all lifestyle factors together jointly mediated 17.3% (95% CI 14.3-21.6) and 14.1% (95% CI 11.3-18.9) of the total effect for ≤ 9 years and 10-12 years of education, respectively. Smoking and alcohol consumption contributed the most to the proportion mediated, for ≤ 9 years (5.0% and 7.0%) and 10-12 years (5.6% and 4.5%) of education. CONCLUSION The association between education and self-reported fibromyalgia was partly explained through lifestyle factors, mainly smoking and alcohol consumption.
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Affiliation(s)
- Faith Owunari Benebo
- Department of Community Medicine, UiT The Artic University of Norway, Tromsø, Norway.
| | - Marko Lukic
- Department of Community Medicine, UiT The Artic University of Norway, Tromsø, Norway
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Malik MA, Sinha R, Priya A, Rahman MHU. Barriers to healthcare utilization among married women in Afghanistan: the role of asset ownership and women's autonomy. BMC Public Health 2024; 24:613. [PMID: 38408956 PMCID: PMC10898116 DOI: 10.1186/s12889-024-18091-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 02/13/2024] [Indexed: 02/28/2024] Open
Abstract
Women face multiple socio-economic, cultural, contextual, and perceived barriers in health service utilization. Moreover, poor autonomy and financial constraints act as crucial factors to their healthcare accessibility. Therefore, the objective of the present study is to study the association between health care utilization barriers and women empowerment, including asset ownership among currently married women in Afghanistan. Data of 28,661 currently married women from Afghanistan demographic health survey (2015) was used to carry out this study. Barriers to access healthcare were computed based on problems related to permission, money, distance, and companionship, whereas women empowerment and asset ownership were computed as potential covariates along with other socio-economic risk factors. Bivariate and logistic analysis was carried out to study the association and odds of explanatory variables. Our results confirm the significant and strong association between the barriers to access healthcare and various explanatory variables. Women having any decision-making autonomy are less likely to face any odds [(AOR = 0.56, p < 0.001), CI: 0.51-0.61] among the currently married women than those who don't have any decision-making authority. Similarly, women who justify their beating for some specific reasons face the greater difficulty of accessing health care [(AOR = 1.76, p < 0.001), CI: 1.61-1.93]. In terms of asset ownership, women having any asset ownership (land or household) are less likely to face any barriers in health services utilization given the lower odds [(AOR = 0.91, p < 0.001), CI: 0.90-0.98]. Accessing maternal health is a crucial policy challenge in Afghanistan. A substantial proportion of women face barriers related to approval, money, distance, and companionship while accessing the health services utilization in Afghanistan. Similarly, women empowerment and asset ownership are significantly associated with health service accessibility. This paper therefore suggests for some policy interventions to strengthen the healthcare needs of women and ensure healthcare accessibility by scaling down these potential barriers like poor autonomy, asset ownership and domestic violence.
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Affiliation(s)
- Manzoor Ahmad Malik
- Center for Applied Health Economics, Menzies Health Institute, Griffith University, Queensland, Australia
| | - Ratnesh Sinha
- Department of Community Medicine, Manipal Tata Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Angelin Priya
- Department of Community Medicine, Manipal Tata Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Mohammad Hifz Ur Rahman
- Department of Community Medicine, Manipal Tata Medical College, Manipal Academy of Higher Education, Manipal, India.
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Jiménez AL, Cruz-Gonzalez M, Forsyth Calhoun T, Cohen L, Alegría M. Late life anxiety and depression symptoms, and suicidal behaviors in racial/ethnic minority older adults in community-based organizations and community clinics in the U.S. CULTURAL DIVERSITY & ETHNIC MINORITY PSYCHOLOGY 2024; 30:22-34. [PMID: 35113605 PMCID: PMC9519187 DOI: 10.1037/cdp0000524] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
OBJECTIVE Late life anxiety and depression represent a significant source of disability, with racial/ethnic minority older adults in the U.S. showing marked disparities in healthy aging. Community-based organizations (CBOs) and community clinics serve these populations for preventive care, yet few identify their mental health service needs. We examine the association between race/ethnicity and risk of mild-to-severe symptoms of anxiety and depression, and suicidal behaviors in minority older adults. METHOD Data come from the multisite randomized controlled trial Building Community Capacity for Disability Prevention for Minority Elders, which screened 1,057 adults (45.5% Asian, 26.8% Latinx, 15.0% non-Latinx Black, 8.5% non-Latinx White, and 4.2% American Indian) aged 60 + years at CBOs and clinics in Massachusetts, New York, Florida, and Puerto Rico. Screened participants completed the Generalized Anxiety Disorder-7 (GAD-7) for anxiety symptoms, the Geriatric Depression Scale-15 (GDS-15) for depression symptoms, and the Paykel Suicide Risk Questionnaire for suicidal behaviors. RESULTS 28.1% of older adults reported mild-to-severe anxiety symptoms, 30.1% reported mild-to-severe depression symptoms, and 4.3% reported at least one suicidal behavior. Compared to non-Latinx Whites, Latinxs had higher odds of mild-to-severe anxiety and depression symptoms and one or more suicidal behaviors, and Asians had higher odds of mild-to-severe depression symptoms only. CONCLUSIONS There is an urgent need to improve outreach for screening and preventive mental health care for minority older adults. Expanding outreach and community-based capacity to identify and treat minority older adults with mental health conditions represents an opportunity to prevent disability. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Aida L. Jiménez
- Department of Psychology, University of Puerto Rico, San
Juan, Puerto Rico
| | - Mario Cruz-Gonzalez
- Disparities Research Unit, Department of Medicine,
Massachusetts General Hospital
| | | | - Lauren Cohen
- Disparities Research Unit, Department of Medicine,
Massachusetts General Hospital
| | - Margarita Alegría
- Disparities Research Unit, Department of Medicine,
Massachusetts General Hospital
- Departments of Medicine and Psychiatry, Harvard Medical
School
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Svanholm S, Carlerby H, Viitasara E. Politicians' views on societal responsibility and possibility to promote newly arrived migrants' health in Sweden. Health Promot Int 2023; 38:daab199. [PMID: 34897484 PMCID: PMC10439525 DOI: 10.1093/heapro/daab199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Newly arrived migrants in Sweden risk facing ill health. Politicians at the local and regional levels are involved in many decisions regarding the social determinants of health. The aim of this study was to explore politicians' views on different societal actors' responsibility and possibility to promote newly arrived migrants' health. Data were collected through online questionnaires completed by 667 politicians from municipality and regional councils in northern Sweden. Bivariate analysis was performed using the Wilcoxon signed-rank test. Multivariate analyses were performed using cluster analysis and binary logistic regression analysis. The results show that politicians generally rate societal actors' responsibility and possibility to promote the general population's health higher than newly arrived migrants' health. Moreover, they consider societal actors' responsibility to be greater than their possibility to promote health. Factors significantly contributing to politicians' high ratings of societal responsibility and possibility are attitude (odds ratio [OR] = 2.156, 95% confidence interval [CI]: 1.306-3.558), specific knowledge of newly arrived migrants' health status (OR = 1.528, 95% CI: 1.005-2.323), personal interest in public health (OR = 2.452, 95% CI: 1.460-4.119), being a municipality politician (OR = 1.659, 95% CI: 1.031-2.670) and being female (OR = 1.934, 95% CI: 1.333-2.806). This study shows that politicians generally rate societal responsibility and possibility to promote newly arrived migrants' health rather high. Personal characteristics are important for politicians' high or low ratings of responsibility and possibility, suggesting insufficient structural support for politicians in health promotion.
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Affiliation(s)
- Sara Svanholm
- Department of Health Sciences, Mid Sweden University, Homgatan 10, 851 70 Sweden
| | - Heidi Carlerby
- Department of Health Sciences, Mid Sweden University, Homgatan 10, 851 70 Sweden
| | - Eija Viitasara
- Department of Health Sciences, Mid Sweden University, Homgatan 10, 851 70 Sweden
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Baker RM, Ahmed M, Bertotti M, Cassidy J, Chipuriro R, Clewett E, Donaldson C, Elders A, Fenge LA, Fox J, Galway K, Gildea A, McGuinness A, McLean J, Manoukian S, Mason H, Morgan A, Mulholland J, O'Hare L, Paterson A, Porter S, Rendall J, Roy MJ, Seaman P, Simpson M, Steiner A, Kelly MP. Common health assets protocol: a mixed-methods, realist evaluation and economic appraisal of how community-led organisations (CLOs) impact on the health and well-being of people living in deprived areas. BMJ Open 2023; 13:e069979. [PMID: 36927592 PMCID: PMC10030928 DOI: 10.1136/bmjopen-2022-069979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
INTRODUCTION This research investigates how community-led organisations' (CLOs') use of assets-based approaches improves health and well-being, and how that might be different in different contexts. Assets-based approaches involve 'doing with' rather than 'doing to' and bring people in communities together to achieve positive change using their own knowledge, skills and experience. Some studies have shown that such approaches can have a positive effect on health and well-being. However, research is limited, and we know little about which approaches lead to which outcomes and how different contexts might affect success. METHODS AND ANALYSIS Using a realist approach, we will work with 15 CLOs based in disadvantaged communities in England, Scotland and Northern Ireland. A realist synthesis of review papers, and a policy analysis in different contexts, precedes qualitative interviews and workshops with stakeholders, to find out how CLOs' programmes work and identify existing data. We will explore participants' experiences through: a Q methodology study; participatory photography workshops; qualitative interviews and measure outcomes using a longitudinal survey, with 225 CLO participants, to assess impact for people who connect with the CLOs. An economic analysis will estimate costs and benefits to participants, for different contexts and mechanisms. A 'Lived Experience Panel' of people connected with our CLOs as participants or volunteers, will ensure the appropriateness of the research, interpretation and reporting of findings. ETHICS AND DISSEMINATION This project, research tools and consent processes have been approved by the Glasgow Caledonian University School of Health and Life Sciences Ethics Committee, and affirmed by Ethics Committees at Bournemouth University, Queen's University Belfast and the University of East London. Common Health Assets does not involve any National Health Service sites, staff or patients.Findings will be presented through social media, project website, blogs, policy briefings, journal articles, conferences and visually in short digital stories, and photographic exhibitions.
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Affiliation(s)
- Rachel Mairi Baker
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | | | - Marcello Bertotti
- Institute for Connected Communities, University of East London, London, UK
| | - John Cassidy
- Scottish Communities for Health and Wellbeing, Glasgow, UK
| | - Rejoice Chipuriro
- Department of Social Sciences and Social Work, Bournemouth University, Poole, UK
| | - Emma Clewett
- Institute for Connected Communities, University of East London, London, UK
| | - Cam Donaldson
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Andrew Elders
- NMAHP Research Unit, Glasgow Caledonian University School of Health and Life Sciences, Glasgow, UK
| | - Lee Ann Fenge
- Department of Social Sciences and Social Work, Bournemouth University, Poole, UK
| | - Julie Fox
- Annexe Communities Glasgow, Glasgow, UK
| | - Karen Galway
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Aideen Gildea
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | | | | | - Sarkis Manoukian
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Helen Mason
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Antony Morgan
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Jill Mulholland
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Liam O'Hare
- Innovation Zones, School of Social Science, Education and Social Work, Queen's University Belfast, Belfast, UK
| | | | - Sam Porter
- Department of Social Sciences and Social Work, Bournemouth University, Poole, UK
| | - Jack Rendall
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Michael J Roy
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Peter Seaman
- Glasgow Centre for Population Health, Glasgow, UK
| | | | - Artur Steiner
- Yunus Centre for Social Business and Health, Glasgow Caledonian University, Glasgow, UK
| | - Michael P Kelly
- Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Petrovskis A, Bekemeier B, Heitkemper E, van Draanen J. The DASH model: Data for addressing social determinants of health in local health departments. Nurs Inq 2023; 30:e12518. [PMID: 35982547 DOI: 10.1111/nin.12518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 07/27/2022] [Accepted: 08/02/2022] [Indexed: 01/25/2023]
Abstract
Recent frameworks, models, and reports highlight the critical need to address social determinants of health for achieving health equity in the United States and around the globe. In the United States, data play an important role in better understanding community-level and population-level disparities particularly for local health departments. However, data-driven decision-making-the use of data for public health activities such as program implementation, policy development, and resource allocation-is often presented theoretically or through case studies in the literature. We sought to develop a preliminary model that identifies the factors that contribute to data-driven decision-making in US local health departments and describe relationships between them. Guided by implementation science literature, we examined organizational-level capacity and individual-level factors contributing to using data for decision-making related to social determinants of health and the reduction of county-level disparities. This model has the potential to improve implementation of public health interventions and programs aimed at upstream structural factors, by elucidating the factors critical to incorporating data in decision-making.
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Affiliation(s)
- Anna Petrovskis
- School of Nursing, University of Washington, Seattle, Washington, USA
| | - Betty Bekemeier
- School of Nursing, University of Washington, Seattle, Washington, USA
| | | | - Jenna van Draanen
- School of Nursing, University of Washington, Seattle, Washington, USA
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Abstract
Policy Points The commercial determinants of health (CDoH) concept, which currently focuses on markets that harm health, should be expanded to refer to the interface between commerce and health, which can sometimes have positive public health consequences. The regulatory stances framework helps us classify public health preferences for regulating specific markets related to CDoH, based on the intended effects of regulations on market size. The regulatory stances a jurisdiction can adopt can be classified as ranging from prohibitionist through contractionist, permissive, and expansionist, to universalist. The regulatory stances framework increases the usefulness of the CDoH concept by expanding the conversation beyond negative determinants of health and providing a fuller view of the tools at the disposal of society to alter markets and improve health. CONTEXT The effects of commerce on the public health are omnipresent. The commercial determinants of health (CDoH) represent a burgeoning area of scholarly debate and activist policymaking to redress markets that adversely affect public health. The CDoH debate is a logical extension of the tobacco control movement, but, to its detriment, the CDoH conversation remains primarily focused policies and proposals that are analogous to historical tobacco control strategies. METHODS This paper argues that for the CDoH to develop further and broaden its appeal, it should expand to cover markets with conditional and positive impacts on health. To explain and order this conversation, a comparative framework for regulatory policy is introduced: the regulatory stances. The regulatory stances classify a regulatory policy based on the intended effect of policy on the size of a market in the future relative to the present. FINDINGS Some markets that interface between commerce and health do not inherently harm health. Regulatory policy toward these markets should be different in intent than regulatory policy for markets with negative health effects. CONCLUSIONS By using the regulatory stances framework to encompass markets that have positive or conditional effects on health as well as those that have adverse health effects, the CDoH conversation can shift away from the exclusive focus on strategies to shrink markets with adverse health impacts to consider a wider array of policy options.
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Affiliation(s)
- ALEX C. LIBER
- Georgetown University Lombardi Comprehensive Cancer Center
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10
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Levasseur M, Naud D, Presse N, Delli-Colli N, Boissy P, Cossette B, Couturier Y, Cadieux Genesse J. Aging all over the place: a multidisciplinary framework that considers place and life trajectories of older adults within their communities. QUALITY IN AGEING AND OLDER ADULTS 2022. [DOI: 10.1108/qaoa-07-2021-0057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This conceptual paper aims to describe aging all over the place (AAOP), a federative framework for action, research and policy that considers older adults’ diverse experiences of place and life trajectories, along with person-centered care.
Design/methodology/approach
The framework was developed through group discussions, followed by an appraisal of aging models and validation during workshops with experts, including older adults.
Findings
Every residential setting and location where older adults go should be considered a “place,” flexible and adaptable enough so that aging in place becomes aging all over the place. Health-care professionals, policymakers and researchers are encouraged to collaborate around four axes: biopsychosocial health and empowerment; welcoming, caring, mobilized and supportive community; spatiotemporal life and care trajectories; and out-of-home care and services. When consulted, a Seniors Committee showed appreciation for flexible person-centered care, recognition of life transitions and care trajectories and meaningfulness of the name.
Social implications
Population aging and the pandemic call for intersectoral actions and for stakeholders beyond health care to act as community leaders. AAOP provides opportunities to connect environmental determinants of health and person-centered care.
Originality/value
Building on the introduction of an ecological experience of aging, AAOP broadens the concept of care as well as the political and research agenda by greater integration of community and clinical actions. AAOP also endeavors to avoid patronizing older adults and to engage society in strengthening circles of benevolence surrounding older adults, regardless of their residential setting. AAOP’s applicability is evidenced by existing projects that share its approach.
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Patay D, Friel S, Townsend B, Baum F, Collin J, Cullerton K, Dain K, Holmes R, Martin J, Ralston R, Westerman L. Governing ultra-processed food and alcohol industries: the presence and role of non-government organisations in Australia. Aust N Z J Public Health 2022; 46:455-462. [PMID: 35616401 DOI: 10.1111/1753-6405.13263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 03/01/2022] [Accepted: 04/01/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The roles of non-governmental organisations (NGOs) in regulating harmful commodity industries (HCIs) are understudied. The aim of this paper is to identify the NGOs and the roles that they play in the governance of the ultra-processed food and alcohol industries in Australia. METHODS We undertook an exploratory descriptive analysis of NGOs identified from an online search based on the typology we developed of type, issue area and governance function. RESULTS A total of 134 relevant Australian NGOs were identified: 38 work on food issues, 61 with alcohol issues and 35 are active in both. In the food domain, 90% of NGOs engage in agenda setting, 88% in capacity building, 15% in implementation and 12% in monitoring. In the alcohol domain, 92% of NGOs are active in agenda setting, 72% in capacity building, 35% in implementation and 8% in monitoring. CONCLUSIONS Australian NGOs are active actors in the food and alcohol governance system. IMPLICATIONS FOR PUBLIC HEALTH There are many opportunities for NGOs to regulate HCI practices, building on their relative strengths in agenda setting and capacity building, and expanding their activities in monitoring and implementation. A more detailed examination is needed of strategies that can be used by NGOs to be effective regulators in the governance system.
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Affiliation(s)
- Dori Patay
- Menzies Centre for Health Governance, School of Regulation and Global Governance, The Australian National University, Australian Capital Territory
| | - Sharon Friel
- Menzies Centre for Health Governance, School of Regulation and Global Governance, The Australian National University, Australian Capital Territory
| | - Belinda Townsend
- Menzies Centre for Health Governance, School of Regulation and Global Governance, The Australian National University, Australian Capital Territory
| | - Fran Baum
- Southgate Institute for Health, Society and Equity, Flinders University, South Australia
| | - Jeff Collin
- School of Social and Political Science, University of Edinburgh, United Kingdom
| | | | | | - Rodney Holmes
- Foundation for Alcohol Research and Education, Australian Capital Territory
| | | | - Rob Ralston
- School of Social and Political Science, University of Edinburgh, United Kingdom
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Plamondon K, Neufeld V. Are we there yet? Principles in advancing equity though global public health research. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022; 113:178-183. [PMID: 35290654 PMCID: PMC8975980 DOI: 10.17269/s41997-022-00624-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Canadian engagement in global and public health includes a long history of centering issues of equity in practice, policy, and research. In 2015, through a series of deliberative dialogues about what ethical standards should guide how people engage in global health research, the Canadian Coalition for Global Health Research (CCGHR) released a set of six equity-centred principles and critically reflective questions. These principles offered a platform for identifying equity implications and choices about theories, methods, approaches, partnerships, or practices in global and public health. In 2022, as questions of how to unsettle systems of power and move beyond rhetorical efforts to advance equity action continue to grow, Canada's global public health research community is turning a critically reflexive gaze at our own practices and ways of working, recognizing excellence as necessarily integrating equity in research pursuits, processes, and outcomes. In this commentary, we reflect on the contexts that led to the evolution of the CCGHR Principles for Global Health Research and highlight their current reach and impact, including their integration in the Canadian Institutes Framework for Action on Global Health Research. We invite others to embrace a lifelong commitment to equity work as an act of solidarity and investment in our collective futures.
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Affiliation(s)
- Katrina Plamondon
- School of Nursing, University of British Columbia, Kelowna, BC, Canada.
| | - Vic Neufeld
- Centre for Global Studies, University of Victoria, Victoria, BC, Canada
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Straneo M, Beňová L, van den Akker T, Pembe AB, Smekens T, Hanson C. No increase in use of hospitals for childbirth in Tanzania over 25 years: Accumulation of inequity among poor, rural, high parity women. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000345. [PMID: 36962703 PMCID: PMC10021586 DOI: 10.1371/journal.pgph.0000345] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 07/14/2022] [Indexed: 11/19/2022]
Abstract
Improving childbirth care in rural settings in sub-Saharan Africa is essential to attain the commitment expressed in the Sustainable Development Goals to leave no one behind. In Tanzania, the period between 1991 and 2016 was characterized by health system expansion prioritizing primary health care and a rise in rural facility births from 45% to 54%. Facilities however are not all the same, with advanced management of childbirth complications generally only available in hospitals and routine childbirth care in primary facilities. We hypothesized that inequity in the use of hospital-based childbirth may have increased over this period, and that it may have particularly affected high parity (≥5) women. We analysed records of 16,080 women from five Tanzanian Demographic and Health Surveys (1996, 1999, 2004, 2010, 2015/6), using location of the most recent birth as outcome (home, primary health care facility or hospital), wealth and parity as exposure variables and demographic and obstetric characteristics as potential confounders. A multinomial logistic regression model with wealth/parity interaction was run and post-estimation margins analysis produced percentages of births for various combinations of wealth and parity for each survey. We found no reduction in inequity in this 25-year period. Among poorest women, lowest use of hospital-based childbirth (around 10%) was at high parity, with no change over time. In women having their first baby, hospital use increased over time but with a widening pro-rich gap (poorest women predicted use increased from 36 to 52% and richest from 40 to 59%). We found that poor rural women of high parity were a vulnerable group requiring specifically targeted interventions to ensure they receive effective childbirth care. To leave no one behind, it is essential to look beyond the average coverage of facility births, as such a limited focus masks different patterns and time trends among marginalised groups.
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Affiliation(s)
- Manuela Straneo
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- Athena Institute, VU University, Amsterdam, The Netherlands
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Lenka Beňová
- Institute of Tropical Medicine, Antwerp, Belgium
- London School of Hygiene &Tropical Medicine, London, United Kingdom
| | - Thomas van den Akker
- Athena Institute, VU University, Amsterdam, The Netherlands
- Department of Obstetrics and Gynecology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Andrea B Pembe
- Department of Obstetrics and Gynaecology, Muhimbili University of Health and Allied Sciences, Dar es Salaam, United Republic of Tanzania
| | - Tom Smekens
- Institute of Tropical Medicine, Antwerp, Belgium
| | - Claudia Hanson
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- London School of Hygiene &Tropical Medicine, London, United Kingdom
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Suarez-Balcazar Y, Mirza M, Errisuriz VL, Zeng W, Brown JP, Vanegas S, Heydarian N, Parra-Medina D, Morales P, Torres H, Magaña S. Impact of COVID-19 on the Mental Health and Well-Being of Latinx Caregivers of Children with Intellectual and Developmental Disabilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:7971. [PMID: 34360263 PMCID: PMC8345447 DOI: 10.3390/ijerph18157971] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/17/2021] [Accepted: 07/25/2021] [Indexed: 01/20/2023]
Abstract
The COVID-19 pandemic has impacted the entire world in unprecedented ways. However, populations that have had a history of marginalization have experienced a more profound impact. One such group is Latinx families of children with intellectual and developmental disabilities (IDD) in the Unites States. In this study, we used a mixed methods approach to explore the impact of the pandemic on the mental health and well-being of Latinx caregivers of children with IDD. Specifically, we (1) identified which social determinants of health are correlated with maternal caregivers perceived general health, mental health, and well-being; (2) explored the impact of the pandemic on families' overall eating and physical activity routines; and (3) identified emergent themes from caregivers' experiences during the pandemic. Thirty-seven Latinx caregivers participated in three interviews in which several validated instruments were administered. The results indicated that perceived social support, annual family income, food security, and receipt of financial benefits were correlated with fewer depressive symptoms. Annual family income was also significantly correlated with perceived general health. Most caregivers reported that the pandemic had placed a strain on their economic situation; increased their isolation; and disrupted their child's therapeutic supports, online education, eating routines, and engagement in physical activity. Meanwhile, some caregivers reported positive changes as a result of the pandemic. Implications for future research and practice are discussed.
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Affiliation(s)
- Yolanda Suarez-Balcazar
- Department of Occupational Therapy, University of Illinois Chicago, 1919 West Taylor, Chicago, IL 60612, USA; (M.M.); (J.P.B.)
| | - Mansha Mirza
- Department of Occupational Therapy, University of Illinois Chicago, 1919 West Taylor, Chicago, IL 60612, USA; (M.M.); (J.P.B.)
| | - Vanessa L. Errisuriz
- Latino Research Institute, University of Texas at Austin, 210 W. 24th St., Austin, TX 78712, USA; (V.L.E.); (D.P.-M.)
| | - Weiwen Zeng
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd., Austin, TX 78712, USA; (W.Z.); (N.H.); (P.M.); (H.T.); (S.M.)
| | - Jasmine P. Brown
- Department of Occupational Therapy, University of Illinois Chicago, 1919 West Taylor, Chicago, IL 60612, USA; (M.M.); (J.P.B.)
| | - Sandra Vanegas
- School of Social Work, Texas State University, Encino Hall, 712 North Commanche St., San Marcos, TX 78666, USA;
| | - Nazanin Heydarian
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd., Austin, TX 78712, USA; (W.Z.); (N.H.); (P.M.); (H.T.); (S.M.)
| | - Deborah Parra-Medina
- Latino Research Institute, University of Texas at Austin, 210 W. 24th St., Austin, TX 78712, USA; (V.L.E.); (D.P.-M.)
| | - Paula Morales
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd., Austin, TX 78712, USA; (W.Z.); (N.H.); (P.M.); (H.T.); (S.M.)
| | - Hilda Torres
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd., Austin, TX 78712, USA; (W.Z.); (N.H.); (P.M.); (H.T.); (S.M.)
| | - Sandy Magaña
- Steve Hicks School of Social Work, University of Texas at Austin, 1925 San Jacinto Blvd., Austin, TX 78712, USA; (W.Z.); (N.H.); (P.M.); (H.T.); (S.M.)
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15
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Friel S, Townsend B, Fisher M, Harris P, Freeman T, Baum F. Power and the people's health. Soc Sci Med 2021; 282:114173. [PMID: 34192622 DOI: 10.1016/j.socscimed.2021.114173] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 02/28/2021] [Accepted: 06/20/2021] [Indexed: 10/21/2022]
Abstract
Public policy plays a central role in creating and distributing resources and conditions of daily life that matter for health equity. Policy agendas have tended to focus on health care delivery and individualised interventions. Asking why there is a lack of policy action on structural drivers of health inequities raises questions about power inequities in policy systems that maintain the status quo. In this paper we investigate the power dynamics shaping public policy and implications for health equity. Using a Health Equity Power Framework (HEPF), we examined data from 158 qualitative interviews with government, industry and civil society actors across seven policy case studies covering areas of macroeconomics, employment, social protection, welfare reform, health care, infrastructure and land use planning. The influence of structures of capitalism, neoliberalism, sexism, colonisation, racism and biomedicalism were widely evident, manifested through the ideologies, behaviours and discourses of state, market, and civil actors and the institutional spaces they occupied. Structurally less powerful public interest actors made creative use of existing or new institutional spaces, and used network, discursive and moral power to influence policy, with some success in moderating inequities in structural and institutional forms of power. Our hope is that the methodological advancement and empirical data presented here helps to illuminate how public interest actors can navigate structural power inequities in the policy system in order to disrupt the status quo and advance a comprehensive policy agenda on the social determinants of health equity. However, this analysis highlights the unrealistic expectation of turning health inequities around in a short time given the long-term embedded power dynamics and inequities within policy systems under late capitalism. Achieving health equity is a power-saturated long game.
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Affiliation(s)
- Sharon Friel
- Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Fellows Road, Canberra ACT, 2601, Australia.
| | - Belinda Townsend
- Menzies Centre for Health Governance, School of Regulation and Global Governance, Australian National University, Fellows Road, Canberra ACT, 2601, Australia.
| | - Matthew Fisher
- Southgate Institute for Society, Equity and Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Patrick Harris
- Centre for Health Equity Training, Research & Evaluation, Australia Research Centre for Primary Health Care & Equity, University of New South Wales, Liverpool, NSW, 1871, Australia.
| | - Toby Freeman
- Southgate Institute for Society, Equity and Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
| | - Fran Baum
- Southgate Institute for Society, Equity and Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
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Jin Y, Assanangkornchai S, Du Y, Liu J, Bai J, Yang Y. Measuring and explaining inequality of continuous care for people living with HIV receiving antiretroviral therapy in Kunming, China. PLoS One 2021; 16:e0251252. [PMID: 33974670 PMCID: PMC8112695 DOI: 10.1371/journal.pone.0251252] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 04/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background In the context of scaling up free antiretroviral therapy (ART), healthcare equality is essential for people living with HIV. We aimed to assess socioeconomic-related inequalities in uptake of continuous care for people living with HIV receiving ART, including retention in care in the last six months, routine toxicity monitoring, adequate immunological and virological monitoring, and uptake of mental health assessment in the last 12 months. We also determined the contributions of socioeconomic factors to the degree of inequalities. Methods A hospital-based cross-sectional survey was conducted among consecutive clients visiting an HIV treatment center in Kunming, China in 2019. Participants were 702 people living with HIV aged ≥18 years (median age: 41.0 years, 69.4% male) who had been on ART for 1–5 years. Socioeconomic-related inequality and its contributing factors were assessed by a normalized concentration index (CIn) with a decomposition approach. Results The uptake of mental health assessment was low (15%) but significantly higher among the rich (CIn 0.1337, 95% CI: 0.0140, 0.2534). Retention in care, toxicity, and immunological monitoring were over 80% but non-significant in favor of the rich (CIn: 0.0117, 0.0315, 0.0736, respectively). The uptake of adequate virological monitoring was 15% and higher among the poor (CIn = -0.0308). Socioeconomic status positively contributed to inequalities of all care indicators, with the highest contribution for mental health assessment (124.9%) and lowest for virological monitoring (2.7%). Conclusions These findings suggest virological monitoring and mental health assessment be given more attention in long-term HIV care. Policies allocating need-oriented resources geared toward improving equality of continuous care should be developed.
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Affiliation(s)
- Yongmei Jin
- Department of Infectious Diseases, The Third People’s Hospital of Kunming City, Kunming, Yunnan, People’s Republic of China
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Sawitri Assanangkornchai
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
- * E-mail:
| | - Yingrong Du
- Department of Infectious Diseases, The Third People’s Hospital of Kunming City, Kunming, Yunnan, People’s Republic of China
| | - Jun Liu
- Department of Infectious Diseases, The Third People’s Hospital of Kunming City, Kunming, Yunnan, People’s Republic of China
| | - Jingsong Bai
- Department of Infectious Diseases, The Third People’s Hospital of Kunming City, Kunming, Yunnan, People’s Republic of China
| | - Yongrui Yang
- Department of Infectious Diseases, The Third People’s Hospital of Kunming City, Kunming, Yunnan, People’s Republic of China
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Mishra PS, Veerapandian K, Choudhary PK. Impact of socio-economic inequity in access to maternal health benefits in India: Evidence from Janani Suraksha Yojana using NFHS data. PLoS One 2021; 16:e0247935. [PMID: 33705451 PMCID: PMC7951864 DOI: 10.1371/journal.pone.0247935] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 02/16/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Caste plays a significant role in Indian society and it influences women to health care access in the community. The implementation of the maternal health benefits scheme in India is biased due to caste identity. In this context, the paper investigates access to Janani Suraksha Yojana (JSY) among social groups to establish that caste still plays a pivotal role in Indian society. Also, this paper aims to quantify the discrimination against Scheduled Castes/Scheduled Tribes (SCs/STs) in accessing JSY. METHODS This paper uses a national-level data set of both NFHS-3 (2005-06) and NFHS-4 (2015-16). Both descriptive statistics and the Fairlie decomposition econometric model have been used to measure the explained and unexplained differences in access to JSY between SCs/STs and non-SCs/STs groups. RESULTS Overall, the total coverage of JSY in India is still, 36.4%. Further, it is found that 72% of access to JSY is explained by endowment variables. The remaining unexplained percentage (28%) indicates that there is caste discrimination (inequity associated social-discrimination) against SCs/STs in access to JSY. The highest difference (54%) between SCs/STs and non-SCs/STs in access to JSY comes from the wealth quintile, with the positive sign indicating that the gap between the two social groups is widening. DISCUSSION AND CONCLUSION It is necessary for the government to implement a better way to counter the caste-based discrimination in access to maternal health benefits scheme. In this regard, ASHA and Anganwadi workers must be trained to reduce the influence of dominant caste groups as well as they must be recruited from the same community to identify the right beneficiaries of JSY and in order to reduce inequity associated with social-discrimination.
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Affiliation(s)
- Prem Shankar Mishra
- PhD Research Scholar, Population Research Centre, Institute for Social and Economic Change, Bengaluru, Karnataka, India
| | - Karthick Veerapandian
- PhD Research Scholar, Center for Economic Studies and Policy, Institute for Social and Economic Change, Bengaluru, Karnataka, India
| | - Prashant Kumar Choudhary
- PhD Research Scholar, Centre for Political Institutions, Governance and Development, Institute for Social and Economic Change, Bengaluru, Karnataka, India
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Mishra PS, Kumar P, Srivastava S. Regional inequality in the Janani Suraksha Yojana coverage in India: a geo-spatial analysis. Int J Equity Health 2021; 20:24. [PMID: 33413412 PMCID: PMC7792199 DOI: 10.1186/s12939-020-01366-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 12/22/2020] [Indexed: 11/21/2022] Open
Abstract
Introduction Although India has made significant progress in institutional delivery after the implementation of the National Rural Health Mission under which the Janani Suraksha Yojana (JSY) is a sub-programme which played a vital role in the increase of institutional delivery in public facilities. Therefore, this paper aims to provide an understanding of the JSY coverage at the district level in India. Further, it tries to carve out the factors responsible for the regional disparity of JSY coverage at district levels. Methods The study used the National Family Health Survey data, which is a cross-sectional survey conducted in 2015–16, India. The sample size of this study was 148,145 women aged 15–49 years who gave last birth in the institution during 5 years preceding the survey. Bivariate and multivariate regression analysis was used to fulfill the study objectives. Additionally, Moran’s I statistics and bivariate Local Indicator for Spatial Association (LISA) maps were used to understand spatial dependence and clustering of JSY coverage. Ordinary least square, spatial lag and spatial error models were used to examine the correlates of JSY utilization. Results The value of spatial-autocorrelation for JSY was 0.71 which depicts the high dependence of the JSY coverage over districts of India. The overall coverage of JSY in India is 36.4% and it highly varied across different regions, districts, and even socioeconomic groups. The spatial error model depicts that if in a district the women with no schooling status increase by 10% then the benefits of JSY get increased by 2.3%. Similarly, if in a district the women from poor wealth quintile, it increases by 10% the benefits of JSY also increased by 4.6%. However, the coverage of JSY made greater imperative to understand it due to its clustering among districts of specific states only. Conclusion It is well reflected in the EAGs states in terms of spatial-inequality in service coverage. There is a need to universalize the JSY programme at a very individual level. And, it is required to revisit the policy strategy and the implementation plans at regional or district levels.
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Affiliation(s)
- Prem Shankar Mishra
- Institute for Social and Economic Change, Bengaluru, Karnataka, 560072, India
| | - Pradeep Kumar
- International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India
| | - Shobhit Srivastava
- International Institute for Population Sciences, Mumbai, Maharashtra, 400088, India.
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Obinna DN. 'Essential and undervalued: health disparities of African American women in the COVID-19 era'. ETHNICITY & HEALTH 2021; 26:68-79. [PMID: 33190539 DOI: 10.1080/13557858.2020.1843604] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/22/2020] [Indexed: 05/23/2023]
Abstract
OBJECTIVES Transforming the landscape of American healthcare, COVID-19 has had unprecedented effects on the African American community. African Americans are more likely to contract COVID-19, develop complications and die from the virus. Amid the growing research on COVID-19, this manuscript pays particular attention to African American women who are disproportionately represented as 'essential' or frontline workers, yet often lack job security and risk contagion. Faced with limited testing centers, they are also at risk of having their symptoms minimized or dismissed by medical practitioners even when they show visible symptoms of COVID-19. METHODS Using the theoretical framework of intersectionality developed by scholars like Kimberlé Crenshaw and Patricia Hill Collins, this manuscript examines the impact of COVID-19 on African American women. It emphasizes that African American women are vulnerable to COVID-19 due to the twin legacies of racism and sexism. Intersectionality theory espouses that racism and sexism often combine with social determinants of health such as economic stability and socio-environmental factors to shape health outcomes. Within the context of COVID-19, this work underscores that African American women are susceptible to the virus due to their higher likelihood of co-morbidities like obesity, diabetes and high blood pressure. They are also likely to face eviction and homelessness if they are laid off or furloughed as a result of the pandemic. CONCLUSION This manuscript asserts that decades of racism and discrimination have isolated communities of color and made them particularly vulnerable to the COVID-19 virus. As many African American women deal with unemployment or continue to work as 'essential workers', the intersectionality framework sheds light on the continued legacies of racism and sexism. It asserts that targeted policy interventions are needed to mitigate the effects of COVID-19 and lessen the devastating impact(s) it has had on African American communities.
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Affiliation(s)
- Denise N Obinna
- Department of Sociology, Mount St. Mary's University, Emmitsburg, Maryland
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20
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Suarez-Balcazar Y, Francisco VT, Rubén Chávez N. Applying Community-Based Participatory Approaches to Addressing Health Disparities and Promoting Health Equity. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2020; 66:217-221. [PMID: 33373469 DOI: 10.1002/ajcp.12487] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
This special issue highlights work that contributes to our understanding of health disparities and community-based participatory research (CBPR) approaches to promoting health equity across diverse populations and issues that matter to communities. We take on a global perspective, and thus, various efforts across international contexts are illustrated. Articles elucidate a variety of CBPR approaches designed to empower and build capacity among individuals and communities in order to seek changes at the level of community practices, programs, and systems. These articles span across diverse populations-children, youth, and families; adults and older adults; immigrants; refugees; Black people; Latinx people; Native Americans/Indigenous people, the Roma community; Muslim women, and women with disabilities-experiencing inequities of interest to community psychologists and other researchers and practitioners.
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Affiliation(s)
| | | | - Noé Rubén Chávez
- Charles R. Drew University of Medicine and Science, Los Angeles, CA, USA
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21
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Mahmood Q, Muntaner C. State-society nexus in Brazil and Venezuela and its effect on participatory governance efforts in health and other sectors. Int J Equity Health 2020; 19:173. [PMID: 33100221 PMCID: PMC7586663 DOI: 10.1186/s12939-020-01278-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 09/10/2020] [Indexed: 11/10/2022] Open
Abstract
Introduction Participatory governance is about state and society jointly responsible for political decisions and services. The origins and trajectory of participatory governance initiatives are determined by the socio-political context and specifically the nature of state-society relations. Participation by communities in health interventions has been promoted globally as a strategy to involve citizens in health decision-making but with little success. Such participatory governance in health should be seen not as a strategy alone but as a political project in which organized communities challenge the status-quo in health. Methods This paper deals with the wider socio-political context of participatory governance initiatives. It uses comparative politics literature to analyze socio-political context in Brazil and Venezuela, historically spanning half century prior to 2015, to assess whether it was conducive to participatory governance. The focus of this paper’s analysis particularly is on the socio-political changes that were taking place in Brazil and Venezuela in the decades of the 1980s and 1990s. Those decades formed the bedrock on which the two countries experienced democratization and a socialist transformation that has lasted well into the first decade of the twenty-first century. The situation in the health sector is also described for the two countries showing a parallel trajectory to the wider political context and that reflected the political ideology. For this assessment, we use a contemporary framework called the ‘socialist compass’ which links dynamics of power relations in various ways among three domains of power, namely, state power, economic power, and social power. Socialist compass can be used to assess whether such reforms are moving towards or against social empowerment. Conclusion Our analysis reveals that both Brazil and Venezuela were moving in the direction of social empowerment until at least the year 2015, just before the political turmoil started engulfing the left-leaning regimes in both the countries.
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Affiliation(s)
- Qamar Mahmood
- International Development Research Centre, Ottawa, Canada.
| | - Carles Muntaner
- Collaborative Program in Global Health, Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
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22
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Lagendijk J, Steegers EAP, Been JV. Inequity in postpartum healthcare provision at home and its association with subsequent healthcare expenditure. Eur J Public Health 2020; 29:849-855. [PMID: 31329862 PMCID: PMC6761843 DOI: 10.1093/eurpub/ckz076] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Background Provision of postpartum care can support new families in adapting to a new situation. We aimed to determine whether various determinants of socioeconomic status (SES) were associated with utilization of postpartum care. In addition, to stress the relevance of increasing postpartum care uptake among low SES-groups, an assessment of the potential (cost-)effectiveness of postpartum care is required. Methods National retrospective cohort study using linked routinely collected healthcare data from all registered singleton deliveries (2010–13) in the Netherlands. Small-for-gestational age and preterm babies were excluded. The associations between SES and postpartum care uptake, and between uptake and health care expenditure were studied using multivariable regression analyses. Results Of all 569 921 deliveries included, 1.2% did not receive postpartum care. Among women who did receive care, care duration was below the recommended minimum of 24 h in 15.3%. All indicators of low SES were independently associated with a lack in care uptake. Extremes of maternal age, single parenthood and being of non-Dutch origin were associated with reduced uptake independent of SES determinants. No uptake of postpartum care was associated with maternal healthcare expenses in the highest quartile: aOR 1.34 (95% CI 1.10–1.67). Uptake below the recommended amount was associated with higher maternal and infant healthcare expenses: aOR 1.09 (95% CI 1.03–1.18) and aOR 1.20 (95% CI 1.13–1.27), respectively. Conclusion Although uptake was generally high, low SES women less often received postpartum care, this being associated with higher subsequent healthcare expenses. Strategies to effectively reduce these substantial inequities in early life are urgently needed.
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Affiliation(s)
- Jacqueline Lagendijk
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Jasper V Been
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands.,Division of Neonatology, Department of Paediatrics, Erasmus MC - Sophia Children's Hospital, University Medical Centre Rotterdam, Rotterdam, the Netherlands.,Department of Public Health, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
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Gwynne K, Jeffries T, Lincoln M. Improving the efficacy of healthcare services for Aboriginal Australians. AUST HEALTH REV 2020; 43:314-322. [PMID: 29335090 DOI: 10.1071/ah17142] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 12/05/2017] [Indexed: 11/23/2022]
Abstract
Objective The aim of the present systematic review was to examine the enablers for effective health service delivery for Aboriginal Australians. Methods This systematic review was undertaken in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Papers were included if they had data related to health services for Australian Aboriginal people and were published between 2000 and 2015. The 21 papers that met the inclusion criteria were assessed using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies. Seven papers were subsequently excluded due to weak methodological approaches. Results There were two findings in the present study: (1) that Aboriginal people fare worse than non-Aboriginal people when accessing usual healthcare services; and (2) there are five enablers for effective health care services for Australian Aboriginal people: cultural competence, participation rates, organisational, clinical governance and compliance, and availability of services. Conclusions Health services for Australian Aboriginal people must be tailored and implementation of the five enablers is likely to affect the effectiveness of health services for Aboriginal people. The findings of the present study have significant implications in directing the future design, funding, delivery and evaluation of health care services for Aboriginal Australians. What is known about the topic? There is significant evidence about poor health outcomes and the 10-year gap in life expectancy between Aboriginal and non-Aboriginal people, and limited evidence about improving health service efficacy. What does this paper add? This systematic review found that with usual health care delivery, Aboriginal people experience worse health outcomes. This paper identifies five strategies in the literature that improve the effectiveness of health care services intended for Aboriginal people. What are the implications for practitioners? Aboriginal people fare worse in both experience and outcomes when they access usual care services. Health services intended for Aboriginal people should be tailored using the five enablers to provide timely, culturally safe and high-quality care.
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Affiliation(s)
- Kylie Gwynne
- Poche Centre for Indigenous Health, Room 223, Edward Ford Building A27, The University of Sydney, Camperdown, NSW 2006, Australia
| | - Thomas Jeffries
- Syndey Medical School, Edward Ford Building A27, The University of Sydney, Camperdown, NSW 2006, Australia. Email
| | - Michelle Lincoln
- Faculty of Health Sciences, The University of Sydney, 75 East Street, Lidcombe, NSW 2141, Australia. Email
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Ataguba OA, Ataguba JE. Social determinants of health: the role of effective communication in the COVID-19 pandemic in developing countries. Glob Health Action 2020; 13:1788263. [PMID: 32657669 PMCID: PMC7480618 DOI: 10.1080/16549716.2020.1788263] [Citation(s) in RCA: 58] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has affected many countries with increasing morbidity and mortality. Interestingly, many of the actions and policies adopted in countries are linked to the social determinants of health (SDH). The SDH are critical determinants of health and health inequalities that are not directly within the health sector. Policies such as social distancing, good hygiene, avoiding large gatherings, cancelling of social and sports events, using personal protective equipment, schools and restaurants closure, country lockdown, etc. are not necessarily within the health sector but have been promoted to prevent and attenuate COVID-19 infection rates significantly. The SDH that serve to reduce morbidity will forestall or substantially reduce the pressure on many weak health systems in developing countries that cannot cope with increased hospitalisation and intensive health care. This paper argues that one of the most critical social determinants of health (i.e. effective crisis and risk communication), is crucial in many developing countries, including those with fewer confirmed coronavirus cases. We note that the effectiveness of many of the other SDH in reducing the burden of the COVID-19 pandemic hinges on effective communication, especially crisis and risk communication. Although many countries are adopting different communication strategies during the COVID-19 crisis, effective crisis and risk communication will lead to building trust, credibility, honesty, transparency, and accountability. The peculiarity of many developing countries in terms of regional, cultural, linguistic and ethnic diversity is an essential consideration in ensuring effective crisis and risk communication. Developing countries facing significant poverty and disease burden cannot afford to handle the burgeoning of COVID-19 infections and must take preventive measures seriously. Thus, we submit that there is a need to intensify SDH actions and ensure that no one is left behind when communicating crisis and risk to the population to address the COVID-19 pandemic.
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Affiliation(s)
- Ochega A Ataguba
- Centre for Film and Media Studies, Faculty of Humanities, University of Cape Town , Rondebosch, South Africa
| | - John E Ataguba
- Health Economics Unit, School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town , Observatory, South Africa
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Noël Racine A, Garbarino JM, Corrion K, D'Arripe-Longueville F, Massiera B, Vuillemin A. Perceptions of barriers and levers of health-enhancing physical activity policies in mid-size French municipalities. Health Res Policy Syst 2020; 18:62. [PMID: 32513193 PMCID: PMC7278119 DOI: 10.1186/s12961-020-00575-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 05/14/2020] [Indexed: 01/09/2023] Open
Abstract
Background Policy is one of the levers for initiating structural change to foster the promotion of health-enhancing physical activity (HEPA). To this end, policy-makers have to deal with complex ecosystems embedded in specific contexts. However, limited research has been conducted on this topic at the local level. The purpose of this study was to identify the perceived barriers and levers of HEPA policies according to department heads and elected officials across various sectors in mid-size French municipalities. Methods This study used a mixed method primarily based on an adaptation of the concept mapping approach. A list of statements completing the sentence: ‘In a mid-size municipal context, to develop HEPA policies, it is necessary to …’ was submitted to key informants of 17 mid-sized French cities. Key informants in each municipality first rated the importance of each statement without considering their local context; they then rated the feasibility of each statement given their local context. In both cases, they used a Likert scale ranging from 1 to 6. Results A total of 23 municipal department heads and 10 elected officials from the sport (n = 14), health (n = 10) and social (n = 9) sectors in 11 mid-size French cities participated in this study. A list of 84 statements, sorted into 16 categories, was rated by participants according to their importance (M = 4.52, SD = 0.86) and their feasibility (M = 3.77, SD = 0.74). Potential barriers to (n = 10) and levers of (n = 38) HEPA policy development were identified. These results varied according to the position and sector of the participants. Conclusions The results suggest that local contextual factors can affect the development of HEPA policies in mid-size French municipalities. The different perceptions of the potential levers and barriers according to sector might affect intersectoral collaboration. This study contributes by enhancing understanding of how local HEPA policies are developed in the French context.
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Affiliation(s)
| | | | - K Corrion
- Université Côte d'Azur, LAMHESS, Nice, France
| | | | - B Massiera
- Université Côte d'Azur, LAMHESS, Nice, France
| | - A Vuillemin
- Université Côte d'Azur, LAMHESS, Nice, France.
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Hernández A, Hurtig AK, Goicolea I, San Sebastián M, Jerez F, Hernández-Rodríguez F, Flores W. Building collective power in citizen-led initiatives for health accountability in Guatemala: the role of networks. BMC Health Serv Res 2020; 20:416. [PMID: 32404089 PMCID: PMC7218564 DOI: 10.1186/s12913-020-05259-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Accepted: 04/28/2020] [Indexed: 11/30/2022] Open
Abstract
Background Citizen-led accountability initiatives are a critical strategy for redressing the causes of health inequalities and promoting better health system governance. A growing body of evidence points to the need for putting power relations at the forefront of understanding and operationalizing citizen-led accountability, rather than technical tools and best practices. In this study, we apply a network lens to the question of how initiatives build collective power to redress health system failures affecting marginalized communities in three municipalities in Guatemala. Methods Network mapping and interpretive discussions were used to examine relational qualities of citizen-led initiatives’ networks and explore the resources they offer for mobilizing action and influencing health accountability. Participants in the municipal-level initiatives responded to a social network analysis questionnaire focused on their ties of communication and collaboration with other initiative participants and their interactions with authorities regarding health system problems. Discussions with participants about the maps generated enriched our view of what the ties represented and their history of collective action and also provided space for planning action to strengthen their networks. Results Our findings indicate that network qualities like cohesiveness and centralization reflected the initiative participants’ agency in adapting to their sociopolitical context, and participants’ social positions were a key resource in providing connection to a broad base of support for mobilizing collective action to document health service deficiencies and advocate for solutions. Their legitimacy as “representatives of the people” enabled them to engage with authorities from a bolstered position of power, and their iterative interactions with authorities further contributed to develop their advocacy capabilities and resulted in accountability gains. Conclusions Our study provided evidence to counter the tendency to underestimate the assets and capabilities that marginalized citizens have for building power, and affirmed the idea that best-fit, with-the-grain approaches are well-suited for highly unequal settings characterized by weak governance. Efforts to support and understand change processes in citizen-led initiatives should include focus on adaptive network building to enable contextually-embedded approaches that leverage the collective power of the users of health services and grassroots leaders on the frontlines of accountability.
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Affiliation(s)
- Alison Hernández
- Center for the Study of Equity and Governance in Health Systems (CEGSS), 11 calle 0-48 Zona 10, Edificio Diamond, oficina 504, Ciudad de Guatemala, Guatemala.
| | - Anna-Karin Hurtig
- Division of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Isabel Goicolea
- Division of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | | | - Fernando Jerez
- Center for the Study of Equity and Governance in Health Systems (CEGSS), 11 calle 0-48 Zona 10, Edificio Diamond, oficina 504, Ciudad de Guatemala, Guatemala
| | | | - Walter Flores
- Center for the Study of Equity and Governance in Health Systems (CEGSS), 11 calle 0-48 Zona 10, Edificio Diamond, oficina 504, Ciudad de Guatemala, Guatemala
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McConkey R, Taggart L, DuBois L, Shellard A. Creating Inclusive Health Systems for People With Intellectual Disabilities: An International Study. JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES 2020. [DOI: 10.1111/jppi.12341] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pérez-Ramos JG, McIntosh S, Barrett ES, Vélez-Vega CM, Dye TD. Qualitative Assessment of Environmental Health Risk Perceptions and Community Challenges in a Puerto Rican Community: Change and Continuity in Response to Hurricanes Irma and María. Behav Med 2020; 46:231-244. [PMID: 31860413 PMCID: PMC8783134 DOI: 10.1080/08964289.2019.1700894] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Culebra, a geographically isolated island located 17 miles from the eastern coast of Puerto Rico's main island, suffers from an amalgam of significant environmental health risk and associated social determinants of health that are affecting the community. In 2017, two major Hurricanes (Irma and María) impacted Culebra, resulting in an increase of preexisting environmental health risk. The present study's primary aim was to explore community attitudes, beliefs, and perceptions of environmental health risk, and to describe the social priorities of Culebrenses in relation to these risks and challenges. Semi-structured interview guide and Rapid Qualitative Inquiry (RQI) focused on topics of environmental health risk was followed. Qualitative focus groups and individual interviews were conducted among community members in Culebra before and shortly after Hurricanes Irma and María affected the island. Environmental health factors identified included: presence of mosquitoes, trash disposal, water quality and tourism. Additionally, a strong sentiment of island pride was found potentially generating a sense of community that could facilitate solutions to the existing environmental health challenges. Preexisting environmental health risk magnified after the pass of Hurricanes Irma and María. Sustainable and community engagement approaches are needed to develop strategies that can assist in the mitigation and resolution of the identified environmental health risk and challenges, including factors associated with threats such as disasters and pollution.
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Affiliation(s)
- José G. Pérez-Ramos
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry
| | - Scott McIntosh
- Department of Public Health Sciences, University of Rochester School of Medicine and Dentistry, University of Rochester Medical Center
| | | | | | - Timothy D. Dye
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry
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Dwivedi P, Huang D, Yu W, Nguyen Q. Predicting geographical variation in health-related quality of life. Prev Med 2019; 126:105742. [PMID: 31158399 PMCID: PMC6697589 DOI: 10.1016/j.ypmed.2019.05.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 04/24/2019] [Accepted: 05/28/2019] [Indexed: 12/13/2022]
Abstract
Goods and services provided by businesses can either promote health or represent an additional risk factor. We assessed the association between business pattern indicators and the prevalence of adult obesity, diabetes, physical inactivity, fair or poor health and frequent physical and mental distress. Data on business types were obtained from the 2013 U.S. Census Bureau County Business Patterns. County health data were obtained from the Centers for Disease Control and Prevention Diabetes Interactive Atlas, Behavior Risk Factor Surveillance System and Fatality Analysis Reporting System. We explored the relationship at county level using the global (Ordinary Least Square regression) and local (Geographically Weighted Regression (GWR)) models in 3108 U.S. counties. Density of full service restaurants and fitness centers was associated with a significant decrease in adult obesity, diabetes, fair or poor health, physical inactivity, physical and mental distress. Conversely, density of payday loan centers was associated with an increase in these adverse health outcomes. However, our GWR models revealed substantial geographical variations in these relationships across the U.S. counties. Better understanding of the association between area-level structures and important health outcomes at the local level is important for developing targeted context-specific policy interventions. Full service restaurants and fitness centers may provide places for people to access higher quality food, socialize and exercise. Conversely, payday loans provide an expensive form of short-term credit and this debt may degrade an individual or family's ability to achieve or maintain health. Our study emphasizes the influence of local built environment characteristics on important health outcomes.
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Affiliation(s)
- Pallavi Dwivedi
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, United States.
| | - Dina Huang
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, United States
| | - Weijun Yu
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, United States
| | - Quynh Nguyen
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, United States
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Cheikh A, Bouatia M, Ajaja MR, El Malhouf N, Cherrah Y, Abouqal R, El Hassani A. Impact of Disparities in Reimbursement Rules Between Public and Private Sectors on Accessibility to Care in Moroccan Mandatory Health Insurance: A Cross-Sectional Study. Value Health Reg Issues 2019; 19:132-137. [PMID: 31470367 DOI: 10.1016/j.vhri.2019.07.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 07/16/2019] [Accepted: 07/23/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Disparities in the reimbursement rules between the 2 funds that manage mandatory health insurance in Morocco could negatively affect the accessibility of insured persons to healthcare services and products. OBJECTIVE The objective is to analyze the impact of these disparities on access to care and to assess the insured's copayment difference between the 2 funds. METHODS Healthcare utilization rates of the insured population in the 2 funds were analyzed by sector, sex, and age groups for 2014. We also looked at the percentage of copayment paid by the insured depending on the fund, methods of reimbursement, type of care, and nature of diseases. The analysis was based on data retrieved and aggregated at the National Agency for Health Insurance. RESULTS The healthcare utilization rate differs significantly between the 2 funds. It is higher for the insured in the public sector (45%) compared with those in the private sector (18.5%) (P < .001). The healthcare utilization rate differs significantly according to the age groups in the 2 sectors (P < .001, respectively), and according to the sex of the insured in the 2 sectors (the healthcare utilization rate is higher for women than for men [P < .001, respectively]). The copayment percentage incurred by insured persons was 32.1% for employees in the public sector and 36.4% for employees in the private sector. CONCLUSION Differences in reimbursement rules between the 2 funds may be the cause of inequity in access to care between insured persons. This situation can jeopardize the objectives of a universal and equitable health insurance scheme.
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Affiliation(s)
- Amine Cheikh
- Abulcasis University, Faculty of Pharmacy, Rabat, Morocco.
| | - Mustapha Bouatia
- Mohammed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | | | | | - Yahia Cherrah
- Abulcasis University, Faculty of Pharmacy, Rabat, Morocco
| | - Redouane Abouqal
- Laboratory of Epidemiology and Clinical Research, Mohammed V University, Faculty of Medicine and Pharmacy, Rabat, Morocco
| | - Amine El Hassani
- Mohammed V University, Faculty of Medicine and Pharmacy, Cheikh Zaid Hospital, Rabat, Morocco
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Edwards RJ, Cyrus E, Bhatt C, Lyons N, Lavia LO, Boyce G. Viral suppression among persons living with HIV in Trinidad & Tobago: Implications for targeted prevention programmes. Glob Public Health 2019; 14:1569-1577. [PMID: 31258000 DOI: 10.1080/17441692.2019.1633379] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
In Trinidad and Tobago, despite persons living with HIV (PLHIV) having access to subsidised treatment and care, only 47% PLHIV attain viral suppression. The study assessed the role of individual-level factors on viral suppression among PLHIV in Trinidad and Tobago. Data from 9,629 PLHIV who attended an HIV clinic between 2016 and 2018 were analysed. Cases were aged ≥18 who met the CDC HIV case definition. Viral suppression defined as a viral load of <200 copies/ml at last assessment. The chi-square test of association determined statistically significant relationships between individual factors and viral suppression. Logistic regression was used to estimate odds ratios (OR) for viral suppression. PLHIV who were males (OR = 0.76, 95% CI 0.67-0.87), men who have sex with men (MSM) (OR = 0.82, 95% CI 0.67-0.99), single/unmarried (OR = 0.69, 95% CI 0.55-0.87), aged 18-24 years (OR = 0.66, 95% CI 0.49-0.89), aged 25-49 years (OR = 0.81, 95% CI 0.70-0.94) were less likely to achieve viral suppression. These study findings demonstrate that retention/adherence programmes must urgently identify and target vulnerable PLHIV populations in Trinidad and Tobago to improve viral suppression. Further research examining community and societal factors, such as stigma and discrimination, is warranted.
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Affiliation(s)
- R Jeffrey Edwards
- Medical Research Foundation of Trinidad and Tobago , Port of Spain , Trinidad and Tobago
| | - Elena Cyrus
- Department of Epidemiology, Robert Stempel College of Public Health & Social Work, Florida International University , Miami , FL , USA
| | - Chintan Bhatt
- Department of Health Promotion and Disease Prevention, Robert Stempel College of Public Health & Social Work, Florida International University , Miami , FL , USA.,Center for Advanced Analytics, Baptist Health South Florida , Coral Gables , FL , USA
| | - Nyla Lyons
- Medical Research Foundation of Trinidad and Tobago , Port of Spain , Trinidad and Tobago
| | - Leon-Omari Lavia
- Medical Research Foundation of Trinidad and Tobago , Port of Spain , Trinidad and Tobago
| | - Gregory Boyce
- Medical Research Foundation of Trinidad and Tobago , Port of Spain , Trinidad and Tobago
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Healthy Ageing and Health Equity: Broader Determinants of Health with a Spotlight on Climate Change. ACTA ACUST UNITED AC 2018. [DOI: 10.1007/978-3-319-96529-1_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023]
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Cha J, Surkan PJ, Kim J, Yoon IA, Robinson C, Cardozo BL, Lee H. Human Rights as Political Determinants of Health: A Retrospective Study of North Korean Refugees. Am J Prev Med 2018; 55:271-279. [PMID: 29934018 PMCID: PMC6257994 DOI: 10.1016/j.amepre.2018.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Revised: 02/07/2018] [Accepted: 04/02/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The gravity, scale, and nature of human rights violations are severe in North Korea. Little is known about the mental health consequences of the lifelong exposures to these violations. METHODS In 2014-2015, a retrospective study was conducted among 383 North Korean refugees in South Korea using respondent-driven sampling to access this hidden population. This study collected information on the full range of political and economic rights violations and measured post-traumatic stress disorder, anxiety and depression symptoms, and social functioning by standard instruments. Multivariate regression analysis was performed with the adjustment of political, economic, and demographic variables in 2016-2017. RESULTS The results indicate elevated symptoms of anxiety (60.1%, 95% CI=54.3%, 65.7%), depression (56.3%, 95% CI=50.8%, 61.9%), and post-traumatic stress disorder (22.8%, 95% CI=18.6%, 27.4%), which are significantly associated with exposures to political rights violations (ten to 19 items versus non-exposure: anxiety AOR=16.78, p<0.001, depression AOR=12.52, p<0.001, post-traumatic stress disorder AOR=16.71, p<0.05), and economic rights violations (seven to 13 items versus non-exposure: anxiety AOR=5.68, p<0.001, depression AOR=4.23, p<0.01, post-traumatic stress disorder AOR=5.85, p<0.05). The mean score of social functioning was also lower in those who were exposed to political (adjusted difference= -13.29, p<0.001) and economic rights violations (adjusted difference= -11.20, p<0.001). CONCLUSIONS This study highlights mental health consequences of lifelong human rights violations in North Korea. Beyond the conventional approach, it suggests the need for a collaborative preventive response from global health and human rights activists to address human rights in regard to mental health determinants of the 20 million people in North Korea.
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Affiliation(s)
- Jiho Cha
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
| | - Pamela J Surkan
- Center for Public Health and Human Rights, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jaeshin Kim
- Dankook Center for Dispute Resolution, Dankook University, Yongin, Gyeonggi, Republic of Korea
| | - Isabel A Yoon
- Department of Anesthesiology, Pain, and Perioperative Medicine, Stanford University School of Medicine, Stanford, California
| | - Courtland Robinson
- Center for Humanitarian Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Barbara Lopes Cardozo
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Hayoung Lee
- Emergency Response and Recovery Branch, Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia; Department of Social Development, Korea International Cooperation Agency, Seongnam, Gyeonggi, Republic of Korea
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Lee J, Schram A, Riley E, Harris P, Baum F, Fisher M, Freeman T, Friel S. Addressing Health Equity Through Action on the Social Determinants of Health: A Global Review of Policy Outcome Evaluation Methods. Int J Health Policy Manag 2018; 7:581-592. [PMID: 29996578 PMCID: PMC6037500 DOI: 10.15171/ijhpm.2018.04] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Accepted: 01/13/2018] [Indexed: 11/24/2022] Open
Abstract
Background: Epidemiological evidence on the social determinants of health inequity is well-advanced, but considerably less attention has been given to evaluating the impact of public policies addressing those social determinants. Methodological challenges to produce evidence on policy outcomes present a significant barrier to mobilising policy actions for health equities. This review aims to examine methodological approaches to policy evaluation of health equity outcomes and identify promising approaches for future research.
Methods: We conducted a systematic narrative review of literature critically evaluating policy impact on health equity, synthesizing information on the methodological approaches used. We searched and screened records from five electronic databases, using pre-defined protocols resulting in a total of 50 studies included for review. We coded the studies according to (1) type of policy analysed; (2) research design; (3) analytical techniques; (4) health outcomes; and (5) equity dimensions evaluated.
Results: We found a growing number of a wide range of policies being evaluated for health equity outcomes using a variety of research designs. The majority of studies employed an observational research design, most of which were cross-sectional, however, other approaches included experimental designs, simulation modelling, and meta-analysis. Regression techniques dominated the analytical approaches, although a number of novel techniques were used which may offer advantages over traditional regression analysis for the study of distributional impacts of policy. Few studies made intra-national or cross-national comparisons or collected primary data. Despite longstanding challenges of attribution in policy outcome evaluation, the majority of the studies attributed change in physical or mental health outcomes to the policy being evaluated.
Conclusion: Our review provides an overview of methodological approaches to health equity policy outcome evaluation, demonstrating what is most commonplace and opportunities from novel approaches. We found the number of studies evaluating the impacts of public policies on health equity are on the rise, but this area of policy evaluation still requires more attention given growing inequities.
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Affiliation(s)
- Janice Lee
- School of Regulation and Global Governance (RegNet), College of Asia and the Pacific, Australian National University, Canberra, ACT, Australia
| | - Ashley Schram
- School of Regulation and Global Governance (RegNet), College of Asia and the Pacific, Australian National University, Canberra, ACT, Australia
| | - Emily Riley
- Menzies Centre for Health Policy, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Patrick Harris
- Menzies Centre for Health Policy, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Fran Baum
- Southgate Institute of Health, Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Matt Fisher
- Southgate Institute of Health, Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Toby Freeman
- Southgate Institute of Health, Society and Equity, Flinders University, Adelaide, SA, Australia
| | - Sharon Friel
- School of Regulation and Global Governance (RegNet), College of Asia and the Pacific, Australian National University, Canberra, ACT, Australia
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Jones DE, Tang M, Folger A, Ammerman RT, Hossain MM, Short J, Van Ginkel JB. Neighborhood Effects on PND Symptom Severity for Women Enrolled in a Home Visiting Program. Community Ment Health J 2018; 54:420-428. [PMID: 29063413 DOI: 10.1007/s10597-017-0175-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Accepted: 10/05/2017] [Indexed: 11/28/2022]
Abstract
The aim of this study was to investigate the association between postnatal depression (PND) symptoms severity and structural neighborhood characteristics among women enrolled in a home visiting program. The sample included 295 mothers who were at risk for developing PND, observed as 3-month Edinburgh Postnatal Depression Scale (EPDS) scores ≥ 10. Two neighborhood predictor components (residential stability and social disadvantage) were analyzed as predictors of PND symptom severity using a generalized estimating equation. Residential stability was negatively associated with PND symptom severity. Social disadvantage was not found to be statistically significantly. The findings suggest that residential stability is associated with a reduction in PND symptom severity for women enrolled in home visiting program.
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Affiliation(s)
- David E Jones
- Counseling Program, School of Psychology and Counseling, Regent University , Virginia Beach, VA, USA.
| | - Mei Tang
- Counseling Program, School of Human Services, College of Education, Criminal Justice, and Human Services, Cincinnati, OH, USA
| | - Alonzo Folger
- Department of Pediatrics, Cincinnati Children's Hospital and Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Robert T Ammerman
- Department of Pediatrics, Cincinnati Children's Hospital and Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Md Monir Hossain
- Department of Pediatrics, Cincinnati Children's Hospital and Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jodie Short
- Department of Pediatrics, Cincinnati Children's Hospital and Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Judith B Van Ginkel
- Department of Pediatrics, Cincinnati Children's Hospital and Medical Center, University of Cincinnati College of Medicine, Cincinnati, OH, USA
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Patterson PB, McIntyre L, Anderson LC, Mah CL. Political rhetoric from Canada can inform healthy public policy argumentation. Health Promot Int 2018; 32:871-880. [PMID: 27006368 DOI: 10.1093/heapro/daw019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Household food insecurity (HFI), insufficient income to obtain adequate food, is a growing problem in Canada and other Organisation of economic cooperation and development (OECD) countries. Government political orientations impact health policies and outcomes. We critically examined Canadian political rhetoric around HFI from 1995 to 2012 as a means to support effective healthy public policy argumentation. We analysed a data set comprised of Hansard extracts on HFI from the legislative debates of the Canadian federal and three provincial governments, using thematic coding guided by interpretivist theories of policy. Extracts were examined for content, jurisdiction, the political affiliation of the legislator speaking and governing status. Members of non-governing, or 'opposition' parties, dominated the rhetoric. A central hunger-as-poverty theme was used by legislators across the political spectrum, both in government and in opposition. Legislators differed in terms of policy approach around how income should flow to citizens facing HFI: income intervention on the left, pragmatism in the centre, reliance on markets on the right. This analysis is a case-example from Canada and caution must be exercised in terms of the generalizability of findings across jurisdictions. Despite this limitation, our findings can help healthy public policy advocates in designing and communicating HFI policy interventions in OECD countries with a similar left-right spectrum. First, even with a divisive health policy issue such as actions to address HFI, core themes around poverty are widely understood. Secondly, the non-polarizing centrist, pragmatist, approach may be strategically valuable. Thirdly, it is important to treat the rhetoric of opposition members differently from that of government members.
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Affiliation(s)
- Patrick B Patterson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Lynn McIntyre
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Laura C Anderson
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Catherine L Mah
- Division of Community Health and Humanities, Faculty of Medicine, Memorial University, St John's, NL, Canada
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Matima R, Murphy K, Levitt NS, BeLue R, Oni T. A qualitative study on the experiences and perspectives of public sector patients in Cape Town in managing the workload of demands of HIV and type 2 diabetes multimorbidity. PLoS One 2018. [PMID: 29538415 PMCID: PMC5851623 DOI: 10.1371/journal.pone.0194191] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Current South African health policy for chronic disease management proposes integration of chronic services for better outcomes for chronic conditions; that is based on the Integrated Chronic Disease Model (ICDM). However, scant data exist on how patients with chronic multimorbidities currently experience the (re)-organisation of health services and what their perceived needs are in order to enhance the management of their conditions. METHODS A qualitative study was conducted in a community health centre treating both HIV and diabetes patients in Cape Town. The study was grounded in the Shippee's Cumulative Complexity Model (CCM) and explored "patient workload" and "patient capacity" to manage chronic conditions. Individual interviews were conducted with 10 adult patient-participants with HIV and type two diabetes (T2D) multimorbidity and 6 healthcare workers who provided health services to these patient-participants. RESULTS Patient-participants in this study experienced clinic-related workload such as: two separate clinics for HIV and T2D and perceived and experienced power mismatch between patients and healthcare workers. Self-care related workloads were largely around nutritional requirements, pill burden, and stigma. Burden of these demands varied in difficulty among patient-participants due to capacity factors such as: positive attitudes, optimal health literacy, social support and availability of economic resources. Strategies mentioned by participants for improved continuity of care and self-management of multi-morbidities included integration of chronic services, consolidated guidelines for healthcare workers, educational materials for patients, improved information systems and income for patients. CONCLUSION Using the CCM to explore multimorbidity captured most of the themes around "patient workload" and "patient capacity", and was thus a suitable framework to explore multimorbidity in this high HIV/T2D burden setting. Integration of chronic services and addressing social determinants of health may be the first steps towards alleviating patient burden and improving their access and utilisation of these services. Further studies are necessary to explore multimorbidity beyond the context of HIV/T2D.
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Affiliation(s)
- Rangarirai Matima
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- * E-mail:
| | - Katherine Murphy
- Chronic Disease Initiative for Africa, Division of Diabetes and Endocrinology, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa
| | - Naomi S. Levitt
- Chronic Disease Initiative for Africa, Division of Diabetes and Endocrinology, Department of Medicine, Groote Schuur Hospital, Cape Town, South Africa
| | - Rhonda BeLue
- Department of Health Policy and Administration, Pennsylvania State University, University Park, Pennsylvania, United States of America
| | - Tolu Oni
- School of Public Health and Family Medicine, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
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Baugh Littlejohns L, Baum F, Lawless A, Freeman T. Disappearing health system building blocks in the health promotion policy context in South Australia (2003–2013). CRITICAL PUBLIC HEALTH 2018. [DOI: 10.1080/09581596.2017.1418501] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Lori Baugh Littlejohns
- University of Sydney, The Australian Prevention Partnership Centre, based at Deakin University, Australia
| | - Fran Baum
- School of Medicine, Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
| | - Angela Lawless
- School of Health Sciences, Flinders University, Adelaide, Australia
| | - Toby Freeman
- School of Medicine, Southgate Institute for Health, Society and Equity, Flinders University, Adelaide, Australia
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Complexity Sciences. HEALTH SYSTEM REDESIGN 2018. [PMCID: PMC7187952 DOI: 10.1007/978-3-319-64605-3_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Complexity sciences, in plain English, are the sciences of interconnectedness. The aim of complexity sciences is to understand the many different facets of phenomena. Complexity sciences employs a variety of different methodological approaches to describe and to analyse multifaceted phenomena like health, the economy, or environmental systems. Basically, a system consists of a number of parts that are connected to each other. Systems differ depending on the nature of their connectedness. Simple systems have one-to-one relationships and their behaviour is precisely predictable. Complicated systems have one-to-many relationships with mostly predictable behaviours. This book deals with complex adaptive systems with many-to-many relationships. Their many-to-many relationships make their behaviour emergent, hence their outcomes are unpredictable. Complex adaptive systems have a special characteristic, the members of the system can learn from feedback and experiences. The relationships in complex adaptive systems change constantly allowing the system to evolve over time in light of changing demands. However, a system’s overall behaviour, despite its adaptation to changing circumstances, remains relatively stable within boundaries, but occasionally, its behaviour may change abruptly and dramatically for no apparent reason.
One can compare the behaviour of complex adaptive systems to that of a family; most of the time a family stays together despite ups and downs, but occasionally a family can abruptly break apart to the surprise of its members and its surroundings. Another important characteristic of complex adaptive systems is its nonlinear behaviour to change, i.e. the magnitude of change in one member of the system shows a disproportional change in that of others. As experience shows, small changes in the behaviour of a system member often show dramatic changes in the behaviour of the whole system, whereas a major change in the behaviour of that member typically results in little or no change.
Studying complex adaptive systems aims to understand the relationships and the dynamics between the members of the systems. This understanding allows for better responses when the system as a whole is challenged by constraints and/or unfamiliar challenges. A special characteristic of social systems is their “goal-delivering” nature. In organisational terms these are codified by their purpose, goals, and values statements.
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Nguyen QC, McCullough M, Meng HW, Paul D, Li D, Kath S, Loomis G, Nsoesie EO, Wen M, Smith KR, Li F. Geotagged US Tweets as Predictors of County-Level Health Outcomes, 2015-2016. Am J Public Health 2017; 107:1776-1782. [PMID: 28933925 PMCID: PMC5637661 DOI: 10.2105/ajph.2017.303993] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To leverage geotagged Twitter data to create national indicators of the social environment, with small-area indicators of prevalent sentiment and social modeling of health behaviors, and to test associations with county-level health outcomes, while controlling for demographic characteristics. METHODS We used Twitter's streaming application programming interface to continuously collect a random 1% subset of publicly available geo-located tweets in the contiguous United States. We collected approximately 80 million geotagged tweets from 603 363 unique Twitter users in a 12-month period (April 2015-March 2016). RESULTS Across 3135 US counties, Twitter indicators of happiness, food, and physical activity were associated with lower premature mortality, obesity, and physical inactivity. Alcohol-use tweets predicted higher alcohol-use-related mortality. CONCLUSIONS Social media represents a new type of real-time data that may enable public health officials to examine movement of norms, sentiment, and behaviors that may portend emerging issues or outbreaks-thus providing a way to intervene to prevent adverse health events and measure the impact of health interventions.
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Affiliation(s)
- Quynh C Nguyen
- Quynh C. Nguyen is with the Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park. Hsien-wen Meng and Geoffrey Loomis are with the Department of Health, Kinesiology, and Recreation; University of Utah College of Health; Salt Lake City. Matt McCullough and Dapeng Li are with the Department of Geography, University of Utah. Debjyoti Paul, Suraj Kath, and Feifei Li are with the School of Computing, University of Utah. Elaine O. Nsoesie is with Institute for Health Metrics and Evaluation, University of Washington, Seattle. Ming Wen is with the Department of Sociology, University of Utah. Ken R. Smith is with the Department of Family and Consumer Studies and Population Science, Huntsman Cancer Institute, University of Utah
| | - Matt McCullough
- Quynh C. Nguyen is with the Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park. Hsien-wen Meng and Geoffrey Loomis are with the Department of Health, Kinesiology, and Recreation; University of Utah College of Health; Salt Lake City. Matt McCullough and Dapeng Li are with the Department of Geography, University of Utah. Debjyoti Paul, Suraj Kath, and Feifei Li are with the School of Computing, University of Utah. Elaine O. Nsoesie is with Institute for Health Metrics and Evaluation, University of Washington, Seattle. Ming Wen is with the Department of Sociology, University of Utah. Ken R. Smith is with the Department of Family and Consumer Studies and Population Science, Huntsman Cancer Institute, University of Utah
| | - Hsien-Wen Meng
- Quynh C. Nguyen is with the Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park. Hsien-wen Meng and Geoffrey Loomis are with the Department of Health, Kinesiology, and Recreation; University of Utah College of Health; Salt Lake City. Matt McCullough and Dapeng Li are with the Department of Geography, University of Utah. Debjyoti Paul, Suraj Kath, and Feifei Li are with the School of Computing, University of Utah. Elaine O. Nsoesie is with Institute for Health Metrics and Evaluation, University of Washington, Seattle. Ming Wen is with the Department of Sociology, University of Utah. Ken R. Smith is with the Department of Family and Consumer Studies and Population Science, Huntsman Cancer Institute, University of Utah
| | - Debjyoti Paul
- Quynh C. Nguyen is with the Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park. Hsien-wen Meng and Geoffrey Loomis are with the Department of Health, Kinesiology, and Recreation; University of Utah College of Health; Salt Lake City. Matt McCullough and Dapeng Li are with the Department of Geography, University of Utah. Debjyoti Paul, Suraj Kath, and Feifei Li are with the School of Computing, University of Utah. Elaine O. Nsoesie is with Institute for Health Metrics and Evaluation, University of Washington, Seattle. Ming Wen is with the Department of Sociology, University of Utah. Ken R. Smith is with the Department of Family and Consumer Studies and Population Science, Huntsman Cancer Institute, University of Utah
| | - Dapeng Li
- Quynh C. Nguyen is with the Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park. Hsien-wen Meng and Geoffrey Loomis are with the Department of Health, Kinesiology, and Recreation; University of Utah College of Health; Salt Lake City. Matt McCullough and Dapeng Li are with the Department of Geography, University of Utah. Debjyoti Paul, Suraj Kath, and Feifei Li are with the School of Computing, University of Utah. Elaine O. Nsoesie is with Institute for Health Metrics and Evaluation, University of Washington, Seattle. Ming Wen is with the Department of Sociology, University of Utah. Ken R. Smith is with the Department of Family and Consumer Studies and Population Science, Huntsman Cancer Institute, University of Utah
| | - Suraj Kath
- Quynh C. Nguyen is with the Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park. Hsien-wen Meng and Geoffrey Loomis are with the Department of Health, Kinesiology, and Recreation; University of Utah College of Health; Salt Lake City. Matt McCullough and Dapeng Li are with the Department of Geography, University of Utah. Debjyoti Paul, Suraj Kath, and Feifei Li are with the School of Computing, University of Utah. Elaine O. Nsoesie is with Institute for Health Metrics and Evaluation, University of Washington, Seattle. Ming Wen is with the Department of Sociology, University of Utah. Ken R. Smith is with the Department of Family and Consumer Studies and Population Science, Huntsman Cancer Institute, University of Utah
| | - Geoffrey Loomis
- Quynh C. Nguyen is with the Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park. Hsien-wen Meng and Geoffrey Loomis are with the Department of Health, Kinesiology, and Recreation; University of Utah College of Health; Salt Lake City. Matt McCullough and Dapeng Li are with the Department of Geography, University of Utah. Debjyoti Paul, Suraj Kath, and Feifei Li are with the School of Computing, University of Utah. Elaine O. Nsoesie is with Institute for Health Metrics and Evaluation, University of Washington, Seattle. Ming Wen is with the Department of Sociology, University of Utah. Ken R. Smith is with the Department of Family and Consumer Studies and Population Science, Huntsman Cancer Institute, University of Utah
| | - Elaine O Nsoesie
- Quynh C. Nguyen is with the Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park. Hsien-wen Meng and Geoffrey Loomis are with the Department of Health, Kinesiology, and Recreation; University of Utah College of Health; Salt Lake City. Matt McCullough and Dapeng Li are with the Department of Geography, University of Utah. Debjyoti Paul, Suraj Kath, and Feifei Li are with the School of Computing, University of Utah. Elaine O. Nsoesie is with Institute for Health Metrics and Evaluation, University of Washington, Seattle. Ming Wen is with the Department of Sociology, University of Utah. Ken R. Smith is with the Department of Family and Consumer Studies and Population Science, Huntsman Cancer Institute, University of Utah
| | - Ming Wen
- Quynh C. Nguyen is with the Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park. Hsien-wen Meng and Geoffrey Loomis are with the Department of Health, Kinesiology, and Recreation; University of Utah College of Health; Salt Lake City. Matt McCullough and Dapeng Li are with the Department of Geography, University of Utah. Debjyoti Paul, Suraj Kath, and Feifei Li are with the School of Computing, University of Utah. Elaine O. Nsoesie is with Institute for Health Metrics and Evaluation, University of Washington, Seattle. Ming Wen is with the Department of Sociology, University of Utah. Ken R. Smith is with the Department of Family and Consumer Studies and Population Science, Huntsman Cancer Institute, University of Utah
| | - Ken R Smith
- Quynh C. Nguyen is with the Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park. Hsien-wen Meng and Geoffrey Loomis are with the Department of Health, Kinesiology, and Recreation; University of Utah College of Health; Salt Lake City. Matt McCullough and Dapeng Li are with the Department of Geography, University of Utah. Debjyoti Paul, Suraj Kath, and Feifei Li are with the School of Computing, University of Utah. Elaine O. Nsoesie is with Institute for Health Metrics and Evaluation, University of Washington, Seattle. Ming Wen is with the Department of Sociology, University of Utah. Ken R. Smith is with the Department of Family and Consumer Studies and Population Science, Huntsman Cancer Institute, University of Utah
| | - Feifei Li
- Quynh C. Nguyen is with the Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park. Hsien-wen Meng and Geoffrey Loomis are with the Department of Health, Kinesiology, and Recreation; University of Utah College of Health; Salt Lake City. Matt McCullough and Dapeng Li are with the Department of Geography, University of Utah. Debjyoti Paul, Suraj Kath, and Feifei Li are with the School of Computing, University of Utah. Elaine O. Nsoesie is with Institute for Health Metrics and Evaluation, University of Washington, Seattle. Ming Wen is with the Department of Sociology, University of Utah. Ken R. Smith is with the Department of Family and Consumer Studies and Population Science, Huntsman Cancer Institute, University of Utah
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Sprague C, Scanlon ML, Pantalone DW. Qualitative Research Methods to Advance Research on Health Inequities Among Previously Incarcerated Women Living With HIV in Alabama. HEALTH EDUCATION & BEHAVIOR 2017; 44:716-727. [PMID: 28882073 DOI: 10.1177/1090198117726573] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Justice-involved HIV-positive women have poor health outcomes that constitute health inequities. Researchers have yet to embrace the range of qualitative methods to elucidate how psychosocial histories are connected to pathways of vulnerability to HIV and incarceration for this key population. We used life course narratives and intersubjectivity-predicated on interview dialogue-to investigate how familial and social settings established their social patterning of HIV, incarceration risk, and poor health. Working with two Alabama community-based organizations, we recruited and interviewed 24 HIV-positive cisgender women with cyclical incarceration. We analyzed the data by charting women's life histories and conducting iterative content analyses. Participants described chaotic home environments, marked by exposure to trauma in childhood. The majority experienced repeated sexual and physical abuse that went undiagnosed and untreated until adulthood. Adolescence and young adulthood were characterized by onset of substance use, violent intimate partnerships, and subsequent behavioral and mental health problems. In adulthood, risk behaviors persisted for decades and women lacked mental health treatment and social support. Life course narratives and intersubjectivity contributed to knowledge by affording agency to marginalized participants to reflect on and narrate their life stories; instilling needed trust for researchers to investigate the complex risk pathways and psychosocial histories with this population; illuminating the nature, timing, sequence, and frequency of events underlying women's vulnerability and exposure to HIV and incarceration; and clarifying that early shaping events in childhood are connected to later risk environments and behaviors in adolescence and adulthood, suggesting the need for earlier interventions than are typically proposed.
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Affiliation(s)
- Courtenay Sprague
- 1 University of Massachusetts Boston, Boston, MA, USA.,2 University of the Witwatersrand, Johannesburg, South Africa
| | | | - David W Pantalone
- 1 University of Massachusetts Boston, Boston, MA, USA.,3 The Fenway Institute, Fenway Health, Boston, MA, USA
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42
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Minh A, Muhajarine N, Janus M, Brownell M, Guhn M. A review of neighborhood effects and early child development: How, where, and for whom, do neighborhoods matter? Health Place 2017; 46:155-174. [PMID: 28528276 DOI: 10.1016/j.healthplace.2017.04.012] [Citation(s) in RCA: 156] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 03/18/2017] [Accepted: 04/27/2017] [Indexed: 11/17/2022]
Abstract
This paper describes a scoping review of 42 studies of neighborhood effects on developmental health for children ages 0-6, published between 2009 and 2014. It focuses on three themes: (1) theoretical mechanisms that drive early childhood development, i.e. how neighborhoods matter for early childhood development; (2) dependence of such mechanisms on place-based characteristics i.e. where neighborhood effects occur; (3) dependence of such mechanisms on child characteristics, i.e. for whom is development most affected. Given that ecological systems theories postulate diverse mechanisms via which neighborhood characteristics affect early child development, we specifically examine evidence on mediation and/or moderation effects. We conclude by discussing future challenges, and proposing recommendations for analyses that utilize ecological longitudinal population-based databases.
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Affiliation(s)
- Anita Minh
- Human Early Learning Partnership, School of Population and Public Health, 2206 E Mall, Vancouver, BC, Canada V6T 1Z3.
| | - Nazeem Muhajarine
- Saskatchewan Population Health and Evaluation Research Unit, University of Saskatchewan, 3333 E-Wing, Health Sciences Building, 104 Clinic Place, Saskatoon, SK, Canada S7N 2Z4
| | - Magdalena Janus
- The Offord Centre for Child Studies, McMaster University, 1280 Main Street West, Hamilton, ON, Canada L8S 4K1
| | - Marni Brownell
- Manitoba Centre for Health Policy, Community Health Sciences, Max Rady College of Medicine, Faculty of Health Sciences, University of Manitoba, 408-727 McDermot Ave., Winnipeg, MB, Canada R3E 3P5
| | - Martin Guhn
- Human Early Learning Partnership, School of Population and Public Health, 2206 E Mall, Vancouver, BC, Canada V6T 1Z3
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Ayanore MA, Pavlova M, Biesma R, Groot W. Stakeholders' views on maternity care shortcomings in rural Ghana: An ethnographic study among women, providers, public, and quasiprivate policy sector actors. Int J Health Plann Manage 2017; 33:e105-e118. [PMID: 28382687 DOI: 10.1002/hpm.2411] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Accepted: 02/01/2017] [Indexed: 11/07/2022] Open
Abstract
Access to skilled provider and emergency obstetric care is not universal across all districts in Ghana. The lived experiences of 3 stakeholder groups on maternity care shortcomings in 3 rural Ghanaian districts are examined in this study. We applied an ethnographic study approach where field data were collected between March to May 2015 in 3 rural districts of northern Ghana. Data were collected among women with recent births experiences (n = 90), health care providers (n = 16), and policy actors (n = 6). Transcripts were read through to identify similar and divergent stakeholders' views. Significant expressions and experiences of stakeholders on maternity care shortcomings were extracted and evaluated to define key themes. Four themes emerged: social/community factors, payments for health care, facility level factors, and policy level factors. The results show that traditional women's roles divest time for maternity care. Poor transport arrangements, insufficient health workforce, health funding gaps, insurance reimbursements delays, and catastrophic health expenditures on travel and drugs are attested as major barriers across all stakeholder groups in all districts studied. The discussion of the study findings suggests it is important to ascertain the scale of informal payments and their impacts on health access. Investments in health workforce and reliable ambulatory service systems could help address poor referral difficulties in rural areas of the country. Social support for community initiatives that pool funds could provide extra resources and relieve cost access-related challenges for using maternity care in rural settings in Ghana.
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Affiliation(s)
- Martin Amogre Ayanore
- Department of Health Services Research, CAPHRI, Maastricht University Medical Centre, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.,Department of Family and Community Health, School of Public Health, University of Health and Allied Health Sciences, Hohoe, Ghana.,Centre for Health Policy Advocacy, Innovation & Research in Africa (CHPAIR-Africa), Accra, Ghana
| | - Milena Pavlova
- Department of Family and Community Health, School of Public Health, University of Health and Allied Health Sciences, Hohoe, Ghana
| | - Regien Biesma
- Department of Epidemiology and Public Health Medicine, Division of Population Health Sciences, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Wim Groot
- Department of Family and Community Health, School of Public Health, University of Health and Allied Health Sciences, Hohoe, Ghana.,Top Institute Evidence-Based Education Research (TIER), Maastricht University, Maastricht, The Netherlands
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Sadana R, Blas E, Budhwani S, Koller T, Paraje G. Healthy Ageing: Raising Awareness of Inequalities, Determinants, and What Could Be Done to Improve Health Equity. THE GERONTOLOGIST 2017; 56 Suppl 2:S178-93. [PMID: 26994259 DOI: 10.1093/geront/gnw034] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE OF THE STUDY Social and scientific discourses on healthy ageing and on health equity are increasingly available, yet from a global perspective limited conceptual and analytical work connecting both has been published. This review was done to inform the WHO World Report on Ageing and Health and to inform and encourage further work addressing both healthy aging and equity. DESIGN AND METHODS We conducted an extensive literature review on the overlap between both topics, privileging publications from 2005 onward, from low-, middle-, and high-income countries. We also reviewed evidence generated around the WHO Commission on Social Determinants of Health, applicable to ageing and health across the life course. RESULTS Based on data from 194 countries, we highlight differences in older adults' health and consider three issues: First, multilevel factors that contribute to differences in healthy ageing, across contexts; second, policies or potential entry points for action that could serve to reduce unfair differences (health inequities); and third, new research areas to address the cause of persistent inequities and gaps in evidence on what can be done to increase healthy ageing and health equity. IMPLICATIONS Each of these areas warrant in depth analysis and synthesis, whereas this article presents an overview for further consideration and action.
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Affiliation(s)
- Ritu Sadana
- Department of Ageing and Life Course, World Health Organization, Geneva, Switzerland.
| | - Erik Blas
- International Public Health and Development, Copenhagen, Denmark
| | - Suman Budhwani
- Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Theadora Koller
- Gender, Equity and Human Rights Team, World Health Organization, Geneva, Switzerland
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Mannell J. Advancing gender equality to improve HIV prevention: A study of practice. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2017; 15:315-323. [PMID: 27974019 DOI: 10.2989/16085906.2016.1221837] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Addressing gender inequality as a social driver of HIV risk and vulnerability has become a key activity of non-governmental organisations (NGOs) in South Africa. This paper sheds light on the environmental factors that influence gender and HIV activities in this context. A multisite ethnographic study including 150 hours of participant observation and 32 in-depth interviews was conducted with 26 NGOs carrying out gender and HIV prevention interventions. Using thematic network analysis, 108 different intervention activities were identified, categorised and further analysed to explore environmental factors that influence the design and delivery of these activities. The findings highlight how practitioners draw on different theories of change about how to address the gender inequalities that contribute to HIV risk and vulnerability, which in turn influence the way interventions are delivered. Despite these theoretical differences, commonalities arise in practitioners' use of popular narratives about the right to health and lived experiences of AIDS to ensure interventions are contextually relevant and to gain buy-in from participants. Other environmental factors influencing intervention activities include the role that insecure funding for gender plays in undermining the capacity of practitioners to design interventions based on their local knowledge and experience by forcing NGOs to adapt to the priorities of international donors.
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Affiliation(s)
- Jenevieve Mannell
- a Institute for Global Health, University College London , London , United Kingdom
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de Leeuw E. Engagement of Sectors Other than Health in Integrated Health Governance, Policy, and Action. Annu Rev Public Health 2017; 38:329-349. [PMID: 28125390 DOI: 10.1146/annurev-publhealth-031816-044309] [Citation(s) in RCA: 120] [Impact Index Per Article: 17.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Health is created largely outside the health sector. Engagement in health governance, policy, and intervention development and implementation by sectors other than health is therefore important. Recent calls for building and implementing Health in All Policies, and continued arguments for intersectoral action, may strengthen the potential that other sectors have for health. This review clarifies the conceptual foundations for integral health governance, policy, and action, delineates the different sectors and their possible engagement, and provides an overview of a continuum of methods of engagement with other sectors to secure integration. This continuum ranges from institutional (re)design to value-based narratives. Depending on the lens applied, different elements can be identified within the continuum. This review is built on insights from political science, leadership studies, public health, empirical Health in All Policy research, knowledge and evidence nexus approaches, and community perspectives. Successful integration of health governance, policy, and action depends on integration of the elements on the continuum.
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Affiliation(s)
- Evelyne de Leeuw
- Centre for Health Equity Training, Research and Evaluation (CHETRE), Part of the UNSW Australia Research Centre for Primary Health Care & Equity, A Unit of Population Health, South Western Sydney Local Health District, NSW Health, A Member of the Ingham Institute, Liverpool Hospital, Liverpool, New South Wales 1871, Australia;
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Dasgupta K, Lichterman P. How a housing advocacy coalition adds health: A culture of claims-making. Soc Sci Med 2016; 165:255-262. [PMID: 27139006 DOI: 10.1016/j.socscimed.2016.04.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Revised: 04/14/2016] [Accepted: 04/18/2016] [Indexed: 11/18/2022]
Abstract
Organizations that pursue health advocacy often tackle other issues too. How do these multi-issue organizations articulate and combine health with other issues? We examine how a Los Angeles coalition focused primarily on housing took up health in its 2008-2011 campaign against a residential development. Participant observation and archival data reveal that cultural context influenced how the coalition made claims about health, in two ways. First, advocates shared two major symbolic categories, which oriented the great bulk of their appeals regarding health. Second, advocates crafted rhetorical appeals that reflected their shared sense of social identity and obligation as spokespersons for a distinctive kind of community. These two kinds of cultural context influenced advocates' claims in public, formal settings as well more internal communication. These distinct, cultural influences on claims-making create challenges for socioeconomically diverse coalitions collaborating on health problems.
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Affiliation(s)
- Kushan Dasgupta
- Department of Sociology, University of Southern California, 851 Downey Way, HSH 314, Los Angeles, CA 90089, USA
| | - Paul Lichterman
- Department of Sociology, University of Southern California, 851 Downey Way, HSH 314, Los Angeles, CA 90089, USA.
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Ortmann LW, Barrett DH, Saenz C, Bernheim RG, Dawson A, Valentine JA, Reis A. Public Health Ethics: Global Cases, Practice, and Context. ACTA ACUST UNITED AC 2016. [DOI: 10.1007/978-3-319-23847-0_1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
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Ferguson L, Tarantola D, Hoffmann M, Gruskin S. Non-communicable diseases and human rights: Global synergies, gaps and opportunities. Glob Public Health 2016; 12:1200-1227. [PMID: 28278754 DOI: 10.1080/17441692.2016.1158847] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The incorporation of human rights in health policy and programmes is known to strengthen responses to health problems and help address disparities created or exacerbated by illness yet this remains underexplored in relation to non-communicable diseases (NCDs). Aiming to understand existing synergies and how they might be further strengthened, we assessed the extent to which human rights are considered in global NCD policies and strategies and the degree of attention given to NCDs by select United Nations human rights mechanisms. Across global NCD policies and strategies, rhetorical assertions regarding human rights appear more often than actionable statements, thus limiting their implementation and impact. Although no human rights treaty explicitly mentions NCDs, some human rights monitoring mechanisms have been paying increasing attention to NCDs. This provides important avenues for promoting the incorporation of human rights norms and standards into NCD responses as well as for accountability. Linking NCDs and human rights at the global level is critical for encouraging national-level action to promote better outcomes relating to both health and human rights. The post-2015 development agenda constitutes a key entry point for highlighting these synergies and strengthening opportunities for health and rights action at global, national and local levels.
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Affiliation(s)
- Laura Ferguson
- a Program on Global Health and Human Rights , Institute for Global Health, University of Southern California , Los Angeles , CA , USA
| | - Daniel Tarantola
- a Program on Global Health and Human Rights , Institute for Global Health, University of Southern California , Los Angeles , CA , USA
| | - Michael Hoffmann
- b Warren Alpert Medical School of Brown University and the Miriam Hospital , Providence , RI , USA
| | - Sofia Gruskin
- a Program on Global Health and Human Rights , Institute for Global Health, University of Southern California , Los Angeles , CA , USA
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de Leeuw E. We Need Action on Social Determinants of Health - but Do We Want It, too? Comment on "Understanding the Role of Public Administration in Implementing Action on the Social Determinants of Health and Health Inequities". Int J Health Policy Manag 2016; 5:379-82. [PMID: 27285516 PMCID: PMC4885729 DOI: 10.15171/ijhpm.2016.25] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 02/24/2016] [Indexed: 11/09/2022] Open
Abstract
Recently a number of calls have been made to mobilise the arsenal of political science insights to investigate - and point to improvements in - the social determinants of health (SDH), and health equity. Recently, in this journal, such a rallying appeal was made for the field of public administration. This commentary argues that, although scholarly potential should justifiably be redirected to resolve these critical issues for humanity, a key ingredient in taking action may have been neglected. This factor is 'community.' Community health has been a standard element of the public health and health promotion, even political, repertoire for decades now. But this commentary claims that communities are insufficiently charged, equipped or appreciated to play the role that scholarship attributes (or occasionally avoids to identify) to them. Community is too important to not fully engage and understand. Rhetorical tools and inquiries can support their quintessential role.
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Affiliation(s)
- Evelyne de Leeuw
- Centre for Health Equity Training Research and Evaluation (CHETRE), University of New South Wales, Sydney, NSW, Australia
- South Western Sydney Local Health District, Liverpool, NSW, Australia
- Ingham Institute, Liverpool, NSW, Australia
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